Monday, June 01, 2020

Relational psychiatry

I wrote in my book chapter:-
Critical psychiatry is the name for an approach that encourages a self-critical attitude to psychiatric practice. An adverse consequence of the term 'critical' is that it tends to have a negative connotation. In this sense, 'critical' means 'inclined to find fault, or to judge with severity'. However, 'critical' also has other meanings, such as 'being characterised by careful, exact evaluation and judgement'. Also, it may have something to do with a crucial turning point, in this sense meaning 'of the greatest importance to the way things might happen'. These latter senses are included in the way I am using the word 'critical' in relation to psychiatry.
There is a problem about how oppositional to be about the current state of modern psychiatry (see eg. previous post). Critical psychiatry has never hidden the fact that it grew out of what mainstream psychiatry has called “anti-psychiatry” (see eg. another previous post).

I have also always emphasised the extent to which critical psychiatry actually is mainstream psychiatry (see eg. previous post). Even though critical psychiatry is a minority position within psychiatry, the dominance of biomedical psychiatry perverts what psychiatry should be. Although psychiatry says it adopts the biopsychosocial model of mental illness, unfortunately it still has a tendency to positivism and reductionism (see eg. my editorial).

I have always wondered if there should be a more positive name for critical psychiatry. I’d be interested in how people react to the notion of ‘relational psychiatry’, instead of critical psychiatry. Understanding how people relate to themselves, to others and to their situations is crucial for making sense of and managing mental health problems (see previous post). An advantage of the term ‘relational psychiatry’ may be that it is more easily understandable than enactive psychiatry, which has had recent uptake (see another previous post). It also links with traditional interests in psychiatry in therapeutic communities (see eg. previous post).

Another advantage of relational psychiatry is that it may make explicit the social dimension of person-centred care in psychiatry (see previous post). Despite all the hype about neuroscientific progress in psychiatry, patients still feel stigmatised and there is ongoing conflict about psychiatric practice. People may be able to converge round relational psychiatry to provide both a conceptual and practical way forward.


Richard Gipps said...

I'd say stick to 'critical psychiatry'. Nobody thinks that, say, 'critical theory' or 'critical thinking' are about doing people down, and it's always a mistake to rebrand simply to avoid connotations that desperately un-smart people are drawn to. Plus 'relational psychiatry' isn't very obvious in its meaning and, perhaps, potentially invites confusion with Sullivan's 'interpersonal psychiatry' or Mitchell's 'relational psychoanalysis'.

DBDouble said...

Point take, Richard. I would add that I have made the case that Kant's critical philosophy (particularly his critique of judgement) is where critical psychiatry (and modern psychiatry overall) first started. Where I think I'm not quite so sure you're right is that I do think the term 'relational psychiatry' is fairly obvious (probably more so, for example, than enactive psychiatry), in that it's a psychiatry that focuses on relationships (which reducing people to their brains doesn't do). I actually don't mind allusions to Sullivan's interpersonal psychiatry, and even person-centred care (eg. a la Gerrit Glas). I'm afraid I don't know anything about Mitchell's relational psychoanalysis. As far as psychotherapy (talking cure) is concerned I think that John Heaton's contribution is neglected more than it should be (which interestingly takes us all the way back to RD Laing!).I agree also that it's important to avoid the wishy-washiness of a Carl Rogers (although Laing was probably a bit too hard on him). Perhaps we need both terms 'critical psychiatry' and 'relational psychiatry'.

Unknown said...

Maybe, 'Critical Relational Psychiatry' or 'Critical/Relational Psychiatry'

Unknown said...


DBDouble said...

What about Critical and Relational Psychiatry, Merrilyne?