EXCLUDING CRITICAL PSYCHIATRY

EXCLUDING CRITICAL PSYCHIATRY

D B Double

Recent Psychiatric Bulletin editorial

New ‘culture war’ between postpsychiatry and academic psychiatry


New ‘culture war’ between postpsychiatry and academic psychiatry

Postpsychiatry strikingly similar to ‘anti-psychiatry’


‘Anti-psychiatry’ used by the mainstream to disparage any opposition


‘Anti-psychiatry’ used by the mainstream to disparage any opposition

Critical psychiatry seeks to avoid the polarisation engendered by anti-psychiatry

Anti-psychiatry defined by the mainstream

International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth, 1973)

Anti-psychiatry defined by the mainstream

International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth, 1973)

Generally seen as a passing phase in the history of psychiatry

What’s so threatening about anti-psychiatry?

Attack on psychiatrists' use of diagnosis, drug and ECT treatment and involuntary hospitalisation

What’s so threatening about anti-psychiatry?

Attack on psychiatrists' use of diagnosis, drug and ECT treatment and involuntary hospitalisation

Some activists do want to abolish psychiatry

RD Laing (1927-1989)

Not an anti-psychiatrist

RD Laing (1927-1989)

Not an anti-psychiatrist Athough agreed with

anti-psychiatric thesis “by and large psychiatry functions to exclude and repress those elements society wants excluded and repressed”

RD Laing (1927-1989)

Madness is much more understandable than commonly assumed

RD Laing (1927-1989)

Madness is much more understandable than commonly assumed

So-called normality is too often an abdication of our true potentialities

Thomas Szasz (1920-)

Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion


Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion

“Because both the anti-psychiatrists and I oppose certain aspects of psychiatry, our views are combined and confused, and we are often identified as the common enemies of all of psychiatry”


Mental illness is a myth, as disease is physical


Mental illness is a myth, as disease is physical

State should not interfere in mental health practice or medicine in general

The “anti” element in anti-psychiatry

Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems

The “anti” element in anti-psychiatry

Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems

May have gone too far in abandoning notion of mental pathology

Excesses of anti-psychiatry

Laing ultimately more interested in personal authenticity than changing psychiatry

Excesses of anti-psychiatry

Laing ultimately more interested in personal authenticity than changing psychiatry

Few would want to go as far as Szasz in proposing no mental health law

David Cooper (1931-1986)

Psychiatry and anti-psychiatry (1967)

David Cooper (1931-1986)

Psychiatry and anti-psychiatry (1967)

Excursion into family, sexual and revolutionary politics

Is critique of psychiatry really so threatening?

Reflective practice should be encouraged


Reflective practice should be encouraged

Psychiatry can be too dogmatic


Professional security needs should not be overriding


Professional security needs should not be overriding

Critical psychiatry should not be tarnished with the same rotten reputation as anti‑psychiatry

Pluralism in psychiatry (1900-1970)

Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909



Pragmatic approach of Adolf Meyer - Psychobiology



Pragmatic approach of Adolf Meyer - Psychobiology

Interpersonal approach of Harry Stack Sullivan focused on the person

Critical psychiatry website

www.anti-psychiatry.co.uk

http://www.anti-psychiatry.co.uk/




www.uea.ac.uk/~wp276





www.uea.ac.uk/~wp276 Critical Psychiatry

Network www.criticalpsychiatry.co.uk



http://www.uea.ac.uk/~wp276

http://www.criticalpsychiatry.co.uk/




Reservations about teaching critical psychiatry to medical students

Asked to take down webpages from my personal webspace



Consultant colleagues concerned I may mislead students



Consultant colleagues concerned I may mislead students

Suggested university should not be seen as linked with critical psychiatry

Critical psychiatry is a legitimate academic and clinical activity

University encourages both staff and students to use their personal webspace



Academic freedom is essential for the development of unorthodox or new opinions



Academic freedom is essential for the development of unorthodox or new opinions

Doctors should be encouraged to think about their professional role

Critical Psychiatry Network

Formed in 1999


Formed in 1999 Small group of

psychiatrists


Formed in 1999 Small group of

psychiatrists Develop a critique of

the contemporary psychiatric system.

Promoting the critical mental health movement

Ranges from reform to revolution



Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness



Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness

Mental disorders must show through the brain but not always in the brain

Historical perspective on critique of psychiatric diagnosis

Crisis of confidence created in the 1960s and 70s



Particularly about its vague diagnostic categories



Particularly about its vague diagnostic categories

Rosenhan - psychiatric diagnosis is subjective and does not reflect inherent patient characteristics

Mainstream response

Psychiatrists do not detect pseudopatients simulating signs of mental illness – Spitzer “…assuredly an unreliable system must be invalid”

Mainstream response

Psychiatrists do not detect pseudopatients simulating signs of mental illness – Spitzer “…assuredly an unreliable system must be invalid”

Operational diagnostic criteria for psychiatric disorders, initially for research, and then for psychiatric classifications, such as DSM-III

Neo-Kraepelinian approach

Psychiatry could again be assured about the validity of its diagnostic categories, which had now been much better defined



Associated with reaffirmation of implicit “medical model” with focus on brain mechanisms



Associated with reaffirmation of implicit “medical model” with focus on brain mechanisms and positivistic approach to science

Acceptable limits of psychiatry

Suspended for 6 months in October 2000


Suspended for 6 months in October 2000

My philosophy about psychiatry would need to be examined and my scepticism about the use of medication challenged


Told I would be sent for retraining in organic psychiatry


Told I would be sent for retraining in organic psychiatry

Designated retrainer refused because “political”.


Not easy to adopt a critical position in psychiatry



Despite Good Medical Practice still requiring doctors to respect colleagues and not allow personal views to affect professional relationships unduly



Despite Good Medical Practice still requiring doctors to respect colleagues and not allow personal views to affect professional relationships unduly

Critical psychiatry is merely arguing for more openness in mental health practice.

Biomedical psychiatry's belief system

Brain pathology as the basis for mental illness



Avoids complicated metaphysics




Provides professional respectability




Provides professional respectability

Scientific ambition of elucidating the cause of mental illness

Synthesis of critical psychiatry

Biomedical hypothesis based on faith, desire and wish fulfilment rather than logic



Threat of anti-psychiatry taints restatement of critical psychiatry



Threat of anti-psychiatry taints restatement of critical psychiatry

Critical psychiatry is acceptable

Whistleblowing’ about psychiatry

"Psychiatry is naked," the child said.Psychiatry could not admit to that. it thought it better to continue the procession under the illusion that anyone who couldn't see its clothes was either stupid or incompetent

Undoing scapegoating of critical psychiatry

Critical psychiatry is stigmatised

Undoing scapegoating of critical psychiatry

Critical psychiatry is stigmatised

Critical psychiatry is discriminated against

Whistleblowing about psychiatry

Critical psychiatry is “different/difficult”

Whistleblowing about psychiatry

Critical psychiatry is “different/difficult”

Wish to punish so-called deviant professional behaviour that could threaten the income, style of practice, prestige, and power of mainstream psychiatrists

Conclusion: Psychiatry is political

Take it with a grain of salt

EXCLUDING CRITICAL PSYCHIATRY

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