Alien Landscapes? Interpreting Disordered Minds
By Jonathan Glover
Cambridge, Mass: The Belknap Press of Harvard University Press, 2014.
Coherent integration of the psychological, emotional and scientific aspects of human conduct is a deep problem for all human sciences including psychiatry, and raises issues about the limits of psychiatric objectives with respect to those experiencing mental illness. The author quotes, “We may think we understand dispositions furthest from our own, but when faced with such people, we feel a gulf which defies description.” The main goal of this inquiry is to contribute a humanistic account of mental illness enriched with interpretive dimensions beyond that of current psychiatric approaches.
Referencing both qualitative interviews and excerpts from classical literature, poetry and visual art, the author arrives at a novel consideration of themes well-established in criminal law theorizing about mental illness, including responsibility, agency, and an identity over which we can exert some control.
How do psychopaths think about their terrible crimes? What are the contours of their inner moral landscape? The author extracts key comments from inmates in a secure hospital setting that reflect a moral shallowness and the dominance of self-interest over empathy. But while the Hare Psychopathy Checklist identifies one factor of the diagnosis as a personality characterized by traits of selfishness, callousness and remorseless use of others, (12) Glover unearths some subjective underpinnings beneath this expressive conduct. In addition to a diminished recognition of the moral status of others, they exhibit “a failure to develop a robust sense of their own identity and worth.” (52) He observes that, consequential to childhoods marked by rejection, abuse, inconsistent care or neglect, in some ways, the interviewees “are not very real to themselves.” The author posits that the real disorder is not one of personality, but of identity.
The author is mindful of the methodological traps of his approach. There is a possibility that his interviewees are presenting themselves disingenuously and manipulatively, as these traits are, after all, central to a traditional anti-social personality disorder diagnosis. But he also cautions that the psychopathy checklist may obliterate the psychological complexity revealed through interactions with fewer preconceptions. (70)
One section, titled “Boundaries of Psychiatry” reviews familiar atrocities whereby the psychiatric profession has been enlisted to reframe and suppress political dissent. The author rightly notes that psychiatry does not stand alone in reinforcing dominant social and belief structures, but that, in its cruder versions, represented by unambiguous definitions of normality and pathology, it is particularly well-suited to this role. An illustrative case in Canada was the extended career of brutality by South African psychiatrist Dr. Aubrey Levin, (aka “Dr. Shock”) who was finally prosecuted and sentenced in Alberta for his criminal conduct in sexually assaulting incarcerated patients under the guise of “correcting” their homosexuality.
Similarly, the author interrogates the boundaries of various disorders such as compulsive gambling, where it is not readily apparent that mere peculiarity or distasteful preference or even the type of motivational force characteristic of behavioural addictions ought to invite medicalized concern, absent significant distress, impaired functioning or risk of harm.
Overall, the author makes a singular contribution to a relatively scarce literature incorporating subjective perspectives on mental illnesses with an analysis situated in philosophy, psychiatry and the humanities. He argues for a dualistic response to transgressions by the mentally ill that incorporates both causation and agency. This book will provoke thoughtful contemplation about the central forensic issues of reason, compulsion and responsibility.
ROSANNA LANGER, PHD
Department of Law and Justice
 Quoting Karl Jaspers, in General Psychopathology, trans. P.R. McHugh (Baltimore: Johns Hopkins University Press, 1997) 447.