Founding member of the Critical Psychiatry Network, psychiatrist Duncan B. Double, reviews the past 20 years of the Critical Psychiatry Network in an editorial published in the British Journal of Psychiatry. Double, a consultant psychiatrist and honorary senior lecturer in the Norfolk and Suffolk NHS Foundation Trust, defines critical psychiatry, delineates its different strands, reviews its implications, and juxtaposes differences within the movement.
“Critical psychiatry,” writes Double, “applies the patient-centered method and adopts the biopsychosocial model, although not in the eclectic, atheoretical way in which it tends to be used in modern psychiatry.”
The Critical Psychiatry Network (CPN) held its first meeting in 1999 out of concern for the increased risk of coercion within the Mental Health Act in the UK. The group evolved and decided to take on a different shape than so-called “anti-psychiatry” movement, standing apart from the biomedical reductionists and shifting away from the exclusionists who deny the existence of mental disorders.
Double roots the difference between mainstream psychiatry and critical psychiatry in the different theories that practitioners use to conceptualize mental health difficulties. Critical psychiatry declares, “functional mental illness should not be reduced to brain disease,” but instead approaches mental health with a biopsychosocial lens which integrates “cultural, social, and psychological considerations as well as biological factors.”
While Double agrees that the brain does indeed enable the mind, he underscores the fact that “no definite biomarkers have been linked to functional mental illness and inconsistencies and cofounders plague research studies.”
Key members in CPN are recognized in Duncan’s editorial, though not all could be included, as contributors to the evolution of the movement. Sami Timimi, a child and adolescent psychiatrist, is acknowledged for speaking to his experience of the field becoming increasingly biologized, through what he described as “indoctrination,” or the feeling that “believing that mental illness is a brain disease is more like a faith” as opposed to scientifically situated.
In addition, critical psychiatry takes on issues of race and culture in psychiatry, as seen, for instance, in the work of CPN member Suman Fernando. Citing Fernando’s work, Double writes:
“Low- and middle-income countries need to develop locally relevant approaches rather than follow the biomedical methods of high-income countries, thereby acknowledging how culturally embedded mental health problems are in the social, economic, and political conditions of countries.”
Finally, critical psychiatry is “prepared to engage with the evidence about psychiatric treatment,” clearly differentiating from the case for “the myth of mental illness,” but towards “the myth of a chemical cure.”
While CPN members are united by the common goal of seeking alternatives to biomedical psychiatry, Double identifies three points of divergence among critical psychiatrists. They center on the following questions:
- Should psychiatry be seen as a medical discipline?
- Should the Mental Health Act be abolished?
- Is it suitable to see mental disorder as illness and disease?
Double reviews both the diagnostic and treatment implications of the critical psychiatry position. When it comes to diagnosis, CPN members pay less attention to seeking a diagnosis and more attention to focusing “on understanding the person and why they have presented with the problems they have in the context of their life situation.”
Taking a critical psychiatry approach to treatment involves taking a rights-based approach, attempting to minimize the use of coercion, and acknowledging the uncertainty of the available evidence of the psychotropic medications prescribed and the risk of discontinuation problems.
Ultimately, Double writes, “the emphasis is on helping people improve their social situation and to be as independent as they want to be.”
“Even after 20 years, the CPN seems marginal to mainstream psychiatry and seeks more recognition of the validity of its position…Further debate on taking psychiatry beyond the current dominant paradigm is required.”
Within the article, Double references ‘Mad in America’ as a supportive resource that seeks alternatives to biomedical psychiatry. To hear more on being a critical psychiatrist, see MIA Radio’s interview with Double (https://www.madinamerica.com/2018/03/dr-duncan-double-critical-psychiatrist/) from last year, where he discusses his experiences working in a bio-medical oriented profession.
Double, D. B. (2019) Twenty years of the critical psychiatry network. British Journal of Psychiatry, 214(61-61). doi: 10.1192/bjp.2018.181 (Link)