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* ''provisional'', i.e. tentative; the theory does not attempt to assert that it is a final description or explanation. |
* ''provisional'', i.e. tentative; the theory does not attempt to assert that it is a final description or explanation. |
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According to critics, psychiatry does not qualify as a science on many counts. Presently, most biological hypotheses in psychiatry are untestable and thus [[falsifiability|unfalsifiable]] [http://www.antipsiquiatria.org/english/why-p-is-a-false-science.html]. Examples, each followed by a common psychiatric response in parentheses, include the notions that: |
According to critics, psychiatry does not qualify as a science on many counts. Presently, most biological hypotheses in psychiatry are untestable and thus [[falsifiability|unfalsifiable]]. This is the sure-fire sign of a pseudoscience [http://www.antipsiquiatria.org/english/why-p-is-a-false-science.html]. Examples, each followed by a common psychiatric response in parentheses, include the notions that: |
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* there exists an ideal neurochemical "[[Chemical imbalance theory|balance]]", which should be roughly the same in all human brains. (Many psychiatrists, however, would also deny such a notion.) |
* there exists an ideal neurochemical "[[Chemical imbalance theory|balance]]", which should be roughly the same in all human brains. (Many psychiatrists, however, would also deny such a notion.) |
Revision as of 06:53, 13 March 2006
In its most general sense, anti-psychiatry refers to approaches (sometimes seen as a coherent movement) which fundamentally challenge the theory or practice of psychiatry (the application of the medical method to problematic emotions, thoughts or behaviors). Common criticisms include that: psychiatry assumes medical concepts and tools that are not always appropriate; is too dominant compared to other approaches; has too many financial and professional links with pharmaceutical companies; uses a system of categorical diagnosis that is over-simplified and stigmatizing; is experienced by too many of its 'patients' as demeaning and controlling. Many of those with personal experience (service 'users' and 'survivors') of psychiatric care (often by force) are involved in an anti-psychiatry movement. Many mental health professionals and academics profess anti-psychiatry views, and some psychiatrists hold such views in regard to mainstream psychiatry. Many, particularly psychiatrists, view anti-psychiatry as a fringe movement with little or no validity, although it is difficult to quantify the proportion of the general public or professionals involved or the range of views held.
Origins of anti-psychiatry
Psychiatry is often seen as originating in the 16th Century when the Dutch physician Johann Weyer argued, in opposition to the views of the religious establishment, that behaviors perceived as witchcraft or sorcery were actually signs of mental disease. This medical approach developed through the centuries, becoming more professionally established during the 19th century, joined closely with neurology. Rights to therapeutic or custodial control of those seen as 'mad' or nonconformist, and the associated theoretical and scientific claims, were contested.
By the 20th century, psychiatry was associated with lunatic asylums and the attempt to achieve 'mental hygiene'. Sigmund Freud rejected neurological medical training as the only or best framework for addressing mental distress, although the practice of psychoanalysis developed as a stream of psychiatry restricted to the medically qualified. Emil Kraepelin advanced new medical categories of mental illness, which gradually came into psychiatric usage despite widespread acknowledgement and criticism of their unscientific basis in perceived patterns of experience and behavior rather than pathology or etiology.
With increasingly visible mental health problems due partly to the effects of world wars, many controversial 'medical' practices were introduced, including inducing seizures (by electroshock, insulin or other drugs) or fevers and applying freezing water (hydrotherapy). The practice of leucotomy (also known as lobotomy) - cutting to divide parts of the brain - became popularly and widely used in the 1940s and 1950s. Initially advanced by neurologists with some psychiatric opposition, the practice became adopted by psychiatrists and commonly conducted with local anaesthetic and an icepick device, in order to control psychosis and abberant behavior. Grave concerns were raised about the morality, the "side-effects" and the misuse, but the most enthusiastic advocate and practitioner (Walter Freedman) was elected president of the American Board of Psychiatry and Neurology in 1948 and the initial inventor (Egaz Moniz) was awarded the Nobel Prize in 1949, after which lobotomies were conducted even more widely and frequently.
