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by JH Berke, M Fagan, G Mak-Pearce and S Pierides-Mueller
Jessica Kingsley, 2001
Review by Duncan Double on Jun 25th 2003

Beyond Madness

This book is an edited collection of essays from authors who have all been involved with the Arbours Crisis Centre (www.arbourscentre.org.uk). The so-called "anti‑psychiatry" movement associated with RD Laing created various therapeutic communities, the pioneering venture being Kingsley Hall (1965-70). Others included the Arbours Crisis Centre, founded by Joseph Berke in 1973 to provide immediate and intensive psychotherapeutic support for individuals, couples or families threatened by sudden mental and social breakdown. Three resident therapists live at the Centre. They are assisted by a resource group of psychiatrists, psychotherapists, psychologists, nurses, social workers and other professionals. People who come to live at the Centre are the "guests" of the resident therapists. The Centre accommodates up to six guests.

The book is divided into sections on historical and theoretical perspectives, methodology, narratives, and authority and money. Generally the chapters hang together. However, like several multi-authored books, I wished at times for a more common thread in the content and not just the structural connection because of the Arbours Centre. Few of the chapters, to my mind, were of sufficient merit to stand alone.

In a way, it is remarkable that an organisation like the Arbours Association has survived so long. The so-called "anti-psychiatry" movement is supposed to have been a passing phase in mental health history. I would have liked to have seen more comment on this aspect of its relationship with mainstream mental health practice. There have been changes over the years. Initially the Centre was run by a small group of psychotherapists who offered their services virtually for free. Now it is registered by the local authorities and funded by social services and health authorities in the NHS health and social care internal market. As pointed out in the chapter by Laura Forti, who has been working with the Arbours Association from the beginning, one of the main functions initially was to provide an alternative to the traditional psychiatric hospital, seen as repressive and damaging, whereas now the role is more to provide a specialised service based on the therapeutic community model enriched by intensive psychoanalytic psychotherapy.

The aim of the book is to demonstrate that integrated psychological and social (PsychoSocial) interventions are an effective means of helping people in psychotic or quasi-psychotic states. Its emphasis on relationships and community is very welcome in the current pharmacological dominance of psychiatric treatment. Overall, the book may best be seen in the context of other books and publications, which may ultimately have a greater impact, that also stress this point. By itself, this book, in my opinion, only partially succeeds in showing the validity and humanity of the PsychoSocial approach. It did not grip me.

I am reminded of RD Laing's conclusion about Kingsley Hall. When he reflected on it later in life in discussion with Bob Mullan, he indicated that he failed to provide "a tactical, workable, pragmatic . . . sort of thing that could work for other people". Providing a truly therapeutic environment is not easy and may be impossible. The unsatisfactory sense with which I am left after reading this book may derive from this fact. Nonetheless, the Arbours Crisis Centre has survived and those who wish to know more about it may benefit from reading this book.

 

© 2003 D B Double

 

D B Double, Consultant Psychiatrist, Norfolk Mental Health Care NHS Trust and founding member of Critical Psychiatry Network (www.criticalpsychiatry.co.uk)