“Western psychiatry is in crisis.” Not just our words, but the opening line of the powerful recent statement by Mental Health Europe (2013), a large and respected umbrella organisation representing both professionals and service users. It goes on to deplore “the simplistic and imposed application of… reductionist science” which can “encroach on basic human rights.”
In this post we examine the ways in which the profession of psychiatry is, in the UK, re-positioning itself in response to the widely-acknowledged threat to its power and status arising from the DSM-5 debacle and the ongoing failure to find the biomarkers that will confirm its theories. There are likely to be parallels with the response in the US and elsewhere. We illustrate this by reference to recent national radio debates between Lucy Johnstone and two psychiatrists who represent respectively the ‘biological wing’ (Professor Nick Craddock) and the ‘social wing’ (Professor Tom Burns) of the profession. These discussions took place in the wake of the Division of Clinical Psychology’s call for a move away from diagnosis and the ‘disease’ model of mental distress.
The controversy about DSM has been presented in the British media as ‘turf wars’ between the professions of psychology and psychiatry. In writing a joint post, we are sending the message that this debate is not about narrow professional interests, but about genuinely alternative ways of thinking, which many psychiatrists (e.g. Pat Bracken, Suman Fernando, Joanna Moncrieff, Phil Thomas) have written about and now call for as a group of critical psychiatrists (Bracken et al., 2012).
The crisis in the profession of psychiatry has been looming for a while, as discussed in a series of articles in the British Journal of Psychiatry. The suggested solutions fall into two very different camps. On the one hand, there are calls to strengthen psychiatry’s identity as neuroscience (eg Craddock et al., 2008; Oyebode and Humphreys, 2011) and thus go further down the road condemned by Mental Health Europe. Advocates of this approach make bold statements such as: “Psychiatry is a medical specialty… Major advances in molecular biology and neuroscience over recent years have provided psychiatry with powerful tools that help to delineate the biological systems involved in psychopathology” (Craddock et al., 2008). In this view, other professions have a role to play but need to be kept firmly in their place, and the “creeping devaluation of medicine”, along with an “increasing tendency of many services to be based on non-specific psychosocial support” is lamented.
Meanwhile, in the opposite corner, another wing of the profession is disputing these claimed advances and advocating exactly the kind of generalised benevolence that the neuroscientists deplore, as a replacement for the failure of the neuroscientific approach:
“The past 30 years have produced no discoveries leading to major changes in psychiatric practice. The rules regulating research and a dominant neurobiological paradigm may both have stifled creativity. Embracing a social paradigm could generate real progress and, simultaneously, make the profession more attractive” (Priebe, Burns and Craig, 2013).
“Psychiatry is utterly based in and dependent on a relationship… It is the core of the activity” (Burns, 2013).
The one thing that both wings agree on is that the profession faces a threat to its survival. “Some… have questioned whether the psychiatrist is an endangered species… Urgent action is required to… ensure the future of psychiatry as a profession” (Oyebode and Humphreys, 2011); “British psychiatry faces an identity crisis… It is imperative that we specify clearly the key role of psychiatrists” (Craddock et al., 2008); “We believe that such a focus… has potential to strengthen our identity, give psychiatrists more societal relevance, and make psychiatry more attractive as a profession” (Priebe et al., 2013.) As these quotes suggest, the solutions are presented primarily in terms of their benefits to the profession, with little attempt to claim, for example, improved outcomes or greater acceptability to service users themselves.
Commentary on the Interviews
The first interview is with Professor Nick Craddock, a research psychiatrist from Cardiff University and first author of the paper referred to above (Craddock et al., 2008). His career has been based on research into categories such as ‘bipolar disorder’, an approach now discouraged by the National Institute of Mental Health. As such, he clearly cannot afford to agree with the recent admission of the chair of the DSM-5 committee, Dr David Kupfer, that ‘We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting’ which Lucy Johnstone quotes at the start of the discussion. He responds confidently: “For the core disorders like schizophrenia, bipolar disorder, ADHD there is very very strong evidence… that there are differences between people.” How this fits with Dr Kupfer’s admission is not clear – is there lots of evidence, or none at all? And of course, differences between people, even biological ones, do not imply anything about causality or aetiology. This is an example of a familiar tactic in which experts simply assert that something is the case in the knowledge that a radio interview is not enough time to unpick the subtleties.
The other strategies used by Craddock have been extensively deployed in the media debate about DSM. The first is blatant question-begging – in other words, assuming the very point that needs to be proved. Thus Craddock states that “If you went back 30 or 40 years in studying cancers or heart disease or whatever, you would also find that medicine wasn’t at that stage…” In a similar vein in his interview, Burns asserts that “There is no need in any branch of medicine for treatment to mirror the cause of the disorder”, etc. This simply sidesteps the main issue which is: ‘But is psychiatry a legitimate branch of medicine?’
