Where psychiatry winning the anti-psychiatry debate has led us

I’ve said before (see eg. previous post) I don’t like the term ‘anti-psychiatry’. Still, it serves a useful purpose of referring to what was seen as a crisis within psychiatry in the 1960/70s. Critics of psychiatry, such as RD Laing and Thomas Szasz, were labelled as anti-psychiatrists by mainstream psychiatrists, such as Martin Roth (see eg. another previous post). Roth suggested anti-psychiatry was “anti-medical, anti-therapeutic, anti-institutional and anti-scientific”. Any sensible psychiatrist should have nothing to do with it!

Psychiatry since then has been polarised between pro-psychiatry and anti-psychiatry. A compromise was sought, particularly in the book Psychiatry in dissent (1976) (see eg. previous post) by Anthony Clare. What Clare argued is that psychiatry does not merely rely on a biological approach to mental illness, and this is true (see eg. another previous post). He wanted to move on from ideological conflict about psychiatry and avoided such disagreement by fudging the difference between mind and brain.

The trouble is that such evasion of conceptual issues about mental illness does not do justice to real differences between functional and organic symptoms in psychiatry. Of course the brain mediates what we think, feel and do. The functioning of the brain can also be impaired by a physical lesion or by a toxic or degenerative process. Such syndromes when acute are known as delirium or toxic confusional states. Chronic, irreversible brain lesions produce dementia. Such brain impairments are not, however, present in the majority of psychiatric presentations, however much psychiatry may encourage people to think they will eventually be discovered by research (see eg. previous post).

Psychiatry officially abolished the distinction between functional and organic conditions in DSM-IV (see eg. previous post). It tends to focus on neuroscientific perspectives (see eg. another previous post). But reducing people to their brains loses the essence of trying to understand why they are thinking, feeling and behaving in the unhealthy way they are. Brains are only part of people. Understanding the whole person may be difficult but isn't resolved necessarily by blaming their brain.

Explaining people in terms of their brain has led to the current situation with neurodivergence (see eg. previous post). Although psychiatry won the anti-psychiatry debate it has created the misleading impression that there are particular kinds of brains that determine our personality. Tending to see ourselves as no more than our brains does not do justice to the nature of human beings and life in general.