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Book Reviews

Principles of Social Psychiatry, 2nd ed

Principles of Social Psychiatry, 2nd ed.

edited by Craig Morgan and Dinesh Bhugra. Wiley-Blackwell, Chichester, West Sussex, UK, 2010, 358 pages, $190.00 (hardcover).

The second edition of Principles of Social Psychiatry is a timely addition to your stack of mental health textbooks. It is timely for several reasons. First, this text offers important insights into the meaning of mental illness at many levels, just when the field of psychiatry struggles with how to best configure our latest Diagnostic and Statistical Manual of Mental Disorders (ie, DSM-5). Second, it helps the reader explore the impact of globalization, technology, and disasters on the mental health of both populations and individuals, just when the world is dealing with such events as the large earthquakes in Haiti, Chile, and Japan and the technology-aided uprisings in Tunisia, Egypt, and Libya. Third, the textbook seeks to balance the allure of scientific certainty that genomics seems to promise with a reminder of the scientific evidence that we are complex creatures shaped in no small part by our environment.

The chapters in the first of 6 parts of the textbook seek to provide a definition of social psychiatry and to review its scope and history. The chapters provide various answers to the question "What is social psychiatry?" but the most direct is given by Leff in the very first chapter: "Social psychiatry is concerned with the effects of the social environment on the mental health of the individual, and with the effects of the mentally ill person on his/her social environment."(p5)

As the chapters progress, the content grows more theoretical, even philosophical at times, in asking questions such as "What is illness?" and "What is a patient?" For our colleagues grappling with how to edit the upcoming DSM-5 and for the rest of us who grapple with how to make appropriate diagnoses in ambiguous moments, this part of the book can provide both a foundation on which to base opinions and also a platform from which to dive into new questions.

The second part reviews "Components of the Social World" and contains one of the most valuable chapters. Chapter 8, "The Social Epidemiology of Mental Disorder," provides both an excellent introduction to some general trends in prevalence of mental disorders and an excellent introduction to interpreting epidemiologic studies. Thus it supports the mental health practitioner in the process of direct patient care as well as reviews the relevant evidence. This chapter should be required reading for all psychiatry residents. This part of the textbook is also where the mental health impact of current events in history and nature can be considered. Chapters review what is understood about the effects of such forces as culture, globalization, and disaster.

The third part, "Social Determinants," contains chapters that focus on a specific illness or group of illnesses, such as "Common Mental Disorders" and "Personality Disorders." These chapters are a good adjunct to a traditional psychiatric textbook for specific topics.

"Social Consequences and Responses" is the topic of the fourth part. These chapters elaborate on both an individual’s and a society’s response to mental illness along the full spectrum from prodrome to full-blown disease. Several excellent chapters provide a review of the effects of gender issues (chapter 25) and stigma (chapter 26) on mental health. Hopper’s chapter (chapter 27) on the effects of poverty and related issues on mental health is masterful and impressively referenced. It should be required reading for politicians as they make choices about how to balance their budgets so they can have a sense for some of the longer-term ramifications of cutting programs to populations living in poverty. The subsequent chapter (chapter 28) does a good job explaining the mysteries of cost-effectiveness and related concepts.

The fifth part, "Social Interventions," reviews some of the approaches to treating, managing, and preventing mental illness that arise from the emphasis on the social aspect of illness. Topics range from "Team Structures in Community Mental Health" to "Social Interventions for Psychosis" to "Problem-Solving Therapy for People with Personality Disorders." Because most of the social psychiatry research has been done in the United States and United Kingdom, this part of the textbook has a discernible focus on the Western world.

The sixth part, "Global Mental Health," returns balance to that overfocus on the West by reviewing issues of social psychiatry in Europe, China, India, and Africa and across the Americas.

Starting from the initial chapters of this text, we are introduced to the tension between social psychiatry and biological psychiatry, and this tension is felt as an undercurrent throughout many of the chapters. In the nature versus nurture argument, the balance of the text’s authors come out squarely in favor of nurture. At times, this perspective is distracting. Occasionally, there is an obvious sense of defensiveness, as if there were something that needed to be proven about the importance of social psychiatry as a discipline. The text as a whole makes this argument best, which is why I recommend you add this to your reference library.

Susan L. Padrino, MD

susan.padrino@uhhospitals.org

Author affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio. Potential conflicts of interest: None reported.

Volume: 72

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