Anti-psychiatry? Not for me

When I started my interested in mental health issues, very quickly I adopted an anti-psychiatric position. In this post, I want to write why (and how) I changed my mind. This post was inspired by another tweet on fighting between psychology and psychiatry. Fighting which, in my view, is unseemly.

For me it all started when in 2004 (or so, I can’t remember now) Chris Barker (with whom I had co-authored an earlier book) suggested we write a book together. I had only just published my emotions book, was finishing a book on identity (with Ulrike Meinhof), I had enjoyed working with Chris before, so I happily agreed. He suggested we write a book on depression, the topic appealed to me, I agreed again. However, it soon became clear that we could not agree on much more. He wanted a very different book from anything I could envisage and we quickly (and amicably) gave up on the book. But I still wanted to write my book on depression. I asked Chris whether he minded, he didn’t and so I started.

I knew I needed to do two things. First, I needed to read a lot. I needed to read about depression and I needed to read about psychiatry. Second, I wanted to see psychiatry first hand.

So, I started reading. I read for about a year and one of the books I read during that time was Lucy Johnstone’s “Users and abusers of psychiatry”, a book which I found very well written, very persuasive, very well argued. And I continue to think it is a great book which asks interesting questions of psychiatry. I disagree a lot with Lucy Johnstone today, but I would still recommend the book. After that came Szasz, Scheff, Laing….and I wanted to stand with anti-psychiatry and march on the psychiatric barricades. And, boy, did it change….

It changed because I became an intern in one of the two best psychiatric hospitals in Poland, the psychiatry clinic of the Collegium Medicum of the Jagiellonian University. I was completely unprepared for what I saw. I saw a woman who was in so much distress that she had pulled half her hair out. I saw a man crushed by his suspicions that he was being followed, a woman who strongly believed her husband was replaced by an agent. The list goes on. I saw pure misery, the suffering that almost crushed me too. I was in touch with so much pain, I could just weep.

But I was also unprepared for another thing I saw. I saw shrinks who cared for their patients. They were people who didn’t have all the answers, but were always ready to reflect on what they were doing. They knew the anti-psychiatric literature much better than I did, and told me they agreed with much of it. They were interested in talking, discussing, challenging their beliefs. They were acutely aware of the stigma of the diagnosis, hospitalisation, and were deeply involved in helping their patients and their families overcome it.

I still remember asking one of the doctors how she knew whether the patient was recovered. She looked at me and said: I ask the patient. I don’t think I appreciated the depth of the answer then.

What I saw presented me with two problems. First, coming in touch with raw misery, I thought the debate whether we called it mental illness or not, was of secondary, or more likely of distant tertiary importance. Surely, what was of primary concern was how to help alleviate the pain those patients were in. Yes, when we’ve done all that, we can have a chat about the nature of patients’ suffering, but surely, not before. Those concerns were so not the patients’ I saw.

The second problem I had was that I really didn’t see the oppressive psychiatry. I once asked the only male psychiatrist about the use of restraints. He said, they had the whole gear, but practically didn’t use them. He was the most ardent opponent of restraining patients, also because he was the one who had to do it, as he was a large man. And he really didn’t want to do it. I hate to admit it, but what I saw was a human being experiencing uncomfortable dilemmas, not an oppressor waiting to exercise his Foucauldian and physical power of his patients.

Things really were more complicated than was dreamt in anti-psychiatric philosophy. I was too readily smitten by arguments against, I was also developing arguments for psychiatry. It was probably because I was in touch with the best psychiatry (the ward I was placed on had been led by (one of) the greatest Polish shrinks, Antoni Kępiński), yes, it perhaps was rare and unique, still, it was real psychiatry, really helping real people. I knew that if ever I had difficulty, they would help and I would trust them to do so. Anti-psychiatry? No, thank you.

One day I witnessed the following scene:

  • Patient: Doctor, I want to be discharged.
  • Psychiatrist: No problem, I’ll start the paperwork. Just consider whether you do want it, please.
  • Patient: Oh, for fuck’s sake, of course I don’t.

I quietly laughed and asked the shrink what would have happened if he’d insisted. He’d be discharged, she answered. Really? I asked in disbelief. Who do you think we are here? Prison guards? She was clearly irritated with me. He is a free a man, he is not detained, he is free to leave whenever he wants. It’s our job to convince him that staying here is useful for him.

Yes, after checking that he could leave, the man stayed. Just like the others.

Am I sugar-coating reality? Not really. Was it all nice and wonderful? Of course, it wasn’t, many things contributed to it. But the care those patients got was excellent.

Now, that was the beginning. Ever since then, I have seen many a hospital, spoke to a legion of shrinks, and to even more patients. Psychiatry doesn’t all look like Ward C in Krakow. Gosh, it doesn’t. I wish I could unsee things I have seen and unhear things I have heard. All too often, it’s also too full of itself, too self-obsessed, too defensive, unreflective, ignorant….you name it, it’s probably guilty of this too. But does it mean it should be scrapped, undermined, insulted? No, it doesn’t.

It’s because all those shrinks in Krakow, and I’m sure many like them, help people deal with their worst nightmares. They really do. They also understand well what it all means. And they really don’t deserve to be undermined.  And I for one prefer to help them on their way, even though I’ve been told I’m not welcome more times than I care to remember. But you occasionally do come across a shrink that listens. Very occasionally.

And that’s why anti-psychiatry is not for me.

 

 

3 Comments
  1. I think Lucy is being disingenuous about there not being an attempt by some psychologists to pick a rumble with psychiatry
    For example Psychology Professors Bentall and Kinderman have both written books attacking psychiatry and Kinderman is at least open about wanting to get rid of as many psychiatrists as possible. Psychology Professor Pilgrim is also well noted for his anti psychiatry views.
    I and other psychiatrists have been the victim of complaints from psychologists who take exception to their ideas being criticised.
    Essentially it’s a guild war really and to be fair it was an earlier generation of psychiatrists in the past who tried to limit the role and influence of psychologists.
    Most psychiatrists these days like myself want more psychologists as we recognise the benefit they give to patients. Sadly some clinical psychologists want to continue the struggle.
    As for many critical psychiatrists there are not that many being largely a group with indiosyncratic views not based on the evidence apart from some notable exceptions.

  2. Lucy Johnstone

    Hi Darius. In the interests of minimising the kinds of battle you deplore, I thought it was worth saying that I agree with nearly everything you say…. I agree that there are many kind, thoughtful, reflective psychiatrists. I’ve learned from many such myself. I agree that the caricature of ‘an oppressor waiting to exercise his Foucauldian and physical power of his patients’ does not represent reality.I have never met such a person. I agree that distress can be extreme and agonising. I agree that there is much good practice within psychiatry as it is. And I’m pleased that you have such a high opinion of my book.

    Points of disagreement are: This is not a ‘fight’ between psychology and psychiatry, and moreover, I believe it is damaging to patient/service user trust to perpetuate this myth. You need only call to mind the many critical psychiatrists (and diagnostically-minded psychologists) to disprove this statement. Equally, just about all the so-called ‘critical’ psychologists of my acquaintance are extremely critical of their own profession (and the Power Threat Meaning Framework highlights the problems of the discipline of Psychology with a capital ‘P’ alongside every instance of critquing Psychiatry with a capital ‘P.’) The core issue is about different ways of thinking, which do not align with professional boundaries. And you are wrong to describe me as an example of ‘anti-psychiatry’ – I am not a member of a movement in the 1960s and I do not identify with that term.
    But let’s celebrate our agreements!

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