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Our Necessary Shadow: The Nature and Meaning of Psychiatry [Hardcover]

Tom Burns
2.9 out of 5 stars  See all reviews (12 customer reviews)
RRP: 20.00
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Book Description

6 Jun 2013

Our Necessary Shadow is the first attempt in a generation to explain the whole subject of psychiatry, from the UK's leading expert, Tom Burns

A lot is written about psychiatry and the things it deals with, but very little that describes psychiatry itself. Why should there be such a need? There isn't a raft of books explaining all the other branches of medicine. But for good or ill, psychiatry is a polemical battleground, critcised on the one hand as an instrument of social control or a barbaric practice, while on the other the latest developments in neuroscience are trumpeted as offering lasting solutions to mental illness.

Which of these strikingly contrasting positions should we believe? This is the first attempt in a generation to explain the whole subject of psychiatry. In this deeply thoughtful, descriptive and sympathetic book, Tom Burns reviews the historical development of psychiatry, the places where there is much agreement on treatment and where there is not, throughout alert to where psychiatry helps, and where it is imperfect. What is clear is that mental illnesses are intimately tied to what makes us human in the first place. And the drive to relieve the suffering they cause is even more human. Psychiatry, for all its flaws, currently represents our best attempts to discharge this most human of impulses. It is not something we can just ignore. It is our necessary shadow.

Tom Burns is Professor of Social Psychiatry at Oxford University. From the late 1980s he has conducted research, in addition his clinical and teaching work, and has produced nearly 200 peer-reviewed scientific articles.


Frequently Bought Together

Our Necessary Shadow: The Nature and Meaning of Psychiatry + Cracked: Why Psychiatry is Doing More Harm Than Good + Doctoring the Mind: Why psychiatric treatments fail
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Product details

  • Hardcover: 384 pages
  • Publisher: Allen Lane (6 Jun 2013)
  • Language: Unknown
  • ISBN-10: 1846144655
  • ISBN-13: 978-1846144653
  • Product Dimensions: 23.8 x 16.2 x 3.8 cm
  • Average Customer Review: 2.9 out of 5 stars  See all reviews (12 customer reviews)
  • Amazon Bestsellers Rank: 121,638 in Books (See Top 100 in Books)

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Review

Superbly clear history of psychiatry ... (Bryan Appleyard, Pick of the Paperbacks Sunday Times) --This text refers to the Paperback edition.

About the Author

Tom Burns is Professor of Social Psychiatry at Oxford University. From the late 1980s he has conducted research, in addition his clinical and teaching work, and has produced nearly 200 peer-reviewed scientific articles. His work into Assertive Community Treatment care for severe psychosis, home based care for general psychiatry, and services to help patients with schizophrenia return to work, has been internationally important. He is currently researching a number of aspects of the doctor-patient relationship, especially those which are experienced as unequal or coercive.


Customer Reviews

Most Helpful Customer Reviews
3 of 3 people found the following review helpful
4.0 out of 5 stars common sense - with a blind spot 30 Oct 2013
By MJ
Format:Hardcover|Verified Purchase
As Burns observes in his introduction, there are few accessible accounts of psychiatry for the layman, and he's written a very lucid and helpful one. The opening chapters give a very good sense of how a thoughtful practitioner operates: nuanced, balancing common sense and fine judgement, showing that the familiar and shrill criticisms of the profession are caricatures of the reality. His historical summary is crisp and insightful, exposing the roots of psychiatry's overconfident biological assertions and showing that the profession has indelible origins in understanding the unconscious mind and the patient's experience, and treating the whole person rather than the diagnostic category.

In his account his job is not only, or even mostly, about doling out pills: talking, occupational and community therapies are at least as important. Whether the majority of his colleagues live up to this exacting and conscientious model is another question, but he is an admirable advertisement for his profession.

However, in soft-pedalling the 'medical model', he opens up the question of whether these conditions really are 'diseases' in the conventional medical sense: a question he addresses at several points but fails to fully answer. He caricatures the rejection of the medical model by presenting it only in its most polemical forms (Szasz, Foucault) and asserts (by definition without proof) that the neuroscience of the future will show he is right.
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12 of 15 people found the following review helpful
By Hector
Format:Hardcover
Good and balanced, and covers the history in a sympathetic and economic way.

Interestingly in the fraught and key debate on causality, he seems to lean towards the results of long-term cohort studies (e.g. Dunedin) that show that early childhood experiences are key.

One issue he highlights well is that of getting good quality US and UK trainee doctors to choose psychiatry as their specialism; partly because psychiatrists position of professional power is so much weaker than that of physical health doctors (who are still dominant in their worlds).

His couple of pages on psychoanalysis (research shows is ineffective, now not offered in US or UK health system, but both analysts and patient enjoy it) reflect fairly typical view within the NHS and effectiveness-based worlds.

