In our penultimate lecture of our penultimate semester as student nurses we heard a disconcerting statement. We were in Critical Psychiatry and, quite frankly, not prepared for what we were about to learn
The Anti-Psychiatry movement dates back to the 1960s. Outspoken critics of the mainstream medicalisation of mental distress stated that psychiatry was a pseudoscience wielded as a coercive instrument of oppression against social deviants.
In his seminal works, Thomas Szasz proclaimed that ‘mental illness’ was a metaphor for human problems in living; diagnoses were euphemisms for behaviours that the state disapproved of and not tangible illness which could be medicated.
”Similarly, [Critical psychiatrists) appreciate that medication may play a role but believe that the case is overstated and medical science has long been undermined by the excessive influence of pharmaceutical giants in service and therapy commissioning”
Similarly, Scottish psychiatrist R D Laing argued that diagnoses of mental disorders contradicted accepted medical procedure - a false epistemology that illness be diagnosed by conduct but treated biologically. Anti-psychiatry was the view that psychiatric treatments were often more damaging than helpful to patients, most clearly demonstrated by opposition to ‘dangerous treatments’ including electroconvulsive therapy, insulin shock therapy and lobotomy.
Born of Anti-Psychiatry, Critical Psychiatry is the more ‘acceptable face’ of the movement today. It acknowledges the use of diagnoses but is opposed to the arbitrary criteria imposed in the DSM and ICD-10. Similarly, they appreciate that medication may play a role but believe that the case is overstated and medical science has long been undermined by the excessive influence of pharmaceutical giants in service and therapy commissioning.
”I found it poignant that ‘survival’ does not refer to illness but the treatment and interventions that they had been prescribed; recovery despite, not because of mental health services.”
Key figures in the UK include Pat Bracken and Joanna MonCrieff as part of the Critical Psychiatry Network. In the USA, Robert Whitaker has been a prolific publisher and runs the Mad in America website whose mission statement is to ”serve as a catalyst for remaking psychiatric care in the United States (and abroad)”.
Unlike Anti-Psychiatry, Critical Psychiatry celebrates the input of service users and groups such as the Hearing Voices Network. We spoke about ‘Survivor Movements’, of which the HVN is a fantastic example. I found it poignant that ‘survival’ does not refer to illness but the treatment and interventions that they had been prescribed; recovery despite, not because of mental health services.
”As student nurses, we know that we have to think of each person holistically – at least that central tenet has not been undermined!”
As student nurses, we know that we have to think of each person holistically – at least that central tenet has not been undermined! Each person and their mental health will be influenced by complex factors such as their socioeconomic position, interpersonal relationships and self-perceptions. These are all separate from any depletion in serotonin or dopamine levels - a vital distinction as Joanna MonCrieff has written extensively that the idea of mental distress stemming from ‘chemical imbalance’ is wholly false. I repeat, there is absolutely no chemical imbalance in the brain that leads to what we think of as ‘mental illness’.
”So, why then are we taught that medication is key to mental health recovery?”
So, why then are we taught that medication is key to mental health recovery? Why are our timetables full of taught sessions on hormonal reuptake and reward-pathways? And, most importantly, how comfortable can we feel administering these medications knowing that their evidence-base has been repeatedly undermined? A quick search on Cinahl or PsychInfo is all you need to become deeply suspicious.
All this came only days before I embark on nine weeks with a busy crisis team, whose ethos is to manage and contain risk using whatever methods possible in a system compromised by too few resources and too great of a need - a team fighting a battle, apparently not alongside but against our service users.
After much heartache and debate amongst my colleagues we realised that there is much more we still have to learn but the best place to start, as always, is with the people in our care. These are the experts and the only way we can ‘treat’ a person is to first understand their needs; that we can only answer a question when we understand what we are being asked.
Maybe medication works, maybe it doesn’t, but there is no better start to recovery than kindness and curiosity. Perhaps we’ll just have to take it from there.
Hazel Nash is Student Nursing Times’ student editor, mental health branch.