Pro-psychiatry and psychiatric diagnosis

I've mentioned before Andrew Scull's (2023) article which claims that David Rosenhan's (1973) 'On being sane in insane places' is a "spectacularly successful case of scientific fraud" (see previous post). I agree the evidence suggests Rosenhan at least exaggerated his finding that people could gain admission to psychiatric hospital and mislead psychiatrists into diagnosing schizophrenia to reinforce his belief that psychiatric diagnosis is subjective and does not reflect inherent patient characteristics.

What I want to emphasise, though, is the importance of Rosenhan's study in reinforcing the split between so-called anti-psychiatry and pro-psychiatry. Generally I don't like people using the term 'anti-psychiatry' because it's used as a way of marginalising even legitimate critique of psychiatry (see eg. recent post). 

However, there is a sense in which we need to accept that 'anti-psychiatry' as used by mainstream psychiatry has stuck (see eg. previous post). It's seen as a passing phase in the history of psychiatry from the 1960/70s from which psychiatry has now recovered. In other words, we're now in the period of pro-psychiatry. Tom Burns suggests that four revolutionary books first published in 1960/1 by R.D. Laing, Michel Foucault, Erving Goffman and Thomas Szasz started off this period of anti-psychiatry (see another previous post).

The term 'anti-psychiatry' itself was not really introduced until 1967 by David Cooper in his books Psychiatry and anti-psychiatry (1967) and The dialectics of liberation (1968). The anti-psychiatry movement was taken up by the counter-culture to free itself from what it saw as the oppressive nature of society, which included psychiatry suppressing our true potentialities. With the waning of the counter-culture, anti-psychiatry is also seen as having faded away in significance.

However, the anti-authoritarian, popular, even romantic, attack on psychiatrists' use of diagnosis, drug and ECT treatment and involuntary hospitalisation caused a crisis for mainstream psychiatry. Rosenhan's (1973) paper on psychiatric diagnosis added to that crisis. In particular, Robert Spitzer, as Chair of the Task Force, was so panicked that psychiatric diagnosis may be unreliable that he introduced operational criteria for the definitions of psychiatric disorders in DSM-III, building on work with the Research Diagnostic Criteria (RDC) (see eg. my article). This provided a way for psychiatry to move on from the criticisms of anti-psychiatry, including Rosenhan. 

So, even if it suits pro-psychiatry to discover that Rosenhan's study was fraudulent or at least exaggerated, it still has to deal with the fact that DSM-III was seen as necessary to counter anti-psychiatry. Although Spitzer always insisted DSM-III was atheoretical, it was associated with a resurgence of biomedical thinking in psychiatry, sometimes called neo-Kraepelinian (see eg. previous post). This is now seen as the pro-psychiatry position and any criticism may still be labelled as anti-psychiatry. 

Actually, what psychiatry needs to do is move on from this polarisation between pro-psychiatry and anti-psychiatry, which it’s still not yet done. There are legitimate critiques of the biomedical perspective in psychiatry. Although the biomedical perspective may always have been dominant, psychiatry has been more open-minded in the past and needs to return to being more open and therapeutic in its approach, rather than defending an outdated biological view of primary mental illness (see eg. my article).