The second strategy is to present the profession of psychiatry as considering a wide-ranging selection of social and psychological factors in mental distress. This is the line taken by Burns as well. The intended messages seem to be: ‘We are not the narrow-minded pill-pushers of your critiques’, along with: ‘And we have lots in common with all the other mental health professions and work happily alongside them.’ But before this argument is pushed to its logical conclusion, it is swiftly noted that doctors are the only ones who do everything – psychological, social, medical, the whole lot. No other profession measures up to our extensive range of skills. The message is: You need us in charge.
The credibility of the ‘but we do everything’ claim depends to a large extent on another strategy – the assertion that critics are ‘ignoring the role of biology’, a position which is self-evidently ridiculous. It would indeed be ridiculous to ignore the role of biology – and of course no one is suggesting such a thing. Lucy Johnstone makes it clear in both interviews that the argument is not about the undoubted existence of biological factors which accompany all human experience, both ‘normal’ and ‘abnormal’, but about whether these are seen as causes or effects (or correlates) of distress. But Craddock does not stick around to debate this further. His last contribution is to assert that people prefer to be called ‘patients’, not service users or survivors. We then hear from a very articulate service user, Michael, who vividly describes the despair and hopelessness induced by a diagnosis of personality disorder, which he now rejects, along with the other 5 psychiatric diagnoses he was given. He also, incidentally, rejects the term ‘patient.’
Craddock is seen as adopting a fairly extreme position even within his own profession, and as such is not necessarily its desired public face. That position is increasingly occupied by spokespeople from the opposite wing – the ‘social wing’ such as, for instance, Professor Burns whose new book Our necessary shadow: the nature and meaning of psychiatry (2013) claims (quite wrongly) to be the first in a generation to attempt to “explain the subject fully to the interested outsider.” The book received a glowing review from Raymond Tallis (The Times 1.6.13), who is normally the first to dismiss simplistic biological explanations of human experience. Presumably he was so seduced by statements in the book such as “mental illnesses… exist between people. They are not contained within an organ or body” that he failed to grasp the implications of retaining all the trappings of the same old biomedical model (the language of illness, the essential role of medication, the psychiatrist in charge, and the call for “recognition of the massive good it (psychiatry) does.”) Burns, then, is a sophisticated player, and one whose arguments require careful scrutiny.
In his co-authored article in the British Journal of Psychiatry (Priebe et al., 2013), Burns frankly admits that the last 30 years have seen no scientific breakthroughs or better treatments, and argues that psychiatry needs to re-introduce the social and relationship contexts of people’s lives, rather than “simply pressing on with ‘more of the same”’. This new vision acknowledges “the abundant evidence of the importance of personal relationships in shaping both cause and cure of disorders.”
Re-defining the profession as virtually indistinguishable from counsellors or social workers (apart from the status and salaries, of course) requires some fairly extensive re-writing of history – his own, and that of the profession as a whole. Burns appears in a rather different guise as the consultant in a 1995 television documentary Whose Mind is it Anyway? As described in Lucy Johnstone’s book ‘Users and abusers of psychiatry’ (2000):
“John Baptist is the adopted name of a black man who believes that he was born white, that he is descended from the royal family, and that his sister has been cannibalised, but he is apparently coping perfectly well with his life. He does not see himself as mentally ill and does not want medication… He… describes how last time he ‘came out of this hospital hardly able to brush my teeth, hardly able to eat, hardly able to stand… I was less than a baby. Now, what sort of medicine is that?’ He demands to know what proof the consultant has that his beliefs are untrue, and forces the consultant to admit that this is in fact a matter of personal judgement: ‘Well, you’re right in a way there… the only way I make that diagnosis is on people’s thoughts and feelings.’ However, in this unequal power battle there is little doubt whose delusion is going to carry the day, and we see the consultant telling the camera that ‘I’ve no doubt this is a schizophrenic illness’, while John is threatened with a locked ward if he tries to leave.
“The rest of the programme charts John’s determined but unsuccessful attempts to gain his freedom, while insisting on retaining his beliefs. His assertiveness and refusal to compromise about his ideas clearly count against him, for the chief evidence against him at a tribunal hearing is that he used to be ‘angry, irritable, shouting at people, verbally aggressive’ and that he still has ‘inappropriate beliefs.’ Meanwhile, forcible administration of the medication he so hates gradually reduces him to a silent, shambling wreck of his former self, with a heart-breaking expression of sadness and hopelessness. This, to his consultant, is actually seen as progress; by a deft shifting of the goalposts, he is able to claim that, though John still retains his beliefs, his sadness indicates that he is ‘more of a whole person’ and has therefore improved. In one of the final scenes, we see a team member persuading John, in ultra-caring tones, to set the seal on his degradation and defeat by signing a form to confirm that he is ‘permanently and substantially disabled’, in return for a bus pass. John’s mental illness is at last being properly treated; or to put it another way, he has now been permanently and substantially disabled for obstinately refusing to regulate his thoughts according to white cultural norms (pp.231-232.)”
