Italian critical psychiatry

I mentioned John Foot's new book The man who closed the asylums: Franco Basaglia and the revolution in mental health care in a previous post before it was published in english. There has been very little published in english about Basaglia, which makes John's book very welcome. He tells the story of Basaglia's move from academia to direct the asylum at Gorizia in 1961, leading up to the passing in Italy in 1978 of law 180, which prevented new admissions to existing mental hospitals and shifted the perspective from segregation and control in the asylum to treatment and rehabilitation in society. Despite the opposition at the time, psychiatric hospitals have closed anyway over most of the Western world, as they became increasingly irrelevant to modern mental health services.

This story is interesting because, as Basaglia said in his own words, he became famous "because I 'opened up' a psychiatric hospital". He was charged twice with criminal liability following serious patient homicides because he was the "man that freed the mad".

However, what most interested me about the book was how little I know about Italian critical psychiatry, particularly the writing of Giovanni Jervis, who worked for a few years with Basaglia at Gorizia. From there he went to Reggio Emilia to develop community services.  His Manuale critico di psichiatria was reprinted continuously from 1975-97. With Gilberto Corbellini, he wrote La razionalità negata. Psichiatria e antipsichiatria in Italia (2008). It would be nice to be able to read both these books (and other related books) in english.

Jervis was not in total agreement with Basaglia. He accepted the social role of psychiatry, but still tried to expose the "margins of dissent and dysfunctionality in the system". Within the Centre for Mental Hygiene in Reggio Emilia, there was a split between Jervis and Giorgio Antonucci, who was more anti-psychiatry, in that he "aimed to destroy psychiatry as a separate technique". Within english language 'anti-psychiatry' there was a similar tension between Laing and Szsaz. I think modern critical psychiatry may well benefit from understanding the Italian historical tradition better.

Modern psychiatry's disgrace

I've mentioned before the unethical nature of modern psychiatry (eg. see previous post). Robert Whitaker and Lisa Cosgrove in their book Psychiatry under the influence call it institutional corruption. They highlight the over-marketing of stimulants for ADHD, the expansion of the notion of depression, the extension of SSRI antidepressants for other neurotic conditions besides depression and for children, and the promotion of mood stabilisers. Psychiatry has been happy to go along with these developments and of course it has suited the drug industry. But, it has required a less than rigorous examination of the evidence and a weak drug regulatory system. The book argues that declaration of conflict of interests is insufficient to correct the problem (see previous post).

The possibility of a causal link between tobacco use and psychosis does not merit further examination

Following my previous post, yet another article on the association between smoking and psychosis has been published in The Lancet Psychiatry. Usefully the article makes reference to the Bradford Hill criteria for deciding whether an association should be interpreted as causal. It suggests that the association is plausibly causal because nicotine may increase dopamine consistent with the excess striatal dopamine theory of schizophrenia. Trouble is that efforts to validate the dopamine theory of schizophrenia empirically have failed (Kendler & Schaffner, 2011).

As the comment in the same issue of The Lancet Psychiatry says, "The most likely explanation ... is that cigarette smoking is associated with an increased risk for schizophrenia." Factors in the social environment, such as family history, urban environment and childhood adversity, are associated with both smoking and psychosis. A social environmental explanation of both psychosis and smoking is much more plausible than a biochemical explanation that the empirical evidence contradicts.