The British Journal of Psychiatry (2014)
205, 413417
Book reviews
Edited by Allan Beveridge, Femi Oyebode
and Rosalind Ramsay
The Shock of the Fall
By Nathan Filer.
Harper Collins/The Borough Press.
2014.
7.99 (pb). 320 pp.
ISBN: 9780007491452
I will not pretend not to have felt a good bit jealous when I heard
about The Shock of the Fall; first novel and Costa Book Award
winner, by psychiatric nurse Nathan Filer. Where are all the
psychiatrists when it comes to fiction writing? Well, they are
certainly not to be found in this story. If, as a psychiatrist, you
are hoping to find yourself portrayed for better or worse within
the 300 pages of this tale of mental illness, you will be, frankly,
disappointed. It is much worse than that. Psychiatrists are
mentioned less than a handful of times throughout. On the face
of it this may seem surprising, given that Matthew Homes, the
narrator and central character, spends a significant part of the novel
in an acute psychiatric unit, a little time on a high-dependency unit
and is subsequently discharged on a community treatment order.
But this is Matthews story; the story of a young man struggling
with a mental illness and looking back on the emotional fallout
since the death of his brother in childhood.
Matthews experiences of being a psychiatric patient both in and
out of hospital are recounted with blush-inducing perceptiveness
of what it must be like for patients caught up in modern-day
mental health services and will undoubtedly ring true with any
psychiatric professional, patient or carer. It is not a comfortable
read.
The story begins at a holiday park a couple of days before
Matthews brother, Simon, dies in circumstances which are kept
tantalisingly oblique until the near end. Near end that is, not
the bitter end which you may be forgiven for anticipating as
you progress through the book. Simon has Downs syndrome
and intellectual disability and dies; Matthew has grief, guilt, drugs
and schizophrenia; there is more than a hint that their mother
suffers from recurrent depression and Munchausen syndrome by
proxy; and Matthews dope-smoking best friend is chained as a
carer for a severely disabled parent. At first glance it reads more
like a diagnostic manual which is not really the stuff of comedy
and yet there are genuine laugh-out-loud moments which come
as a more-than-welcome respite from this otherwise quietly
disturbing novel.
Nothing seems to escape Filers microscopic gaze in his effort
to paint a searingly accurate canvas of the world inhabited by
patients, but it is the external world within the confines of the
hospital, rather than the internal world of Matthews mental
illness, where the observations of staff and his interactions with
them are so well crafted with a brutal insight that makes you
cringe and laugh in equal measure. The risk assessment form, in
particular, is a masterful parody of justification, and I would
challenge anyone having read this novel to ever complete another
in the same way again. I have already said that psychiatrists make a
very brief showing and also that it is a very real and true account
of the current mental health services. The fact is that from
Matthews vantage point the psychiatrist is a very peripheral
character with whom he has no interaction or relationship outside
of the brief and heavily populated ward round. Apart from the
very talented storytelling Nathan Filer has produced a fine
description of psychiatry under New Ways of Working.
Some people read novels and say I didnt want it to end.
I wanted this book to end. If I am honest, I probably wanted it
to end at the top of the cliff on page 247. It left me feeling sad.
Sad for the patients, carers, nurses, support workers, but mostly
sad for psychiatry.
Naomi Mehta Northumberland, Tyne and Wear NHS Trust, Northgate Hospital,
Morpeth NE61 3BP, UK. Email: naomi.mehta@ntw.nhs.uk
doi: 10.1192/bjp.bp.114.150821
Brainwashed:
The Seductive Appeal
of Mindless Neuroscience
By Sally Satel & Scott O. Lilienfeld.
Basic Books. 2013.
US$26.99 (hb). 154 pp.
ISBN: 9780465018772
With this impressive book, Satel & Lilienfeld (practising clinicians
in psychiatry and psychology respectively) have achieved a timely
and balanced work on the limits of contemporary neuroscience.
Brainwashed is an expose of mindless neuroscience: the over-
simplification, interpretive license, and premature application of
brain science in the legal, commercial, clinical and philosophical
domains, and a damning critique of our now dominant assumption
that a biological/neural explanation is the best way to understand
human behaviour.
