John D. Williamson

A Theoretical Perspective On Social Psychiatry

type of psychiatry see nothing wrong in making the philosophical and political leap I from the idea of physiological homeostasis (or equilibrium) to that of socially j J acceptable mentation or behaviour. Similarly, nothing threatening is seen in the j! statement that &dquo;normal behaviour must be generated by normal experience&dquo; despite its obvious moral, or at least social value-laden, overtones. Such practitioners see Medicine in terms of a &dquo;good institution aimed at human betterment&dquo;. The moral and political implications of that aim are rarely acknowledged, except when the i

Psychiatric Screening and the Middlesex Hospital Questionnaire (MHQ)

T HE stupendous magnitude of diagnosed mental illness is one of the major problems of our twentieth-century society. The numbers of patients so diagnosed are an embarrassment to our health service planners, not only because demand for medical services outstrips availability, but also because of the enormous costs involved. Just looking at one particular type of treatment, the pharmacological, we note that the prescription of tranquillisers and antidepressants to people in the United Kingdom between 1965 and 1970 has increased fourfold (Woodcock, 1970) and threefold (Parish, 1971) respectively. In terms of logistics, most of the prescriptions issued to patients in the United Kingdom originate from general practicel. It would seem that general practitioners are not idle in terms of psychiatric medicine, but the figures do not tell us anything about their effectiveness. In a study which examined the medical histories of 25 achieved suicides2, it was shown that nearly all had consulted their general practitioner in the few weeks preceding death. Their families were able to give histories which summated to a diagnosis of severe depression in 80 per cent of cases, yet the general practitioner had rarely picked this up from the patient; none of them being treated (Barraclough et al., 1968). On the other hand, the drug overdose is often the first public expression of distress (Varah, 1974); a serious situation, given that it is now the commonest single cause of medical admission to hospital (Smith, 1972). If

'New Town Blues' : Planning Versus Mutual

When Le Corbusier put forward ideas for the Radiant City of 1922, he expressed a vision of an ordered, leisurely way of life made possible by twentieth-century technology (1). It was a dream which was to haunt planners for half a century. With the dramatic post-war increase in population, the suburbs soon became saturated and planners were able to achieve many of their ambitions. Their designs for modernised city centres and entire new towns made them media-heroes.

Book Reviews : Psychiatric Illness. Third Edition: by HAROLD MERSKEY pp.434. £7.50 (Paperback). London. Bailliere Tindall

value. It is one widely used by students and primary care physicians, ignoring, as it does, the more institutionally-orientated aspects of the speciality. However, my major complaint is that it is written by doctors with a clear psychiatric bent. As a primary care physician, one of the audience they were trying to reach, I found myself having to realign many of my own thought processes to match the authors. Nowhere in the book is there the remotest indication of a family doctor’s viewpoint and, without such a perspective, I fail to see how the authors hope to teach their generalist colleagues. The other fault in presentation is an inadequate index, without authors.

Book Reviews : "The Symptom Iceberg: A Study of Community Health" By DAVID RAINSFORD HANNAY. Routledge & Kegan Paul, Oxford. 218 pp. Price: £5.95 (paperback)

terms of the social changes relating to Women’s Liberation. One senses a keen intellect and a warm human response in the author, which adolescents should appreciate and respond to. The author is a psychoanalyst who once worked with August Aichorn. He is deeply committed to the classical psychoanalytic theory and is seeking to adapt it to child analysis and specifically adolescent analysis. He clearly has an intense need

Book Reviews : Propranolol and Schizophrenia. By Eugene Roberts PH.D. & Peter Macher PH.D. Alan R. Liss Inc., New York. Pp. 162.

hardly be detrimental to our practice in the field of mental health. In this book there is just one chapter on ’psychiatric psychology’ and the rest is about ordinary undisturbed people and their reaction to illness. It includes a section on compliance with doctors orders, an overview of pain and the psychological input to theatrical models of pain. It takes a behavioural view of sleep disorders and looks at the whole field of biofeedback with regard to headaches and body functions. It also looks at reducing risks by behavioural modification. Finally it gives an overview of placebo power, the impact of hospitalization, an dends with a whole discussion of the role of medical profesion and the psychologist in a modern health service. As I have said it is a stimulating little book and one which is certain to sell widely.

15.00

This monograph reports the findings of a survey of psychiatric workload in the northern city of Leeds. It details in classical epidemiological language the major socio-demographic characteristics of the patients together with some modified morbidity data. While interesting, the book undoubtedly suffers from its emphasis on that psychiatric caseload known to the hospital, ignoring the contributions of community-based physicians. Hospital practice in the United Kingdom is intimately linked to the practice of these doctors and it has been long known that hospital workload studies can vary much more with referral habit than with ’need’. Similarly, only one of the three teams in the City was examined, thereby increasing any bias resulting from selective referrals. Though written lucidly and with a very clear style, I fear that this book does not add very much to the published literature.

Book Reviews : Pica A Childhood Symptom. IRMMH Monograph 3. By JOAN BICKNELL. Butter worths, London. Price: £3.65

This monograph reports the findings of a survey of psychiatric workload in the northern city of Leeds. It details in classical epidemiological language the major socio-demographic characteristics of the patients together with some modified morbidity data. While interesting, the book undoubtedly suffers from its emphasis on that psychiatric caseload known to the hospital, ignoring the contributions of community-based physicians. Hospital practice in the United Kingdom is intimately linked to the practice of these doctors and it has been long known that hospital workload studies can vary much more with referral habit than with ’need’. Similarly, only one of the three teams in the City was examined, thereby increasing any bias resulting from selective referrals. Though written lucidly and with a very clear style, I fear that this book does not add very much to the published literature.

Book Reviews : Psychiatry in a General Hospital. By J. CRAWFORD LITTLE, with assistance of J. J. KEAR COLWELL and A. T. LLOYD. Butterworths, London. Price : £2.00 net in UK only

This book provides up-to-date information and evidence relative to dependence on various forms of addiction which are incurred by women, this often being alcohol in combination with prescribed drugs. It recognises the underlying problem that contact for these women is often very difficult to establish in the first instance with most forms of professional help. This often being due to the social norms that society exercises in their expectations of individual behaviour.

Book Reviews : Psychology & Medicine. By S. J. Rachman & Clare Phillips. Penguin Books Ltd. Pp. 205. 90p

The non-specialist reader would have to be careful to appreciate that Professor Van Pragg’s summary on schizophrenia refers to a particular sector and not to the whole field. These slight criticisms apart, the book will be of interest to all psychiatrists, including those in training as an authoritative, relatively brief summary of current work in this field, and illustrates the old adage that the trouble with psychiatry is not that little is known but that psychiatrists do not know it. Professor Van Praag is to be thanked for a real contribution to the diminution of our ignorance.