“Another” psychiatry is possible?

“Another” psychiatry is possible?

Psychological Medicine , Volume 53 , Issue 1 , January 2023 , pp. 46 – 54
DOI: https://doi.org/10.1017/S003329172200383X
Published online by Cambridge University Press: 11 January 2023
Diana Rose, Nikolas Rose

Abstract

In this paper, we examine a number of approaches that propose new models for psychiatric theory and practices: in the way that they incorporate ‘social’ dimensions, in the way they involve ‘communities’ in treatment, in the ways that they engage mental health service users, and in the ways that they try to shift the power relations within the psychiatric encounter. We examine the extent to which ‘alternatives’ – including ‘Postpsychiatry’, ‘Open Dialogue’, the ‘Power, Threat and Meaning Framework’ and Service User Involvement in Research – really do depart from mainstream models in terms of theory, practice and empirical research and identify some shortcomings in each. We propose an approach which seeks more firmly to ground mental distress within the lifeworld of those who experience it, with a particular focus on the biopsychosocial niches within which we make our lives, and the impact of systematic disadvantage, structural violence and other toxic exposures within the spaces and places that constitute and constrain many everyday lives. Further, we argue that a truly alternative psychiatry requires psychiatric professionals to go beyond simply listening to the voices of service users: to overcome epistemic injustice requires professionals to recognise that those who have experience of mental health services have their own expertise in accounting for their distress and in evaluating alternative forms of treatment. Finally we suggest that, if ‘another psychiatry’ is possible, this requires a radical reimagination of the role and responsibilities of the medically trained psychiatrist within and outside the clinical encounter.

Keywords
critiques of psychiatrycommunity, psychiatrybiopsychosocial, nichethe patient’s voiceepistemic, injusticesocial, sufferingstructural violence, alternative futures for psychiatry

É possível “outra” psiquiatria?

^{Psychological Medicine , Volume 53 , Issue 1 , January 2023 , pp. 46 – 54
DOI: https://doi.org/10.1017/S003329172200383X
Published online by Cambridge University Press: 11 January 2023
Diana Rose, Nikolas Rose}

Resumo

Neste artigo, examinamos uma série de abordagens que propõem novos modelos para teorias e práticas psiquiátricas: 

1. como incorporam dimensões ‘sociais’, 
2. como envolvem ‘comunidades’ no tratamento,
3. como engajam os usuários dos serviços de saúde mental
4. como tentam deslocar as relações de poder no interior do encontro psiquiátrico. 

Examinamos até que ponto as “alternativas” – incluindo a “Pós-psiquiatria”, o “Diálogo Aberto”, a “Estrutura de Poder, Ameaça e Significado” e o Envolvimento do Usuário de Serviços na Pesquisa – realmente se afastam dos modelos convencionais em termos de teoria, prática e pesquisa empírica e identificamos algumas deficiências em cada uma delas. Propomos uma abordagem que busque fundamentar mais firmemente o sofrimento mental no mundo da vida daqueles que o vivenciam, com foco particular nos nichos biopsicossociais dentro dos quais fazemos nossas vidas e no impacto da desvantagem sistemática, da violência estrutural e de outras exposições tóxicas dentro dos espaços e lugares que constituem e constrangem muitas vidas cotidianas. Além disso, argumentamos que uma psiquiatria verdadeiramente alternativa requer que os profissionais psiquiátricos vão além de simplesmente ouvir as vozes dos usuários dos serviços: superar a injustiça epistêmica requer que os profissionais reconheçam que aqueles que têm experiência em serviços de saúde mental têm sua própria experiência em dar conta de seu sofrimento e em avaliar formas alternativas de tratamento. Finalmente, sugerimos que, se “outra psiquiatria” é possível, isso requer uma reimaginação radical do papel e das responsabilidades do psiquiatra medicamente treinado dentro e fora do encontro clínico.

