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by Lucy Johnstone
Brunner-Routledge, 2000
Review by Christian Perring, Ph.D. on Jun 26th 2003

Users and Abusers of Psychiatry

Lucy Johnstone's Users and Abusers of Psychiatry takes a critical look at current psychiatric treatment, mostly in the UK. It is a substantial book, with nearly 300 pages, 11 chapters and 25 pages of footnotes. It combines personal narratives with discussion of psychiatric theory, sociological data about trends in psychiatric care, and some current controversies. Johnstone does not doubt the existence of mental illness, but she is dissatisfied with the current reductionist approach to its conceptualization and treatment, which she argues does not serve patients well. Her approach is clearly influenced by sociological views about mental illness that emphasize medicalizing people's psychological problems can disempower them and confine them to a "sick role." She is also very critical of the reliance on psychiatric medications, which she argues are often unhelpful and even dangerous.

Johnstone clearly believes that we would serve people better if we could provide them with individual psychotherapy, and we could do more to change their family interactions and even the structure of society. She emphasizes the role of gender in causing mental disorders and argues that sexism in psychiatry leads stereotypical female psychological conditions to be classified as mental illnesses. Her work is informed by a large body of work from critical psychiatry and a more general left or liberal perspective, including the Glasgow Media Group, Barham and Hayward's Relocating Madness, Peter Breggin's many attacks on psychiatric medication and ECT, Foudraine's Not Made of Wood, and even Richard Warner's Recovery from Schizophrenia. However, most of all her work is based on her own observations of the British psychiatric system and studies she has collected over the years. She makes an impressive case for her views, since even if one is unconvinced by one or two pieces of evidence she presents, the effect of the whole body of evidence she provides is overwhelming. She may not have proved that the medical model to treating mental illness is intrinsically worthless, but she does enough to throw a great deal of doubt on its value, and she shows that it is folly to rely exclusively on such a model to the exclusion of others. She also gives strong reason to believe that whatever the best model might be, the current system is not very successful in helping people diagnosed with mental illness, and in many cases may be making their lives worse.

There is in Britain a relatively thriving movement of researchers and activists with a critical attitude towards mainstream psychiatric theory and treatment. In the US, there are many critics of psychiatry, and there are a number of psychiatric survivor/consumer groups, as well as many Internet websites and email lists devoted to discussing the excesses and dangers of medications. However, all this activity in the US is too fragmentary to be described as a cohesive movement. With the pharmaceutical industry having so much influence though providing grants to groups such as the National Alliance for the Mentally Ill and having direct access into people's homes through direct-to-consumer advertising, the mainstream view of mental illness has a powerful hold over the public. Users and Abusers of Psychiatry is a model of a sophisticated critique of the mainstream medical model, showing a good understanding of the complexities of psychiatry theory and an impressive knowledge of the way that treatment actually affects people. It is also written clearly, and with its repeated use of the cases of particular individuals and their stories, should be accessible to a general readership. There is no equivalent book that addresses the state of mental health treatment in the USA, and that is a real shame. While there are major differences between health care in the Britain and other countries, Johnstone's book does have enough general discussion in it to be relevant to readers outside of the UK. I recommend it highly.


2003 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island, and editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.