Tuesday, October 03, 2023

The limits of psychiatry

I have recently re-read my 2002 BMJ article ‘The limits of psychiatry’. As I said in a post on my personal blog, the article was rushed through by the BMJ for a theme issue on the dangers of too much medicine. This article is still relevant to the current unsustainability of the NHS, including its mental health services. The overmedicalisation of society needs to be reduced in the interests of the country’s health (see another personal blog post). 

There were several errors made in publication of my BMJ article, which I was not given a chance to correct, and it may be worth spelling these out. Firstly, a picture of Alfred Meyer was used rather than Adolf Meyer. The quote given underneath that picture was also from Adolf, not Alfred, Meyer as the article wrongly states. Throughout this relational psychiatry blog and in other publications (see eg. my article), I have emphasised how relational psychiatry is built on the work of Adolf Meyer, who was the foremost American psychiatrist in the first half of the 20th century. Not that I’m suggesting a mere resurrection of Meyer’s ideas, as he tended to compromise too much with biomedical psychiatry.

Another error was in box 2 where I listed the assumptions of the biopsychological model. The publication process made the mistake of inserting Meyer’s name into the title of the box. I was meaning that these assumptions were not just of Meyer, but more generally of what I was calling the biopsychological model. More recently than Meyer (well, 1977), this model was reframed by George Engel, which he called the biopsychosocial model (see eg. previous post). The trouble is, as I have pointed out throughout this blog, modern psychiatry has come to see the biopsychosocial model in an eclectic rather than anti-reductionist way (see eg. my review of Nassir Ghaemi’s book The rise and fall of the biopsychosocial model).

A second error in box two was to transpose the last item in the list from box 3 to box 2. Box 3 was a summary of postpsychiatry (again, a hyphen was wrongly inserted into postpsychiatry, but that may have been my mistake rather than the editors, but, as I said, I wasn’t given a chance to correct the final version). That last item said, “Postmodernity provides doctors with an opportunity to redefine their roles and responsibilities”. This was the argument made by Pat Bracken and Phil Thomas, the originators of postpsychiatry (see eg. previous post). Their book entitled Postpsychiatry is one of what I have called the four essential texts of critical psychiatry (see another previous post). 

As I concluded in the BMJ article, The Critical Psychiatry Network (CPN), formed in 1999, was dedicated to establishing a constructive framework to renew psychiatric practice. As I said in my editorial twenty years later, CPN still seems marginal to mainstream psychiatry. This is despite its original dismay and outrage at the hegemony of biomedical psychiatry (see previous post).

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