reviewed by Mark Ragins, M.D.*

When Phyllis Vine asked me to read this book and write a review for MIWatch my first reaction was that I haven't written a book report since the fifth grade. The name of the book sounded interesting if not catchy or inspiring, and she’s very earnest so I said OK. As usual, I ended up turning my homework in late, but here it is:

This book is really two books in one. The first half is a review of the literature about the impact of mental illness on people’s lives and the second half is a historical review of employment services for people with mental illnesses.

The first part contains many of the studies that I never learned in school, but which have become my favorites over time, including the one that says that people with schizophrenia in third world countries do better than those in first world countries and the one that says that talking to people about their hallucinations and delusions (CBT) is actually very helpful, not harmful as I was taught. There’s lots of good information included here. I even found a few new gems like one that says that insight improves treatment compliance and function, but decreases self esteem. Now I know where to find the actual references for these studies when people ask me for them.

Unfortunately, the narrative storyline of linking all this together as aspects of stigma didn't really work for me. Rapidly, I felt I was reading an unending list of abstracts of research findings instead of a story. Whether it's because of their British reserve or the style of professional distance and objectivity that plagues all research writing or the lack of self disclosure on the authors' part, very little of their passion and dedication came through to me. Overall, it makes a better reference book than page turner. I’m going to try to get my students to read this, but I’m afraid it won’t be easy.

They try to bring the material to life by sprinkling in short tastes of first person accounts of what it’s really like to live with these issues and for me it worked. After a while I looked forward to each one. Throughout this section of the book the authors hit my trifecta - studying people’s lives and not just their illnesses, including outcomes and not just theories or opinions, and emphasizing first person, subjective experiences of the people with the illnesses - and yet it still wasn’t compelling reading overall.

The picture that emerges in this section is depressing in two regards: First, it's impressive how little research on living with mental illness there really is. I get more articles every week in journals filled with drug company sponsored "evidence" to guide my prescribing patterns that I throw directly into the trash can than there are studies contained in this book. We really only have isolated islands of evidence about people’s lives. Second, most of the data itself is depressing. Whether they look at self-esteem, rejection, poverty, or anti-stigma efforts most of the news is grim. Fortunately, the authors never give up hope and keep encouraging us.

The second part of the book focuses on employment. Almost everyone who seriously focuses on improving the lives and social inclusion of people with mental illness eventually come to the conclusion that employment is essential and these authors are no exception. Unfortunately, despite the compelling arguments and data they champion, the system has never come to that same conclusion.

Even for an experienced rehabilitation professional like me their personal involvement in most of this history and their unique bridging of American and British approaches gave me some new information and insights.

I felt a twinge of pride when I found my program, the Village, complemented along the way, but that was also when I realized that this was a review of model programs as they have evolved, not a review of the system itself. Sadly, the vast majority of people being treated for mental illness has never had and still doesn’t have access to any of these services. None of it, effective or not, has ever become mainstream.

Their final two chapters find innovation and hope upon which to build our future. The first one focuses on mental health programs hiring consumers, consumer-run businesses, and coops as novel approaches to employment. It's interesting stuff and forward looking. The second one focuses on recovery and the consumer movement.

From their points of view, these are two more promising extensions of the work they've been describing. From my point of view, these developments are something different entirely. They move beyond technical innovations, professional research based approaches, and model programs to become major social movements. The sheer numbers of people involved, the strength of their organization and political advocacy, and their ability to tell powerful stories publicly give these movements a power to affect public opinion, policy, and even funding in unprecedented ways. In my opinion, that’s why they could finally catalyze the system and social transformation these authors have worked so hard to promote.

Although I didn’t find a passionate story line or a lot of personal inspiration in this book, I'd still recommend it to readers who are already inspired and passionate workers, advocates, or searchers in our world of mental illness. You’ll have more meat on your bones.

*To read more of Mark Ragins' writings, including his short book, A Road to Recovery, or learn more about his program, the Village in Long Beach, Calif., click www.village-isa.org