Monday, 10 June 2013




The publication of DSM V, the latest version of the Diagnostic and Statistical Manual, used by Psychiatrists to order, collate and regiment human suffering into neat linear classifications in the same year as this book is as ironic as fortuitous. Like its cousin the ISDM, it has metamorphosed over the years- always expanding to discover, register and rationalise the creation of yet more diagnoses and classifications of the human condition. The individual contributors to this book share a passion for needs-informed, person-centred care for those people affected by mental ill- health and a deep scepticism about the way help and support is quantified, organised and provided to the 1 in 4 people in the population who at some time will suffer mental health problems.


The chapters include a diverse and rich mixture of stark personal testimony, reflective narrative,  case studies in user-informed care, alternative models of intervention and support, rigorous empirical research and a forensic analysis of mental health law-making. Although the overarching philosophy of this book is critical of contemporary psychiatric care, each chapter offers an individual perspective on an aspect of provision. And critical need not mean negative. We take the concept of critical to mean…subjecting to an interrogation from a different point of view than the prevailing orthodoxy.. in the manner of the Classical writer Socrates.


So this book will move away from that position of resigned helplessness in the face of Government and Psychiatric professional orthodoxy. Our inspiration is that of predecessors who have challenged the prevailing ethos and assumptions dictating mental health policy and practice such as Sontag, Ssaz, Lacan, Laing, and Foucault to name only a few. Anthony Clare, who as a Psychiatrist was better placed than most to reflect on his profession and the prevailing complacency in Psychiatry in the mid 1970's voiced criticism from within the establishment in his seminal work: Psychiatry in Dissent. The Feminist writers such as Segal, Friedan, Orbach, Greer; and other radical voices have been supplemented by authors such as Fernando, Bhugra, Young, Hall,  whose thoughtful work on Racism in Psychiatry proved so unsettling to many practitioners resting on their laurels after the flurry of anti-racist and anti-discriminatory policies in the latter part of the 20th Century.


NHS managers in England were accused in the Summer of 2012 of "shocking discrimination" in commissioning mental health services. The Mental Health Policy Group from the London School of Economics said three-quarters of people with depression or anxiety got no treatment. The group said the NHS was guilty of injustice in its treatment of people with mental illness. The committee of senior academics and medical professionals described this as a "real scandal". The committee headed by economist Professor Lord Richard Layard included some of the country's most eminent mental health experts. Care Services Minister Paul Burstow said mental health should be treated as seriously as physical health issues.


The group's report found that among those aged under 65, nearly half of all ill-health was mental illness. It said the NHS in England was guilty of injustice in its treatment of people with mental illness. Six million people had depression or anxiety conditions and yet three-quarters got no treatment. This was often because NHS managers failed to commission properly the mental health services recommended in official guidance, the experts added. They said £400m earmarked by the government for psychological therapy was not always used for its intended purpose because there was no obligation on managers to do so. The committee concluded that mental health services should be expanded, but if anything they were being cut. Of particular concern was the news that child and adolescent mental health service provision was being cut. Untreated young people with mental health problems are the adults with mental health problems of the future, so this short-sighted saving will produce much more cost in the future.


The book is a new addition to a corpus of existing literature that refuses to accept the status quo in Psychiatry and is prepared to ask difficult questions. It will appeal to the hungry, inquisitive mind of Junior Doctors, newly-qualified Psychiatrists, Nurses, Social Workers and all of those in a variety of educational and training contexts where they hope to qualify and acquire a professional status that allows them to intervene in the lives of the most vulnerable people in the population. It is dedicated to Thomas Stephen Szasz, (1920-2012).


Steven Walker, Editor: Modern Mental Health- critical perspectives on psychiatric practice. Critical Publishing, St.Albans. ISBN: 9781909330535. (2013).