The need for a critical approach to psychiatry in Ireland

antrim | rights, freedoms and repression | opinion/analysis Saturday February 21, 2004 12:47 by s.fleming

psychiatry's answer to mental health problems is psychiatric drugs which they believe help to correct the 'patient's' brain chemistry or bio-chemical imbalance. Critical psychiatry seeks a more holistic approach seeing personal/interpersonal, social and environmental contexts as the origins of severe mental distress. Psychiatric drugs with their damaging effects on the individual and the genetic hypothesis that psychiaty operates behind have failed and must be replaced with a new social and holistic model which can truly help people.

Today there is an urgent need to challenge the dominance of psychiatry and its control over the lives of people it deems ‘mentally ill’. Psychiatry believes that ‘mental illness’ is related to an underlying biological pathology or genetic defect. There are though no reliable diagnostic tests whereby it can be proven that someone has a so-called mental illness, such as schizophrenia for instance, which is related to or caused by biological factors. Psychiatric diagnosis rests on the assessment of a psychiatrist categorising reported symptoms. The cause of a person’s severe mental distress or ‘mental illness’ as psychiatry would judge it is very often not seen as the result of personal, societal or psychosocial factors but instead the problem is seen as one residing within the patient’s brain. Psychiatry’s answer is psychiatric or neuroleptic drugs which they argue help to redress the ‘bio-chemical imbalance’ in the brain and thereby treat the symptoms of the ‘disease’. The fact is though that these drugs have been proven to have a debilitating and blunting effect on a person’s emotional and mental capabilities. Psychiatry admits that these drugs can and do lead to tardive dyskinesia and other serious neurological disorders and yet it continues to prescribe them.

There needs to be a much greater recognition that severe mental distress is often the result of people’s sense of alienation and fragmentation within the political and economic structure of society where meaning and value is attributed only to the pursuit of money, privilege and status. In today’s consumerist and capitalist driven societies people have largely lost a sense of meaning and belonging. It is no coincidence that this has been accompanied by a rise in people reporting symptoms of severe mental distress. Psychiatry often removes these perspectives from its practice. People need to question psychiatry and its adherence to the biological model which labels mental suffering as illness. One should examine psychiatry in the context of its ignoble history and on the grounds of sound and holistic treatment. The anti/critical psychiatry movements are pointing the way forward when they say that people should be helped to come to terms with their suffering and not feel that they must endure a lifetime of disabling drug ‘treatments’. It is appalling that today the degrading practice of Electro Conclusive ‘Therapy’ (ECT) continues. There is a serious attempt to revive this brain damaging ‘treatment’ as a more widely practised ‘intervention’ in psychiatric practice.

Unlike in many other countries, Ireland, north and south, has no critical or anti- psychiatry movement. Psychiatry, it has to said, exists to protect its own prestige and professional power and in certain respects it shares an interesting similarity with colonialism. Given the experience of colonisation in Ireland, cultural oppression and emigration, we know that there is a link between this experience and high levels of mental suffering. It does not mean that Irish people, blacks, or any other oppressed ethnic group or indigenous population, are more genetically predisposed to ‘mental illness’ than others. As with colonialism, psychiatry today continues to extend its borders in the whole area of human behaviour. Many aspects of human variation and behaviour have been drawn into its territory of pathology and colonised. This has been done through a close alignment with the multi-national pharmaceutical companies. There now exists ‘a pill for every ill’ culture, pills for shyness, social phobias, and so on. Children are now being targeted with drugs for so called attention deficit disorder. These are now all viewed as disorders related to bio-chemical imbalances in the brain which can be treated through new drugs. We are expected to think and act in certain ways, a ‘project of homogenisation’ as described by the anti –psychiatrist R D Laing. Any deviation from this as such is often regarded as a sign of pathology or disease in the individual. Like colonial powers psychiatry does not welcome resistance. Psychiatry’s role in eugenics and racism is well documented and the writings of Michel Foucault and Thomas Szasz have been instrumental in making this visible. We in Ireland need a critical or anti-psychiatry movement that can offer real alternatives and support, a movement that rejects the biological model of so-called mental illness.

Thankfully, courageous individuals highly qualified in psychiatry who became disillusioned with the practice have challenged this model. The most controversialist perhaps of the 20th century was R D Laing. His book, The Divided Self, was an attempt to portray the inner world of a ‘schizophrenic’ which he presented as an attempt to live in an unliveable situation. His work was centred on understanding and treating the person with support in the form of daily group and individual therapy in a caring environment without mind disabling drugs. He believed that the experience of a breakdown could lead to a breakthrough. David Cooper, a contemporary of Laing, was ideologically more Marxist and believed that a whole new socio-economic cultural shift was needed to end psychiatric oppression.
One of the most brilliant anti-psychiatrists and thinkers of our time is Thomas Szasz, Professor of Psychiatry Emeritus at the State University of New York Health Science Centre in Syracuse, New York. Throughout his long and distinguished career Szasz has waged a relentless battle against biological psychiatry. According to Szasz, the very concept of ‘mental illness’ is a myth. He has argued effectively that a ‘disease of the mind’ is not the same as a disease of the brain. He has brilliantly taken issue with the semantics of psychiatry, the definitions, who gains from the definitions, and who loses out as a result of them. Also psychiatrists present themselves as scientists and psychiatry and the political system through it gain the power to effectively ‘detain’ and control people, subjecting them to forced psychiatric drug ‘treatment’. His latest book, Liberation by Oppression, is a strong and insightful debunking of the psychiatric pseudoscience that demeans the human spirit and has hurt countless lives.

In relation to the multi-national pharmaceutical companies producing these psychiatric drugs, Ireland today is an attractive base. They are amongst the biggest companies operating in Ireland. The profitability of the industry is reflected in the amount of corporate tax paid to the 26 county government in the last two years, over $250 million. No other ‘medical speciality’ is underwritten by the drug industry to a degree even vaguely approaching that of psychiatry. There is no disputing the fact that these drugs for many people act as chemical straitjackets and cause a wide range of serious and distressing symptoms.

Given that there is no empirical and reliable evidence to prove a biological cause to mental illness we need to recognise how society can cause people mental suffering which can then get labelled as ‘mental illness’. The way forward therefore is not a practice that is fundamentally flawed and loaded with an ignoble history which largely benefits drugs companies and can act as a form of social control. The dehumanising ideology of psychiatry must be replaced. We need a re-connecting of the individual with a meaningful culture, a re-visioning of medicine as the art and science of holistically healing body and mind. Given the growing control that psychiatry is exercising this is one form of oppression that must be resisted and the Irish experience should place people in a position to understand and inspire opposition to it.