This book is one of a series - the next title to be produced is Key Concepts in Leisure Studies - that, according to the publisher's blurb, ‘encourages critical evaluation through understanding’. Pilgrim provides the reader with 50 brief clearly written essays, structured into three parts: Mental Health and Mental Health Problems, Mental Health Services and Mental Health and Society. Essay titles include Psychiatric Diagnosis, Psychiatric Epidemiology, Mental Health Professionals, Coercion and Corruption of Care. Despite the necessarily fragmented structure of the book, Pilgrim puts forward a coherent argument. In these essays, heroes, villains and victims emerge. Heroes include the usual suspects (Szasz, Laing, Cooper, Foucault) together with the rising stars of the user and survivor movement and, presumably, Pilgrim himself. The villains are the psychiatrists, who have abrogated to themselves power over the fate of ‘mad’ people, and more specifically those who, in league with big pharmaceutical companies, peddle biomedical explanations of ‘madness’ in place of social and psychological causation. The victims are those who are labelled or identified as ‘mad’.
Pilgrim has some harsh things to say about the conceptual basis of psychiatric diagnoses, despite at times using terms such as ‘ madness’ in a quasi-diagnostic fashion. He has read the literature widely, if not always deeply, and might be criticised for dismissing too readily that which he does not or chooses not to understand (for example, the nature and extent of the claims of neurobiologists and psychiatric geneticists). Some essays are gems of concise exposition of complex concepts (for example, the essay on labelling). Others draw welcome attention to forgotten literature (an essay on corruption of care cites John Martin's important book Hospitals in Trouble, published in 1984).
The target audience for the book is ‘students’, in this context encompassing an enviably wide group of people who need to write essays or submit project work about mental health topics. I suspect that many an essay will be based on an entry in Pilgrim's book, which is certainly critical in its evaluation of the concepts underlying contemporary psychiatric practice. It is, perhaps, a pity that the author, given his satisfaction with his world view, has not engaged fully with these concepts. The understanding that emerges for the reader of the book is, to my mind, distinctly partial.
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