Lucy Johnstone's Users and
Abusers of Psychiatry takes a critical look at current psychiatric
treatment, mostly in the UK. It is a
substantial book, with nearly 300 pages, 11 chapters and 25 pages of
footnotes. It combines personal
narratives with discussion of psychiatric theory, sociological data about
trends in psychiatric care, and some current controversies. Johnstone does not doubt the existence of
mental illness, but she is dissatisfied with the current reductionist approach
to its conceptualization and treatment, which she argues does not serve
patients well. Her approach is clearly
influenced by sociological views about mental illness that emphasize
medicalizing people's psychological problems can disempower them and confine
them to a "sick role." She is
also very critical of the reliance on psychiatric medications, which she argues
are often unhelpful and even dangerous.
Johnstone clearly believes that we
would serve people better if we could provide them with individual
psychotherapy, and we could do more to change their family interactions and
even the structure of society. She
emphasizes the role of gender in causing mental disorders and argues that
sexism in psychiatry leads stereotypical female psychological conditions to be
classified as mental illnesses. Her
work is informed by a large body of work from critical psychiatry and a more
general left or liberal perspective, including the Glasgow Media
Group, Barham and Hayward's Relocating
Madness, Peter Breggin's many attacks on psychiatric medication and ECT,
Made of Wood, and even Richard Warner's Recovery
from Schizophrenia. However,
most of all her work is based on her own observations of the British
psychiatric system and studies she has collected over the years. She makes an impressive case for her views,
since even if one is unconvinced by one or two pieces of evidence she presents,
the effect of the whole body of evidence she provides is overwhelming. She may not have proved that the medical
model to treating mental illness is intrinsically worthless, but she does
enough to throw a great deal of doubt on its value, and she shows that it is
folly to rely exclusively on such a model to the exclusion of others. She also gives strong reason to believe that
whatever the best model might be, the current system is not very successful in
helping people diagnosed with mental illness, and in many cases may be making
their lives worse.
There is in Britain a relatively
thriving movement of researchers and activists with a critical attitude towards
mainstream psychiatric theory and treatment.
In the US, there are many critics of psychiatry, and there are a number
of psychiatric survivor/consumer groups, as well as many Internet websites and
email lists devoted to discussing the excesses and dangers of medications. However, all this activity in the US is too
fragmentary to be described as a cohesive movement. With the pharmaceutical industry having so much influence though
providing grants to groups such as the National Alliance for the Mentally Ill
and having direct access into people's homes through direct-to-consumer
advertising, the mainstream view of mental illness has a powerful hold over the
public. Users and Abusers of
Psychiatry is a model of a sophisticated critique of the mainstream medical
model, showing a good understanding of the complexities of psychiatry theory
and an impressive knowledge of the way that treatment actually affects
people. It is also written clearly, and
with its repeated use of the cases of particular individuals and their stories,
should be accessible to a general readership.
There is no equivalent book that addresses the state of mental health
treatment in the USA, and that is a real shame. While there are major differences between health care in the
Britain and other countries, Johnstone's book does have enough general
discussion in it to be relevant to readers outside of the UK. I recommend it highly.
© 2003 Christian Perring.
All rights reserved.
Christian Perring, Ph.D., is Chair of the Philosophy
Department at Dowling College, Long Island, and editor of Metapsychology
Online Review. His main research is on philosophical issues in
medicine, psychiatry and psychology.