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CPN maintains close links with service user or survivor led organisations such as
the Hearing Voices Network, Intervoice and the Soteria Network, and with like-
minded psychiatrists in other countries. It maintains its own website. The network
is open to any sympathetic psychiatrist, and members meet in person, in the UK,
twice a year. It is primarily intended for psychiatrists and psychiatric trainees
and full participation is not available to other groups.
Contents [hide]
1 Key issues
1.1 Coercion and social control
1.2 The role of scientific knowledge in psychiatry
1.3 Meaning and experience in psychiatry
2 Efficacy
3 Critical Psychiatry and Postpsychiatry
4 Anti-psychiatry and Critical Psychiatry
5 Critical Psychiatry Network - Activities
6 Comparison of anti-psychiatry, early Critical Psychiatry, Critical Psychiatry
and postpsychiatry
7 See also
8 References
9 Further reading
10 External links
Key issues[edit]
CPN is concerned with a number of issues, including the problem of coercion and the
role of psychiatry in social control, the role of biological science in psychiatry,
and the implications of the decontextualisation of experience in psychiatry.
The other involved the introduction of community treatment orders (CTOs) to make it
possible to treat people against their wishes in the community. CPN submitted
evidence to the Scoping Group set up by the government under Professor Genevra
Richardson.[2] This set out ethical and practical objections to CTOs, and ethical
and human rights objections to the idea of reviewable detention. It was also
critical of the concept of personality disorder as a diagnosis in psychiatry. In
addition, CPN�s evidence called for the use of advance statements, crisis cards and
a statutory right to independent advocacy as ways of helping to sustain autonomy at
times of crisis. CPN also responded to government consultation on the proposed
amendment,[3] and the white paper.[4]
The concern about these proposals caused a number of organizations to come together
under the umbrella of the Mental Health Alliance[5] to campaign in support of the
protection of patients� and carers� rights, and to minimise coercion. CPN joined
the Alliance�s campaign, but resigned in 2005 when it became clear that the
Alliance would accept those aspects of the House of Commons Scrutiny Committee�s
report that would result in the introduction of CTOs.[6] Psychiatrists not
identified with CPN shared the Network�s concern about the more coercive aspects of
the government�s proposals, so CPN carried out a questionnaire survey of over two
and a half thousand (2,500) consultant psychiatrists working in England seeking
their views of the proposed changes. The responses (a response rate of 46%)
indicated widespread concern in the profession about reviewable detention[7] and
CTOs.[8]
The CPN was paid attention by Thomas Szasz who wrote: �Members of the CPN, like
their American counterparts, criticize the proliferation of psychiatric diagnoses
and �excessive� use of psychotropic drugs, but embrace psychiatric coercions.�[9]
There is a strong view by CPN that contemporary psychiatry relies too much on the
medical model, and attaches too much importance to a narrow biomedical view of
diagnosis.[10] This can, in part, be understood as the response of an earlier
generation of psychiatrists to the challenge of what has been called �anti-
psychiatry�. Psychiatrists such as David Cooper, R. D. Laing and Thomas Szasz
(although the latter two rejected the term) were identified as part of a movement
against psychiatry in the 1960s and 1970s. Stung by these attacks, as well as
accusations that in any case psychiatrists could not even agree who was and who was
not mentally ill,[11] academic psychiatrists responded by stressing the biological
and scientific basis of psychiatry through strenuous efforts to improve the
reliability of psychiatric diagnosis based in a return to the traditions of one of
the founding fathers of the profession, Emil Kraepelin.[12] This signaled the rise
of what has been called neo-Kraepelinianism as evident in DSM-III and DSM-IV.
The use of standardized diagnostic criteria and checklists may have improved the
reliability of psychiatric diagnosis, but the problem of its validity remains. The
investment of huge sums of money in Britain, America and Europe over the last half-
century has failed to reveal a single, replicable difference between a person with
a diagnosis of schizophrenia and someone who does not have the diagnosis.[13][14]
[15] The case for the biological basis of common psychiatric disorders such as
depression has also been greatly over-stated.[16] This has a number of
consequences:
The most forceful critic of this view was R. D. Laing, who famously attacked the
approach enshrined by Jaspers� and Kraepelin�s work in chapter two of The Divided
Self,[25] proposing instead an existential-phenomenological basis for understanding
psychosis. Laing always insisted that schizophrenia is more understandable than is
commonly supposed. Mainstream psychiatry has never accepted Laing�s ideas, but many
in CPN regard The Divided Self as central to twentieth century psychiatry. Laing�s
influence continued in America through the work of the late Loren Mosher, who
worked at the Tavistock Clinic in the mid-1960s, when he also spent time in
Kingsley Hall witnessing Laing�s work. Shortly after his return to the USA, Loren
Mosher[26] was appointed Director of Schizophrenia Research at the National
Institute of Mental Health, and also the founding editor of the journal
Schizophrenia Bulletin.
