Tuesday, August 22, 2017

Pledge support for changes in understanding of psychosis

The International Society for Psychological and Social Approaches to Psychosis (ISPS) has produced a 'Liverpool Declaration' before its upcoming 20th International Congress. As the declaration says, psychosis needs to be understood as largely a response to life experiences. For too long, social and psychological experiences have been "viewed as simply ‘triggering’ underlying disease processes, a perspective no longer supported by research". Social and cultural psychiatry should not merely be a diluted form of biomedical psychiatry (see previous post).

Monday, August 14, 2017

Differences within critical psychiatry

I have uploaded a video of my talk 'Critical psychiatry: Its definition and differences' given at the AAPP conference in San Diego in May this year. Critical psychiatrists don't always agree. I suggested in the talk that there are three main areas of disagreement, although these issues may not be totally distinct:-

  1. Whether psychiatry should be seen as a medical discipline. Where there is agreement is that psychiatry is different from medicine. The disagreement arises because of how much is made of that difference. Some want to go a far as saying that psychiatry should be non-medical. Others emphasise that medicine covers both physical and mental aspects. The reality is that many patients do complain of physical symptoms which have psychosocial origins and any view on this issue has to take note of psychosomatic medicine.
  2. Whether the Mental Health Act should be abolished. Where there is agreement is that critical psychiatry emphasises the rights of people with mental health problems. This emphasis leads some to argue for abolishing all forced treatment and others to accept that detention can be justified by the loss of mental capacity in mental illness. All would accept that psychiatric abuse is not justified and coercion needs to be minimised.
  3. Whether it is suitable to see mental disorder as illness and disease. Where there is agreement is that all identify there is a problem with seeing mental disorder as brain disease. But the questions are: should it be seen as illness; and is psychiatric diagnosis valid? Some conclude that mental disorder is not illness and alternatives are required to psychiatric diagnosis and others accept that psychological dysfunction can be understood as illness and that diagnostic concepts should be understood for what they are. Diagnoses should not be reified, and seen as ‘things’. Instead they are merely idealised, hypothetical constructs and if they have any value should be understood as such.

In summary, the essential critical psychiatry position of challenging the claim that mental disorders have been established to be brain diseases can lead to some differing perspectives within critical psychiatry. As I have said several times, critical psychiatry is a 'broad church', but it does coalesce round the view that the biomedical hypothesis that functional mental illness is due to brain disease is based on faith, desire and wish fulfilment rather than logic (eg. see previous post).

(with thanks to Kermit Cole for making the video)

Wednesday, August 02, 2017

Why fetishise outcome measurement in IAPT?

Jay Watts has a chapter 'IAPT and the ideal image' in The future of psychological therapy in which she describes the chasm between the image and actuality of Improving Access to Psychological Therapies (IAPT). She concludes that "IAPT operates in a virtuality focussing on performativity and surveillance rather than real encounters between clinician and patient".

In particular, she describes the "pernicious pressure on IAPT workers to gain outcome measures for each session". I've mentioned before talks given by David Clark (eg. see previous post) in which he makes much of the fact that IAPT is collecting this data. As Jay says, "During training, workers are sold into the excitement of producing the largest database on wellbeing in history". It would be nice to know what those promoting IAPT think all this effort has achieved, because I can't see much gain. Data accumulates on a monthly basis without much being done to it (see Reports from IAPT). In fact, this process may well be hindering IAPT from really helping people.

I've mentioned before (see previous post), the perversion of care, as Rosemary Rizq called it, of turning away from the realities of managing distressed people. As Rizq says, society has traditionally allocated to mental health practitioners an "unconscious anxiety-containing function". Mental health practitioners experience enormous emotional difficulties in working with mentally distressed and disordered patients. Focusing on outcomes, as Jay says, "stops pain being listened to and the meaning of symptoms heard".