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 Postpsychiatry strikingly similar to ‘anti-psychiatry’

Recent Psychiatric Bulletin editorial ‘Anti-psychiatry’ used by the mainstream to disparage any opposition

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

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 ( ) Not an anti-psychiatrist

RD Laing ( ) 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 ( ) Madness is much more understandable than commonly assumed

RD Laing ( ) 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

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”

Thomas Szasz (1920-) Mental illness is a myth, as disease is physical

Thomas Szasz (1920-) 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 ( ) Psychiatry and anti- psychiatry (1967)

David Cooper ( ) Psychiatry and anti- psychiatry (1967) Excursion into family, sexual and revolutionary politics

Is critique of psychiatry really so threatening? Reflective practice should be encouraged

Is critique of psychiatry really so threatening? Reflective practice should be encouraged Psychiatry can be too dogmatic

Is critique of psychiatry really so threatening? Professional security needs should not be overriding

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

Pluralism in psychiatry ( ) Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909

Pluralism in psychiatry ( ) Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909 Pragmatic approach of Adolf Meyer - Psychobiology

Pluralism in psychiatry ( ) 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

Critical psychiatry website psychiatry.co.uk psychiatry.co.uk

Critical psychiatry website psychiatry.co.uk psychiatry.co.uk

Critical psychiatry website psychiatry.co.uk psychiatry.co.uk Critical Psychiatry Network co.uk co.uk

Reservations about teaching critical psychiatry to medical students Asked to take down webpages from my personal webspace

Reservations about teaching critical psychiatry to medical students Asked to take down webpages from my personal webspace Consultant colleagues concerned I may mislead students

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

Critical psychiatry is a legitimate academic and clinical activity University encourages both staff and students to use their personal webspace

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

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

Critical Psychiatry Network Formed in 1999

Critical Psychiatry Network Formed in 1999 Small group of psychiatrists

Critical Psychiatry Network 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

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

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

Historical perspective on critique of psychiatric diagnosis Crisis of confidence created in the 1960s and 70s

Historical perspective on critique of psychiatric diagnosis Crisis of confidence created in the 1960s and 70s Particularly about its vague diagnostic categories

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

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

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

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

Acceptable limits of psychiatry Suspended for 6 months in October 2000

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

Acceptable limits of psychiatry Told I would be sent for retraining in organic psychiatry

Acceptable limits of psychiatry Told I would be sent for retraining in organic psychiatry Designated retrainer refused because “political”.

Acceptable limits of psychiatry Not easy to adopt a critical position in psychiatry

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

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.

Biomedical psychiatry's belief system Brain pathology as the basis for mental illness

Biomedical psychiatry's belief system Brain pathology as the basis for mental illness Avoids complicated metaphysics

Biomedical psychiatry's belief system Brain pathology as the basis for mental illness Avoids complicated metaphysics Provides professional respectability

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

Synthesis of critical psychiatry Biomedical hypothesis based on faith, desire and wish fulfilment rather than logic

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

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

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