In an era when the biopsychosocial model is more of a slogan than a reality and social and psychological factors are undervalued, this book comes as a welcome corrective. Professor Brugha and his colleagues have provided us with a highly comprehensive and critical review of the literature on social support and psychiatric disorders. The book consists of 14 chapters written by a group of international scholars from Great Britain, Canada, the United States, Norway, and Australia. The chapters form a cohesive unit and are of uniformly high quality. Although the book is not bedtime reading, it is written with clarity, shows a great deal of scholarship, and provides a balanced perspective.
In his preface, Professor Brugha suggests two aims for his book. The first is to help practitioners approach the psychosocial aspects of care with greater knowledge and understanding. The second is to stimulate a much-needed expansion in formal clinical evaluation. To these ends the authors present a wide range of theoretical and methodological issues. The authors examine the nature of social support from biological, cognitive, developmental, and social perspectives. They convincingly emphasize the complex interaction between environment and the individual. For example, social support seems to aid recovery for women without partners, but for women with partners it appears to have a negative impact. (For the explanation of this counterintuitive finding, see chapter 6 by Dr. Veiel.)
The second and third sections of the book consist of empirical studies involving social networks. I found the chapter “Case Management and Network Enhancement of the Long-Term Mentally Ill” of special interest. In this chapter the authors discuss the case management concept and evaluate a specific program (the COSTAR program in Baltimore). Although the results were complex, they did indicate that patients in longer contact with a program demonstrated improved social functioning.
The final section of the book deals with clinical issues and would probably be of most interest to the active clinician. Among the interesting issues raised are how psychotherapy can be conceptualized as a form of social support. The authors raise the intriguing suggestion that the research on psychotherapy efficacy is really to some extent research on social support.
It is impossible in the short span of this review to do justice to this work. It is a timely and important contribution. Dr. Brugha and his colleagues have presented us with a feast of new ideas. It would be a shame if we did not indulge.
