What I'm reading this week: The culture of our disconent

Small, M (2006).  The culture of our discontent: Beyond the medical model of mental illness.  Washington, DC: Joseph Henry Press.

To start off with, let me say I really liked this book.  Meredith Small is an anthropologist who sets out to look at models of understanding mental illness in both Western Society and around them world.  I've never read much anthropology, so I'm not sure how things hold up from an anthropological stand point, but from a Social Work perspective the book was well written, concise and easy to understand.  To be honest, my favourite part about it was the length; not too long and not too short!

The stage is set in the introduction which describes the American Psychiatric Association's annual conference.  Small is surrounded by drug advertisements and drug representatives and says, "the ads addressed a cornucopia of negative human behaviors, and every symptom, syndrome or condition called for pharmaceutical treatment" (page 2).

The first chapter of the book looks at the impact of the medical model on mental illness, while the second chapter explores alternative models already present in Western Culture.  Third, Small looks at the biological basis for mental illness citing a variety of studies on monkeys (or non-human primates as the book describes them).  Moving on the book looks at how diet contributes to mental illness and how the slow change in diet of a country exposed to Western styles of eating can have mental illness increase in prevalence.

The middle of the book begins to look at things from the perspective of cultural anthropology.  Small discusses how mental illness is viewed in different cultures and the impact this has.  Next she discusses how some mental illnesses appear to be "culture bound" appearing only in certain populations living in more isolated parts of the world.  Small further discuss different treatments considered to be the norm in different parts of the world, placing importance on the link between the believed cause and the selected treatment (i.e. if possession causes mental illness then an exorcism is necessary).

The book ends without coming to a conclusion about which model is best, which is something I appreciated.  Small believes that what is universal, is that in all cultures treatment of mental illness is tied to hope.  "Sadness and despair might be the hallmarks of mental illness, but quite remarkably, every culture believes that something can always be done to bring relief" (page 4).

All in all, the book was a good read.  I learned a surprising amount from it without feeling that I was being overwhelmed by difficult to understand information.  The content flows together nicely with good transitions from one chapter to the next.  While I would recommend this book to anyone interested in learning more about Western thinking, I would especially recommend it to professionals who deal with a diverse population on a regular basis or with recent immigrants.  I would not however recommend this book to people who are looking for books about a very "anti" medical model of mental illness.  The book presents each view equally and it in no way raises one model above any other.