The Critical Psychiatry Network’s 2017 conference raised some tricky issues for the audience and like-minded people, but also pointed to the potential for radical transformation of our approach to mental health problems. Three top quality speakers, big names in the Recovery field, gave inspiring and provocative talks. Dave Harper argued that the Recovery concept is another way of blaming the individual, and diverting efforts from the sort of social changes that would really bring about better mental health for all. Geoff Shepherd looked at the history of mental health care, which reminds us that the dominant medical orientation of services is to some extent an accident of history. If we can throw off current assumptions, we can start to imagine how mental health services could be provided quite differently, prioritising decent and secure housing and employment, for example. Mike Slade reminded us of the radical potential of the Recovery concept with its focus on quality of life and personal goals rather than symptoms and pathology. He talked of mental health field being at a point of transition, with numerous forces, including the Critical Psychiatry Network and the survivor movement, chipping away at the dominant paradigm.
In discussion, the audience pointed out how current political rhetoric continues to focus on the individual and their deficiencies, rather than addressing the social conditions that make modern life so challenging for many.
The night before the conference there was a trip to see the recent film about R.D. Laing with David Tenant, Mad to be Normal. The film was sympathetic to Laing's views, despite his unorthodox methods. It was an endorsement of many of the Critical Psychiatry Network's points about the importance of finding meaning in madness and the dangers of simply suppressing this with drugs or other means.
Recovery in a Time of Austerity: Critical Psychiatry Network conference, Nottingham, 25th April 2017
The fourth consecutive annual Critical Psychiatry Network conference in Nottingham looks like it will be an exciting event. The impressive line-up of speakers are well-known in the Recovery field and include Mike Slade, Tim Kendall (the government's new mental health Czar, and former head of NICE), Dave Harper and Geoff Shepherd. Speakers will debate whether the Recovery concept is still radical and what it means in practice in our cash-strapped times. Has Recovery been co-opted by the mainstream as a way of saving money by telling people they don’t need care anymore? Can Recovery still inspire the idea of empowerment and help match support to the real-life goals of patients? Attendees will be keen to discuss how they can support the original aims of the Recovery movement in the current NHS climate.
The US Association for the Advancement of Philosophy and Psychiatry are holding a conference entitled 'Philosophical Perspectives on Critical Psychiatry: opportunities and challenges' in San Diego in May 2017. The conference promises to address the relationship between Critical Psychiatry, antipsychiatry and psychiatric reform, how to conceive of mental distress, the influence of Big Pharma on psychiatric science, the significance of 'sites of resistance,' such as the psychiatric survivor movement, and whether traditional psychiatric assumptions are antithetical to the recovery movement. The call for abstracts is open until 16th November 2016.
CPN co-chairs, Hugh Middleton and Joanna Moncrieff, went to meet Luciana Berger MP (the shadow minister for Mental Health) to convey the importance of a Critical Psychiatry perspective in developing the Labour Party's mental health policy.
After his victory in the Labour Party leadership last year, one of Jeremy Corbyn’s early moves was to appoint the first dedicated Shadow Minister for Mental Health. Luciana Berger, MP holds the post. Even before her appointment, the Labour Party had made mental health one of its priority areas. The following is a report of a meeting with Luciana Berger at Portcullis House on 14th June.
We explained that Critical Psychiatry offers a critique of the now widely accepted view that mental illness is a brain disease, consisting of a chemical imbalance or other specific abnormality, and that this abnormality can be effectively treated with prescribed drugs. This view has become established through the efforts of the pharmaceutical industry, sometimes with support from the psychiatric profession. However, it is not supported by scientific evidence. There is no evidence that people with depression have any specific abnormality of their serotonin system, or any other system. There is no evidence that antidepressants ‘work’ by correcting this hypothetical abnormality.
The problem with looking at mental disorders as if they were a sub-species of physical illness is that it renders the problems people have meaningless, and it obscures the role that social problems such as poverty, insecure employment, precarious housing, social isolation and loneliness play in the genesis and perpetuation of mental health difficulties. Locating the problem in an individual’s brain encourages passivity and dependence and discourages people from playing an active role in their own recovery. Although thankfully we no longer chop out bits of brains, and only rarely subject people to electric currents, it is this idea that mental disorders are brain diseases that need to be eradicated that allows pointless, harmful and sometimes downright cruel things to be done to people under the rubric of ‘treatment.’
So, Luciana rightly asked, what should be done? We agreed that one of the most important long-term solutions to mental health problems is the creation of a fairer and more integrated society. Support for families and children, decent jobs, secure housing, educational opportunities, and community centres and activities will help reduce the difficulties that lead to mental health problems in the first place. Moreover, some basic social interventions such as befriending schemes, social support during a crisis and basic counselling or therapy can help address the sort of social difficulties that most people with mental health problems face. Luciana emphasised how she has been working across departments to achieve the social conditions that would promote better mental health for all.
Critical Psychiatry suggests we need a radical change of perspective, however; an alternative to conceiving of mental distress as a form of sickness. As a society we need a mechanism to provide help and support to people who are struggling with one aspect of life or another that doesn’t involve designating them as ill. Such provision could be embedded within social services, for example, and could help to empower people to identify their own solutions to their particular problems. It could relieve the pressure on GPs who are confronted daily with a tidal wave of misery that medicine has no answers to, and avoid the huge levels of prescribing that this situation creates, and that Luciana indicated she too was worried about.
We also expressed concern about the care of people with serious and long-term mental disorders. There seems to be an increasing view that a mental breakdown is like the flu, and that people should recover in a matter of weeks. But mental disorder is rarely this short-lived, and some people need care for months and some for years. Since the closure of the old asylums, provision for this group of people has been whittled down, and handed to the private sector, which is costly and of variable quality. Luciana was also concerned about child and adolescent inpatient services being largely run by the private sector.
It is heartening that the Labour Party is taking mental health policy seriously, and Luciana appears to be thoughtfully considering different positions and solutions. Let’s hope the Party will put some genuinely radical ideas into its new mental health policy.
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