Saturday, May 25, 2019

Critical psychiatry is reformist

Bonnie Burstow's chapter entitled 'From 'bed-push' to book activism: Anti/Critical psychiatry activism' in the Routledge handbook of political activism (2019) helpfully summarises her antipsychiatry position. She makes clear that "The chapter is written from an anarchist perspective". Antipsychiatry is distinguished by the fact that
... all antipsychiatry activists seek the total abolition of institutional psychiatry (and this distinction is crucial) not some just part of it and not the mere 'reform' of the institution. This, in practice, would mean that insofar as anything vaguely resembling psychiatry continued to exist, it would have no state powers, no state funding or promotion and no authoritative 'medical’ status [emphasis in original].

I've complained before about how the americanisation of critical psychiatry seems to be devaluing its meaning. For example, the Mad in America website reduces critical psychiatry to a general term for alternatives to the biomedical model in psychiatry (eg. see my book review). At places in her chapter, Bonnie Burstow seems to use the terms 'critical psychiatry' and 'antipsychiatry' interchangeably (as apparently, for example, in the subtitle of the chapter), but I'm not sure if this is intentional.

Rather than allowing the highjacking of the term 'critical psychiatry' by antipsychiatry, I think I need to make clear that critical psychiatry is a reformist movement. There are differences within the movement (see previous post) and although I'm more at the reformist end, I'm not against seeing critical psychiatry as a broad spectrum, which it is (eg. see previous post). But it's unrealistic to expect that the wish to find a physical basis for mental illness will ever go away completely. There's always been this wish, even before our modern understanding of medical psychology developed at the end of the 18th century. I've even argued that critical psychiatry was present in the origins of modern psychiatry (eg. see previous post). Critical psychiatry is certainly a medical enterprise (again, see eg. previous post).

I'm not against activism such as the 'Fast for Freedom' hunger strike in 2003 by six 'psychiatric survivors' (eg. see previous post). I attended an Occupy American Psychiatric Association meeting in the past (see previous post) and I do think there are particular issues about American psychiatry (see eg. previous post) that may require a more radical response. I also use social media as a form of activism, and some of the motivation for doing this is because of the difficulty in getting my perspective into mainstream psychiatric journals.

However, I'm not convinced that there really is what Bonnie Burstow calls "an unstoppable radical politic". But I do respect her position. and value her attempt to restate an antipsychiatry position. I originally called my Critical Psychiatry website the Anti-psychiatry website (see previous post), although it has became more defunct as it has now essentially been taken over by this blog. But I'm glad I changed the name because I never intended to promote anarchy. I'm sure that's what some people fear about critical psychiatry, but that's a misunderstanding.

I agree with Bonnie Burstow that "the mad and the antipsychiatry movements in themselves present challenges". I'm not against reconsidering my politics. But my ultimate aim is to make psychiatry more pluralistic, not to abolish it.


Anonymous said...

In an interview with Camden New Journal to publish his latest book Graham Music states
'You can actually predict Facebook use in (by?) a child by looking at a brain scan'. He and his colleagues such as Peter Fonagay, who describes him as a 'great thinker' are now promoting neuropsychiatry combined with psychoanalysis and attachment theory with it's emphasis on the effect of early caregiving plus an emphasis on the negative effects an impoverished environment. Funding is going into neuropsychiatry but very little is actually done by those promoting this project to work on the need for better housing and education for the massive number of under-priveledged people they talk about/research etc to even up the advantages they have accrued for themselves and their own children -so it comes over too much as a remnant of the well off telling the 'lower classes' as one of the group described them once, how to live. It is becoming something of a retirement project for some but however many events and theories are developed children won't thrive unless more projects are run by people who understand their lives from the inside. Change the environment and leave childrens' brains develop without this weird level of interference susanne

F68.10 said...

"But it's unrealistic to expect that the wish to find a physical basis for mental illness will ever go away completely."

Of course it will never go away. Part of it is hugely misguided. Some of it is on the right track: I have nothing against finding underlying biological phenomenon of stress or stuff about circadian rhythms, nor the rightful use of SSRIs (or whatever medication may be useful).

But believing that paranoia has a physical underpinning seems to me completely besides the point. Utterly and completely.

"Critical psychiatry is certainly a medical enterprise"

I believe that there is a place for psychiatry as a medical enterprise. I also believe that a large part of it should be demedicalised and nevertheless still exist in some form or another. Another part should be abolished plain and simple.

So it seems I'm sort of halfway between critical psychiatry and antipsychiatry, though I still believe we should address all these issues in the most rigorous and scientific way.

"However, I'm not convinced that there really is what Bonnie Burstow calls "an unstoppable radical politic"."

I think she is misguided, that she does believe in what she claims, and that even if she didn't believe in what she claims her position would still be a useful societal one.

@susan: "In an interview with Camden New Journal to publish his latest book Graham Music states 'You can actually predict Facebook use in (by?) a child by looking at a brain scan'."

Do you have a link to that interview?

Just read your comment. Graham Music's position represents to me exactly the kind of thinking that is dead wrong in psychiatric research. We really should find a way to stop researchers from focusing only on their pet peeves and start considering, in the most objective and rational manner, how their work should be redirected to contribute to the public good. We have to force them. They won't do it on their own...

F68.10 said...

For example:

"Finding the imposter: brain connectivity of lesions causing delusional misidentifications"

That kind of pathology, reduplicative amnesia, is a typical case where I believe medical psychiatry can be required, and I have no problem with people coming up with physical basis for that kind of mental illness.

That's a typical example where I find Bonnie Burstow's abolitionist perspective completely contradicted by facts. I believe she should take a position on such type of pathologies and explain how she believes they should be handled without psychiatry. If she doesn't, I believe her argument falls flat.

Anonymous said...

F6810 - if you google Camden New Journal'- Health - Tues 28th May 2019 'Childrens' brains 'hijacked' by phones and apps, warns leading psychotherapist'. That should get you there.

F68.10 said...

@Susan: Yes. I've read the article.

I'm completely appalled. We honestly need to have rationalists/skeptics out there taking all these kind of issues very seriously and poking serious fun on this type of crank.

Name and shame.

That's the only solution (well not the only one, but a requirement...) against quackery.

There should be a version of the website Respectful Insolence dedicated to all the REAL psychiatric quackery out there. And there is a fucking ton of it!