Critical Psychiatry: What Is It And What Does It Claim?
Psychiatry, a medical specialty that is responsible for detecting and treating mental illnesses, has gone through a major crisis in recent times due to the emergence of different questions about the characteristics of its knowledge and practices.
Critical Psychiatry has emerged from these questions, a theoretical current that questions and seeks to reform the practices of psychiatric care. Among other things, it shows that traditional psychiatry has some fundamental limits in the way it understands and deals with psychological suffering, which specifically generates ethical dilemmas in the use of its knowledge.
One of the most recent antecedents is the conference of the Critical Psychiatry Network (Critical Psychiatry Network) held in Bradford, England in 1999, where the need to promote a radical transformation in our approach to mental health problems ; which thousands of professionals around the world have subscribed to, mainly through academic publications, but also through political mobilization.
Along the same lines, Critical Psychiatry has many of its antecedents in antipsychiatry, a theoretical and political movement promoted by mental health professionals that began in the second half of the last century and that firmly questioned the way in which psychiatry operated, especially in Europe and the United States.
Although antipsychiatry and Critical Psychiatry are movements that emerged at different times, what they have in common is that reject the pathologization of human heterogeneity and remain committed to transforming psychiatric care.
Finally, this trend has been driven by different first-person associative movements, that is, groups managed by users of psychiatric care services. For example, the British collective Hearing Voices Network, who reject traditional psychiatric understandings of such an experience, seeking also to eliminate the stigma and strengthen mutual aid groups.
The above is subsequently articulated with the rights paradigm that has been formalized since 2006 in the International Convention on the Rights of Persons with Disabilities approved by the United Nations, as well as through other disability prevention documents and reports. torture in psychiatry that have been developed in different countries.
Fundamental principles
In general terms, Critical Psychiatry seeks to make visible the intersection between psychological, social and somatic relationships both of people and of psychiatric practice itself, so that it is possible to reform it.
More specifically we can follow Philip Thomas (2013) to list five topics of discussion that emerge from Critical Psychiatry: the problem of psychiatric diagnoses, the problem of evidence-based medicine in psychiatry (and its relationship with the industry pharmaceutical), the role of the context where psychiatry develops and acts, the problem of coercive practices, and finally, the theoretical and philosophical basis of psychiatric knowledge and its practices
1. The problem of psychiatric diagnoses
Critical Psychiatry makes visible that the barriers between “normality” and “disorder” are easily manipulated and largely arbitrary. In fact, frequently the number of psychiatric diagnoses available varies ; These appear and disappear and are updated from time to time (some of them every time the same diagnosed population expresses itself against being considered sick or disordered, for example, what happened with homosexuality, which until just the second half of the century past it was no longer considered a mental disorder).
Likewise, the scientific bases of psychiatric diagnosis began to be questioned because although organic substrates have been found, the scientific evidence that postulates that mental disorders have a biological origin and a definitive cure in the same sense is insufficient.
2. Evidence-based medicine and the pharmaceutical industry
Evidence-based medicine is a concept that refers to medical practice based on clinical trials, statistics and manuals that offer generic information about a given condition.
This has been questioned by Critical Psychiatry, since the causes of mental disorders are nonspecific and evidence-based medicine can promote and generalize practices that are also non-specific, but also potentially harmful in some senses, because in psychiatry the practices are par excellence of direct intervention (pharmacological or mechanical).
Likewise, in many cases the diagnoses and pharmaceutical treatment are strongly influenced by economic interests of the industries in charge of producing and distributing drugs, as well as financing a large part of the training of professionals. This has been highly debated in recent decades by an important sector of mental health professionals around the world.
3. The context of psychiatry
The range of psychiatric diagnoses is related to the context in which they are constructed, that is, the percentage of people to whom certain problems are attributed varies depending on the specific population to which they belong.
Psychiatric practice itself is found within a social context, which means that ideologies are reproduced in the diagnosis and in the care relationship and ways of relating; and that psychological suffering is more than an individual experience, it is an experience that has to do with the conditions of possibility or vulnerability of the environment itself.
4. Coercive practices
Among the strongest criticisms of psychiatry since the last century are forced psychiatric confinement and restraint practices such as restraints, electroconvulsive therapy, and overmedicalization.
Far from being conceived as a set of techniques (and therefore free of values), Critical Psychiatry seeks to constantly review the practices that are promoted and their possible harmful effects (from intrinsic paternalism in clinical practice to stigmatizing attitudes or explicitly aggressive practices).
In many contexts, alternatives have been promoted, ranging from the closure of psychiatric hospitals or gradual demedicalization, to the creation of community centers and the reinforcement of mental health that is promoted in a more collective and less coercive way.
5. Theoretical and philosophical basis of psychiatry
Critical Psychiatry questions mind-body dualism which underlies traditional biomedical psychiatry, as well as the biologicalist ideology that reduces mental health and illness to the molecular sciences of the brain.
The latter makes them consider a series of social demands where psychiatry was positioning itself as the only or the best solution to understand people’s problems; which It often translates into the omission of emotional, social or economic deficiencies promoted by social structures.
Finally, and given that attention to mental health problems is a globalized phenomenon, despite having been generated and promoted based on the needs of the European and American context, the movement of Critical Psychiatry has had repercussions around the world.
However, this is not the only criticism that has been made of traditional psychiatry. For example, in social sciences such as anthropology, social psychology or sociology in Latin America, community forms of health care (including mental health) have recently been investigated, as well as pre-Hispanic ways of understanding what we currently call “mental disorder” or “mental illness”; on par with the deficiencies in institutional care and in more traditional mental health services.
