Related to this is the issue of psychiatrists snooping on social media to check on some patients for signs of suicidal ideation. It is not uncommon practice in the UK and they are clever enough to use pseudos because, well, it’s not really ethical, is it….
This is regularly discussed at an ethics (!) committee meeting of the Royal College of Psychiatrists …
Hi,
Great piece (again).
ADHD has just “landed” in France and is the latest “hot topic” on social media. However no one discusses or even explores the validity of the diagnosis and any criticism is met with another, i.e. it’s all very well criticising but what do you do with the suffering of these children?
The language is emotive, it’s a way of reasserting positions and blocking said criticism.
Still outside of stating the usual, i.e. let’s stop pathologising what is essentially a sociocultural issue with psychological implications (e.g. worn out parents in need of answers), no one seems indeed to mention what can be done in such situations. I am therefore interested in your thoughts… Thanks
PS: I answered “yes” on pretty much all the “symptoms”, but then I was called an extrovert as a kid….
I agree with you. This argument about having faith in the young psychiatrists coming into the profession or the many people who are trying tom do a good job and who care for their patients who need their help is a constant argument I hear in France in particular. It is held by well meaning individuals who still have a blind faith in the healing power of psychiatry.
Well meaning is key. It’s a form of paternalism which permeates psychiatry.
They agree there is a lot of bad practice and that things need to change but they instinctively reject the implications of this much needed change, i.e. the demise of psychiatry and the choice of a different paradigm of care.
They, the well meaning psychiatrists trying to do a good job, end up portraying themselves as pseudo victims of unjust attacks by eccentrics and others who just don’t know what they are saying, people like me, like the many other activists who would clearly put people in danger by pushing the self-determiantion agenda….
In France a collective of such psychiatrists ws formed in 2009 which completely drives the so called reform agenda, in other words they exist to preserve psychiatry as a “science” and as a corporation. They have a lot of influence in the media and all dissenting voices are promptly shot down into silence. They are supported by many so called user organisations and by family organisations, both often funded by pharma.
Thank you Bonnie Burstow for this very clear, very well argued piece. This is very much needed at a time when global psychiatry is fighting back with every chance it gets. Allen Frances, the weathervane APA man (the man who changed his mind about the DSM when he felt the wind turn), has now also taken the mantle of criticizing the survivor movement with similar myths infused arguments about anti psychiatry.
According to mental health advocates friends of mine, such a condition to the receipt of welfare benefits would require at the very least a change in the UK Mental Health Act (MHA).
The pilot which is due to take place in the Autumn should not even take place since it will breach the terms of the Act. Therefore the pilot may be illegal.This would/will constitute (yet another) violation of our human rights, something that should be our first concern…. My hunch is that they are trying to force a change to the MHA through the pilot… i.e. pilot first, then forced change even if the outcome is inconclusive or negative (quite the norm for this gvt).
And yet no one among the mental health charities and other groups at the high table of the Gvt are saying anything that I am aware of….
The Royal College of Psychiatrists (England) is currently looking at the possibility of monitoring the social media activity of their patients (with consent). Most of the discussion is (as with everything else) about process (e.g. consent) as opposed to: is this a good, ethical, thing to do… even if the object is to get information about their state of mind.
My personal feeling is that it is not. It violates so many human rights and is open to subjective judgements which may lead to further violations of human rights.
We live in societies which have a more and more policing attitude towards people which hides behind notions of informed consent or therapeutic purposes.
I would like to clarify a few points about France.
You say:
“I would say that most mental health professionals and much of the public in France appreciate theories of human development.”
Or rather, they used to. France had a long tradition of supporting a psychoanalytic approach, with a vibrant community of psychologists and psychotherapists who work as Jungians, Freudians, Lacanians etc. Many people seeking help would still choose their therapists accordingly. In the UK (where I now live) this has disappeared, you get what you get in the public system, and you need to know your stuff to choose a particular approach in the private sector.
