Thursday, March 05, 2020

Critical thinking in psychiatry

I've been struggling trying to understand why Awais Aftab hasn't interviewed many critical psychiatrists in his 'Conversations in Critical Psychiatry' series for Psychiatric Times (see post on his blog). I think the title of the series should really be 'Critical Conversations in Psychiatry'.

The last chapter of my edited Critical Psychiatry book (see previous post) had a section on the relationship between critical psychiatry and critical thinking (see extract). Critical psychiatry, of course, wants to promote critical reflection on practice and research in psychiatry. Psychiatrists need to be conceptually competent (see previous post).

Critical psychiatry is also based on critical theory, which is quite a loose term. When the Critical Psychiatry Network was first formed, probably the best known version of critical psychiatry was postpsychiatry (see previous post). I always had my doubts about basing critical psychiatry on postmodernism, and over recent years, perhaps particularly since reading John Iliopoulos's book (see eg. previous post), I think I have gained a better understanding of Foucault. David Ingelby (see another previous post) probably originated the term 'critical psychiatry' and, in the American context, where Awais is based, Manschrek and Kleinman (1977) decried the deficiency of critical rationality in psychiatry in their edited book Renewal in psychiatry (see yet another previous post).

Furthermore, critical psychiatry is a social and professional activity. The Critical Psychiatry Network provides a forum to develop a critique of the contemporary psychiatric system. It is a challenge to the biomedical dominance of psychiatry. More specifically critical psychiatry's challenge to reductionism and positivism, including mechanistic psychological approaches, creates a framework which focuses on the person and has ethical, therapeutic and political implications for clinical practice (see eg. my editorial).

I'm very happy for psychiatrists to identify themselves as critical thinkers. I don't want to undermine the series Awais is doing for Psychiatric Times. On the other hand, the number of psychiatrists prepared to adopt the theory and role of critical psychiatry may well be a different matter. As far as I can see, critical psychiatry is still marginal to mainstream practice. In fact, psychiatrists saying they are "all critical now" is a way of marginalising critical psychiatry further (see previous post).

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