The Inner Level
| Published date | 05 September 2019 |
| DOI | https://doi.org/10.1108/JPMH-09-2019-085 |
| Pages | 207-208 |
| Date | 05 September 2019 |
| Author | Woody Caan |
| Subject Matter | Health & social care,Mental health,Public mental health |
and school leaders to create a school culture
which enables everyone who is part of the
school community to talk openly about
mental health”(Introduction).
Julian Ashton
Julian Ashton is based at NIHR Research
Design Service (SW), Paignton, UK.
References
Fukuo, J., Maroney, M. and Corrigan, P. (2019),
“Pilot of a consumer based anti-stigma mentorship
program for nursing students”,Journal of Public
Mental Health, doi: 10.1108/JPMH-02-2019-0020.
Kosyluk, K.A. et al. (2016), “Challenging the stigma
of mental illness among college student”,Journal of
Adolescent Health, Vol. 59 No. 3, pp. 325-31.
Edited by Richard Wilkinson and Kate Pickett
Allen Lane London
2018
ISBN 978-1-846-14741-8
Review DOI
10.1108/JPMH-09-2019-085
Keywords Inequalities, Social anxiety, Stress
This book carries the subtitle “How more
equal societies reduce stress, restore sanity
and improve everyone’s well-being”,soI
eagerly awaited practical tips for the reader on
mental health promotion. The authors’
previous book had been full of interesting,
international observations on various impacts
of inequality (Caan, 2011). Four years ago,
the Institute of Health Equity at University
College London prepared a very helpful report
on the social determinants of mental health
(World Health Organization and Calouste
Gulbenkian Foundation, 2014) including
recommendations for action across the
lifecourse, at both local and national levels.
The new book by Wilkinson and Pickett has
325 pages with 512 references, but after page
110 and “Myths of human nature, meritocracy
and class”began, I found little of interest for
mental health professionals. Most of the
evidence relates to income inequalities across
American states or OECD member countries.
The underlying theory seems to be that social
anxiety related to “status”leads to illness in
individuals and societies, and that may well be
reasonable in relation to the pathogenesis of
some clinical disorders. The essence of the
whole bookis summarized in one sentence in a
chapter on “Self-doubt”:“The reality is that
inequality causes real suffering, regardless of
how we choose to label such distress”.
The authors have many elegant turns of
phrase, for example “in a society of strangers,
outward appearances and first impressions
become more important”. However, as a
mental health educator, I became
exasperated by their conflation of everyday
distress, isolated symptoms, survey ratings
and psychiatric diagnoses into one “huge
burden of unhappiness and mental illness”.
Having researched the diverse antecedents of
both clinical depression and alcohol
dependence, the shallow views given
here on the roots of “depression”or
“addiction”really grated. This book
reaches a nadir in a section “Narcissism
Trumps good leadership”in which the
authors, whom I assume are neither
authorities on personality disorder nor closely
acquainted with the US President, speculate
wildly on his mental functioning.
For all its 512 references, there seems to be only
one point where the book considers any
evidence that is contradictory to its claims. My
old colleague Derek Summerfield (2011) is
disparaged for doubting the validity of the
reported prevalence measures the book plots
against International income data.
Dr Summerfield worked as a Psychiatrist
across diverse cultures, nationalities and
languages, so perhaps his concerns do merit
serious consideration? One of the blind spots
inthebookisitsfailuretoseeapossible
reverse relationship between inequalities and
mental illness. Perhaps improved mental
health care might improve income, housing,
social relationships and even “status”as
opposed to stigma. Improved prevention of
mental illness through better antenatal care,
child protection, parenting programmes,
community development linked to education
or community safety, and better workplace
environments, all appear likely to impact on
“well-being”–what would that do to
inequality in the population? That sounds like
a case for evidence-based mental
health promotion!
The Inner Level
VOL. 18 NO. 3 2019
j
JOURNAL OF PUBLIC MENTAL HEALTH
j
PAGE207
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