Abstract
Reviewed by : Claire Moran, University of Queensland, Australia
The Routledge International Handbook of Critical Mental Health is a one-stop resource for those with a professional or academic interest in mental health. Each chapter lays out evidence and arguments that challenge the purported expertise of psychiatry and related professions dealing with mental health and illness. The authors systematically problematise and critique the field of mental health, challenging the practices, priorities and knowledge base of mental health professions. While this is not the first resource to problematise the field of mental health, no other volume has covered such a broad range of theoretical approaches or critical analyses of topics.
The book is broken down into six sections. The first of these consists of 12 chapters outlining distinct critical theoretical perspectives on mental health. The remaining five sections contain three to four chapters each and critically examine the following topics: critical histories of psychiatry, medicalisation and pharmaceuticalisation, the politics of diagnosis, colonial and global psychiatry, and critical approaches to therapy. The first section sets the foundation for the remainder of the book, setting forth a number of core arguments that are further progressed through the subsequent sections.
The first of these substantive arguments builds the case regarding how the label of mental illness acts as a form of social control, with psychiatrists acting as moral entrepreneurs and mental illness representing social deviance. Those who have less power, such as women and people of colour, are labelled as deviant and requiring treatment. This draws into question the legitimacy and function of the mental health system, and indeed the label of mentally ill – who gets to be labelled as mentally ill and by whom, thus problematising the work of mental health professionals.
The relationship between disadvantage and mental health is a significant theme across the various sections, with excellent theoretical considerations and accounts of how mental health systems further oppress already oppressed populations – namely, women and ethnic and sexual minorities. The focus here really is on demonstrating the systemic, cultural and social basis for diagnosis, and psychiatry’s lack of acknowledgement of these socio-political factors. This results in the misdiagnosis and overdiagnosis of disadvantaged groups across a plethora of psychiatric categories; for example, conditions such as depression and PTSD are disproportionately experienced by women. Medicalisation provides apparently quick and straightforward solutions to problems that psychiatry claims are rooted in the biological domain – despite a clear lack of evidence.
Another substantive argument that is explored throughout the book is the extent to which neoliberal ideology has expanded, thus narrowing the possibilities for people in neoliberal societies, whereby certain behaviours and ways of being are constructed as normal, while others are constructed as deviant or signs of mental illness. Notions of mental illness such as ‘syndrome’ and ‘dysfunction’ are in fact based on cultural and economic drivers, which determine how mental health can be and is defined. The impact of neoliberalism is explored through a number of theoretical lenses (e.g. Foucauldian, Marxist and critical cultural perspectives) which examine the surveillance and regulating power of mental health systems. These chapters demonstrate how, through capitalism, neoliberal ideologies of individualisation, medicalisation, scientism, competition and commodification mean that the self (rather than the community, or society) has become the site for improvement.
The rise of neoliberalism has fundamentally resulted in a dramatic increase in the volume of categories of psychiatric diagnoses – more people being labelled with more conditions and, of course, a growing number of professionals, services and treatment models available. This landscape is of significant benefit to those with vested interests, such as the pharmaceutical industry, as new markets are continually created and profits driven. The reality is that the evidence is simply not there to support either the labels or the efficacy of the various forms of treatment on offer.
Another important argument highlights the failure of psychiatry and its systems of diagnosis, such as the DSM and the mental health section of the International Classification of Disease, to be scientifically credible or clinically useful. Mapping, categorising and defining mental illness and distress is deeply political, as it involves a range of judgements and interpretations being made by those who have a vested interest. Despite half a century of bio-psychiatric research, and two more revisions of the DSM (bringing us up to the DSM-5), there remains a lack of reliability and diagnostic validity and a lack of psychological, neurological, or genetic evidence that mental illness should be classified as a disease. Furthermore, the incidence and prevalence of mental illness has in fact increased rather than reduced over this time.
While the impact of psychiatry on minority populations is considered across numerous chapters, three chapters specifically focus on the experiences of women. These chapters share a focus on how women’s experiences have been decontextualised and pathologised and reduced to psychological symptoms and treatment options. The first of these is Jane Ussher’s chapter on madness, where from a critical feminist perspective she argues that women have historically been subjected to misdiagnosis and mistreatment, and that women’s distress can be largely understood as a response to their lives, rather than representing a pathology. This focus on psychological symptoms rather than the impact of gender and structural inequality on women’s experiences also takes centre stage in Emma Tseris’s chapter critiquing trauma therapy. As Tseris argues, trauma therapies frequently label women who have experienced trauma as suffering from a mental health condition, therefore reproducing, rather than disrupting, decontextualised understandings of women’s distress, and placing the focus – and the onus – on the individual woman rather than at a structural level. Further, gender-based violence is depoliticised by positioning women as survivors of trauma, rather than survivors of male perpetrated abuse.
In their chapter on female sexual dysfunction and medicalising desire, Annemarie Jutel and Barbara Mintzes detail how the pharmaceutical industry has medicalised female sexuality for commercial gain. By positioning libido in biological terms, female sexual desire has been situated in the medical realm rather than social, interpersonal and cultural. Through aggressive marketing, pressure on the FDA and framing low desire in the language of women’s rights and equity, drug therapy (Flibanserin) was eventually passed by the FDA, despite little difference between the drug and a placebo. This chapter provides an excellent example of how the pharmaceutical industry defines the pathology, and then markets the concomitant cure.
Currently there is a lack of critical theoretical work or investigations into mental health systems and issues, and there is no push by funding bodies or universities to carry out this type of work. This handbook has been produced with the objective of shining a light on how ineffective mental health systems have been in improving health and wellbeing – as such, the handbook provides an extremely important collection. Moreover, the book is very timely given the dominance of conservative approaches to mental health, the rise of neoliberal ideologies, and the increasing medicalisation of everyday life. This book is highly recommended for those with an interest in exploring critical perspectives to mental health and illness and would be a valuable resource for students, researchers or professionals in mental health or related fields.