Knowledge (XXG)

Critical Psychiatry Network

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published by people associated with the network over the last twelve years or so. These cover a wide range of topics, from child psychiatry, psychotherapy, the role of diagnosis in psychiatry, critical psychiatry, philosophy and postpsychiatry, to globalization and psychiatry. CPN has also organized a number of conferences in the past, and continues to do so in collaboration with other groups and bodies. It has run workshops for psychiatrists and offers peer supervision face to face and via videolink. It also supports service user and survivor activists who campaign against the role of the pharmaceutical industry in psychiatry, and the campaign for the abolition of the schizophrenia label. The CPN has published a statement in support.
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depression, for example, such as that produced for the UK National Health Service by the National Institute for Health and Clinical Excellence (NICE), one might be fooled into believing that the evidence for the efficacy of selective serotonin reuptake inhibitors (SSRIs) is established beyond question. In reality this is not the case, as re-examinations of drug trial data in meta-analyses, especially where unpublished data are included (publication bias means that researchers and drug companies do not publish negative findings for obvious commercial reasons), have revealed that most of the benefits seen in active treatment groups are also seen in the placebo groups.
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the study comments that cases may have left the system in the 'non-diagnostic' approach, not because treatment had worked, but because (1) multi-agency involvement meant long-term work may have been continued by a different agency, (2) the starting question of 'Do we think our service can make a positive difference to this young person's life?' rather than 'What is wrong with this young person?' may have led to treatment not being continued, and (3) the attitude of viewing a case as problematic when no improvement has occurred after five sessions may have led to treatment not being continued (rather than the case 'drifting' on in the system).
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more understandable than is commonly supposed. Mainstream psychiatry has never accepted Laing's ideas, but many in CPN regard The Divided Self as central to twentieth century psychiatry. Laing's influence continued in America through the work of the late Loren Mosher, who worked at the Tavistock Clinic in the mid-1960s, when he also spent time in Kingsley Hall witnessing Laing's work. Shortly after his return to the US, Loren Mosher was appointed Director of Schizophrenia Research at the National Institute of Mental Health, and also the founding editor of the journal Schizophrenia Bulletin.
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became clear that the Alliance would accept those aspects of the House of Commons Scrutiny Committee's report that would result in the introduction of CTOs. Psychiatrists not identified with CPN shared the Network's concern about the more coercive aspects of the government's proposals, so CPN carried out a questionnaire survey of over two and a half thousand (2,500) consultant psychiatrists working in England seeking their views of the proposed changes. The responses (a response rate of 46%) indicated widespread concern in the profession about reviewable detention and CTOs.
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metaphysics). A common theme running through Laingian antipsychiatry, Ingleby's critical psychiatry, contemporary critical psychiatry and postpsychiatry is the view that social, political and cultural realities play a vital role in helping us to understand the suffering and experience of madness. Like Laing, Ingleby stressed the importance of hermeneutics and interpretation in inquiries about the meaning of experience in psychiatry, and (like Laing) he drew on psychoanalysis as an interpretative aid, but his work was also heavily influenced by the critical theory of the
144:(although the latter two rejected the term) were identified as part of a movement against psychiatry in the 1960s and 1970s. Stung by these attacks, as well as accusations that in any case psychiatrists could not even agree who was and who was not mentally ill, academic psychiatrists responded by stressing the biological and scientific basis of psychiatry through strenuous efforts to improve the reliability of psychiatric diagnosis based in a return to the traditions of one of the founding fathers of the profession, 880: 196:, an environment modeled on Kingsley Hall in which people experiencing acute psychoses could be helped with minimal drug use and a form of interpersonal phenomenology influenced by Heidegger. He also conducted evaluation studies of the effectiveness of Soteria. A recent systematic review of the Soteria model found that it achieved as good, and in some areas, better, clinical outcomes with much lower levels of medication (Soteria House was not anti-medication) than conventional approaches to drug treatment. 112:. This set out ethical and practical objections to CTOs, and ethical and human rights objections to the idea of reviewable detention. It was also critical of the concept of personality disorder as a diagnosis in psychiatry. In addition, CPN's evidence called for the use of advance statements, crisis cards and a statutory right to independent advocacy as ways of helping to sustain autonomy at times of crisis. CPN also responded to government consultation on the proposed amendment, and the white paper. 233:, although this does draw attention to the person's relationship with their experiences (such as voices or unusual beliefs), and focuses on helping them to find different ways of coping, it however, it is based on a particular set of assumptions about the nature of the self, the nature of thought, and how reality is constructed. The pros and cons of this have been explored in some detail in a recent publication. 241:
given the considerable evidence that in Britain, Black and Minority Ethnic (BME) communities are particularly poorly served by mental health services. For this reason an important practical aspect of postpsychiatry is the use of community development in order to engage with these communities. The community development project Sharing Voices Bradford is an excellent example of such an approach.
