This is Madness Too

As many readers will recognise, this is a companion of This is Madness (the pun attracts attention, doesn't it?), a book published in 1999 and which followed in the tradition of critical psychiatry and its perspective on psychiatric practice and services. Like its predecessor, it is a collection of essays by practitioners, academics and consumers, some well-known, others not so, which tackle some of the fundamental preconceptions about mental health as a concept, and mental health services as an institution. This is not a new debate, and of course, the very nature of mental illness, true experience and compromised judgement, is at the heart of it.

Like all such anthologies, it is a curate's egg. And while some of the essays are tinged a little too heavily with unsupported, or at least selective, rhetoric, others are serious, considered and thought-provoking. At their best the essays share and reveal a common humanity and explore, without blaming, finger-pointing or anger, the extraordinary situation that those who suffer from a mental illness, and those who seek to care for them, are in. At their worst they betray what seems to be an unresolved anger and self-definitional victim status. The appellation of survivors of the mental health system is something worthy of deconstruction itself.

The common humanity is perhaps best shown by Bucknall and Holmes' chapter on relatives and carers in which the tensions and dilemmas that living with a severe mental illness are delicately and sensitively explored. Some others, perhaps like Peter Breggin's familiar approach to the drug treatment of children, tend towards the didactic and selective.

The book is not a text book. It is not an authoritative account of the territory. It is however, provocative, deliberately so, and ultimately, in the final chapters, a call for partnerships and mutuality in mental health. It is not a simple situation and there are no simplistic answers, as some chapters might suggest. Mental illness is a terrible thing, it is a real and sometimes devastating experience, and is not something that can be lightly discounted as the result of social oppression. The essays rarely give much credit to ordinary practitioners who are really and truly trying to do their best in the face of tremendous difficulties and often severe ethical dilemmas. Some of that, however, is resolved at the end. The mutual respect for different levels of types of knowing is an important element in the formation of a therapeutic relationship, and relationships are clearly seen as the essence of psychiatric care.

Wallcroft and Michaelson, in the final chapter, develop what they call the SPIRAL Model (Systematic Prevention, Recovery and Learning) and out of these learning may be the most neglected. It is out of learning from the experience, from extracting some sense of meaning or understanding, that individuals, be they sufferers, carers, relatives or professionals can move beyond the stagnation of victimhood. It is through this that individuals can reform and reconstruct their own sense of self and place in and to the world. If that one thought comes from this book, then it is worthwhile, but I suspect that for many readers the strident tone, and aggressive attack of some of the chapters will make them, like the curate, discreetly place the less palatable bits in a handkerchief to be disposed of later.

© 2003 Mark Welch 

Link: Publisher's web site.

Dr Mark Welch is currently a Senior Lecturer and Postgraduate Coordinator in The School of Nursing at the University of Canberra, Australia. His PhD investigated the representation of madness in popular film, and his other research interests include the mental health of refugees and victims of torture, and the history of psychiatric epistemology.