Palavras chaves

psiquiatria biopsicossocial,  injustiça social, sofrimento e violência estrutural, futuros alternativos para a psiquiatria

References

Adams, V., Behague, D., Caduff, C., Löwy, I., & Ortega, F. (2019). Re-imagining global health through social medicine. Global Public Health, 14, 1383–1400.CrossRefGoogle ScholarPubMed

Barker, D. J. (2007). The origins of the developmental origins theory. Journal of Internal Medicine, 261, 412–417.CrossRefGoogle ScholarPubMed

Bister, M. D. (2018). The concept of chronicity in action: Everyday classification practices and the shaping of mental health care. Sociology of Health & Illness, 40, 38–52.CrossRefGoogle ScholarPubMed

Bister, M. D., Klausner, M., & Niewöhner, J. (2016). The cosmopolitics of ‘niching’. Rendering the city habitable along infrastructures of mental health care. In Blok, A. & Farias, I. U. (Eds.), Urban cosmopolitics. Agencements, assemblies, atmospheres (pp. 187–206). London: Routledge.Google Scholar

Borg, M., & Davidson, L. (2008). The nature of recovery as lived in everyday experience. Journal of Mental Health, 17, 129–140.CrossRefGoogle Scholar

Bracken, P. (1995). Beyond liberation: Michel Foucault and the notion of a critical psychiatry. Philosophy, Psychiatry, & Psychology, 2, 1–13.Google Scholar

Bracken, P., Fernando, S., Alsaraf, S., Creed, M., Double, D., Gilberthorpe, T., … Timimi, S. (2021). Decolonising the medical curriculum: Psychiatry faces particular challenges. Anthropology & Medicine, 28(4), 420–428.CrossRefGoogle ScholarPubMed

Bracken, P., & Thomas, P. (2001). Postpsychiatry: A new direction for mental health. British Medical Journal, 322, 724–727.CrossRefGoogle ScholarPubMed

Brooke, E. M. (1959). National statistics in the epidemiology of mental illness. Journal of Mental Science, 105, 893–908.CrossRefGoogle ScholarPubMed

Bynum, W. F., Porter, R., & Shepherd, M. (2004). The anatomy of madness: Essays in the history of psychiatry. London: Taylor & Francis.Google Scholar

Carr, S., Holley, J., Hafford-Letchfield, T., Faulkner, A., Gould, D., Khisa, C., & Megele, C. (2017). Mental health service user experiences of targeted violence and hostility and help-seeking in the UK: A scoping review. Global Mental Health, 4, e25. doi: 10.1017/gmh.2017.22CrossRefGoogle ScholarPubMed

Caspi, A., & Moffitt, T. E. (2006). Gene–environment interactions in psychiatry: Joining forces with neuroscience. Nature Reviews Neuroscience, 7, 583–590.CrossRefGoogle ScholarPubMed

Clark, A. (1997). Being there: Putting brain, body, and world together again. Cambridge, MA: MIT Press.Google Scholar

Conrad, P. (1992). Medicalization and social control. Annual Review of Sociology, 18, 209–232.CrossRefGoogle Scholar

Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11, 11–19.CrossRefGoogle Scholar

Department of Health. (1999). The national service framework for mental health: Modern standards and service models. London: Department of Health.Google Scholar

Duntley, J. D., & Buss, D. M. (2008). Evolutionary psychology is a metatheory for psychology. Psychological Inquiry, 19, 30–34.CrossRefGoogle Scholar

Ecks, S. (2005). Pharmaceutical citizenship: Antidepressant marketing and the promise of demarginalization in India. Anthropology & Medicine, 12, 239–254.CrossRefGoogle ScholarPubMed

Ecks, S. (2013). Eating drugs: Psychopharmaceutical pluralism in India. New York: NYU Press.Google Scholar

Evans, D. (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12, 77–84.CrossRefGoogle ScholarPubMed

Farmer, P. (1996). On suffering and structural violence: A view from below. Daedalus, 125, 261–283.Google Scholar

Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3, e449.CrossRefGoogle ScholarPubMed

Fricker, M. (2007). Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.CrossRefGoogle Scholar

Friedli, L., & Stearn, R. (2015). Positive affect as coercive strategy: Conditionality, activation and the role of psychology in UK government workfare programmes. Medical Humanities, 41, 40–47.CrossRefGoogle ScholarPubMed

Fusar-Poli, P., Correll, C. U., Arango, C., Berk, M., Patel, V., & Ioannidis, J. P. (2021). Preventive psychiatry: A blueprint for improving the mental health of young people. World Psychiatry, 20, 200–221.CrossRefGoogle ScholarPubMed

