Toxic Interactions and the Social Geography of Psychosis is a timely and considered collection of poignant chapters reflecting on a series of social, cultural and geopolitical challenges.

The book navigates through a kaleidoscope of vivid presentations, providing a unique perspective on understanding mental illness through the lens of urban living, stress, trauma, cultural literacy and family life, yet at the same time juxtaposing the reality of social and environmental factors such as austerity and climate change, which are part of a much wider set of geopolitical determinants of mental health and mental illness.

Middleton, in presenting a qualitative timeline of testimonies, gives the reader an understanding of both the art and science of psychiatry in practice: the art of compassion, humanity and humility involved in care, alongside the science of formulation, diagnostic framing and interventions.

The issues of ethnicity and migration are much more nuanced than is described in Chapter 5, ‘Ethnicity, migration, and troubling psychotic experiences’. There have been for many years concerns regarding race, racism and access to services from patients, families and communities. The description of some of the countries of origin of migrants as erstwhile colonies gives a timely reminder that the mental health outcomes and experiences of migrant communities tend to be much poorer than those of the host population. Middleton acknowledges that research into schizophrenia and psychosis among migrants and first- and second-generation adults has been undertaken in the UK and other parts of Europe, for example The Netherlands, for over 40 years; nevertheless, there is still a great deal to be achieved with the development of pragmatic culturally literate policies and clinical practice.

The notion of urban living cannot be overstated, with over 50% of the world's population – 4.4 billion inhabitants – currently living in cities, expected to double by 2050, to about 70%, nearly 6 billion human beings. Chapter 6, ‘Living in the city’, highlights the field of psychosis research, which has been remarkably productive and useful in the past 15 years. It is quite detailed and puts the spotlight on people with psychosis, who face a 10- to 15-year shorter lifespan owing to physical health comorbidities such as cardiovascular, metabolic and respiratory diseases.

This book provides an excellent insight and evidence of the multidimensional challenges in psychiatry. It is clearly written to help improve policy-making and clinical practice; it is also valuable to psychiatric undergraduates, practitioners, historians and educators. It adds to the reservoir of psychiatric knowledge.