I very much hope in future he can focus on the now emerging movement towards prevention; he just finger-tip touches in this book. Our outcomes in mental illness treatment are still very poor; as mental illness causes a large and increasing share of human disability (c.23% now) and suffering (we should include collateral suffering of family and friends also), prevention programmes (such as parenting/attachment skills training and use of pre-emptive CBT) are desperately needed; but these need to come from public health, not psychiatry.
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18 of 24 people found the following review helpful
2.0 out of 5 stars Psychiatry is wonderful because I say so 24 July 2013
Format:Hardcover
"I wrote this book to give an understanding of what psychiatry is, what it can do and what it cannot do." With this explanation the author starts his introduction. He goes on to acknowledge that zillions of books have already been written on the subject representing a broad spectrum of views for and against psychiatry. "[W]hich should you believe? Should you believe either? Is it perhaps possible to believe both?...I hope to clarify some of these contradictions so you can decide for yourself. ... I hope I have succeeded in conveying both sides of the debate." Yet the reader knows what Burns wants him to conclude before opening the book: we need psychiatry. The title says so.

Why do we need psychiatry? Because, according to Burns, it works. He repeats this sentiment in a variety of wordings scores of times throughout the book. How it works, how often it works, and how its efficacy is determined he mentions nowhere. "I made a decision to keep this book free of references" he states in the acknowledgments even ahead of the introduction. Fair enough. A reference makes a statement look scholarly but doesn't make it true. However if you're going to rest your entire case on this one claim, expecting the reader to accept it on faith won't do. In fact I don't. Psychiatry does not work, ever. Nobody gets better from it, only worse. My source for this is the testimony of my own eyes and ears.

"Establishing and sustaining a trusting relationship with a troubled and suspicious patient is a skill," he posits, suggesting that psychiatrists have this skill. "It is simply not the case that psychiatrists only focus on symptoms and prescribing pills." This is not fact, it is propaganda.
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6 of 8 people found the following review helpful
4.0 out of 5 stars a good overview from the inside 27 July 2013
Format:Hardcover
This is a warts-and-all view of psychiatry from the inside. There is a lot of contemporary debate, particularly online, about the validity of "mental illness" and the "medical model" used to treat it. The pragmatic reality however is that if people with mental health problems are to be assisted by the health services, then doctors are needed to pronounce illness and sort according to diagnosis, however imperfect the labels themselves may be. Professor Burns is very clear in the book about his opinion that psychiatry is not just another medical specialty, just as depression is something different in quality from a chest infection. Psychiatrists and patients alike are aware of these differences whether they admit it or not, and it can make psychiatry a complicated and uncertain business. Nevertheless, anyone who has worked as a doctor in this field will have seen people being helped enormously despite all the difficult dilemmas, and the book conveys this also. I would recommend it to anyone considering entering psychiatric training, and from my own point of view I found it a useful and enjoyable refresher on the history of my profession.
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Most Recent Customer Reviews
4.0 out of 5 stars Illuminating, honest, and readable book!
Started slowly but very helpful overview of putting psychiatry in perspective. Describes where its origins lay and how it has progressed with new directions taken. Read more
Published 4 months ago by John Anderson
1.0 out of 5 stars A book with a hole in the middle
Professor Burns writes: "Like the rest of medicine, psychiatry has improved by leaps and bounds through the course of the twentieth century as treatments have become more... Read more
Published 9 months ago by E. J. Moir
1.0 out of 5 stars Not a real critique
Professor Tom Burns has received payments for lectures and consultancies from the pharmaceutical companies Eli Lilly and Janssen and Otsuka.... Read more
Published 9 months ago by Peter j
2.0 out of 5 stars The nature of the Shadow
When I purchased this book I was expecting a book that would explain more into the Shadow side of Psychiatry and what the nature of psychiatry is. Read more
Published 11 months ago by Robert Winstanley
5.0 out of 5 stars Welcome publication
A one-star reviewer, who says he couldn't read this book, asks why anyone would want to. People forget, or perhaps are not fully aware, that the 20th century will go down as the... Read more
Published 11 months ago by A purchaser
1.0 out of 5 stars Very confused
A very confused book. Burns tries to show us that psychiatry is credible and then towards the end turns to psychoanalysis/therapy saying how much patients like it and benefit from... Read more
Published 13 months ago by Jean T
1.0 out of 5 stars Why Should Anyone Want to Read this Book?
One star is maybe unfair. I didn't read the book. That is because I couldn't get past the introduction. Here the author explains what drew him to psychiatry. Read more
Published 13 months ago by Jo
5.0 out of 5 stars Fascinating book
I would highly recommend this book - it is very interesting, and very well-written - I started reading it and ended up staying awake to finish it. Read more
Published 13 months ago by Amazon Customer
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