This book deals with some of the most difficult and important issues facing us today. How should we work and live together in a multicultural society? The malevolent influence that racism, individual or institutional, has on all our lives means that science and medicine can no longer be seen as neutral or disinterested. Science adopts a position of neutrality on matters that are fundamentally ethical, such as the nature of the relationships between different groups in society, men and women, young and old, Black and White. Bhui argues that we may grasp the difficult and painful nature of these relationships if we engage with our subjective responses to them, rather than denying them in the interests of ‘objectivity’. This is an area where values and ethics are of prime importance. His analysis of the role of racism in society is powerful and compelling. He shows how the tribal and defensive responses to the Macpherson report originate in crude distinctions between ‘us’ and ‘them’. He points out that the confusion underlying definitions of race and ethnicity often hides the political forces that underlie these terms. He refuses to privilege either the ‘inner’ or ‘outer’ view of racism. He also develops a powerful and compassionate argument about the value of different belief systems without lapsing into cultural relativism, by considering the different moral and ethical principles that underlie cultural practices, and how our Western perspective usually overshadows these.
My main reservation about the book is that I am not convinced that Bhui has thought through the implications of his analysis. How exactly are the interests of the biomedical model in conflict with the interests of the communities we serve? What ethical approach should we adopt in working with different communities? What sorts of values should guide our work? His critical thought sometimes lacks structure. He makes no attempt to analyse scientific racism in terms of critical philosophical theory. He upholds the value of considering contemporary dilemmas in terms of our colonial history, yet misses an opportunity to extend the colonial metaphor to the contested land of madness. This is important, because without a full exegesis of the historical, political and philosophical underpinnings of colonialism, Western thought and psychiatry, he is limited to a restricted analysis of the problems of service delivery for ethnic minorities.
Despite these shortcomings, Kam Bhui makes a valuable and important contribution to our understanding of culture and ethnicity. I strongly advise all psychiatrists, both consultants and trainees, to read this book and to respond honestly to the challenges it presents. It demonstrates the value of political and social analyses of our work in the training of psychiatrists. But for me, its greatest value is in the way it shows how we must acknowledge the influence of our own histories and cultural backgrounds on the way we approach our work and those we struggle to help. The Other will cease to be an Other only when we accept the Other in ourselves.
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