Psychiatry must be clear that most mental illness is not due to brain abnormality

I reviewed Samei Huda’s book The medical model in mental health: An explanation and evaluation (2019) when it first came out (see review). Jo Moncrieff and I also responded to his Asylum article entitled ‘Critical psychiatry: Dead ends and avenues of opportunity’ (see both articles).

Samei has taken forward his commentary on critical psychiatry in a recent BJPsych Bulletin article ‘Critical psychiatry in the UK: Potentially useful but in need of regeneration’. As he recognises, critical psychiatry aims to improve practice. This acknowledgement may indicate that critical psychiatry has at least moved on from anti-psychiatry, which Martin Roth (1973) condemned as  “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (see eg. previous post).

Samei accuses critical psychiatry of not fully taking on board the evidence against some of its views. His critique is not dissimilar to Anthony Clare's critique of anti-psychiatry (see eg. previous post) or Awais Aftab's promotion of integrative and critical pluralism as a variant of critical psychiatry (see eg. another previous post). The claim being made by Clare, Aftab and Huda is that mainstream psychiatry is not really as damned as critical psychiatry makes out.

As I've often said, critique psychiatry seeks to move on from the reductionism and positivism of much of modern psychiatry. Similarly, I've often said psychiatry needs to move on from a system based on a ‘disease’ model of primary mental illness. Despite Samei, I do think mainstream psychiatry is as damned as critical psychiatry makes out. Quite simply, most mental illness is not due to brain abnormality. This is not what most people hear from psychiatry and has consequences for their understanding and treatment of their mental health problems (see eg. recent post).