Researchers Call for Transparency About Limits of Psychiatric Knowledge

A new paper explores how the disputed nature of psychiatric knowledge influences public perceptions and debates within the field of mental health.

Rebecca Troeger
23
2801

In an article published recently in Social Theory and Health, Dr. Jeremy Dixon and Dr. Dirk Richter consider the contested nature of psychiatric knowledge and implications for mental health practice. Dixon, of the University of Bath’s Department of Social Policy and Sciences, and Richter, of University Bern Psychiatric Services, argue that practitioners must be open about the “socially constructed state” of the psychiatric canon, and should seek to understand and adapt their approaches to clients’ conceptual frameworks for mental illness (i.e. biomedical, psychosocial, etc.).

“Professional mental health workers need to be transparent about the assumptions and limitations of psychiatric knowledge and base therapeutic decisions around the way in which service users and carers construct mental disorder,” the authors write.

Photo Credit: iStock

Dixon and Richter provide a brief overview of the history of theories of mental disorders, including biomedical, psychosocial, social constructionist, and critical realist models. Social constructionists view mental disorder diagnoses as a “social response to particular types of behavior deemed ‘deviant’ by wider society.” Critical realists, on the other hand, posit that “every psychiatric crisis is also a social crisis,” and that psychiatry transforms common, often passing human experiences into clinical situations that require medical intervention.

The authors review recent mental health public attitudes research and conclude that Western populations have complex, sometimes contradictory views of mental illness and its treatment. For example, although a biomedical view of mental health has been increasingly embraced by those in the West, many still believe that psychosocial circumstances play an important role in the development of mental illness. Attitudes towards treatment also vary; while Western individuals have become more likely to endorse drug treatment for schizophrenia and depression, they still prefer psychological treatment.

Dixon and Richter consider ongoing debates amongst psychiatrists, psychiatric nurses, and social workers in England and Wales in order to explore how mental health professionals are reacting in real-time to these disparate views of mental disorder. They highlight recent shifts in English and Welsh mental health policy towards prioritizing service user involvement and choice, and suggest that these changes have “challenged traditional notions of professionalism which had held that professionals were schooled in bodies of knowledge that lay people were not equipped to access.”

These changes have forced psychiatrists to re-assess how to position themselves and their professional know-how to patients with different conceptualizations of mental illness. Dixon and Richter explain that psychiatrists have reacted to this predicament differently – while some have responded by advocating for the “re-professionalization” of psychiatry, others have pushed for embracing “shared definitions” and a move away from the idea that “there is a ‘correct’ way to treat madness.”

The authors offer two recommendations for psychiatry and other mental health professionals in response to these challenges. First, they state that practitioners must be upfront about the field’s “socially constructed state of knowledge.” This includes the impossibility of drawing clear distinctions between constructs such as sanity/insanity and normality/abnormality, as well as the largely unknown, poorly understood etiology of mental disorders as they are currently defined.

“As efforts to align categories of mental disorder to genetic evidence remains some way off,” they write,” we submit that mental health professionals need to be clearer that these instruments are social constructs used to describe problem behaviors (rather than illnesses).”

Secondly, the authors implore mental health professionals to “explore the patient’s model and adjust therapeutic options accordingly.” For those patients who do not subscribe to a biomedical framework, other possibilities include psychosocial approaches, the recovery model, and alternative decision-making methods such as supported decision-making.

Although taking this route will inevitably present additional quandaries – for example, moves that diminish clinicians’ position as experts may provoke anxiety in some patients – Dixon and Richter argue that this is a necessity given the field’s “socially constructed knowledge base.”

 

****

Dixon, J., & Richter, D. Contemporary public perceptions of psychiatry: some problems for mental health professions. Social Theory & Health, 1-16. (Link)

23 COMMENTS

  1. Thank you for this story. I had looked for the words to describe myself as an antipsychiatrist activist that didn’t connect myself too closely with the practice of critical psychiatry. I now suppose the term I was searching for to be social constructionist. As regards so-called “critical realists”, humoring people seeking treatment for imaginary diseases isn’t what I would call particularly “real”, nor is it something I would call “transparent”.

