Criticising psychiatry is not ‘antipsychiatry’

In their commentary on the recent Report of the Special Rapporteur on the ‘right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (UN Human Rights Council, 2017), Dharmawardene and Menkes (2018) took very strong exception to what they saw as its inherent bias against the biomedical model of psychiatry. By challenging this model, they argued, the Report aligned itself with the ‘global anti-psychiatry movement’. They saw what they called the creeping demedicalisation of psychiatry in the United Kingdom as akin to ‘throwing the baby out with the bathwater’. Patients, they averred, are not so much concerned with ‘ideological baggage’ as with what works, and ‘many psychiatric presentations are effectively and quickly treated with purely biological treatments’.

My reading of their paper shows many faults but, constrained by space, I will focus on just two. First, they appear to have very little understanding of how these reports are formulated. A report of this nature represents a huge amount of work by a team of highly skilled people from many different countries and backgrounds who consult widely to produce a moderate position paper representing, as far as possible, the diversity of views they have found. Despite their own perception of their importance, it is a fact that psychiatrists are only one of many groups and professions the Rapporteur’s team consulted.

In fact, they really didn’t need to consult any psychiatric professional groups, because everybody knows in advance what they will say: more diagnoses; more drugs, earlier, longer and in larger doses; more electroconvulsive therapy (ECT) and more hospitals: more power to detain people for longer. What they wouldn’t get from psychiatrists is any sense of self-criticism, any sense that the headlong rush to biological reductionism is not necessarily the best of all possible worlds.

Psychiatrists may not like the Rapporteur’s conclusions, but one thing they cannot dispute: the Report represents the distilled views of a diversity of people – professionals, patients, carers and so on – who are under no compulsion to echo mainstream psychiatry’s opinion of itself. In this sense, the Rapporteur’s conclusions show that psychiatry is now the outlier. It behoves the profession to take this point very seriously.

Second, I have been publishing material critical of mainstream psychiatry since 1982: I can state flatly that there is no such thing as a ‘global antipsychiatry movement’. I don’t even know what form such a movement would take. Would it copy Thomas Szasz, who claimed that all mental disorder is a fraud, that all psychiatrists are charlatans? I have never met anybody who would adopt that extreme position. Or would it argue that we need to re-examine our notion of what Dharmawardene and Menkes called the biomedical model of mental disorder? If so, it would be on very strong ground, because there is no such thing: it doesn’t exist, it has never been written. The very notion represents an ideology of mental disorder, not a science (McLaren, 2013). The concept of a reductionist biological psychiatry is testimony to the triumph of wishful thinking over evidence.

Could it be that the antipsychiatry non-movement questions psychiatric treatment? That would also be very sound, as the recent expose of deception in antidepressant trials showed (Le Noury et al., 2015). Similarly, a recent review of ECT showed that everything the Royal Australian and New Zealand College of Psychiatrists (RANZCP) has claimed about that treatment modality is false (McLaren, 2018). These are matters of demonstrated fact, not of malign intent.

I submit that by attempting to dismiss this very important document as the product of malicious actors, psychiatrists are missing a terribly important point: if such a conspiracy existed, why would it? If psychiatry were so successful as it likes to claim, there would be no need for opposition. The authors have fallen into the trap of argumentum ad hominem, of questioning the motives of critics as though that somehow neutered their critique.

Science progresses by self-criticism. When such an authority as the UN says psychiatry is not doing as well as psychiatrists would like to believe, it is time to listen. While a ‘global antipsychiatry movement’ is a fantasy, there is worldwide a rapidly growing disenchantment with psychiatry which psychiatrists ignore at their peril.