Over the last twenty years there has emerged a body of work that questions the assumptions that lie beneath psychiatric knowledge and practice. This work, appearing as academic papers, magazine articles, books, and chapters in books, hasn’t been written by academics, sociologists or cultural theorists. It has emerged from the pens and practice of a group of British psychiatrists.
This is not antipsychiatry. There are important differences between the antipsychiatry of the 1960s and present-day critical psychiatry; there are also important points of convergence, but the two nonetheless are quite different. Some of these similarities and differences will become clear as this series of blogs, written to complement the narrative blogs I’ll occasionally be posting, evolve over time.
In this series of postings, to appear under the ‘Critical Psychiatry’ tag, I want to present an overview of some of this work. This is because interest in critical psychiatry is growing, especially in the USA. There will be presentations by British critical psychiatrists at the APA annual meeting in San Francisco, and the Institute on Psychiatric Services in Philadelphia, both this year. This series of blogs about critical psychiatry is also by way of a sneak preview of a book I’m writing about British critical psychiatry, to be published by PCCS Books –
http://www.pccs-books.co.uk – in the near future; watch this space!
So what exactly is critical psychiatry? The bulk of this work has been written by a small group of psychiatrists, all of whom are, or were, practicing psychiatrists in the NHS in England. All are associated with the Critical Psychiatry Network –
http://www.criticalpsychiatry.co.uk – which first met in Bradford, England in 1999. The most active members of this group have between them written ten single or dual author books, ten edited books with forty-two chapters, and one hundred and thirty seven papers mostly in peer-reviewed journals. A survey of this work reveals that it covers five themes:
- The problems of diagnosis in psychiatry
- The problems of evidence based medicine in psychiatry, and related to this, the relationship between the pharmaceutical industry and psychiatry.
- The central role of contexts and meanings in the theory and practice of psychiatry, and the role of the contexts in which psychiatrists work.
- The problems of coercion in psychiatry.
- The historical and philosophical basis of psychiatric knowledge and the practice of psychiatry.
These themes are not mutually exclusive, for example, there is a close relationship between some aspects of the problems of diagnosis, particularly the problem of validity, and the problems of evidence-based medicine. In addition, the problems of diagnosis in psychiatry may also be seen in terms of another set of issues, that of the application of the methods of scientific inquiry to human subjects. This in turn relates to a third, that of the neglect of contexts and meanings in contemporary psychiatric practice. And, at a conceptual level, these problems can be understood in terms of three key philosophical issues, the nature of knowledge and different ways of knowing about the world (epistemology), the nature of the body-mind relationship, and the relationship between mind and the world, especially the social world.
These three issues are of fundamental importance in understanding the limitations of scientific psychiatry. Most important of all, however, is a focus on the moral and ethical implications of the use of scientific knowledge (whether biological, psychological, sociological) in relation to madness and distress. Ultimately, critical philosophical thought has a great deal to offer when it comes to understanding how these different problems of psychiatric knowledge and practice are related. In this blog I will focus on the first of these themes. Subsequent blogs in the coming months will deal with the others.
The problems of diagnosis in psychiatry
The writings of critical psychiatrists see the problems of diagnosis in psychiatry in two areas: problems with the scientific basis of psychiatric diagnoses, and the moral problems that can arise from the use of psychiatric diagnosis.
The scientific basis of diagnosis in psychiatry
Joanna Moncrieff (1997) points out that despite extensive scientific research, there is no convincing evidence that specific biological causes account for either depression or schizophrenia. Research councils and other funding bodies have invested huge sums of money over the years in the quest for the biological basis of the condition called schizophrenia, but without success. Researchers in molecular genetics, neuroimaging and other neuroscientific fields persistently overstate the significance of their findings. Duncan Double (2000) also questions the evidence to support a biological basis for psychiatric diagnoses. He points out that a low level of agreement over the diagnosis of schizophrenia between psychiatrists in different countries has hampered psychiatric research.
Until the 1970s, American psychiatrists had a much broader conception of schizophrenia than their British colleagues, who used the diagnosis much less frequently. He also points out that the monoamine theory of depression and the dopamine theory of schizophrenia developed
after the introduction of drugs that were claimed to ‘cure’ these conditions. Prior to this there was little interest in neurotransmitters like dopamine and the monoamines. This emerged when laboratory research drew attention to the effects of these drugs on neurotransmitters. Only then did these theories emerge. In contrast, the discovery of drugs to treat neurological conditions like Parkinson’s disease resulted from extensive laboratory research into the role of dopamine as a neurotransmitter.