Mid-century public outrage and opposition to such practices grew, however. New psychiatric drugs, particularly the antipsychotic Chlorpromazine, were discovered and gradually adopted. Although often accepted as an advance in some ways, there was opposition to a perceived 'chemical straightjacket' effect, especially given apparently serious harmful effects usually termed "side-effects" by psychiatry. Patients often refused or stopped these new medications, but were seen as 'non-compliant' or lacking 'insight', routinely forced to take the medication, and often became 'revolving door' patients - off and on medication.
Coming to the fore in the 1960s, anti-psychiatry (a term first used by David Cooper in 1967) vocally challenged the fundamental claims and practices of mainstream psychiatry. Psychiatrist R.D. Laing argued, in bestselling books such as 'The Divided Self', that 'madness' can be a sane response to a sick society or victimisation by family, and that psychotic experiences have meaning to a person which can be listened to and understood. Psychiatrist Thomas Szasz was associated with the movement, arguing that 'mental illness' is an inherently incoherent combination of a medical and a psychological concept, but popular because it legitimises the use of psychiatric force to control and limit deviance from societal norms (a more general argument made by libertarians on constitutional or other legal grounds). Adherents of this view referred to "the myth of mental illness" after Szasz's paper and controversial book of that name. French philosopher Michel Foucault also prominently criticised the power and role of psychiatry in society.
Holocaust documenters argued that medicalization of social problems and systematic euthanasia of people in German mental institutions in the 1930s provided the institutional, procedural, and doctrinal origins of the mass murder of the 1940s. The Nuremberg Trials convicted a number of psychiatrists who held key positions in Nazi regimes. Observation of the abuses of psychiatry in the Soviet Union also led to questioning of the validity of the practice of psychiatry in the West. In particular, the diagnosis of many political dissidents (e.g. Solzhenitsyn) with sluggishly progressing schizophrenia led some to question the general diagnosis and punitive usage of the label schizophrenia.
Other mental health professionals advanced antipsychiatry views. Sociologists argued that psychiatry was engaging in 'labelling', 'stigmatising' and using 'total institutions', in a way that caused many of the problems they saw as illness. "One Flew Over the Cuckoo's Nest (novel)" became a bestseller in 1962 (quickly turned into sell-out plays, and in 1975 a lauded Hollywood movie), which was based on the author's work in a psychiatric ward, and addressed the poor conditions and use of forced medication, lobotomy and electroshock procedures to control rather than help patients.
Attempts were made to develop community care services rather than custodial asylums, including non-medically (e.g. Soteria projects), as well as to base hospital care on a collaborative group approach rather than on medication and psychiatric control (e.g. therapeutic communities). Humanistic or existentialist therapeutic approaches (and others) sought to understand and address mental distress in a way more sensitive to the lives, feelings and personal beliefs of individuals. Social Psychiatry addressed the life history and social-environmental context of mental health.
The movement originally described as anti-psychiatry became associated with the general counter-culture movement from the 1960s. Theories and practices opposed to psychiatry at that time were often based on an anti-establishment philosophy of free self-expression, but came to be seen by many as lacking credibility or responsibility.
However, new challenges and alternatives to psychiatry were developing. The profession of clinical psychology was becoming more established. Although initially restricted by psychiatry to narrow psychometric assessment, it was gradually taking on more roles within mental health and applying therapeutic concepts and findings from general psychology rather than general medicine. Other fields such as social work, counselling and self-help were becoming more established and often in opposition to psychiatry. The predominantly psychiatric practice of psychoanalysis was increasingly criticised as scientifically incoherent and harmful, falsely denying the prevalent occurence of childhood abuse, and a form of misogyny based on medical and social power.
The anti-psychiatry movement was also being driven by individuals with experience of psychiatric care. This included, but was not limited to, those compulsorily (including via physical force) admitted to pyschiatric institutions and/or been subjected to compulsory (including via physical force) medication or procedures. It included those who felt they had been harmed by psychiatry, including by the adverse effects of psychiatric medications and other procedures, or who felt that they could have been helped more by other approaches. During the 1970s, the anti-psychiatry movement acquired sufficient respectability to advocate and effect restraint from many practices seen as the worst psychiatric abuses. The gay rights movement challenged the classification of homosexuality as a mental illness, and in a climate of controversy and activism in 1973/1974 the American Psychiatric Association decided by a small majority (58%) to remove it as an illness category, although "ego-dystonic homosexuality" remained until 1987. Increased legal and professional protections, and merging with human rights and disability rights movements (including the social model of disability, added stature and validity to anti-psychiatry theory and action.
