- Book review
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Peter Stastny, Peter Lehmann: Alternatives beyond Psychiatry Peter Lehmann Publishing:431. IBSN-978-0-954428-1
Philosophy, Ethics, and Humanities in Medicine volume 3, Article number: 18 (2008)
Peter Stastny and Peter Lehmann's Alternatives beyond Psychiatry offers a comprehensive and up to date account of the alternatives to mainstream psychiatry that are being developed by service consumers and survivors across the world. As psychiatry moves into a new age less dominated by a biomedical paradigm many of the approaches described in this book may be adopted by mainstream health services. This is a hugely readable and accessible book for professionals and consumers alike.
Psychiatry as a science has had a profound political element from its infancy. For example many commentators, notably Masson , have suggested that Freud's reversal of his original belief that 'hysterical illness' was rooted in genuine childhood trauma, was politically rather than scientifically driven. Similarly, attempts to eradicate serious mental illness through manipulation of the gene pool that formed the driving force behind the eugenics movement in the early part of the last century mirrored extreme political views of the time from both the left and right wings of politics . Once again, in the 1960's and 1970's critical views of psychiatry emerged [3, 4] which corresponded with the prevailing liberal and anti-establishment zeitgeist. However the response was vigorous promotion of the biological model of psychiatry from the mainstream medical establishment and the pharmaceutical companies, which has been described by Bentall  as the second coming of biological psychiatry. This led to the absolute dominance of the medical/biological model of psychiatry, a situation that has persisted for the last thirty years. Such a one sided promotion of a disease model of serious mental illness, with medication as the only possible 'cure' has seen the exclusion of more holistic and humanistic approaches, and created an intellectual argument resembling the biblical battle between David and Goliath.
Orthodoxy is once again being challenged. Alternatives to psychiatry are back on the agenda, with one crucial difference. On this occasion the agitators for change are not disaffected professionals, but dissatisfied mental health care consumers many of whom feel that traditional psychiatry failed them, and that their recoveries have taken place outside of it.
Not even the authors themselves would claim that this is a balanced book; 'balancing' would be a better description. They present a refreshing wholly one sided view that will delight some and infuriate others. The book takes the form of forty-one brief essays and conference speeches from mainly European and service users and radical practitioners. Some of the essays take the form of life narratives and recovery stories; others are descriptions of specific recovery organisations such as Loren Mosher's famous Soteria project, whilst other essays cover specific topics such as the use of advanced directives or effective involvement of families.
The editors take as their starting point an unequivocal stance that modern psychiatry does not work, evidenced, in Robert Whitaker's "Preface," by the fact that since chlorpromazine was synthesized and introduced in 1954 the rate of 'disabled mentally ill' in the USA has increased nearly six-fold from 3.38 people per 1,000 population in 1955 to 19.69 people per 1,000 population in 2003. Furthermore, since the introduction of Prozac in 1987 the number of 'disabled mentally ill' has been increasing at the rate of 150,000 per year. This is a powerful argument. Whilst research into physical disease has led to huge improvements in outcomes in conditions such as breast cancer and HIV; psychiatry appears to be going backwards, and at an alarming rate. Following cautions about psychiatric drugs and treatments, Editors Peter Stastny and Peter Lehmann offer a volume of alternatives "beyond psychiatry."
The strength of this book is the diverse source of its contributors. Ninety year old Dorothea describes seventy years in the German psychiatric system which included involuntary sterilisation but ended in recovery and a determination to help others – a powerful testament to human resilience! Two other essays in this anthology stand out: Peter Lehman and Maths Jesperson's contribution, 'Self Help, Difference and User Control in the Age of the Internet,' shows how and why consumers groups will become significant players in the future shaping of psychiatry. Marc Rufer offers an eighteen page summary of the position of alternative theorists, 'Psychiatry: Its Diagnostic Methods, Its Therapies, Its Power,' that is destined to become a classic and by itself is worth the cover price of the volume.
The main weakness of this book is an absence of data. These are opinion pieces, a fact addressed in an excellent contribution from Jan Wallcraft, 'User Led Research to Develop an Evidence Base for Alternative Approaches.' While this weakness is obvious, overconfidence in 'data' can also be dangerous. A recent meta-analysis in the UK of the effectiveness of new generation anti-depressants concluded that they were equivalent in effectiveness to placebo if 'buried' negative findings from randomised control trials were included in the analysis . This 'data' was only available because of a new freedom of information act
Psychiatry is about to experience fundamental changes that will not be driven by research chemists or neurobiologists. Politics and social justice have returned to the discussion. Consumers and service users that we claim to help recover are unhappy with what they are being offered, they are motivated and they are getting organised.
If memory serves me correctly, David beat Goliath.
This is an important book
About the author
Paul Hammersley is the Programme Director for Post Graduate Studies in cognitive behavioural therapy for psychosis at Manchester University's COPE Initiative in The United Kingdom. He is also an active therapist specialising in CBT for individuals experiencing severe psychological problems following traumatic life events. He has been widely published and has lectured extensively. 2006 along with Professor Marius Romme from Holland and The UK Hearing Voices Network, he founded CASL (The Campaign for the Abolition of the Schizophrenia Label.)
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Szasz TS: The Myth of Mental Illness. The Foundations of a Theory of Personal Conduct. 1974, New York: Harper and Row,
Bentall RP: Madness Explained: Psychosis and Human Nature. 2003, London: Penguin Books.
Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT: Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008, 5 (2): e45- 10.1371/journal.pmed.0050045
The author declares that they have no competing interests.
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Hammersley, P. Peter Stastny, Peter Lehmann: Alternatives beyond Psychiatry Peter Lehmann Publishing:431. IBSN-978-0-954428-1. Philos Ethics Humanit Med 3, 18 (2008) doi:10.1186/1747-5341-3-18