Book review of David Ingleby (ed) (1981) Critical Psychiatry: The Politics of Mental Health
Reprinted from New Society 30 April 1981

A couple of years ago I received a request from an appointments committee of Cambridge University asking me to write a formal testimonial on the suitability for a tenured lectureship of David Ingleby, a social psychologist holding an untenured post as assistant lecturer in that university's department of social and political studies. "Department" is in formal terms misleading, for the institute concerned has no proper administrative standing in the Cambridge power-structure: hence its actual designation as the "Social and Political Sciences Committee" - a term perhaps even more misleading, since even a committee normally enjoys some attributes of power or control.

The reference I wrote for Ingleby's application for tenure was composed after extensive reading of his academic publications. I cannot, however, claim to have read all of his papers: for example, his "Use of the d' statistic in interpreting the nature of proactive interference in short-term memory" (British Journal of Psychology, 1973, 64, 521-29) remains, like his four other papers on memory and cognition contributed to reputable journals of experimental psychology, unknown to me. Nor have I studied his computer programme SIGDET, produced to assist the Medical Research Council's Applied Psychology Unit in the analysis, graphical representation and statistical treatment of signal-detection data."

I did know, and appreciate, his paper on "The psychology of child psychology" which formed part of the book, The Integration of a Child into the Social World, edited by Martin Richards for the Cambridge University Press in 1974. But I still cannot pretend to have read all seven of the articles and reports which Ingleby co-authored, in the quantitative study of infant classroom behaviour, between 1970 and 1974, as part of the distinguished research team led in this important area by Dr J.W.B. Douglas.

What I did read - including, as part of the evidence presented to Ingleby's referees for their evaluation, the introductory editorial article and opening chapter for Critical Psychiatry (the book under review) - was quite enough to convince me that here was an eminently proper candidate for the move from an untenured temporary appointment to a tenured post in a reputable university interested in promoting vanguard work in the social and political sciences. I therefore wrote a short commendatory testimonia1, not unmixed with qualification as to the particular theoretical positions held by Ingleby in this or that debate, and sent it off to the assessing authorities at Cambridge.

It seemed, at the time, a matter of some fairly routine move of a junior lecturer to permanent status. In other universities, a teacher and researcher like Ingleby, with about 25 articles and reports to his bibliographical credit, and a serious book (the present one) on the stocks for publication (all in the span of nine years), would hardly be in the league for an initial tenured appointment: he would be in the stakes for promotion from a tenured lectureship to a senior lectureship. I expected to hear no more about the matter except the news of this candidate's appointment to tenure.

A number of facts, either unknown to me at the time or whose significance was still to transpire in subsequent developments of the case, were to prove me wrong.

1. Another referee chosen by the assessing board to report on Ingleby's suitability for upgrading to a tenured post was Sir Martin Roth; the university's professor of psychiatry and a figure of national eminence.

2. Roth's methodological standpoint on psychiatry is attacked vigorously in Ingleby's own contribution to the present book (which I take to be part of the evidence seen by all the referees and assessors), and by implication in a number of Ingleby's other papers on psychology and psychiatry (also available in evidence for the tenure decision).

3. Ingleby was refused upgrading twice and is now looking for work.

4. The unofficial rumours that were leaked back to Ingleby (as I subsequently learnt when I met him, for the first time) claimed that the board had turned him down because of adverse (indeed hostile) reports from his referees.

5. In the case of my own reference on his work, any such implication was a deliberate and mischievous untruth (and one which I am unable to refute in detail because of the confidential character of the reference requested).

6. On hearing of Ingleby's difficulties in securing tenure every single colleague of his in the Social and Political Sciences Committee signed a letter regretting the appointments committee's decision.

7. In 1980 Ingleby, despite a further spate of high-quality publications and papers (I have before me, for instance, his "'Freud and Piaget: the phoney war," presented at an international conference on child psychiatry last year), had his second application to obtain upgrading refused by the Cambridge authorities - who are, doubtless, fully competent to judge, the detailed and informative discussion of Freudian and Piagetian notions contained in this and other papers. Readers are invited to discover the names of the various professors who composed the relevant committee, and button-hole them at parties to find out what exactly are the disagreements which they feel so strongly on - for example, Ingleby's treatment of genetic epistemology in Piaget, or his discussion of interpretative versus positivistic approaches in psychopathology (contained in the present volume).

8. The treatment of David Ingleby has stimulated a large and vocal current of undergraduate protest. He is obviously appreciated and liked as a teacher.

Now it may well be that the rumour which (after elimination of myself as a possible cause) renders Professor Roth into the crucial rejecting referee is just as insubstantial as other bits of university tittle-tattle sometimes turn out to be. If, however, it should be the case that an adverse and even perhaps bellicose report from Professor Roth was indeed the key signal to the assessing board in the negative decision that they took, we have surely a singularly disquieting position in the affairs of Cambridge University: one in which an immensely powerful figure who has become the target of some vigorous theoretical polemic from a junior has been asked to pronounce on that junior's future career (in a department, be it noted, which has no connection at all with the senior figure's specialism).