Burns’ apparently colour-blind and culture-blind approach in diagnosing John Baptist in 1995 may well have resulted in an institutionally racist outcome to the latter’s hospital experience as a result of invalidation of his subjective reality in the interactions depicted in the film. Perhaps Burns has undergone a dramatic conversion recently, in line with the call for change issued by critical psychiatrists (Bracken et al., 2012). If so, a public apology to John Baptist is merited in view of the apparent injustice done to him in 1995.
In his radio interview, Burns does not refer to this documentary, although he is at pains to find areas of agreement with his critics. He enthusiastically welcomes the fact that DSM “has come in for a real kicking” and openly admits the lack of progress of the last 30 years. Naturally, he does not extend this to an argument for dispensing with diagnosis, or psychiatrists, altogether, but nevertheless the position is clear: The profession has gone too far down the biomedical route. Burns and his allies present themselves as reasonable people who can acknowledge these errors – as a profession, that is, not as individuals – and usher in a new, humanitarian era of psychiatry.
Curiously, Burns hardly bothers to deny the range of charges that Lucy Johnstone forcefully puts to him: that there is no evidence for biological causal factors in mental distress; that psychiatry is not a legitimate branch of medicine; that there is overwhelming evidence that service users are experiencing the understandable consequences of traumatic life experiences; that psychiatric treatments often do not ‘work’ but create disability; and that many survivors only recover by escaping psychiatry and renouncing their labels. Instead, he escapes into lofty generalisations in which psychiatric activities simply become a sensible, pragmatic way of finding out what works in practice.
Burns has also developed an ingenious, if contradictory, set of new defences, as illustrated in the interview. These are 1) that medicine has no particular theoretical basis, and that is a good thing and 2) that medicine draws on every possible theoretical basis, social, psychological and biological, and that is an even better thing.
It is worth examining these claims in more detail. Both rely on the assumption that mental distress is best understood in medical terms – exactly the point that is at issue, as Lucy Johnstone reminds him. Leaving that aside, the admission that psychiatry has no specific theoretical basis at all could perhaps be seen as an honest response to the fact that its evidence-base has now been officially acknowledged as entirely absent. However, Burns takes this to quite an extraordinary level. Rather than elevate psychiatry to the status of neurology, as Craddock et al. attempt to do, he seeks to reduce the whole of medicine to the state of psychiatry, and in doing so, describes a scenario reminiscent of the days of blood-letting and leeches, with interventions drawn out of a hat because there is no established theoretical basis for the discipline. Medicine is, he argues, ‘a pragmatic, atheoretical approach…the advantage of medicine is that it is NOT a theory-driven activity.’ This describes psychiatry very accurately, but extending it to the whole of modern medicine is quite bizarre, given that other branches are supported by clear theoretical frameworks and evidence bases which have brought about the progress that is conspicuously absent in psychiatry.
This exposition leaves psychiatrists in a very vulnerable position. If medicine and psychiatry are in such a primitive state, why shouldn’t other professionals or indeed lay people take over their role? However, Burns quickly moves to counter this threat by slipping into the ‘but we can do everything’ rhetoric. No specific theoretical knowledge is needed, but this very fact means that we might have to call on almost any type of skill. And who has the broadest range of skills around here? Why, psychiatrists! Just to be clear on this point, we are reminded that this brave new world of psychiatry will not involve “in any way diluting its core medical responsibility” (Priebe et al., 2013).
Of the two responses, the second presents the bigger threat to the wholesale change that survivors are calling for, because it is superficially more plausible and, up to a point, welcome. If psychiatry maintains its dominant position, then at least let’s have psychiatrists who acknowledge the role of social factors, relationships and personal meanings – as many already do. The dwindling band of neuro-enthusiasts can be left to pursue their fantasies about mysterious brain dysfunctions even further down a dead-end alley. However, the new re-branded social psychiatrists are hard to pin down, and not everyone is convinced by their change of heart. In the words of one blogger:
“For the past 30 years, psychiatry has conceptualised human problems as illnesses and has promoted drugs as the only viable ‘treatment’ for these pseudo-illnesses. They have ruthlessly expanded their spurious, disempowering and stigmatising ‘diagnoses’. They have developed corrupt and corrupting relationships with pharma….They have legitimised the widespread prescription of dangerous drugs, and have stood by complacently as clients succumbed to the most devastating side effects… Now, with their reputation in tatters, and the survivors of the ‘treatments’ in open revolt, they seek to rehabilitate themselves. But there’s no apology. Not even an oops, sorry. Just ‘We’ve messed up our own patch. Can we come over to yours? And by the way, we’ll still be in charge.'” (Phil Hickey at www.behaviorismandmentalhealth.com, May 8th 2013)
Important clues to this group’s real position can perhaps be found it two linked areas. First, there is the failure, as above, to make any acknowledgement at all of the appalling damage and suffering (vividly illustrated by John Baptist’s story) that the existing paradigm has inflicted. Second, there is the cavalier attitude to survivor testimony – a perspective not even mentioned in their articles and airily dismissed by Burns in his interview with the words ‘We’re not perfect.’
