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Mental illness and the economy
161
Book reviews
Mental Illness and the Economy. M. HARVEY BRENNER.Harvard University Press. 1973.287 pp. f7.00. THE RELATIONSHIPbetween
mental illness and the economy is obviously relevant to both social policy and psychiatric treatment. It has in addition a certain uneasy topicality. The substance of this book is a highly complex statistical analysis of the inter-relationship between cyclical changes in two sets of data. The data which cover the years 1919-1967 are: 1. The Annual Reports of admissions to the Department of Mental Hygiene of New York State. 2. An “Index of Economic Activity” that derives from reports prepared by the Department of Labour of New York State. The period studied includes two major wars and substantial populations movements as well as changes in the availability of hospital places and psychiatric diagnostic and admission policies. The raw data is manipulated to remove long term trends which do not seem visually to be related to economic changes. The modified data is then subjected to Fourier analysis and several forms of regression analysis. Factors such as age, sex, social class and ethnic group were all analysed separately. Statistically significant correlations emerged for almost all of the 44 years analysed. Economic “down-swings” were associated with a sharp increase in the admission rate for almost all the categories studied. “Up-swings” were associated with a less pronounced but still significant, decrease. Increased admission rates were associated with increased discharge rates and with overcrowded wards showing that the changes were not simply due to altered bed availability. The explanation of these changes is almost certainly multifactorial. The author discusses ways in which economic changes could increase the incidence of mental illness, decrease family tolerance of the mentally ill and lead to the use of psychiatric hospitals as “shelter” and “poor relief”. The discussion is less satisfactory than other parts of the book. It poses questions which go beyond the data on which the survey is based and the review of the literature misses recent references. PETERNOBLE
Lithium: Its Role in Psychiatric Research and Treatment. Press, New York, 1973. 358 pp. Price $22.50.
Ed. S.
GERSHON and
B.
SHOPSIN. Plenum
THIS timely compendium of review articles summarises the literature on the chemistry, pharmacology and clinical effects and uses of lithium. There are no major omissions, but the articles vary in quality, some providing little more than lists of citations, others, in particular the chapters by Schon, Schildkraut, Goodwin and Ebert, Mendels and Quitkin, Rifkin and Klein offering conceptualizations based on thought and experience in the field. Fieve provides a useful discussion on the classification of the affective disorders and an entertaining historical account of the methodological disputes provoked by therapeutic and prophylactic trials of lithium. His discussion of the indications for lithium in the management of “productive cyclothymics” and the “creative personality” is particularly valuable to psychiatrists. It is a pity that the clinical appeal of the book was not extended by the inclusion of a discussion by specialist physicians including an endocrinologist, a neurologist and a nephrologist. They are increasingly interested in the uses of lithium; they encounter its toxic effects masquerading as other diseases and are not always alerted to them as only a fraction of the literature appears in general medical journals. However, it is a very useful reference work for psychiatrists and for researchers. RACHEL ROSSER
Book reviews
Mental Illness and the Economy. M. HARVEY BRENNER.Harvard University Press. 1973.287 pp. f7.00. THE RELATIONSHIPbetween
mental illness and the economy is obviously relevant to both social policy and psychiatric treatment. It has in addition a certain uneasy topicality. The substance of this book is a highly complex statistical analysis of the inter-relationship between cyclical changes in two sets of data. The data which cover the years 1919-1967 are: 1. The Annual Reports of admissions to the Department of Mental Hygiene of New York State. 2. An “Index of Economic Activity” that derives from reports prepared by the Department of Labour of New York State. The period studied includes two major wars and substantial populations movements as well as changes in the availability of hospital places and psychiatric diagnostic and admission policies. The raw data is manipulated to remove long term trends which do not seem visually to be related to economic changes. The modified data is then subjected to Fourier analysis and several forms of regression analysis. Factors such as age, sex, social class and ethnic group were all analysed separately. Statistically significant correlations emerged for almost all of the 44 years analysed. Economic “down-swings” were associated with a sharp increase in the admission rate for almost all the categories studied. “Up-swings” were associated with a less pronounced but still significant, decrease. Increased admission rates were associated with increased discharge rates and with overcrowded wards showing that the changes were not simply due to altered bed availability. The explanation of these changes is almost certainly multifactorial. The author discusses ways in which economic changes could increase the incidence of mental illness, decrease family tolerance of the mentally ill and lead to the use of psychiatric hospitals as “shelter” and “poor relief”. The discussion is less satisfactory than other parts of the book. It poses questions which go beyond the data on which the survey is based and the review of the literature misses recent references. PETERNOBLE
Lithium: Its Role in Psychiatric Research and Treatment. Press, New York, 1973. 358 pp. Price $22.50.
Ed. S.
GERSHON and
B.
SHOPSIN. Plenum
THIS timely compendium of review articles summarises the literature on the chemistry, pharmacology and clinical effects and uses of lithium. There are no major omissions, but the articles vary in quality, some providing little more than lists of citations, others, in particular the chapters by Schon, Schildkraut, Goodwin and Ebert, Mendels and Quitkin, Rifkin and Klein offering conceptualizations based on thought and experience in the field. Fieve provides a useful discussion on the classification of the affective disorders and an entertaining historical account of the methodological disputes provoked by therapeutic and prophylactic trials of lithium. His discussion of the indications for lithium in the management of “productive cyclothymics” and the “creative personality” is particularly valuable to psychiatrists. It is a pity that the clinical appeal of the book was not extended by the inclusion of a discussion by specialist physicians including an endocrinologist, a neurologist and a nephrologist. They are increasingly interested in the uses of lithium; they encounter its toxic effects masquerading as other diseases and are not always alerted to them as only a fraction of the literature appears in general medical journals. However, it is a very useful reference work for psychiatrists and for researchers. RACHEL ROSSER