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The British Journal of Developmental Disabilities
Book ReviewTHE PSYCHIATRY OF LEARNING DISABILITIESOliver Russell (Ed.) Gaskell/Royal College of Psychiatrists
Given that this book is written by psychiatrists for psychiatrists on a subject within a narrow field of specialism, it seems appropriate to declare the reviewer's own background at the outset. As a lecturer in social work with an interest both in mental health and learning disability, I found this collection of articles to be particularly valuable as very little has been written about the prevalence of serious mental ill-health among people with learning disabilities. I am unable to comment upon the value of this book to its intended audience (students of psychiatry), but I found it to be accessible to the non-medical reader, and furthermore, it gives an excellent view of selected issues from the psychiatric perspective. Moreover, while this is not the central theme of the book, it reflects the impact upon psychiatry of developments such as normalisation, that are less the domain of medical oriented services, and more associated with a social orientation to service delivery. The book is well edited, pulling together a broad scope of articles which may be read discretely or as a well-organised and comprehensive collection. To the non-medically trained, some chapters will be more readable than others, with writing in the areas of diagnosis and epidemiology being necessarily more jargon-laden. The central orientation of the book is psychiatric diagnosis and treatment and the considerable problems that these endeavours entail. While this may seem at first glance to be an off-putting subject to a non-medical practitioner, much of it is extremely relevant. The book addresses the problems of communication, without which diagnosis cannot be made. It has a discrete chapter on autism, a chapter concerning behavioural interventions, one relating to counselling and psychotherapy, an overview of ethical issues and a chapter on forensic psychiatry as it relates to learning disability - an important subject on which very little has been written. Also amongst the subjects covered by the book is a very comprehensive discussion of epilepsy, a look at the use of psychiatric medication, the heart of modern psychiatry (which is again, necessarily heavily reliant upon the language of the profession), and examination of the subject from the perspectives of child psychiatry, the psychiatry of old age and the problems of intervention in the range of severe disability. From my personal experience of working with practitioners in general psychiatry I am aware of the dispute about the prevalence of mental health problems among people with learning disabilities. It is therefore, extremely interesting to read a chapter devoted to diagnosis of psychiatric disorder which acknowledges the dispute and attempts to quantify the problem. The book also covers common ground between the medical and the social work fields, such as the chapter relating to impairment, disability and handicap. It could be that certain readers will find the discussion here over-medicalised, but for my part I found the content sufficiently refreshing to encourage me to re-assess my own views. While the introductory chapter which gives an historical overview of concepts is of great general interest, touching as it does upon such events as the discovery in 1799 of Victor, the ‘wild child of Aveyron' by a French physician, I found the perspective here less critical of modern psychiatry's precedents than a number of other histories of this subject. For example, the author discusses 19th century psychiatry's preoccupation with post-mortem craniometry (drawing inferences from the capacity of a person's cranium), without acknowledging the use that this long discredited study lent to the pseudoscientific basis of racism, theories of criminality and, closer to home, eugenics. Being Scottish, my only other criticism of this excellent book is a criticism that can be levelled at many texts. The chapter on forensic psychiatry does not acknowledge the existence of any legal system in the UK other than the English! As a social work tutor, most texts I encounter on learning disability are written from a sociological, psychological, philosophical or social standpoint. This book provides an opportunity to view learning disability from a rarely encountered perspective. Setting aside the independent value of each chapter, the uniqueness of the content of this book justifies the read.
Michael Lowit
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