Book Review
The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person and Illness
Robert J Barrett
ISBN: 978-0-521031462; 2006; 360 pages; Cambridge University Press, Melbourne;
Nicholas G Procter
Professor and Chair: Mental Health Nursing, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide SA
In recent years there has been a steadily accumulating literature published about mental health care in a changing world. Many of these publications have concentrated on developments within and organisation of community care in an epoch of realignment and subsequent reshaping of future treatment settings. This publication by Rob Barrett is the first to focus with sustained attention on relationships and encounters within and between mental health professions responsible for the assessment and treatment of people with serious mental illness in a modern Australian psychiatric setting.
'Ridgehaven Hospital' is a State run institution for the mentally ill familiar to anyone working in the field. It is gradually reducing its beds and the focus of care is shifting away from hospital to community care. Barrett, the psychiatrist and anthropologist, sets out to examine using ethnographic techniques the major organising concepts that the professions of psychiatry, nursing and social work use to undertake their roles in a changing environment. Drawing insight from Foucault's interpretation of power and historical constructions of madness, the author generates a detailed understanding of the illness schizophrenia, and subsequent interventions by the professions by examining how the illness is experienced and treated.
The generation of research materials was through analysis of case-note documentation; listening to casual conversations in tea rooms, corridors and before and after formal meetings; as well as carefully documenting observations and recordings from formal interviews with families, clients and clinical staff.
Nurses and nursing feature strongly in this book and almost always favourably. The distinctiveness of Barrett's contribution to mental health scholarship and nursing's role in the treatment of the mentally ill is situated in how he adroitly shifts between the features of schizophrenia, its historical situation and models of care, and the way we understand and relate to 'the person'. Through its analysis, the book explores the social, behavioural and biological interpretations of the illness and ensuring interventions. It is clear that the author appreciates the dynamic and multi-skilled nature of mental health nursing, and there is much in this book that speaks to nursing's uniqueness of perspective and professional identity. For these reasons I believe that this book will serve as an important reference point for nurses researching and working with the mentally ill.
The proximity and skill used by the author in this ethnography inevitably leads him to examine situations that confront some of the more controversial nursing actions. There is, for example, illuminating discussion of the practice of patient restraint, the dehumanisation of 'person' in illness, nurses use of humour and use of power relations in nursing work. From this point of view this book is essential reading for educators, clinicians and postgraduate students concerned with subtle associations between nursing in purpose-built institutions for the mentally ill and therapeutic relationships.
Analytically sound and carefully written this book may be, it would be good to see something more of the voices of the clients' family. It is almost as if Barrett stops short of having more to do with the family and significant others of people with schizophrenia. In addition, this volume is rather expensive and I encourage Cambridge University Press to consider releasing a paperback edition to reduce the purchase price.
Nevertheless, the book is very readable, well organised and presented. I particularly like the way each chapter concludes by transporting the main arguments contained within it to a higher level of analysis.
In summary, The Psychiatric Team and the Social Definition of Schizophrenia constitutes a confronting eye-opener with respect to the dynamics and interpersonal issues between people with schizophrenia and professionals in a psychiatric hospital. It presents a detailed insight into the potential dangers that nursing must be alert to, as it re-defines itself during an era of change and uncertainty in mental health care. For nurses interested in questions of how they care and comfort people with serious mental illness, the book is an endless source of information and analysis of the phenomena. As such, it will become indispensable for all those studying the complexity of nursing in mental health environments and professional interaction in general.
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