This woefully inadequate response fails to acknowledge the devastating harm that many psychiatric survivors have experienced at the hands of biological psychiatry, along with the urgent need to address how to prevent such harm continuing in the future. Instead, intelligent people are expected to continue to accept discredited diagnoses for fear of being labelled as `lacking in insight’ and having treatment forced on them, incarcerated against their will, ‘for their own good’. People are coerced, both within hospital settings and even within their own homes through the widespread use of Community Treatment Orders (which as Burns notes regretfully in the documentary, did not exist in 1995, thus preventing him from imposing neuroleptics on John Baptist for even longer), into taking medication that they don’t want and which frequently does more harm than good (Whitaker, 2010).
Rather than re-positioning itself in response to the widely-acknowledged threat to its power and status arising from the DSM-5 debacle, psychiatry, along with colleagues from all professional disciplines, needs to work in genuine partnership with people with lived experience of diagnoses, in order to find less damaging and more humane ways of making sense of, and responding to, madness and distress. Fighting for the rights of those labelled mentally ill has been called the last great civil rights movement. Let us not allow the vested interests and dubious arguments of a powerful minority to waste this vital opportunity to replace the discredited biomedical model and its unscientific and stigmatising labels.
References
Bracken, P. et al (2012) Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201, 430-434.
Burns, T. (2013) Our necessary shadow: the nature and meaning of psychiatry. London: Penguin
Craddock et al. (2008) Wake-up call for British psychiatry. British Journal of Psychiatry, 193, 6-9.
Mental Health Europe (2013) More harm than good: DSM 5 and exclusively biological psychiatry must be completely rethought. http://www.mhe-sme.org/news-and-events/mhe-press-releases/dsm5_more_harm_than_good.html
Oyebode, F. and Humphries, M. (2011) The future of psychiatry. British Journal of Psychiatry, 199, 439-440.
Priebe, S., Burns, T. and Craig, T. (2013) The future of academic psychiatry may be social. British Journal of Psychiatry, 202, 319-320.
Whitaker, R. (2010) Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Crown Publishing Group.
This article illustrates something which I think is crucial but easily forgotten: although we are used to speak of “psychiatry” and of how psychiatry must change, psychiatry is of course an abstract concept and we should be careful not to reify it. Psychiatry cannot change any more than it can stay the same or eat a hamburger, it is psychiatrists who need to change.
Psychiatrists who, like Craddock, cannot change because that would mean throwing away the careers they have build for themselves or who, like Burns, do not mind to change provided they are allowed to stay on top, regardless of how ill-suited they might be to be on top of anything other than a scrap-heap.
And that is really the problem, isn’t it? I mean, put yourself in their shoes. What is the one quality most practicing professional psychiatrists must develop in the course of their professional careers in order to be good psychiatrists? An utter lack of empathy for their patients and an astonishing capacity to treat them as objects and ignore anything they say. And now, what do you want them to do? Enter into a human relationship with their patients? Retrain? Go back to school? Is that realistic? I don’t know, to me it sounds like giving a copy of the Tao Te Ching to Vladimir Putin and expect him to give up everything and become a Zen monk. It’s just not going to happen.
The gap between what psychiatrists know how to do and what actually needs to be done to help people is just too big, and most of them will not be able to close that gap in their actual professional practices. So the question is, what do you do with these thousands of highly-trained well-paid professionals who are good for nothing? If only we could offer them something equally well-paid that they could do with their skills in some other field, then I’m certain we would see real change in the field of mental health, real fast. I just can’t think of anything.
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First of all Morias, I love you! haha!…yeah after an extended hiatus (about 24 hrs i think) from this site and now due to popular demand…what?…i`m back, well for this one instance you hear…your comment is too good for words and yes i love you…haha…in fact i thought i wrote your comment for a minute in some kind of Philip K. Dick turn of events…but on rereading it I quickly realized the sheer quality and coherence (not to mention grammar spelling and argumentation precluded any possibility of it being mine!)…plus people who think those kind of things are delusional! …geez!…having said that it reminded me of something the psychiatrist Stuart Shipko said about bio psychiatry in North Amercia : something like we would all be infintiely better off if the whole box and practise known as psychiatry just dissolved. This would be the most optimum solution and cause the least harm.
