Time for a change of mind

'Abolishing the Concept of Mental Illness: Rethinking the Nature of Our Woes' by Richard Hallam (Routledge; Pb £31.99). Reviewed by Paul Moloney.

29 November 2018

In this timely publication, Richard Hallam – a British clinical psychologist – questions the main tenets of public mental health care in the UK and beyond. He argues that the field is stuck with a medical outlook that is scientifically incoherent and unhelpful, but that persists because it suits politicians, policy makers and service managers. All of whom are eager to demonstrate ‘measurable health outcomes’ and to cut costs. Almost 60 years ago the dissident psychiatrist Thomas Szasz wrote that mental illness is a myth, and Hallam deftly distils a wide array of research and philosophical literature in support of this claim. He goes beyond Szasz, however, in acknowledging (and showing) that the experience of chronic social and economic marginalisation can restrict human agency, grinding all too many people down into the kinds of poor physical health and despair that drive them to seek professional treatment.

While Hallam does not reject psychological therapy as a partial answer to this kind of misery, he shows that it has been consistently overrated and oversold. Instead, he advocates a broader psychosocial approach to our ‘woes’: preferring this lay term, because it encapsulates how distress and any attempt to understand and alleviate it must take account of the sufferer’s history, of what they want out of life, and – not least – of their current circumstances. In the final chapter the author explores some promising approaches that begin from this standpoint, having grown in most cases from an alliance of professionals, ‘mental health service users’ and grassroots organisations.

While the extent of Hallam’s scepticism about the science of his own field (as opposed to psychiatry) might not satisfy all readers, his overall thesis is nonetheless to be welcomed. If few of us these days worry about people being possessed by the devil, then this lucid and thought-provoking book shows that the time has come for a similar change of mind about the notion of mental illness.

- Reviewed by Paul Moloney, Counselling Psychologist at the Royal Shrewsbury Hospital