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Psychiatry: no longer in dissent?

  • Brendan D. Kelly (a1) and Larkin Feeney (a2)
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Medicine thrives on dissent. Of all the medical disciplines, psychiatry seems to generate the highest level of dissent, both from inside and outside the profession: no other medical discipline, for example, has some of its own members consistently argue that its very foundations are rooted in a series of harmful myths (Szasz, 1974, 2003). The best responses to this type of criticism identify the core concerns of the critic, dissect out the most relevant arguments and develop ways to integrate useful suggestions with existing knowledge, so as to advance the field in a pragmatic, sensible and evidence-based fashion. Such constructive responses to controversy are rare.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Psychiatry: no longer in dissent?

  • Brendan D. Kelly (a1) and Larkin Feeney (a2)
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eLetters

Creating consensus in psychiatry

DB Double, Consultant Psychiatrist
06 September 2006

Kelly & Feeney (2006) provide a useful re-evaluation of Anthony Clare's (1980) Psychiatry in Dissent, first published 30 years ago. As they note, there is still an active critical psychiatry movement, with postpsychiatry (Bracken & Thomas, 2005) perhaps being the best known version. However, critical psychiatry is wider than its identification with postmodernism (Double, 2006).Moreover, critical psychiatry is seeking to move on from the eclectic consensus created by Psychiatry in Dissent. To avoid conflict about different models of mental illness, Clare eschewed a well-defined theoretical basis for practice. In this way, he avoided the worst excesses of reductionism and the objectification of patients that caused particular concern to "anti-psychiatry". However, Clare still believes that "the advantages of the disease approach, the diagnostic process and the present rudimentary classification system outweigh the disadvantages" (1997: 52). Over recent years, it has become generally accepted that scientific advances have proven beyond reasonable doubt that mental disorders, such as schizophrenia, are diseases of the brain. I am not wanting to be misunderstood. Of course, all thought, emotion and behaviour involve brain changes, and this is true for "normal" experience as much as for abnormal experience such as mental illness. However, the dogmatic and misleading way in which claims that mental disorders are brain diseases are made does need to be challenged. The evidence is not as strong as is commonly believed. Despite this, psychiatric practice has commonly become contingent on taking the step of faith in the biomedical hypothesis. Drug companies put advertisements in the medical press encouraging doctors to believe in their treatment and simplistic notions of biochemical imbalance as the cause of mental illness are widely promulgated. The problem with the claim that mental disorders are biological diseases is that it creates the reductionist tendency to treat people as brains that need their neuropathological lesions cured. Psychosocial factors in aetiology tend to be avoided. If biological and genetic factors determine psychopathology, the implication may be that personal and social efforts to improve one's state of mind may be pointless. As suggested above, this critique is not meant to imply that bodily factors can be ignored. Emotional problems clearly have physical effects, and vice versa. Nor does it mean that critical psychiatry is unscientific. Rarely does neurobiology have more than indicators to conclude that brain pathology is the cause of functional mental illness.Critical psychiatry does not want to disrupt the sense of harmony created by Psychiatry in Dissent for its own sake. However, mainstream psychiatric theory still has the mistaken tendency, for which it was attacked by anti-psychiatry, of relying on unfounded speculations about the nature of mental illness. Although biomedical psychiatry may wish it were a simple, straightforward, scientific discipline, in fact its ideological nature and its relationship to issues of power are unavoidable. The debate about the connection between mind and matter and the way it impinges on the relationship between facts and values does need to be approached afresh. Sufficient time has elapsed since the publication of Psychiatry in Dissent to reinvigorate this debate. BRACKEN, P. & THOMAS, P. (2005) Postpsychiatry: Mental health and postmodernism Oxford: Oxford University Press.CLARE, A. (1980) Psychiatry in dissent. (Second edition) London: RoutledgeCLARE, A. (1997) The disease concept in psychiatry. In: R. Murray, P. Hill & P. McGuffin (eds) The essentials of postgraduate psychiatry. Cambridge: CUPDOUBLE, D.B. (2006) (ed) Critical psychiatry: The limits of madness. Basingstoke: Palgrave MacmillanKELLY, B.D. & FEENEY, L. (2006) Psychiatry: No longer in dissent? Psychiatric Bulletin, 30, 344-5 ... More

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