Psychiatry and the Business of Madness Book Review

Psychiatry and the Business of Madness: A Book Review

by Simon Adams, RN, PhD

Author: Bonnie Burstow
Publisher: Palgrave MacMillan

ISBN: 978-1-137-50384-8 (Paperback $40)
ISBN: 978-1-137-50383-1 (Hardcover $95)

I picked up this book with the intent to see how the mental health professional is handled, particularly, how nursing is theorized. As an academic nurse and professional participant in the research, I have a particular engagement with this book. Having long grappled with the effects of psychoactive drugs on the human brain, reading Burstow’s psychopharmacology analysis concretized this for me. While she is not a medical doctor, her analysis made accessible the chemistry of the drugs and its impact on the body. The book also gave me a solid look into where nursing stands in relation to the larger establishment of psychiatry. As an institutional ethnographer, I am delighted with this use of institutional ethnography. What is particularly special about this book is its very thorough analysis of the institution. 

In her rather troubling institutional analysis, Burstow unveils the ethically dubious relations of power and the discourses that establish and maintain modern day psychiatry. She begins with a disturbing, visceral account in the everyday world of the psychiatrized and methodically proceeds to trace the various intricate political and historical workings of the regime. Leaving no stone unturned, the author sketches distant and recent history, dissects discourses, examines texts, interrogates practices, maps out vested interests, relationships, politics, and processes. Advancing a sobering (and at times, bloodcurdling) analysis, she implicates history and brings attention to the disconcerting philosophical, political, and moral underpinnings of the psychiatric regime. Burstow carries out a carefully-investigated institutional ethnography within which she weaves a dynamic critical discourse analysis. She does this with impeccable logic.

The book, an original contribution to the critical and abolitionist literature, is unique in the following ways: It gives an inside look at the workings of the Ontario Consent and Capacity Board, advances an analysis of how psychiatry comes together as a multi-institutional system, and offers a real and everyday vision for a better world.

The mental health industry is exposed as a system that is fitted together by a number of sub-institutions: psychopharmacology, the research industry, the State, and the hospital, to name a few. As its textual locus of control, psychiatry, and by extension, the mental health team draws on the DSM. On the DSM, Burstow writes that it is “conceptually, phenomenologically, and otherwise flawed,” its categories have “no relationship to validity,” its diagnoses have no biological basis, and its criteria sets “are blatantly sexist, racist, classist, and transphobic.” This, she roots in an analysis of the text – the “boss text” – as a presiding “ruling” mechanism whose textual logic eclipses and overrides that of the humanistic and the compassionate. A formidable and cogent ethnography!

The author establishes that “psychiatry’s basic tenets are insupportable, that no biological basis has been established for any mental illness, that the claims of chemical imbalance lack foundation, the profession has no ability to predict dangerousness.” She probes the profession and its practices, paving the way for a compelling analysis of psychiatric drugs, advancing that they themselves lead to chemical imbalances and irreversible brain damage. To that respect, she writes: “no medical credibility can be attached to a substance that is not medical, that addresses nothing medical, that gives rise to medical disorders, and whose modus operandi is dysfunction and damage.”

In chapter five, what is arguably her most powerful chapter – and they are all indeed powerful – Burstow demonstrates how the institution comes together, both a unique and a compelling contribution. Unique because no other scholar in the area has carried out an investigation on this level, and compelling because of the utter palpability of the evidence she presents to secure this institutional picture. The author demonstrates the functioning of psychiatry as an “extensive network of laws, forms, organizations, agents, procedures, all of a transcarceral bent, all of it circular, all of it facilitating psychiatric rule.” She takes us through the never-before-investigated Ontario Consent and Capacity Board hearings, exposing their institutional and discursive smokescreens. She transplants the reader alongside her while observing psychiatry’s “processing” of the patient, noting that “aspects of the system purportedly designed to protect ‘patients’ from ‘psychiatric excesses’ – the Consent and Capacity board, for example – are predicated on and overwhelmingly reinforce psychiatry.”

It is in Burstow’s micro and macro investigative style that the reader eventually finds herself unable to hold on to psychiatry as a helping profession or as a legitimate medical entity altogether. Without the reader needing to look further, psychiatry is left to crumble in the face of Burstow’s commanding historical archeology, her institutional and discourse analyses, and her methodical step-by-step look at the system from within and from without.

With her final chapter, which is notably the most original contribution to the literature, Burstow challenges the boundaries of our thinking. She offers a beginning to an alternate, psychiatry-free world, one rooted in community and individual autonomy. And still, in this “eutopia,” she does not ignore the possibility of violence and interpersonal conflict, only here, they are convincingly theorized as a rare occurrence. She offers what no other scholar in this area has: Real and everyday interpersonal and relational case scenarios, complete with possibilities of what to do and how to proceed.

While holding on to the complexities, the author writes with exceptional clarity. The book, though a multi-decade scholarly investigation that dialogues with professionals and other scholars, is more importantly an accessible, informative, and sensitive piece of work that speaks to the everyday person. Burstow addresses doctors, nurses, social workers, psychologists, researchers, legislators, survivors, parents, friends, and community members. She navigates such complex and multilayered discussions beautifully.

This book is long-coming. It creates a rift in our thinking. It begins a commanding counter-narrative to the psychiatric status quo. A daring piece of work that is both unsettling and necessary and an enriching and an essential possibility to social work, nursing, psychology, and medical curricula. Psychiatry and the Business of Madness marks a long-awaited radical trajectory change in the direction in which the world ought to go.

In ending, do yourself a favour and pick up this remarkable book. If you are like me, besides that you will learn a great deal, like with so many other of the classic in the field – and yes, I am predicting that it will quickly become a classic – you will not be able to put it down. 

See more at: EmpathicTherapy.org