Critical Psychiatry: what is it and what does it claim?
Psychiatry, a medical specialty that is responsible for detecting and treating mental illnesses, has gone through an important crisis in recent times due to the emergence of different questions about the characteristics of their knowledge and practices.
From these questions has emerged Critical Psychiatry , a theoretical current that questions and seeks to reform the practices of psychiatric care. Among other things, it shows that traditional psychiatry has some fundamental limits in the way of understanding and dealing with psychic suffering, which in particular generates ethical dilemmas in the use of their knowledge.
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Where does Critical Psychiatry come from?
One of the most recent antecedents is the conference of the Critical Psychiatry Network (Network of Critical Psychiatry) held in Bradford England in 1999, where the need to promote a radical transformation in our approach to mental health problems ; what thousands of professionals have subscribed around the world, mainly through academic publications, but also through political mobilization.
In the same vein, Critical Psychiatry has many of its antecedents in antipsychiatry, a theoretical and political movement driven by mental health professionals that began in the second half of the last century and that strongly questioned the way in which psychiatry operated, especially in Europe and the United States.
Although antipsychiatry and Critical Psychiatry are movements that arise at different times, what they have in common is that reject the pathologization of human heterogeneity and they are committed to transforming psychiatric care.
Finally, this current has been driven by different associative movements in the first person, that is, collectives managed by users of psychiatric care services. For example, the British collective Hearing Voices Network who reject the traditional psychiatric understanding of that experience, seeking to eliminate stigma and strengthen mutual aid groups.
The above is articulated later with the rights paradigm that has been formalized since 2006 in the International Convention on the Rights of Persons with Disabilities approved by the United Nations Organization, as well as through other documents and reports on the prevention of torture in psychiatry that have developed in different countries.
In general terms, Critical Psychiatry seeks to make visible the intersection between psychological, social and somatic relationships , both of the people and of the psychiatric practice itself, so that it is possible to reform it.
More specifically, we can follow Philip Thomas (2013) to list five discussion topics that emerge from Critical Psychiatry: the problem of psychiatric diagnoses, the problem of evidence-based medicine in psychiatry (and its relationship with industry pharmaceutical), the role of the context in which psychiatry develops and acts, the problem of coercive practices, and finally, the theoretical and philosophical basis of psychiatric knowledge and its practices .
1. The problem of psychiatric diagnoses
Critical Psychiatry makes visible that the barriers between "normality" and "disorder" are easily manipulated and to a large extent arbitrary. In fact, frequently varies the amount of available psychiatric diagnoses ; these appear and disappear and are updated every time (some of them every time the same population diagnosed manifests itself against being considered sick or upset, for example, what happened with homosexuality that until just the second half of the century past ceased to be considered a mental disorder).
Likewise, the scientific basis of psychiatric diagnosis began to be questioned because although organic substrates have been found, the scientific evidence that postulates that mental disorders have a biological origin and a definitive cure in the same sense, is insufficient.
2. Evidence-based medicine and the pharmaceutical industry
Evidence-based medicine is a concept that refers to medical practice based on clinical trials, statistics and manuals that offer generic information about a certain condition.
This has been questioned by Critical Psychiatry, since the causes of mental disorders are nonspecific , and evidence-based medicine can promote and generalize nonspecific practices, but also potentially harmful in some ways, because in psychiatry practices are par excellence of direct intervention (pharmacological or mechanical).
Likewise, in many cases the diagnoses and the pharmaceutical treatment are strongly influenced by economic interests of the industries responsible for producing and distributing drugs, as well as financing a large part of the training of professionals. This has been much debated in recent decades by a significant sector of mental health professionals around the world.
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3. The context of psychiatry
The range of psychiatric diagnoses is related to the context in which they are constructed, that is, the percentage of people to whom certain problems are attributed according to the specific population to which they belong.
The same psychiatric practice is found within a social context, which means that in the diagnosis and in the welfare relationship, ideologies are reproduced and ways of relating; and that psychic suffering is more than an individual experience, it is an experience that has to do with the conditions of possibility or vulnerability of the same environment.
4. Coercive practices
Among the strongest criticisms that have been made to psychiatry since the last century are forced psychiatric internment and containment practices such as ties, electroconvulsive therapy and overmedicalization.
Far from being conceived as a technical set (and therefore free of values), Critical Psychiatry seeks to constantly review the practices that are promoted and their possible harmful effects (from intrinsic paternalism in clinical practice to stigmatizing attitudes or explicitly aggressive practices).
In many contexts, alternatives have been promoted, ranging from the closing of psychiatric hospitals or gradual demedicalization, to the creation of community centers and the reinforcement of a mental health that is promoted in a more collective and less coercive manner.
5. Theoretical and philosophical basis of psychiatry
Critical Psychiatry questions the mind-body dualism that bases traditional biomedical psychiatry, as well as the biologicist ideology that reduces health and mental illness to the molecular sciences of the brain.
The latter means that a series of social demands are considered where psychiatry was positioning itself as the only or the best solution to understand the problems of the people; what many times it translates into the omission of affective, social or economic deficiencies promoted by social structures.
Finally and given that attention to mental health problems is a global phenomenon, despite having been generated and driven based on the needs of the European and American context, the current Critical Psychiatry has had repercussions around the world.
However, this is not the only criticism that has been made to traditional psychiatry. For example, social sciences such as anthropology, social psychology or sociology in Latin America have recently investigated community forms of health care (including mental health), as well as pre-Hispanic ways of understanding what we call at the moment "Disorder" or "mental illness"; along with the shortcomings in institutional care and more traditional mental health services.
- Critical Psychiatry (2018). Psychiatry in transition- Critical Psychiatry Network 2017 conference report. Retrieved April 17, 2018. Available at //www.criticalpsychiatry.co.uk
- Hearing Voices Network (HVN). (2018). The aim of the network. Hearing Voices Network for people who hear voices, see visions or have other unusual perception. Retrieved April 17, 2018. Available at //www.hearing-voices.org
- Nmucia (2017). About the (disturbing) medicine based on evidence (By Germán Barrios). Platform No Thanks. Retrieved April 17, 2018. Available at //www.nogracias.eu/2017/01/29/about-the-inquietante-medicina-basada-en-la-evidencia-por-german-barrios/
- Ortiz, A. (2013). Towards a critical psychiatry. Editorial Group 5: Spain
- Thomas, P. (2013) What is Critical Psychiatry ?. Mad in America: science, psychiatry and social justice. Retrieved April 17, 2018. Available at //www.madinamerica.com/2013/01/what-is-critical-psychiatry/
- Thomas, P. (2013). What is Critical Psychiatry ?. Retrieved April 17, 2018. Available at //discapacidades.nexos.com.mx/?p=113#_ftnref1
- Vásquez, A. (2013). Antipsychiatry Deconstruction of the concept of mental illness and critical of the "psychiatric reason". Nomads Critical Journal of Social and Legal Sciences, 31: //dx.doi.org/10.5209/rev_NOMA.2011.v31.n3.368
- Desviat, M.(2006). Antipsychiatry: criticism of psychiatric reason. NORTH of Mental Health, 25: 8-14
- Moncrieff, J. (2005). Psychiatry and the pharmaceutical industry: who pays the piper ?. Psychiatric Bulletin, 29: 84-85