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are of primary importance. Recent meta-analyses into the effectiveness of antidepressants and cognitive therapy in depression confirm that non-specific, non-technical factors (such as the quality of the therapeutic relationship as seen by the patient, and the placebo effect in medication) are more important than the specific factors.
96:, and with like-minded psychiatrists in other countries. It maintains its own website. The network is open to any sympathetic psychiatrist, and members meet in person, in the UK, twice a year. It is primarily intended for psychiatrists and psychiatric trainees and full participation is not available to other groups. 228:
According to Bracken, progress in the field of mental health is presented in terms of 'breakthrough drugs', 'wonders of neuroscience', 'the Decade of the Brain' and 'molecular genetics'. These developments suited the interests of a relatively small number of academic psychiatrists, many of whom have
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One comparison study showed 34% of patients of a 'medical model' team were still being treated after two years, compared with only 9% of patients of a team using a 'non-diagnostic' approach (less medication, little diagnosis, individual treatment plans tailored to the person's unique needs). However
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Shea, M. Tracie; Elkin, Irene; Imber, Stanley D.; Sotsky, Stuart M.; Watkins, John T.; Collins, Joseph F.; Pilkonis, Paul A.; Beckham, Edward; Glass, David R.; Dolan, Regina T.; Parloff, Morris B. (October 1992). "Course of Depressive Symptoms Over Follow-up: Findings From the National Institute of
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There are many commonalities between critical psychiatry and postpsychiatry, but it is probably fair to say that whereas postpsychiatry would broadly endorse most aspects of the work of critical psychiatry, the obverse does not necessarily hold. In identifying the modernist privileging of technical
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Framing mental health problems as 'technical' in nature involves prioritising technology and expertise over values, relationships and meanings, the very things that emerge as important for service users, both in their narratives, and in service user-led research. For many service users these issues
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Another consequence of the domination of psychiatry by biological science is that the importance of contexts in understanding distress and madness is played down. This has a number of consequences. First, it obscures the true nature of what in fact are extremely complex problems. For example, if we
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Anti-psychiatry can best be understood against the counter-cultural context in which it arose. The decade of the 1960s was a potent mix of student rebellion, anti-establishment sentiment and anti-war (Vietnam) demonstrations. It saw the rise to prominence of feminism and the American civil rights
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Postpsychiatry tries to move beyond the view that we can only help people through technologies and expertise. Instead, it prioritises values, meanings and relationships and sees progress in terms of engaging creatively with the service user movement, and communities. This is especially important
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The most forceful critic of this view was R. D. Laing, who famously attacked the approach enshrined by Jaspers' and Kraepelin's work in chapter two of The Divided Self, proposing instead an existential-phenomenological basis for understanding psychosis. Laing always insisted that schizophrenia is
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There is a common theme, here, with the work of David Ingleby whose chapter in Critical Psychiatry: The Politics of Mental Health sets out a detailed critique of positivism (the view that epistemology, or knowledge about the world is best served by empiricism and the scientific method rather than
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The concern about these proposals caused a number of organizations to come together under the umbrella of the Mental Health Alliance to campaign in support of the protection of patients' and carers' rights, and to minimise coercion. CPN joined the Alliance's campaign, but resigned in 2005 when it