Gilburt, H., Rose, D., & Slade, M. (2008). The importance of relationships in mental health care: A qualitative study of service users’ experiences of psychiatric hospital admission in the UK. BMC Health Services Research, 8, 92.CrossRefGoogle ScholarPubMed

Gilburt, H., Slade, M., Rose, D., Lloyd-Evans, B., Johnson, S., & Osborn, D. P. J. (2010). Service users’ experiences of residential alternatives to standard acute wards: Qualitative study of similarities and differences. British Journal of Psychiatry, 197, S26–S31.CrossRefGoogle Scholar

Ginsburg, S., & Jablonka, E. (2019). The evolution of the sensitive soul: Learning and the origins of consciousness. Cambridge, MA: MIT Press.CrossRefGoogle Scholar

Gone, J. P. (2013). Redressing first nations historical trauma: Theorizing mechanisms for indigenous culture as mental health treatment. Transcultural Psychiatry, 50, 683–706.CrossRefGoogle ScholarPubMed

Gone, J. P. (2016). Alternative knowledges and the future of community psychology: Provocations from an American Indian healing tradition. American Journal of Community Psychology, 58, 314–321.CrossRefGoogle Scholar

Habermas, J., Honneth, A., & Joas, H. (1991). Communicative action. Westport, CT: Greenwood Publishing Group.Google Scholar

Han, C. (2012). Life in debt: Times of care and violence in neoliberal Chile. Berkeley, CA: University of California Press.CrossRefGoogle Scholar

Harrison, S., & Mort, M. (1998). Which champions, which people? Public and user involvement in health care as a technology of legitimation. Social Policy & Administration, 32, 60–70.CrossRefGoogle Scholar

Horwitz, A. V., & Scheid, T. L. (1999). A handbook for the study of mental health: Social contexts, theories, and systems. Cambridge: Cambridge University Press.Google Scholar

Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford: Oxford University Press.Google Scholar

Howell, A., & Voronka, J. (2012). Introduction: The politics of resilience and recovery in mental health care. Studies in Social Justice, 6, 1–7.CrossRefGoogle Scholar

Jackson, C., & Rizq, R. (Eds.) (2019). The industrialisation of care: Counselling, psychotherapy and the impact of IAPT. PCCS Books.Google Scholar

Johnson, S., Bingham, C., Billings, J., Pilling, S., Morant, N., Bebbington, P., … Dalton, J. (2004). Women’s experiences of admission to a crisis house and to acute hospital wards: A qualitative study. Journal of Mental Health, 13, 247–262.CrossRefGoogle Scholar

Johnstone, L., & Boyle, M. (2018). The power threat meaning framework: An alternative nondiagnostic conceptual system. Journal of Humanistic Psychology. https://doi.org/10.1177/0022167818793289CrossRefGoogle Scholar

Kaplan, A., Cromley, J., Perez, T., Dai, T., Mara, K., & Balsai, M. (2020). The role of context in educational RCT findings: A call to redefine “evidence-based practice”. Educational Researcher, 49, 285–288.CrossRefGoogle Scholar

Keating, F., Robertson, D., McCulloch, A., & Francis, E. (2002). Breaking the circles of fear: A review of the relationship between mental health services and African and Caribbean communities. London: The Sainsbury Centre for Mental Health.Google Scholar

Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60, 420–430.CrossRefGoogle ScholarPubMed

Kleinman, A., Das, V., & Lock, M. M. (1997). Social suffering. Berkeley: University of California Press.Google Scholar

Kuhn, T. S. (2012). The structure of scientific revolutions. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar

Laland, K. (2017). Darwin’s unfinished symphony. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar

Lamb, S. D. (2014). Pathologist of the mind: Adolf Meyer and the origins of American psychiatry. Baltimore: Johns Hopkins.CrossRefGoogle Scholar

Landry, D. (2017). Survivor research in Canada: ‘Talking’ recovery, resisting psychiatry, and reclaiming madness. Disability & Society, 32, 1437–1457.CrossRefGoogle Scholar

Lane, C. (2007). Shyness: How normal behavior became a sickness. New Haven, CT: Yale University Press.Google Scholar

