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Marie Thompson provides a clear and informative introduction to both the history of, and current provision for, the treatment of mental illness. The book is well laid out, conveniently divided into sections, with good text size, and informative charts and text boxes.
Chapter 1 discusses the history of mental illness from Ancient times up until the present. Assumed causes are considered, from magic to sin, and Thompson reflects on how these have affected treatment and attitudes to mental illness over the centuries. The Middle ages were a dark time, the Church having authority over the afflicted: those who suggested physical causes rather than sin, such as Pietro Albano, were sometimes put to death. Witch hunts were also rife and large numbers of the mentally ill were condemned for being in league with Satan. Thompson illustrates how much of the history of mental illness focuses on the issue of whether it should be seen as physical, and at various times attempts to return to such a model -- one common in Ancient Greece -- have been suggested. Very often, though, such suggestions were ridiculed or suppressed by the Church, and the mentally ill have consequently been seen as sinners, criminals, and wild animals, with treatment thus neglected. (A particularly interesting claim, I found, was that Cicero (106-43 BC) devised an early assessment tool: interviews should determine whether the cause of mental illness is related to social, personal, family and educational issues, and significant life events. We now -- after many dark centuries -- know that these factors do play a major role and Cicero's approach seems to be a clear precursor to modern assessment techniques.)
Freud (1856–1939) is covered, as are the brain cell staining techniques of Alois Alzeimer (1864-1915) which helped to identify the physical changes associated with mental illness. Emil Kraepelin's (1856-1926) DSM, the Diagnosis and Statistical Manual of mental Disorders, is also discussed; this catalogued for the first time the physical and behavioral symptoms of sufferers and updated versions of this continue to be used today.
Chapter 2 turns to the diagnosis of mental illness and provides summaries of schizophrenia, various kinds of depression, bipolar disorders, post-traumatic stress disorder, and dementia. Symptoms, genetic links, and possible causes are noted. I particularly like how diseases of the elderly are covered, a group that is often side-lined. There is also an illuminating text box containing an autobiographical sketch of what it is like to live with schizophrenia.
Chapter 3 covers the history and development of psychoanalysis and psychotherapy, cognitive behavioral therapy, the biological approach, and psychopharmacology, and Chapter 4 focuses on 20th century scientific developments. The focus on the physical causes of mental illness is continued with discussion of brain imaging and MRI scans, and on how genetics can play a role in diagnosis, treatment and possibly prevention. There are useful diagrams and informative tables concerning brain physiology and neurochemistry, and the development of anti-psychotic drugs is covered along with their mechanisms of action, and side effects. Treatment is also the topic of Chapter 7 where a multi-disciplinary approach is recommended -- that involving psychotherapy, alternative therapies, and drug treatment -- and some criticisms of psychotherapy are put forward concerning its cost and possible problems associated with emotional dependence.
Section 2 looks at various controversial issues surrounding mental illness. In chapter 5 anti–psychiatry movements are considered from R. D. Laing (mental illness is a sane response to a mad society), to scientology (note Tom Cruise's recent high profile rant against psychoanalysis), to cultural relativism. There is an unbiased portrayal of these approaches (although perhaps a little too unbiased given the radical nature of many of their claims).
Chapter 6 covers political and legal issues, including involuntary commitment and deinstitutionalization, and chapter 8 considers medical insurance and associated financial problems (perhaps more details of actual costs would be useful here).
There is a useful References and Resources section, a Bibliography, a list of mental heath organization websites, and a glossary. I would, though, have liked the Bibliography to be split into sections; it is fairly extensive and suggestions for each chapter would be more helpful.
There are a couple of ways that the book could be improved. First, in places the structure of the book is a little clumsy, and this was sometimes annoying. Certain topics are introduced in various places, as if for the first time -- the four humors theory, Krepelin and the DSM, and the same bits of Greek history keep coming back -- it can make one double take ("haven't we already been told that"). A small point in itself, but indicative of this structural problem, is that the acronym DSM is only spelt out many pages after first appearing.
Second, the contemporary focus is almost solely on the US, and as a health professional working in Europe this was frustrating. Statistics are only given for the US, as are details concerning training time for practitioners, and relevant laws and commissions, and the problems associated with the cost of health insurance are in certain ways a peculiarly American problem.
These thoughts notwithstanding, there is much to commend Thompson's book, and it would be of use to undergraduates and BTec students in Heath care, interested general readers (particularly family and relatives of those who are ill), social workers specializing in mental health, and health care workers.
© 2008 Lucy Russell and Dan O'Brien
Lucy Russell, BSc (hons), RMN, Birmingham and Solihull Mental Health Trust and Dr Dan O'Brien, Department of Philosophy, University of Warwick, UK
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