The Quest for Mental Health: A Tale of Science, Medicine, Scandal, Sorrow, and Mass Society (review)

The historiography of psychiatry is well developed. Some even believe it is overdeveloped relative to its importance to the history of medicine. Despite this, there are few general overviews of the history of psychiatry, and several that exist are marred by dogmatic and unpersuasive advocacy for one kind of psychiatry over another. This new volume by Ian Dowbiggin is at once ambitious and concise and even-handed in its recognition that various styles of psychiatry have made worthwhile contributions.

The Quest for Mental Health is also even-handed in criticizing all styles of psychiatry for their various contributions to the medicalization of unhappiness. Like the best of recent medicalization studies, Dowbiggin's does not treat it as a simple power grab by psychiatrists. He recognizes that many actors, including pharamaceutical companies, insurers, the state, and not least, patients and their families, have had crucial roles to play. There is much to be said for his argument. Medicalization certainly exacts cost—financial, social, and cultural. Dowbiggin places special emphasis on characterological losses, portraying the citizens of industrialized countries as increasingly unable to bear modest psychological discomfort.

Dowbiggin does not question the reality of severe mental illness, nor the right of those who suffer from it to obtain medical care. But while many of us might agree that the proliferation of psychiatric diagnoses has led to some absurd illness categories, the question of just how high the threshold of suffering needs to be to entitle one to the sick role is one he never addresses explicitly and one that is more challenging than he allows. In his eagerness to show how over-reliant on psychological medicine we have become, he at times runs the risk of underestimating the suffering of people who do not have an outright psychosis or similarly blatant disorder.

This problem comes to a head in a too-brief discussion of the work of Judith Lewis Herman, best known for her work on Post-Traumatic Stress Disorder, which she influentially applied to survivors of domestic abuse and rape. Dowbiggin writes that "Armed with the PTSD diagnosis, experts such as Herman redefined the private relations between men and women as public health issues amenable to professional intervention" (p. 190). If there are costs to medicalization, surely there are also costs to sequestering matters as serious as rape and domestic abuse to the "private relations between men and women." And these matters are, I think, legitimately considered public health issues.

The Quest for Mental Health is a lament for the world we have lost—a world characterized by stoic, pioneer values of self-reliance. Like all such laments, it raises the question of whether the lost world was really all that great. There is much to be said for the ability to bear suffering. There is also much to be said for not suffering needlessly.