Community psychiatry and community mental health

Community psychiatry and community mental health


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pertaining to the same general topic of Community Mental Health the two books* for review possess opposite characteristics which tend to make them complementary. Susser’s book presents the specific experiences of one man in one position in a particular geographical area. Dr. Susser obtained his professional qualifications in South Africa and obviously can relate to a Western community with the detachment possible to those who have lived, experienced and/or have had professional contacts with other cultural systems. In his book Dr. Susser organizes his experiences, his opinions and the theoretical and clinical material he has accumulated during the eight years he was Director of Mental Health in Salford, an English city with a population of 150,000, a few miles from Manchester. The fact that Dr. Susser is now professor and head of Epidemiology at Columbia University School of Public Health testified to the high level of achievement he has attained in his field. Susser’s book is divided into four parts. The first part considers the rationale and objectives of Community Care of Mental Disorders and includes a short but excellent historical exposC on the concept of Community Care. The author develops also his theoretical perspective leaning heavily on Lemert’s theory of social deviance and studies in depth the factors which affect the performance and accommodation of patients to ther mental disorders. In part two Susser examines the antecedent factors in mental disorders paying special attention to social stresses such as war, anomie, and social transitions, isolation and disintegration. He outlines also his views concerning prospects for prevention. Part three deals with the operation of services and presents in details a case study in the coordination of community care using Salford as the model. As a practicing Community Psychiatrist I found this section most interesting and useful as it presented epidemiological notions in simple unpretentious language making them immediately available to the clinician with a small number of carefully chosen references. Part four deals with Mental Subnormality, that step child of Community Psychiatry, and presents a paradigm of health and medical care for mild as well as severe cases of retardation. By contrast the book edited by Bindman and Spiegel is a compendium of key articles on the field of Community Mental Health published during the past decade. Dr. Yolles, up to a recent upheaval at HEW, Director of the National Institute of Mental Health underlines in the foreword the fact that it was mental health planning which brought for the first time professionals of all disciplines and other citizen leaders to the realization that there are mental health implications in almost every facet of community life. This statement sets the tone of the book: the fifty-five articles included cover almost every aspect of the community network connected in any way with mental health, and describes programs involving children as well as the aged, schools, police and even sociotherapeutic camping. All the familiar names in Community Mental Health are included: Bertram Brown, Gerald Caplan, Eisenberg, Alvin, Becker, Eunham, Schulberg, Lemkau, Greenblatt, Farnworth, Plaut, Harris Peck and Colby to name but a few. lSUSSER,MERVYN.CommunityPsychiatry. Epidemiological and Social Themes. Random House. 398 pp. 38.95 GIWMAN,ARTHUR J. and SPIEGEL, ALLEN D. (eds.) Perspectives Chicago. 718 pp. $15.

in Community







The book is divided in six parts. Part one consists of several articles attempting to answer the question : what does Community Mental Health mean ? Part two surveys elements of planning and development. Part three focuses more specifically on techniques and methods whereas part four consists of various attempts to define and determine where do Community Mental Health activities take place. Part five deals with the tasks, roles and training of professional and nonprofessional Mental Health workers. The sixth and last part deals with research and evaluation. Fortunately, each part is preceded by a short but excellent summary of the material ahead, each article being condensed to four or five lines. I recommend highly reading these summaries which add up to approximately 29 pages from which the reader can select the articles of greatest interest to him as it is obviously impossible even for a responsible reviewer to read such a book (718 pages!) from cover to cover. In the search for an organizing framework to give a semblance of order to the polymorphous material originating from so many disciplines, system theory and the ecological model stand fare-head and are sensibly presented by J. R. Newbrought (“Community Mental Health: A movement in search of a theory”) and James G. Kelly (“Ecological Constraints on Mental Health Services”). Bertram Brown who had so much to do with the development of the Community Mental Health Center movement describes the impact of Public Health concepts on Mental Hygiene in his article: “Philosophy and Scope of Extended Clinic Activities”. The very last Article by Kenneth Colby and others “A Computer Method of Psychotherapy: Preliminary Communication”, attracted my attention. The programmed comments made by the computer to a patient sounded threateningly like those I would have made myself when working at my highest level of efficiency. I assuaged my anxiety by chuckling when I noted that the first reference quoted by the authors was entitled: “Programming a computer model of neurosis”. I fantasied a computer-patient model of a computer-therapist while the flesh and blood psychiatrist and patient go about their business in the community! One important perspective in Community Mental Health which according to my own bias I found missing is the dimension of the family as a social unit linking the individual and the social levels both from a theoretical and clinical point of view. In summary, the two books under review complement one another. Susser gives us an example of an organized approach to the field of Community Psychiatry based on the’experience and theoretical formulations of one man : the author himself. The book has the interest, continuity but also the same limitation in applicability of that perspective. Bindman and Spiegel’s compendium give us a “pot pourri” of the ideas and experiences of close to one hundred of the best specialists in the field of Community Mental Health. Consequently Healbook can only be used as a handy reference book bringing together articles otherwise spread through a dozen journals during the past decade. Susser’s book furthermore conveys the experience of being a Community Psychiatrist on the human scale: it should arouse the interest of the beginner and old time practitioner as well. I recommend both highly for the perusal of the expert and the informed citizen seeking a background in Community Mental Health. Psychiatric Institute of Washington, Washington, D.C.