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amongst psychiatric diagnoses and scepticism about the efficacy of anti-depressants, mood stabilisers and anti-psychotic agents. According to them, these concerns have ramifications in the area of the use of psychiatric diagnosis to justify civil detention and the role of scientific knowledge in
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Elkin, Irene; Shea, M. Tracie; Watkins, John T.; Imber, Stanley D.; Sotsky, Stuart M.; Collins, Joseph F.; Glass, David R.; Pilkonis, Paul A.; Leber, William R.; Docherty, John P.; Fiester, Susan J.; Parloff, Morris B. (November 1989). "National Institute of Mental Health Treatment of Depression
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As far as schizophrenia is concerned, neuroleptic drugs may have some short-term effects, but it is not the case that these drugs possess specific 'anti-psychotic' properties, and it is impossible to assess whether or not they confer advantages in long-term management of psychoses because of the
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The use of standardized diagnostic criteria and checklists may have improved the reliability of psychiatric diagnosis, but the problem of its validity remains. The investment of huge sums of money in Britain, America and Europe over the last half-century has failed to reveal a single, replicable
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CPN is involved in four main areas of work, writing and the publication of academic and other papers, organizing and participating in conferences, activism and support. A glance at the members' publication page on the CPN website reveals in excess of a hundred papers, books and other articles
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movement and the Northern Ireland civil rights movement. Across the world, formerly colonised peoples were throwing off the shackles of colonialism. Some of these themes emerged in the Dialectics of Liberation, a conference organized by Laing and others in the Round House in London in 1968.
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First, the aggrandisement of biological research creates a false impression both inside and outside the profession of the credibility of the evidence used to justify drug treatments for disorders such as depression and schizophrenia. Reading clinical practice guidelines for the treatment of
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consider depression to be a biological disorder remediable through the use of antidepressant tablets, then we may be excused from having to delve into the tragic circumstances that so often lie at the heart the experience. This is so in adults and children.
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severe disturbances that occur when people on long-term active treatment are withdrawn to placebos. These disturbances are traditionally interpreted as a 'relapse' of schizophrenia when in fact there are several possible interpretations for the phenomenon.
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Thomas, P. & Yasmeen, S. (2007) Choice and Diversity: Developing real alternatives for people from non-Western (and Western) cultures. Chapter in (eds. P. Lehmann & P. Stastny) Alternatives Beyond Psychiatry. Berlin, Peter Lehmann publishing. (pp.
374: 50:. They expressed concern about the implications of the proposed changes for human rights and the civil liberties of people with mental health illness. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom's 819: 2994: 132:, and attaches too much importance to a narrow biomedical view of diagnosis. This can, in part, be understood as the response of an earlier generation of psychiatrists to the challenge of what has been called 'anti-psychiatry'. Psychiatrists such as 217:, which imagines what would happen in a world after psychiatry. Independently, Patrick Bracken and Philip Thomas coined the word later and used it as the title of a series of articles written for Openmind. This was followed by a key paper in the 355: 119:
The CPN was paid attention by Thomas Szasz who wrote: "Members of the CPN, like their American counterparts, criticize the proliferation of psychiatric diagnoses and 'excessive' use of psychotropic drugs, but embrace psychiatric coercions."
