Friday, August 10, 2018

Realising the right to mental health

The European Psychiatric Association (EPA) has expressed "great concern and disappointment" in a position paper about what it sees as "the misleading and false portrayal of psychiatry ... as well as the lack of any evidence or statistics supporting this opinion" in a report from the UN Special Rapporteur, Dainius Pūras, who I mentioned in my last post. I actually thought the report was very good (see previous post).

EPA is particularly concerned by what it sees as the ignoring of evidence for the effectiveness of psychotropic medication, which it says "risks harming people" by encouraging avoidance of treatment. It defends the biomedical approach and does not see it as "a source of neglect, abuse and coercion" or as "the key factor explaining the current unsatisfactory status of mental healthcare". Rather, it sees inadequate government funding as the primary obstacle to mental health.

The EPA position paper is helpful in clarifying points of disagreement. I've always emphasised the need to avoid polarisation in the debate about psychiatry. However much I think the biomedical view is wrong, I am aware that it will never go away.

Recognising the bias in the evidence for psychotropic medication is not unscientific. In fact, I've always said psychiatry needs to be more scientific in its interpretation of the evidence (eg. see previous post). It is true that biomedical theories are used to encourage people to take their medication (eg. see previous post) but I've always found that patients are able to understand that a physical basis for mental illness has not been established.

I do see the dominance of the biomedical approach as an obstacle to the realisation of the right to mental health. We need a more balanced perspective. The tendency to reduce people to objects, which the biomedical approach can encourage, hinders understanding of peoples' problems and may prevent helping them deal with their problems. Of course some patients take a biomedical perspective but imposing such a view on people is a misuse of psychiatric power. The EPA should encourage further debate on these issues.

Thursday, August 09, 2018

Institutional corruption in psychiatry

I've commented before on corruption within psychiatry (eg. see previous post). Dainius Pūras, the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, who I have mentioned before (eg. see previous post), produced a report last year on corruption and the right to health, with a special focus on mental health. The World Psychiatric Association (WPA) objected strongly to the report (see letter sent to Dainius Pūras) and seems to be particularly complaining about the specific focus on psychiatry.

Robert Whitaker and Lisa Cosgrove in their book Psychiatry under the influence highlighted the institutional corruption due to over-marketing of stimulants for ADHD, the expansion of the notion of depression, the extension of SSRI antidepressants for other neurotic conditions besides depression and for children, and the promotion of mood stabilisers (see previous post). Perhaps WPA need to read this book to find the evidence for the statements in the Special Rapporteur's report.

There is no doubt that psychiatric power is misused for private gain. It seems reasonable that the Special Rapporteur should have a focus on corruption in mental health in this report, taking into account the context of his previous report, which raised the issue of the global burden of obstacles that persists in mental health care systems globally and how this hinders the realisation of the right to mental health. These obstacles include (1) the dominance of the biomedical model and the overuse of biomedical interventions, in particular psychotropic medications (2) power asymmetries and (3) the use of biased evidence.

Institutional corruption develops when systemic practices, which are legal, accepted and normative, nonetheless undermine the integrity of the institution. Disclosure is insufficient to control conflicts of interest (see previous post). In fact, there is little attempt to hide the commercialisation of psychiatry. Ironically being open about commercial interests does not purify psychiatric science but rather exposes its self-interest (see another previous post). The WPA does need to recognise and correct its own institutional corruption. The corrupting self-interests of psychiatry demand change in psychiatric practice.