The biological basis of schizophrenia remains elusive and unsubstantiated (Thomas, 2011). One reason for this as Duncan Double (2002) points out that is the poor level of agreement between psychiatrists over the diagnosis. This was one of the factors responsible for the move towards a more scientific psychiatry heralded by DSM-III. The first edition of the DSM published in 1952 gave definitions and criteria for 106 categories of psychiatric disorders, but the publication of the fourth edition in 1994 saw this number swell to 354. The third edition ‘…encouraged the reification of psychological conditions. Social phobia, post-traumatic stress disorder, for example, were first included in international classifications in DSM-III.’ (Double, 2002:902). The third edition, he suggests, coincided with the growing influence of scientific psychiatry, and a return to the values expounded by the German psychiatrist Emil Kraepelin a hundred years earlier.
Sami Timimi (2004) argues that the diagnosis of attention deficit hyperactivity disorder (ADHD) is a cultural construct. He points out that there are no specific biological or psychological markers for the condition, and as a result of disagreements and uncertainties over the definition there are wide variations in the prevalence of the condition. One thing that is clear from epidemiological studies is the condition has become much more common over time. In order to understand this we have to adopt a cultural perspective, and in particular recent changes in Western culture.
The expansion of diagnosis has also been a feature of child psychiatry. Until relatively recently the emphasis here was on child development, the family, and psychodynamic and social understandings of childhood. Sami Timimi (2004a) points out that before the introduction of DSM-III, depression was an uncommon diagnosis in childhood. It was also considered to be different from depression in adults, and not to respond to antidepressant drugs. This changed when an influential group of academic child psychiatrists claimed that childhood depression was more common than most people thought, and that it responded to physical treatments. Sami Timimi argues that current psychiatric diagnostic criteria in depression are so broad as to be useless. Most children can be identified as suffering from some form of psychiatric disorder. In addition there are low levels of agreement between the diagnosis of depression and the psychosocial problems that are usually associated with it. This raises serious doubts about the value of constructs like childhood depression.
The moral problems of diagnosis
In Britain this is seen most tragically in the problematic encounter between psychiatry and people from Black and Minority Ethnic (BME) communities. Suman Fernando (1991) argues that belief in the neutrality of psychiatric knowledge and practice has helped to conceal the racist assumptions in which the two are based. This problem operates nationally and globally. In Britain there a huge body of evidence has accumulated over the last fifty years that the incidence of schizophrenia is much higher in people from African-Caribbean communities, especially young men. This fact, allied with what is a widely held but racist perception that young Black men are dangerous, is linked to the higher rates of compulsion and coercion they experience in mental health services. Young black men are also more likely to receive physical treatments and higher doses of drugs in hospital than other groups.
But the problem doesn’t end there. Psychiatric theories resort to racist explanations for the raised incidence of schizophrenia in black people, based either in supposed biological or genetic differences between black people and the white majority, or in the family structures and life styles (especially cannabis use) that are said to characterise the African-Caribbean cultures. Psychiatry consistently locates the origins of the problem of schizophrenia in the biology or culture of these young men, and not in the experiences of racism and discrimination that feature prominently in their lives. This is a serious moral failure.
Racism is a difficult issue for health professionals to have to face up to. Kwame McKenzie (2003) argues that the experiences of racism have adverse effects upon the health of those affected. This can be seen in the raised incidence of high blood pressure, respiratory illnesses, anxiety, depression and psychosis in black people. Writing in the context of the Macpherson Report into the failure of the Metropolitan Police to bring about a prosecution in the racist murder of black teenager Stephen Lawrence, he (McKenzie, 1999) points out that like the police, doctors take offence to accusations of racism. This is where the idea of institutional racism is helpful, because it considers how the values and structures of mental health services inadvertently discriminate against minority groups.
More generally, as Duncan Double (2002) argues, the use of diagnosis based in biological explanations of experience eliminates the possible significance of the meaning of distress, and obscures its social and psychological origins. This encourages people to see themselves as powerless to do anything about their problems. This has important implications for recovery.