Additionally, and largely separately, and for reasons not originating from concerns specific to mental health, some contemporary cults or new religious movements, most notably Scientology, were challenging non-spiritual or materialistic approaches to mental health (including psychiatry), as had more traditional religions for a long time. In addition, again for mostly separate reasons, anti-realists argued that the definition of a "lack of capacity to recognize reality," both clinically and legally, constitutes or could constitute a direct attack on their ideas.
Antipsychiatry came to challenge an increasingly biomedical focus of mainstream psychiatry, defined to mean an emphasis on genetics rather than environment, and on medication rather than other forms of intervention. Social Psychiatry had come to the fore at times over the century, but had become sidelined. For a long time much of psychiatry had engaged in psychoanalytic theorizing and the provision of neo-Freudian psychoanalysis, often consisting of regular expensive sessions for many years, but the practice had diminished with increasing controversy and evidence of harm and limited or no efficacy. Although Cognitive Therapy was pioneered by a psychiatrist, Aaron T. Beck, mainstream psychiatry did not embrace the therapy or its combination with behavioral techniques Cognitive Behavioral Therapy, or other psycho-social techniques with evidence of safe efficacy. Antipsychiatry increasingly came into conflict with a psychiatry combined with the financial and political power of pharmaceutical companies, claimed to have excessive, unjustified and underhand financial and professional influence on psychiatric research and practice.
Antipsychiatry also faced the increasing codification of Kraepelinian psychiatric diagnosis into manuals that gained a great amount of clinical and public acceptance, as well as financial and professional gain for psychiatry, particularly the American Psychiatric Association who control, expand and publish the DSM. Opponents criticised the theoretical basis, medical control, and clinical and political (mis)usage of such diagnostic or labelling schemes.
Anti-psychiatry challenged a psychiatric pessimism regarding many of those categorized in this way, arguing for full recovery, empowerment and self-management. Schemes to assist or encourage people with mental health issues to more fully engage in work and society were developed, alongside challenging stigma and discrimination. Collaborative models of mental health services were promoted, giving more of a voice to service users as experts alongside professionals. Those actively and openly challenging the fundamental ethics and efficacy of mainstream psychiatric practice remained relatively marginalised within psychiatry, and to a lesser extent within the wider mental health community. Anti-psychiatry arguments remain prevalent, however, and predominantly anti-psychiatry individuals and organisations - including those of users and survivors of psychiatry - have become prominent both within mental health services and regional and international political bodies such as the European Union and United Nations.
Challenges and alternatives to psychiatric theory
Modern mainstream psychiatric theory is based on a number of axioms including that: psychiatry is a branch of medicine; is scientific in theory and practice; treats people who are sick; there is a distinct boundary between the normal and the sick; there are many discrete kinds of mental illness which psychiatry can medically understand, diagnose and treat; the focus should be primarily on biochemical factors; a statistically codified diagnostic classification scheme is required. This approach has been dubbed 'neo-Kraepelian' (Klerman, 1978) after psychiatrist Emil Kraepelian who first proposed the kind of categories of illness used by psychiatry today (as opposed to the approach taken by, for example, psychiatrist Adolf Meyer). These categories are represented today in diagnostic manuals such as the DSM and the psychiatric section of the ICD, based on a pattern of so-called 'Feighner criteria (lists of symptoms with rules on the combinations required for different diagnoses, starting in the early 1970s). Anti-psychiatry challenges a number of these theoretical assumptions or their implications.
Biochemical factors
The focus on biochemical investigations of mental distress is seen as unjustified. Genetic and environmental factors both appear to be of vital importance. 'Social Psychiatry' is more in line with this approach than mainstream psychiatry. In biology, illness is caused by pathogens, poisons, or injuries. In psychiatry, the balance of neurotransmitters in the brain is thought to be the biological basis for mental health. In this theory, people are damaged by disruptions of neurochemicals. Happiness and other positive emotions reflect a proper balance of neurochemicals, but depression and other negative emotions reflect an imbalance. Medications that regulate neurotransmitters are thought to heal damaged personalities in the way that antibiotics heal infected organs. However, it is claimed that such broad assertions and assumptions are not supported by evidence and are partly value judgements. Different balances of neurotransmitters may reflect valid variations of neurology and life experience, and not pathologies. This has been dubbed neurodiversity, for example by the autistic community.
