Norman Sartorius
Sartorius was for many years Director of the Mental Health Division at the World Health Organisation—a grand sounding title, although, as he amusingly describes, in practice it described an office that consisted of just Sartorius himself. From that inauspicious base his achievements were remarkable—a series of groundbreaking studies on the international epidemiology of mental disorders, blueprints for mental health services in developing countries, and a classification system that, for all its faults, probably represents the best we can manage at present.
Born in Croatia, where part of his education was in underground schools organised by the Partisans during World War II, he qualified in Zagreb, spent time at the Maudsley Hospital in London (an enduring influence), and has held chairs in his native Zagreb, as well as in Geneva and Prague. His is a classic Mittel Europa life, giving him an enviable facility to deliver elegant and witty lectures in a bewildering variety of languages. Many of those lectures are the basis of the 19 essays in this book, and I loved every one.
Some of the essays, such as the problems of psychiatry in developing countries, the neglect of the prevention of neuropsychiatric disorders, and the false dogmas of development, reflect Sartorius' international perspective from his time at WHO, and latterly as President of the World Psychiatric Association. Most doctors whose careers climax in similarly grandiose positions hide their powerlessness underneath a panoply of pomposity; no word could less describe Sartorius. Anyone ever called upon to give advice to government would do well to read his playful advice on giving advice—he suggests “avoiding advising but if you have to do it remember that most often your advice will not be followed, that you will not usually be better liked for giving it and that you will often discover that your advice was not all that great”.
If the book has a theme, it is the willingness of health-care systems, the medical profession, and governments to make light of mental health. Sartorius' own time at WHO exemplifies this collaborators, which showed the immense public-health burden of mental disorders (a burden that continues to rise), what he describes as WHO's “mental health adventure” was always on a wing and a prayer. His achievements are once again under threat after his departure from WHO. Sartorius has tirelessly campaigned against the stigma of mental disorders, and his moral, ethical, and even economic arguments for why health-care systems are wrong to neglect mental health are cogent and clear sighted. Psychiatry itself is not above criticism— rather the reverse. He is frustrated by our tendencies to divorce ourselves from general medicine, where, paradoxically, the most mental health care is delivered, and our tendency to schism and division. The factionalism of biological versus social psychiatry baffles and infuriates him.
Sartorius' style is often playful, but he uses his wit to reach serious conclusions, principally concerning the neglect of the mentally ill and the right those he loves to hate—such as “consumer”, which seems to link health-care delivery with the supermarket trolley and also imply that people with mental health disorders only “take, not give”. Instead, Sartorius reminds us that “living with disease and nevertheless making a contribution to society is an achievement that requires enormous effort and personal investment, it should be recognised and praised not obscured by calling it health care consumption”.