Where There is No Psychiatrist

by Reviewed by Marjory F. Foyle

The book will be of help to a wide range of people working cross-culturally, as well as within their own culture.

By Vikram Patel. Gaskell, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG (www.rcpsych.ac.uk/publications), 2003, 266 pages, £8.00.

—Reviewed by Marjory F. Foyle, medical doctor and psychiatrist with 31 years missionary experience in India and Nepal.

Many people are familiar with the excellent books Where There is No Doctor and Where Women Have No Doctor. This new book, Where There is No Psychiatrist, has been on plan for a long time, and in my opinion was worth waiting for. The author has experience in Africa and India, as well as holding professional posts in the UK, and has therefore the knowledge and background to write for a cross-cultural community. He has succeeded well. The book will be of help to a wide range of people working cross- culturally, as well as within their own culture. These include those who have considerable experience of mental health problems, those with a little knowledge, and those who are not medically trained at all.

At first sight the book may appear to be heavy going because there is a lot of print in only 266 pages, but this is offset by clear and comprehensible language. Technical terminology is utilised, but in most cases is explained clearly either by words, drawings or useful tables. My only criticism would be that those for whom English is not a first language might find the quantity of writing on each page a little daunting. I hope it will be translated into other languages within the near future.

The book is divided into four parts which cover: 1) An overview of mental illness; 2) Clinical problems; 3) Integrating mental health, which includes exciting topics such as mental health in primary health care, caring for carers, and meeting refugee needs; and 4) Localising the manual for your area. There follow flow charts for problem solving, Bibliography, Glossary of terms, and a request for comments.

I would strongly recommend this book to all those involved in health care, however senior, for there is much that is refreshingly helpful. I would also recommend it for leaders of communities of all kinds, including those working in a pastoral capacity. Non-medical volunteers and longer-term workers will find it useful, for they are often asked for advice by the local community. It is not, of course, a religious book, but a simply written text-book which has tried to be culturally acceptable to peoples of all religious communities. In areas where mental health is little understood it may do much to remove the prejudice and misunderstanding that add so much suffering to those with mental health difficulties.

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