Mental Health, Race and Culture. (2nd edn) By Suman Fernando. London: Palgrave. 2002. 256 pp. £16.99 (pb). ISBN 0 333 96026 2

The first edition of Suman Fernando's book in 1991 was perhaps the most influential of the ‘second wave’ of British transcultural psychiatry. Not especially original in sources nor themes, it was nevertheless an outstanding critique of psychiatric practice in the area of ethnicity and race. It resolutely commented on the failures of our profession to provide equal and appropriate treatment for minority ethnic groups, and sustained a vigorous attack on psychiatric diagnoses as presumed entities rather than explanatory models, their being taken as universal despite the lack of systematic validity studies in non-European populations. In particular, he launched an onslaught on the diagnosis of schizophrenia.

In this new edition, he rightly pays greater attention to social anthropological attempts to look at notions of normality and abnormality, the concept of the self and non-biomedical systems of therapy. Again he attempts to integrate ideas on ‘race’ (Western and politico-economic) with those on ‘culture’ (less overtly theorised here), but does not go far enough: in certain situations racism itself becomes an indigenous culture, whereas culture itself is less autonomous, more fleeting and more politically determined than many anthropologists once allowed for. At times Fernando relies too much on tertiary sources and sometimes rather romantic ‘Afrocentrist’ literature, and the absence of good narratives about patients and their healing (or otherwise) experiences is to be regretted. His preference for a ‘holistic’ perspective recalls good old-fashioned functionalism of a systems-theory kind, and he is a little harsh on colonial anthropology for apparently neglecting individual experience in Africa (what of Goody, Prince, Sow, Field and Fortes?), but he is quite on top of the usual suspects such as Lévy-Bruhl and Carothers.

I was most disappointed in his rather promising section on integrating non-Western healing with psychiatry. With a little on East Asian healing practices in the West (Naikan, Morita, acupuncture), it is rather uncertain how we might proceed with assimilating, say, ‘African healing’ (or Caribbean or Eastern European healing) into mental health in the way that French enthnopsychiatrie has done. But that perhaps is not for psychiatrists alone to determine.