The use of diagnosis has become an important tool in the pharmaceutical industry’s attempts to extend its global commercial interests, and Suman Fernando (1991) points out that this has harmful consequences on local understandings of distress and madness and the systems of support that are based in this, especially in non-Western countries. Western scientific understandings of distress originate in historical and philosophical assumptions about the self that are a feature of Western civilization. International agencies like the World Health Organisation (WHO) place additional pressures on non-Western countries to adopt Western ‘solutions’ to the problem of madness, indirectly endorsing the pharmaceutical industry’s agenda and further weakening local support systems. Support for this view comes from a paper that Pat Bracken & I wrote (Bracken & Thomas, 2001), which argues that scientific accounts of distress exemplified by the DSM are rooted in the view that human suffering would ultimately yield to scientific progress.
The notion of progress through rational scientific thought originated in the European Enlightenment. One of the important outcomes of this period of thought and history was the replacement of religious belief and superstition by science and rationality in our attempts to understand our lives and our relationship to the world. The scientific approach, which reached its apogee in the
Decade of the Brain, replaced a wide variety of non-scientific ways of understanding madness and distress, first in Europe, but increasingly through the second half of the twentieth century, across the globe.
If it is the case that psychiatric diagnoses have no firm scientific basis, and that they are little more than consensus statements produced by committees of experts, then it should come as no surprise to discover that political factors play an important part in their creation and abolition. Forty years ago the British and American psychiatric establishments rightly attacked the former Soviet Union for its use of the diagnosis sluggish schizophrenia as a means of silencing dissidents. At the same time gay activists in the USA campaigned politically to have homosexuality removed as a diagnosis from the DSM, and in 1973 it was replaced by the category sexual orientation disturbance. Derek Summerfield draws attention to the political nature of psychiatric diagnosis, and the moral problems that arise from this. He argues that the origin of the diagnosis of post-traumatic stress disorder (PTSD) was a political, not scientific, achievement.
Following the Vietnam War the U.S. anti-war movement persuaded military psychiatry to provide help and support for veterans. As a result the diagnosis of PTSD replaced earlier conceptions of battle fatigue and war neurosis, and drew attention to the traumatogenic nature of war. In doing so the diagnosis also transformed Vietnam veterans from perpetrators of war atrocities to victims of trauma; the category ‘…legitimized the “victimhood”, gave moral exculpation…’ (Summerfield, 2001:95). The diagnosis of PTSD has less to do with science and natural categories than it has to do with internal political struggles to salve a nation’s conscience after a terrible conflict.
Western concepts of trauma and the psychiatric diagnosis of PTSD attempt to redefine the moral consequences of conflict. In another paper Derek Summerfield points out that surveys of the residents of war zones tend to interpret feelings of revenge as an indicator of poor mental health (Summerfield, 2002) For example in Croatia, a foreign-led project told Croatian children affected by the war that not hating Serbs would help them to recover from trauma. In South Africa, studies of the victims of apartheid found that PTSD was significantly more common in those who were unforgiving (as measured by their score on a ‘forgiveness’ scale).
These, and similar, studies give weight to the view that forgiveness is necessary for recovery. Thus the emotional responses of those affected by war, ‘traumatisation’ or ‘brutalisation’, are held to be harmful and in need of modification. This belief, he argues, provides the basis for large scale counselling interventions by Western aid agencies. He challenges this view, by asking is anger and the need for revenge necessarily a bad thing. They draw attention to the moral aspects of injustice that lead to suffering in the first place, and the importance of social cohesiveness and solidarity as a social and cultural response to the injustices of war.
References
Bracken, P. & Thomas. P. (2001) Postpsychiatry: a new direction for mental health.
British Medical Journal, 322, 724 – 727.
Double, D. (2000) Critical Psychiatry.
CPD Bulletin Psychiatry, 2, 33 – 36.
Double, D. (2002) The Limits of Psychiatry.
British Medical Journal, 324, 900-904.
Fernando, S. (1991)
Mental Health, Race and Culture. Macmillan / Mind Publications, London. (1
st edition).
McKenzie, K. (1999) Something borrowed from the blues?
British Medical Journal, 318, 616 – 617.
McKenzie, K. (2003) Racism and Health.
British Medical Journal, 326, 66.
Moncrieff, J. (1997) The medicalisation of modern living.
Soundings, 6, 63 – 72.
Summerfield, D. (2001) The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category.
British Medical Journal 322, 95 – 98.
