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The Shock of the Fall
The Shock of the Fall
by Nathan Filer
Edition: Hardcover
Price: 11.25

1 of 2 people found the following review helpful
5.0 out of 5 stars Brilliant, human, revealing, wonderful, 26 Jun 2013
This review is from: The Shock of the Fall (Hardcover)
There are a number of aspects to this novel which elevate it to the heights of the best writing about psychiatry. Firstly, is the wonderfully accurate portrayal of mental health services, community and hospitals, in England at this time. I have worked for over a decade as a mental health nurse, in fact I have worked on the unit which I believe this novel is set, although the names have been changed. The descriptions of life on the ward, the strengths and weaknesses of the staff, the atmosphere of meetings, the smoking garden, and above all, the utterly patronising nature of the organisational side of care (especially the paperwork) were masterfully depicted. I have been 'Denise' the Community Psychiatric Nurse, both in meetings awkwardly trying to introduce myself as someone with high hopes to help, and writing letters about medication which do not mention medication. However, the book is not written from the point of view of staff. It is written from the point of view of the 'service-user', and through his eyes the system is revealed in true colours.

The second aspect which is perhaps perfectly portrayed is that the 'psychosis' - that of hearing voices mainly - is not a random experience, somehow out-of-the-blue. Despite the nonsense that psychiatry regularly touts promoting genetic or neurological explanations over personal experience, in practice it is this story of trauma and relationships with family and misplaced guilt and trying to avoid/cope with strong emotions which is the most common story behind 'mental illness'. Yet in the book, as is so frequent in real life, the services which are there to help people are not contributing to people making sense of their lives but rather just trying to prevent them from (a) acting in risky ways and (b) feeling anything too strongly.

Nowhere in the book are concepts of 'mental illness' openly debated. There will be a few who read this book who feel that the real tragedy is 'schizophrenia'. However, by giving an account which renders 'psychosis' understandable, the author is undermining the medical model of psychiatry, and for that reason this book will be welcomed by voice-hearers and anyone with an interest in de-medicalising services for distressed people in this country, and increasing the understanding that so called 'mental illness' is more usually a sane person trying to make sense of insane circumstances, usually on bucketfuls of sedatives.

I'm going to recommend this book to all my friends and colleagues.


Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
by American Psychiatric Association
Edition: Paperback
Price: 72.00

37 of 48 people found the following review helpful
1.0 out of 5 stars Fifth edition now worse than ever, 5 Jun 2013
The astonishing failure of the categorizations of psychiatric diagnoses to self-vindicate is now even more evident. Instead of the 'true nature' of 'mental illness' becoming more clear and accurate over time, the efforts to 'carve nature at its joints' continues and it has never been more controversial. The British Psychological Society have described this document as shrinking the pool of people who may be considered normal in society 'to the size of a puddle'. This version, longer than ever, had a pilot study (their own pilot study!) which showed that it is now even less reliable in use than before. The sad fact is that a very average writer of pulp fiction knows more about range and depths of human experience than the authors of this book.

The basic misunderstanding comes from the belief that 'mental illnesses' may be adequately described as 'natural kinds', that is, occurring 'in nature'. We can know what a mental illness is, says the American Psychiatric Association, in the same way that we can know what a tiger is, or a beech tree, or multiple sclerosis - they are what they are, and we will define and understand them fully given time. However, 'mental illness', like many other aspects of human culture, are not 'natural kinds' in this way. Of course they are not divorced from biology, but they are interactive. As we interact with them, they change. The ways in which we express and understand distress today is different now to just a hundred years ago, and will go on changing. So, 'mental illnesses' in society change, come and go, morph, loop, become highly prevalent or be almost never seen. As society changes, certain things will become considered deviant or unreasonable, others will stop being so. Beech trees don't change depending on what we think about them, and they existed in their current form before we started thinking about them, but this is not true for 'mental illnesses'. They are items with a past, present and future. They are ideas, and they are very powerful ones.

