Mental Health and the Environment Edited by Hugh L. Freeman, Mse, MA, BM, BCh, FRCPsych, DPM London, Churchill Livingslone, 1984, 490 pages.
The true meaning of a holistic viewpoint ut human experience in health and illness mus.1 include not only intrapsyehic and biological dimensions, but an environmental one us well. Modern psychiatric thinking attempts to encompass all three. However, u hile the first half fol this century was characterized hy expeditions into our inner minds and the last 3 decades by adventures in psychopharmacologie treatment and neurophysiological research, only recenlly has the nature of man's environment received a reasonable amount ol attention. Undoubtedly stimulated by a general concern about ecological disturbance, the vision of the world we inhabit and its influence on our behavior has become a locus for more extensive experimental scrutiny. Much of the data derived have not yet become part of the practicing physician's common knowledge.
Perhaps it would he more accurate to say that until now we have lacked theoretical structures within which to position what information we have. To be sure, in practice we no longer ignore interactions among family members as a force for good or ill; recent studies have clearly substantiated that the nature of; a recovering patient's human rcbtionships has a profound effect on his ability to attain and sustain improvement. In treatment centers we try to construct so-called therapeutic milieus, although our approach to such efforts is often pragmatic, unintegrated with individual regimens established for individual patients, usually given cursory attention compared with that paid to other treatment modalities, and rarely based on a body of 'experimentallybased data.
What Hugh Freeman (who, in addition to his many other professional responsibilities is Editor of the British Journal of Psychiatry has assembled is a remarkable text that provides us with a veritable anthology of knowledge about man's interaction with his world. Such issues as the effect of crowding on behavior and urban malaise, and such social processes as disintegration, rigidity, isolation, stress, and socioeconomic class are explored with admirable thoroughness. For those of us with the curiosity of the researcher, the book coma ina a wealth of specific information. Those of us with a more clinical hem would do well to read it with a yellow highlighting pen in hand; then, by re-reading what we have underscored, we will find ourselves able to identify invaluable hypotheses thai will permit us to view our patients in a rather different way and formulate enriched, more carefully honed approaches to the therapy we carry out.
Because of this reviewer's special interest in the relationship between perception and psychological experience - we have documente visual perceptual dysfunctions in a substantial number of psychiatric patients suffering with chronic illness and occupational disability - I found the discussions of man's spatial interactions particularly compelling. "The theme of personal space recurs throughout ihis volume." notes Freeman, "particularly in relation to topics such as crowding, density, and privacy." "Personal space" or "portable territory" has been defined (by Sommer) as "the area surrounding the body into which intrusions by others are seen as threatening, thus resulting in anxiety and defensive behavior." Consider the possibility ihal "introverts" and schizophrenics may become easily overloaded at a lower level of sensory input: in such insiances "the boundary between self and environment may he infirm. leading to a breakdown of the abilitv to distinguish between fantasy and perception and a projection of a fragile ego onto the external environment." Techniques, such as Pasitron Emission Tomography, now allow us to test such hypotheses experimentally. Other approaches, such as visual perceptual analysis and modification, permit us to explore new therapeutic approaches to such issues as overstimulation by or underreacm ity to environmental events.
Mental Health and the Enviroment is a textbook in the true sense of the word. At times, the style hogs down as a result of the effort Io present detailed findings in as objective a way as possible. Certainly, the chapters would have benefited from tight summaries. Nonetheless, particularly in Freeman's own sections, the writing is superb, a characteristic this reviewer has noted far more often among British authors than among American ones.. It is a singular pleasure to encounter writing thai is both literate and scientific at the same time.
The last chapter of the hook offers unique evidence of the creativity with which it has been put together. Entitled "Continuity and Sense of Place: The Importance of the Symbolic Image." it was written by R. Randolph Langenbach, an Assistant Professor of Architecture at the University of California, Berkeley. Addressing himself to contemporary man's willingness to destroy antiguity- motivated by greed, functional concern, or simply the desire fora new look - he reminds us lhat "liuildings gain meaning through their association with history . . . this transformation of the perception of a place beyond the everyday reality lo a more abstract connection wiih human history and life is how a conscious sense of place is created and reinforced in a community. Continuity in the evolution of the environment is achieved by man's conscious actions to encourage this awareness, be it through literature, art. or social and political efforts." His appeal for conservation is lungian in tone, reminding me of the small cemeiary on the hill above St. George's, in Granada and of people walking by on their way to work each day. taking lor granted the casual greeting they may offer to parents and grandparents long gone.
In spite of its understandable but rather lofty price ($69.00). Mental Health and the Environment should be available to every psychiatrist, if not in his own library, certami) in the institutional ones he regularly uses.