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Mental Illness, Medicine and LawReview - Mental Illness, Medicine and Law
by Martin Lyon Levine
Ashgate, 2009
Review by Tony O'Brien,, RN, MPhil,
Mar 23rd 2010 (Volume 14, Issue 12)

Mental Illness, Medicine and Law is the twentieth book in the International Library of Medicine, Ethics and Law series. It is a collection of 57 previously published papers on various aspects of mental health and law. Each paper is reproduced as a facsimile, with the original referencing and pagination. The topics cover those directly related to mental illness and others where mental capacity is affected by medical illness. Most papers are from the United States, but there are a number from England and continental Europe giving the book and international flavor. International comparisons usually suffer from the lack of a common conceptual framework, but it would be fair to say that this collection does have international reach, given that many of the issues covered are common across jurisdictions and readers will make the necessary interpretations. Editorial policy was to select reasonably brief papers, favoring variety over extended debate, but the trade off seems worth it given the range of topics covered.

The variety of areas and authors is impressive. The list includes authorities such as Appelbaum, Winick, Perlin and Stone, and the topics cover ethics of practice, rights and advocacy, involuntary treatment and the limits of medicine. There is also coverage of emerging issues such as the ethics of enhancement through neurothreapeutics, as well as controversial issues such as the reliability of reports of memories. Papers are grouped into three overall sections (The Seriously Ill, The Ordinary Mind and The Therapist), with eighteen individual topics, each of two to five papers. Some inclusions in the three main sections seem a little arbitrary, but the smaller topics bring a tight focus to the work.

A range of professions are represented. Perhaps predicatably most are from psychiatrists and lawyers, but there are a large number from psychologists, as well as some from sociology and nursing. Lawyers and clinicians have different ways of thinking and arguing about ostensibly the same issues. This difference is described by one contributor as epistemological, with clinicians favoring subjective accounts whereas lawyers tend to seek a more objective standard. What a clinician will regard as clinically 'normal' (a partial and perhaps disorganized account) a lawyer, especially a defense lawyer, will regard as unreliable, yet both are concerned with the same event. Overall the number of disciplines included as depth to the book.

The collection is not as current as it could have been, although it was obviously not the aim of the book to include only the most current literature. While it is useful to include well known papers such as Lamb's one page editorial on the problems with deinstitutionalization, in other respects the selections cover arguments that have been significantly updated. One example of this is therapeutic jurisprudence. Tyler's 1992 paper on the psychology of judicial procedures is well worth including, but its conclusions are necessarily speculative, as most of the empirical work on perception of coercion has been carried out subsequently. Similarly the contribution by Mozes et al. on competence seems well out of touch with contemporary thinking, talking as it does of 'the psychiatric patient'. Still there is value in showing the development of concepts and issues over time. Engel's classic 1977 paper 'The Need for a new Medical Model' makes fascinating reading thirty years on. The 'biopsychosocial' model advocated by Engel has been widely taken up, although some recent literature suggests the biological still dominates, with psychological issues being about appraisal and adaptation, and social being about the social context in which something fundamentally biological plays out.

Surprisingly little attention is given to involuntary outpatient treatment, with just two papers, the first on perception of coercion paper, and the second a review by Elyn Saks. I expected something on the international growth in community based involuntary treatment. There is a considerable volume of research and academic scholarship in this area, and the international differences in approach make for interesting reading. The North Carolina and New York studies produced some provocative publications, and debate continues with the release last year of a further New York study. England, Wales and Scotland have recently introduced compulsory treatment orders of the type used in Australia and New Zealand for the last two decades, and recent legislative reform has also allowed for community treatment orders in Sweden. The idea of a 'fused' form of legislation in which incapacity and mental disorder are considered according to a common set of criteria is also under discussion and could have been a useful inclusion.

Something that is apparent throughout this volume is the influence of Paul Appelbaum in the international literature. Appelbaum contributes to five individual papers, and is cited in many others. His range of interests is diverse, including international psychiatry, boundaries, the psychiatrist as expert witness, and privacy. He is also referenced in many other papers. Appelbaum's scholarship is nowhere better illustrated than in his paper on expert witnesses, a response to Alan Stone. The two are a long way apart, but Appelbaum's writing is a model of restraint and reason.

The book addresses individual, interpersonal, social and political issues, so most clinicians and academics will find something of interest. I found the discussion of managed care interesting in light of current debate in the US about health care. Similarly Kleinman's 1977 contribution on cross cultural psychiatry speaks to current epistemological and taxanomic debates in psychiatry, and to the development of the DSM V. The value of this book is in the comprehensiveness of its coverage. While not all papers fit neatly within the subject matter as suggested by the title, overall they amount to a wide-ranging review of mental health issues. Mental Illness, Medicine and Law willl be a valuable resource in any mental health library, and a useful resource for students and clinicians from a range of disciplines.

 

© 2010 Tony O'Brien

 

Tony O'Brien, RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz


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