Our Necessary Shadow: The Nature and Meaning of Psychiatry

As Burns observes in his introduction, there are few accessible accounts of psychiatry for the layman, and he's written a very lucid and helpful one. The opening chapters give a very good sense of how a thoughtful practitioner operates: nuanced, balancing common sense and fine judgement, showing that the familiar and shrill criticisms of the profession are caricatures of the reality. His historical summary is crisp and insightful, exposing the roots of psychiatry's overconfident biological assertions and showing that the profession has indelible origins in understanding the unconscious mind and the patient's experience, and treating the whole person rather than the diagnostic category.In his account his job is not only, or even mostly, about doling out pills: talking, occupational and community therapies are at least as important. Whether the majority of his colleagues live up to this exacting and conscientious model is another question, but he is an admirable advertisement for his profession.However, in soft-pedalling the 'medical model', he opens up the question of whether these conditions really are 'diseases' in the conventional medical sense: a question he addresses at several points but fails to fully answer. He caricatures the rejection of the medical model by presenting it only in its most polemical forms (Szasz, Foucault) and asserts (by definition without proof) that the neuroscience of the future will show he is right. As his history shows, however, this was what the likes of Henry Maudsley believed 150 years ago: since then generations of psychiatrists have awaited this revelation, and despite staggering quantities of recent research the etiology of the psychoses in particular remain entirely opaque: there is still no physical test, scan or measurement that can establish their presence or absence, let alone point to a cause or cure. It's time, perhaps, to consider a little more fully why this is so and what it might mean.The second half of the book reflects calmly on the hot-button topics and trends that define psychiatry in the wider culture today; this feels a little more like series of newspaper columns, without quite the incisiveness of the early overview. But the text is exceptionally well edited throughout, with a first class index for quick navigation.

A one-star reviewer, who says he couldn't read this book, asks why anyone would want to. People forget, or perhaps are not fully aware, that the 20th century will go down as the Age of Psychiatry. That is enough of an answer to the one-star protester. I am a lay reader and a voracious one and 'Our Necessary Shadow' is one of the best books I have read over the past year, because it gives us such a clear perspective of this Age in which I grew up, and a framework within which we can delve deeper should we want to. When the psychologists and psychiatrists came into our lives they influenced everything for good and bad. The 20th century was the time people began really to talk to one another and to unburden themselves and to communicate in a way that was simply not done before, even by husband and wife. Psychologists also took hold of the whole consumer revolution of course, propelling it forward. And most important - which is the area Burns looks at so well - the psychiatrists began to look at mental patients with humanity. Asylums had been a cross between prisons and zoos, with 'patients' often chained in cells and on show to the fee-paying public; the asylums then became hospitals; and an ever clearer understanding of mental illness and its treatment released many who should never have been patients in the first place (imagine what their lives had been like!) back into the community; and ordinary people's attitudes changed too. The theories of Freud, Jung and others are ingrained into our language and into our culture now. It is essential that every so often a man like Burns comes forward and says, 'This is the state of play; this is where we are at with this psychiatry thing.' It is a question of books like this being necessary to our cultural evolution, how we perceive things and each other, that the insights of this science closest to the arts be apprehended and made ever more relevant to day-to-day life.

Started slowly but very helpful overview of putting psychiatry in perspective. Describes where its origins lay and how it has progressed with new directions taken. Is a kindly book whose author tries above all else to be transparent, engaging the reader not only on the role and place of psychiatry, but also giving insight into the unique individual doctor and patient transaction.It is also a sharing book that is aimed to be enjoyed by both professional and lay reader alike. It does not shirk study of the mistakes along the way - but asks only that they be judged by the same critiques as due to other branches of medicine.Overall it tries to de-mystify our recognition of the mind as a place mystery, and shed light on the way a psychiatrist tries to understand and care.

I would highly recommend this book - it is very interesting, and very well-written - I started reading it and ended up staying awake to finish it. A clear and thought-provoking survey of the history of psychiatry, including its many errors, and the controversies facing it today.

Easy to read and informative for a layman.