I like your question on what to then do with these unemployed psychiatrists. I think they would have the skill set to do well in the Pentagon, and on a less lethal note they might have the tempermental disposition to work at the Canadian/American border….
on a similar note I worry about the effects of bring the kids to work day with regard to psychiatry and the pentagon (although i have written extensively on the pentagon with regard to bring the kids to work day)
thank you
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Thank you abbot (Philip K. Dick is one of my favorite writers; personal favorite: “Now Wait for Last Year”)
I was just trying to be realistic (and coherent which, believe me, does not come easily or quickly) in my comment above. I think we often get carried away into thinking that this is all a question of getting “them” to see the light. And to some extent it is, but what happens after they see the light? In the end I don’t think you can change “the profession” any more than you change “society”; real change happens one person at a time or not at all. This real individual change might take the shape of a psychiatrist realizing the DSM5 has fatally poisoned the golden egg goose and retraining to become a neurologist or psychologist while there’s still time, or it might take the shape of a religious conversion in which a psychiatrist realizes the sinfulness of his or her actions and gives up the profession to spend the rest of his or her days in penance and contrition, or it might take the shape of a psychiatrist losing his or her job when it becomes clear he or she doesn’t know what he or she is talking about (and this is an important point: this decision will be made one person at a time by the public or private organizations which employ them; don’t expect big sweeping mass deportations of psychiatrists or a UN resolution banning psychiatry), or it might take the shape of lawsuits against individual psychiatrists. One person at a time.
But having said that, I think you really have something there with this Canadian/American border patrol idea. Not as an enforced deportation, of course (as I just said, that’s just wishful thinking), but as a generous offer to relocate into a different job with better long-term prospects. I see a lot of promise in this plan, particularly if you are referring to the Yukon/Alaska border. Maybe they could even be offered a field research job in a big study on human/bear interaction.
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Hi Morias,
Yes so many great PKD books…I love a ton of them but my faves probably: Martian Time Slip, Time out of Joint…and UBIK is overrated!!
I find your comments very refreshing…as Neil Young would say long may you post!
My impression is that these are points that many get stuck on here: It is for everyone individually to decide on the course of action to change/reform/dismantle psychiatry. Needless to say there is great value to any and all approaches: the more change from with in (the more Whitaker approach…as i understand it at least), and the more grass roots “survivor“ led alternatives…and of course individuals who are far removed from either of those big or bigger tents…often wisely having run as far and fast as possible from the “mental health“ shitstem and developed their own personal networks of support and most importantly their own strengths….However I don`t think any approach has a monopoly on the truth and can mathmatically state this approach should/shall prevail…one can argue the merits and then go from there. Personally I think its fine to appeal to those of conscience within the system but believe the history of any social movement shows that simply appealing to your oppressors just ain`t gonna work!…you need to do the things that so many honourable people at MIA already do: build the new in the shell of the old…and be wary of the tendency of movements to suck defeat from the jaws of victory through self destructive infighting/ sabotage…i mean rigorous debate but no monopolies on truth
My sympathies lie mostly with just making psychiatry irrelevant…and yes i get it so many can`t right now…yes i get that to my very bones thank you…in some sense appealing to psychiatry is oppressive in itself and in that way not the preferred approach for many…don`t really care to communicate to the oppressor in that form…
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Well with the way the world appears to be going my guess is the essence of psychiatry will have to remain useful in the law and order field to really continue to exist in the same vein.
Focusing essentially on the existence of unwanted behavior as their mandate. The problem is there’s a line with this that really looks quite scary the further it’s pushed along.
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I don’t know, I read the post and the comments above, and I mainly see adolescent point scoring to one degree or another, IMHO.
The authors write;
Rather than re-positioning itself in response to the widely-acknowledged threat to its power and status arising from the DSM-5 debacle, psychiatry, along with colleagues from all professional disciplines, needs to work in genuine partnership with people with lived experience of diagnoses, in order to find less damaging and more humane ways of making sense of, and responding to, madness and distress.
I would love to see a list of the people with genuine lived experience, that the authors are working with, to glean real wisdom from? In my experience the usual “educated priesthood,” tends to be as condescending towards those of us who do a double degree in life, simply because we don’t have letters after our name.
The “subconscious” need for rank and status, is as strong within anti-psychiatry, as it in mainstream psychiatry IMO. With the usual educated elites being no more self-aware, than the blue bloods they rail against, IMO. When I acted-out an active psychosis within the sacred walls of theicarusproject in 2010, the reaction was no different to any mainstream situation, and the denial that we’re not like “them,” is one of those paradoxical realities of being human, IMO. When will we learn that a “postural attitude,” towards “them,” will always beget an equally strong reaction, in the subconscious reality of our e-motive reactivity?
Which is why I wrote, “asking people to be aware of unconscious affect and e-motive reactivity, is like asking a fish about water. “What’s water?”
Read more here: http://www.born2psychosis.blogspot.com.au/p/chp-17_16.html
Best wishes to all,
david Bates.
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Hi David,
I concede that your adolescent point scoring is more erudite than mine. I also concede that your enlightenment is bigger than mine….and my “e-motive reactivity“ has worked well since encountering psychiatry.
good day sir! why I never!
oh know that’s ok. takes many flowers to bloom I think and keep on with yours sir. I mean that. Good luck to you sir.
