Thursday, December 20, 2018

Progress in psychiatry

Peter Tyrer (who I have mentioned before, eg. see previous post) has recognised the value of critical psychiatry, however grudgingly, in his commentary on a BJPsych Advances article by Hugh Middleton & Joanna Moncrieff (also previously mentioned eg. see post). However, Tyrer thinks critical psychiatry is Luddite by hindering progress in psychiatry. Psychiatry has always had the forlorn hope that it will discover the biological basis of mental illness, and I don’t think that Tyrer has given up this wishful thinking. The examples he gives of progress in psychiatry include lithium for bipolar disorder and methylphenidate for ADHD, and these must be suspect, and even CBT for traumatic stress disorders is questionable.

I actually agree with him that critical psychiatry should be constructive. I also agree critical psychiatry’s views on psychiatric diagnosis can appear confused, but this is because there are actually different views within the critical psychiatry movement about whether psychiatric diagnosis is valid and whether mental disorder should be seen as illness (eg. see point 3 in previous post). Critical psychologists within the critical psychiatry movement, such as David Pilgrim, who Tyrer quotes, tend to be against psychiatric diagnosis. Michel Foucault, who again Tyrer mentions, actually probably wasn’t against diagnosis as such. What he was against was the positivist reduction of mental illness to brain disease (see last post). Despite what Tyrer says, incorporating positivism into psychiatry has actually made it less scientific not more (see another previous post).

Psychiatry, as well as human and life sciences in general (see previous post), need to take Kant’s explanatory anti-reductionism seriously. Kant was clear that it is absurd to expect to understand goal-directed mental disorder in physical terms. Epistemologically it’s just not possible. Consciousness is a puzzle we’d like to be able to solve but we can’t (see previous post). That doesn’t mean that we can’t study part-functions such as the brain, but we need an organismic psychiatry to treat the whole person. Such a view was present in the origins of psychiatry, such as Ernst von Feuchtersleben’s Principles of Medical Psychology (see eg. point (1) on previous post). Psychiatry needs to go back to its roots to make progress. Critical psychiatry is arguing for a positive way forward by promoting an organismic psychiatry. Psychiatry has never really been able to achieve this because of its dominant biomedical positivism.


cobweb said...

The Beast Within - Peter Tyrer has written this particularly offensive book with an especially nasty cover to attract attention but which further stigmatises people diagnosed with a mental health problem'. One of whom wrote in the Independant in June 2018 'I do not have a beast within me waiting for a mental health practitioner to tame......He is arrogant enough to publish a book which is described by those he writes about as irresponsible, painful and stigmatising. And then ends it with 'the beast may be changed into a pussy cat'!!! Foreword by Stephen Fry the go to name for added publicity. A more useful read:- ' A Simple Guide to How to Be a Good Psychotic - Recovery in the Bin' 'A Simple Guide to It's Time psychiatrists Stopped Stereotyping Women with Personality Disorder - We Can Speak for Ourselves' 'A Simple Guide to Avoiding a Diagnosis of Personality Disorder' P D being P Tyrer's label of choice. susanne

BB999 said...

Isn’t it about time psychiatric diagnosis was removed completely in favour of searching for the root causes of the symptoms that are labelled as mental illness AND the masses were were not being medicated under the medical fraud of chemical imbalances and the dopamine hypothesis?

cobweb said...

Hi BB999

with refereence to your comment - have you come across David Healy blog abd Rxisk blog....susanne

DBDouble said...


I’m not defending Tyrer’s use of the term ‘beast’. It is true though that some people do think they need a psychiatric diagnosis to explain what they feel is ‘wrong’ with them. This has been an increasing trend, I think, over recent years, perhaps encouraged by the extension of the concept of bipolar disorder (see eg. previous post - isn’t this what Stephen Fry has been doing? - but it also applies to personality disorder, perhaps particularly borderline or unstable personality disorder. I agree with you that I’m not sure how helpful this really is in terms of people understanding their problems.


cobweb said...

Thanks very much Duncan These labels-phoney diagnoses have left the door wide open for those with an interest in neuropsychiatry to get a piece of the action - even more dehumanising developments when diagnoses by brain scans can lead to even more 'treatments' including with drugs -psychotherapists are claiming they will 'treat' people by providing a 'good relationships' which will have an effect on peoples' brains and personality - which will be proven by scanning changes in their brain. (where would they befound anyway)No talk as far as I have seen about scanning the changes in the therapists' brains which surely must be altered too or of the need to scan the therapists' brains before allocated to 'treat' someone to 'assess' them as suitable. And which paragon will be doing the 'assessments' anyway. Arrogance and ignorance and access to the funds provided by governments are a dangerous combination as the history of psychiatry shows