The authors acknowledge neuroscience as a hugely important
and influential field but emphasise its fledgling status. They focus
particularly on the fMRI, the hallmark tool of neuroscience, and
misapplied neuroscience, outlining the dangers of stretching
paradigms beyond their appropriate use. The potential results
are not only neuroredundancy (fMRIs telling us things we
already know about the world and contributing little or nothing
in terms of useful data or knowledge) but also real societal harm.
Brainwashed is a cautionary tale on the dangers of
reductionism and the central question running through the book
is whether we can ever understand the psychological through the
neurological. This is, of course, nothing new, it is one of our oldest
philosophical debates the mind/body (brain) divide and the
413
 Book reviews
resultant explanatory gap, i.e. how we comprehend our felt
experience with reference to our neural activity. Brainwashed,
however, has much to add not only by presenting authoritatively
and clearly the philosophical issues at stake but in choosing to
focus on the practical (mis)applications of neuroscience such as
neuromarketing, addictions (and the brain disease fallacy), lie
detecting and the errant use of neuroimaging within the criminal
justice system, the rise of neurolaw, and issues of moral
responsibility.
Satel & Lilienfeld write with a rare clarity and economy of
language. Their intended audience is wide and they seamlessly
bridge the gap between popular-science book and academic essay
on the important challenges facing current neuroscience. The
book is well referenced and up to date, and they write
authoritatively on all the disparate topics they cover. That said,
the succinct nature of the book is also a weakness. Given the
complexity of the subject matter, I did feel at times it might
benefit from a more in-depth analysis. This is, I imagine, a
necessary trade-off to reach the wide-ranging audience this book
deserves.
Brainwashed is ultimately about what neuroscience can and
cannot tell us about ourselves and a thought-provoking plea for
the understanding of human behaviour on multiple levels,
including the psychological, cultural and social.
Lisa Conlan Clinical Tutor in Global Mental Health, Institute of Psychiatry,
Kings College London, 16 De Crespigny Park, London SE5 8AF, UK. Email:
lisa.2.conlan@kcl.ac.uk
doi: 10.1192/bjp.bp.113.139287
The Bitterest Pills:
The Troubling Story
of Antipsychotic Drugs
By Joanna Moncrieff.
Palgrave Macmillan. 2013.
19.99 (pb). 296 pp.
ISBN: 9781137277435
This is an important book. You might think I would say that as a
member of the Critical Psychiatry Network, like the author, Joanna
Moncrieff, senior clinical lecturer at University College London.
However, I do think her critique has a sound academic grounding
and engages with public concerns about antipsychotic medication.
The book describes the extent to which the prescription of
antipsychotics is marketing-based rather than evidence-based.
Chlorpromazine, of course, was the first drug seen as having a
specific role in the treatment of mental illness. Moncrieff, instead,
emphasises the non-specific nature of antipsychotic effects,
which she frames by promoting a drug-centred rather than
disease-centred model of their action. Nonetheless, she says that
antipsychotics can help individuals gain relief from intense and
intrusive psychotic experiences or destructive emotional states
414
(p. 18). By this she means more than their placebo effect and
believes they can be of value as emotional suppressants. I would
encourage you not to dismiss her approach as unbalanced. Despite
what may seem like niggling overstatement at some points, she
does present a genuine argument, with which I think it is
important to engage.
She describes the wish-fulfilling nature of the dopamine
theory of schizophrenia. She also makes a stronger case than even
I was aware of for ventricular enlargement in schizophrenia being
a drug-induced phenomenon. Historically, as she points out, there
has been denial in psychiatry about traditional antipsychotics
causing tardive dyskinesia and atypical antipsychotics producing
the metabolic syndrome. Her summary critique of the early inter-
vention approach also seems to me to be one of the best available.
I am sure this book will be too sceptical for most psychiatrists.
It may seem to undermine psychiatrys cultural system. Personally,
I think psychiatry needs to face up to the truth about the psycho-
pharmacological revolution, rather than continuing to rely on its
aura of factuality. Even the past editor of this Journal Professor
Peter Tyrer agrees1 we should call an end to the post-chlorpromazine
era. I hope Jos book makes a significant contribution to this debate.