Today, behavioural “tools” (Ah the dreaded toolbox!) are used increasingly. It suffices to see the debate (war) that has taken place around autism and children in France.
For as long as I can remember the French system has lived alongside the influence of the pharmaceutical industry (I grew up in a medical family) but a healthy distance was maintained. Now psychoanalytical approaches are under severe attack and pressure, partly because of strong stances for more pragmatic approaches (the sooner the person is active again, the better… glorification of productive-tax paying man, some coming from EU programmes for mental health (the cost of “mental illness” is a leitmotiv in the discourse).
My psychoanalytical friends tell me they are struggling to survive in their profession and my colleague user-survivor friends tell me that as patients, the bio medical approach in psychiatry has pretty much won the upper hand.
“To appreciate why I call this a cultural difference, keep in mind that France has the most accessible and best performing health care system in the world.”
I would take this out of the debate, it is irrelevant to how the medical system views ADHD and other forms of distress. Besides, France’s ranking has been challenged by some. It is meaningless in many respects.
“Also, it reimburses virtually every drug prescribed to its citizens.”
Wow, this is another of those rose-tinted views. The French social security system is extremely complex with a base rate of reimbursement and for some, the possibility of not having to advance the cost of seeing a doctor/treatment/medication.
However, there is a significant and growing proportion of the population still only gets the social security base rate which, at best is 75% of the original cost, but can go as low as 20% for some medication, or nothing at all as not every meds is reimbursed.
This is because they cannot afford, or can no longer afford, the infamous “mutuelle” a private health care supplementary insurance that compensate for the difference between the social security rate and the actual cost of doctor/treatment/meds etc. Some employers offer the “mutuelle” as part of the contract package, but that is not the norm.
“In child mental health, the DSM is barely used, but this appears to be changing.”
The DSM is barely used because they have been using the CFTMEA or Classification française des troubles mentaux de l’enfant et de l’adolescent (French lassification of children and adolescent mental disorders), developed by Prof Misès. It is no better than the DSM or ICD and uses those as a starting point.
Hi Licinia
I don’t know but I can tell you that it very much depends on which perspective you are coming from. Indeed, there are still practitioners who have trained in psychoanalysis who would offer a different presentation, looking at the relationship between “language, unconscious and symptom”. Then there are practitioners whose approach follows the medical model. Even then there are perspectives which look at causality between psychological experiences and physical explanations (different explanations).
I will see what I can find out from a psychoanalyst I am in contact with about your particular question.
cheers
Anne-Laure
Lucy,
When you say that formulation “can be defined as the process of co-constructing a hypothesis or ‘best guess’ about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them”, this describes what the French have long called “la clinique”,(long before “formulation” came about), i.e. the therapeutic relationship and collaboration between person and therapist to work towards recovery.
The problem with that is that it can and often leads the psychiatric system to take a so-called humane way to still put their bio-medical stamp on your story, i.e. pathologising it.
As you quite rightly say, there is a need to acknowledge different cultures.
I can tell you that the French system still thinks that there is nothing better than the diagnostic system but they also cling on to certain diagnostics no matter what, e.g. BDP or schizophrenia. The French psychiatric culture also intellectualises “psychiatric disorders” in a way that does not exist in Anglo-Saxon culture. French descriptions of the BPD, for instnace, are quite extraordinary in that respect.
Actually I am going to present at a psy seminar in Paris in May (to coincide with the publication of the DSM) and I already know that I am going to have a fight on my hands. The French users are not educated politically about psychiatry as they can be in the UK where I am based or in other Anglo-Saxon countries. Besides the French, and others, would argue that they do not use the DSM but the WHO’s ICD-10. It does not matter that the DSM and ICD are currently harmonising their codes and desciptions, they point to the prestige of the WHO, as an organisation said to produce quality tools, to legitimise the use of diagnoses. It is self-serving and hyprocritical of course, but also extremely powerful lobbying.
