Review

A more able label required

HALLAS’ CARING FOR PEOPLE WITH MENTAL HANDICAPS
ed WI Fraser, RC MacGillivray and Ann M Green,
Butterworth-Heinemann, 1991

Despite the rhetoric and the promises of planners, states the uncompromising introduction to Caring for people with mental handicaps, the actual changes in services have been faltering and piecemeal. I know how the editors of this weighty volume feel, since despite the promises of the book jacket blurb, it cannot escape the verdict of being found faltering and piecemeal itself.

From the first page a tone of no-nonsense moderation is set. The debate about the effects of labelling people ‘defective’, ‘imbeciles’ and now ‘mentally handicapped’ has engaged and challenged the attitudes of hosts of people from the seminar room to the sluice room. No matter. We are briskly told that this has been a heated and unproductive controversy and that labelling is required, full stop.

In similar vein, the reader is informed that plastic surgery will increasingly be demanded for children with the ‘stigmata’ of Downs syndrome. As the children will then look more ‘normal’ expectations of them will be higher. ‘This is a good thing’, say the editors. Or is it just an example of devaluing difference, trying to make diversity invisible, and avoiding the inevitable challenge to our assumptions about who and what is of value?

The book rapidly situates itself in a clinical rather than socio-political context, and in doing so becomes a book about caring for, not caring about. It misses the opportunity to enthuse and inspire staff to continue with the task of transforming outdated services and tackling widespread prejudice. On the other hand, it fails to compensate for this with comprehensive care-related information.

Breadth is certainly there — from dentistry to microcomputers to parents but often at the expense of depth. For example, I was pleased to find space devote to self-advocacy (Mary Holland) but disappointed that no first hand accounts were given of what it is like to speak for oneself — or, more commonly, not.

Similarly, William Lindsay’s otherwise interesting chapter on psychological therapies was marred by its failure to mention psychodynamic (relationship-oriented) approaches. The respectability that Valerie Sinason and others have won for these approaches has already proved that there is life beyond behaviour modification.

This patchy coverage of issues arises partly because the book is a victim of its own ambitions. Billed as an ‘essential handbook’ for all members of the multi-disciplinary team, I can well imagine it being leafed through by all, but read by none.

Those who do read it will find that the broad selection of topics contributed by no fewer than 30 authors produces a tendency to incoherence, and a lack of clear organisation to the chapters. The style of writing is irritatingly inconsistent, at times addressed to ‘you the parent’, at others to ‘you the expert’ who knows microphthalmia and epicanthic folds at a glance.

But there is potential. Instead of continuing, in this 8th edition, to cash in on a formula whose time is past, Hallas should spawn two or three confident and thorough progeny — and then retire gracefully.