Madness Contested was conceived from two national conferences in Nottingham in 2008 and 2010 which brought together an impressive selection of contributors. The book is a substantial work of 21 chapters covering the views of predominantly clinical psychologists but also psychiatrists, nurses, philosophers, professors of social policy, psychopathology and sociology and service user groups and activists. The authors offer a fundamental challenge to the powerful but limited positivistic medical model of mental health. Madness is therefore chosen politically over other terminology to avoid biological reductionism and build on a new coherent critic. The book is divided into two sections the first of which examines power and madness from multiple perspectives. The second presents new ways of organising and working in mental health. Chapter 1 questions the long lasting influence of the medical model of psychosis and seeks to move the focus from brain anatomy to the reality of people's lives. Boyle (p. 10) writes on this “Medicalisation of problematic behaviour and emotions locates their primary causes in faulty genes or biology rather than in social structures, power relations or life experiences”.
Paranoia gets similar treatment by Cromby and Harper in Chapter 2 reconstructing it within a framework of personal narratives. Chapter 3 usefully seeks the roots of madness in the effects of marginalisation, Coles (p. 49) writes that “Diagnosis is a powerful practice that sanitises a range of complex human interactions, interpretations, feelings and a rich range of subjectivities”.
Recovery is explored in Chapter 4 with particular reference to the juxtaposition of coercive practices such as Community Treatment Orders to the current drivers of respect, choice and reduction in stigma. The presented idea that “people will recover if they like it or not” is significant and indicates some of the current concerns over the potential professional hijacking of both the theory and practice of recovery. Chapter 5 intriguingly brings in the social model of disability which has never had a strong footing within the mental health field. These first five chapters really engage with the cutting edge issues in the reconceptualising of madness within society.
I believe that Chapter 8 is key to the book's intentions as it sets out a “Manifesto for a Social Materialist Psychology of Distress”. In part this asserts that distress arises from the “outside” and is caused by social and material influences. Biology enables but does not cause it and it does not fall into discrete diagnostic categories. Finally distress is proposed as a way of being in the world and it subsequently cannot be removed by medication and/or therapy. In support, The Midlands Psychology Group (p. 133) state that “Distress is not an ‘illness’, so cannot be ‘cured’. It is not bad genes, faulty cognition or the Oedipus complex, but misfortune and the widespread abuse of power that mire so many in madness, addiction or despair. These are not symptoms of illness: they are states of being that encapsulate how most of us might respond to chronic adversity”.
A number of chapters within the second section refer to the hearing voices movement; Longden, Coretens and Dillon in Chapter 10 reinforce the position that voice hearing is a “normal human variation”. Beresford in Chapter 11 asks the important question “is it possible to theorise or write about madness now without referring to the direct views of people included as mad or ‘mentally ill?’” The key threads running through the next chapters include: emancipatory research, concern with the pharmacological industry, recovery, evidence-led practice and the drastic limitations of using diagnostic categorisation. There is a strong and inspiring focus on the innovative work of service user led organisations in Nottingham, Leicester and Leeds. Later it is interesting to see theories in the field of learning difficulties being applied to mental health. In particular Wolf Wolfensberger's Social Role Valorisation (p. 258) and John O’Brien's Five Accomplishments (p. 261). Wolfensberger's work is not without its critics but its central tenant of increasing value still has utility.
When I finished the book I wondered why a mental health equivalent of the social model of disability has never been clearly developed, this could act as unifying structure for such a book as this. The concept of recovery in its various guises does not take this leading role in the work but forms part of a wider movement and manifesto. It is interesting that some of the presented material mirrors the disabled people's movements’ social conceptualisation of disability, the book arguing that madness needs to be understood by reuniting it with the social context it is realised within.
As with any edited work some of the material varies in the quality of writing and there are some repetitions but as a whole this is a very impressive addition to the field. This book provides a significant and important reinterpretation and reclaiming of the state of madness. It is impressively eclectic and moves the debate on by powerfully challenging the medicalisation of madness. No other book brings together anywhere near this much key material in such a meaningful way. It should become core reading to those in service user organisations, universities and mental health services.