Related to this is the issue of psychiatrists snooping on social media to check on some patients for signs of suicidal ideation. It is not uncommon practice in the UK and they are clever enough to use pseudos because, well, it’s not really ethical, is it….
This is regularly discussed at an ethics (!) committee meeting of the Royal College of Psychiatrists …
Hi,
Great piece (again).
ADHD has just “landed” in France and is the latest “hot topic” on social media. However no one discusses or even explores the validity of the diagnosis and any criticism is met with another, i.e. it’s all very well criticising but what do you do with the suffering of these children?
The language is emotive, it’s a way of reasserting positions and blocking said criticism.
Still outside of stating the usual, i.e. let’s stop pathologising what is essentially a sociocultural issue with psychological implications (e.g. worn out parents in need of answers), no one seems indeed to mention what can be done in such situations. I am therefore interested in your thoughts… Thanks
PS: I answered “yes” on pretty much all the “symptoms”, but then I was called an extrovert as a kid….
I agree with you. This argument about having faith in the young psychiatrists coming into the profession or the many people who are trying tom do a good job and who care for their patients who need their help is a constant argument I hear in France in particular. It is held by well meaning individuals who still have a blind faith in the healing power of psychiatry.
Well meaning is key. It’s a form of paternalism which permeates psychiatry.
They agree there is a lot of bad practice and that things need to change but they instinctively reject the implications of this much needed change, i.e. the demise of psychiatry and the choice of a different paradigm of care.
They, the well meaning psychiatrists trying to do a good job, end up portraying themselves as pseudo victims of unjust attacks by eccentrics and others who just don’t know what they are saying, people like me, like the many other activists who would clearly put people in danger by pushing the self-determiantion agenda….
In France a collective of such psychiatrists ws formed in 2009 which completely drives the so called reform agenda, in other words they exist to preserve psychiatry as a “science” and as a corporation. They have a lot of influence in the media and all dissenting voices are promptly shot down into silence. They are supported by many so called user organisations and by family organisations, both often funded by pharma.
Thank you Bonnie Burstow for this very clear, very well argued piece. This is very much needed at a time when global psychiatry is fighting back with every chance it gets. Allen Frances, the weathervane APA man (the man who changed his mind about the DSM when he felt the wind turn), has now also taken the mantle of criticizing the survivor movement with similar myths infused arguments about anti psychiatry.
According to mental health advocates friends of mine, such a condition to the receipt of welfare benefits would require at the very least a change in the UK Mental Health Act (MHA).
The pilot which is due to take place in the Autumn should not even take place since it will breach the terms of the Act. Therefore the pilot may be illegal.This would/will constitute (yet another) violation of our human rights, something that should be our first concern…. My hunch is that they are trying to force a change to the MHA through the pilot… i.e. pilot first, then forced change even if the outcome is inconclusive or negative (quite the norm for this gvt).
And yet no one among the mental health charities and other groups at the high table of the Gvt are saying anything that I am aware of….
The Royal College of Psychiatrists (England) is currently looking at the possibility of monitoring the social media activity of their patients (with consent). Most of the discussion is (as with everything else) about process (e.g. consent) as opposed to: is this a good, ethical, thing to do… even if the object is to get information about their state of mind.
My personal feeling is that it is not. It violates so many human rights and is open to subjective judgements which may lead to further violations of human rights.
We live in societies which have a more and more policing attitude towards people which hides behind notions of informed consent or therapeutic purposes.
I would like to clarify a few points about France.
You say:
“I would say that most mental health professionals and much of the public in France appreciate theories of human development.”
Or rather, they used to. France had a long tradition of supporting a psychoanalytic approach, with a vibrant community of psychologists and psychotherapists who work as Jungians, Freudians, Lacanians etc. Many people seeking help would still choose their therapists accordingly. In the UK (where I now live) this has disappeared, you get what you get in the public system, and you need to know your stuff to choose a particular approach in the private sector.