392: 295:(although he rejects the use of the label in relation to his own work, as did Laing and Esterson), and sociologists (Thomas Scheff). Szasz discards even more what he calls the quackery of 'antipsychiatry' than the quackery of psychiatry. 2639: 283:, who used it to refer to the ending of the 'game' the psychiatrist plays with his or her victim (patient). It has been widely used to refer to the writings and activities of a small group of psychiatrists, most notably 1432:
Bracken, P. & Thomas, P. (2008) Cognitive Therapy, Cognitivism and the Moral Order. Chapter Eight in (eds R. House & D. Loewenthal), Against and For CBT: Toward a constructive dialogue? Ross-on-Wye, PCCS Books.
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responses to madness and distress as a primary problem, postpsychiatry has looked to postmodernist thought for insights. Its conceptual critique of traditional psychiatry draws on ideas from philosophers such as
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interests in the pharmaceutical industry, although so far the promised insights into psychosis and madness were yet to be realized. Some psychiatrists have turned to another form of technology,
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Faulkner, A. & Layzell, S. (2000) Strategies for Living: A Report of User-led Research into People's Strategies for Living with Mental Distress. London: Mental Health Foundation.
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psychiatry, and an interest in promoting the study of interpersonal phenomena such as relationship, meaning and narrative in pursuit of better understanding and improved treatment.
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Participants in the Critical Psychiatry Network share concerns about psychiatric practice where and when it is heavily dependent upon diagnostic classification and the use of
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Thomas, P. & Bracken, P. (2010) Dualisms in The Myth of Mental Illness. Chapter in (Ed. J. Moncrieff) Demedicalising Misery. Forthcoming, Palgrave Macmillan, London
108:(CTOs) to make it possible to treat people against their wishes in the community. CPN submitted evidence to the Scoping Group set up by the government under Professor 2445: 732:
Klerman, G. (1978) The evolution of a scientific nosology. In Shershow, J. (ed.) Schizophrenia: Science and Practice. Cambridge, Mass., Harvard University Press.
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Campbell, P. (1996) Challenging loss of power. In (eds J Read and J Reynolds) Speaking Our Minds: An Anthology. London, Macmillan, Open University (pp.56-62).
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Timimi, S; Tetley, D; Burgoine, W; Walker, G (April 2013). "Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS): a whole service model".
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Ingleby, D. (1981) Understanding 'mental illness'. In Critical Psychiatry: The Politics of Mental Health (ed. D. Ingleby), pp. 23–71. Harmondsworth: Penguin.
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Bracken, Pat; Thomas, Philip (2006). "Democracy, Citizenship and the Radical Possibilities of Postpsychiatry". In Double, D.B. (ed.).
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CPN has similarities and contrasts with earlier criticisms of conventional psychiatric practice, for example those associated with
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Kirsch, Irving; Deacon, Brett J.; Huedo-Medina, Tania B.; Scoboria, Alan; Moore, Thomas J.; Johnson, Blair T. (26 February 2008).
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Thomas, Philip; Bracken, Patrick; Leudar, Ivan (February 2004). "Hearing Voices: a phenomenological-hermeneutic approach".
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Anckarsäter, Henrik (March 2010). "Beyond categorical diagnostics in psychiatry: Scientific and medicolegal implications".
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and a book of the same name. This culminated with the publication by Bradley Lewis, a psychiatrist based in New York, of
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and someone who does not have the diagnosis. The case for the biological basis of common psychiatric disorders such as
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House, R. and Loewenthal, D. eds (2008) Against and For CBT: Toward a constructive dialogue? Ross-on-Wye, PCCS Books.
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Bracken, Pat; Khalfa, Jean; Thomas, Philip (November 2007). "Recent translations of Foucault on mental health".