  2. Psyche is and always was a mythical reality. Phenomenology of the psyche was destroyed by Kraepelin, Bleuler , DSM, materialists, theologians, and so on.

    Biological model is false empiricism and negation of psychological reality. Apollonian ego is the greatest enemy of psychological man, because of lack of empathy, material and theological fundamentalism. To search for the reason of depression, or to search for cure for depression is also a theological destruction of depression (psychosis and so on). Because psychology see psyche as a theological sin, as evil. This is theology in medical disguise.

    There is depression, there is psychosis, there is happiness, there is faith, there is death, there is suicide, there is lack of hope. Everything is a part pf psychological reality, but not for apollonians. To cure means also to omit, to destroy. We, as psychological people, cannot omit psychopathology, but apollonians (psychiatric power, theological fundamentalists, haters of the psyche, the shallowest archetype) can, and they will, for power, for money, for ego, for career.

    Apollonians are those privileged, and psychological man is a slave for them,all they can see is theological evil, not human psyche.

    James Hillman Re – visioning psychology.

  3. Frank, this was kind of my reaction too. Humoring people’s beliefs in a biochemical imbalance or gene-environment theory is especially bad for those who actually do have a physical illness that is going untreated or mistreated in the meantime while the experts are busy addressing behavioral manifestations of that physical illness as if those behaviors ARE the illness.

    I know one thing, with all the groundbreaking research on actual medical causes of psychiatrically labeled misbehaviors (brain-gut connection, infections, inflammation), I’ll bet the psychiatrists are more scared of being made obsolete by new branches of medicine that properly address the etiology of neuropsychiatric illness than they are that there will be any shortages of people suffering the ill effects of this toxic culture. But maybe slowly people are waking up to that too, so that one day sick people will be identified and get appropriate medically sound evidenced based care and strange people will learn that they’re ok just the way they are and supported through difficulties rather than stigmatized. I’m probably dreaming here… That would require far too much kindness in a culture that is built on shaming those who don’t have boots to strap up.

    I also sincerely doubt strong-willed antiauthoritarian women will be celebrated any time soon as much as it might be cute to titter about well behaved women seldom making history. We really haven’t moved much beyond labeling women as hysterical. Heart attack deaths bear this out.

    I just fail to see how this approach, while kinder to the patient’s wishes, will produce radically different results. What about those people who strongly believe in the biomedical model with its brain imbalances but actually have chronic inflammation due to infectious disease? What about the high false negative test rate of Lyme disease that leaves people sick for years or decades? Psych meds don’t cure physical illnesses. At best, they kick the can down the line until the person is so sick they can’t be ignored.

    And how does drugging someone with “medications” known to be neurotoxic help someone to learn to live with or recover from distressing psychological symptoms? Or just the distress of being radically different from the norm, such as transgendered folks who overwhelmingly have psychiatric distress due to severe life threatening discrimination. Especially since these neurotoxic medications reduce the effectiveness of therapy and hinder learning new things? Because let’s face it, most patients aren’t just getting a small dose of one medication. Poly pharmacy is the norm.. So is inequality, racism, sexism, poverty, trauma, etc. And our society further stomps on the downtrodden to make the misery worse.

    Honestly, this approach just makes no sense to me from my experience and the experiences of so many others who comment here. No offense to the author because I can see where validating the patient will lead to better results than invalidating them. But we’ve had three decades now of having it drummed into our heads here in America that mental illness is due to chemical imbalances in the brain and this has been repeatedly shown to be untrue, so I think what is really in order is a campaign to correct the record and new treatment guidelines that make it malpractice to lie to patients about chemical imbalances. Then meet them where they are. But by no means should the “controversy” extend to continuing to allow people to believe things about the nature of “mental illness” that have been shown to be so far from the truth that their most ardent of adherents acknowledge them to be a convenient myth to keep people from stopping their meds.

    TL;DR – validation of people’s core beliefs is a great concept right up to where it encourages people to hold scientifically invalid views of “mental illness” that result in treatments that have little benefit over placebo and often make things much worse. That’s harmful. I support the other findings of this study.

