It is understandable why those critical of the dominant biomedical approach to human distress sometimes feel despondent. Despite our collective efforts to offer sufferers more humane, non-pathologising alternatives to the drugs and coercion currently imposed by biological psychiatry, there are times when it seems we might not be making progress. Recent events add to this pessimism: the missed opportunity to revoke the human-rights abuses inherent to the Mental Health Act; the mass psychiatric drugging of 25% of the adult population; and psychiatry’s colonisation of non-Western countries, encouraging the locals to view understandable distress as a medical ‘disorder’ (1). Occurrences such as these can promote helplessness and dismay in those advocating radical alternatives to biological psychiatry.
But is it all doom and gloom?
Maybe not. One recent morning, when I noticed my shoulders were drooping more than usual under the weight of the ubiquitous psychiatric bullshit, I decided to scour my memory for any observations that might suggest that the psychiatric monster is ailing. Here’s a list of what I came up with; my 12 reasons to be cheerful.
- THE ACKNOWLEDGMENT BY THE ROYAL COLLEGE OF PSYCHIATRISTS THAT ANTIDEPRESSANT WITHDRAWAL SYMPTOMS OFTEN LAST MUCH LONGER THAN A WEEK OR TWO
Thanks to the tireless campaigning of service users and activists, the Royal College of Psychiatrists abandoned their strategy of denial and finally accepted that – contrary to their previous guidance – antidepressant withdrawal symptoms are often troubling and frequently last much longer than a week or two. Activism that pressures the psychiatric establishment into making an about-turn is rare and represents a major achievement.
- THE ESCALATING CLAMOUR FOR CHANGE FROM A HETEROGENOUS GROUP OF STAKEHOLDERS
Who cannot be inspired by the eloquence, passion and integrity of the ‘critical movement’, a collective of service users, survivors, mental health professionals and researchers all working towards a paradigm shift in the way we make sense of, and respond to, human suffering. If you harbour any remaining doubts about why we urgently need this radical change in approach, or the integrity of those advocating for it, I suggest you attend one of the ‘A Disorder for Everyone’ events taking place throughout the UK.
- THE POWER THREAT MEANING FRAMEWORK (PTMF) (2)
For the first time, we now have a comprehensive, non-pathologising framework for making sense of human distress. The PTMF describes how power differentials and social adversity can lead to the emergence of the various expressions of human suffering and overwhelm. As such, it offers a viable alternative to the pernicious psychiatric diagnostic system, a system that currently props up the often-harmful biomedical paradigm.
- THE REJECTION OF THE ‘BIOCHEMICAL IMBALANCE’ THEORY
The pervasive myth that a biochemical imbalance in the brain is the primary cause of severe human distress has been a key reason why biological psychiatry has dominated mental health services for over half a century. Over recent years, the psychiatric profession has explicitly rejected this ‘explanation’, with even some of the staunchest advocates of the biomedical approach dismissing it as ‘never a real theory’ and not one propounded by ‘responsible practitioners in the field of psychiatry’.
- WORLD-WIDE RECOGNITION OF THE GROSS HUMAN- RIGHTS VIOLATIONS INFLICTED BY BIOLOGICAL PSYCHIATRY
The psychiatric fortress is now under fire from reputable human-rights institutions. In 2012, the World Health Organization stated that provision of mental health services constituted a hidden human rights emergency. More recently, the special rapporteurs appointed by the Human Rights Council bemoaned Western psychiatry’s response to distress, stating that, ‘Reductive biomedical approaches to treatment that do not adequately address contexts and relationships can no longer be considered compliant with the right to health’ (my emphasis).
- THE INCREASING EMPHASIS ON SURVIVOR KNOWLEDGE IN RESEARCH AND SERVICE PROVISION
Although there remains a long way to go, over recent years there has been enhanced recognition of the importance of survivor experience in shaping research and service provision. Instead of remote, randomised control trials led by academic ‘experts’, the ‘Mad Studies’ movement centres the knowledges of those deemed mad to develop their own theories, practices and understandings. It is an uplifting experience to learn about the range of activity in which they are currently engaged; a read of the Searching for a Rose Garden (3) book is an excellent place to start.
