Thursday, October 12, 2023

UN community does not endorse biomedical psychiatry

I’ve mentioned before reports produced by professor Dainius PÅ«ras, when he was Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, a position appointed by the UN Office of the High Commissioner on Human Rights (OHCHR). Oute & McPherson (2023) examine formal organisational responses to the reports he produced. He is a psychiatrist from Vilnius University in Lithuania and was appointed mandate holder for the period 2014–2020.

I have mentioned two of his reports previously. The first focused on the right of everyone to mental health (see post). The second was on corruption and the right to health, with a special focus on mental health (see post). These reports gained particular attention and I have commented on some of the adverse reaction in two further previous posts (see first and second). 

The UN Committee on the Rights of Persons with Disabilities has argued for even more radical reforms of mental health services than Dainius, for example, the abolition of capacity, detention and other practices that may violate human rights (see previous post). As noted by Oute & McPherson, there is a "discourse defending psychiatric practices within which critics ... [tend] to be categorised as ‘anti-psychiatry’", something which even happens to me (see eg. previous post)!

Oute & McMillan analysed 13 responses from medical or psychiatric organisations to the UN reports. Responses (and commentaries) from individually named authors were excluded from the analysis. They found two overarching themes: (1) Binary positions and contesting articulations of good mental health care and (2) Rejecting the UN reports in defence of psychiatry. The former had several sub themes: (i) psychiatric stakeholders have authority, (ii) the Special Rapporteur is unscientific and dangerous, (iii) abandoning biomedicine and long-term psychiatric care would be harmful, (iv) psychiatry is scientific and ethical, (v) psychiatry is a branch of medicine, (vi) psychiatric science always advances, (vii) critiques of the biomedical paradigm are wrong and (viii) psychiatric pluralism is common sense. All of these givens logically underpinned the second overarching theme, whose subthemes articulated reasons for rejecting the Special Rapporteurs's reports: (i) the report damages patient trust in psychiatrists, (ii) the report is offensive and unfair and (iii) failures in mental healthcare are located in society, governments and patients.

As Oute & McMillan discuss, medical and psychiatric organisational response to the Special Rapporteurs' reports has been largely or wholly negative and deploys a relatively homogeneous discourse "reflecting a number of firmly held assumptions underpinned by the depiction of a binary relationship between the ... [Special Rapporteur] and themselves". As I have said before (eg. see my interview). the arguments about anti-psychiatry that took place in the 1960/70s, subsequently polarised psychiatry between pro-psychiatry and anti-psychiatry. But that's missing the point that psychiatry needs to move on from the dominance of biomedical psychiatry (see eg. my book chapter). 

Oute & McMillan note that the responses they analysed did not include responses from national psychiatric organisations, such as the American Psychiatric Association. The organisational responses analysed are clearly acting in the interests of biomedical psychiatry. Although biomedical psychiatry may be dominant in national psychiatric organisations, such organisations may find it more difficult to reach a consensus view about the Special Rapporteur's reports and be more open to the criticisms it offers. There are diverse views both between and within national psychiatric organisations which may give hope for change to a more relational psychiatry (see previous post). 

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