Tuesday, June 21, 2016

Stop psychiatric abuse

Peter Breggin has a blog on Mad in America entitled "Forced 'treatment' is torture". His blog follows that by Peter G√łtzsche entitled "Abolishing forced treatment in psychiatry is an ethical imperative". I agree psychiatric abuse must be prevented.

For both Peters, as it did for Thomas Ssasz, psychiatric abuse includes detention in hospital. They want to abolish all forced intervention in psychiatry. Here I do not agree. Society does expect psychiatry to manage madness on its behalf. However much informal and voluntary interventions, including psychotherapy, may have developed since the origins of psychiatry with the asylums in the 19th century, they have not completely replaced the need for compulsory detention. From a position in private practice, Peter Breggin may well have never detained anyone against their will. As he says, "Someone in an out-of-control manic episode or someone threatening to do harm in a psychotic episode presents difficult problems to civil libertarians and to those of us who wish to help people in distress while protecting others from them." However, he can't use these situations to justify mental health legislation, whereas I think I can.

Where I do agree is about the need to improve safeguards for forced medication. In England, apart from the right of appeal to the Mental Health Tribunal and hospital managers, this is primarily about having access to a Second Opinion Approved Doctor (SOAD) but only after 3 months of receiving medication. Patients on a community treatment order (CTO) with the threat of recall to hospital may take medication and be considered to be consenting to medication and therefore not be referred to a SOAD. The Alaska Supreme Court case ruling, referred to by Peter G√łtzsche, needs to be enforced so that someone should not be given medication against their will without "first proving by clear and convincing evidence that it is in their best interests and there is no less intrusive alternative available". We do need to have much more of an open debate about whether there is any justification for the forcible injection of medication, and, therefore, I welcome the two Peters contribution to this debate. Coercion in psychiatry needs to be reduced.

Wednesday, June 15, 2016

Philosophical perspectives on critical psychiatry

Next May's meeting of the Association for Advancement of Philosophy and Psychiatry in San Diego is on "Philosophical Perspectives on Critical Psychiatry: Challenges and Opportunities" (see call for abstracts). It should be an interesting meeting.

I just wanted to comment on the blurb saying that critical psychiatry  is primarily about taking the "profession to task for being a source of oppression". There is no doubt that psychiatry can be oppressive. There is also no doubt about the role of psychiatry in social coercion, as it is expected to manage mental illness on behalf of society. Critical psychiatry does focus on the rights of psychiatric patients.

However, I have always argued that critical psychiatry is primarily about the conceptual nature of mental illness (see my attempt to summarise critical psychiatry in previous post). Reducing people's problems to something the matter with their brain is unhelpful, even oppressive at times. The reference to the Frankfurt school in the blurb may come from one of my references (eg. see chapter 12 of my Critical psychiatry book). I have also always been sceptical whether critical psychiatry is really based on Foucault's thinking, however much Foucault was concerned that the reason of the Enlightenment was oppressive.

Still, the suggested topics for the conference do merit further examination and I encourage you to contribute by submitting an abstract.