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Bad Souls: Madness and Responsibility in Modern Greece

by Elizabeth Anne Davis. Durham, N.C., Duke University Press, 2012, 344 pp., $25.95.

Reviewed by Miltos Livaditis, M.D.
Am J Psychiatry 2013;170:686-686. doi:10.1176/appi.ajp.2013.13010100
View Author and Article Information

The author reports no financial relationships with commercial interests.

Alexandroupolis, Greece
Dr. Livaditis is Professor of Social Psychiatry, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.

Accepted March , 2013.

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The enterprise of psychiatric reform in Greece during the last decades, mainly after the fall of the dictatorial regime in 1973, is of multiple interests: scientific, political, sociological, cultural, and anthropological. During this period, Greece, for the first time in its modern history, enjoyed long-lasting political stability and financial growth. The requests for social changes, including the reformation-modernization of social institutions, were almost ubiquitous. Under such a social climate and with the encouragement of European Union authorities, various initiatives were undertaken for the establishing and functioning of new community-orientated psychiatric services. The main aim of psychiatric reform was declared to be the development of sectorized comprehensive psychiatric services available for the total of a local population.

The book Bad Souls: Madness and Responsibility in Modern Greece, by Elizabeth Anne Davis, presents some aspects of the above-mentioned efforts, especially considering the everyday functioning of services in a catchment area of Thrace, northeastern Greece. Thrace presents some special, interesting characteristics: it is a multicultural, borderline area, with a high degree of traditionality, and used to be a region of ethnic and religious tensions. The author lived many months in this area and followed the activities of psychiatric services. These services are staffed by psychiatrists and other professionals, most of which seem to be motivated by a pioneering apprehension of their job.

The main psychiatric services operating in the area are mobile units, hostels, and a psychiatric department in the general hospital for relatively brief hospitalizations. Patients are no longer secluded in asylum-like psychiatric hospitals. Locally provided psychiatric services, continuity of care, and systematic sensitization of the population to mental health issues have enhanced secondary prevention and ensured a better quality of life for thousands of patients with psychosis and the members of their families. Analogous services for other categories of health care receivers (e.g., children with mental disabilities, persons with alcohol dependence or other addictive disorders, and aged people with dementia) have been established or are to be established. Unfortunately, their deployment (in Thrace or elsewhere in Greece) is threatened by the present financial and social crisis.

Ms. Davis’s book is an ethnographic-anthropological approach of the above-mentioned activities in Thrace, with many philosophical and sociological connotations. The author focuses on therapist-patient communication, in the context of the newly created services, especially considering the topics of responsibility, truth (suspicions, deceptions), cultural divergence (various “idioms” of psychopathological expression and understanding), and freedom and autonomy.

Throughout the pages of this book, many persons related to these psychiatric activities are presented—not only leaders and members of the multidisciplinary teams, but also mental health care recipients, patients, relatives, and members of the local community, each with his or her own history to narrate and own view to present. Throughout the book, the various narrations and the sensible observations of the author invest her theoretical analyses and vivid views: the surrounding landscape, the villages and towns, the small communities, the hospital and mobile units, the aspiration and disappointments of the protagonists, the conflicts and negotiations between different groups having diverging social interests and psychological needs, and, above all, the efforts of suffering people (of “bad souls”) to handle their problems and to confront asymmetrical relationships and discriminative or stigmatizing conditions without losing their autonomy and freedom.

In my opinion, the author, being a keen ethnographer and anthropologist, has succeeded in gathering and presenting factual information that can help readers to make up their opinion about subjects that by far surpass the problems of psychiatric reform in a remote area (e.g., exercising authority and negotiation within the framework of modern psychiatry, the limits of scientific knowledge in psychiatry, the difficulties of modern reformatory, and the libertarian ideology to deal with the “inhuman face of severe pathology” [p. 4]). Probably, some might find that there is a lack of systematicity, or of cold “scientific” objectivity, considering the presented matters. On the other hand, the book has the power of fluency and liveliness. It seems as if sometimes the presented persons try to jump out of the pages and speak directly to the reader about their story or view.

At this point, I have to confess that I am one of those who participate in the efforts of psychiatric reform in Thrace. I met the author many times during her stay in Thrace and collaborated with her on various relevant topics. I have admired her devotion to her work, as well as her frankness, humanitarian spirit, and real respect toward other people. These qualities of character are reflected in her book that I recommend, especially to those working in helping professions who feel the need to enrich their knowledge and skills with a deeper understanding of sociological, cultural, ethical, and political issues.




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