Book Review: The Philosophical Defence of Psychiatry

As I turned the last page of this book I felt quite dispirited and somewhat depressed. A quick glance at the DSM-III-R diagnostic criteria for 'depression' reassured me that I was not 'clinically depressed'. But had I fulfilled the criteria and were I to have been diagnosed as 'depressed' would I have found reassurance in Dr Reznek's words: "If anything psychiatry is liberating rather than repressive" (p230)? A few pages on, seemingly swept along by his enthusiasm for his profession, Dr Reznek boldly states that "..the practice of psychiatry makes revolution more likely!" (p234). I have my doubts about many of Dr Reznek's assertions but these short quotes sum up the spirit in which this book has been written.

The book has two main parts to it. In the first part Dr Reznek outlines the various arguments that have been put forward by the critics of psychiatry. Amongst others he reviews the ideas of Laing, Szasz, Sedgwick, Scheff and Foucault. The second half of the book represents his attempt to challenge the critics.

Dr Reznek concludes that "the medical paradigm does not survive all challenges intact" (p. 233) The greatest challenge, he argues, is that if the concept of mental illness is value-laden, it is because we value the consequences of certain behaviours that we do not consider those behaviours to be diseases. Whilst Dr Reznek concedes that the 'facts' cannot help us to solve this problem, he argues that as long as "we are clear that the issue is an evaluative one, and we are clear what we value, we can solve these problems....As soon as we know what we value we will have decided what are and are not diseases" (p.234). But surely, is this not the most serious indictment of psychiatry namely, that there are no objective criteria that can help us to establish whether someone is 'mentally ill' or not? What if what Dr Reznek values differs from what you or I value? His answer to this is that even though we have to accept that psychiatric diagnoses are value-laden, this does not imply that we have to embrace relativism. He writes: "If different psychiatrists or cultures have different values, we do not have to concede that they are correct to classify the conditions differently. If Nazis classify psychopaths as healthy we do not have to agree" (p.234). But in this sense nor do we have to agree with Dr Reznek that if someone says that they hear voices and are 'deluded' that they are schizophrenic or indeed any more disturbed than himself.

Alessandra Lemma