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Book Reviews   |    
The Sanity of Survival: Reflections on Community Mental Health and Wellness
Reviewed by David Pollack
Psychiatric Services 2006; doi:
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by Carl C. Bell, M.D.; Chicago, Third World Press, 2004, 534 pages, $27.95 softcover

Dr. Pollack is medical director of the Oregon Office of Mental Health and Addiction Services and professor of psychiatry at Oregon Health and Science University in Portland.

Carl Bell has been an icon of community mental health for the past 25 years. His work has touched many of his colleagues, whether mentors, peers, patients, trainees, or supervisees, not to mention many members of the general community who have benefited from his effective public policy and media activities. The book The Sanity of Survival: Reflections on Community Mental Health and Wellness, a compendium of his greatest hits, demonstrates on multiple levels what a treasure he is to public-sector psychiatry, especially to patients and to the practitioners who work in cross-cultural settings. (Isn't that all of us?)

First, the book exposes us to the many areas of theory and practice that Bell has explored during his career. These range from diagnosis-specific epidemiologic and treatment reports to carefully considered prevention and early intervention strategies to novel and culturally relevant research initiatives to broader social and public policy treatises. Many of these papers are focused on the African-American population from whose broad and diverse culture he emerged and to whom he has dedicated his considerable energy, curiosity, creativity, insight, and problem-solving skills.

The book is organized into six sections: "Public Health and Community Psychiatry," "Intervention Research and Advocacy," "Violence and Victimization," "States of Consciousness," "Cultural Sensitivity and Racism," and "Health and Wellbeing." Each section contains selected papers that Bell has authored alone or in collaboration since the late 1970s. Each paper includes a brief introduction describing its relevance to the section theme and a postscript, which updates the paper's apparent clinical, policy, and personal career impacts. Many of the papers provide explanations for phenomena that have been masked by cultural insensitivity. Two notable examples are his vanguard work on black-on-black violence and altered states of consciousness among African Americans.

On a second level, this book demonstrates the career path of a model community psychiatrist. It follows the trajectory of a young and dedicated clinician who adapts to his clinical and social environment. He maximizes the financial and collegial resources available to him at any particular time to parlay them into powerful research-based clinical and policy forces. We see him transform educated observations into impressive and credible research projects that establish justification for funding for patients (and corresponding treatment modalities) who have received little prior attention or support. We rejoice in the maturation of a caring researcher and clinician into a powerful and influential policy thinker whose substantial and charismatic leadership is balanced by a deep respect for and acknowledgment of the patients and colleagues with whom he has collaborated. Without question, Bell is the epitome of the effective combination of evidence-based thinking with assertive socially responsible advocacy, essential ingredients for success in the difficult arena of public mental health.

Third, The Sanity of Survival is a searing treatise on the impact of culture and racism in our society and our profession. Bell's primal and primary dedication to the African-American community is the vehicle through which we all can learn and relearn the basic lesson that good clinical practice must seriously and comprehensively take cultural and ethnic factors into account.

Some readers may find the book too long, some of the papers a bit redundant, and some commentaries overly self-referential. These apparent excesses can easily be excused and accounted for by seeing the book for what it is: a generous "how-to" book for young and aspiring public mental health professionals and an unintentional, but justly deserved, monument to an exemplary career and a remarkable human being.

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