Lewis, A. (1953). Health as a social concept. The British Journal of Sociology, 4, 109–124.CrossRefGoogle Scholar

Lief, A. (1948). The commonsense psychiatry of Dr. Adolf Meyer. New York: McGraw Hill.Google Scholar

Marmot, M. (2015). The health gap: The challenge of an unequal world. London: Bloomsbury.Google ScholarPubMed

Marmot, M., & Bell, R. (2012). Fair society, healthy lives. Public health, 126, S4–S10.CrossRefGoogle ScholarPubMed

McEwen, B. S. (2012). Brain on stress: How the social environment gets under the skin. Proceedings of the National Academy of Sciences, 109, 17180–17185.CrossRefGoogle ScholarPubMed

McKeown, T., & Lowe, C. R. (1966). An Introduction to social medicine. Oxford: Blackwell.Googlv Scholar

Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126–133.CrossRefGoogle ScholarPubMed

Metzl, J. M., & Hansen, H. (2018). Structural competency and psychiatry. JAMA Psychiatry, 75, 115–116.CrossRefGoogle ScholarPubMed

Mezzich, J. E. (2007). Psychiatry for the person: Articulating medicine’s science and humanism. World Psychiatry, 6, 65.Google ScholarPubMed

Modinos, G., Iyegbe, C., Prata, D., Rivera, M., Kempton, M. J., Valmaggia, L. R., … McGuire, P. (2013). Molecular genetic gene–environment studies using candidate genes in schizophrenia: A systematic review. Schizophrenia Research, 150, 356–365.CrossRefGoogle ScholarPubMed

Murray, R., Bora, E., Modinos, G., & Vernon, A. (2022). Schizophrenia: A developmental disorder with a risk of non-specific but avoidable decline. Schizophrenia Research, 243, 181–186.CrossRefGoogle ScholarPubMed

Murray, R. M., & Cannon, M. (2021). Public health psychiatry: An idea whose time has come. World Psychiatry, 20, 222.CrossRefGoogle ScholarPubMed

Neilson, B., & Rossiter, N. (2008). Precarity as a political concept, or, fordism as exception. Theory, Culture & Society, 25, 51–72.CrossRefGoogle Scholar

Olson, M., Seikkula, J., & Ziedonis, D. (2014). The key elements of dialogic practice in open dialogue: Fidelity criteria. The University of Massachusetts Medical School, 8, 2017.Google Scholar

Perestelo-Perez, L., Gonzalez-Lorenzo, M., Perez-Ramos, J., Rivero-Santana, A., & Serrano-Aguilar, P. (2011). Patient involvement and shared decision-making in mental health care. Current Clinical Pharmacology, 6, 83–90.CrossRefGoogle ScholarPubMed

Pilgrim, D. (2019). Key concepts in mental health. New York: SAGE.Google Scholar

Pilling, S., Clarke, K., Parker, G., James, K., Landau, S., Weaver, T., … Craig, T. (2022). Open dialogue compared to treatment as usual for adults experiencing a mental health crisis: Protocol for the ODDESSI multi-site cluster randomised controlled trial. Contemporary Clinical Trials, 113, 106664.CrossRefGoogle ScholarPubMed

Razzaque, R., & Stockmann, T. (2016). An introduction to peer-supported open dialogue in mental healthcare. BJPsych Advances, 22, 348–356.CrossRefGoogle Scholar

Roe, J., & McCay, L. (2021). Restorative cities: Urban design for mental health and wellbeing. London: Bloomsbury.CrossRefGoogle Scholar

Rose, D. (2015). The contemporary state of service-user-led research. The Lancet. Psychiatry, 2, 959–960.CrossRefGoogle ScholarPubMed

Rose, D. (2022). The fate of the idea of recovery today: A user-centred analysis. Community Psychology in Global Perspective, 8, 103–119.Google Scholar

Rose, D., Evans, J., Laker, C., & Wykes, T. (2015). Life in acute mental health settings: Experiences and perceptions of service users and nurses. Epidemiology and Psychiatric Sciences, 24, 90–96.CrossRefGoogle ScholarPubMed

Rose, D., Perry, E., Rae, S., & Good, N. (2017). Service user perspectives on coercion and restraint in mental health. British Journal of Psychiatry International, 14, 59–61.Google ScholarPubMed