- HUGE FINES IMPOSED ON PHARMACEUTICAL COMPANIES FOR MIS-SELLING PSYCHIATRIC DRUGS
The symbiotic relationship between biological psychiatry and the multinational drug companies represents one of the most pernicious collusions in peacetime history. It is, therefore, satisfying to learn that one half of this gruesome twosome (the pharmaceutical industry) has been financially penalised for malpractice. Indeed, over the last decade Eli Lilley, Pfizer, Glaxo Smith Kline, and Johnson & Johnson have all received fines of well over $1 billion for the miss-selling of psychiatric drugs (antipsychotics and/or antidepressants). Although amounting to a small dint in their overall profits, this formal recognition of their wrongdoings is a welcome step forward.
- A LEGAL FRAMEWORK THAT DOES NOT DISCRIMINATE AGAINST PEOPLE IN DISTRESS
The Mental Health Act in England and Wales, in keeping with other ‘mental health’ laws across the Western world, represents a form of legalised discrimination against those tagged as suffering a ‘mental disorder’, habitually trampling over the human rights of those ensnared within it. In 2016 Northern Ireland developed a unitary legal framework for substitute decision making that makes no distinctive reference to ‘mental health’ or ‘mental disorder’ – in other words, everyone who loses the capacity to make their own decisions, irrespective of the reason for this loss, is treated the same. In stark contrast to the fudge of the recent ‘Independent Mental Health Act Review’, the Northern Ireland framework represents a radical shift from the discriminatory, stigma-inducing ‘mental health’ laws seen across most of the developed world. If other jurisdictions follow suit, this could be a real game-changer.
- CRISIS HOUSES AS EFFECTIVE, MORE HUMANE ALTERNATIVES TO PSYCHIATRIC INPATIENT WARDS
We urgently require accessible alternatives to acute psychiatric units, places where people in crisis can go without being psychiatricised. Two excellent examples of such establishments (offering person-centred, compassionate, trauma-informed support) are the Drayton Park Women’s Crisis House and the Leeds Survivor-Led Crisis Service. Both these services have demonstrated the viability of a normalising, non-risk-averse approach to people in acute crisis and – given their cost-effectiveness and acceptability to those enduring emotional overwhelm – there are no valid reasons why they shouldn’t be rolled out across the country.
- THE GROWING RECOGNITION THAT MORE PSYCHIATRIC DRUGGING IS NOT THE ANSWER TO OUR ‘MENTAL HEALTH’ CRISIS
Over recent years there has been increasing awareness that psychiatric drugs are – at best – only modestly effective and often harmful; drugging 20% of the adult population now seems indefensible. On average, any benefit from ingesting antidepressants will predominantly be a placebo effect and of little clinical significance. Long term antipsychotic use has been shown to significantly increase the risk of heart, metabolic and neurological problems and reduce the likelihood of recovery. These research findings should act as a springboard to promote alternatives to psychiatric drugs as a first-line response to human distress.
- THE GROWING POPULARITY OF NON-DRUG INTERVENTIONS
Alongside the growing awareness of the limitations of psychiatric drugs, there has been a parallel increase in the profile of some non-drug approaches that emphasise social contexts and personal stories. Two prominent examples of these alternative interventions are Open Dialogue and trauma-informed therapies. Hopefully, the availability of these non-pathologising interventions for people experiencing severe levels of distress will continue to expand.
- THE PROSPECT OF NURSES ‘CONSCIENTIOUSLY OBJECTING’ TO COLLUDING WITH COERCION
As stated earlier, the Mental Health Act legitimises discrimination against people suffering distress and overwhelm. In 2018, the Critical Mental Health Nurses Network – a forum for psychiatric nurses to think critically about their role within the mental health system – posed the following question: ‘Should there be a right for individual mental health nurses to object to taking part in forced treatment as a matter of personal/professional conscience?’ Should such ‘conscientious objection’ gain traction, within the psychiatric nursing profession and beyond, it may jolt us out of our collective apathy and act as a catalyst for us all to question why we collude with legalised discrimination against those people tagged with a ‘mental disorder’.
So there you have it, my 12 reasons to be cheerful. I feel lighter already. And I hope my summary of positive events acts as an antidote if you are feeling stymied by the slow pace of change.
Please add to my list by sharing your own thoughts in the comments section.
- Davies, J. (2019). ‘Deceived! How Big Pharma persuades us to keep taking its medicines’, In Drop the Disorder: Challenging the culture of psychiatric diagnosis’ (Ed. J. Watson). PCCS Books.
- Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). The Power Threat Meaning Framework: Overview. Leicester: British Psychological Society.
- Russo, J. & Sweeney, A. (2016). Searching for a Rose Garden: challenging psychiatry, fostering mad studies. PCCS Books.
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