Book Review: “Cracked: Why Psychiatry is Doing More Harm than Good”

I have long been wary of efforts to explain mental health problems simply and uncritically as illnesses. This important new book confirms that I was right to do so. The author is an anthropologist and psychotherapist, and so is well placed to comment on such matters.

This is a very well-written book – intellectually sound, but written in an accessible way. It is based in large part on interviews with a number of key people in the history of the medical model of mental disorder. The author provides a cogent critique of dominant ways of thinking about mental distress, and presents convincing arguments that there is little evidence to support a disease conception of such matters. He shows how the whole history of psychiatry has been based on some very unsound thinking and unsupported assumptions and assertions.

The tendency for psychiatry to increase over time the number of diagnosable mental illnesses is explored, with concern rightly expressed about the negative and detrimental consequences of this. With each new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM – the standard reference book for western psychiatry) more areas of our lives are defined as mental illnesses. Most recently we have seen a significant level of concern over forms of grief being defined as a mental disorder, rather than as part of what it means to be human.

His well-crafted and well-supported arguments tell a revealing story of how a medical model is not only difficult to support, but also counterproductive in terms of helping people cope with the mental health challenges they face. His critique focuses in particular on the very strong influence of the pharmaceutical industry on treatment practices. His analysis makes clear that the dominance of prescribing medication for a wide range of disorders is highly problematic, and the fact that drug company profits are such an influential factor is equally concerning if not more so.

This book therefore raises very important questions about the mental health ‘industry’ and how it has evolved. These are important questions not only for mental health professionals, but also for politicians and policy makers in terms of the large sums of money being spent on approaches that this book shows to be highly questionable.

Seeing mental health problems simply as illnesses is not only theoretically unsound (in terms of the gross oversimplification of some highly complex issues), it is also dangerous in terms of policy and practice, as it closes off other avenues of help and support by focusing narrowly on (largely drug-based) ‘treatment’ of what are seen as biologically based pathologies. This narrowness means that the importance of meanings in people’s lives is more or less completely neglected, as are wider social pressures and challenges. A medical model of mental health and well-being is premised on a very narrow perspective on people’s lives that does not do justice to the richness of human experience and the wide variety of factors that can and do contribute to mental distress.

This book does not represent the only voice to challenge the medical model; it joins a growing trend in the literature to raise serious concerns about dominant approaches. The author has clearly taken great care to ensure that his ideas cannot be dismissed as some sort of unsupported radical fantasy. His points are tightly argued, and well supported by research evidence and direct interviews with important historical figures in the development of the medical model. His rigorous approach contrasts strongly with the highly dubious arguments and unsound research underpinning the medical model that he exposes so effectively.

This is a very important book. It should be read by all mental health professionals and, just as importantly if not more so, by all politicians and policy makers charged with shaping future mental health provision. Arguably, many people with mental health problems and their friends and relatives could also benefit from reading this very persuasive critique of dominant approaches to psychiatric practice.

Reference: Davies, J. (2013) Cracked: Why Psychiatry is Doing More Harm than Good, London, Icon, ISBN 978-184831556-3

Written by Neil Thompson, PhD
SJS Contributor

This post was originally published at: and has been syndicated with permission of the author.

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