Asking vital but troubling questions

The Routledge International Handbook of Critical Mental Health by Bruce M.Z. Cohen (Ed.) (Routledge; Hb £165.00, reviewed by Paul Moloney.

This edited handbook is aimed at anyone who works in or studies the mental health field, and who wants to question the reigning assumptions about the nature of personal malaise and its treatment.  Why is there a need for this volume? In almost every country, levels of distress appear to be on the rise. While in the field of mental health treatment, critical thinking is in retreat. Universities and public healthcare services are subject to business values. Researchers focus mainly on safe ‘pragmatic’ issues, and clinicians proclaim their expertise in fixing the mad, the troubled and the troubling.  

But their confidence is unwarranted, as the contributors to this book show. It begins, sensibly enough, with an overview of some of the key theoretical frameworks that have unmasked the coercion behind many kinds of mental health treatment – extending from feminism, Marxism and Foucauldian analysis, to relative newcomers like mad studies and queer theory. In every case these arguments are applied to key current developments and debates, within the world of health care. Reflective chapters on the progress of ‘critical psychiatry’ and on the philosophy of critical realism add to this nuanced landscape; which leads on to illuminating histories of the psychiatric profession and its appropriation of the management of madness from laypeople. This is followed by sections on the growing tendency for almost every kind of human problem (or difference) to be turned into a supposedly treatable illness, and then with the politics of diagnosis itself.

Psychiatry and its clinical manual, the DSM, emerge as largely pseudoscientific undertakings; the products of a clinical research field corrupted by the interlocking appetites of state power, trans-global pharmaceutical companies, consumer advocacy groups, and the mental health professions themselves. Appropriately for an international handbook, the penultimate segment focuses upon the export of Western mental health diagnoses and treatments to the less industrialised parts of the globe. Rather than gifts of the enlightenment, they are convincingly shown as forms of latter-day colonialism, undermining indigenous healing methods and the ability of communities to cope with war and environmental trauma in their own ways.

In critiques of this kind, psychotherapy is customarily presented as the humane alternative to the drugs and electroshock of biomedicine. Here, by contrast, in the final section, the general argument is that talking treatments too often partake of the same reductive outlook, encouraging sufferers to see themselves rather than their world as the source of the problem.  

A publication as ambitious as this one is unlikely to cover every base. Many of the contributors ignore the shaky science upon which most forms of psychological therapy ultimately rest, including those that they champion in the name of empowerment. Given the many themes and voices to be found between the covers, a final summary chapter might have been useful; if only to help the reader find their own path through the sometimes conflicting themes, and the many suggestions for how the current philosophy of ‘treatment’ needs to be replaced by one of genuine care. Nevertheless, this book is well worth reading for the range and depth of its subject matter, and above all, for its determination to ask vital but troubling questions about the mental health treatment professions and whose interests they really serve.

- Reviewed by Paul Moloney, Counselling Psychologist at the Royal Shrewsbury Hospital

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