by Patrick Bracken and Philip Thomas; New York, Oxford University Press, 2006, 312 pages, $57.50 softcover
Mr. Provost is affiliated with the Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, Massachusetts.
The President's New Freedom Commission on Mental Health called for a consumer-centered mental health system (1). Unfortunately, many consumers "find it little more than a vehicle for delivering medications, sometimes under the cloud of court orders" (2). Postpsychiatry represents a framework for mental health through the lens of critical psychiatry and consumer involvement in treatment. The authors are affiliated with the Centre for Citizenship and Community Mental Health, School of Health Studies, University of Bradford in the United Kingdom and specialize in hermeneutics, phenomenology, narrative, and community development. Concepts in this book were previously published in an article on critical psychiatry (3).
The book contains ten chapters organized into three sections. The first section provides context about the mental health profession and how treatment is delivered to consumers. Section 2 reviews the philosophy of science, including the work of postmodern philosophers such as Foucault and Wittgenstein as applied to mental health practice. It also critiques current trends in psychiatry, including the perceived control that pharmaceutical companies exert on academic psychiatry through the marketing of medications for depression and schizophrenia. The final section describes the influence that narrative, recovery, community development, and consumer-centered social policies and programs can have on shaping postpsychiatry. This section contains examples of innovative community development and consumer empowerment programs, including the Soteria project developed to help individuals during acute psychotic episodes without the use of neuroleptic medication. In addition to the three main sections, the book also includes six fictional vignettes from a consumer perspective highlighting illustrative points.
Overall, Postpsychiatry is quite relevant to readers of this journal. Themes in this book will resonate with those interested in comparative mental health policy, consumer empowerment, human rights, and action research. The authors also emphasize the importance of including humanities and cultural studies in medical education, which could be offered as a source of dissenting opinion for training in evidence-based psychiatry.
To truly appreciate this book, it is helpful if the reader has an understanding of the philosophy of science. A drawback is that the book does not specifically include a concluding summary chapter. Although readers may argue that postpsychiatry is simply antipsychiatry, the authors assert that "postpsychiatry is our attempt to subdue the bright light of medical science: not because we want to get rid of or deny its benefits, but because we believe that the insights of other approaches are equally important and valuable. We hope that our critique of the central assumptions of the psychiatric canon will open a space in which other voices will be heard and taken seriously. We believe that these voices will hold the key to the future." Although the authors do not include any specific policy prescriptions, the postpsychiatry framework may help to engage clinicians, consumers, program managers, and policy makers in a dialogue about directions to take in transforming the mental health system.
Achieving the Promise: Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President's New Freedom Commission on Mental Health, 2003: Final Report.
Bernstein R: A seat at the table: trend or illusion? Health Affairs 25(3):720—729, 2006
Thomas P, Bracken P: Critical psychiatry in practice. Advances in Psychiatric Treatment 10:361—370, 2004