Book Review


also has deep questions relevant to all design and environmental professions.


RISK OF MISDIAGNOSIS This book is very revealing about the diagnosis of different mental illnesses. Mental illness is not a measurable science and, based on our own personal experience, it cannot be factually measured or scanned to reveal the ‘evidence’ of the illness. Surprisingly, research suggests clinicians in different countries made different diagnoses when presented with identical sets of problems. What would lead to a diagnosis of schizophrenia in one country would lead to one of Bipolar disorder if you were to consult with a clinician in another country. The central issue is that different countries have different diagnostic systems, different rules for combining symptoms, and different systems of naming the disorders being diagnosed.


ANTIPSYCHOTIC MEDICATION On the matter of medication, you would imagine that the drugs known as antipsychotics are specific treatments for schizophrenia, but this is not the case. Not all people with a diagnosis of schizophrenia benefit significantly. If you are experiencing a manic episode, for example, you may find that antipsychotic medication offers temporary respite. This is not what you would expect if Bipolar disorder were carved at the joints from schizophrenia. Peter Kinderman argues against misdiagnosis, because it is bad news in a very competitive and risk-averse by world to have a mental illness in your medical history. Writer Fay Thomas, diagnosed with


Dr Malcolm Rigler GP, ambassador of The


‘There is still much opportunity for good design with service-user participation’


Bipolar, argues that we should treat psychiatric diagnoses as potentially defamatory. Diagnosis invariably is followed by medication. Peter Kinderman absolutely doesn’t think drugs are the answer, and neither do we.


DESIGN, MENTAL, AND THERAPEUTIC ENVIRONMENTS It is worth pointing out that many of these concerns apply to medication used to ‘treat’ so called Bipolar disorder. People experience episodes of depression, and some experiences episodes of mania (feeling very agitated or high), sometimes leading to actions they later regret. In our experience, Bipolar manic episodes can be very distressing and dangerous, and might culminate in attempted suicide. Medication does not help us learn to identify the early warning signs of manic episodes and help to avoid them. Discussion, counselling, and talking, does help. Unfortunately, perhaps the NHS psychiatric services cannot afford the time to talk.


Patients Association, says: “With my patients I all the time try to avoid prescribing medication, and often suggest time away from work to rest, as well as play and writing, talking, and music therapy, and reading. Time and well-designed space are needed for these therapeutic activities. Outdoor gardens, courtyards, and places to sit in the sun, are all vital spaces in the hospital.”


The book’s author, Peter Kinderman, who is Professor of Clinical Psychology at The University of Liverpool, argues for ‘a complete paradigm change in our thinking’, say the reviewers.


RESONATING WITH EXPERIENCE We have great empathy with Professor Peter Kinderman’s book, A Prescription for Psychiatry, because it resonates with our own experiences as mental health service-users and carers. Between us we have seen, survived, and experienced, the inside of three mental health hospitals. One of them still has shared single-sex wards and inward access courtyards. Another still has a shared sex dining room, with the institutional feel and smell of a school kitchen and smoke-filled lounge. None of them has a ‘Better Bedroom’. There is still much opportunity for good design with service-user participation. Peter Kinderman makes a clear case for more humane mental hospitals and care environments, and we recommend his new ‘prescription’ to all in the Design in Mental Health Network and medical humanities.


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34


THE NETWORK


April 2015


Photo courtesy of the University of Liverpool.


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