IMPLEMENTING CRITICAL PSYCHIATRY IN PRACTICE: POSITIVE AND NEGATIVE ASPECTS

1. IMPLEMENTING CRITICAL PSYCHIATRY IN PRACTICE: POSITIVE AND NEGATIVE ASPECTS D B Double

2. Critical psychiatry website • www.anti-psychiatry.co.uk

3. Critical psychiatry website • www.anti-psychiatry.co.uk • www.uea.ac.uk/~wp276

4. Critical psychiatry website • www.anti-psychiatry.co.uk • www.uea.ac.uk/~wp276 • Critical Psychiatry Network www.criticalpsychiatry.co.uk

5. Reservations about teaching critical psychiatry to medical students • Asked to take down webpages from my personal webspace

6. Reservations about teaching critical psychiatry to medical students • Asked to take down webpages from my personal webspace • Consultant colleagues concerned I may mislead students

7. Reservations about teaching critical psychiatry to medical students • Asked to take down webpages from my personal webspace • Consultant colleagues concerned I may mislead students • Suggested university should not be seen as linked with critical psychiatry

8. Critical psychiatry is a legitimate academic and clinical activity • University encourages both staff and students to use their personal webspace

9. Critical psychiatry is a legitimate academic and clinical activity • University encourages both staff and students to use their personal webspace • Academic freedom is essential for the development of unorthodox or new opinions

10. Critical psychiatry is a legitimate academic and clinical activity • University encourages both staff and students to use their personal webspace • Academic freedom is essential for the development of unorthodox or new opinions • Doctors should be encouraged to think about their professional role

11. Critical Psychiatry Network • Formed in 1999

12. Critical Psychiatry Network • Formed in 1999 • Small group of psychiatrists

13. Critical Psychiatry Network • Formed in 1999 • Small group of psychiatrists • Develop a critique of the contemporary psychiatric system.

14. Promoting the critical mental health movement • Ranges from reform to revolution

15. Promoting the critical mental health movement • Ranges from reform to revolution • Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness

16. Promoting the critical mental health movement • Ranges from reform to revolution • Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness • Mental disorders must show through the brain but not always in the brain

17. Criticism of psychiatry • Crisis of confidence created in the 1960s and 70s

18. Criticism of psychiatry • Crisis of confidence created in the 1960s and 70s • Particularly about its vague diagnostic categories

19. Criticism of psychiatry • Crisis of confidence created in the 1960s and 70s, • Particularly about its vague diagnostic categories • Rosenhan - psychiatric diagnosis is subjective and does not reflect inherent patient characteristics

20. Mainstream response • Psychiatrists do not detect pseudopatients simulating signs of mental illness – Spitzer

21. Mainstream response • Psychiatrists do not detect pseudopatients simulating signs of mental illness – Spitzer • “…assuredly an unreliable system must be invalid”

22. Mainstream response • Psychiatrists do not detect pseudopatients simulating signs of mental illness – Spitzer • “…assuredly an unreliable system must be invalid” • Operational diagnostic criteria for psychiatric disorders, initially for research, and then for psychiatric classifications, such as DSM-III

23. Neo-Kraepelinian approach • Psychiatry could again be assured about the validity of its diagnostic categories, which had now been much better defined

24. Neo-Kraepelinian approach • Psychiatry could again be assured about the validity of its diagnostic categories, which had now been much better defined • Associated with reaffirmation of implicit “medical model” with focus on brain mechanisms

25. Neo-Kraepelinian approach • Psychiatry could again be assured about the validity of its diagnostic categories, which had now been much better defined • Associated with reaffirmation of implicit “medical model” with focus on brain mechanisms and positivistic approach to science

26. Rotten reputation of anti-psychiatry • International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth 1973)

27. Rotten reputation of anti-psychiatry • International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth 1973) • Anti-psychiatry defined more by mainstream psychiatry than the identified protagonists themselves

