Book review: ‘The most attractive quality of Tom Burns’s account of the profession to which he has devoted his life – he is Professor of Social Psychiatry at the University of Oxford – is its tone of voice. He is calm, sympathetic, willing to listen to a wide variety of views and eager to understand ... “Psychiatry,” Burns says, “has made mistakes and will continue to make further mistakes. I hope, however, that a recognition of the massive good it does, and a fuller understanding of the constraints under which it has to operate, will put these failings in perspective.” In this aim he is entirely successful. This is as good an introduction to the subject as one could imagine. Honest, undogmatic, humane and clear-eyed, Our Necessary Shadow is a brilliant apologia for Burns’s much-maligned profession.’
Burns explains: "The first half outlines the history and development of the discipline. Starting in a fairly revolutionary manner outside medicine at the end of the 18th century it was soon taken over by doctors. There were two simultaneous origins. The first, the asylum movement gave rise to diagnoses and a more medical approach. The second, a psychological investigation of disturbed mental states initiated by early hypnotists made us aware of the unconscious. These two strands have vied with each other ever since. The result has been a fluctuating identity for psychiatry over the last century, sometimes predominantly psychological, sometimes more social and recently an aggressively medical model.
The book (published June 2013) explores the dilemmas that psychiatry inevitably faces as it operates in the complex social interface between doctor and patient. Society changes, illnesses change, treatments change. Mistakes are made and dramatic advances radically alter what we think it is to be human.
Throughout the book emphasises that mental illnesses are consequences of who and what we are. They are in no way arbitrary – they and the striving of psychiatry to alleviate them are our necessary shadow."