Anti-psychiatry in 2019,and why it matters

Our critique (Dharmawardene and Menkes, 2019) of the UN Special Rapporteur’s Report on mental health (UN Human Rights Council, 2017) has been challenged by two further articles in the ANZJP (Cosgrove and Jureidini, 2019; McLaren, 2019). Both attempt to defend the Report, but the latter’s fundamental anti-psychiatry bias remains both unmissable and dangerous.

Cosgrove and Jureidini (2019) advocate a rights-based approach to mental health, but their endorsement of the Rapporteur’s emphasis on a ‘global burden of obstacles’ is confused; while their focus is on structural determinants of mental health (poverty, discrimination, violence), the Rapporteur’s concept of these ‘obstacles’ instead focuses on the dominance of the biomedical model and the power of psychiatrists (UN Human Rights Council, 2017, paragraph 17). Accordingly, Cosgrove and Jureidini’s claim that the Report does not disregard the importance of biological psychiatry is unconvincing, particularly when considered alongside the Rapporteur’s reference to the medical model as ‘ineffective and harmful’ (paragraph 84) and his conclusion that

… a shift in approach should prioritize policy innovation at the population level, targeting social determinants and abandon the predominant medical model that seeks to cure individuals by targeting ‘disorders’. (paragraph 87, emphasis added)

McLaren (2019), on the contrary, makes the astonishing assertion that the biomedical model of mental illness ‘doesn’t exist’; he perceives a monolithic, self-absorbed psychiatric profession that regards all mental disorders as biological. His extreme views, typical of anti-psychiatry, are unsurprisingly promulgated by the Church of Scientology (www.youtube.com/watch?v=nzdu3WQyIZg). McLaren’s sweeping criticism of contemporary psychiatry and dismissal of our critique ignores both the diversity of opinion within our discipline as well as our contention (Dharmawardene and Menkes, 2019) that psychiatric practice and biological reductionism require ongoing critical scrutiny.

Scientific medicine progresses in the context of robust debate, and legitimate criticism of psychiatry is welcome; science is about evidence and evolving utility, not ‘truth’ (Jablensky, 2016). By contrast, anti-psychiatry discredits biomedicine’s role in mental health as a matter of principle and in so doing privileges values-based policy over scientific evidence. This rhetoric, as espoused by the Rapporteur and endorsed by McLaren, threatens to foreclose rather than foster debate about what works for people with serious mental illness.