Summerfield, D. (2002) Effects of war: Moral knowledge, revenge, reconciliation, and medicalised concepts of recovery
. British Medical Journal, 325, 1105-1107.
Thomas, P. (2011) Biological explanations for and responses to madness. Chapter Fourteen in (eds. D. Pilgrim, A. Rogers and B. Pescosolido)
The SAGE Handbook of Mental Helath and Illness. London, Sage. (pp 291 – 312).
Timimi, S. (2004) In Debate: ADHD is best understood as a cultural construct – For
. British Journal of Psychiatry (In Debate) 184, 8-9.
Timimi, S. (2004a) Rethinking childhood depression.
British Medical Journal, 329, 1394-1397.
Reprinted from CPD Bulletin Psychiatry
(2000) 2 33-36
Critical Psychiatry
- Modern-day psychiatry relies too much on the "medical model" and emphasises
diagnostic decisions. If psychiatrists adopted a more social or therapeutic
community approach treatments would be more effective.
- The categorisation of psychiatric illness is not as clear as most
psychiatrists believe. Assessment of aetiology too often fails to take personal
and social factors into account.
- There is too much emphasis on the scientific possibilities of randomised
controlled trials. The evidence of these trials is biased.
Introduction
Psychiatry is open to criticism because of its power of
compulsory detention and treatment. This issue could be avoided by psychiatrists
restricting themselves to voluntary treatment, and psychotherapists indeed
routinely do practise on this basis. However, the social responsibility of
caring for the mentally ill is an essential function of psychiatry and should
not be neglected. The question is how well psychiatry fulfills its role.
Critical psychiatry suggests that psychiatric practice is often
inadequate for a number of reasons. This article will review this critique of
psychiatry by examining its main constituents. Over recent years mainstream
psychiatry has marginalised its critics by dismissing them as
"antipsychiatrists". However, those identified as part of the antipsychiatry
movement, such as David Cooper, Thomas Szasz and RD Laing do not represent a
single view (Tantam 1991). Cooper was politically Marxist and the only one that
accepted the designation "antipsychiatrist"; Szasz (1972) regards mental illness
as a myth; Laing recognised the turmoil of mental suffering, whilst
acknowledging that the term mental illness is used metaphorically. Arguably, the
"antipsychiatrists" are only linked by their willingness to criticise
psychiatric practice.
Biological bias in psychiatry
Detaining the mentally ill creates the potential for abuse.
From the 1950s, attempts were made to make psychiatric hospitals more
therapeutic by unlocking the doors (WHO 1953). The maltreatment of patients in
hospital was exposed in several scandals that gave an impetus to the
dehospitalisation of patients (Martin 1984). Conversely, inquiries over recent
years, particularly following homicides by psychiatric patients, have expressed
concern about neglect of patients in the community (Peay 1996). Psychiatric
services have to find a precarious balance beside abuse and neglect.
Accordingly it can be difficult to sustain interpersonal
relationships. One temptation is to retreat into objectification of those
identified as mentally ill, insisting on the somatic nature of their illness. An
advantage of this strategy is that it protects those trying to provide care from
the pain experienced by those needing support. Notwithstanding some intuitive
understanding of mental illness as a disorder of the mind, it is simpler to
concentrate on its bodily substrate. Such a biological bias is not new in
psychiatry, although psychopharmacological developments following the discovery
of antipsychotics and antidepressants have reinforced this emphasis. As
expressed by John Haslam (1798) over two centuries ago: "[T]he various and
discordant opinions, which have prevailed in this department of knowledge, have
led me to disentangle myself as quickly as possible from the perplexity of
metaphysical mazes."
Both the dopamine theory of schizophrenia (dopamine
overactivity in schizophrenic brains) and the amine hypothesis of depression
(amines depleted in depressed brains) arose following the introduction of
psychotropic drugs, at a time when only few neurotransmitters had been
discovered. Despite the subsequent discovery of a vastly more complex
neurotransmitter network, psychiatrists still use such simplistic notions in
their everyday management of patients when they explain that mental illness is
due to "chemical imbalance".
The evidence for the organic basis of functional psychiatric
conditions such as schizophrenia is not as considerable as certain claims
suggest. Functional imaging of receptors has produced equivocal results.
Structural and functional cerebral abnormalities in schizophrenia are at best
subtle rather than gross (Chua & McKenna 1995). In contrast, the
identification and cloning of genes and the elucidation of chromosomal
abnormalities has led to major progress in the molecular biology of genetic
neuropsychiatric disorders, such as Huntington's disease, in which the
abnormality of triplet repeat on chromosome four has now been demonstrated.
