Progress in psychiatry

Peter Tyrer (who I have mentioned before, eg. see previous post) has recognised the value of critical psychiatry, however grudgingly, in his commentary on a BJPsych Advances article by Hugh Middleton & Joanna Moncrieff (also previously mentioned eg. see post). However, Tyrer thinks critical psychiatry is Luddite by hindering progress in psychiatry. Psychiatry has always had the forlorn hope that it will discover the biological basis of mental illness, and I don’t think that Tyrer has given up this wishful thinking. The examples he gives of progress in psychiatry include lithium for bipolar disorder and methylphenidate for ADHD, and these must be suspect, and even CBT for traumatic stress disorders is questionable.

I actually agree with him that critical psychiatry should be constructive. I also agree critical psychiatry’s views on psychiatric diagnosis can appear confused, but this is because there are actually different views within the critical psychiatry movement about whether psychiatric diagnosis is valid and whether mental disorder should be seen as illness (eg. see point 3 in previous post). Critical psychologists within the critical psychiatry movement, such as David Pilgrim, who Tyrer quotes, tend to be against psychiatric diagnosis. Michel Foucault, who again Tyrer mentions, actually probably wasn’t against diagnosis as such. What he was against was the positivist reduction of mental illness to brain disease (see last post). Despite what Tyrer says, incorporating positivism into psychiatry has actually made it less scientific not more (see another previous post).

Psychiatry, as well as human and life sciences in general (see previous post), need to take Kant’s explanatory anti-reductionism seriously. Kant was clear that it is absurd to expect to understand goal-directed mental disorder in physical terms. Epistemologically it’s just not possible. Consciousness is a puzzle we’d like to be able to solve but we can’t (see previous post). That doesn’t mean that we can’t study part-functions such as the brain, but we need an organismic psychiatry to treat the whole person. Such a view was present in the origins of psychiatry, such as Ernst von Feuchtersleben’s Principles of Medical Psychology (see eg. point (1) on previous post). Psychiatry needs to go back to its roots to make progress. Critical psychiatry is arguing for a positive way forward by promoting an organismic psychiatry. Psychiatry has never really been able to achieve this because of its dominant biomedical positivism.