Anil Aggrawal's Internet Journal of Book Reviews

Volume 11, Number 1, January - June 2012

Book Review Section

(Page 1)

ESSENTIAL READING ...The book is concise but gives a broad conceptualization of trying to make meaning out of madness and certainly makes an interesting read....

 The Meaning of Madness by Neel Burton. Softcover, 5" x 7.5".
Acheron Press, , 2, Morrell Avenue, Oxford OX4 1NE, UK. Publication Date 2009. 202 pages, ISBN-10: 0956035302; ISBN-13: 978-0956035301. Price $25.00

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The “Meaning of madness” by Neel Burton is meant for anyone who may want to know more and make sense of the highly enigmatous entity of mental disorder . There are two quite different ways of conceptualizing common mental disorders: as categorically distributed or as dimensions. Categorical implies the presence/absence of a disorder- Either you are depressed or you are not depressed. Dimensional system rank on a continuous quantitative dimension i.e degree to which a symptom is present- How depressed are you on a scale of 1 to 10? There are currently two widely established systems for classifying mental disorders — International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Both these are categorical classification that divides mental disorders into types based on criteria sets with defining features. Categorical approach has advantages for research and understanding and form the cornerstone of clinical care. However as all practicing mental health professionals know- Individuals do not fit into categories and there may be significant overlap between two categories e.g anxiety with depression. Hence, dimensional systems may better capture an individual's functioning. The author's presentation of mental disorder subscribes more to the dimensional understanding of mental illness and as the author writes- these experiences lie on a continuum of normal human experience, and so it is impossible to define the point at which they become pathological.

The book has 6 chapters- the first five are common mental disorders(personality disorders, schizophrenia, depression, manic depressive illness and anxiety disorders and the sixth is on suicide. In all the chapters, the author interestingly amalgamates clinical, philosophical, historical and literary viewpoints. The text is richly embellished with case vignettes, literary quotes and self descriptions of people who have experienced psychologically distressing symptoms or disorder. All the chapters have certain uniformity, wherein the reader is familiarized with current clinical concepts- as understood by ICD-10 and DSM-IV which are discussed in detail. The author attempts to a historical understanding of mental disorders wherein mental disorders were understood in terms of divine punishment or demonic possession or imbalance of four bodily humors and then adds philosophical and literary viewpoints.

...The author looks at all these disorders from a interesting viewpoint- wherein he reiterates that conditions such as anxiety disorders, depression and personality disorders may have arisen from a need to make sense of the human experience whereas disorders like schizophrenia and bipolar disorder may have arisen from characteristics such as language and creativity that set us apart from other animals and define us as human beings. ...

For example chapter 3 describes the current concepts and clinical symptoms of depression, prevalence and sociodemographic correlates, modern pharmacological treatment as well as the rationale and limitation of behavioral techniques used in the psychological treatment . Further, the author opines that depression as a symptoms may not always be pathological but may act as a spur to explore the meaning of life. Similarly in Chapter I, the author expresses that distress and impairment associated with personality disorder may provoke maladaptive behavior in certain individuals and may become the very basis of creativity in some individuals

The author looks at all these disorders from a interesting viewpoint- wherein he reiterates that conditions such as anxiety disorders, depression and personality disorders may have arisen from a need to make sense of the human experience whereas disorders like schizophrenia and bipolar disorder may have arisen from characteristics such as language and creativity that set us apart from other animals and define us as human beings. The author points out that it may be interesting to note that genes that predispose to schizophrenia and bipolar disorder may also predispose to creativity.

However, as the current knowledge indicates - mental disorders have genetic predispositions and are intensely distressing and disabling disorders requiring long term treatment. Hence as the author states that it is important not to romanticize these disorders and emphasizes the need for adequate treatment and care.

The book is concise but gives a broad conceptualization of trying to make meaning out of madness and certainly makes an interesting read.

-Sonali Jhanjee

Dr. Sonali Jhanjee is working as an associate professor of psychiatry at the prestigious All Indian Institute of Medical Sciences, New Delhi. She was among the top most candidates in Post graduate entrance examinations. She can be contacted at sonali_arj@hotmail.com

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