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Book Reviews   |    
Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Destroying Sanctuary: The Crisis in Human Service Delivery Systems
by by Sandra L. Bloom,Brian Farragher.; New York, Oxford University Press, 2011, 440 pages, $45

Reviewed by Maggie Bennington-Davis, M.D.
Psychiatric Services 2011; doi: 10.1176/appi.ps.62.11.1396
View Author and Article Information
Dr. Bennington-Davis is chief medical and operating officer, Cascadia BHC, Portland, Oregon.

The reviewer reports being a faculty member of the Sanctuary Institute, although she has had no financial or commercial gain from this affiliation or from Dr. Bloom's book.

Copyright © 2011 by the American Psychiatric Association.

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I am a psychiatrist and have spent my career in community and hospital mental health. Destroying Sanctuary tells the story of my professional life. This book should be required reading for anyone who cares about or works in the mental health system—or, for that matter, any social system. Everyone I know who has read this book believes that somehow Bloom and Farragher were privy to the organization in which they serve. You will too.

Before I explain why, a disclaimer: I am a Sandra Bloom groupie. Her first book, Creating Sanctuary: Toward the Evolution of Sane Societies, published in 1997, became my guide and touchstone, sparked my friendship with Sandy, and remains the most read book in my office.

Destroying Sanctuary is part 2. Like Creating Sanctuary, this book is difficult to categorize. It is history, text, statistics, science, politics, anthropology, psychology, and story book. It is an excellent and accurate account of community mental health—a painful story of the dream never realized. There are coherent descriptions of the criminalization of people with mental illness, consequences of fundamentalist biological psychiatry, and the effects of reductionist behaviorism in children's services.

Bloom and Farragher review the economic and human burdens resulting from an underfunded (and steadily less funded) system, with multiple references to health statistics. In fact, there is exquisite attention to data from health and human services. They recap state-of-the-art thinking about trauma and its effects in order to apply that same thinking to organizations.

It is the organizational behavior part that hooks me. The authors eloquently explain why organizations behave as they do when they've been under stress or are in crisis. Workplace violence, bullying, secrecy, authoritarianism, mistrust, gossip, burnout, low morale, ultimate failure—these authors explain it all in a wonderful piece of writing.

For any of us who have devoted our professional lives to community mental health, this is our story. It's also for everyone in the social sector: children's protective services, disability services, and aging-adult services. It is both reassuring and horrifying to see ourselves and our organizations so explicitly described.

Although the book sets a somber mood, hope is not lost. The ending chapter, “Restoring Sanctuary,” is the perfect segue to a third book (due out next year) and gives us a taste of how traumatized and stressed organizations, like traumatized and stressed individuals, can and do recover.

Read this book • and let's talk.




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