excluding critical psychiatry
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EXCLUDING CRITICAL PSYCHIATRY. D B Double. Recent Psychiatric Bulletin editorial. New ‘culture war’ between postpsychiatry and academic psychiatry. Recent Psychiatric Bulletin editorial. New ‘culture war’ between postpsychiatry and academic psychiatry - PowerPoint PPT PresentationTRANSCRIPT
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EXCLUDING CRITICAL PSYCHIATRY
D B Double
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Recent Psychiatric Bulletin editorial
New ‘culture war’ between postpsychiatry and academic psychiatry
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Recent Psychiatric Bulletin editorial
New ‘culture war’ between postpsychiatry and academic psychiatry
Postpsychiatry strikingly similar to ‘anti-psychiatry’
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Recent Psychiatric Bulletin editorial
‘Anti-psychiatry’ used by the mainstream to disparage any opposition
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Recent Psychiatric Bulletin editorial
‘Anti-psychiatry’ used by the mainstream to disparage any opposition
Critical psychiatry seeks to avoid the polarisation engendered by anti-psychiatry
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Anti-psychiatry defined by the mainstream
International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth, 1973)
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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
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What’s so threatening about anti-psychiatry?
Attack on psychiatrists' use of diagnosis, drug and ECT treatment and involuntary hospitalisation
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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
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RD Laing (1927-1989)
Not an anti-psychiatrist
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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”
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RD Laing (1927-1989)
Madness is much more understandable than commonly assumed
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RD Laing (1927-1989)
Madness is much more understandable than commonly assumed
So-called normality is too often an abdication of our true potentialities
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Thomas Szasz (1920-)
Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion
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Thomas Szasz (1920-)
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”
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Thomas Szasz (1920-)
Mental illness is a myth, as disease is physical
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Thomas Szasz (1920-)
Mental illness is a myth, as disease is physical
State should not interfere in mental health practice or medicine in general
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The “anti” element in anti-psychiatry
Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems
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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
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Excesses of anti-psychiatry
Laing ultimately more interested in personal authenticity than changing psychiatry
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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
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David Cooper (1931-1986)
Psychiatry and anti-psychiatry (1967)
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David Cooper (1931-1986)
Psychiatry and anti-psychiatry (1967)
Excursion into family, sexual and revolutionary politics
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Is critique of psychiatry really so threatening?
Reflective practice should be encouraged
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Is critique of psychiatry really so threatening?
Reflective practice should be encouraged
Psychiatry can be too dogmatic
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Is critique of psychiatry really so threatening?
Professional security needs should not be overriding
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Is critique of psychiatry really so threatening?
Professional security needs should not be overriding
Critical psychiatry should not be tarnished with the same rotten reputation as anti‑psychiatry
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Pluralism in psychiatry (1900-1970)
Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909
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Pluralism in psychiatry (1900-1970)
Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909
Pragmatic approach of Adolf Meyer - Psychobiology
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Pluralism in psychiatry (1900-1970)
Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909
Pragmatic approach of Adolf Meyer - Psychobiology
Interpersonal approach of Harry Stack Sullivan focused on the person
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Critical psychiatry website
www.anti-psychiatry.co.uk
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Critical psychiatry website
www.anti-psychiatry.co.uk
www.uea.ac.uk/~wp276
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Critical psychiatry website
www.anti-psychiatry.co.uk
www.uea.ac.uk/~wp276 Critical Psychiatry
Network www.criticalpsychiatry.co.uk
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Reservations about teaching critical psychiatry to medical students
Asked to take down webpages from my personal webspace
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Reservations about teaching critical psychiatry to medical students
Asked to take down webpages from my personal webspace
Consultant colleagues concerned I may mislead students
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Reservations about teaching critical psychiatry to medical students
Asked to take down webpages from my personal webspace
Consultant colleagues concerned I may mislead students
Suggested university should not be seen as linked with critical psychiatry
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Critical psychiatry is a legitimate academic and clinical activity
University encourages both staff and students to use their personal webspace
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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
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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
Doctors should be encouraged to think about their professional role
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Critical Psychiatry Network
Formed in 1999
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Critical Psychiatry Network
Formed in 1999 Small group of
psychiatrists
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Critical Psychiatry Network
Formed in 1999 Small group of
psychiatrists Develop a critique of
the contemporary psychiatric system.
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Promoting the critical mental health movement
Ranges from reform to revolution
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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
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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
Mental disorders must show through the brain but not always in the brain
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Historical perspective on critique of psychiatric diagnosis
Crisis of confidence created in the 1960s and 70s
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Historical perspective on critique of psychiatric diagnosis
Crisis of confidence created in the 1960s and 70s
Particularly about its vague diagnostic categories
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Historical perspective on critique of psychiatric diagnosis
Crisis of confidence created in the 1960s and 70s
Particularly about its vague diagnostic categories
Rosenhan - psychiatric diagnosis is subjective and does not reflect inherent patient characteristics
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Mainstream response
Psychiatrists do not detect pseudopatients simulating signs of mental illness – Spitzer “…assuredly an unreliable system must be invalid”
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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
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Neo-Kraepelinian approach
Psychiatry could again be assured about the validity of its diagnostic categories, which had now been much better defined
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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
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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 and positivistic approach to science
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Acceptable limits of psychiatry
Suspended for 6 months in October 2000
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Acceptable limits of psychiatry
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
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Acceptable limits of psychiatry
Told I would be sent for retraining in organic psychiatry
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Acceptable limits of psychiatry
Told I would be sent for retraining in organic psychiatry
Designated retrainer refused because “political”.
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Acceptable limits of psychiatry
Not easy to adopt a critical position in psychiatry
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Acceptable limits of psychiatry
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
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Acceptable limits of psychiatry
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
Critical psychiatry is merely arguing for more openness in mental health practice.
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Biomedical psychiatry's belief system
Brain pathology as the basis for mental illness
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Biomedical psychiatry's belief system
Brain pathology as the basis for mental illness
Avoids complicated metaphysics
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Biomedical psychiatry's belief system
Brain pathology as the basis for mental illness
Avoids complicated metaphysics
Provides professional respectability
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Biomedical psychiatry's belief system
Brain pathology as the basis for mental illness
Avoids complicated metaphysics
Provides professional respectability
Scientific ambition of elucidating the cause of mental illness
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Synthesis of critical psychiatry
Biomedical hypothesis based on faith, desire and wish fulfilment rather than logic
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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
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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
Critical psychiatry is acceptable
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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
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Undoing scapegoating of critical psychiatry
Critical psychiatry is stigmatised
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Undoing scapegoating of critical psychiatry
Critical psychiatry is stigmatised
Critical psychiatry is discriminated against
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Whistleblowing about psychiatry
Critical psychiatry is “different/difficult”
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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
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Conclusion: Psychiatry is political
Take it with a grain of salt