1 Tyrer P. From the Editors desk. Br J Psychiatry 2012; 201: 168.
Duncan Double Norfolk and Suffolk NHS Foundation Trust, Victoria House,
28 Alexandra Road, Lowestoft NR32 1PL, UK. Email: dbdouble@dbdouble.co.uk
doi: 10.1192/bjp.bp.113.138917
Electroconvulsive
Therapy in Children
and Adolescents
Edited by Neera Ghaziuddin
& Garry Walter.
Oxford University Press USA. 2013.
37.50 (hb). 316 pp.
ISBN: 9780199937899
Reading this book was a fantastic opportunity to form a view on
the best evidence available, although I should preface my review
by pointing out that there are no controlled electroconvulsive
therapy (ECT) trials in young people under 18.
ECT was introduced in Rome in 1938 and from 1940 until
1950 was used in all age groups. ECT studies demonstrated
effectiveness in conditions such as mania, melancholia and
childhood schizophrenia, but the public image of ECT took a nose
dive in the 1960s and even more so after films such as One Flew
Over the Cuckoos Nest (1975). However, the past decade has seen
resurgent interest in the use of ECT with young people.
The application of ECT in adults and young people differs.
Studies in the USA and Australia indicate that less than 1% of
all patients treated with ECT are children and adolescents.
Children have a lower seizure threshold and the risk of prolonged
seizures is increased. There have been no reported deaths linked to
ECT. Side-effects in young people appear to be generally mild and
transient.

In this comprehensive and rare text on ECT, Ghaziuddin &
Walter systematically address the issues of stigma, training,
consent and practice. Procedures and practice have been
progressively refined and now modern anaesthetic methods are
in use. Pre-assessment is thorough, outcome measures are both
generic and specific, including cognitive assessment scales and
neuropsychological testing; electrocardiography, electroencephalo-
graphy and brain imaging are recommended. It would appear that
there are no absolute medical or neurological contraindications to
ECT. Specific chapters are dedicated to ECT treatment studies and
procedures for particular disorders, with accompanying case
vignettes.
In conclusion, the evidence from open studies and case series
for ECT in children and adolescents is convincing. Those
clinicians who have during the course of their practice seen
profoundly depressed children and young people unresponsive
to treatment, young people with life-threatening catatonic states,
or severely self-injurious children with autism spectrum disorder
who head-banged until brain damage ensued, will, no doubt,
consider ECT more readily after referring to this book. Others
need training. If you are considering the administration of ECT
for your patients or discussing the pros and cons with the young
person and their family, be sure to refer to this work.
Gordana Milavic Michael Rutter Centre for Children & Young People, The
Maudsley Hospital, De Crespigny Park, Denmark Hill, London SE5 8AZ, UK.
Email: gordana.milavic@slam.nhs.uk
doi: 10.1192/bjp.bp.114.150565
Mental Health
and Deafness:
Professional Perspectives
on Deafness, Evidence
and Applications
By Margaret Du Feu
& Cathy Chovaz.
Oxford University Press USA. 2014.
25.99 (pb). 320 pp.
ISBN: 9780199860753
Like the authors of this book, I work as a consultant psychiatrist
with adults who have been deaf from an early age and communicate
in sign language. Unlike the authors, I am hearing and when I go
home at night I switch back into the hearing world. Both authors
are deafened and rely on sign language to communicate. This
book is remarkable in that it is the first textbook on mental
health and deafness written by deaf professionals, a consultant
psychiatrist and Canadas first-ever deaf clinical psychologist.
From my perspective the two greatest challenges in working
with this patient group are sharing their experiences of
discrimination and abuse and the difficulty mainstream health
services consistently have understanding and meeting their needs.
This book has been written for clinicians who have relatively little
experience working with deaf children and adults and is designed
to be an introductory text for mainstream clinicians to better
equip them to serve the needs of their patients.
Book reviews
It is beautifully written and as a result it is an easy and
entertaining read, with illustrative case studies that provide
windows into the real-life world of deaf people. Humour, pathos
and tributes to the resilience of deaf people are woven adroitly
into the clinical narrative. The content covers broad facts about
deafness and deaf people in society, moving on to discuss deaf
childrens early development and the massive impact on them of
communication and education choices made for them by others.