Genetic factors
Psychiatry proposes that certain genetic weaknesses or vulnerabilities predispose people to particular mental illnesses. However, compared to gene-coding for traits such as gender, hair color, skin color or eye color, to date few specific connections have been evidenced, despite numerous high-profile claims that have been discredited after acknowledged failure to replicate. In addition, the links between genes and states defined as abnormal are highly complex; involve environmental influences at every stage; and can be mediated in numerous different ways, for example by personality, temperament or life events. While twin studies and other research suggests that personality is heritable to some extent, the basis for particular personality or temperament traits, and their links to mental health problems, is extremely unclear. In addition, psychiatry presents one theory of personality, and can be accused or ignoring or denigrating others, such as philosophical, spiritual, religious, information, or literary theories.
Anti-psychiatrists often argue that psychiatry uses genetic terminology in an unscientific way that reinforces their approach, for example by referring to findings of the genetic basis for illnesses and weaknesses, rather than the role of genetic factors in traits which may make some problems more likely in some environments and societies. Psychiatrists also concentrate on understanding and potentially altering the genetics of those individuals with mental health problems, and not on understanding and potentially altering the genetics of individuals who may worsen or cause mental health problems for others.
Normality and illness judgements
Proponents of anti-psychiatry generally do not dispute the notion that some people have emotional or psychological problems, and that sometimes the person themselves can, sometimes with help, develop more helpful skills or ways of approaching issues. They do usually disagree with psychiatry on the source of these problems; the appropriateness of characterizing these problems as illness; and on what the proper management options are.
A common pro-illness argument is that persons diagnosed with a psychiatric disorder suffer from significant liabilities due to the disorder. To take an example, researchers have argued about "the side-effects of not treating ADHD" [1], which may include increased risk of accidental injury. To anti-psychiatry proponents, this is no different from persistent claims that homosexuality is a disorder due to increased risk of sexually-transmitted disease [2]. It is true that a highly active child is more likely to cause damage to physical things (including themselves) than a relatively inactive child. This point helps to illustrate a primary concern of anti-psychiatry: in a community that places a high degree of value on material possessions, a person that disregards this intensity of material value runs the risk of being diagnosed as mentally ill. Herein lies the considerable danger that an individuals degree of adherence to communally held values may be used to determine that persons level of mental health. Using this logic it could be argued that in a communal display of violence (as in a public stoning) the person who abstains from violence could be diagnosed mentally ill and should, subsequently, be treated. This is alleged to have been the case in recent years, for example in Iraq [citation needed].
A complaint often leveled against psychiatrists is that they tend to focus only on the negative aspects of disorder phenotypes, and seldom document any positive aspects, with some of them actively denying that positive aspects exist at all. For instance, there is no mention of hyperfocus in the scientific literature even though persons diagnosed with ADHD and Asperger's syndrome have reported it time and again. This is not true of the entire research community. For example, studies that link increased creativity to bipolar disorder exist [3]. Autism researchers, such as Uta Frith, speak of "cognitive style" rather than "cognitive impairment" and have shown that the autistic phenotype really does include information processing advantages in certain areas [4]. The relatively high prevalence of savant skills among autistics is undisputed [5]. Others, such as Simon Baron-Cohen, have started to speculate that autism may lead to 'difference' rather than 'disability' [6]. In general, there appears to be increasing recognition that 'eccentricity' can be a gift as well as a curse.
In addition, many feel that they are being pathologised for simply being different. Some people diagnosed with Asperger's Syndrome or autism hold this position (see autism rights movement). While many parents of children diagnosed autistic oppose the efforts of autistic activists, there are some who say they value the uniqueness of their children and do not desire a 'cure' for their autism. The autistic community has coined a number of terms that would appear to form the basis for a new branch of identity politics; terms such as "neurodiversity", "neurotypical", "neurodivergent", etc.
Another example is the pro-ana movement, consisting of anorectic people who believe that anorexia nervosa is a legitimate lifestyle choice instead of an eating disorder.
