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Reasons to be cheerful (Part II): developments that instil optimism about the future of mental health provision

In part I of this blog, I listed three reasons to be cheerful about the future of mental health. Here I describe another three positive developments that promote optimism that, over the next few years, we might witness radical improvements in the way the Western world responds to human suffering and overwhelm.

Courtesy of Stuart Miles at FreeDigitalPhotos.net9

4. Moncrieff’s ‘drug-centred’ notion of medication effects
British psychiatrist, Joanna Moncrieff, proposed a sensible way of explaining why psychotropic drugs – like the so-called ‘antipsychotics’ and ‘antidepressants’ – can sometimes benefit the recipient.

Moncrieff described how, contrary to what has been peddled by biological psychiatry and the pharmaceutical industry for the last two decades, psychiatric medications do not achieve their effects through a ‘disease-centred’ mode of action. In other words, they do not rectify biochemical imbalances in the brain. Instead, Moncrieff persuasively argued that psychiatric drugs realise their effects through a ‘drug-centred’ process that creates an abnormal brain state. Sometimes these chemically-induced, abnormal states of mind are preferable to the alternatives, at least in the short term – for example, sedation for someone who is highly agitated – but abnormal states they are nonetheless (1)(2).

Explaining the disease-centred/drug-centred distinction to people in receipt of mental health services should enable them to make an informed decision as to whether to accept psychotropic medication. Importantly, such explanations might illustrate why the option to decline psychiatric drugs is not synonymous with a diabetes sufferer choosing not to take insulin.

Moncrieff’s distinction between disease-centred/drug-centred actions should helpfully determine the tone of language used by professionals when describing the likely effects of psychiatric drugs. Thus, references to ‘treating underlying illness’, ‘balancing brain biochemistry’ and ‘correcting abnormal states’ are spurious and should be avoided. Instead, service users should be informed that the medication will induce an altered state of mind that, depending on the particular drug, may be experienced as ‘sedation’, ‘a numbing of painful emotions’ or ‘slowed thinking’.

5. A shifting focus onto mental wellbeing
Recent years have witnessed the beginnings of a shift away from the traditional and narrow focus on the treatment of ‘mental illness’ towards promotion of a much broader concept: ‘mental wellbeing’.

In 2014, the World Health Organisation (WHO) defined mental health as ‘a state of wellbeing in which every individual realises his/her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her and his community’ (3). Crucially, the improvement of people’s mental wellbeing cannot be achieved solely by transformations to healthcare, but instead requires coordinated changes to a range of domains, including the social, vocational, economic and political.

It is encouraging to witness that in recent years some mainstream political parties in the UK have created dedicated ministerial posts with responsibility for mental health Such appointments reflect the need for a multi-faceted, multi-layered approach that extends far beyond the remit and competencies of health service providers. To achieve a meaningful reduction in levels of human suffering and misery will require an approach that grapples with a wide range of societal problems, including: discrimination, disempowerment, poverty, homelessness, criminality, unemployment and intra-family abuse.

6. An array of groups clamouring for radical change
Criticism of traditional psychiatry is not a new phenomenon; dissenting voices have been agitating for at least half a century. Alas, until now, it has been easy for the vested interests (biological psychiatry and the multi-national drug companies) to claim that these critics are extreme mavericks, or the product of turf wars where different professional groups jostle for power and influence. However, this dismissive response from advocates of the bio-medical approach to human suffering is looking increasingly feeble and inadequate.

The range and heterogeneity of critical voices protesting about Western psychiatry has never been greater: a multitude of service users sharing their personal stories; civil rights activists; organisations like the Hearing Voices Network offering alternative, non-medical approaches; dissident psychiatrists across Europe and the USA; influential journalists like Robert Whitaker; and critical authors from a range of mental health professions. Even traditional psychiatry, with its stubborn (and self-serving) history of resisting change, cannot continue to ignore this collective scream of disapproval. Can it?

(1) Moncrieff, J. (2008). The Myth of the Chemical Cure: A critique of psychiatric drug treatment. Basingstoke: Palgrave-MacMillan
(2) Moncrieff, J. (2015). The Bitterest Pills: The troubling story of antipsychotic drugs. Basingstoke: Palgrave-MacMillan.
(3) World Health Organisation (WHO). (2014). Mental Health: A state of wellbeing.


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