28. Rotten reputation of anti-psychiatry • International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth 1973) • Anti-psychiatry defined more by mainstream psychiatry than the identified protagonists themselves • Generally seen as a passing phase in the history of psychiatry

29. Proponents of “anti-psychiatry” • David Cooper - “[P]sychiatry … has aligned itself far too closely with the alienated needs of society”

30. Proponents of “anti-psychiatry” • David Cooper - “[P]sychiatry … has aligned itself far too closely with the alienated needs of society” • RD Laing - “By and large psychiatry functions to exclude and repress those elements society wants excluded and repressed”

31. Proponents of “anti-psychiatry” • David Cooper - “[P]sychiatry … has aligned itself far too closely with the alienated needs of society” • RD Laing - “By and large psychiatry functions to exclude and repress those elements society wants excluded and repressed” • Thomas Szasz - State should not interfere in mental health practice or medicine in general

32. Biomedical vs interpretive approaches • “Mental diseases are brain diseases” – Wilhelm Griesinger 1845

33. Biomedical vs interpretive approaches • “Mental diseases are brain diseases” – Wilhelm Griesinger 1845 • “It is only from the neuropathological standpoint that one can try to make sense of the symptomatology of the insane"

34. Biomedical vs interpretive approaches • “Mental diseases are brain diseases” – Wilhelm Griesinger 1845 • “It is only from the neuropathological standpoint that one can try to make sense of the symptomatology of the insane" • "The notion, mental disease, must be deduced neither from the mind nor from the body, but from the relation of each to the other." Baron von Feuchtersleben 1845

35. Pluralism in psychiatry (1900-1970) • Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909

36. Pluralism in psychiatry (1900-1970) • Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909 • Pragmatic approach of Adolf Meyer - Psychobiology

37. Pluralism in psychiatry (1900-1970) • Psychoanalysis – Freud first spoke publicly in USA at Clark University in 1909 • Pragmatic approach of Adolf Meyer - Psychobiology • Interpersonal approach of Harry Stack Sullivan focused on the person

38. Definition of “critical” • Inclined to find fault, or to judge with severity

39. Definition of “critical” • Inclined to find fault, or to judge with severity • Characterised by careful, exact evaluation and judgement

40. Definition of “critical” • Inclined to find fault, or to judge with severity • Characterised by careful, exact evaluation and judgement • Of the greatest importance to the way things might happen

41. What is acceptable practice? • “Incompatible with effective teamwork in a community psychiatric service”

42. What is acceptable practice? • “Incompatible with effective teamwork in a community psychiatric service” • Inappropriate defensiveness in mainstream practice

43. What is acceptable practice? • “Incompatible with effective teamwork in a community psychiatric service” • Inappropriate defensiveness in mainstream practice • Apparent difference may lead to unnecessary polarisation in debate

44. Promoting critical practice • Diagnosis:

45. Promoting critical practice • Diagnosis: assessment is broader than simple diagnostic labels, even if rarely possible to be sure about the origins of personal problems.

46. Promoting critical practice • Diagnosis: assessment is broader than simple diagnostic labels, even if rarely possible to be sure about the origins of personal problems. • Treatment:

47. Promoting critical practice • Diagnosis: assessment is broader than simple diagnostic labels, even if rarely possible to be sure about the origins of personal problems. • Treatment: social support and personal therapy may be beneficial; medication has its place, but prescribing should not be beyond the evidence.

48. Psychiatric diagnosis • Should be person-centred and not necessarily imply a statement about bodily dysfunction

49. Psychiatric diagnosis • Should be person-centred and not necessarily imply a statement about bodily dysfunction • Attempt needs to be made to understand psychiatric presentations in personal and social terms

50. Psychiatric diagnosis • Should be person-centred and not necessarily imply a statement about bodily dysfunction • Attempt needs to be made to understand psychiatric presentations in personal and social terms • Not only about identifying disease, but also the reasons for human action