Understanding Critical Psychiatry: A Balanced Approach to Mental Health Practices

1. Is critical psychiatry the same as “anti-psychiatry”? D B Double

2. David Cooper (1931-1986) • Psychiatry and anti-psychiatry (1967)

3. David Cooper (1931-1986) • Psychiatry and anti-psychiatry (1967) • “[P]sychiatry … has aligned itself far too closely with the alienated needs of society”

4. David Cooper (1931-1986) • Villa 21 – an experiment in anti-psychiatry

5. David Cooper (1931-1986) • Villa 21 – an experiment in anti-psychiatry • Positive non-action, “an effort to cease interference, to ‘lay off’ other people and give them and oneself a chance”

6. Definition by mainstream psychiatry • International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth, 1973)

7. Definition by mainstream psychiatry • International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth, 1973) • Generally seen as a passing phase in the history of psychiatry

8. RD Laing (1927-1989) • Not an anti-psychiatrist

9. RD Laing (1927-1989) • Not an anti-psychiatrist • Athough agreed with anti-psychiatric thesis that “by and large psychiatry functions to exclude and repress those elements society wants excluded and repressed”

10. RD Laing (1927-1989) • Madness is much more understandable than commonly assumed

11. RD Laing (1927-1989) • Madness is much more understandable than commonly assumed • So-called normality is too often an abdication of our true potentialities

12. Thomas Szasz (1920-) • Not an anti-psychiatrist

13. Thomas Szasz (1920-) • Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion

14. Thomas Szasz (1920-) • Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion • “Because both the anti-psychiatrists and I oppose certain aspects of psychiatry, our views are combined and confused”

15. Thomas Szasz (1920-) • Mental illness is a myth, as disease is physical

16. Thomas Szasz (1920-) • Mental illness is a myth, as disease is physical • State should not interfere in mental health practice or medicine in general

17. The “anti” element in anti-psychiatry • Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems

18. The “anti” element in anti-psychiatry • Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems • May have gone too far in abandoning notion of mental pathology

19. Excesses of anti-psychiatry • Cooper and Laing ultimately more interested in personal authenticity than changing psychiatry

20. Excesses of anti-psychiatry • Cooper and Laing ultimately more interested in personal authenticity than changing psychiatry • Few would want to go as far as Szasz in proposing no mental health law

21. Excesses of anti-psychiatry • Cooper and Laing ultimately more interested in personal authenticity than changing psychiatry • Few would want to go as far as Szasz in proposing no mental health law • Cooper’s excursion into family, sexual and revolutionary politics

22. Critical psychiatry • Does not deny its roots in anti-psychiatry

23. Critical psychiatry • Does not deny its roots in anti-psychiatry • Seeks to avoid excesses of anti-psychiatry and polarisation in the debate about nature of mental disorder

24. Critical psychiatry • Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness

25. Critical psychiatry • Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness • Minds are enabled but not reducible to brains

26. Critical psychiatry • Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness • Minds are enabled but not reducible to brains • Genes set the boundaries of the possible; environments define the actual

27. Encouraging self-criticism • Inclined to find fault, or to judge with severity

28. Encouraging self-criticism • Inclined to find fault, or to judge with severity • Characterised by careful, exact evaluation and judgement

29. Encouraging self-criticism • Inclined to find fault, or to judge with severity • Characterised by careful, exact evaluation and judgement • Of the greatest importance to the way things might happen

30. Reflective practice • Preparedness to think critically

31. Reflective practice • Preparedness to think critically • Tolerate the uncertainty and ambiguity required during reflection

32. Reflective practice • Preparedness to think critically • Tolerate the uncertainty and ambiguity required during reflection • Ability to think about own thinking processes and critically assess assumptions and beliefs

33. Critical theory • Loose collection of theories critical of society and the human sciences

34. Critical theory • Loose collection of theories critical of society and the human sciences • Frankfurt Institute for Social Research

35. Critical theory • Rational basis of social existence theoretically impossible

36. Critical theory • Rational basis of social existence theoretically impossible • Systems of collective beliefs legitimate various power structures

37. Scientific basis of critical psychiatry • Critique of science as positivism

38. Scientific basis of critical psychiatry • Critique of science as positivism • Interpretation important in establishing “facts”

39. Scientific basis of critical psychiatry • Corporate interests are compromising objective research

40. Scientific basis of critical psychiatry • Corporate interests are compromising objective research • Bias in interpretation of randomised controlled trials

41. A simplified comparison

42. A simplified comparison

43. A simplified comparison

44. A simplified comparison

45. A simplified comparison

46. Conclusion • Mental disorders are not brain diseases

47. Conclusion • Mental disorders are not brain diseases • Psychiatrist is agent of social control

48. Conclusion • Mental disorders are not brain diseases • Psychiatrist is agent of social control • Mental disorders must show through the brain but not always in the brain