Abstract
Bedlam on the Streets is an excellent book that demands reading by anyone concerned with mental health care, social policy and planning and methodological and theoretical aspects of sociology, ethnography and qualitative research.
The author sets out to distinguish the rhetoric from reality for community mental health care in Montreal. Race and ethnicity are viewed in context and through interactions. In doing so we are taken on a journey through city landscapes, via the precarious existence of ‘mad’ people who occupy and transit urban spaces/places.
The use of the term ‘mad’, often viewed as stigmatizing in today's formal world of mental health care and consumer advocacy, is reappropriated by the author to clearly reflect the reality of mental distress. It is also used subjectively by the characters in the text to refer to themselves and their peers.
The life world of the mad is theoretically informed by Bourdieu, Foucault, Nietzsche and importantly, Lefebve's ‘concept of space as a domain of social relationships and political priorities’ (p.70).
The reader journeys or voyeurs the public and private spaces and relationships of the real and imagined world of mad people through the richness of voice, photographic images and text. Privacy occurs where the only things ‘that occur outside of the gaze of others happen inside you’ (p.157).
We see asylums without walls as the mad are released from incarceration. The revolving door of psychiatric institutions creates a situation where the mad are constantly mobile as ‘system nomads’ (p.36). Living arrangements are described in terms of degrees of autonomy and freedom contrasted with control, surveillance and compliance. These include supported accommodation with community mental health care support (this is the elite of the system), the foster home model (or the cottage industry of asylum where the public welfare system is transferred to the private system), supervised apartments or rooming houses, and lastly the human warehousing of homeless shelters, where the old spaces of religion and industry are redefined.
The fine detail and texture of the spaces and social problems associated with madness and social disadvantage is revealed in stories of schizophrenia and its multiple meanings (to self/system), where the mad live a life of ‘walking exile’ (p.99).
Urban myths of dangerousness are explored revealing fears that mad people are a risk to society. Many of these myths are exposed showing that these people are a vulnerable and endangered group. Indeed, ‘we fear the mad and we fear becoming them’ (p.161).
Community mental health care when properly planned and resourced, can have positive results. However, the author clearly demonstrates that in Montreal this system is only for a minority of those in need, resulting in a larger system of neglect.