Is critical psychiatry the same as “anti-psychiatry”?

D B Double

David Cooper (1931-1986)

Psychiatry and anti-psychiatry (1967)

David Cooper (1931-1986)

Psychiatry and anti-psychiatry (1967)

“[P]sychiatry … has aligned itself far too closely with the alienated needs of society”

David Cooper (1931-1986)

Villa 21 – an experiment in anti-psychiatry

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”

Definition by mainstream psychiatry

International movement against psychiatry which is “anti-medical, anti-therapeutic, anti-institutional and anti-scientific” (Roth, 1973)

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

RD Laing (1927-1989)

Not an anti-psychiatrist

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”

RD Laing (1927-1989)

Madness is much more understandable than commonly assumed

RD Laing (1927-1989)

Madness is much more understandable than commonly assumed

So-called normality is too often an abdication of our true potentialities

Thomas Szasz (1920-)

Not an anti-psychiatrist

Thomas Szasz (1920-)

Not an anti-psychiatrist, although also not a “psychiatrist”, as psychiatry is associated with coercion

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”

Thomas Szasz (1920-)

Mental illness is a myth, as disease is physical

Thomas Szasz (1920-)

Mental illness is a myth, as disease is physical

State should not interfere in mental health practice or medicine in general

The “anti” element in anti-psychiatry

Psychiatry objectifies people and therefore becomes part of the problem rather than the solution to mental health problems

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

Excesses of anti-psychiatry

Cooper and Laing ultimately more interested in personal authenticity than changing psychiatry

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

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

Critical psychiatry

Does not deny its roots in anti-psychiatry

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

Critical psychiatry

Psychiatry can be practised without the justification of postulating brain pathology as the basis for mental illness

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

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

Encouraging self-criticism

Inclined to find fault, or to judge with severity

Encouraging self-criticism

Inclined to find fault, or to judge with severity

Characterised by careful, exact evaluation and judgement

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

Reflective practice

Preparedness to think critically

Reflective practice

Preparedness to think critically

Tolerate the uncertainty and ambiguity required during reflection

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

Critical theory

Loose collection of theories critical of society and the human sciences

Critical theory

Loose collection of theories critical of society and the human sciences

Frankfurt Institute for Social Research

Critical theory

Rational basis of social existence theoretically impossible

Critical theory

Rational basis of social existence theoretically impossible

Systems of collective beliefs legitimate various power structures

Scientific basis of critical psychiatry

Critique of science as positivism

Scientific basis of critical psychiatry

Critique of science as positivism

Interpretation important in establishing “facts”

Scientific basis of critical psychiatry

Corporate interests are compromising objective research

Scientific basis of critical psychiatry

Corporate interests are compromising objective research

Bias in interpretation of randomised controlled trials

A simplified comparison

Biomedical psychiatry

Anti-psychiatry

Critical psychiatry

Science Positivist Non-positivist

Non-positivist

A simplified comparison

Biomedical psychiatry

Anti-psychiatry

Critical psychiatry

Science Positivist Non-positivist

Non-positivist

Focus Brain mechanisms

Person Person

A simplified comparison

Biomedical psychiatry

Anti-psychiatry

Critical psychiatry

Psycho-pathology

Yes No Yes

A simplified comparison

Biomedical psychiatry

Anti-psychiatry

Critical psychiatry

Psycho-pathology

Yes No Yes

Empirical Yes No Yes

A simplified comparison

Biomedical psychiatry

Anti-psychiatry

Critical psychiatry

Psycho-pathology

Yes No Yes

Empirical Yes No Yes

Social control

Yes No Yes

Conclusion

Mental disorders are not brain diseases

Conclusion

Mental disorders are not brain diseases

Psychiatrist is agent of social control

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