Wednesday, September 24, 2014

Controversy in psychiatry

A Lancet Psychiatry editorial argues for compromise in debates about mental health issues. I do agree that "the opportunities for global discussion on blogs and social media [shouldn't be] ... squandered". However, it is important, if there is going to be any change in mental health services, that the critical psychiatry position is stated explicitly.

The danger of accommodating all perspectives is that what is being said becomes "intellectually empty" and "ethically blind". This was the verdict, for example, of Andrew Scull on Meyerian psychobiology in his book Madhouse about Henry Cotton, whose programme of radical surgery led to significant mutilation and death by removing parts of the bodies of patients to eliminate what Cotton thought were focal infections believed to be the cause of mental illness. Meyer seemed unable to acknowledge the damage Cotton caused, instead writing a favourable obituary, suggesting he had "an extraordinary record of achievement". When Cotton was alive, Meyer suppressed a report of the poor outcome of Cotton's work in the forlorn hope he could persuade Cotton to accept the reality of his results.

I have indicated several times in this blog that Meyer's theoretical position was not dissimilar from critical psychiatry. However, his compromising position meant that he did not follow through on his challenge to biomedical psychiatry. I quote in my article from a heartfelt note written in the early hours of the morning a few years before he died, where he questions whether he "pussyfoot[ed] too much". He wished he had made himself "clear and in outspoken opposition, instead of a mild semblance of harmony" [his emphasis]. I would actually like mainstream psychiatry to engage more with critical psychiatry, rather than marginalising it.

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