Lives that are high in emotion

This is a layperson's introduction to one bit of social psychiatry. The author is mindful of the reader's need to understand the role of social factors in generating or maintaining "psychiatric disorder". The book is also a useful historical document - an autobiographical account by one key respondent from a sub-culture of British social psychiatry in the last quarter of the 20th century. Julian Leff has a well-deserved reputation within this self-told story. He is generous in his praise of colleagues. Most of these are psychiatrists, but others he commends strongly are medical sociologists or clinical psychologists. George Brown comes out as the main man in the methodological driving seat. Social psychiatry is depicted by Leff as an interdisciplinary effort, dominated by, but not limited to, medical practitioners.

Leff is at his most convincing when summarising this recent amalgam work on the role of life events and high expressed emotion in patients' families in predicting relapse or explaining triggers in neurotic depression and psychosis. When he strays into history, he is less convincing. It will be news to historians of academic psychology that its beginnings can be found in the competing works of Freud and Skinner.

The text refers overwhelmingly to psychiatry and is severed from social science. Virtually all 64 references in the bibliography are to medical journals or books. Given that psychiatry has been the subject of controversy in modern society, the book highlights the distinction between social psychiatry and the sociology of psychiatry. The epistemology of the first is incapable of generating the second. This is a feature of the specific interdisciplinary nexus Leff documents.

A robust theme of the text is to limit or challenge the bioreductionist claims to be found in contemporary psychiatry. Leff sets out this case well but does not follow through the conclusions of his own critical thoughts. While confessions about the limited value of categorical distinctions (between, say, madness and sanity) pepper the text, he ploughs on in his diagnostic quest. He recalls a personal world tour, on which he was both sceptical of western psychiatric categories and compelled to advocate the need for their global export. This is despite Leff's seeming to argue that madness and misery come in all shapes and sizes and are evaluated differently according to their social context.

In the end, the author retains a faith in the legitimacy of psychiatric diagnosis. It may be abused, but it must not be abandoned.

David Pilgrim is professor of mental health, University of Liverpool.