It must be stressed, once again, that this supposition can, on our present knowledge, only be speculative. The world of mental health politics has, however, only recently seen a vivid, public display of The Gripes of Roth (as Sir Martin's more eloquent prises de position are affectionately known among his public) when he took the trouble to announce his withdrawal from the sponsorship of MIND (National Association of Mental Health) in the furore which followed William van Straubenzee's denunciation - under the protection of parliamentary privilege - of the MIND national office as a hotbed of sympathy for the Irish Republican Army (an accusation which has given rise to some speculation as to whether van Straubenzee represents his constituency, in which is situated the special hospital of Broadmoor, from inside or outside the walls of that institution).

Whatever one's views may be about the excessive legalism which characterises some of MIND's campaigning, it should be clear that Roth's public dissociation from its national work came at a time when that organisation was under pressure from particularly reactionary quarters. Let us hope that his referee's report on David Ingleby reflected the calm and judicious assessment which has formed the basis for Sir Martin's eminent reputation in psychiatric science. And, in order to set all doubts definitely aside, let the testimonials on David Ingleby's academic suitability - my own as well as his - be released from the "confidential" secrecy which at present binds them. In a matter of such urgent public interest, the authorities at Cambridge should take the necessary steps for this disclosure.

Critical Psychiatry has been published by Penguin after a very considerable delay since it was accepted for publication. In this interim of years, some of its material, has become dated. Sherry Turkle's chapter on Lacanian antipsychiatry in France, which was doubtless intended as a foretaste of her book on the same topic, Psychoanalytic Politics, has come out here later than the book, and adds nothing to it.

The chapter by Peter Conrad (not to be confused with the British literary critic of the same name) on the medicalisation of deviance, with special reference to the "hyperactivity" diagnosis as used with children, has many good points and arguments: but the political thrust of such biologistic assessments of disadvantage in the young has become less clearlv reactionary than he surmises in his concluding paragraphs - for, without some such medically-based assessment of children's learning and behavioural difficulties, how are we to evaluate the very strong case that is being mounted by, for example, those researchers who argue that such maladaptations are caused through the ingestion of lead from petrol fumes?

The section, "Towards a critical history of the psychiatric profession," by Andy Treacher and Geoff Baruch seems to lean excessively on two sources, Andrew Scull's Museums of Madness (now widely available as a published book) and D. Ewina's unpublished (but, to judge from their quotations, eminently publishable) thesis on the social and legal context of the Mental Health Act, 1959. Treacher and Baruch direct a considerable portion of their criticism against the role of the state in making provision for psychiatric welfare: and yet, within the current climate of monetarist cutback in provision for the national health, is an anti-statist argument here a particularly progressive or appropriate one?

Two of the chapters of Critical Psychiatry can be recommended unreservedly: Joel Kovel's sardonic "The American mental health industry", and Svein Haugsgjerd's report on the crisis of the public psychiatric services in the threatened welfare state of Norway. These two international contributions sit uneasily with a very brief (and not very informative) account by Franco Basaglia of the reforms in mental hospital management that he has pioneered in Trieste: a topic which has been covered just as sympathetically and with a much more thorough evaluation in the report by Dr Douglas Bennett, The Changing Pattern in Mental Health Care in Trieste, published by the WHO Regional Office in Copenhagen two years ago.

David Ingleby's own contribution (about one third of the book) tackles a number of very salient points in the evaluation of modern psychiatry's role. He does, however, tend to use, the term "positivism" as a slur-word to cover a large number of rather divergent positions which require more careful and separate treatment. Owing to the sharp (I believe unnecessarily sharp) distinction which he draws between "positivist" and "interpretative" approaches in the analysis of human action, he is led to utter some rather paltry niggles at such serious contributions to the understanding of psychological ills as George W. Brown and Tirril Harris's Social Origins of Depression, which he (unaccountably) chides for failing to raise the question, "Is depression understandable?" (a question which is surely the very one which is posed squarely by Brown and Harris in their work).

There are also here and there, in Ingleby's discussion, some woolly comments and snap judgments which with a little more care could have been re-drafted at no expense at all to the main argument. For example, at one point he suggests that "tranquillisers make people able to handle their emotions only by leaving them with no emotions to handle." In another rather loose passage, he suggests that "all the studies used as evidence for genetic transmission of mental illness are as weak methodologically as the reports on the genetic transmission of IQ criticised so effectively by Leo Kamin: a very sweeping dismissal which is not based on a thorough perusal of this large body of work. Such spatterings from the anti-positivist blunder-buss may well irritate readers with some special knowledge of the psychiatric fields in question.

Still, it needs to be said that the interpretative, anti-scientistic arguments produced by David Ingleby here and elsewhere do deserve an airing, and are free from the Laingian and Szaszian excesses which have given anti-psychiatry such a rotten reputation. There are only a very few critical writers in Britain now trying to do serious and consistent work in this fraught and vital area. The removal of one of them marks a loss to the debate on the future of psychiatry which our culture can ill afford.