Assessment, diagnosis and treatment of mental disorders in deaf
children, adolescents, adults, older people and deafened and
deaf-blind people are all covered. The sections on taking a history
and working with interpreters are particularly detailed and helpful.
I recommend this book to mainstream clinicians and to all the
clinicians already working with deaf people. Reading it opens
ones mind to the unusual experiences and presentation of mental
illness in a group who have a different perspective on the world
and who hear through their eyes.
Helen Miller consultant psychiatrist, Adult Deaf Service, Bluebell Ward, Springfield
Hospital, 61 Glenburnie Road, London SW17 7DJ, UK. Email: helen.miller@swlstg-
tr.nhs.uk
doi: 10.1192/bjp.bp.114.153130
The Nostalgia Factory:
Memory, Time and Ageing
By Douwe Draaisma.
Yale University Press. 2013.
US$25.00 (hb). 176 pp.
ISBN: 9780300182866
Nostalgia is often portrayed as a rather cosy emotion, for example
the Ostalgie for the former East Germany portrayed in films such
as Wolfgang Beckers 2003 Good Bye Lenin! or the nostalgia shop
(Out of the Past) described in Woody Allens 2011 Midnight in
Paris: What was prosaic and even vulgar to one generation had
been transmuted by the mere passing of years to a status at once
magical and also camp (opening lines of a book written by Gil
Pander). However, Professor Draaisma, of the University of
Groningen, reminds us of the painful root of the word nostalgia,
invented in 1688 by Dr Johannes Hofer by translating the German
Heimweh into Greek. Jaspers also described a case series of
individuals who, in despair, committed arson and murder in order
to get home a world away from the magical and camp.
The essays in this engaging volume deal with ageing, normal
forgetfulness and reminiscence, and summarise a large amount
of empirical research. One particularly fascinating chapter deals
with the commodification of memory loss through memory
training (which only seems to train you to be better at memory
training games). The chapter ends, in an interesting parallel to
Barbara Ehrenreichs Smile or Die: How Positive Thinking Fooled
America and The World, with a thoughtful consideration of the
415
 Book reviews
implications of the maxim use it or lose it and the unhelpful
corollary that someone might be considered responsible for their
memory problems through not having used it enough.
Interestingly, a 19th-century prediction that nostalgia would
become extinct due to increased communication has not come
to pass in our era of social networks. The nostalgia factory of
the title refers to the resurgence in later life of childhood
memories in emigres, [but] the real nostalgia factory is time,
which makes emigrants of us all . . . [Your] reminiscences impress
upon you that you are no longer living in the land of your youth.
You find yourself in a foreign country without ever having left
(pp. 1434).
Tom C. Russ Clinical Lecturer in Old Age Psychiatry, Division of Psychiatry,
Alzheimer Scotland Dementia Research Centre, Centre for Cognitive Ageing and
Cognitive Epidemiology, all at the University of Edinburgh, and Scottish Dementia
Clinical Research Network, NHS Scotland. Division of Psychiatry, Kennedy Tower,
Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK.
Email: tc.russ@ed.ac.uk
doi: 10.1192/bjp.bp.114.144675
Our Necessary Shadow:
The Nature and Meaning
of Psychiatry
By Tom Burns.
Allen Lane. 2013.
20.00 (hb). 384 pp.
ISBN: 9781846144653
As an FY2 doctor hoping soon to enter into psychiatry training,
Our Necessary Shadow was for me an eye-opening read. Having
had first-hand experience of the day-to-day job of a psychiatrist,
I now also have much greater understanding of and respect for
clinical psychiatry.
The book is aimed at the general public in an attempt to
provide greater understanding of what psychiatry is, what it can
and what it cannot do. In the first section, the reader is taken
on a tour through the history of psychiatry, including the way
its development has been influenced by societal changes and
international events such as wars. This historical background helps
the reader to better understand past decisions, both good and
bad. Current practice is described and challenged in a balanced
and candid way. The future of psychiatry is honestly discussed,
including areas and practices that could be improved.