Psychiatry, a pseudo-science
Many of the above issues, and others, lead to the common claim within the anti-psychiatry movement that psychiatry is a pseudo-science. Some describe psychiatry as a materialistic religion masquerading as a science [7]; as a mythology [8]; an ideology or belief system [9];[10]; a social construct; and as a practice comparable to astrology [11].
According to the generally-accepted philosophy of science, for a theory to qualify as scientific it needs to exhibit most if not all the following characteristics:[citation needed]
- consistency, internally and externally;
- parsimony, as simple as the phenomena to be explained allow (see Occam's Razor);
- relevance, i.e. it describes and explains only the phenomena addressed (although it may make predictions about others);
- empirically testable and falsifiable (see Falsifiability);
- based upon multiple observations, often in the form of controlled and repeated experiments.
- changeable, i.e. if necessary, changes may be made to the theory as new data are discovered;
- progressive, encompasses previous successful descriptions and explains and adds more;
- provisional, i.e. tentative; the theory does not attempt to assert that it is a final description or explanation.
According to critics, psychiatry does not qualify as a science on many counts. Presently, most biological hypotheses in psychiatry are untestable and thus unfalsifiable. This is the sure-fire sign of a pseudoscience [12]. Examples, each followed by a common psychiatric response in parentheses, include the notions that:
- there exists an ideal neurochemical "balance", which should be roughly the same in all human brains. (Many psychiatrists, however, would also deny such a notion.)
- closely related to the above, that there is an ideal human neuroanatomy. (Again, most psychiatrists would deny such a notion.)
- behavior may be classified as either objectively normal or abnormal. (Many psychiatrists would only cite this notion as an ideal.)
- Classifications of disorders in the DSM correspond to true physical disorders. (Here is where the bulk of research and discussion lies.)
- a given patient is "in denial" or suppressing thoughts, wishes or actions (see closed circle). (Some schools of psychiatry may reach such a conclusion, but many would not.)
- claims by psychiatric patients to the effect that they don't have a disorder or are not "suffering" from it are not believable because of cognitive distortion caused by the disorder. (Either point of view may be criticised for begging the question.)
- a young child or a patient without communication skills is "suffering from a disorder". (A conclusion that suitably-trained psychiatrists would not make without great consideration, usually with advice and/second opinions.)
- a given defendent is not guilty because he could not tell right from wrong. (Once again, begs question.)
- hypnosis helps recall "repressed memories". (Many psychiatrists would question the reliability of such methods.)
Critics often argue that while psychiatrists routinely name or label behavior patterns and call them "illnesses" or "diseases", their application of a medical model is unjustified, unscientific and with a predictive validity little or no better than astrology. Most of all, they claim that psychiatrists' approach does little to gain an understanding of the issues involved.
Challenges and alternatives to psychiatric practice
Psychiatric diagnosis in reality
There is a recognised problem regarding the diagnostic reliablity and validity of mainstream psychiatric diagnoses, both in regard to ideal controlled circumstances {Williams et al. 1992} and even more so in routine clinical practice (McGorry et al. 1995), and especially when comparing the criteria of the different psychiatric manuals, the DSM and ICD (van Os et al. 1999). Comorbidity, when an individiual meets criteria for two or more disorders, is said to be the rule rather than the exception. There is much overlap and vaguely-defined or changeable boundaries between what psychiatric claims are distinct illness states.
There are also problems with using standard diagnostic criteria in different countries, cultures, genders or ethnic groups. Antipsychiatry often contests that Westernised, white, male-dominated psychiatric practices and diagnoses disadvantage and misunderstand those from other groups. For example, young African American males in the United States and the UK are disproportionately prescribed "anti-psychotic" medication, and African Americans are disproportionately subjected to involuntary commitment {references needed}.
Changes in what is classed as a medical illness, occuring alongisde social or political change rather than scientific developments, are problematic for psychiatry. For a long time homosexuality was diagnosed and treated by psychiatrists as a medical illness, and wasn't removed as a distinct category from the DSM until the mid 1970s. The change followed a period of political activism and controversy resulting in a special vote of the Board of Trustees of the American Psychiatric Association at the end of 1973, supported by just over half (58%) of members {citation needed} in a 1974 referendum called by opponents of the decision. Today, attempts to "cure" homosexuality by means of behavioral intervention have been left to a few religious organizations and some hold-out psychiatrists. The unexplained increases in the incidence of autism and ADHD have raised questions about the subjectivity involved in diagnosing psychiatric disorders, which in this case some critics attribute to a kind of mass hysteria on which psychiatric and pharmaceutical companies are trading.
