Monday, April 27, 2020

Reflections on postpsychiatry

I've mentioned Pat Bracken and Phil Thomas's work on postpsychiatry previously (see eg. previous post). I'm very pleased they've agreed to do this guest blog.

We would like to thank Duncan for the invitation to write a guest blog.

Our use of the term postpsychiatry began when we started to collaborate together in the 1990s. We were both working in Bradford and trying to change the way we encountered people with mental health conditions, how we understood their struggles and how we worked with them.

Employed as consultant psychiatrists, we were very conscious of working in a service that was very much ‘psychiatry-led’. We had come to realise how limited psychiatry was and how damaging its interventions could be; whether through the side-effects of drugs, demoralising diagnostic labels or theories that were sometimes little more than pseudoscience. We were sympathetic to the views of Thomas Szasz but were uncomfortable with, what we saw as, the binary nature of his thinking. We were also unconvinced by his characterisation of medicine as something that only had a legitimate role to play in relation to diseases that could be verified in the pathology lab, and were wary of his antipathy to any sort of collectivist politics.

After our training in medicine and our experience of work with different communities in different contexts, it was impossible for us not to see the ‘embodied’ and ‘encultured’ nature of all human suffering. It was clear to us that mind and flesh do not inhabit different worlds but exist as one. All experience of illness (whether we call it physical or mental) is complex. Thinking, feeling, relating to others are done by the same creature who sleeps, eats, has endocrine problems and gets old. And the same creature lives its life in the midst of language, culture and economy. We were interested in linguistics, anthropology and philosophy and had come to believe that states of madness, distress and dislocation were profoundly messy, and that no singular narrative, whether from psychiatry or anti-psychiatry, could account for it all.

This is what drew us to the work of Foucault, Bauman and others who might be characterised as ‘postmodern’. For us they offered a form of scholarship that did not see the messiness, contradictions and uncertainties of human reality as irritations that could be eliminated by more science, better science or more analysis and conceptual clarification. For us, postmodern thought was about facing and accepting the reality that there might not be solutions for all our problems, there might never be resolutions to all our ethical contradictions nor answers to all the questions we asked of the world. The word ‘postpsychiatry’ was used to signal our quest to imagine what a non-modernist medicine of the mind might look like. We wanted to think ‘beyond’ and ‘after’ psychiatry.

Crucially, we wanted a form of mental health medicine that worked towards the possibility of meaningful dialogue with the emerging ‘service-user’ movement. We saw that our job as critical psychiatrists was the creation of the conditions wherein genuine dialogue with this movement could take place. The main question for postpsychiatry was: how can we bring biological and medical insights to bear on mental suffering in a way that does not silence, distort and colonise the understandings that emerge from service users themselves both individually and collectively?

Of course there was no singular answer to this. In our work we looked for insights from post-colonial scholarship, feminist philosophy, queer theory, mad studies and critical pedagogy. Gayatri Spivak argues that educators and scholars who are genuinely trying to get beyond the legacy of colonial forms of knowledge must be engaged in ‘the unlearning of one’s own privilege. So that, not only does one become able to listen to that other constituency, but one learns to speak in such a way that one will be taken seriously by that other constituency’ (Spivak, 1990, p. 42). Postpsychiatry represented our attempt to unlearn, and to find a way of listening and speaking differently.

Pat Bracken & Phil Thomas are retired consultant psychiatrists. They were psychiatrists together in Bradford and professors of Philosophy, Diversity and Mental Health in the University of Central Lancashire. They co-authored Postpsychiatry: Mental health in a postmodern world (2005). They brought the group together that became the Critical Psychiatry Network.

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