“The Doctor/Patient Relationship Comes First, Last, and Always”


Allen Frances traces the history of empathic listening from Philippe Pinel in the early 19th century, through his own recent conversation with Eleanor Longden. He notes the help Longden received from Pat Bracken, a founder of the Critical Psychiatry Network, and invites Bracken’s comment, “The mind is not simply another organ of the body. It is impossible to understand mental illness without understanding the experiences, meanings, relationships, and values of the person and his social context. A purely medical approach that works well in the field of cardiology or respiratory medicine is incomplete for psychiatry. It is our task to develop a medical discourse that takes a broader view.”

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  1. Of course Frances praises Pinel ‘who created modern psychiatry as a medical specialty not by demonstrating that mental diseases are diseases but by defining coercion as moral treatment.’ Not against straitjackets or even forced feeding. Read more on what Szasz has to say here.


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  2. Thanks for the post, Nick.

    Since Szasz’s relatively recent death, a renewed round of one-sided criticism’s and evaluations of his understanding have emerged, as well as the continuing of the uninterrupted moratorium on public discussion of the human rights aspects of coercive psychiatry. It remains helpful to refer to Szasz, his ideas, and his work on fundamental issues of all kinds that affect consumers and influence received opinion.

    Al Frances means to present views of someone who responded to criticism, but seems not to want to champion psychiatry in dissent. He is not at all radical and perhaps not thorough enough with his challenges to the latest breed of colleagues that he hopes to inform.

    Se we definitely have the task of investigating further for a balance of factual information and humanistic perspective than his moderate position affords us, who constantly have to dispel the myths and discharge the misinformation of doctors and their ideology.

    Despite well-intentioned efforts such as his and those of other critics and converts to a more people-friendly model, we have to go at things in a mercinary way to learn how the situation really is. And we get treated as outsiders and antagonists by anyone who goes along with perceived authority, the more independently we represent alternative views.

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  3. The link for Thomas Szasz writing about Pinel in Nick Stuart’s reflects the deficiencies of Allen Francis’s statements for provoking a critical response to the central aspects of coercive psychiatry.

    Given the chance to say what he thinks about all this, only Frances just says that Szasz “goes too far”. But is that in characterizing Pinel as assigning superiority of judgment to the acting psychiatric authority until the notion of “rights” is meaningless, except as dictated by that authority? …It looks that way.

    Frances seems like a Mary Poppins type of critic, insisting to sweeten the results of looking as the history of Western psychiatry and including only so much hard fact as will not spoil the effect of obscuring issues of the legitmacy of intending to coerce or infantilize mental patients, and ultimately restrict their claims of self-sufficiency and independence unless these follow the most sanctioned recommendations.

    Frances’s new bold face isn’t offensive, but it’s not very audacious and isn’t rigorous enough about the relevant historical contexts. This is too bad, since he writes fairly well.

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