Mental abnormalities associated with dysfucntion, but which aren't classfied as disorders, are also problematic. For example, Left-handedness has been linked to certain neurological deficits and other disadvantages, but is generally not considered pathological. Giftedness is an example of a behavior that is generally considered to be normal-variant, despite some recognized liabilities such as higher propensity to myopia, depression, introversion, etc. Giftedness has also been shown to have a neurobiological basis [13]. The prevalence of giftedness is significantly lower than that of certain psychiatric disorders, such as ADHD, so it could be said to be more "abnormal". It is therefore not surprising to some critics that psychiatrists have started to label gifted children as mentally disordered [14][15].
Alternative or complimentary approaches to the assessment of mental health issues that have been proposed are: the continuum or dimensional model of diagnosis, which deals with individual problems or dimensions on which everyone is seen to vary, rather than distinguishing normality from illness; formulation as practiced by clinical psychologists; 'life story' or 'narrative' approaches; qualitative approaches in general.
Medication and the pharmaceutical industry
In practice, psychiatry specialises in psychoactive medication. This is the treatment in which psychiatrists are primarily educated and trained. Psychiatry contends that a number of medications have a proven efficacy for improving or managing a number of mental health disorders. This includes ranges of different drugs referred to as antidepressants and antipsychotics.
The anti-psychiatry movement often suggests that some drugs can help some people at some times, but generally claim that psychiatry exaggerates the evidence for psychiatric medication and understates the evidence for adverse effects. Further claims are that individuals are not given sufficient balanced information on medication in order to give truly informed consent; that current psychiatric medications do not appear to be specific to particular disorders or problems in the way that psychiatry asserts (Johnstone, Crow et al, 1988; Moncrieffe and Cohen, 2006); they they do not appear to fix a chemical imbalance in the brain, as psychiatry commonly asserts, but that they appear to induce an abnormal state of their own. For example, parents of children on Ritalin have reported that their children are widthdrawn, not the same as usual, and "come back" after they are taken off the drug.
A related claim is that psychiatric medication is very often used primarily to stop certain behaviours which others find disruptive or annoying, rather than to treat in the sense of helping a person. This is a particular issue when individual's are subject to forced medication, as is routinely the case in the psychatric system. [16] details problems with psychiatric drugs. Cost-benefit analyses of drugs are rarely conducted addressing all the relevant issues, the long-term effects of [[Ritalin] are not well understood, despite the fact that drug is now prescribed to approximately six million children every year in the United States.
The influence of pharmaceutical companies is another major issue for the antipsychiatry movement. The pharmaceutical industry is one of the most profitable and powerful industries in existance {statistic needed} and there are many financial and professional links between psychiatry, regulators and pharmaceutical companies. Drug companies routinely fund much of the research conducted by psychiatrists; routinely advertise medication in psychiatric journals and conferences; routinely fund psychiatric and healthcare organisations and health promotion campaigns; and routinely send reprentatives to general physicians and politicans to promote medications. Many psychiatrists are members of, shareholders of, or special advisors to pharmaceutical or associated regulatory organisations.
Antipsychiatry tends to be against all these practices. There is strong evidence that research findings and the prescribing of drugs are influenced as a result. For example, a UK cross-party parliamentary inquiry into the influence of the pharmaceutical industry conducted in 2005 details some of the evidence it found in Europe, concluding that "[t]he influence of the pharmaceutical industry is such that it dominates clinical practice" (page 100) and that there are serious regulatory failings resulting in "[t]he unsafe use of drugs; and the increasing medicalisation of society" (page 101). The campaign organization No Free Lunch details the prevalent acceptance by medical professionals of 'free' gifts from pharmaceutical companies and the effect on psychatric practice. The ghost-writing of articles by pharmaceutical company officials, which are then presented by esteemed psychiatrists, has also been highlighted. Research reviews suggests that evaluations of drugs that were conducted with pharmaceutical funding have tended to report more beneficial and large effects than evaluations without such funding. The number of pychiatric drug prescriptions by general physicians and psychiatrists have been increasing at an extremely high rate since the 1990s and shows no sign of abating. Antipsychiatry argues that this is often causing more harm than good and is being driven as much by profit as by healthcare.
