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Introduction
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Research and Practice
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Introduction
Critical Psychiatry
Over the last twenty years there has emerged a body of work that questions the assumptions that lie beneath psychiatric knowledge and practice. This work, appearing as academic papers, magazine articles, books, and chapters in books, hasn’t been written by academics, sociologists or cultural theorists. It has emerged from the writing and practice of a group of British psychiatrists.
They assert that contemporary psychiatry relies too much on the medical model, and attaches too much importance to a narrow biomedical view of diagnosis.
The general concern of critical psychiatry is the dominant role played by biological science in contemporary psychiatry. It is concerned with two aspects of the use of science in psychiatry. One relates to the improper use of scientific evidence by the pharmaceutical industry and those psychiatrists with links to it. The other concerns the limitations of biological science in understanding distress and madness.
Post Psychiatry
Peter Campbell first used the term ‘postpsychiatry’ in the anthology Speaking Our Minds, which imagines what would happen in a world after psychiatry. Independently, Patrick Bracken and Philip Thomas coined the word later and used it as the title of a series of articles written for Openmind. This was followed by a key paper in the British Medical Journal and a book of the same name.[21] This culmanated with the publication by Bradley Lewis, a psychiatrist based in New York, of Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry.
A significant developments in mental health over the last thirty years has been the emergence of vocal and critical service-users and survivor movements.Examples of such organisations include Survivors Speak Out, the National Self Harm Network, Mad Pride, Mad Women and the Hearing Voices Network. British postpsychiatry can be understood as an attempt to respond to these groups. These groups disagree on many issues with mainstream psychiatry, and instead seek a more equal relationship with mental health services. These groups main demand is that doctors and nurses in all areas of health care relinquish paternalistic ways of relating to patients and relatives, and work with them on a more equal footing.
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Critical Psychiatry
The bulk of this work has been written by a small group of psychiatrists, all of whom are, or were, practicing psychiatrists in the NHS in England. All are associated with the Critical Psychiatry Network - http://www.criticalpsychiatry.co.uk - which first met in Bradford, England in 1999. The most active members of this group have between them written ten single or dual author books, ten edited books with forty-two chapters, and one hundred and thirty seven papers mostly in peer-reviewed journals.
A survey of this work reveals that it covers five themes:
- The problems of diagnosis in psychiatry
- The problems of evidence based medicine in psychiatry, and related to this, the relationship between the pharmaceutical industry and psychiatry.
- The central role of contexts and meanings in the theory and practice of psychiatry, and the role of the contexts in which psychiatrists work.
- The problems of coercion in psychiatry.
- The historical and philosophical basis of psychiatric knowledge and the practice of psychiatry.
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Postpsychiatry
Postpsychiatry tries to move beyond the view that we can only help people through technologies and expertise. Instead, it prioritises values, meanings and relationships and sees progress in terms of engaging creatively with the service user movement, and communities. This is especially important given the considerable evidence that in Britain, Black and Minority Ethnic (BME) communities are particularly poorly served by mental health services. For this reason an important practical aspect of postpsychiatry is the use of community development in order to engage with these communities.
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Publications (date ordered)
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Decolonizing Global Mental Health: The Psychiatrisation of the Majority World Concepts for Critical Psychology, China Mills, Routledge, 2013
Decolonizing Global Mental Health is a book that maps a strange irony. The World Health Organization (WHO) and the Movement for Global Mental Health are calling to 'scale up' access to psychological and psychiatric treatments globally, particularly within the global South. Simultaneously, in the global North, psychiatry and its often chemical treatments are coming under increased criticism (from both those who take the medication and those in the position to prescribe it). The book argues that it is imperative to explore what counts as evidence within Global Mental Health, and seeks to de-familiarize current 'Western' conceptions of psychology and psychiatry using postcolonial theory. It leads us to wonder whether we should call for equality in global access to psychiatry, whether everyone should have the right to a psychotropic citizenship and whether mental health can, or should, be global. As such, it is ideal reading for undergraduate and postgraduate students, as well as researchers in the fields of critical psychology and psychiatry, social and health psychology, cultural studies, public health and social work.
