Matthew Dumont's powerful description of community psychiatry is a fascinating read as it delves into social commentary in an effort to understand the nature of mental illness and how we see it. You will be glued to this book as he zooms in on single individuals and fans out, viewing them within their family, political landscape, culture, environment. He takes us through the history of what we take for granted as routine practice. As a nurse I have handed out methadone to patients to control heroin abuse, one was a newborn baby born of an addicted mother. In his book we see the history of competing ideologies of drug rehabilitation: community self help to get completely off drugs versus a drugged methadone constituency. Drugs dominated then, and they are dominating now.Matthew Dumont confronts environmental hazards, such as lead and chemicals used in factories, that endanger the health of those who are exposed to them. We see the politics of preventing and treating exposure to toxins, and the frustration that accompanies such attempts.Matthew Dumont challenges the pharmaceutical, biological approach that modern psychiatry is trending towards. This contrasts with the slow pace of community psychiatry, the long term trust that must be built between patient and psychiatrist for the patient to approach healing, as in his gripping account of "Queenie". A woman who murdered her own son, it took nearly fifteen years for her to remember the moments of the event and open up to Dr. Dumont in the healing that she needed. No shock treatment or drug could do that.Dr. Dumont has no quick fixes, no easy answers. His left leaning politics are apparent, but he does not seem overly tied to any political agenda, and that challenges the reader. Just like there are no quick fixes to the problems of mental health, no little pill to make the problems go away, there are no quick fixes to the culture of medicine for profit, economics that promote wealth for some and poverty for others, environmental hazards that cannot be easily washed away; no political party will make everything okay.Dr. Dumont contextualizes mental illness, and in so doing contextualizes family dysfunction and even crime. To contextualize does not mean to condone. It means we are all challenged to find its many faceted sources, and just keep trying, like Matthew Dumont did.
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