Profile of a postpsychiatrist

Profile of Pat Bracken in Irish Times. Pat wrote Postpsychiatry with Phil Thomas. Postpsychiatry is one form of critical psychiatry.

I've always said that critical psychiatry can be understood without postmodernism. The split between biomedical and biopsychological approaches goes back to before the 1960s. The theoretical views of Adolf Meyer about the nature of mental illness are no different from those of critical psychiatry (eg. see my article).

My attempt to gain a profile for critical psychiatry was published in THES.

Formulating psychiatric diagnosis

This post is prompted by a comment on a previous post suggesting that psychiatric diagnosis is unscientific and that formulation is a better alternative. I've nothing against formulation. As I indicated in a previous post, it's remarkable how a full assessment in psychiatry is too often seen as almost out-of-date. When I did my membership examination for the Royal College of Psychiatrists, I was asked what my formulation of a clinical case was. This was because it was recognised that assessment was about more than formal psychiatric diagnosis.

So, I do agree that formulation is better than unscientific psychiatric diagnosis that sees diagnosis as an entity or "thing" of some sort. But I have a wider understanding of diagnosis (see eg. my article). And I do see it as scientific to do a full assessment.

I recommend the book edited by Lucy Johnstone and Rudi Dallos on formulation on my book recommendations page. It's also worth looking at Lucy's Users and abusers of psychiatry  (see my review).

Has the psychopharmacological revolution come to an end?

I don't know what to make of Peter Tyrer, the editor of the British Journal of Psychiatry, saying in his latest 'From the Editor's desk' that "The time has come to call an end to the psychopharmacological revolution of 1952". I pointed out in a previous post that he seemed to be agreeing with me about so-called 'remedicalised psychiatry' (eg. see another previous post). But surely this isn't an indication that critical psychiatry's time has come, is it?!

Actually I don't think the psychopharmacological revolution is over. Biomedical psychiatry continues to reign supreme. For example, the British Journal of Psychiatry still publishes uncritical neuroscience editorials (see previous post).

What has inspired Peter Tyrer is an editorial suggesting that the risk-benefit ratio of antipsychotics needs to be re-evaluated to facilitate informed choice and decision-making. It even suggests reappraising whether anti-psychotic medication must always be first line of treatment for people with psychosis. 

I'm sure proposals like this will be watered down. For example, I have already commented on a paper (see previous post) that the editorial references that its authors say found "a smaller antipsychotic drug-placebo difference than we had intuitively expected". Those authors went on to publish a subsequent paper which they interpreted as showing that psychiatric drugs were just as effective as other medical drugs. They even seemed to label as anti-psychiatry attempts to interpret trial data in a critical way.

I welcome any indication that mainstream psychiatry is open to critical approaches, but I think we just need to be aware of the power of the biomedical myth (see previous post). Let's see where Peter Tyrer leads the British Journal of Psychiatry in what I guess must be coming up to his retirement as editor.