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America Robert Whitaker,Broadway Books, 2011
In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades? Every day, 1,100 adults and children are added to the government disability rolls because they have become newly disabled by mental illness, with this epidemic spreading most rapidly among our nation's children. What is going on?
Anatomy of an Epidemic challenges readers to think through that question themselves. First, Whitaker investigates what is known today about the biological causes of mental disorders. Do psychiatric medications fix "chemical imbalances" in the brain, or do they, in fact, create them? Researchers spent decades studying that question, and by the late 1980s, they had their answer. Readers will be startled--and dismayed--to discover what was reported in the scientific journals.
Then comes the scientific query at the heart of this book: During the past fifty years, when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? Or did they find that these medications, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness?
This is the first book to look at the merits of psychiatric medications through the prism of long-term results. Are long-term recovery rates higher for medicated or unmedicated schizophrenia patients? Does taking an antidepressant decrease or increase the risk that a depressed person will become disabled by the disorder? Do bipolar patients fare better today than they did forty years ago, or much worse? When the National Institute of Mental Health (NIMH) studied the long-term outcomes of children with ADHD, did they determine that stimulants provide any benefit?
By the end of this review of the outcomes literature, readers are certain to have a haunting question of their own: Why have the results from these long-term studies--all of which point to the same startling conclusion--been kept from the public?
In this compelling history, Whitaker also tells the personal stories of children and adults swept up in this epidemic. Finally, he reports on innovative programs of psychiatric care in Europe and the United States that are producing good long-term outcomes. Our nation has been hit by an epidemic of disabling mental illness, and yet, as Anatomy of an Epidemic reveals, the medical blueprints for curbing that epidemic have already been drawn up.
The Emperor's New Drugs: Exploding the Antidepressant Myth Irving Kirsch, ReadHowYouWant, 2010
Do antidepressants work? Of course-everyone knows it. Like his colleagues, Irving Kirsch, a researcher and clinical psychologist, for years referred patients to psychiatrists to have their depression treated with drugs before deciding to investigate for himself just how effective the drugs actually were. Over the course of the past fifteen years, however, Kirsch's research-a thorough analysis of decades of Food and Drug Administration data-has demonstrated that what everyone knew about antidepressants was wrong. Instead of treating depression with drugs, we've been treating it with suggestion. The Emperor's New Drugs makes an overwhelming case that what had seemed a cornerstone of psychiatric treatment is little more than a faulty consensus. But Kirsch does more than just criticize: he offers a path society can follow so that we stop popping pills and start proper treatment for depression.
Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? Richard Bentall, 2009
Toward the end of the twentieth century, the solution to mental illness seemed to be found. It lay in biological solutions, focusing on mental illness as a problem of the brain, to be managed or improved through drugs. We entered the “Prozac Age” and believed we had moved far beyond the time of frontal lobotomies to an age of good and successful mental healthcare. Biological psychiatry had triumphed.
Except maybe it hadn’t. Starting with surprising evidence from the World Health Organization that suggests that people recover better from mental illness in a developing country than in the first world, Doctoring the Mind asks the question: how good are our mental healthcare services, really? Richard P. Bentall picks apart the science that underlies our current psychiatric practice. He puts the patient back at the heart of treatment for mental illness, making the case that a good relationship between patients and their doctors is the most important indicator of whether someone will recover.
Arguing passionately for a future of mental health treatment that focuses as much on patients as individuals as on the brain itself, this is a book set to redefine our understanding of the treatment of madness in the twenty-first century. See Wikipedia article here
Psychiatry – The Alternative Textbook, Volume 1: Psychiatry Deconstructed Phil Virden with Alec Jenner and Lin Bigwood, 2009
Volume 1: Psychiatry Deconstructed by Phil Virden with Alec Jenner and Lin Bigwood
The first alternative, non-medical textbook of Psychiatry. Volume 1 demonstrates the striking absence of bio-chemical or genetic evidence for any aspect of Psychiatry’s conventional ‘medical model of mental illness’.
