How to change mental health services

As I said (see last post), I am grateful for Lucy Johnstone summarising our disagreements about psychiatry. Basically, I think this boils down to the best way to effect change in psychiatry. Lucy talks about creating an alternative to mainstream psychiatry. Certainly psychiatry does need to change. It is too dominated by a biomedical model of mental illness, which in fact is outdated in terms of recent conceptual developments in biology, psychology and philosophy.

Lucy thinks that there is evidence that paradigms in psychiatry are changing. I'm not so convinced. As I have always said, the wish to find a physical basis for mental illness will never go away completely. However, I think the realisation of the extent to which that wish cannot be fulfilled can change. As it keeps emphasising, mainstream psychiatry is actually more pluralistic than simplistic critiques of the biomedical model seem to imply. The balance of perspectives can change and I think this should be the aim of any critique of psychiatry.

I have no objection to alternatives being set up. However, these do need to have firm conceptual foundations. I just think that Lucy's understanding of the notion of 'illness' is wrong. She's right that mental illness should not be understood as brain disease. But she doesn't want to use the term 'mental illness'. Of course I know that people have used, and continue to use, the term to mean brain disease. But this is mere conjecture, however much it may seem to make sense to them. Even mainstream psychiatry admits that it has not yet proven that mental illness is brain disease. The reason for this is that it cannot. The change that needs to happen is that mental illness should no longer be seen as brain disease.