rating*: Very Good
Review by: Paul Grof, MD, FRCPC
Dr Norman Sartorius is an eminent psychiatrist who, for a couple of decades, directed the Mental Health Division of the World Health Organization (WHO). In this collection of essays, he reflects on many critical challenges facing psychiatry and mental health globally.
In the preface, Dr Sartorius explains that, in his professional life, he has attempted to strengthen psychiatry ethically and scientifically and has sought ways to bring psychiatry closer to medicine, for the benefit of both. He has also explored how political tools can be used to develop mental health programs and improve education, research, and training in the field of mental health. When one’s goal is to significantly improve the fate of most of the 500 million people with mental illness and their families, one clearly deals with a different dimension of problems than does a psychiatrist facing a single patient.
The book is divided into 3 sections: “The Context of Health and Mental Health Programs,” “Mental Health and Medicine,” and “Psychiatry and Mental Health Programs.” No reviewer can do justice to topics of this scope, and I will focus on a few examples that illustrate what fascinating reading this book represents.
The first 7 essays deal with the context of mental health programs. Given the set of problems one encounters at a global level, it is important to start with the right principles. Dr Sartorius clarifies that this context includes some basic principles of society that are important for mental health programs: equity, solidarity among people, and the recognition of duties and rights of the society’s members, including those who have mental illness. These principles sound abstract and philosophical but are indeed of direct relevance to psychiatry. The interesting differences between ethical principles, societal morals, and local laws emerge quite clearly when one deals with practical issues, such as the certification of mentally disturbed persons in different countries under different circumstances and how the process has been changing over time. Particularly intriguing are 2 essays discussing Dr Sartorius’ pessimism with respect to the potential impact that currently funded research can have on speeding up progress and to health systems’ capacity to learn from examples or advice based on other peoples’ experience. Another challenging set of problems for mental health emerges from increasing global urbanization.
The second group of essays deals with issues at the border between medicine and mental health. Incorporating mental health elements into primary health care emerges as both critical and challenging, and it is important to define the limits of a sound interpenetration of mental health and general health care services. The example of how difficult it has been to develop the mental health division within the WHO over the past 50 years tellingly illustrates the problems and misunderstandings one encounters and the persistence needed to put the mental health domain on a solid, stable footing.
The third part of the book focuses specifically on psychiatry. It points out how important, yet challenging, it is to assess mental health needs—a task essential to building services that respond to these needs. Dr Sartorius points out that many measures for primary prevention of mental disorders are the responsibility of several sectors other than health and require solid interdisciplinary collaboration.
What will happen to psychiatry in the years to come is the question that particularly preoccupies him. He concludes that, for ethical and immediate practical reasons, we cannot abandon established mental health programs. Rather, we must achieve a change of emphasis for them: we must elevate mental health on the scale of values of individuals, communities, and governments. Because of what we, as individuals and as a society, owe to people with mental illness and to their families, psychiatrists must help their patients and must fight the necessary social and political battles to improve the fate of people struck by mental illness. The message emerges that psychiatrists must make psychiatry and related disciplines useful to society and responsive to its ethical duties. These principles sound abstract when offered in summary; however, with his unique international experience, Dr Sartorius converts them into intensely captivating reading.
Rating Scale/ Échelle dévaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé