Western psychiatry is fundamentally flawed and, therefore, a paradigm shift away from the prevalent ‘illness like any other’ approach is urgently required. Despite the powerful vested interests continuing to actively obstruct change, I remain optimistic that, in the next decade or so, we will witness a radical change in the way we as a society respond to human suffering and overwhelm.
So why so hopeful? In the words of the Ian Dury song in the late 1970s, what are the ‘reasons to be cheerful’? Below I list three developments that support my positive expectations. In Part II of this article I will share a further three.
1. Growing recognition of a link between past experiences and mental health problems
Although there remains much work to be done to prise psychiatry away from its destructive ‘internal biological defect’ assumptions about the causes of mental health problems, there is growing awareness of the central role of life experience in the genesis of human distress and suffering. Thus, there is wide-ranging evidence that adverse past experiences can be potent determinants of the symptoms that psychiatry relies upon to diagnose the presence of so-called ‘mental disorders’.
Examples of this link include: a victim of child sex abuse is far more likely to suffer psychosis in adulthood; childhood neglect predisposes to relationship instability, and growing up in high-crime neighbourhoods increases the likelihood of subsequent paranoia.
2. Greater recognition of the value of service-user led initiatives
There is growing awareness of the benefits associated with mental health initiatives that are wholly or substantially led by people with experience of using psychiatric services. The notion that many of those people suffering misery and overwhelm can stabilise and move forward without recourse to professional psychiatry is one that is gaining credence. Thus, access to drop-in centres and peer support may often be more acceptable (and helpful) than the ‘expert’, medicalised provision of mainstream mental health services.
Similarly, more and more people are striving to make sense of their unusual experiences rather than viewing them as symptoms that require treatment by professional psychiatry. A prominent example in this regard is the Hearing Voices Movement in its adoption of a normalising paradigm to embrace and celebrate the diversity of the voice-hearing population. Hearing Voices networks have now been established in 21 countries; a testament to the growing popularity of this approach.
With regards to research – an area where biological psychiatry squanders vast sums of money searching for the elusive bio-genetic causes of mental illness – people with personal experience of mental health challenges are increasingly shaping the agenda. For example, Mad Studies provides a framework for such people to promote a radically different way of making sense of their experiences and narratives.
3. The emergence of recovery academies
With regards to mental health problems, the term ‘recovery’ can be abused; in the United Kingdom, the concept has sometimes been deployed as justification for a heavy-handed approach to reducing the number of benefits claimants. Nonetheless, the original principles of recovery remain sound and enabling, acting as a counter to the hope-quashing pessimism of traditional psychiatry.
Key assumptions underlying the recovery approach include: a positive expectation that everyone can achieve a worthwhile and rewarding life irrespective of the severity of their difficulties; an expectation that goals should always be idiosyncratic, generated by the individual service user, rather than determined by psychiatric professionals; and the recognition of the value of proactivity on the part of service users, controlling their own destinies rather than passively accepting the administrations of so-called ‘experts’.
In support of this ethos, an increasing number of Recovery Academies have emerged across the Western world. In these establishments, people who have experienced mental health problems develop and deliver educational courses in partnership with professionals. Typically, those attending these training sessions are a combination of service users, carers and psychiatric staff members.
As someone who has been involved in a Recovery Academy for several years, I can testify to the distinctive nature of this training, one that is refreshingly vibrant in comparison to the more traditional professional-teaching-professional approach.
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