Winning Friends and Influencing People

Peter Kinderman
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Some readers of Mad in America may be aware that Scientific American published a short blog by me on 17th November 2014 – Why We Need to Abandon the Disease-Model of Mental Health Care. This blog was rather wonderfully (and slightly embarrassingly) described by Phil Hickey on his website, Behaviorism and Mental Health, as “an important milestone.”

My blog attempts to summarise many of the key points of a perspective widely shared on Mad in America: 

“We need radical change, not only in how we understand mental health problems, but also in how we design and commission mental health services.”

“It’s all too easy to assume that mental health problems — especially the more severe ones that attract diagnoses like bipolar disorder or schizophrenia — must be mystery biological illnesses, random and essentially unconnected to a person’s life. But when we start asking questions about this traditional disease-model way of thinking, those assumptions start to crumble.”

“We need to place people and human psychology central in our thinking. Psychological science offers robust scientific models of mental health and well-being, which integrate biological findings with the substantial evidence of the social determinants of health and well-being, mediated by psychological processes.”

“We must stop regarding people’s very real emotional distress as merely the symptom of diagnosable ‘illnesses’.”

“It is important that we are able to define, identify and measure the phenomena we are attempting to study and the problems for which people seek help. But we obfuscate rather than help when we use the language of medical disease to describe the understandable, human and indeed normal response of people to traumatic or distressing circumstances.”

“… we should replace traditional diagnoses with straightforward descriptions of problems.”

“A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and for the design and planning of services.”

“This is an unequivocal call for a revolution in the way we conceptualize mental health and in how we provide services for people in distress, but I believe it’s a revolution that’s already underway.”

Phil’s contention is that we have reached a welcome milestone when ideas such as this are presented in Scientific American; with nearly 4 million visitors to its website each month, and with its status as the planet’s leading mainstream scientific publication. Phil’s hope is that such publication will help ideas such as this reach a wider and important audience. I hope he’s right. And I think Phil is suggesting that the acceptance of these kinds of arguments in a forum such as this indicates their increasing acceptance in the scientific community. I hope he’s right.

I have some reason to be gently pleased. The article has been widely circulated on social media (it’s been “liked” two thousand times, and it remains one of the “most read” blogs on the Scientific American website.

On the other hand … one commentator (herself a widely-read journalist) commented that my piece was “… a bunch of blather … embarrassing … the lowest of the low …” written by “ … a nincompoop with an ax to grind.”

I guess we can conclude that I haven’t been able to persuade everybody — yet.

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Peter Kinderman
Peter Kinderman
Peter Kinderman is Professor of Clinical Psychology at the University of Liverpool, an honorary Consultant Clinical Psychologist with Mersey Care NHS Trust, and Vice President of the British Psychological Society. His research interests are in psychological processes as mediators between biological, social and circumstantial factors in mental health and wellbeing. His most recent book, ‘A Prescription for Psychiatry’, presents his vision for the future of mental health services. You can follow him on Twitter as @peterkinderman.

20 COMMENTS

  1. I feel like I’m getting a little bit of spin here, but the spin is coming from a different direction than that coming from bio-psychiatry. A lot of it has to do with language. Critics can manipulate language, too. What about “disease model” is different from “medical model”? Alright. Somebody has read the “alternative” lit. “Mental health problems”, “mental health issues”, “mental health challenges”, there are hundreds of weasel words there that can be employed in this matter. The fact that “mental health” is a figure of speech just eludes people. I like the call for getting to the roots of matter, and facilitating radical change. One radical change that could go far would be, just as we outlaw non-consensual sexual relations, to outlaw psychiatry between non-consenting adults. Outlaw non-consensual psychiatry, and the only people with psychiatric labels are those who consent to have them. Enough with the surveillance and monitoring already! I don’t like social control. I don’t care whether the social controllers are “disease model” or “distress model”. Not only do I prefer, to quote an adversary, “to die with my rights on,” but I prefer to live with my rights on. Of course, the prequisite for living with my rights on are human and civil rights, human and civil rights that are persistently violated and denied by “mental health” law.

    • Coercion and forced treatment are synonymous with *psychiatry*, which is a medical specialty first and by extension, a means of social control , because psychiatric treatment is sanctioned by law. The law does not dictate or limit- in any real sense, the practice of psychiatry.

      So, although it resonates with most of us here to say:

      ” Outlaw non-consensual psychiatry, and the only people with psychiatric labels are those who consent to have them.”

      I really don’t think coercion and force can be taken away from the mainstay of psychiatry by law–

      My strategy is to strip psychiatry of “MD” status– and thereby remove it’s *untouchable* legal intervention status.

      And that requires Doctors to step up to the plate and simply call a spade, a spade–

      IF we were to wake up tomorrow to breaking news that the AMA has revoked all claims to MD,medical doctor status/privilege/authority from psychiatry–, we will see the dawn of human and civil rights — at long last!

      • Of course, “coercion and force can be taken away from the mainstay of psychiatry by law”, expressly because “coercion and force” is the law. Whatever way would you have for changing the law? Look into what Tina Minkowitz and others have done with the UN CPRD. Such amounts to taking away coercion and force by outlawing it with international law, and then having having international law apply locally.

