Essay Review : Joan Busfield. Managing Madness, Changing Ideas and Practice. London: Unwin Hyman (Paperback edition) 1989. Pp. 406. £13.95. ISBN 004-445-380-9 (First published by Hutchinson Education, 1986

Abstract

Managing Madness, Changing Ideas and Practice. London: Unwin Hyman (Paperback edition) 1989. Pp. 406. £ (First published by Hutchinson Education, 1986). The object of this work is 'to examine the forces and pressures that have determined the form and nature of psychiatry and of the mental health services in which psychiatric work is carried out'. What is wrong with psychiatry can thus be understood and the ways in which it should be changed identified. Trained in psychology at the Tavistock Clinic, London, the author employs sociological and historical approaches, especially the former. For both she relies almost exclusively on the secondary literature. The first part of the book deals with theoretical issues and the second with historical developments. Either part could be read first.The first chapter delineates the 'liberal-scientific' conception of psychiatry and medicine, with science viewed as the lynchpin of psychiatric practice and the psychiatrist an autonomous professional. Medicine concentrates on bodily processes at the expense of psychological and social ones and the approach is mechanistic. Psychiatry diverges from medicine more in terms of its object of interest and its institutional location than its objectives. It draws more heavily on psychology than the natural sciences proper and it is often concerned with chronic rather than acute sickness and when compulsory powers of detention are involved it does not conform to the voluntarism of the rest of professional practice. These divergences between psychiatry and medicine account in part for the low status of psychiatry within medicine as a whole.The longest chapter in the book is devoted to conceptualizing and identifying illness. The germ theory model of disease, although successful in the nineteenth century, intensifies medicine's continuing organic orientation. The critique from within medicine relies heavily on the works of McKeown and Cochrane and psycho-social research findings are said to be adapted to fit the clinical mould