"Yesterday I received your encyclopedia (for that’s what it is) of alternative psychiatry … I spent much of the past 24 hours scanning and reading it and congratulate you and your collaborators for this fine piece of work." Thomas Szasz
The Myth of the Chemical Cure: A critique of Psychiatric Drug Treatment Moncrieff, J. 2008 This book exposes the traditional view that psychiatric drugs correct chemical imbalances as a dangerous fraud. It traces the emergence of this view and the way it supported the vested interests of the psychiatric profession, the pharmaceutical industry and the modern state. Instead it is proposed that psychiatric drugs 'work' by creating abnormal brain states, which are often unpleasant and impair normal intellectual and emotional functions along with other harmful consequences. Research on antipsychotics, antidepressants and mood stabilisers is examined to demonstrate this thesis and it is suggested that acknowledging the real nature of psychiatric drugs would lead to a more democratic practice of psychiatry.
Alternatives Beyond Psychiatry Peter Stastny / Peter Lehmann (Eds.), (2007)
The book highlights alternatives beyond psychiatry, current possibilities of self-help for individuals experiencing madness, and strategies toward implementing humane treatment. 61 authors (ex-)users and survivors of psychiatry, therapists, psychiatrists, lawyers, social scientists and relatives from all continents report about their alternative work, their objectives and successes, their individual and collective experiences.
Madness explained – psychosis and human nature Richard P Bentall (2004)
This groundbreaking work argues that we cannot define madness as an illness to be cured like any other, that labels such as ‘schizophrenia’ and ‘manic depression’ are meaningless, and that experiences such as delusions and hearing voices are in fact exaggerations of the mental foibles to which everyone is vulnerable.He shows there is no reassuring dividing line between mental health and mental illness. Severe mental disorders can no longer be reduced to brain chemistry, but must be understood psychologically, as part of normal behaviour and human nature. Bentall argues that we need a radically new way of thinking about psychosis and its treatment. Could it be that it is a fear of madness, rather than the madness itself, that is our problem?
This is madness too : critical perspectives on mental health services edited by Craig Newnes, Guy Holmes and Cailzie Dunn. (2001)
Part One: The lunatics have taken over the asylum. Mental health policy: a suitable case for treatment, Peter Beresford and Suzy Croft Integrating critical psychiatry into psychiatric training, Duncan Double Policing happiness, Mark Rapley
Part Two: Risk and dangerousness. What people need to know about the drug treatment of children, Peter Breggin The SSRI suicides, David Healey ‘I’ve never said ‘no’ to anything in my life': helping people with learning disabilities who experience psychological problems, Biza Stenfert Kroese and Guy Holmes Coming off neuroleptics, Peter Lehmann
Part Three: Rights . . . and wrongs. Surviving social inclusion, Peter Campbell When ‘No’ means ‘Yes': informed consent themes with children and teenagers, Steve Baldwin Controlled bodies, controlled eating: the treatment of eating disorders, Vivien J Lewis and Sara Cureton Relatives and carers, Olive Bucknall and Guy Holmes
Part Four: An end to madness. Survivor research, Vivien Lindow This is therapy: a person-centred critique of the contemporary psychiatric system, Pete Sanders and Keith Tudor The future approach for community mental health, Fran Silvestri and Susan Hallwright Developing a survivor discourse to replace the ‘psychopathology’ of breakdown and crisis, Jan Wallcraft and John Michaelson
Users and Abusers of Psychiatry: A Critical Look at Psychiatric Practice Lucy Johnstone and Dorothy Rowe (2000)
This book is a critical look at traditional psychiatric treatment, arguing that it very often makes people worse rather than better, and illustrated by various real-life examples. The book goes on to show how the theory underpinning psychiatry is deeply flawed and lacking in evidence, and discusses the various vested interests in keeping things this way and resisting change. It also looks at a number of alternatives to the biomedical model. It is written in clear language, accessible to service users and carers as well as professionals.
