Comments by Pat Bracken, MD

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  • Dear Richard,

    Thank you for taking the time to respond to my article. I am in agreement with a great deal of what you say. As someone who has participated in all the forms of ‘positive’ dissident work that you mention, I have no illusions about the current baleful situation of psychiatry. I have no interest in trying to salvage something that is harmful and corrupt. I don’t speak for anyone but myself, but what I am trying to do is to imagine a form of medical practice that could be genuinely helpful to people who are struggling with states of madness or distress. Humans are ’embodied’ and, whether we like it or not, such states often involve a somatic dimension. I believe that there is a legitimate and important role for doctors in this area but modernist psychiatry, as you and other commentators point out, has been a disaster. Maybe I was wrong, maybe psychiatry does not have a future. Phil Thomas and I (and others) have used the term ‘postpsychiatry’ to frame our thinking about a positive way of bringing medicine to bear on mental suffering. This is a term that was first used by Peter Campbell, a British activist, when imagining the future. However, whether we call it psychiatry, postpsychiatry or something else, I still believe that there is a need to challenge the reductionism that currently guides research, education and practice and to think about what could really help. A shift towards hermeneutic (that is meaning-focused) mental health work would be about a shift towards negotiation and respect and away from the idea that psychiatrists have a knowledge that can trump everything else. In this it would be a move away from psychiatric authority and the current justification for coercive psychiatric interventions.

    Thank you for your comments Richard. I agree with you that the current state of psychiatry is bound up with the dynamics of consumer capitalism. Very powerful economic and political forces are shaping the discourses that are made available to people to think about and respond to their distress and dislocation. Critical psychiatry, as I understand it, is an attempt to deconstruct the authoritative voice of psychiatry and, in so doing, help to create the conditions in which real dialogue can take place.

    Best wishes


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