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Lucy, Jacqui, and Suman,
Thank you for your perspective and this article, I largely agree. The psychiatric industry is debating about how and why they should maintain their right of respectability, control, and power. When it seems they’ve spent the past 50 years doing nothing other than writing a DSM “bible” describing the psychiatric illnesses their drugs CAUSE, according to the medical evidence. And, of course, medicalizing normal human emotions and behaviors in order to railroad everyone they possibly can onto their drugs, that cause the serious bipolar symptoms and schizophrenia symptoms, for profit.
But the psychiatrists still seem completely ignorant of the crimes the psycho / pharmaceutical complex have committed against humanity, due to their delusions their meds are beneficial. They don’t want to confess, apologize, or make proper amends, despite having malpractice insurance intended for this exact purpose. And the concept they were only trusted in the first place because they had malpractice insurance in the event their DSM theories or meds were incorrect and bogus seems completely beyond their comprehension.
As someone who had bad reactions to a “safe” smoking cessation drug (actual dangerous antidepressant) misdiagnosed as bipolar and dealt with “Foul up” after “Foul up” with antipsychotics, I know I am owed an apology. I know all who were turned into bipolar patients with antidepressants or ADHD drugs, then tortured with antipsychotics are owed an apology and proper compensation.
If the psychiatric industry is unable to confess and repent for their crimes against humanity, due to their ignorance and/or greed, they have no right to have their profession saved or respected, in my opinion.
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Someone Else, you write:
“As someone who had bad reactions to a “safe” smoking cessation drug (actual dangerous antidepressant) misdiagnosed as bipolar and dealt with “Foul up” after “Foul up” with antipsychotics, I know I am owed an apology. I know all who were turned into bipolar patients with antidepressants or ADHD drugs, then tortured with antipsychotics are owed an apology and proper compensation.”
This is similar to my own experience. Can you think of a way of measuring how many “bipolar” diagnoses are actually a reaction to psych meds? Do you know if this has ever been studied? And as for an apology and proper compensation, the only way that’s going to happen is through groundbreaking and successful lawsuits.
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This is all great stuff, but Lucy, Jacqui, Suman what really hacks me off about British survivors and critical thinkers is that the debate all too often gets stuck on diagnosis as the be all and end all of the debate when psychiatry does not exist in a vacuum. It exists within a political system which would crush anyone not conforming with or without psychiatry. So while all the earnest discussion about the profoundly damaging impact of diagnosis and forced treatment goes on people being killed in other ways by systems and policies which hand deliver them to psychiatry’s doorstep and get little comment, no comment or paid lip service to. It’s disability and human rights activists who are speaking on these issues not mental health activists.
Diagnosis means nothing to those facing social security assessments where GP’s are being instructed to not help, psych reports are not available due to service cuts and yes diagnosis is actually needed for them like it or not. I’m seeing service users face the prospect of destitution because if they appeal a negative decision (after a harrowing process) they face months of no income before they are allowed to formally appeal (a process in itself which takes at least a year and requires formal representation from ever hard pressed CAB’s at tribunal court). Months of no income means losing social housing (eviction notices issued within 2 non-payments of rent), non-payment of council tax can mean jail time, and food banks can only offer a maximum of 3 tinned food parcels a year. We might not approve of those who use services, and/or use their diagnosis to access an income to survive on (or Direct Payments to pay for their chosen non-medical support which still requires some health & social care backing) but this is their reality.
I’m fine with the debate on diagnosis and support change, I want to envisage a future where distress is met with; Open Dialogue, Soteria, non-medical crisis houses, more peer support, where ‘recovery’ is truly self-defined (or not used as a concept at all if chosen), where everyone is free to chose their own explanatory framework (even if we don’t agree with it), and assisted to live to the very best of their abilities and aspirations and where if there are enduring difficulties these are also accepted.
Where people are assisted to live and work in paid, unpaid, and variable ways which suits them best because what we currently have does the complete opposite.
Fighting psychiatric oppression has to go hand in hand with fighting social and political injustice too which also kills people and those very injustices also drive people mad along with the personal, relationships, and traumas, and can drive people into the psych system, and keep them there.
Removing diagnostic systems in itself doesn’t shift everything, because they are infused within many administrative and financial structures like the raspberry ripple of an ice cream. You can’t just remove the raspberry sauce, you have to address the ice cream too.
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Hi Joanna, I completely agree that psychiatry does not exist in a vacuum. Here in the UK, as you say, we are facing devastating attacks on the most needy, who are demonised as ‘scroungers’ while the privileged elite line their own pockets. There is overwhelming evidence that poverty, unemployment, social inequality, poor housing, discrimination etc lead to increased levels of mental distress. So yes, we need to fight against this kind of social injustice. One of the problems in the UK at present, as you will know, is that opposition and protest is currently so muted, and not just from psychiatric campaigners. It feels as if everyone is too scared to speak out, and indeed they may have good reasons for this feeling.