This is madness : a critical look at psychiatry and the future of mental health services edited by Craig Newnes, Guy Holmes and Cailzie Dunn. (1999)
Part One: Psychiatry in context. Histories of psychiatry, Craig Newnes Social inequalities and mental health, Jennie Williams Racism and mental health, Nimisha Patel and Iyabo A. Fatimilehin
Part Two: What psychiatry does. Diagnosis, Mary Boyle Drugs, David Crepaz-Keay ECT: The facts psychiatry declines to mention, Katy Arscott Do families cause ‘schizophrenia’? Revisiting a taboo subject, Lucy Johnstone Psychiatric hospitals and patients’ councils, Marese Hudson
Part Three: Alternatives and alliances. Hearing voices and the politics of oppression, Ron Coleman Collaborative conversations, Peter Hulme User involvement in mental health service development, David Pilgrim and Lesley Hitchman The service user/survivor movement, Peter Campbell Survivor controlled alternatives to psychiatric services, Vivien Lindow
Part Four: Beyond psychiatry. The duty of community care: The Wokingham MIND crisis house, Pam Jenkinson Promoting community resources, Janet Bostock, Valerie Noble and Rachel Winter The role of education in the lives of people with mental health difficulties, Tracey Austin Green approaches to occupational and income needs in preventing chronic dependency, Brian Davey The future of mental health services, Craig Newnes and Guy Holmes
Deconstructing Psychopathology Ian Parker, Manchester Metropolitan University, UK; Eugenie Georgaca, City College, Greece; David Harper, University of East London; Terence McLaughlin; Mark Stowell-Smith Ashworth Hospital, Liverpool (1996)
Accessible and practical, Deconstructing Psychopathology provides a critical perspective on the institutions, practices, and presuppositions that underlie the study of psychopathology. The authors, who come from such areas as clinical psychology, psychiatric social work, psychoanalysis, and action research, challenge the traditions of the field in three ways: First, they analyze the notion of psychopathology as a conventional term in psychology and psychiatry, through the language and institutions that keep it in place. Next, they explore the deconstructive responses and resources and their implications for the theoretical practices that sustain clinical treatments. And finally, they offer an alternative way of seeing psychopathology along with practical models for critical professional work and good practice. This practical and well-written book will be an invaluable text for students and practitioners working to understand mental health.
The Emperor’s New Drugs: Exploding the Antidepressant Myth Irving Kirsch Basic Books
Unhinged: The Trouble With Psychiatry—A Doctor’s Revelations About a Profession in Crisis, Daniel Carlat, Free Press, 256 pp., $25.00
Schizophrenia: a scientific delusion Mary Boyle, (1993) London, Routledge.
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Research and Practice
Bibliography of First-Person Narratives of Madness In English (4th edition, 2008) Compiled by Professor Gail A. Hornstein (2009) This Bibliography is in four sections: (1) personal accounts of madness written by survivors themselves; (2) narratives written by family members; (3) anthologies and critical analyses of the madness narrative genre; and (4) websites featuring oral histories and other first-person madness accounts.
Critical Psychiatry in Practice Philip Thomas & Patrick Bracken Advances in Psychiatric Treatment (2004), vol. 10, 361–370 'Critical psychiatry is starting to have an impact on mainstream psychiatry. The fact that APT is prepared to publish our article confirms this. Nevertheless, there is a great deal still to be achieved. Critical reflection on the history and the social position of our discipline are a central concern for critical psychiatry, and this way of approaching our discipline must be brought into the mainstream.'
Videos and Presentations
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Organisations
Critical Psychiatric Network
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Links
Critical Psychiatry Network The Critical Psychiatry Network Website. On the site you will find papers and documents written by CPN in response to consultation documents from the National Institute for Health and Clinical Excellence in England (NICE). You will also find responses to documents from other organisations, including the British Government's consultation process that lead to the 2008 amendment to the 1983 Mental Health Act. There is also an extensive list of members' publications. You can download many of these from the site, but some articles are links to other sites.There are also sections for news, a forum for discussion, and news of events that may be of interest.
Critical Psychiatry Network From Wikipedia Article about the Critical Psychiatry Network is an organisation created by a group of British psychiatrists. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom's National Health Service (NHS).
Madness in America