Sanctuary: The Arbours Experience of Alternative Community Care edited by Joseph H Berke, Chandra Masoliver and Thomas J Ryan Published by Process Press (1995) pp 189 Price £15.95

I enjoyed this book a great deal, both as a piece of literature ant] as an account of the work undertaken by the Arbours Community. As a piece of literature it is enjoyable because so many people have contributed to it and each writer has their own style. Rather like chinese meals where each person orders a different dish - from seaweed to shark's fill soup. You can sample -a range of flavours quite safely. The contributors come from a range of cultural backgrounds, Spain, Ireland, America and Manchester, each writer bringing to the book their own experience of the Arbours Communities. It is this diversity that makes the book fascinating, being written not only by professionals, but also by ex-patients. 'Matilda' writes about the 'Confessions of a Misfit', whilst Peter remembers being told 'We Never Promised you a Rose Garden'. Mixed in with these papers are pieces that cover the spectrum of community life. Sol Salunn Kjartansdottir writes of what it meant for her when two men could not be contained by the community. One killed himself and one was admitted to hospital. "For me", she writes "this was a shattering experience, bearing ill mind that when I entered the world of psychotherapy I had little doubt that I was going from a bad alternative to an ideal one. But with the recognition that therapeutic communities are not ideal, my perception of good therapy and bad medicine has lost its force" (p58). (I, too, have had to reach a similar conclusion over time.) If Salmin Kjartansdottir writes from the kitchen, Alasdair Sokeld takes us on a tour of inspection throughout the house pointing out tile importance of the physical environment and its impact oil the guests. I wonder what the Feng Shui practitioner Arbours uses would make of the average NHS acute admission ward?

Having sampled some of the individual dishes it's time to review the meal as a whole. The book's full title is Sanctuary - The Arbours Experience of Alternative Community Care and that is what we have a picture of; the Arbour's model of care. As I was reading the book, I found myself feeling quite envious of those who are involved with Arbours, it seems such a rich experience. Yet it is easy to glamorise tile work. Joe Berke's piece on 'Psychotic Interactions' gives a vivid picture of the pressure staff work under, and their very everyday reaction to this stress. Rage, scapegoating and a near lynch-mob gunning for their leader. Similar themes emerge in the accounts of almost all the therapists, their time was remarkable but they are glad it's behind them!

The writers of this book made a valuable contribution to the story of tile Arbours Communities. They also raise important questions about the kind of care the mentally ill receive. I suspect that (he Arbours cart exist only because there is an NUS willing to take the bulk of (lie mentally ill within its wards. Were they an NHS unit they would be hard pressed to function as they do. That ill its turn raises vital questions about health care in its broadest terms. The relationship between money and health is a complicated one, but nevertheless, a real one.

To return to my metaphor of a meal, lily favourite dish was provided by Ron Lacey in his paper 'Still Pioneering After All These Years'. He is talking about traditional psychiatry and traditional organic psychiatrists. lie writes &Tile prescription pad is the magical fetish object which maintains organic psychiatry's lofty position as the final arbiter oil the "feeds of the mentally ill' (p148). I wish I'd coined that phrase!!

Terry Burridge

Mental Health Nurse

334 Therapeutic communities (1998) Vol. 19(4)