3029: 3024: 2959: 2949: 2898: 2474: 2052: 1711:"Language, games and the role of interpreters in psychiatric diagnosis: a Wittgensteinian thought experiment" 2588: 2526: 2222: 2162: 218: 51: 879: 3034: 2919: 2848: 2674: 2546: 2536: 2237: 2177: 1227: 569: 89: 47: 2989: 2984: 2623: 2598: 2541: 2187: 250: 1288:"A Systematic Review of the Soteria Paradigm for the Treatment of People Diagnosed With Schizophrenia" 2878: 2833: 2719: 2573: 2435: 2299: 2284: 2279: 2217: 2202: 2182: 2172: 688: 1232: 574: 2613: 2608: 2274: 2269: 258: 2939: 2644: 2379: 2212: 1738: 1688: 1642: 1360: 1253: 712: 587: 109: 66: 62: 2364: 1871:. International perspectives in philosophy and psychiatry. Oxford, UK: Oxford University Press. 1213:"Treatment of Acute Psychosis Without Neuroleptics: Two-Year Outcomes From the Soteria Project" 58:. A number of non-consultant grade and trainee psychiatrists are also involved in the network. 3005: 2969: 2873: 2818: 2758: 2405: 2400: 2354: 2334: 2264: 2252: 2021: 2011: 1994: 1984: 1967: 1957: 1936: 1926: 1909: 1899: 1882: 1872: 1833: 1823: 1800: 1790: 1764: 1730: 1680: 1634: 1557: 1518: 1482: 1434: 1417: 1401: 1381: 1352: 1317: 1245: 1139: 1121: 1072: 1020: 979: 930: 868: 798: 765: 749: 733: 704: 646: 530: 489: 375:"Response of the Bradford Group to the Draft Outline Proposals of the Scoping Study Committee" 335: 2863: 2450: 2384: 2359: 2136: 2115: 2089: 1722: 1672: 1626: 1549: 1510: 1472: 1344: 1307: 1299: 1237: 1168: 1111: 1103: 1062: 1054: 1010: 969: 961: 920: 912: 896: 858: 848: 790: 696: 579: 520: 479: 471: 418: 182: 55: 192:
One of his most notable contributions to this area was setting up and evaluating the first
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Crawford, MJ; Hopkins, W; Thomas, P; Moncrieff, J; Bindman, J; Gray, AJ (7 April 2001).
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Bracken, P. (2002) Trauma: Culture, Meaning and Philosophy. London: Whurr Publications.
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Bentall, R. (2003) Madness Explained: Psychosis and Human Nature. Allen Lane, London.
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CPN maintains close links with service user or survivor led organisations such as the
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There is a strong view by CPN that contemporary psychiatry relies too much on the
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Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry
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Calton, Tim; Ferriter, Michael; Huband, Nick; Spandler, Helen (January 2008).
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Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry
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American Association for the Abolition of Involuntary Mental Hospitalization
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We've Had a Hundred Years of Psychotherapy – and the World's Getting Worse
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Boyle, M. (1993) Schizophrenia: a scientific delusion. London, Routledge.
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Mental Health Treatment of Depression Collaborative Research Program".
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The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment
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Collaborative Research Program: General Effectiveness of Treatments".
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has also been greatly over-stated. This has a number of consequences:
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Peter Campbell first used the term 'postpsychiatry' in the anthology
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Thomas, Philip; Romme, Marius; Hamelijnk, Jacobus (October 1996).
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Liberatory Psychiatry: Philosophy, Politics and Mental Health
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Psychiatric Drugs: Key issues and service user perspective
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Laing. R. D. (1959) The Divided Self. London, Tavistock.
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Crawford, MJ; Hopkins, W; Henderson, C (December 2000).