  4. As to the “traditional notions of professionalism which had held that professionals were schooled in bodies of knowledge that lay people were not equipped to access.” I believe this is more of a paternalistic, than “professionalism,” attitude. But suffice it to say, now that we all live in the internet age, we are all “equipped to access” the medical literature.

    I agree “that practitioners must be upfront about the field’s ‘socially constructed state of knowledge. This includes the impossibility of drawing clear distinctions between constructs such as sanity/insanity and normality/abnormality.” But I do not agree that “the largely unknown, poorly understood etiology of mental disorders as they are currently defined,” has a largely unknown or poorly understood etiology.

    I think Robert Whitaker did a fabulous job pointing out the iatrogenic etiology of America’s “bipolar epidemic.” The ADHD drugs and antidepressants create the “bipolar” symptoms, and millions of people – including over a million American children – have had the adverse effects of these drug classes misdiagnosed as “bipolar,” a misdiagnosis according to all DSMs, except the DSM5.

    And the “schizophrenia” treatments create both the negative and positive symptoms of “schizophrenia.” The negative symptoms are created via neuroleptic induced deficit syndrome and the positive symptoms are created via antipsychotic and/or antidepressant induced anticholinergic toxidrome. So the primary etiology of “schizophrenia” is likely also iatrogenesis.

  5. Your average layman imagines psychiatrists have an intimate knowledge of the human brain no human being has yet. I actually saw this on the series Longmeyer. Someone has been obtaining psych drugs illegally for PTSD veterans lacking insurance? Insight? Maybe both?

    Anyhow the psychiatrist bitterly laments how people are getting these drugs underground for their crazy relatives. Says, “How can they get the proper care they need without the hours of painstaking tests including body scans and blood work to provide the exact medicine necessary to stabilize their brain chemistry and restore equilibrium?”

    Hmm. Where were my hours of painstaking tests including scans and blood work? All I got was a BS questionnaire similar to the kind found in tabloid magazines. Gosh darn it, do I feel cheated.

    😀 Bwahahaha!!!

  6. 25 years in the Mental Illness System and the only model ever presented was the bio-medical model. They told us we had brain diseases proven by science to exist. This settled science had also proven life-saving medicines would save our brains from deteriorating by restoring the proper chemical balance to our brains.

    All the while psychiatrists were laughing up their sleeves–not just at their victims–but the gullible public. While expressing private indignation that anyone thinks psychiatrists are ignorant enough to believe their own lies, Dr. Ronald Pies has yet to put out any PSA’s setting the public straight.

    This chem. imbalance bovine excrement is taught everywhere as the gospel truth. (Btw, Pete Earley and other NAMI bigwigs know it’s a lie, yet do their best to promote it. For shame, Pete!)

    I finally convinced my dad of the truth. He endorsed my coming off the drugs. He never wanted me damaged body and soul. He thought the doctors would help me.

    So did I. That’s why I took the pills for over two decades though they made me miserable, stupid, and so horribly sick I’ll never recover. The moral? Never believe anything your doctor tells you.

  7. Here here kindredspirit!

    It is ALREADY illegal, unethical medical malpractice for a practitioner to lie to someone that they have a disease when they don’t.
    Misdiagnosis IS medical malpractice and insurance fraud. By law, Informed Consent cannot be garnered via misinformation or fraud.
    The “mental illness” myth is not now, nor has it ever been any different than lying to someone that they have cancer and “treating” them with chemo therapy & radiation that could kill them when they never had cancer to begin with.
    Misinforming the public that they have a chemical imbalance resulting in a brain disease called “mental illness” is medical fraud- period.

    The reason for the resistance is that the costs of righting the fraud far outweighs any other mass medical fraud in the history of humanity (AIDS, Opioids, thalidomide, smoking…)
    What is lacking is the will to prosecute but there are a myriad of ways that we could go about this. Paula Caplan talks at length about legal action that could/must be taken.

    Inane arguments that people have a right to “believe’ in and perpetuate medical fraud if they like that “idea” is no more ethical than a dr’s say, I’m labeling you with a non-existent disease and knowingly risk your health & safety (your life) and give you a drug addiction along with your social crisis so you have something else to struggle with so I can retain you as a lucrative captive “mental patient” for the rest of your life.”