Antipsychiatry uggestions for alternatives to the current situation with the pharmaceutical industry include: To strengthen and extend legislation separating the industry from the profession; giving more funding to alternatives to medication approaches; develop far better processes for taking into account the experiences and feedback of those who use psychiatric services, and others.
Other psychiatric procedures
Despite its occasional adverse effects (such as post-traumatic stress and memory loss) and only a poor understanding of its action on the brain, the use of electroconvulsive therapy (ECT) for a wide range of mental illnesses has increased over the past twenty or so years. Some people credit ECT for their recovery and some scientific studies conclude that, as performed today, it is relatively safe and humane, but antipsychiatry higlights the common findings that in practice ECT machinery is often outdated, misused and routinely given to individuals who have not given sufficient informed consent or been given access to alternative interventions.
Psychiatry in law and finance
Psychiatrists often give testimony as to whether an individual is mentally fit to face trial, and whether they have an illness that can be treated by psychiatry (the so-called insanity defence). Antipsychiatry often questions the right of psychiatrists to do this or the way in which they do it. One view is that psychiatric explanations of behavior do no better than traditional lay perceptions or that other non-medical other professionals would fulfill this role better. While the insanity defence is the subject of much public controversy as a possible excuse for wrong-doing, partly because it is perceived to be used and granted far more often than is the case {reference needed}, anti-psychiatry argues that psychiatric 'care' is often not much more or better than criminal prisons, and often involves compulsory medication and electroshock, and a length of sentence that is unspecified and dictated by unaccountable psychiatric decisions. Thomas Szasz notoriously argues that, because mental illness is an incoherent concept, the insanity defense should be abolished, although most do not accept this view.
Psychiatrists often also have a role in deciding whether an individual has a right to state financial benefits or other forms of support and assistance. Many antipsychiatrists dispute the way in which psychiatrists make such evaluations and their role in the system in this way. Many feel that this represents a conflict of interest for psychiatry and that they often side with the general public, or the government, reflecting misconceptions about risk and care needs, rather than providing the best and most impartial assessments and decisions.
Alternatives are for the experiences and feedback of service users to be more routinely and fully taken into account, including in official records; for other non-medical professionals to be given the same or greater legal, financial and political status.
Medical settings and coercive treatment
Psychiatry has been and is at the forefront of the practice of basing mental health care in hospital wards or other medical settings, and using legally-sanctioned force to admit individuals against their will. Many argue that, even if it is sometimes necessary to detain a few people with extreme mental illnesses, psychiatry - reflecting wider society and popular concerns often fuelled by biased media reporting - is far too eager to coercively utilize psychotropic medication or lock up people with mental health problems (see New Freedom Commission on Mental Health) which could be addressed in other ways. The growing practice in the U.K., and elsewhere, of "care in the community" was instituted partly in response to such concerns. There are ongoing legal and political challenges to this practice, whether from a wider human rights or specifically mental health treatment perspective. This includes numerous legal challenges to the legality of much forced psychiatric treatment, for example according to the constituation of the United States.
Alternatives to this approach include the development of non-medical crisis care in the community, for example modelled on so-called Soteria houses; changes to the law to ensure more regulation and safeguards against coercive treatment; the use of advance directives so that individuals can specify their treatment wishes in advance of any alleged inacapacity.
The medicalization of society
A related major area of concern to critics of modern psychiatry is that of over-diagnosis by a narrow medical model. In the UK, the increasing medicalisation of problems which do not appear primarily medical in nature has been criticised following a 2005 official cross-party inquiry. The US is currently planning to implement a nation-wide universal screening programme, which will seek to diagnose disorders according to evidence-based medicine and the Texas Medication Algorithm Project developed in Texas when current President George Bush Jr. was the Governor, and with significant pharmaceutical company influence.