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Psychiatric organization based in the United Kingdom
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The Politics of Experience and The Bird of Paradise
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Postpsychiatry: Mental health in a postmodern world
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(1980). 1677:10.1097/YCO.0b013e3282f08782 899:; Kirsch, I (16 July 2005). 854:10.1371/journal.pmed.0050045 701:10.1126/science.179.4070.250 2705:National Empowerment Center 2665:Critical Psychiatry Network 2532:History of mental disorders 966:10.1136/bmj.39510.531597.80 100:Coercion and social control 32:Critical Psychiatry Network 3066: 2975:The Myth of Mental Illness 2710:Radical Psychology Network 2111:Outline of critical theory 2008:Recovery Beyond Psychiatry 1921:Double, D.B., ed. (2006). 795:10.1016/j.ijlp.2009.12.001 476:10.1136/bmj.322.7290.866/a 328:Moncrieff, Joanna (2008). 268: 106:community treatment orders 38:organization based in the 3003: 2700:MindFreedom International 2512:Biopsychiatry controversy 2411:Hermeneutics of suspicion 1631:10.1080/13546800344000138 1619:Cognitive Neuropsychiatry 1108:10.1136/bmj.329.7479.1394 3045:Psychiatry organizations 2960:Madness and Civilization 2950:Liberation by Oppression 2006:Whitwell, David (2005). 1349:10.1177/1359104512444118 1059:10.1136/bmj.322.7288.724 917:10.1136/bmj.331.7509.155 584:10.1177/0957154X12450236 2589:Positive disintegration 2527:Hearing Voices Movement 1727:10.1136/jmh.2008.000422 1698:(subscription required) 1652:(subscription required) 1588:Sharing Voices web site 1567:(subscription required) 1528:(subscription required) 1370:(subscription required) 820:Psychiatric Imperialism 808:(subscription required) 722:(subscription required) 639:CPD Bulletin Psychiatry 604:(subscription required) 219:British Medical Journal 52:National Health Service 2920:Anatomy of an Epidemic 2675:Hearing Voices Network 2547:Martha Mitchell effect 2537:Involuntary commitment 1292:Schizophrenia Bulletin 415:Mental Health Alliance 90:Hearing Voices Network 48:Mental Health Act 1983 2990:The Radical Therapist 2985:The Protest Psychosis 2624:Therapeutic community 2599:Psychoanalytic theory 2542:Involuntary treatment 1478:10.1192/bjp.178.3.192 1304:10.1093/schbul/sbm047 1016:10.1192/bjp.169.4.401 818:Moncrieff, J. (1997) 635:"Critical Psychiatry" 617:"Critical Psychiatry" 561:History of Psychiatry 526:10.1192/bjp.177.6.563 92:, Intervoice and the 54:(NHS), among them Dr 2574:Nouthetic counseling 2436:Critical rationalism 2248:medical anthropology 1267:on 28 September 2010 1174:10.1192/apt.10.5.361 2614:Rosenhan experiment 2609:Rhetoric of therapy 2522:Critical psychiatry 2168:applied linguistics 1102:(7479): 1394–1396. 693:1973Sci...179..250R 621:Critical Psychiatry 445:Critical Psychiatry 397:Critical Psychiatry 379:Critical Psychiatry 360:Critical Psychiatry 18:Critical psychiatry 2965:Radical Psychology 2940:Doctoring the Mind 2645:Aspies For Freedom 2380:Siegfried Kracauer 2305:technical practice 2258:university studies 2243:management studies 2233:language awareness 2198:discourse analysis 1979:Read, Jim (2009). 1715:Medical Humanities 645:(1): 33–36. 2000. 399:. 8 December 2010. 215:Speaking Our Minds 110:Genevra Richardson 67:construct validity 63:psychopharmacology 3012: 3011: 3006:Psychiatry portal 2970:The Gene Illusion 2874:Elizabeth Packard 2834:Peter C. 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Index

Critical psychiatry
psychiatric
United Kingdom
Bradford
Mental Health Act 1983
National Health Service
Joanna Moncrieff
psychopharmacology
construct validity
David Cooper
R. D. Laing
Thomas Szasz
Hearing Voices Network
Soteria Network
community treatment orders
Genevra Richardson
medical model
David Cooper
R. D. Laing
Thomas Szasz
Emil Kraepelin
schizophrenia
depression
Frankfurt School
Soteria House
British Medical Journal
Cognitive Behavioural Therapy
Heidegger
Merleau-Ponty
Foucault

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