The book addresses the difficulties many people and their families affected by mental illness experience and the stigma of mental illness. Professor Hinshaw argues that this causes untold pain and severely impairs functioning. The pain is easy to recognize. He suggests that lack of diagnosis, treatment, support and education leads to all those involved feeling isolated and helpless, living in the worst areas, on benefits, or in poorly paid work, and academically underachieving. He gives a good and clear description of mental disorder and stigma, which would be useful for those who have little professional or broad experience of what these may be.
In the chapter ‘Perspectives from Social Psychology, Sociology and Evolutionary Psychology’, he argues that mental illness as a disability is easily hidden leading to the patient's dilemma whether to tell family, friends or colleagues about his/her illness. The course of the illness can be variable, relapsing and remitting. The episodes of illness are often disruptive (not necessarily playing loud music at night) but social withdrawal, non-attendance at school or work and loss of awareness of current affairs. Often, when ill, the patient is dishevelled and even when not ill may display physical attributes to illness, such as tardive dyskinesia, extrapyramidal side-effects or weight gain. Occasionally, but not, as often a described by the media, there may be dangerousness. Then there is the lack of knowledge about cause or origin of mental illness. He argues that genes are important in the cause but not the sole or even main cause and we must consider environment and social factors.
He asks, ‘How have various societies and cultures conceptualized abnormal behaviour throughout human history?’ There is possible evidence that there may have been attempted removal of spirits or demons as early as 5000 b.c. He describes the persecution of witches in the medieval period, and discusses the first asylums, as early as a.d. 1100. He talks of the history of asylum and how others would amuse themselves by watching those in the asylum, referring to Bethlem (London), Bicetre (Paris) and Pennsylvania Hospital (Philadelphia), where this was a common entertainment for others. Tuke (York retreat), Rush (USA) and Pinel (France) are highlighted as those who campaigned for liberation of the asylums.
Hinshaw describes modern concepts of mental disorder, and demonstrates the obvious weaknesses in the system he works in. It must be considered if there has been any progress in acceptance, openness and less stigma since Victorian times. The evidence from scientific investigations is a great cause for concern. It appears that stigma is much less overt and much more covert. It is now unacceptable to be obviously prejudiced against those with mental disorder but people still are but expressing this in much more subtle ways.
He continues by showing there is still a great deal of stigma in the media and this needs constantly reviewing and addressing. Mental health professionals also have been shown to display covert stigma against those with mental illness. He explains how further legislation, policy and community efforts may lessen stigma, arguing that families and individuals need more education and support, to enable them to effectively access diagnosis, treatment and other services (education, employment, housing and benefits).
This is a very well-written book and it is easy to read. It is a book for professionals but others could use it although the title, cover and small print do make it look much more like a textbook, which is regrettable; after all, one way to combat stigma has been education, awareness and increased proximity.