One of his most notable contributions to this area was setting up and evaluating
the first Soteria House, an environment modeled on Kingsley Hall in which people
experiencing acute psychoses could be helped with minimal drug use and a form of
interpersonal phenomenology influenced by Heidegger. He also conducted evaluation
studies of the effectiveness of Soteria.[27] A recent systematic review of the
Soteria model found that it achieved as good, and in some areas, better, clinical
outcomes with much lower levels of medication (Soteria House was not anti-
medication) than conventional approaches to drug treatment.[28]
Efficacy[edit]
There is currently no research base for the efficacy of the critical psychiatry
approach.
One comparison study showed 34% of patients of a 'medical model' team were still
being treated after two years, compared with only 9% of patients of a team using a
'non-diagnostic' approach (less medication, little diagnosis, individual treatment
plans tailored to the person's unique needs). However the study comments that cases
may have left the system in the 'non-diagnostic' approach, not because treatment
had worked, but because (1) multi-agency involvement meant long-term work may have
been continued by a different agency, (2) the starting question of �Do we think our
service can make a positive difference to this young person�s life?� rather than
�What is wrong with this young person?� may have led to treatment not being
continued, and (3) the attitude of viewing a case as problematic when no
improvement has occurred after five sessions may have led to treatment not being
continued (rather than the case �drifting� on in the system).[29]
A significant developments in mental health over the last thirty years has been the
emergence of vocal and critical service-users and survivor movements.Examples of
such organisations include Survivors Speak Out, the National Self Harm Network, Mad
Pride, Mad Women and the Hearing Voices Network. British postpsychiatry can be
understood as an attempt to respond to these groups Although these groups disagree
on many issue with mainstream psychiatry, and instead seek a more equal
relationship with mental health services. These groups were supported by the Labour
government commitment to democracy and accountability in the NHS on its election in
1997. This created a political environment in which doctors and nurses in all areas
of health care were expected to relinquish paternalistic ways of relating to
patients and relatives, and to work with them on a more equal footing.
For Bracken and Thomas, postpsychiatry represents an attempt to move beyond the
dichotomies that characterised the anti-psychiatry era, and to engage
constructively and positively with the concerns of service users and carers.
Postpsychiatry identifies the central problem of the mental health field not
necessarily in psychiatry, but in the modernist search for technical solutions to
life's problems. This modernist impulse drives changes in psychiatry, psychology
and nursing. It existed before the biological or DSM shift of the 1980s, and has
been skillfully manipulated by the pharmaceutical industry subsequently. (citation
needed)
Postpsychiatry tries to move beyond the view that we can only help people through
technologies and expertise. Instead, it prioritises values, meanings and
relationships and sees progress in terms of engaging creatively with the service
user movement, and communities. This is especially important given the considerable
evidence that in Britain, Black and Minority Ethnic (BME) communities are
particularly poorly served by mental health services. For this reason an important
practical aspect of postpsychiatry is the use of community development in order to
engage with these communities.[38] The community development project Sharing Voices
Bradford is an excellent example of such an approach.[39]
There are many commonalities between critical psychiatry and postpsychiatry, but it
is probably fair to say that whereas postpsychiatry would broadly endorse most
aspects of the work of critical psychiatry, the obverse does not necessarily hold.
In identifying the modernist privileging of technical responses to madness and
distress as a primary problem, postpsychiatry has looked to postmodernist thought
for insights. Its conceptual critique of traditional psychiatry draws on ideas from
philosophers such as Heidegger,[40] Merleau-Ponty,[41][42] Foucault[43] and
Wittgenstein.[44]
One of the most important aspects of CPN�s work has been that of mutual support. In
recent years it has become increasingly difficult to practise psychiatry flexibly,
in ways that recognize the limitations of the scientific evidence that underpins a
great deal of contemporary psychiatry. There are many reasons for this, including
the rise of evidence-based medicine and the risk-averse culture in which we live.
Consequently, anyone whose practice is seen to diverge even modestly from clinical
practice guidelines is likely to attract unwelcome attention, criticism from peers
and managers, or worse. It has thus become increasingly difficult to hold views
that differ from what is claimed to be mainstream opinion, even though there are
legitimate grounds for doing so based in carefully argued critiques of existing
evidence. For example, many critical psychiatrists are highly sceptical about the
effectiveness of antidepressant drugs and other forms of physical treatments, the
use of diagnoses such as schizophrenia, or the use of the Mental Health Act in
social control. CPN thus has a vital role in justifying and supporting those who
espouse a critical position in relation to psychiatric theory and practice, and in
recent years has supported a number of colleagues who have fallen foul of their
peers because their work is wrongly seen not to follow clinical practice
guidelines. This is one of the main reasons why membership is restricted to
psychiatrists.