Is critical psychiatry creating its own myths?

I’ve just watched Joanna Moncrieff being interviewed on It’s your life with James “JC” Cooley” (see video), one of several video podcasts to which she has contributed. She says that antidepressants numb people, which may initially be helpful, but cannot be a long term solution because they may prevent people being “tuned into what they need to do to feel better”. She talks as if the numbing is a physiological effect, but I think it is more likely to be the result of a placebo reaction (see eg. previous post). Any apparent benefit of antidepressants because of a placebo reaction may not last, or may diminish over time, and/or cause a nocebo effect, such as emotional numbing because people do not think their psychosocial problems have really been dealt with. 

I’ve expressed concern before about how social media can misrepresent the truth about psychiatry (see eg. previous post). Video podcasts may be helpful in promoting personal perspectives, such as Jo’s, but there are not necessarily the same checks on transmitted information as more traditional forms of communication. As far as I know, Jo cannot point to any academic reference to support SSRI antidepressants being pharmacologically emotionally numbing, In fact SSRIs were introduced partly because they tended to be less sedative than tricyclics, the previous generation of antidepressants. I’m not of course saying that patients do not complain of emotional numbing with antidepressants, particularly over the longer term; the argument is about the mechanism of this effect. There does seem to be a need for discussion on this issue in the academic medical press.

As I’ve also said several times before, although ideologically I am close to Jo, I do worry about her niggling overstatement (see eg. previous post). She makes very clear in the interview on the JC Cooley show that her motivation for change is not necessarily to stop people using antidepressants, but more to ensure they are properly informed to be able to make a decision about them. She also says she’s always had a “rebellious streak”. Misplaced authority should be challenged but the rebel within Jo may need to be tempered by accuracy and truth. It’s important critical/relational psychiatry does not merely replace the myths of biomedical psychiatry with its own myths.

Changing the way the facts of mental health and illness are seen

As I wrote in my book chapter (see extract), "From the beginning, the aim of the Philadelphia Association (PA) was to "change the way the 'facts' of 'mental health' and 'mental illness' are seen" (R. Cooper, 1994). Current activities of PA include the support of their two community houses, a low-cost psychotherapy service and a training programme in psychotherapy and other study programmes and events.

Despite PA’s intentions for change, psychiatry still clings to what is really an outdated view of mental health and illness (see eg. last post). Psychiatry has always hoped that a biological understanding of mental illness as brain abnormality is just round the corner. It does now tend to accept that the pharmacological and neuroscientific emphasis of the last 50 or so years has not really progressed practice, but nonetheless refuses to acknowledge that the flaw is its own conceptual foundations.

People have been so indoctrinated into believing that they are their brains that they cannot see the conceptual fallacy in doing so. People’s brains are only part of them, like their other bodily parts. Most mental illness is not caused by faulty brains; it relates more to them as a person as a whole. By thinking of ourselves as machines, we fail to recognise the purposiveness of life.

Will psychiatry ever change?

As Diana and Nikolas Rose wrote in their 2023 Psychological Medicine article (see previous post), psychiatrists tend to see themselves as 

exponents of highly effective, neurobiological based, targeted treatment of brain disorders, like their peers in other biomedical specialities. The leaders of the psychiatric establishment are likely to resist … a reconfiguration of their profession [by giving up such a claim].

This is despite the fact that psychiatric disorders are not dependent on biological pathology, whereas physical diseases are. A purely biological account of primary mental disorder is not possible, but psychiatrists keep hoping one will be found.

It’s depressing to see how much psychiatry is prepared to cling to its outdated understanding of mental illness, which it actually promotes as a major advance, misleading people that there has been real progress (see eg. recent post). As I’ve commonly said (see eg. my editorial), the essential position of critical/relational psychiatry is that functional mental illness should not be reduced to brain disease. Although, of course, all mental disorders involve cerebral processes, despite what psychiatry says, neuroscience is not moving us towards having a biological and genetic understanding of primary mental disorders (see eg. previous post).