Thursday, February 27, 2020

Has psychiatry really moved on from its radical reductionism?

I am grateful for Mohammed Rashed’s commentary on my BJPsych Bulletin editorial. At least we agree radical reductionism has had its day (or at least should have done). I also agree that the argument of critical psychiatry is partly empirical and partly philosophical, although Mohammed does not seem to appreciate that the philosophical implications, as well as empirical, are that there are no structural abnormalities in the brain in functional mental illness.

But Mohammed seems to have missed the point that critical psychiatry is not an argument just against radical reductionism. I would dispute that White et al (2012) do not take a reductionist position (see previous post). For example, they believe brain scans have shown structural brain abnormalities in various mental disorders. Mohammed does not seem to realise that critical psychiatry is against the eclecticism, which he seems to want to perpetuate, which was proposed by Anthony Clare, in particular, as the response to anti-psychiatry (see eg. previous post).

In my effort to show the continuity of critical psychiatry with mainstream psychiatry, I did not mean to give licence to the argument that “we are all now critical psychiatrists”. Psychiatry still needs to move on from a system based on a ‘disease’ model of mental illness (see eg. my Lancet Psychiatry letter). The editorial focused on conceptual aspects but feeds into all the ongoing critiques that Mohammed lists. I may not have succeeded in getting my message across but I am very clear that my version of critical psychiatry is not merely of historical interest. In fact, Mohammed shouldn’t marginalise its impact or indeed its conceptual argument.

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