Earlier this month, the British Journal of Psychiatry published an article from 28 psychiatrists that was essentially a call to reassert the ‘authority’ of the science and ideology of medicine in mental health. The lead author, Nick Craddock, and his colleagues were concerned that terms like ‘patient’ were being replaced by ‘service user’, and ‘mental illness’ by ‘mental health’. The psychiatrists appeared to want the world to acknowledge that the medical model was the primary tool in addressing anything vaguely thought of as madness and that a doctor should be recognised as the emperor of all she or he surveys.
One can’t help feeling that if 28 psychiatrists were going to gather together they should have gone for a curry, laughed together and let off a bit of steam. But no, they are very concerned about things like the recovery approach, psychosocial interventions, multidisciplinary teams and new ways of working. They are concerned not only that they may lose some power but also that the patient is missing out on the most important thing the world can give them – a diagnosis.
I have never been all that convinced by psychiatry. I think of it in the same way as I think of happy hour at the pub. Sometimes it helps. Sometimes it doesn’t. Unfortunately, I am not clever enough to know in every instance when it will be helpful and when it won’t. And as I type that, I can hear a psychiatrist yelling: ‘Yes, but I am clever enough, pick me, pick me!’ Which is essentially what the tension between mental health treatment models is all about. The capacity for assuming certainty versus the willingness to remain curious.
I respect Professor Craddock and his colleagues for choosing to address the tensions that have existed in mental health for more than 30 years, and a transparent debate can only be a healthy thing.
So, what is the best way to address mental distress and on what evidence do we make these decisions? How do we compare cognitive behavioural therapy with antipsychotic medication or sanctuary and support? At what point do we claim to be the expert in another person’s life and at what point do we rescind that claim?
Mental health practitioners are good at asking questions and one hopes nurses, doctors and the multidisciplinary team are capable of discussing them in an open manner. However, there are thousands of other experts who have joined that debate. Sometimes called patients, sometimes called service users, and their voice is getting ever louder and clearer. Perhaps some elements of psychiatry need to start treating them with a little more respect?
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