Personality Disorder and Human Worth: Papers from a Conference Organised by the Board for Social Responsibility Edited by the Board for Social Responsibility. London: The Church of England. 2001. 43 pp. £3.00 (pb). No ISBN

Although most psychiatrists have heard of Michel Foucault, I suspect that they do not spend much time worrying about the proper limits of medical power. It is easy to ignore ideas expressed in a manner that is obscure even by the standards of French intellectuals. In any case, the experience of working in the National Health Service soon reduces one's ability to empathise with a man who worries about doctors taking over the world.

Although psychiatrists may not worry about medical power, medical responsibility is a different matter, and they have been learning a lot about it in recent years. In this context, dangerous severe personality disorder (DSPD) is ‘Foucault's revenge’. Doctors have been attaching stigmatising labels to difficult people for years and they will now be forced to treat them (with discipline and punishment for doctor and patient alike, if things go wrong).

Critics of the DSPD initiative emphasise the problem of ‘medicalisation’. They fear that psychiatric concepts are being extended into areas of life where other models, whether moral or criminological, are more appropriate. As a contribution to this debate, one must welcome a publication from the Church of England's Board for Social Responsibility. Is this the Church's big fightback, a crusade to reclaim moral territory from the medical infidel? The title, with its reference to human worth, promises a critique of reductionism. We look forward to an alternative to the scientific view of human problems as technical difficulties to be solved by experts.

These expectations are dampened by the realisation that the first two contributors are psychiatrists, a disappointment offset by the fact that there is little psychiatry in their papers. Professor Nigel Eastman summarises the ethical objections to the proposed new Mental Health Act and Dr Bob Johnson reminds us that many violent offenders had terrible childhoods. Next the Governor of Grendon Prison summarises that institution's approach to therapy, and Jonathan Sedgewick (then Head of the DSPD programme at the Home Office) sets out proposals for the shape of services for people with DSPD. It is only in the fifth and final paper that one comes to ‘a theologian's questions’, addressed by Professor Nicolas Sagovsky, a specialist in Christian social ethics.

The most surprising thing about the theologian's questions is the extent to which they resemble those asked by the other contributors. They raise concerns about the precision of risk assessment and about the proper balance between the rights of the individual and of society. Despite the references to God, one is left with the feeling that there is little to distinguish religious and humanistic ideas in this field.

This pamphlet is inexpensive and provides a good introduction to the area for anyone who is new to it. Many psychiatrists will be familiar with the arguments and there are no new ethical insights. I was disappointed by the avoidance of some difficult questions. Contributors point out that, if we detain people on the basis of risk, the nature of probability is that we lock up people who would not have committed an offence together with those who would have. This fact is presented as though it precludes the detention of those whose personality disorder is associated with a high risk of violence. None of the contributors goes on to ask how psychiatry can justify detaining people with mental illness, to whom the same laws of probability apply. Foucault would have asked this question, and it deserves an answer.

I may have been unfair in failing to identify a distinctive religious element in this publication. As I wrote the review, the morning's news was dominated by a fierce row about whether or not a confused 94-year-old woman had made a racist remark that could justify her neglect during a 3-day stay in a casualty department. Medical staff pitched into the fray, as if dignity and confidentiality were going out of fashion. The theologian's paper includes an optimistic call for informed debate and responsibility in political life. The difference is faith.