For the general reader, psychiatry is explained in comprehensible
terms. Many feared aspects, for example ECT, are demystified and
their benefits clearly explained. Many readers will be from a
generation accustomed to viewing psychiatry with a degree of
suspicion. Much of the book is dedicated to giving a truthful
account of the darker parts of psychiatrys history, with fascinating
insights into the character of the individuals involved. There are
no excuses made for the darkest hours of psychiatrys past.
However, there is also plenty of material provided to challenge
the views of the hardest cynic.
416
Throughout the book, Professor Burns uses professional and
personal anecdotes and gives constructive opinions, which make
this so much more than just another textbook. For early-career
psychiatrists, this is an inspirational volume. For more experienced
clinicians, it is a welcome refresher and reminder of psychiatrys past
and present, with a glimpse of what the future may hold. Most
importantly of all, it is a chronicle of the impact of the profession
on society, thinking and psychiatry itself that most human of
medical disciplines.
Mariam Ali FY2, Faculty of Medicine, Imperial College London, and Oxford
University Hospitals NHS Trust, London, UK. Email: mariam.ali06@imperial.ac.uk
doi: 10.1192/bjp.bp.113.143727
The Pursuit of the Nazi
Mind: Hitler, Hess,
and the Analysts
By Daniel Pick.
Oxford University Press. 2014.
10.99 (pb). 368 pp.
ISBN: 9780199678518
When W. H. Auden wrote poetically soon after Freuds death that
Freud had become a whole climate of opinion, this was certainly
true in the world of 1940. Psychoanalysis and world events had
collided with Freud dying in exile from his beloved Vienna
in Hampstead, London soon after the declaration of war in
September 1939. The regard for psychoanalysis then and the
centrality of the theory to mainstream psychiatry is well illustrated
in this new work of detailed scholarship by Daniel Pick. Pick is
best known to those interested in the history of psychiatry for
his Faces of Degeneration (1989) and in this most recent book
he combines his interests as a professor of history and a trained
psychoanalyst in giving an account of how the theory of psycho-
analysis was called upon by military intelligence to give insight
into the mindset of Nazism and fascism. Psychoanalytic theory
was already exploring the issue of mass psychology and how
populations might fall under the sway of a charismatic leader, and
Pick references the work of Fromm, Reich and others in this regard.
Where this book is most fascinating is in its account of
psychiatrists coming face to face with Nazi leaders. The most
celebrated example is the case of Rudolf Hess, Hitlers deputy,
who in a bizarre episode flew himself to Britain in May 1941,
ostensibly to try to arrange peace talks with Britain. Concerns
soon emerged about the sanity of the deputy Fuhrer and Dr Henry
Dick of the Tavistock Clinic was engaged as part of the medical
team looking after Hess under conditions of secrecy and security
and with British Military Intelligence involvement. (A more
popular account of the Hess internment can be found in
Camp Z by Stephen McGinty (2012), including the drama of
Hesss suicide attempts.) Pick reproduces the statement by Hess

at the Nuremberg trial along with extracts from the clinical notes
of Dick. In the end it is difficult to tell with Hess where paranoid
and perverted political ideology becomes psychopathology but his
testimony and that of other Nazi leaders at Nuremberg, both to
the court and to psychiatrists, illustrates well the powerful hold
that an ideology and a charismatic leader can exert even after
defeat. Hess clearly states he would have behaved no differently
if he had his time over again and his faith in Hitler remained to
the end. A number of psychiatrists published accounts of their
examinations of the Nuremberg war criminals in the post-war
years and Pick draws on these accounts.
Book reviews
For such a detailed work of scholarship this book is inexpensive
and is a recommended addition to both institutional and personal
libraries. It is doubtful today that psychiatrists would be viewed as
having a position of privileged insight into a political phenomenon
such as the rise of fascism and this book therefore documents an
important and forgotten juncture in the history of our discipline.
Iain David Smith consultant addiction psychiatrist, Gartnavel Royal Hospital,
1055 Great Western Road, Glasgow G12 0XH, UK. Email: iain.smith@ggc.scot.nhs.uk
doi: 10.1192/bjp.bp.112.124669
417
Electroconvulsive Therapy in Children and Adolescents
Gordana Milavic
BJP 2014, 205:414-415.
Access the most recent version at DOI: 10.1192/bjp.bp.114.150565

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