This fascinating book does exactly what is says in the subtitle: it provides an anthropological insight into how people in Sylhet, a city and district in Bangladesh, perceive mental illness and how they can adapt it ‘to save face’ by falling back on cultural views of sorcery, witchcraft and possession states.

Pathways of entry into psychiatric care are described. In the government-run hospital patients are still kept in chains; individuals willingly accept interventions simultaneously from traditional healers and psychiatrists, seeing no contradiction in this. You will not, however, learn much about psychiatry in Sylhet as this was not the aim of the author, herself a psychiatrist. What she does focus on are the various facets of mental illness in the light of social changes occurring in Bangladesh on a large scale.

The wealth generated by British Bangladeshis sending money back home has accelerated the pace of modernity in Sylhet and also changed the role of wives of the émigré. To remain in their parental homes while their husbands work in the UK they may sometimes resort to ‘madness’. The new wealth can produce tensions within families between brothers staying in Bangladesh and those working in Britain. This leads to uncertainties and massive changes which increase the utilisation of sorcery and witchcraft just as it has done elsewhere in the world in similar circumstances.

The majority of Bangladeshi people follow Islam and so spirits - both good and bad - are seen within this religious context. The role of Hindu healers, perceived to be more powerful, is also explored. Interestingly, their interventions are also unquestionably accepted as they are seen as the medium through which Allah works, just as is the case for hakims or Western-trained doctors. Yet the inherent conflict between personal and cultural autonomy is non-existent in Sylhet as the individual accepts personal autonomy by attributing it to ‘Allah’s command’. This unquestioning acceptance is rarely seen in Western-influenced psychiatry. The inappropriateness of viewing ‘local concepts entirely through the prism of [Western] epistemological frameworks’ is emphasised.

This is one of the most interesting books I have read in some time. It brings together many themes that anthropological researchers will be familiar with. It forces us to look again at our own beliefs and prejudices in the light of what is happening in Sylhet, where the majority of UK Bangladeshis come from. This book will be of particular interest to professionals whose casework consists of people from abroad, anthropologists and psychiatrists working with UK Bangladeshis seeking a greater understanding of the interplay of the complex issues affecting mental illness.