Book Review: Psychiatry in Context: Experience, Meaning and Communities

by Philip Thomas
Published by PCCS Books June 2014
ISBN 978 1 906254 72 8
Reviewed by Mary Peyton

This is a wonderful book, well worth a read. Published last summer, written by Philip Thomas, consultant psychiatrist, it brings together many facets of the world of psychiatry in a thoughtful, inclusive, skilled and challenging way. As psychotherapists, we often work with people who have different relationships with psychiatry. This book looks in depth at the relationship between psychosis and psychiatry and most of us will recognise our clients in one way or another.

Thomas is a founder member of the Critical Psychiatry Network. In this book he looks at the direction psychiatry has taken, steering a course towards the biological understanding of human distress. His arguments against this course are compelling, and I found myself impressed both by his humanity and the research quoted. He speaks of the diminution of the biopsychosocial model and the growth of the Bio-Bio-Bio model, which is of course supported by the pharmaceutical industry. Much has been written about this latter phenomenon by various authors in the light of the publication of DSM‒5 in 2013 with its additional 14 disorders. One interpretation of the relentless increase in the number of disorders is that either we are becoming more disordered or that we are now in a position to recognise disorders that we have previously missed and that can be medicated.

What is most impressive in this publication is the author’s inclusivity in relation to looking at the narrative of the person who is suffering. He places the person who is distressed in a central position. His own humility in the relationship with the person who is suffering is also evident. He speaks of context, and included in this is the social context. I found myself wondering whether we, as psychotherapists, give this area enough space, perhaps concentrating on the individual’s inner world. I wonder whether we speak sufficiently to the wider context of the person either in the session or in the public domain.

He addresses the pitfalls of evidence-based medicine, the measuring of success, and indeed questions how it can be measured. He also discusses the deification of neuroscience, which is occurring not only in psychiatry, but also in psychology and in psychotherapy circles. Neuroscience is exciting in how it is helping us understand some of what is going on but, we need to remember, it is at its best some of the answer but not all.

Thomas looks at how the current paradigm in psychiatry sets out to place the answer in disordered processes occurring within the individual, omitting the personal context of the person. This of course then allows interventions which can be evaluated from that premise of ‘disorder’. This dehumanises suffering, reducing it to a molecular biological event.

He looks specifically at the social context for psychosis, exploring childhood trauma, abuse and racial discrimination. Discrimination is not limited to societal contexts but is also enacted within the medical context where for example, black males are more likely to be given a diagnosis of schizophrenia than are white males. They are also more likely than white males to be treated with medication and not offered psychological therapies. He also addresses the Service User/Survivor Movement and what it has to offer going on to look at community development and mental health.

I would recommend this book to all psychotherapists who have an interest in the wider context in which we work, and in the directions being taken by society that will ultimately impact on us all.