Authors such as Robert Whitaker have been instrumental in showing that WHO statistics make it clear that recovery from mental distress is better the less contact one has with psychiatry. Other statistics show that inequality is a far bigger indicator that there will be poor mental health than any other factor. And this is why this book is much more than just a joke. A group of well intentioned (well, most of them) people - doctors for goodness sake - are doing more harm than good, and the statistics prove it. They are using this manual, and the grave mistakes within it. And the result is political - because the real causes of distress - messy things like abuse, inequality, trauma, prejudice etc are hidden under illness categories. We do not have to ask all the difficult questions if we can take distressed people, quieten them with 'medication', remove them to 'hospitals' and locate the original or fundamental problem within them. And there are a lot of people whom that situation suits - in fact, before you get on too much of a high horse - you, the reader, may also have contributed to this by perpetuating the general attitude that when people are hard to understand or express strong emotions at socially awkward moments it is because they are wrong, or have something wrong with them. But it also suits professions, governments, corporations, employers and abusers to locate the causes of distress within individuals, to make it your fault (although they claim that 'since it is biochemical/genetic', it is really nobody's fault, which sounds like a lovely comforting thing to say but is actually the most stigmatizing idea of all).

The American Psychiatric Association recently (this year) had to admit that the term 'chemical imbalance', used to describe the causes of mental illness, 'was only ever a metaphor'. Likewise, this book is 'only a metaphor', although in just the same way it is presented as fact. If you are serious about helping people in distress, this book is not for you. Lift your game, read some decent authors (Ian Hacking springs to mind as a gateway to some bigger ideas, as well as Marius Romme and Sandra Escher, Lucy Johnstone, Jacqui Dillon, John Read, Richard Bentall, Mary Boyle, Joanna Moncrieff, Gail Hornstein, Pat Bracken, Phillip Thomas, and the recent 'Madness Contested: Power and Practice by Steven Coles et al., John Dupre, Stuart and Cohen or any half-decent book on the philosophy of science), and don't try to reduce the mind to the brain, meanings to chemicals, society to individuals, the phenotype to the genotype, the complexity of human experience to 'mental illness'. It doesn't work, it is poor science, it is poor philosophy, and it damages what it human in all of us.
Comment Comments (3) | Permalink | Most recent comment: Aug 15, 2014 2:31 PM BST


The Collapse of Chaos: Discovering Simplicity in a Complex World (Penguin Science)
The Collapse of Chaos: Discovering Simplicity in a Complex World (Penguin Science)
by Ian Stewart
Edition: Paperback
Price: 10.99

2 of 2 people found the following review helpful
5.0 out of 5 stars Reductive simplicity vs emergent complexity.... and simplicity, 1 Feb 2011
Having just read the other reviews about this great book, I am a bit surprised how little they refer to the central themes!

Essentially, this book is a discussion of reductive science (and it gives a wonderfully concise and fascinating description of its achievements) set against the idea of emergent complexity. This is the debate which questions whether all levels of complexity can be adequately explained by using more simple and law-like ideas. Having set this scene, the authors show some of the ways that patterns (simplicity) emerge from apparently chaotic systems... suggesting that understanding where such simplicities come from is actually more interesting and fruitful than understanding complexity.

Perhaps the most striking of the many illustrations and ideas are the ones about the relationship between geneotype and phenotype. This they do in ways which lead one to be excited about genetics but much more skeptical about its usefulness in answering many of the questions we find most important about ourselves.


Mad Travellers: Reflections on the Reality of Transient Mental Illnesses
Mad Travellers: Reflections on the Reality of Transient Mental Illnesses
by Ian Hacking
Edition: Paperback

10 of 10 people found the following review helpful
5.0 out of 5 stars Important book, both profound and readable!, 25 Nov 2010
This book is one I have studied as part of a masters in philosophy and ethics of mental health. It stands out from many other texts as being particulalry elegantly written - a pleasure to read rather than a strain, with much to think about along the way.

Hacking uses a mental illness from the late 1800's in France, "Fugue", to show the way in which concepts of mental illness are influenced by many factors, both in societies and within medicine. By taking a historical (and absolutely fascinating) example, he poses questions about the way in which similar processes may shape our current view of what is "mad". As a reader, one is left with a greater understanding of some of the history of psychiatry in all it's bizarre detail, and then some significant questions about the way in which mental illness is understood now.

The book engages the reader with a real person, Albert, the very first to be diagnosed with "Fugue". Hacking writes with great empathy.


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