Taken to its extreme, the danger is that people with mental
health problems will be reduced to purely physical terms wherein their brain
chemistry needs correction. Moreover, the biological hypothesis is used to give
justification to medical control in the treatment of mental illness. In
relations of power, it suits psychiatrists to keep other mental health
professionals thinking that they may be missing vital knowledge about bodily
processes. The authority of the challenge to the biological hypothesis is
thereby undermined.
Diagnosis
Single-word diagnoses fail to give an adequate understanding of
a person's mental health problems. The modern explicit and intentional concern
with diagnosis and classification disguises uncertainty about psychiatric
disease entities.
In particular, over recent years, psychiatric diagnosis has
become increasingly codified following the original paper by Feighner et al
(1972), and the introduction of the Research Diagnostic Criteria (Spitzer et al
1975), through editions of DSM-III, DSM-IIIR and DSM-IV (APA 1994) and ICD-10
(WHO 1992). Robert Spitzer, who chaired the DSM-III Task Force, was particularly
concerned about a study by Rosenhan (1973), which raised the fear that
unreliable diagnoses may invalidate the whole process of psychiatric practice
(Spitzer & Fleiss 1974). Rosenhan demonstrated that normal people could gain
admission to hospital and acquire a diagnosis of schizophrenia by merely
feigning a mundane, simple hallucination, saying they were hearing a voice say
"thud", "empty" or "hollow". He concluded that professionals were unable to
distinguish the sane from the insane. Operationalisation of psychiatric criteria
arose as a response to the perceived need for objectification in diagnosis.
The US-UK Diagnostic Comparison Study demonstrated that
American psychiatrists were using the term schizophrenia more inclusively than
their British counterparts (Kendell et al 1971). This finding also contributed
to a tightening of diagnostic criteria, particularly a restriction of the use of
the term schizophrenia. Concern about stigmatisation has made psychiatrists much
less ready over recent years to use a diagnosis of schizophrenia which tends to
imply poor prognosis.
The movement to create explicit diagnostic criteria has been
called neo-Kraepelinian, as it promotes many of the ideas associated with the
views of Emil Kraepelin, often seen as the founder of modern psychiatry (Klerman
1978). Adolf Meyer was regarded as extremely influential in American psychiatry
in the first half of this century, and his influence came to Britain via Aubrey
Lewis and David Henderson (Gelder 1991). Meyer (1951/2) is remembered for his
opposition to the preoccupation of the Kraepelinians with diagnosis. Although he
accepted that there may be a place for classification, he argued that if
diagnosis was meaningful, it was secondary to the assessment of the patient as a
person (Double 1990). He may be held responsible for helping to create a trend
which depreciated the role of diagnosis, which the neo-Kraepelinian movement
deliberately countered. Psychoanalysis was strong in academic psychiatry in the
post-war period in America and also appears to have played a role in
de-emphasising the importance of diagnosis and classification..
It is illegitimate to postulate an underlying disease entity
just because mental disorders may seem unintelligible. Assessment should
concentrate on the "facts of the case", as Meyer was fond of saying, and
diagnosis usually does justice to only part of "the facts". Even if "the facts"
do not constitute a diagnosis, clinical management has to act on them. Meyer
favoured a psychogenic explanation of mental illness and regarded it as not
completely foreign to normal experience. In particular, he explained
schizophrenia (dementia praecox) as a maladaptation that could be understood in
terms of the patient's life experiences. Psychiatric assessment too often fails
to appreciate personal and social precursors of schizophrenia by avoiding or not
taking account of such considerations.
Social therapy
Several experimental attempts have been made to provide a more
therapeutic milieu than the traditional hospital environment. For example, Harry
Stack Sullivan established a small ward for schizophrenic men that was staffed
with hand-picked attendants, set apart from the rest of the Sheppard Pratt
Hospital in the 1920s (Barton Evans III 1996). He gave his staff autonomy to
operate on their own with patients. As Sullivan (1962) stated:
[W]e found intimacy between the patient and the employee
blossomed unexpectedly, that things I cannot distinguish from genuine human
friendship sprang up between patient and employee, that any signs of the alleged
apathy of the schizophrenic faded, to put it mildly, and that the institutional
recovery rate became high.
