Tuesday, April 07, 2020

Not all psychiatrists are critical psychiatrists

Abdi Sanati, Chair of the philosophy special interest group at the Royal College of Psychiatrists, tweeted that anyone who is interested in critical psychiatry should read the article by Mohammed Rashed, that I commented on in a previous post. It worries me that Mohammed's article seems to be gaining such mileage, because as I see it, the article merely creates another way of marginalising critical psychiatry. The sentiment behind it seems to be that "we're all critical psychiatrists now". The argument seems to be that silly old critical psychiatry was attacking the straw man of radical reductionism and we've all moved on from that, haven't we?

This is a variant of the argument used by people like Anthony Clare to undermine the critique of so-called anti-psychiatry. As I've pointed out several times (eg. see previous post), what Clare did was suggest we didn't need to be ideological about psychiatry. Again, in a way, anti-psychiatry is seen as having attacked the straw man of the biomedical model, which people shouldn't be rigid about, and should instead incorporate the different perspectives in psychiatry in a wholistic way. Ok, there is some truth in this argument. Most psychiatrists are not rigidly biomedical, or at least some are less biomedical than others. But ultimately the vast majority of psychiatrists are very fearful about giving up the biomedical model, which I think underlies the motivation of Mohammed's article and its support from Abdi Sanati (and others).

Psychiatry is a cultural system like religion (see eg. previous post). Believe it or not, the biomedical model of mental illness is a model that does not necessarily define the real world. That's not the essential point for psychiatry. The model is needed to justify treatments such as medication and other physical treatments. It gives a way of operating for psychiatry that provides a framework to treat people in certain ways. Basically it provides a worldview. I can remember the trauma of giving up my belief in god as a teenager. Psychiatrists would be like theists giving up their belief in god if they gave up the biomedical model. Their personal essence is challenged by critiques of the biomedical model. That's why they're so sensitive to even the remotest indication that they may not have got it right. It creates the gravest anxiety if the way they've been operating is found to be no longer valid. That's why they have to cultivate what Clifford Geertz called the 'aura of factuality' about the biomedical model to sustain it and get all of us gullible people to believe in it. It's stupid not to believe it, isn't it (see eg. another previous post)?

I have mentioned before (see previous post), that Robin Murray has now accepted he made mistakes in his career, specifically, for example, promoting the neurodevelopment theory of schizophrenia. It's important not to be taken in by this. Robin would also like to say "we're all critical psychiatrists now". But the best he's become is 'semi-critical' and he hasn't pushed his critique of psychiatry far enough. As I said on my personal blog (see post), it's understandable he has taken the position he has in his career. He has been a professor in psychiatry and knighted for his research efforts, whereas I have tended to concentrate on my clinical work and been suspended twice (okay, maybe the second suspension wasn't definitely related to critical psychiatry, but the first was - see THES article).

I've pointed out before (see previous post) that a chapter by Manschrek & Kleinman (1977), which could be seen as one of the originating papers of critical psychiatry, divided psychiatrists into those that took either hubris or semi-critical positions. Things haven't changed much. There are still a few dogmatists about, despite what Mohammed says in his article. What we actually need is a critical rationality about psychiatry and it seems to be very difficult to create, because psychiatrists are so frightened about giving up their worldview and the power that goes with it.

1 comment:

Sarah said...

Thank you. Well stated.