Anti-psychiatry quotes
- "If you talk to God, you are praying. If God talks to you, you have schizophrenia." - Thomas Szasz
- "Psychiatric expert testimony: mendacity masquerading as medicine." - Thomas Szasz
- "Human salvation lies in the hands of the creatively maladjusted." - Martin Luther King, Jr
- "I`d rather be alone / with a schizophrenic / than a psychiatrist" - Carol Batton
See also
- Autism rights movement
- Bruce Levine
- Chemical imbalance theory
- Douglas C. Smith
- Elliott Valenstein
- E. Fuller Torrey
- Evolutionary neuroscience
- ICSPP
- Joe Sharkey
- Laura's Law
- Peter Breggin
- Psychopathology
- Sanity
- Social constructionism
External links
Psychiatry media reports and opinion
- BBC.co.uk 'The Century of the Self', BBC documentary (explores Freud family role in fostering the "rise of the self", from Sigmund Freud, to Anna Freud, to Edward Bernays and to Matthew Freud)
- AntiPsychiatry.org 'Schizophrenia: a nonexistent disease', Lawrence Stevens, JD
- Mother Jones Medicating Aliah, 'When state mental health officials fall under the influence of Big Pharma, the burden falls on captive patients. Like this 13-year-old girl.'
- Oikos.org - The Dark Side of Psychiatry
- ZMagSite.org - 'Eli Lilly, Zyprexa, and the Bush Family: The diseasing of our malaise', Bruce Levine (May, 2004)
- Tripod.com - 'The Myth of Mental Illness', Dr. Sam Vaknin
- UEA.ac.uk - 'What was Anti-Psychiatry?' (article critical of psychiatry)
- UKY.edu - Philosophy of Psychiatry Bibliography
- findarticles.com 'The quandary over mental illnes', an archived copy of the article in USA Today, with a focus on disagreement between psychiatrists and its critics; by Richard E. Vatz, Associate Psychology Editor of USA Today.
Sites dedicated to prominent figures
- Breggin.com - Homepage of Peter Breggin
- Claudio Ajmone - official Home Page
- LaingSociety.org - The Society for Laingian Studies
- Mosher Soteria - Loren Mosher, MD, (1933-2004)
- PsychLaws.org - E. Fuller Torrey, MD (critic of anti-psychiatry)
- Szasz.com - The Thomas S. Szasz, MD, Cybercenter for Liberty and Responsibility
Organizations critical of psychiatry
- AdBusters.org - Prozac Spotlight
- AHRP.org - Alliance for Human Research Protection
- AntiPsychiatry.org - The Antipsychiatry Coalition
- CCHR.org - Citizens Commission on Human Rights, website of the Church of Scientology off-shoot
- GIDReform.org - Gender Identity Disorder Reform Advocates (opposes psychiatric classifications of transgendered people)
- IAAPA.ch - International Association Against Psychiatric Assault
- ICSPP.org - International Center for the Study of Psychiatry and Psychology
- OISM - Italian Observatory on Mental Health
- MindFreedom.org - Support Coalition International (a coalition of groups supporting "United Action for Human Rights in Mental Health")
- PsychRights.org - Law Project for Psychiatric Rights
- Psychosurgery.org - Lobotomy victims remembered
References
- Williams, J.B., Gibbon, M., First, M., Spitzer, R., Davies, M., Borus, J., Howes, M., Kane, J., Pope, H., Rounsaville, B., and Wittchen, H. (1992). The structured clinical interview for DSM-III-R (SCID) II: Multi-site test-retest reliability. Archives of General Psychiatry, 49, 630-636.
- van Os J, Gilvarry C, Bale R et al (1999) A comparison of the utility of dimensional and categorical representations of psychosis. Psychological Medicine 29 (3) 595-606
- McGorry PD, Mihalopoulos C, Henry L et al (1995) Spurious precision: procedural validity of diagnostic assessment in psychiatric disorders. American Journal of Psychiatry 152 (2) 220-223
- Deegan G (2003) Discovering recovery. Psychiatric Rehabilitation Journal 26 (4) 368-376
- Seeker J, Grove B & Seebohm P (2001). Challenging barriers to employment, training and education for mental health service users: the service user's perspective. Journal of Mental Health 10 (4) 395-404
- Moncrieff and Cohen (2004) Rethinking Models of Psychotropic Drug Action. Psychotherapy and Psychosomatics 74:145-153
- The Influence of the Pharmaceutical Industry (2005) House of Commons Health Committee, Fourth Report, Vol 1.