Sullivan's experimental ward could be seen as a precursor of
the therapeutic community movement, whose influence came to be integrated with
mainstream psychiatry (Jones 1952, van Putten 1973). This emphasis on the social
aspects of treatment, though, is much less obvious in the current climate of
risk assessment and psychotropic drug management (Clark 1974).
The "antipsychiatrists" also experimented with institutional
alternatives. For example, David Cooper set up Villa 21 in Shenley Hospital,
although Cooper's positioning as an antipsychiatrist makes it difficult to
appreciate the similarity with ventures like that of Sullivan. Cooper's (1967)
"experiment in antipsychiatry" failed to change the ward staff's role-bound
behaviour. Laing's Kingsley Hall was outside the hospital system and was perhaps
more like a commune. Criticism of its laissez-faire ethos should take account of
Laing's own concession - that he had failed to find "a tactical, workable,
pragmatic . . . . sort of thing that could work for other people" (Mullan
1995).
Scepticism about therapeutic efficacy
Historically doctors have prescribed medications which are now
regarded as useless and often dangerous. Non-specific placebo effects can be
powerful (Shapiro & Shapiro 1997). Uncontrolled evaluation of the efficacy
of treatment was eventually replaced by clinical trials and the acceptance and
use of the double-blind method. However, randomised controlled trials are
commonly flawed in practice and the most rigorous trials are associated with
less treatment benefit than poor quality trials (Moher et al 1998). The recent
emphasis on evidence-based medicine with initiatives such as the Cochrane
Collaboration has also focused on methodological issues.
The double-blind method is not infallible because frequently
the double blind can be broken (Fisher & Greenberg 1997). Patients and
doctors may be cued in to whether patients are taking active or placebo
medication by a variety of means. For example, they may notice that placebo
tablets they have been taking taste differently from medication to which they
have previously become accustomed. Active medication may produce side effects
which distinguishes it from inert medication. There is evidence even of
deliberate deceit in clinical trials so that randomised allocation is not
concealed (Schultz 1996).
Studies where an attempt to measure unblinding has been made
confirm that it does occur and significant correlations with efficacy ratings
have been found (Shapiro & Shapiro 1997). These problems of unblinding may
be minimised by trialists because there seems to be nothing that can be done to
prevent it completely. Nonetheless, there should then be no pretence that
unbiased evaluation of treatment is being carried out. Although the apparent
specific effect of treatment may not be as great as the placebo effect itself,
it may merely be the wishfulfilling amplification of nonspecific effects. Using
active drugs without apparent specific treatment effects as controls generally
reduces the effect size of the active treatment, maybe because patients are less
likely to be unblinded in the trial because of the detection of active effects
in the control drug (Thomson 1982).
The placebo effect may be relevant to problems in
discontinuation. People may form attachments to their medication more because of
what it means to them than what it does. Any change threatens an equilibrium
related to a complex set of meanings that their medication has acquired. These
issues of reliance on medication should not be minimised, yet commonly
compliance with treatment is reinforced by emphasising that antidepressants, for
example, are not addictive (Double 1997). Psychotropic medication is often
prescribed in life crises reinforcing defensive mechanisms against overwhelming
anxiety, and the power of the placebo effect should be recognised. Counteracting
such placebo effects may not be easy when discontinuing medication.
Conclusion and future developments
Psychiatric practice can be criticised for its failure to
regard the patient as a person. Mainstream psychiatry acts on the somatic
hypothesis of mental illness to the detriment of understanding people's
problems. Laing's (1982) primary motivation was his appreciation that
schizophrenia, in particular, was more understandable than mainstream psychiatry
recognized. This stance is consistent with Adolf Meyer's (1951/2) philosophy.
The neo-Kraepelinian has eclipsed the Meyerian approach over recent years and
encouraged excessive enthusiasm about diagnosis and treatment which requires
critical analysis (Double 1991).
Antipsychiatry has been marginalised because it accuses
psychiatry of social control (Farrell 1979). Renewed criticism of modern
psychiatry is required and the Critical Psychiatry Network gives expression to a
"post-psychiatry" (Critical Psychiatry Network website). Psychiatry need not
feel negative about this process. Patients and society will continue to demand
its services and appreciate realistic expectations.
References
American Psychiatric Association (1994)
Diagnostic and
Statistical Manual of Mental Disorders (4th edition). Wahington: APA.