Our post is not specifically about diagnosis, but about the various ways in which the profession of psychiatry is seeking to preserve its power and status. Critics have, of course, argued for many years that its core function (not necessarily intended by the individual practitioner) is to silence dissent by re-defining the consequences of social policy as medical illnesses. If you accept this view, then campaigning needs to happen on both fronts. As you rightly
say, we need to highlight the injustices that lead to breakdown in the first place, along with challenging psychiatry for its role in concealing the causal factors behind unscientific and stigmatising labels, and for its many other dubious practices.
Meanwhile, of course people will need to use diagnoses to gain access to essential benefits – that is how the system works at present. It is not going to vanish overnight, and we all have to survive in the best way we can.
I like your recipe for the way forward!
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Lucy thank you very much for replying, I’ve always been an admirer of your work and positions on many issues.
I knew you would have a wider analysis on this and my point of posting was in the hope that you would flesh that out which you have, and I for one appreciate it because of our country’s current suppression, we have many battles on our hands at the moment including our NHS being deliberately set up to fail and sold off along with the much else. The medical profession is being complicit in some quarters with concealment of social injustice causing mental distress, whilst others are trying their darn hardest to help against a fascist tide.
There are few UK survivor activists who always refer to psychiatric oppression within its wider political context never seeing it in isolation, Peter Beresford and Jan Wallcraft are examples of people who always do so, otherwise there are not enough high profile voices within UK survivor activism who do so – so my call to peers is to please do so, because if we don’t speak out we are colluding with it.
The ice cream analogy – a forensic psychiatrist once used it to describe people deemed to be Schizophrenic being like a cherry on top of a raspberry ripple ice cream (which could be removed) whilst psychopathy was likened to the raspberry ripple (which could not be removed), so I decided to put the picture to better use!
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There is a council where people with “known MH problems” cannot bid on properties where the previous occupant also had “known MH problems” and this is at a time of housing crisis. There is a form of MH/disability cleansing going on here and that’s local and national government (all parties). Capitalism is causing Western crisis on a scale as big as psychiatry and they go hand in hand
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Isn’t that against the law? Such actions here in Canada would offend our Charter of Rights and Freedoms. And who determines who has “known MH problems”? This sounds very creepy to me.
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Probably but how do you counter it with virtually no legal aid? Being ‘known’ is easy enough if you need ‘floating support’ housing support on moving via landlord
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Amnesty rightly condemns UK:
http://www.leftfootforward.org/2013/04/amnesty-international-condemns-coalition-assault-on-disabled/
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I note Priebe in ref’s – he did a study where service users were paid to take antipyschotics, to incentivise treatment adherence.
Equally there are recovery activists who would feel as repulsed by their peers taking state support utilizing their diagnosis to do so (because that’s how the system works).
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I would love it if the psychiatric profession was really “in crisis,” that is, in danger of losing their power. I think it is more that psychiatry has become so used to not being challenged that when they are, even in what I see as a rather ineffective way, it throws them into a panic. If only things were as bad for them as they think they are. I think we have a long way to go
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I must agree with you Ted on this.
Our RCP [Royal College of Psychiatrists] recently produced
a “guide” for MP’s about us, on how to “support” constituents, it’s a sick joke:
http://www.rcpsych.ac.uk/policyandparliamentary/projects/live/discriminationagainstmh-1/mpguidetosupporting.aspx
Their policies (all parties) are hammering survivors now more than ever and they are the seat of rising levels of hate crimes and they produce this shit.
These are the people who also believe it’s helpful to produce ‘get well’ cards:
http://www.rcpsych.ac.uk/usefulresources/getwellsooncards.aspx
They don’t have anything better to do..
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Get well cards? Are they mad? And it says they were “designed in collaboration with service users, carers, psychiatrists and other mental health professionals”. As if everything is just fine in psychiatric system land. I can’t believe it.
The card endorsements from ex-patients mention feeling isolated from family when in psychiatric situations, as if it was the family’s fault. When it’s been my experience, as both a patient and carer, that psychiatry separates patients from their family members, if they think it best. As in, patriarchal decision making.
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I know Chrys it’s obscene, my rage is getting beyond words.
‘Time for Change’ (otherwise known as Time for Fuck All)waste 20 MILLION on stupid adverts to target ‘stigma’ in the general public whilst Amnesty rightly condemn our govnt for abuses of human rights, I’d rather that money was spent on human rights lawyers to take our govt to court. A survivor said today “Enforced passivity as the price exacted for requiring help has been the most corrosive thing to happen to me”. The sense of powerless and loss of hope is greater now than I’ve witnessed in a some time, the crisis is amongst us not them..
