Mental Health Care and Social Policy, ed. Phil Brown.
(New York: Routledge and Kegan Paul, 1986.)

Book review by Rob Couteau







Published in:
The Journal of Contemporary Psychotherapy, autumn 1987
(NY: Uniondale

The experience of reading through this anthology of eighteen articles on the history, changing social policies, and institutional structures of the mental health field is not unlike the experience of actually working in the present-day American mental health system. Some of the articles have the same distant, unfeeling touch of the bureaucratized mental health worker as they unfold into stretches of endless statistics penned with the peculiarly stunted tone of official reports. This is a format that has always seemed unforgivable to me when one is discussing psychological matters, even if the focus is on institutions and social policy. Therefore, articles that discuss the same subject matter and yet retain some sense of life are even more appreciated-just like the rare mental health advocate who's actually trying to do his job.

Not surprisingly, most of the articles that fall into the latter category are contained in the closing chapter: "Alternatives to traditional mental health services." Here, we find an insightful study on the importance of "nonprofessional" client-run systems, by Audrey J. Gartner and Frank Reissman ("Those who help are helped most") as well as an article on the important (but poorly named) "Mental Patient's Association," by Judi Chamberlin ("The responsibility of the service is to the client, and not to the relatives, treatment institutions, or the government"). Anne M. Lovell and Yi-chuang Lu close the book with research that suggests the most interesting developments in mental health are not happening in America but overseas, in their respective articles: "From confinement to community: The radical transformation of an Italian mental hospital" and "The collective approach to psychiatric practice in the People's Republic of China."

Lovell tells how

A man appeared to be hallucinating. He claimed to see dark insects. Rather than interpret the 'case' as might be likely in an American mental health practice, a group of workers accompanied the man to his house-which they found filled with little black insects. 'Treatment' thus became a collective effort to clean the man's house. Not surprisingly, his 'hallucinations' disappeared.

While Lovell concentrates on the transformation of a mental hospital as "but one chapter in an ongoing struggle against what was then defined as psychiatric oppression," Lu's focus is on the collective approach in Chinese society. Lu reports on practices that American psychiatrists would consider heretical but that, nonetheless, far surpass our shallow "innovations":

The involvement of the society is indicated by the practice whereby patients continue to receive their wages or salary during the period of hospitalization. Their jobs are held for their return.

The clients' peers are invited to the hospital to assist in their treatment and provide support and "reliable reality-testing sources."

Unlike the American system, where an increase in client contact implies a decrease of professional status (with psychiatrists maintaining the least contact and highest status), Lu notes a "minimization of elitism in the interpersonal relationships in mental hospitals" and "observed a high degree of social interaction between patients and staff, and among patients themselves." Clients even conduct the equivalent of "grand rounds" upon each other:

Each patient in [the] meeting reported to the group his own symptoms and problems. Then these symptoms and problems were commented on and analyzed by other patients in the group.

At the beginning of the group meeting, I was surprised to hear patients casually using psychiatric terms and concepts. Later I learned [that] patients were given lectures on psychiatry. This process is called 'transmitting psychiatric knowledge to patients.'

After the rest of the patients analyzed a patient's symptoms-the patient defended his own position vigorously-I was amazed at how easily the patients handled the criticisms of others.

The remainder of Mental Health Care and Social Policy (that is, the first three-quarters) suffers because the editors failed to select articles that transcend the predictable perimeters. Although authors were drawn from the fields of sociology, psychiatry, psychology, epidemiology, and social history, their general frame of reference is one of a hyperrational, orthodox sociological perspective (just as the orthodox perspective in psychiatry today is one-sidedly biochemical). Therefore, the book has the dangerous appearance of being modern and innovative while, in essence, it is not.

For example, we all know that the traditional American system is not working, is pitifully uncoordinated, is largely not client directed, and that it eclipses the client's cultural identity with a homogeneous mental health "culture." A more significant problem in the field, however, is that the system ignores the inner spiritual life of the client. Therefore, it remains superficially focused, which further alienates the client. Unfortunately, the same approach is reflected in this collection. The notion of a "rational" social policy is implicitly woven throughout the articles as the panacea with which to deal with all the woes of the failing system. Even the more interesting articles in the last section feature this view as a central theme.

If sociology is to offer anything of substance to the problem of mental health, it must make a contribution that extends unflinchingly into the complexities of inner life, thereby transforming the very fabric of the individual and, thus, of the group itself. Unless the sociological perspective metamorphoses into something else-something with an amplifying rather than a reductive quality-it can offer nothing to the individual separated from his inner life as well as from his outer society.

An exploration of such inner values and of their relationship to society would deepen the meaning of the social group and reconnect the therapeutically isolated individual to the collective. Yet, such problems are not dealt with here. Any mention of inner life is viewed as a threat to the concerns of the collective, instead of being recognized as the core matrix that is only secondarily reflected in the outer collective.

Inner life must not be ignored, turned into some ultimate taboo, or looked upon as naive or "romantic." Instead, it must be met in its own right. Otherwise, the social perspective of societies of the past, which always pivoted on the spiritual center of the individual, will continue to be eclipsed by the "modern" policies described in this work, which advocate a rationalism that "rescues" the individual from a homogenized psychiatric culture merely so that he may be homogenized by the soulless policies of some spiritually neutered social group.


 fine art

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