Barton Evans III, F. (1996)
Harry Stack Sullivan.
Interpersonal theory and psychotherapy. London: Routledge.
Chua, S.E. & McKenna, P.J. (1995)
Schizophrenia - a
brain disease? A critical review of structural and functional cerebral
abnormality in the disorder. British Journal of Psychiatry, 166,
563-582.
Clark, D.H. (1974)
Social therapy in psychiatry.
Harmondsworth: Penguin.
Cooper, D. (1967)
Psychiatry and anti-psychiatry.
London: Tavistock Publications.
Critical Psychiatry Network (no date)
Double, D.B. (1997)
Prescribing antidepressants in general
practice. People may become psychologically dependent on antidepressants.
[Letter] BMJ, 314, 829.
Double, D.B. (1991)
What would Adolf Meyer have thought of
the neo-Kraepelinian approach? Psychiatric Bulletin, 14,
472-4.
Farrell, B.A. (1979)
Mental illness: a conceptual
analysis. Psychological Medicine, 9, 21-35.
Feighner, J.P., Robins, E., Guze, S.B., et al (1972)
Diagnostic criteria for use in psychiatric research. Archives of General
Psychiatry, 26, 57-63.
Fisher, S. & Greenberg, R.P., (eds) (1997)
From
placebo to panacea. Putting psychiatric drugs to the test. Chichester: John
Wiley.
Gelder, M. (1991)
Adolf Meyer and his influence on British
psychiatry. In Berrios, G.E. & Freeman, H., (eds) 150 years of British
psychiatry. London: Gaskell.
Haslam, J. (1798)
Observations on Insanity. London:
Rivington.
Jones, M. (1952)
Social psychiatry: A study of
therapeutic communities. London: Tavistock.
Kendell, R.E., Cooper, J.E., Gourlay, A.J., et al (1971)
Diagnostic criteria of American and British psychiatrists. Archives of
General Psychiatry, 25, 123-130.
Klerman, G.L. (1978)
The evolution of a scientific
nosology. In Shershow, J.C. (ed) Schizophrenia: Science and Practice.
Cambridge, Mass: Harvard University Press.
Laing, R.D. (1985)
Wisdom, madness and folly. The making
of a psychiatrist. London: Macmillan.
Martin, J.P. (1984)
Hospitals in trouble. Oxford:
Blackwell.
Meyer, A. (1951/2)
Collected Papers (Four Volumes).
Baltimore: John Hopkins.
Moher, D., Pham, B., Jones, A., et al
(1998) Does quality of reports of randomised trials affect estimates of
intervention efficacy reported in meta-analyses? Lancet, 352,
609-613.
Mullan, B. (1995)
Mad to be normal. Converations with RD
Laing. London: Free Association.
Peay, J. (ed) (1996)
Inquiries after homicide.
London: Duckworth.
Rosenhan, D.L. (1973)
On being sane in insane places.
Science, 179, 250-258.
Schultz, K. (1996)
Randomised trials, human nature, and
reporting guidelines. Lancet, 348, 596-98
Shapiro, A.K. & Shapiro, E. (1997)
The powerful
placebo. From ancient priest to modern physician. London: John
Hopkins.
Spitzer, R.L. & Fleiss, J.L. (1974)
A reanalysis of the
reliability of psychiatric diagnosis. British Journal of Psychiatry,
125, 341-347.
Spizer, R.L., Endicott, J. & Robins, E. (1975)
Research diagnostic criteria (RDC) for a selected group of functional
disorders. New York: New York State Psychiatric Institute.
Sullivan, H.S. (1962)
Schizophrenia as a human
process. New York: WW Norton & Co.
Szasz, T.S. (1972)
The myth of mental illness.
London: Paladin.
Tantam, D. (1991)
The anti-psychiatry movement. In Berrios,
G.E. & Freeman, H. (eds) 150 Years of British Psychiatry, 1841-1991.
London: Gaskell.
Thomson, R. (1982)
Side effects and placebo amplification.
British Journal of Psychiatry, 140, 64-68.
Van Putten, T. (1973)
Milieu therapy: contraindications?
Archives of General Psychiatry, 29, 640-643.
World Health Organisation (1992)
The ICD-10
classification of mental and behavioural disorders. Geneva: WHO.
World Health Organisation (1953)
Third report of the
expert committee on mental health. Geneva: WHO.
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