    We are not bound to dr’s “belief’s”. Nor should the public be inundated by propaganda, lies and medical misinformation spread by the naive & misinformed public, that in fact does a large part of psychiatry’s work for them. The myth of “mental illness” is a mass social fraud that absolutely must end. People who know that there is no science supporting any of it, but continue to support upholding myths, memes & lies for the “comfort” of and to respect other people’s “belief’s (up to and including at the UN level) are acting unethically and perpetuating the problem, not remotely solving it.

    • Judi, there are many in my situation who started out taking an SSRI for depression or some off label use and wound up labeled “bipolar.” (I want to write a book about this atrocity.)

      Big Pharma and the APA are too big to fight. How about a couple hundred individual lawsuits against shrinks who drove depressed people bonkers–lying about the drug the whole time? And try to publicize the legal suits.

      Shrinks should also be held legally responsible every time someone under their care murders others and they mislead the police, claiming the “meds compliant” person is not a threat. This happened in Florida. If they know there is a small chance the person may try this can’t they at least keep an eye on him or lock him up for observation while they drug him? Manslaughter 1 sounds appropriate.

      • Please don’t give them any ideas.

        How about a couple hundred individual lawsuits against shrinks who drove depressed people bonkers–lying about the drug the whole time?

        Legally that’s not malpractice, but part of accepted practice. So you can’t do that until the psych establishment itself defines itself as malpractice.

        • The shrink would be locked up for Manslaughter. The test subject is already screwed. At least they could keep others from being harmed.

          Shrinks tell everyone their drugs make murderers safe to be around. If someone is on AOT and kills someone punish the shrink.

          But what shrink wants to prevent mass murders when they’re great PR? Mass shooting sprees are great for devils like Torrey to spread their lies. The APA probably throws a party every time a Sandy Hook happens, damn them.

          Will the real monster stand up?

          • Lying to the FBI is a crime, I don’t know about cops. But spreading misinformation, even causing the “patient’s” death unless deliberate, is usually part of accepted practice, not subject to penalties.

        • Dear Oldhead,
          Having been in a medical malpractice lawsuit against 2 shrinks, I can assure you that although Rachael didn’t position the cause of action accurately, disinformation, lack of informed consent which cannot be garnered via misinformation or fraud, claiming to be “treating diseases’ people don’t have, breach of bodily integrity, failure to allow one to refuse treatment and more is all a breach of the standards of practice, medical malpractice and insurance fraud. The idea that it is not, is part of the problem.
          It would be better addressed via a class action law suit or thousands of human rights complaints – and its just a matter of time before it happens.
          As such, ideas are exactly what people need.

          • I’m referring to what the current interpretation of the law is; I’m not suggesting that it is right. And I agree we need class actions on both this and the “Miranda” issues, to start.

          • Convince the public the shrinks are the (indirect) cause of mass shootings, enormous numbers on disability and a waste of tax dollars and the battle is half won.

            Dialogue with unrepentant shrinks is useless. “Please Mr. Beater, quit hitting your wife. She’s here to tell you how bad it makes her feel.”

            What we need to focus on is reeducating real people. Those who want to help us.

            OH you say the drugs “work” since all People want is to make others quiet and dependent. Not EVERYONE.

            Have you read Anatomy lately? Folks took those neurotoxins believing they would cure their unhappiness or keep them from running around biting like rabid dogs. Not all mothers of the “mentally ill” are NAMI mommies. A lot of these women never wanted their sons or daughters to turn into drooling houseplants who couldn’t think straight and had to live in their basements till the kid dies from the drugs’ eventual toll. Reaching these folks would be great.

            A good friend who encouraged my withdrawal lost a sister to psychiatry. I told her about Pies’ self-congratulatory article about the “harmless metaphor” and she was very angry. L started out as a NAMI member who introduced me to the group. We finally left when it became obvious they didn’t care about ANYTHING but drugs. Not crime prevention, saving lives, improving quality of life…none of these mattered .1% as much as forcing “meds” down as many throats as possible.

