Contesting Psychiatry: Social Movements in Mental Health (review)

In the introductory remarks to the book, Nick Crossley notes that "It seemed that almost every perspective in sociology had something to say about psychiatry and in most cases what they had to say centered upon issues of power and control. Much less, in fact scarcely anything at all, was written about resistance to this power and control" (p. 1). And indeed, while every nuance of psychiatric power seems to have been explored, the question of resistance to this power has remained a strangely overlooked problem.

The book sets out to trace the emergence of patients' organized resistance to what they all too often perceived as psychiatrists' abusive control of their lives, which included internment in hospitals and painful treatments without their consent. The work concentrates on developments in the United Kingdom, beginning in the 1960s, and is written from a sociologist's angle. Thus the author does not dwell on anecdotes, personalities, or stories, which we would find in a history book, but rather analyzes the emergence of groups of resistance as a sociological phenomenon. The first three chapters lay out the book's theoretical stance. There is, however, one exception: Crossley devotes a separate chapter to the work of R. D. Laing and his colleagues, since it was decisive for the emergence of the patients' resistance movements; throughout the 1960s, "psychiatric publics had . . . been radically transformed" (p. 123). This led to a climate that allowed space for voices of discontent. In this period we see the emergence of a number of organizations representing the patients, MIND being the best known to the general public in Britain.

However, "[r]adicals who were politicised by British anti-psychiatry . . . [became] disillusioned with it, [. . . nevertheless, they] found new cause for hope in the Italian experiment" (p. 166). This is a reference to the remarkable developments in Italy. Led by the Venetian psychiatrist Franco Basaglia, within twenty years a group of psychiatrists demonstrated the possibility of organizing a comprehensive psychiatric service without a hospital and thus produced a rationale for completely dismantling the asylum structure. This transformed the mental health landscape of the entire country. In 1978, a new law compelled the authorities to close all the country's hospitals and set up alternative community-based services, which went further than any legislation elsewhere; Rome is today the only capital in Europe without a mental hospital.

The Italian experiment is little known to the English-speaking community, and, in view of the importance that it had for development of patients' movements, the few words about it in the book feel too sketchy, while the description of the Trieste experiment leaves the impression that it was a bigger version of Laing's Kingsley Hall, which it was not. The book would feel more complete had Basaglia's activities been more comprehensively presented. But, in all fairness, Crossley concentrates on developments in the United Kingdom; he does not follow a historical agenda, and it is certainly not his fault that historians have been systematically ignoring the Italian developments.

One of the difficulties in following the narrative of the book is an overabundance of acronyms, for we are told what they stand for only once, when they are introduced, and the reader sometimes gets lost (headings in chapter 8 read: "Trieste and Psichiatria Democratica"; "ENAP and BNAP"; "From MPU to CAPO"; "Back to BNAP"; "From BNAP to SSO"; "Culture"; "The fate of CAPO and BNAP").

However, what matters most is that the author signals an unexplored topic. We learn how patients found their voice and how their organizations evolved, and, very importantly, Crossley reminds the reader that psychiatry is not reducible to the theories and activities of the professionals. For the story to be complete, it has to include those who are at the receiving end of psychiatrists...