Navigating the Crossroads of Postpsychiatry and Academic Perspectives

1. EXCLUDING CRITICAL PSYCHIATRY D B Double

2. Recent Psychiatric Bulletin editorial • New ‘culture war’ between postpsychiatry and academic psychiatry

3. Recent Psychiatric Bulletin editorial • New ‘culture war’ between postpsychiatry and academic psychiatry • Postpsychiatry strikingly similar to ‘anti-psychiatry’

4. Recent Psychiatric Bulletin editorial • ‘Anti-psychiatry’ used by the mainstream to disparage any opposition

5. Recent Psychiatric Bulletin editorial • ‘Anti-psychiatry’ used by the mainstream to disparage any opposition • Critical psychiatry seeks to avoid the polarisation engendered by anti-psychiatry

6. Anti-psychiatry defined by the mainstream • International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth, 1973)

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

8. What’s so threatening about anti-psychiatry? • Attack on psychiatrists' use of diagnosis, drug and ECT treatment and involuntary hospitalisation

9. What’s so threatening about anti-psychiatry? • Attack on psychiatrists' use of diagnosis, drug and ECT treatment and involuntary hospitalisation • Some activists do want to abolish psychiatry

10. RD Laing (1927-1989) • Not an anti-psychiatrist

11. RD Laing (1927-1989) • Not an anti-psychiatrist • Athough agreed with anti-psychiatric thesis “by and large psychiatry functions to exclude and repress those elements society wants excluded and repressed”

12. RD Laing (1927-1989) • Madness is much more understandable than commonly assumed

13. RD Laing (1927-1989) • Madness is much more understandable than commonly assumed • So-called normality is too often an abdication of our true potentialities

14. Thomas Szasz (1920-) • Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion

15. Thomas Szasz (1920-) • Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion • “Because both the anti-psychiatrists and I oppose certain aspects of psychiatry, our views are combined and confused, and we are often identified as the common enemies of all of psychiatry”

16. Thomas Szasz (1920-) • Mental illness is a myth, as disease is physical

17. Thomas Szasz (1920-) • Mental illness is a myth, as disease is physical • State should not interfere in mental health practice or medicine in general

18. The “anti” element in anti-psychiatry • Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems

19. The “anti” element in anti-psychiatry • Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems • May have gone too far in abandoning notion of mental pathology

20. Excesses of anti-psychiatry • Laing ultimately more interested in personal authenticity than changing psychiatry

21. Excesses of anti-psychiatry • Laing ultimately more interested in personal authenticity than changing psychiatry • Few would want to go as far as Szasz in proposing no mental health law

22. David Cooper (1931-1986) • Psychiatry and anti-psychiatry (1967)

23. David Cooper (1931-1986) • Psychiatry and anti-psychiatry (1967) • Excursion into family, sexual and revolutionary politics

24. Is critique of psychiatry really so threatening? • Reflective practice should be encouraged

25. Is critique of psychiatry really so threatening? • Reflective practice should be encouraged • Psychiatry can be too dogmatic

26. Is critique of psychiatry really so threatening? • Professional security needs should not be overriding

27. Is critique of psychiatry really so threatening? • Professional security needs should not be overriding • Critical psychiatry should not be tarnished with the same rotten reputation as anti‑psychiatry

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

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

30. 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

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

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

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

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

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

36. 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

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

38. 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

39. 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

40. Critical Psychiatry Network • Formed in 1999

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

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

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

44. 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

45. 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

46. Historical perspective on critique of psychiatric diagnosis • Crisis of confidence created in the 1960s and 70s

47. Historical perspective on critique of psychiatric diagnosis • Crisis of confidence created in the 1960s and 70s • Particularly about its vague diagnostic categories

48. Historical perspective on critique of psychiatric diagnosis • 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

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

50. 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