This multi-author book is a critique of psychiatry and its role in the world. Many authors are from the school of critical psychiatry, which maintains that science and psychiatry are complicit in the oppression of people, because scientific knowledge exists in the context of the prevailing social and political environment and its development requires establishment of institutions, privilege, power, and adheres to normative choices and their values. Science is not value free, but carries the aspirations of those who wield power, and alternative views struggle to achieve legitimacy since their position is powerless within such sociopolitical systems. The authors describe recent changes in the global socioeconomic and political environment and some of the devastating impact that societal structures of power have had on individuals and their health. This is wide-ranging and includes concerns about the role of the pharmaceutical industry, Western practice and service delivery (US-style managed healthcare) which ‘commodifies’ distress. The book advocates a bottom-up perspective to make sense of these dynamics.

Many readers would object to the denial of professional expertise to alleviate distress. Others would consider the call to dismiss scientific knowledge as counterproductive. We are, however, well reminded that contexts are important, especially since mainstream psychiatry tends to locate problems in individuals – it does not always acknowledge the influence that socioeconomic factors may have on health.

The authors offer a ‘constructive postmodernism’ approach, which is unconvincing as it appears to have little substance to offer assimilation between traditional/subjective and modern/objective practice. The hegemony of societal institutions is already being challenged in various ways and value systems are changing, with a growing awareness of the consequences of consumerism, added to by the fallibility of financial systems. I would have thought that the recovery paradigm, with its emphasis on personalised outcomes, self-direction and valuing the local narrative while acknowledging the usefulness of science and biomedicine, would be the way forward.

Although it is sometimes difficult to follow the twists and turns of the philosophical debate unless the reader is well versed in this discourse, the book provides an impetus to debate and offers some insights into the historical context of how we live, often lacking in conventional discourse.