Friday, March 02, 2018


I have been re-reading the book Postpsychiatry by Pat Bracken (see previous post with link to his profile) and Phil Thomas (see his About Me webpage). They also wrote a chapter for my Critical Psychiatry book and a recent book chapter entitled 'Reflections on critical psychiatry' (see another previous post). Other pieces they have written together include a PPP article.

As Phil says in his 'Critical Psychiatry in The UK: A Personal View':-
Postpsychiatry started life as a series of short articles in Open Mind magazine [see reprints] from 1997 – 2001 .... This was followed by an article in the British Medical Journal Education and Debate section (Bracken & Thomas, 2001), and a book of the same name four years later in Oxford University Press’s series on philosophy and psychiatry (Bracken & Thomas, 2005). 
Postpsychiatry sees psychiatry as a creation of the Enlightenment and a modernist enterprise. The book starts with a reference to Foucault's Madness and Civilisation. Foucault viewed the Enlightenment as oppressive and saw the 'great confinement' in the 17th and 18th centuries as, in Pat and Phil's words, "a massive European move towards the social exclusion of 'unreason'" (p. 91). Pat and Phil note that Foucault moved away from an understanding of power as something negative. As they also say, "in the 20th century, psychiatry became something bigger than simply the governing power of the asylum" (p. 93).

They, therefore, view postmodernism as "an addition to, rather than a rejection of, previous critical positions" and insist that it is "not a flight to mindless relativism" (p. 95).  Just to be clear, they say that "Foucault did not get everything right" (p.189). They, therefore, want to also follow Heidegger and Wittgenstein with a hermeneutical perspective. In the book, they look at what they call the narrative turn in medicine and psychiatry. Overall, they are not proposing "some sort of postmodern canon" (p.189).

Postpsychiatry is, therefore, not arguing for a strong form of social constructivism. My main problem with postpsychiatry is its historical narrative, maybe because it starts from Foucault. I have always tended to emphasise that there has always been a critical perspective within psychiatry (eg. see previous post), since the origins of modern psychiatry, which I would tend to date from state intervention in the asylum, rather than the 'great confinement'. The development of pathology in medicine from the beginning of the nineteenth century and the application of the anatomoclinical method led to psychiatry not completely fitting with an organic understanding of illness and, for example, produced the idea of functional psychosis (see another of my book chapters).

Although Pat and Phil mention the Enlightenment, they don't talk about Romanticism, which, in a way, was a reaction against the norms of the Enlightenment. I have highlighted the work of Ernst von Feuchtersleben in this respect (see eg. another previous post) and he used the critical philosophy of Immanuel Kant to argue against a materialistic understanding of mental illness. Similarly, modernism wasn't the only perspective at the turn of the twentieth century and, as I have said, Pat and Phil themselves mention hermeneutics. Personally, I have emphasised the pragmatic perspective of Adolf Meyer (eg. see another previous post), which, at least in theory, focused on the limitations of psychiatric practice (see eg. my article).

Postpsychiatry may be the best known form of critical psychiatry and is central to critical psychiatry's understanding of its own nature.


Anonymous said...

You might also have included the dact that Meyer was interested in the idea of 'mental hygeine of races' and a prominent member of the Eugenics movement. He was involved with the eugenics records office in USA which collected masses of data on citizens.

Duncan Double said...

Might be more complicated than that - see

Clive Sherlock said...

We might be in a hall of mirrors with infinite reflections of reflections without realising what drives and colours and steers and gives rise to those reflections that appear in our individual consciousness (mind).

As Thomas Merton wrote (Seven Story Mountain, (1st ed., 1948) SPCK ed., page 205):

'How deluded we sometimes are by the clear notions we get out of books. They make us think that we really understand things of which we have no practical knowledge at all. I remember how learnedly and enthusiastically I could talk for hours about mysticism and the experimental knowledge …, and all the while I was stoking the fires of the argument with Scotch and soda.
My internal contradictions were resolving themselves out, indeed, but still only on the plane of theory, not of practice: not for lack of good-will, but because I was still so completely chained and fettered by … my attachments.
I think that if there is one truth that people need to learn, in the world, especially today, it is this: the intellect is only theoretically independent of desire and appetite in ordinary, actual practice. It is constantly being blinded and perverted by the ends and aims of passion, and the evidence it presents to us with such a show of impartiality and objectivity is fraught with interest and propaganda. We have become marvelous at self-delusion; all the more so, because we have gone to such trouble to convince ourselves of our own absolute infallibility. The desires of the flesh, and by that I mean … even the ordinary, normal appetites for comfort and ease and human respect, are fruitful sources of every kind of error and misjudgement, and because we have these yearnings in us, our intellects (which, if they operated all alone in a vacuum, would indeed, register with pure impartiality what they saw) present to us everything distorted and accommodated to the norms of our desire.
And therefore, even when we are acting with the best of intentions, and imagine that we are doing great good, we may be actually doing tremendous material harm and contradicting all our good intentions. There are ways that seem to men to be good, the end whereof is in the depths of hell.'