Monday, August 14, 2017

Differences within critical psychiatry

I have uploaded a video of my talk 'Critical psychiatry: Its definition and differences' given at the AAPP conference in San Diego in May this year. Critical psychiatrists don't always agree. I suggested in the talk that there are three main areas of disagreement, although these issues may not be totally distinct:-

  1. Whether psychiatry should be seen as a medical discipline. Where there is agreement is that psychiatry is different from medicine. The disagreement arises because of how much is made of that difference. Some want to go a far as saying that psychiatry should be non-medical. Others emphasise that medicine covers both physical and mental aspects. The reality is that many patients do complain of physical symptoms which have psychosocial origins and any view on this issue has to take note of psychosomatic medicine.
  2. Whether the Mental Health Act should be abolished. Where there is agreement is that critical psychiatry emphasises the rights of people with mental health problems. This emphasis leads some to argue for abolishing all forced treatment and others to accept that detention can be justified by the loss of mental capacity in mental illness. All would accept that psychiatric abuse is not justified and coercion needs to be minimised.
  3. Whether it is suitable to see mental disorder as illness and disease. Where there is agreement is that all identify there is a problem with seeing mental disorder as brain disease. But the questions are: should it be seen as illness; and is psychiatric diagnosis valid? Some conclude that mental disorder is not illness and alternatives are required to psychiatric diagnosis and others accept that psychological dysfunction can be understood as illness and that diagnostic concepts should be understood for what they are. Diagnoses should not be reified, and seen as ‘things’. Instead they are merely idealised, hypothetical constructs and if they have any value should be understood as such.

In summary, the essential critical psychiatry position of challenging the claim that mental disorders have been established to be brain diseases can lead to some differing perspectives within critical psychiatry. As I have said several times, critical psychiatry is a 'broad church', but it does coalesce round the view that the biomedical hypothesis that functional mental illness is due to brain disease is based on faith, desire and wish fulfilment rather than logic (eg. see previous post).

(with thanks to Kermit Cole for making the video)


cobweb said...

Thank you very much Duncan for putting up the video. To be honest I am not sure how much the significant differences between you all are going to help service users. One of the big problems is actually that people have no choice about who they get referred to - and as you point out one will have one perspective another a different one which will effect how a service is provided and the lives of real individals . The truth is that there is a rise of over 30percent of people going to emergency departments by ambulance as there are no appropriate services to get help - psychological, medical or social. It is likely to lead to more over medication and more involuntary hospitalisation. Whereas at one time therapy seemed to provide hope even that is being undermined by the obvious lack of provision , the m0st person centred practice of all - psychoanalysis, is being corrupted by the mechanisation of assessment and diagnoses as described in the Psychodynmic Diagnostic Manual -pub july 2017 which apes the dehumanising psychiatric diagnostic manual in an attempt to make it more 'scientific'. The training of new mental health workers is being made to seem more modern and 'exciting' by the neuroscience project.
So you ask for suggestions - abolish the college of psychiatrists which has too many vested interests which do not serve the public, close down the remaining institutions where people do not get properly cared for, close down the private clinics which are profiting from misery and open small user led centres, give the massive amounts of funds which are wasted on institutions to projects users want including 'meetups' and other peer led projects. let service users themselves employ those who will best serve and genuinely care about them. Psychiatric colleges have had their day. Small is beautiful. The power differential needs to be radically adjusted =there are a whole two services users and carers on the college of psychs cttee - what a joke - so that service users and others who could radically change the services are enabled rather than constantly disempowered from making provision humane and trustworthy.

Claire Muir said...

Obviously the fact that one can be forced treated even if you have capacity should be changed in the scottish mental health act and the human rights act should be amended to reflect any disagreement on this.As it stands, we have two conflicting laws. This can't be right no matter who agrees or disagrees.

cobweb said...

A complete ban of people being pinned face down, their clothes pulled down and injections given in the buttocks. Apart from being an assault, some clinics have never used it, that this has obvious sexual implications is obvious.
Bring in sanctions against heath workers who make derogatory remarks in persons' files - not only insulting and unethical but has knock on effects on how subsequent workers may behave.
Strengthen rights to have proof of consent to medications and other treatments recorded on files ie clients' signatures to state informed consent has been given.
Give people rights to know what type of treatment the health worker they are referred to favours and practices and in reality rather than on paper the right of choice of an alternative.
When adverse effects of medication is experienced there must be reliable way of clients being able to report them and have their report acknowledged and recorded on a data base if they agree. so that a record of adverse effects can be built up too often -they are belittled and undermined which is causing harm. The Yellow Card Scheme is not working. People can still be blocked from reading their files - there needs to be something done about this.
More funding to be given to 'user' controlled projects