Book Review: The Social Organisation of Mental Illness

The Social Organisation of Mental Illness by Lindsay Prior, Sage Publications (1992), £35.00 HB, £12.95 PB

Recent years have marked the beginning of trend in the psychiatric profession away from hospitalization of the mentally ill. This shift in thought signifies a dramatic change in this century's basic assumptions about what constitutes mental illness and the need for the psychiatric institution.

Lindsay Prior shows that it is our overall view of the constitution of mental illness that actually decides if hospitalization is indispensable or not. The current anti-institution view is more accepted today as it does not contradict the new and changing vision of psychiatric disorder. In fact, it is this new vision that dictates the needs of the mentally ill. The move towards community care is simply an expression of new psychiatric ideologies rather than economic interests, technological advances or policy changes.

The current representations of mental illness are comprised of various groups concerned with the mental health profession. These numerous representations tend to express interlinking ideas in different ways and in different contexts. Whether the representation appears in text form as classification and description, whether in aspects of architectural design, or in the organization of the professional division of labour, it is their mutual support that creates a paradigmatic vision of the mentally ill today. The professional paradigm is aligned over those actually suffering and in effect redefines these human beings and their conditions to fit the representative framework. As Prior remembers, "scientific facts are not so much discovered as created and invented".

Prior reminds us it would be a serious mistake to let the mentally ill be the missing link in the chain of representation. Yet ironically and somewhat typically, the social worlds of the institutionalized are too often overlooked. In order to conduct a study that avoids simply summarizing existent theory, the author must link the frameworks of psychiatric creation to the details of everyday practice. With this in mind, Prior insists of using real patients hospital (and community) experiences to recognize and make real more abstract psychiatric development. As Prior unearths the patients' desires, we learn that the fate of the mentally ill continues to be defined by the professionals treating them.

The author conducts a lucid survey of psychiatric ideologies starting with the early twentieth century when mental illness was understood as a result of some kind of physical malfunction. As time went on, views of what mental illness might be and how it should be treated began to split. Freud began to move from neurological to an increasingly psychological explanation of neurosis. Meyer's notion of mental illness as reaction types maintained the unity of mind and body. Later still, Laing and Cooper recognized the role of social interaction in the aetiology of mental illness. The exclusively neurologically determined theories of mental disorder became progressively more fragmented, completely breaking up the relatively simple unity of early twentieth century consensus.

The trend today to transfer the mentally ill from the hospital to the community represents one result of the unending metamorphosis of psychiatric attitudes. Prior presents his readers with the framework of mental illness developed by those who make it their business to describe, explain, manage and treat suffering individuals. In this way, he dispels the myth that it is our reformers, lawmakers and politicians that control the psychiatric organization.

Prior provides a concise historical overview of the sociological impact on the evolution of the twentieth century psychiatric perspectives which naturally uncovers all kinds of consequences for psychiatric professionals as well as those under their care. From a time when the 'insane' were confined in the asylum where the professionals of the day perceived a distinct border between the physical and the mental, the normal and the abnormal to times when a slow growth in the awareness of social relationships within the therapeutic community began to take hold in vehement anti-institutional views. Prior brings us up to date with present day psychiatric ideology with all of its sociological affectations and permutations. By linking the mentally ill to the social responses they have generated, this book confronts the inevitable tie between the social and the individual in the ever-changing views of psychiatry.

This book represents a much-needed examination of the sociological impact on the definitions of mental illness which in turn effects the mentally ill and all those concerned with their circumstances. Prior's study reminds us of the incredible impact of all groups surrounding and affecting the mentally ill and how little their changing definitions reflect the needs of the suffering individuals. I close the book in the hopes that professionals, academics and students will take away an important and often forgotten message. Prior's study indicates that the psychiatric disorders being treated both in the hospital and in the community belong to individuals with interests and perspectives as varied and diverse as any other social group. Perhaps in future, by keeping results like Prior's in mind, the psychiatric profession could find a way to incorporate more thoroughly the needs of the mentally ill into the socially organized definition of mental illness. Kathleen Langstroth, University of Toronto.

Kathleen Langstroth