Friday, July 03, 2015

Psychiatry's 'nemesis'

I don't want to make a habit of commenting on trainees' articles when they get them published in Royal College of Psychiatrists' journals (see previous posts - Neurology-psychiatry integration and Being explicit about the nature of mental illness), but I just wanted to pick up a comment from Helen Henfrey in her recent BJPsych editorial. She suggests that, "Psychiatry is unique among other specialties in that it has its own ‘nemesis’ in the form of the ‘antipsychiatry movement’". True, she has put the word 'nemesis' in inverted commas. Psychiatry in fact needs to be critical and I think it would help recruitment to psychiatry, which is what her article is about, if it engaged with anti-psychiatry.

If anti-psychiatry is psychiatry's nemesis, it is partly psychiatry's creation by including RD Laing and Thomas Szasz within its remit (eg. see my book chapter). Of course there are people that want to abolish psychiatry. Laing and Szasz were legitimate psychiatrists in challenging the biomedical model of mental illness (eg. see previous post on Szsaz). I've commented before (eg. see previous post) that recruitment to psychiatry would be improved by encouraging debate about the basis of psychiatry. Helen Henfrey shouldn't be frightened of conflict with so-called anti-psychiatry. Psychiatry by its very nature is conflictual and that's part of its attraction as a career.

17 comments:

Bernard Carroll said...

Well, you are making a habit of doing just that - carping at trainees... don't be disingenuous... pick on someone your own size. As for the antipsychiatry movement, they will never be more than a bunch of hand wavers until they produce outcomes data that confirm their patients enjoy better results and fewer tragedies like suicides. We are not holding our breath for that day to come.

Duncan Double said...

I'm sure you can provide evidence that your approach is better!?

Bernard Carroll said...

That is a logical impossibility until we know your outcomes data.

Duncan Double said...

Have you got outcome data that shows patients enjoying better results and fewer tragedies?

Bernard Carroll said...

Aren't you being perseverative? Of course there are outcomes data for standard treatments. They are widely available in textbooks and the journals. But it is logically impossible to know how these compare to yours because you have never told us what your outcomes data are.

Duncan Double said...

I use standard treatments. Perhaps you do not realise this.

Bernard Carroll said...

Thank you for clearing that up… who knew? Perhaps you could persuade colleagues in your Critical Psychiatry circle to do the same. They are in the habit of demonizing medications and ECT, not to mention being dismissive of diagnoses. One of them, Joanna Moncrieff, is on record as urging that deeply depressed patients be managed with “simple measures such as looking after people (who are deeply depressed), keeping them safe, and gently trying to coax them out of despair with human warmth and sympathy.” Evidence, please? Outcomes data, please? Suicide counts, please?

Duncan Double said...

I think you'll find what's being said is that the evidence for medication and ECT is generally overstated. Diagnosis is not necessarily being dismissed, more the limitations of a single word diagnosis. Do you have Jo's reference?

Bernard Carroll said...

Statements made in the Critical Psychiatry domain go well beyond your characterization. Same for the dismissal of diagnosis. Sami Timimi may be the most flamboyant in that respect. I have E-mailed to you the source of Dr. Moncrieff's words quoted earlier.

Duncan Double said...

I agree that critical psychiatry represents a range of opinion!

Tim O'Grady said...

Helen Henfrey seems mainly concerned with poor prestige for psychiatrists - within the wider medical profession, within society and even within their own families. She seems to advocate some kind of 'united community working to promote the speciality'.
Sadly, trainees and students have enough exposure to psychiatry to take an astute look at it and most of them don't like what they see.

Angela Ursery said...

Carroll should go directly to former patients who have found different, less destructive paths to health. We are all over--he could start at Beyond Meds, for example, or many others. I, for example, was told by a psychiatrist that I "would always have to be on one antipsychotic or another for the rest of [my] life." After more than 2 decades on psych meds (beginning with antidepressants, and progressing to mood stabilizers, then antipsychotics) I let go of all medication (and tardive dyskinsia, word-searching, high cholesterol, weight gain, and a dead feeling inside) nearly five years ago, and have never looked back. Instead, I have used a range of tools that have helped me regain and extend my physical and emotional health. I truly have never been better.
But I'm not an exception--there are thousands of people just like me. Mr. Carroll can chatter on all he likes about outcomes data, but when was the last time he researched those who brought back their wandering minds without the help of pharmaceuticals? Likely never.
A larger issue, of course, is how pharma and psychiatry cling so desperately to dwindling authority and legitimacy. Your biggest challenge, my dears, is not critical psychiatry, but being irrelevant.

Bernard Carroll said...

Angela, we all can be happy for your improved outcome. We need to listen to individuals about their lived experiences, but we cannot make policy or shape practice guidelines from individual narratives. As one prominent researcher in alternative and complementary medicine has noted, the plural of anecdote is anecdotes, not data. The main importance of individual narratives is to suggest incisive questions for systematic research.

Speaking of systematic research, current evidence indicates that withholding antipsychotic medications from patients with schizophrenia can lead to very bad outcomes. See http://www.ncbi.nlm.nih.gov/pubmed/25422511. This report describes death rates in a Swedish national register of over 22,000 patients with schizophrenia. These were matched with 10-times as many persons without schizophrenia. The highest mortality was seen in patients with no exposure to antipsychotic drugs (Hazard Ratio 6.3). The lowest HR (4.0) occurred in patients managed with medium doses of antipsychotic drugs. The highest excess mortality was observed in first-episode patients with no exposure to antipsychotic drugs (HR 9.9)! These data tell us that schizophrenia is associated with elevated mortality in its own right, independent of medications, which actually bring down the excess mortality.

Angela Ursery said...

Bernard, if I had a dollar for every time I saw a patronizing reference to individuals' lived experience of transformation (e.g., "the plural of anecdote is anecdotes...") I would be very wealthy indeed. There is data in the experience of individuals, it's simply not data that you value. And that's a pity--and also one of the most massive shortcomings and blind spots of our mental health research and policy.
Besides, I mentioned that there are thousands--thousands--of individuals who have created similar paths to health--yet you ignored that. And you wonder why your type of science is being ignored? In what other line of research would a massive population finding health through methods unresearched--remain unstudied? Heart disease? No? Arthritis? I doubt it.
And please don't call your approach to mental health research systematic. It's more than pathetic that all of the research on trauma-related mental distress is wringing but a few pennies' worth of funding from NIH, while billions are being thrown at the expensive (tax-funded) bust known as personalized healthcare--and more pills.

Eric Setz said...

Bernard here is your evidence. The Courtney Harding study is the biggest study not funded by a drug company. Here are links to this study:

http://www.apa.org/monitor/feb00/schizophrenia.aspx

http://psychrights.org/Research/Digest/Chronicity/vermont1.pdf

The findings align with David Cooper's as outlined in Psychiatry Anti- Psychiatry.

Angela Ursery said...

Eric,
Thanks for these resources--they're extremely helpful.

Anonymous said...

Angela thanks for such a terrific defence of victims of traditional coercive psychiatry.

You are better because "At the first day you were diagnosed wrongly. A better assessment could recognise it."

You are better because, "You were border-line and due to medication you rolled back."

These are reasons that actually Bernard might put forward. But if any of his colleagues argues differently then that colleague might be being considered for bad practice.