Rose, N. (2016). Neuroscience and the future for mental health? Epidemiology and Psychiatric Sciences, 25, 95–100.CrossRefGoogle ScholarPubMed

Rose, N. (2018). Our psychiatric future: The politics of mental health. Polity.Google Scholar

Rose, N., Birk, R., & Manning, N. (2021). Towards neuroecosociality: Mental health in adversity. Theory, Culture & Society, 39, 121–144.CrossRefGoogle Scholar

Rose, N., & Fitzgerald, D. (2021). The urban brain: Mental health in the vital city. Princeton, NJ: Princeton University Press.Google Scholar

Rosenberg, C. E. (2002). The tyranny of diagnosis: Specific entities and individual experience. The Milbank Quarterly, 80, 237–260.CrossRefGoogle ScholarPubMed

Rosenberg, C. E. (2006). Contested boundaries – psychiatry, disease, and diagnosis. Perspectives In Biology and Medicine, 49, 407–424.CrossRefGoogle ScholarPubMed

Rylko-Bauer, B., & Farmer, P. (2016). Structural violence, poverty, and social suffering. In Brady, D. & Burton, L. (Eds.), The Oxford handbook of the social science of poverty (pp. 47–74). Oxford: Oxford University Press.Google Scholar

Sashidharan, S., & Francis, E. (1999). Racism in psychiatry necessitates reappraisal of general procedures and Eurocentric theories. British Medical Journal, 319, 254.CrossRefGoogle ScholarPubMed

Savalescu, J., Davies, L. W., Roache, R., Davies, W., & Loebel, J. P. (2020). Psychiatry reborn: Biopsychosocial psychiatry in modern medicine. Oxford University Press.CrossRefGoogle Scholar

Scheper-Hughes, N., & Lovell, A. (1987). Psychiatry inside out: Selected writings of Franco Basaglia. New York: Columbia University Press.Google Scholar

Scull, A. (2015). Madness in civilization: A cultural history of insanity, from the Bible to Freud, from the madhouse to modern medicine. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar

Scull, A. (2021). American psychiatry in the new millennium: A critical appraisal. Psychological Medicine, 51, 2762–2770.CrossRefGoogle ScholarPubMed

Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. Journal of the American Medical Association, 301, 2252–2259.CrossRefGoogle ScholarPubMed

Slade, M. (2009). Personal recovery and mental illness: A guide for mental health professionals. Cambridge: Cambridge University Press.CrossRefGoogle Scholar

Slade, M., & Priebe, S. (2001). Are randomised controlled trials the only gold that glitters? British Journal of Psychiatry, 179, 286–287.CrossRefGoogle ScholarPubMed

Sterelny, K. (2003). Thought in a hostile world: The evolution of human cognition. Oxford: Blackwell.Google Scholar

Thornicroft, G. (2000). National service framework for mental health. Psychiatric Bulletin, 24, 203–206.CrossRefGoogle Scholar

Turner, E. H., Cipriani, A., Furukawa, T. A., Salanti, G., & de Vries, Y. A. (2022). Selective publication of antidepressant trials and its influence on apparent efficacy: Updated comparisons and meta-analyses of newer versus older trials. PLoS Medicine, 19, e1003886.CrossRefGoogle ScholarPubMed

Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, 252–260.CrossRefGoogle ScholarPubMed

Ullrich, S., Keers, R., & Coid, J. W. (2014). Delusions, anger, and serious violence: New findings from the MacArthur violence risk assessment study. Schizophrenia Bulletin, 40, 1174–1181.CrossRefGoogle ScholarPubMed

Venner, F. (2009). Risk management in a survivor-led crisis service. Mental Health Practice, 13, 18–23.CrossRefGoogle Scholar

Wallcraft, J., Read, J., & Sweeney, A. (2003). On our own terms. London: Sainsbury Centre for Mental Health.Google ScholarWheeler, C., Lloyd-Evans, B., Churchard, A., Fitzgerald, C., Fullarton, K., Mosse, L., … Johnson, S. (2015). Implementation of the crisis resolution team model in adult mental health settings: A systematic review. BMC Psychiatry, 15, 1–14.CrossRefGoogle ScholarPubMed