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Book Reviews   |    
The Necessity of Madness
Reviewed by Anita Everett
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.5.730
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by John Breeding, Ph.D.; London, Chipmunkapublishing, 2003, 476 pages, $45 softcover

Dr. Everett is senior medical advisor for the Substance Abuse and Mental Health Services Administration in Rockville, Maryland.

The title draws you in; is there a useful aspect to madness in human and psychological development? Certainly individuals throughout time have hoped and searched for meaning in the experience of madness. Families as well have hoped and prayed that on the other end of a period of psychosis or madness will come new insights and interpersonal growth. Although this may happen sometimes, it is also true that for many people periods of madness or psychosis are disruptive and distracting and do not result in useful interpersonal development. Dr. Breeding asserts that "madness is a dynamic process which can result in breakthroughs to deeper levels of spiritual maturity and a richer fuller life." This is one of several tenets included in this work that bring a perspective that is inconsistent with the way most professionals and advocates today characterize mental illness, which is exactly the point of Dr. Breeding's work.

The Necessity of Madness includes numerous opinions espoused on a variety of subjects that have in common Breeding's views on mental health. Three central themes are: "Psychiatry is inherently coercive" and has been developed as a social mechanism to control nonconformational behaviors and beliefs; our current understanding of mental illness as a medical disease is not well founded; and with hope, courage, complete self-appreciation, and the "good attention of another safe caring human being," individuals can set about to do the work of emotional recovery.

From the perspective of a psychiatrist who has spent more than 20 years working in partnership with consumers, patients, professionals, advocates, elected officials, and family members to improve the lived experience of individuals with mental illness on many levels, the continued psychiatry bashing in this work is very difficult to wade through. Dr. Breeding makes numerous references to the use of psychiatry as a tool of the Third Reich to control and exterminate mentally ill and otherwise nonproductive and defective individuals. It is inarguable that there were aspects of international unrest preceding World War II that led to a hope that science, including social science, would help to solve many levels of problems. However, most of us would not go so far as to blame psychiatry as the principal cause of Nazi atrocities, although it is undeniable that there were physicians who participated in the atrocities. Perhaps we are comfortably in denial, and perhaps that is part of the value in a very biased work such as this, salted with ideas that at least partially resonate.

If you are looking for a book that depicts many of the themes and ideas that are upheld by individuals who identify with the psychiatric survivor movement, this would be a very practical resource. The prominent antipsychiatry language distracts from Breeding's useful ideas regarding recovery and self-care near the end of the book that would be very helpful to certain consumers who are looking for a high level of intellectual peer-to-peer support and exchange of positive and constructive ideas they could incorporate into their own recovery. Hopefully, in the not so distant future, we might all be able to work together to advocate for necessary tools so that all people affected by mental illness can pursue a meaningful life in the community of their choice.

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