Any reader who has attended a large international meeting on psychiatry will know that only a small percentage of presentations, even those selected carefully, remain in the mind after the jet lag has subsided. Thus, one approaches a book based on presentations at the 11th World Congress of Psychiatry with a certain degree of trepidation. The overarching theme is given by the title of the book, but is broad enough to include almost anything other than brain scans and biochemistry. In fact, the first half of the book (the first 5 of the 11 chapters, plus Chapter 7) deals with general issues in psychiatry and is far more wide-ranging than the presentations can have been. I was pleasantly surprised by how much I was engaged by these chapters. Even though they deal with relatively familiar material, the broad contexts in which this is embedded are enlightening. Furthermore, in each chapter there is the sense of the author's individual voice conveying a wealth of experience and mature judgement.
To give the prospective reader a feel for the content, Eisenberg briefly presents the evidence for the impact of economic and cultural conditions on the health status of populations, and Häfner offers a wide-ranging review of the development of state and privately funded health care systems. A number of points that he makes struck me forcibly: ‘Whether and to what extent the mentally ill are disadvantaged, is primarily a question of a political decision in a centralized health care system’; ‘The consequence of integrating mental health care into general health care is that it is subject to the same attempts to contain costs’. Lewis & Araya, addressing issues of globalisation, develop Eisenberg's theme further by exploring the links between socio-economic status and the prevalence of common mental disorders. They conclude that financial strain appears to be more pathogenic than absolute socio-economic status and that the evidence that poverty causes common mental disorders is still not convincing enough to support changes in social and economic policy. Bertolote and colleagues use examples from three countries to illustrate the complex relations between legislation and mental health policy, and Okasha contributes a thoughtful piece on ethics. A chapter on quality of life contains a useful review of current thinking by Katschnig & Krautgartner. The other contributions are more pedestrian, although those unfamiliar with ways to introduce positive messages into the media will gain useful tips from the last chapter, by Cuenca. Overall, this is a book to be dipped into selectively by readers following their particular interests.
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