        Removing the M. D. status wouldn’t hurt either though. Especially since, unless you believe bio-psychiatry’s very biased Pharma financed studies, there is little basis for it.

        • What you are naming with the terms, coercion and force, are the means by which psychiatrist’s assure that those in need of *treatment* for *disorders* they have the authority to diagnose, receive the *treatment* that they resist due to their *disorder*– refer back to their authority as doctors., to diagnose and treat the *mentally ill*. What sort of law, in the context of our society, would prohibit a psychiatrists from exercising their authority as MDs to diagnose and treat according to their own professional standards?

          • Coercion and force are the means by which the authorities control certain segments of the population. There is no medical science in that. Police science, maybe. The criminal justice system is just more honest about it. They even admit to making mistakes on occasion. The mental health system, on the other hand, operates on deception and self-deception as a kind of pre-criminal justice system. I will always prefer civil liberties and human rights to no civil liberties and no human rights. There’s not a lot of oversight involved when you’re system is just a matter of getting around the law anyway.

    • Frank: One method I used on Saturday was to take my stash of Szasz and Chomsky books to the bookstore in town which is going to start a used book section in January. They are down with Chomsky, but had never heard of Szasz. They are going to put the Manufacture of Madness on their shelf, and I am trying to persuade them to shelve other of Szasz’s works. I am looking to move up in the ranks of the Green Party affiliate-The Mountain Party-We are in a pretty good position to put our boot on the throat of the local Democrat Party. I participate in Green Drinks, and a foreign policy study group at the library. Besides MIA, I blog at zcomm, Counterpunch, Truthout, Fairness and Accuracy in Media, and local environmental groups. I am a card carrying member of the ACLU, and am looking to push them along the path being laid out here on MIA. The revolution is already here. It is just a matter of opening up the lines of communications and linking up like minded groups.

  3. Thanks Peter, for stepping forward enough to get your well described points out to so many people!

    Some of us don’t face much criticism because we usually don’t get our views out to a wide enough audience to really bother the guardians of the status quo, but it seems you did make it far enough to encounter some hostility – good for you!

  4. I agree with you about the etiology of many distressful emotions coming from social determinants but when I read articles such as yours, I am always left with the feeling, why does it have to be either or?

    Examining and correcting issues in society is long overdue, but to ignore biology would not be correct either. I think of things like syphilis, ergot fungus, nutritional deficiencies, and illicit substances as examples of things that can cause symptoms of mental illness.

    I hear that all sorts of medical problems are ruled out prior to a mental health diagnosis, but I doubt this is true. However, say it is, then think of all of the things we don’t know yet that could being causing these symptoms.

    While unknown physical causes may not be ignored as much psychosocial issues, they are still being ignored and I would hate to see a return to everything being blamed on your mother or some ego/id struggle or even poverty if someone is in fact physically ill.

    • Because the error is typically made in the other direction, that is, in favor of biology, and without overwhelming evidence to support such a supposition. In other words, don’t rule in both/and before you rule out either/or. Either ahem way, we are still a long way from the final word. Keeping an open mind means just that, keeping an open mind.

  5. Hi Peter,

    I like your writing as well.

    I identify with grief and anger. A psychologist explained the similarity to me – when anger subsides things appear manageable, and this can also be applied to anxiety. When I experienced this for myself I thought he was a genius.

  8. Congrats on getting this in Scientific American. And while it may in fact be a monumental milestone, I sense what i believe is your bemusement regarding the fact that publication of such a relatively moderate and benign set of assertions on your part could constitute a “momentous” occasion. This is of course primarily a commentary on the media blackout of even the most innocuous commentaries critical of psychiatry.

    You must also be aware that you help promote confusion by challenging “disease models,” yet constantly referring to “mental health.” Szasz pointed out that if mental illness is a myth, so is mental health; you can’t put the former in quotation marks and not the latter. Maybe you could incorporate this into your analysis, it would help make it more consistent.

  10. Hi Peter,

    I know this is an old post linking to an older one, but just got to it and read down to the comment you mentioned by Gina Pera. You say pretty much all the right things, although your language itself is so conventional that I’m not used to it. I appreciate your position statement and your reasons for making your stand. That is, I’m grateful for the effect it has in the world.

    People who take our popular culture and conventional authority figures as the near perfect source for their moral principles, values, and personal style seem to me the craziest and most unwise and harmful in society. But they also are the clear majority in various social environments, wholly dominant in some venues, and whether or not they’ve become unruly, they aren’t the type to maintain order on their own. They tend to believe that social harmony exists naturally and only disappears because of unwelcome intrusions by nonconforming types, troublemakers who are not of their own kind, social rejects.

    Of course many of them like to support the mentally ill and the bold humanitarian approach of modern psychiatry. I can’t understand why these advocates believe that psychiatry needs their help. It continues to do the awesome job it has done throughout history. Even more I can’t see what makes psychiatrists welcome their gracious endorsements–these great public masses and their pundits cheering the doctors on, when they are so busy fighting the stigma that comes from out of nowhere that they must definitely prefer little getaways from how important titration and electroconvulsive shock is. How saintly of them.

    And so on. Anyway, I continue to get encouraged by carefully modulated remarks like yours that remain careful about the distinction between proof and supposition.

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