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Your description of the so-called anti-stigma campaign as Time for F All is very funny Joanna, and true. Sometimes laughter is the only antidote to the madness of psychiatry and their cohorts. “They’re coming to take me away, ho ho, hee he, ha ha”:
http://www.youtube.com/watch?v=hnzHtm1jhL4
The survivor quote is on the button “Enforced passivity as the price exacted for requiring help has been the most corrosive thing to happen to me”. I’ve shared it on Facebook. Thanks.
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Oh that was the polite version Chrys!
I’m in need of anger management…anger is great when you can channel it into activism in a productive way to help effect change, I can’t find a way of using it right now, I feel like I’m going to spontaneously combust with rage at what is happening around us and there’s little recourse
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What about writing and blogging Joanna? Writing Emails to folk in power or who think they’re in power. Writing your own blogs with stories and quotes from survivors, poetry and musings? It’s a great way of taking back the power and being empowered.
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Maybe, I used to write more, many better writers than me around
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Go for it Joanna. Practice makes perfect. And anyway the most important opinion is your own and you have plenty to say that is relevant. In my opinion.
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Joanna – thanks for posting the link above to the Members of Parliament guide to supporting constituents with mental health problems. I’ve rarely read a document that combines insult and inaccuracy in such a patronising way. We learn that these difficult people with mental health problems are liable to ‘direct anger unfairly at you’, be ‘unfocused or confused’ about their requests, need firm boundaries, become ‘angry or abusive’ and so on – and all because they may be suffering from a range of conditions such as ‘personality disorder’ (which involves being paranoid, anti-social, narcissistic etc), ‘bipolar’, ‘schizophrenia’, and so on. I am sure that MPs see many people who are angry, confused, unclear about their requests and so on – but to attribute all these qualities specifically to the ‘mentally ill’ is really shocking. And this is the combined effort of the Royal College of Psychiatrists and the UK’s 2 main mental health charities. The same charities who are promoting the anti-stigma ‘Time to change’ campaign! Read it and see what you think!
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Thanks Lucy, I’ve tried to take the RCP, Rethink and Mind to task but I’m ignored or deleted. Par for the course I know..
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Critical Psychiatry Network (CPN) in UK, now extending to an international scope as the International Critical Psychiatry Network has done a great job in enlightening the circumstances of psychiatry profession in modern world. What they and similar organizations need is attracting the attention of lawyers with similar ideas regarding mentally ill to join to them. Even CPN themselves fell in legal trouble in promoting their proposed paradigm (In a case very similar to Galileo). The problem arises from the UN declaration of human rights and European guidelines on human rights. It deprives mentally ill of enjoying equal rights with other people once and even before being labelled as such. Recent legislations in Britain made it easier to put restrictions on anybody labelled for his madness, and the law extended the power of detention from a psychiatrist to actually whoever that could be around as part of the psychiatry institution. The new law has elongated the intervals of assessments from months to years and to open ended. They can put harmless people under guardianship without their consent and without being informed or without informing their next of kin. Law uses or abuses a vague term as “when it is regarded just for well being of the patient even though has not done harm to self or others.” It is not known how that well being can be gauged and when that will be achieved. Only lawyers can handle such situations and push the case for emancipation of mentally ills. No scientific debate would penetrate into the ears of judges. In US, judges say it is the idea of Scientology. In Europe they say it is the idea of a bunch of belated radical Internet forums. Critical Psychiatry Network needs lawyers to join to them.
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I think all critical thinking groups need lawyers now..
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My son killed himself 15 days after being prescribed an SSRI by a psychiatric registrar who despite conducting what he considered a thorough assessment, found no mental disorder. At inquest, he told the Coroner that when he was advised that my 17 year old had hanged himself he “couldn’t remember his name or face.” That says much about psychiatry. The fact he would say it in front of the mother of his dead ‘patient’ says just as much.
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“Curiously, Burns hardly bothers to deny the range of charges that Lucy Johnstone forcefully puts to him: that there is no evidence for biological causal factors in mental distress; that psychiatry is not a legitimate branch of medicine; that there is overwhelming evidence that service users are experiencing the understandable consequences of traumatic life experiences; that psychiatric treatments often do not ‘work’ but create disability; and that many survivors only recover by escaping psychiatry and renouncing their labels. Instead, he escapes into lofty generalisations in which psychiatric activities simply become a sensible, pragmatic way of finding out what works in practice. ”
Exactly to the point…
I have seen this so many times, hundreds, if not thousands of times. The usual progression is that someone sees a psychiatrist because of some minor emotional problems, only to be put on very strong medications. The so called patient has no idea of just how powerful those drugs are. ,
The drugs do not keep their symptoms entirely at bay, and this necessitates, regular medication changes, and increasing dosages. For many people there are also increased levels of anxiety, and depression, as the medications cause the very symptoms they are meant to treat.
When the medications stop working, then ECT will be tried…at first it may work. But then it too usually begins to fail.. Maintenance ECT is then tried monthly, and this may go on for years, and years….
Ultimately leaving the pt. in a permanent vegetable like state…
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