Today, behavioural “tools” (Ah the dreaded toolbox!) are used increasingly. It suffices to see the debate (war) that has taken place around autism and children in France.
For as long as I can remember the French system has lived alongside the influence of the pharmaceutical industry (I grew up in a medical family) but a healthy distance was maintained. Now psychoanalytical approaches are under severe attack and pressure, partly because of strong stances for more pragmatic approaches (the sooner the person is active again, the better… glorification of productive-tax paying man, some coming from EU programmes for mental health (the cost of “mental illness” is a leitmotiv in the discourse).
My psychoanalytical friends tell me they are struggling to survive in their profession and my colleague user-survivor friends tell me that as patients, the bio medical approach in psychiatry has pretty much won the upper hand.
“To appreciate why I call this a cultural difference, keep in mind that France has the most accessible and best performing health care system in the world.”
I would take this out of the debate, it is irrelevant to how the medical system views ADHD and other forms of distress. Besides, France’s ranking has been challenged by some. It is meaningless in many respects.
“Also, it reimburses virtually every drug prescribed to its citizens.”
Wow, this is another of those rose-tinted views. The French social security system is extremely complex with a base rate of reimbursement and for some, the possibility of not having to advance the cost of seeing a doctor/treatment/medication.
However, there is a significant and growing proportion of the population still only gets the social security base rate which, at best is 75% of the original cost, but can go as low as 20% for some medication, or nothing at all as not every meds is reimbursed.
This is because they cannot afford, or can no longer afford, the infamous “mutuelle” a private health care supplementary insurance that compensate for the difference between the social security rate and the actual cost of doctor/treatment/meds etc. Some employers offer the “mutuelle” as part of the contract package, but that is not the norm.
“In child mental health, the DSM is barely used, but this appears to be changing.”
The DSM is barely used because they have been using the CFTMEA or Classification française des troubles mentaux de l’enfant et de l’adolescent (French lassification of children and adolescent mental disorders), developed by Prof Misès. It is no better than the DSM or ICD and uses those as a starting point.
Hi Licinia
I don’t know but I can tell you that it very much depends on which perspective you are coming from. Indeed, there are still practitioners who have trained in psychoanalysis who would offer a different presentation, looking at the relationship between “language, unconscious and symptom”. Then there are practitioners whose approach follows the medical model. Even then there are perspectives which look at causality between psychological experiences and physical explanations (different explanations).
I will see what I can find out from a psychoanalyst I am in contact with about your particular question.
cheers
Anne-Laure
Lucy,
When you say that formulation “can be defined as the process of co-constructing a hypothesis or ‘best guess’ about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them”, this describes what the French have long called “la clinique”,(long before “formulation” came about), i.e. the therapeutic relationship and collaboration between person and therapist to work towards recovery.
The problem with that is that it can and often leads the psychiatric system to take a so-called humane way to still put their bio-medical stamp on your story, i.e. pathologising it.
As you quite rightly say, there is a need to acknowledge different cultures.
I can tell you that the French system still thinks that there is nothing better than the diagnostic system but they also cling on to certain diagnostics no matter what, e.g. BDP or schizophrenia. The French psychiatric culture also intellectualises “psychiatric disorders” in a way that does not exist in Anglo-Saxon culture. French descriptions of the BPD, for instnace, are quite extraordinary in that respect.
Actually I am going to present at a psy seminar in Paris in May (to coincide with the publication of the DSM) and I already know that I am going to have a fight on my hands. The French users are not educated politically about psychiatry as they can be in the UK where I am based or in other Anglo-Saxon countries. Besides the French, and others, would argue that they do not use the DSM but the WHO’s ICD-10. It does not matter that the DSM and ICD are currently harmonising their codes and desciptions, they point to the prestige of the WHO, as an organisation said to produce quality tools, to legitimise the use of diagnoses. It is self-serving and hyprocritical of course, but also extremely powerful lobbying.