A blind spot for psychology?

Our psychiatric future: The politics of mental health by Nikolas Rose (Polity Press; £17.99); reviewed by Richard Hallam.

Nikolas Rose’s writings on the politics of health have been stimulating and influential. The title of this book is intriguing. Rose believes that ‘another psychiatry … is possible’ if it can turn itself into what he calls ‘social medicine’ (p.21). In other words, he believes that psychiatry can be saved from itself, even suggesting it should demedicalise distress (p.191).

The academic style is irreproachable – even-handed, meticulously researched, offering a wealth of historical detail explaining how psychiatry has got to where it is today. Consequently, it reads rather like a series of reviews, certainly of great value to students. Initially, it is not clear that Rose wants to move outside a medical framework or question the concept of mental health. The focus is on psychiatry, including, for instance, arguments put forward to support each version of the DSM from 1 to 5. The neoliberal critique of psychiatry is analysed, as well as the concept of social capital, although he comes to no firm conclusion about either. He imagines psychiatrists giving up diagnosis and formulating people’s individual life circumstances.

So what is the message? In essence, mental health is not just about brain disorders, psychopharmacology is flawed, Western psychiatry will not solve global mental health problems, and service users’ own store of knowledge should be recognised. If you do not already agree with this position, Rose’s book is for you. It is only in the final chapter that he proposes ways in which psychiatry could be reformed. It should adopt a biopsychosocial model, with an emphasis on the social determinants of distress, and endorse political and social policies to back this up. He feels that any radical suggestion to abolish psychiatry is ‘sadly simplistic’ (p. 174). (Sadness in an academic is usually a sign of superior wisdom). Nevertheless, he would like people to be helped outside the formal mental health system and social adversity should be addressed directly. Formulation should replace diagnosis and psychiatry should contest the ‘narrative of disease’. The chance of this coming about? Zilch, in my opinion.

Remarkably, Rose does not discuss non-medical approaches to mental health (apart from the role of service users), or any psychological theory whatsoever, nor mention that applied psychologists have been working on methods of formulation for the past 60 years. (But then sociologists have always had a blind spot for psychology).  

- Reviewed by Richard Hallam, Independent researcher

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