            If a group juxtaposed against NAMI were formed, those who lost loved ones to psychiatry should be allowed to join. Or watched loved ones damaged beyond recognition like that British doctor who comments here. I know L would love to join. Or Sam Ruck.

            Not saying shrinks aren’t people. Just the roles they take on make it impossible to act like real people around their test subjects. If you perceive someone as a thing to be fixed or broken into splinters you won’t take what it says seriously.

          • No, sorry, you’re wrong. That is not the law, or the standards of practice. The law in fact clearly states that just because something is a ‘standard of practice” does not mean it cannot be wrong. Or if a minority of practitioners deviate from the “standard” that they are wrong. It is addressed on a case by case basis and because of the mass misinformation around this topic people fail to challenge the law, think outside the box, make novel claims or fight the fraud in general- and as such, articles like this are actually considered reasonable. It is anything but.

  8. The authors have not gone nearly far enough in unraveling the root of the problem rendering the article another piece of transparent propaganda thinly disguised as an attempt at a benevolent solution but remains more disinformation.

    1. Knowingly accusing a group of historically disadvantaged people of being “mentally ill, mad” without documented medical evidence, based on failed, contradictory &; specious theories, meets the definition of disinformation and fraud.
    2. If there are no diseases, there are no “patients”
    3. If there is no disease to treat, it is inappropriate to drug people
    4. It’s unethical to drug people without telling them that they don’t actually have a disease, but their troubling SYMPTOMS could be the result of over 100 bona fide medical diagnosed medical conditions called “medical mimics/psychiatric pretenders, an adverse drug event (effect) of 500+ prescription and street drugs and/or a host of common experiences such as dehydration, lack of sleep, vitamin deficiency or being in a hospital.
    5. There is no difference between diagnosing and treating someone with cancer they don’t have as criminally negligent and diagnosing and treating someone with a “MI” no one can prove they have as a criminally negligent act.
    6. In the same way that the law criminalizes pseudo-patients opening Go-fund me accounts soliciting the public for money to treat cancer they do NOT have, it is unethical and unheard of to allow pseudo-mental patients to “personally choose” to self-dx/declare themselves as “MI, mad” and disseminate misinformation in the same way that the public did not support scam artists claiming to be victims of 9-11.
    7. If it is to have any credibility whatsoever, medical science cannot be left up to the pseudo-patients fancy of how they wish to interpret the experience of their symptoms.
    8. Mental illness’s are either biological diseases or they are not- period. No-one including the so-called patient, gets to pick and choose that. COME ON!
    9. No one should be held to a false medical definition and incur the discrimination, stereotyping, targeting, slander, defamation, social death etc inherent in a fraudulent label.
    10. Just as gays were considered to be “diseased” one day and then owing to mass social pressure were socially released from under that discrimination by the DSM inventors succumbed to the pressure to remove that slur, no one should ever be subjected to a false “disease” paradigm and forced to endure the medical and social wrath of the same.
    11. Nor can “anti-stigma” campaigns correct the damage done to victims of medical fraud and pseudo-science.

    • If there are no diseases, there are no “patients”

      Which is what i meant about needing to justify those professional degrees. Even if someone is “diagnosing” society they are dependent on having the medical metaphor accepted as as something scientific to make “professional” determinations about, rather than a figure of speech, easily understood by all.

      • And next time a psychiatrist posting here mocks the idea that “mental illness” is a social construct we should ask him some questions.

        “Hey ‘Doctor’ could you tell us about Drapetomania? What modality of treatment would you employ for this disorder? Is it classified as a personality disorder in the DSM5? How come it only afflicts African Americans?”

        “Hey ‘Doctor,’ there is some disagreement on the origins of the ‘mental illness’ known as Hysterics. Is it entirely neurological or does a wandering womb play a prominent role? Would you advocate the Weir Mitchell cure as a form of therapy in combination with medications and/or ECT for women thus afflicted?”

        Legitimate diagnoses agreed upon by psych experts. Till overt racism and sexism were no longer socially acceptable. (Not referring to the covert forms.)