If the numbers of us who will one day experience one of the conditions classed under the broad rubric of mental illness are substantial, and a majority of families are likely to be affected, then the truly staggering number is how few in need will receive much in the way of help from professionals trained to provide it. Where There Is No Psychiatrist summarises this grim maths, as do hundreds of studies of communities, counties, countries, and continents. That's one reason the book deserves ubiquity more than any others that have come along in recent years. (Even Antarctica's tiny and snowed-in population could use a shelf-full of copies.)
But Where There Is No Psychiatrist is anything but grim, and for three reasons.
First, it is, like its earlier edition, an admirably concise overview of what might be done to respond to common mental disorders, and also to the even more common disorders of everyday life: disturbing behaviour, prolonged sadness and grief, addiction, abuse. This doesn't sound like a cheerful list, and it's not, but the reason the book isn't grim is that it underlines just how much can be done to ease suffering, fear, and stigma. Not all, perhaps not even most, of the afflictions classed as mental illness require pharmaceutical interventions, and this new edition has been updated to reflect the best evidence gathered over the past few decades about both pharmacotherapy and non-pharmaceutical interventions. Where There Is No Psychiatrist not only avoids jargon, it also eschews the partisan debates that have riven academic psychiatry for a century, in part by drawing on evidence and experience from around the world. The fact that both authors are psychiatrists and social scientists is clear in these pages, as in their other work, but this book is not promoting cultural competence so much as cultural humility. (A watered-down Diagnostic and Statistical Manual of Mental Disorders this is not.)
In an inviting, rather than a hectoring, tone, this volume serves to remind the reader that social context shapes symptoms, illness experience, and outcomes. Although these are well-recognised facts in American and European psychiatry, clinic- or hospital-based practitioners often forget that one person's serious mental illness causes social suffering within families and social networks.