Sunday, September 19, 2021

Comments by Phil Barker

Showing 1 of 1 comments.

  • I am sure that Phil Thomas is a decent man. I don’t know him in any personal sense, but his writings suggest a genuine interest in the ‘human condition’ however defined. However well-intentioned, or decent, might be the motives that underlie the ‘Inquiry into the schizophrenia label’ Thomas and his colleagues have led, the overriding impression is that this inquiry is a pointless exercise. Psychiatrists (so-called) first proposed the ‘diagnosis’ of ‘schizophrenia’ more than century ago and a small proportion are (only now) bowing to the pressures that have been building over the past 40-odd years to challenge, if not dispense with, this facile label for various complex problems in human living. Might I suggest that the question is not ‘how valid/appropriate/useful/disabling/demeaning(etc)’ is the ‘schizophrenia’ diagnosis, but how valid (etc) are any of the other psychiatric diagnoses in common use within the broad medical-psychaitric system? Why not propose dispensing with ALL of them, and get on with the serious work of building a new framework for appreciating and helping with, problems in human living?

    Ron Unger hints at the challenges that might be involved in confronting this issue head on. As a social worker he, perhaps more than anyone, must be aware that to avoid confronting such diagnostic’ madness, seeking alternatives means of framing problems in living, will only lead to further disenfranchisement of the people he (and his many interdisciplinary colleagues) seek to help.

    Two points may be worth emphasising. Firstly, if there is no ‘diagnosis’then how can the practice of psychiatric medicine survive? Personally, I would dispense with ALL psychiatric diagnoses, which I consider to be humanly and scientifically worthless. (See Barker P (2011) Psychiatric diagnosis. Ch 11 in P. Barker Mental Health Ethics: The human context Routledge: London and New York). However, I am not a psychiatrist. If I were I might appreciate the need for some kind of ‘diagnosis’, since this particular function underpins all medical practice. (The first law of professionalism is ‘protect the profession’).

    Without ‘diagnosis’ we are just people (lay or profesional) trying to identify other people’s problems in human living, with a view to helping them deal with them. Very simple. Very straightforward. Indeed, so simple and straightforward that one might ask why ‘psychiatrists’ have made the whole business so complicated, for so long.

    The ‘Inquiry into the Schizophrenia label’ runs alonside some other ventures, which seek to challenge the extant ‘diagnosis’ but seem concerned only to replace it with some other, ultimately flawed, label. People are complicated. People experience complex problems. How are we ever to address the personal, interpersonal and social complexities of such problems by flattening them with a label, which suggests that, ultimately, such problems are all, in some sense, the same?

    So, if I were a psychiatrist, I would accept that ‘diagnosis’ will be an essential part of my professional function. If it were not, then I would be asking, why do I want to be a psychiatrist, rather than any other member of the ‘helping disciplines’, most if not all of whom are NOT obliged to ‘diagnose’ (at least in the ‘medical’ sense) in order to offer help, support or caring to people in distress or difficulty.

    The seond point is more tricky. If people (patients/clients/ users/consumers etc) however defined, are NOT attributed a ‘diagnosis’, however inappropriate/useless/demeaning etc, how will they qualify for SUPPORT within the extant health/social care systems. Many such persons have challenged the current diagnostic system, but (arguably) many more are happy to accept the ‘diagnosis’ to qualify for different health/social care ‘benefits/insurance’. Why should I assert that this ‘diagnosis’ is ‘flawed’ or ‘worthless’ and risk prejudicing their means of economic survival? What would be gained by changing the ‘schizophrenia’diagnosis to (for example) the ‘integration disorder’ proposed in Japan? Ultimately, if not very soon, ‘integration disorder’ will come to mean exactly the same as schizophrenia’ to members of the lay community.

    When I read such ‘reports’ I hear the sound of people psyching themselves up for a battle that they are unlikely ever to fight, in person hand to hand: a battle that could have been fought, and won, 30 years ago, were it not for same vested interests that might prevent it from being won tomorrow.