The acceptable limits of
psychiatry
D B Double
What are the acceptable
limits of psychiatry?
What are the acceptable
limits of psychiatry?
There is a psychiatric orthodoxy
Peter Breggin on Oprah
Winfrey Show
September 1987
Peter Breggin on Oprah
Winfrey Show
September 1987
Complaint by NAMI
that he acted
irresponsibly when
seemed to suggest
that people should
refuse to take
medication
Peter Breggin on Oprah
Winfrey Show (cont)
The view that
mental illness has
biological causes is
"all lies" repeated to
justify giving drugs.
Peter Breggin on Oprah
Winfrey Show (cont)
The view that
mental illness has
biological causes is
"all lies" repeated to
justify giving drugs.
He did not mean
that people should
stop taking their
medication
Peter Breggin on Oprah
Winfrey Show (cont)
Maryland
Commission on
Medical Discipline
ruled he did not
commit a "legal
violation or ethical
impropriety"
My personal experience
I currently work for a
medical director that
regards me as
outside the
acceptable limits of
psychiatry
My personal experience (cont)
When suspended I
was told by two
auditors of my
practice from Royal
College of
Psychiatrists that I
was outside the
acceptable range of
psychiatry
My personal experience (cont)
Advised that my
philosophy about
psychiatry would
need to be
examined and my
scepticism about the
use of medication
challenged
The fundamentalism of The
American Psychiatric
Association
Tom Cruise interview on NBC
show "Today"
"Before I was a
Scientologist I never
agreed with
psychiatry… There
is no such thing as a
chemical imbalance
… I'm not saying
that that isn't real….
I'm saying that drugs
aren't the answer"
Response to Tom Cruise
interview on NBC show
"It is irresponsible
for Mr Cruise to use
his movie publicity
tour to promote his
own ideological
views and deter
people with mental
illness from getting
the care they need."
Response to Tom Cruise
interview on NBC show (cont)
There is
considerable
investment in
research and a
vastly expanded
understanding of
mental illness, which
is highly treatable.
Response to Tom Cruise
interview on NBC show (cont)
"It is unfortunate that
in the face of
remarkable scientific
and clinical progress
that a small number
of individuals and
groups persist in
questioning the
legitimacy of mental
illness."
Fast for Freedom in Mental
Health
Asked for evidence for
claims that mental
illnesses are "proven
biological diseases of
the brain" and that
emotional distress
results from "chemical
imbalances" in the brain
Response to Fast for
Freedom in Mental Health
Mental disorders are
serious neurobiological
disorders as (a)
research has shown
reproducible
abnormalities of brain
structure and function
(b) evidence for a
strong genetic
component is
compelling and (c) the
mechanism of action of
effective mechanisms
have been elucidated.
What is psychiatry’s belief
system?
What is psychiatry’s belief
system?
Brain pathology as the basis for mental
illness
What is psychiatry’s belief
system?
Brain pathology as the basis for mental
illness
Avoids complicated metaphysics
What is psychiatry’s belief
system?
Brain pathology as the basis for mental
illness
Avoids complicated metaphysics
Provides professional respectability
What is psychiatry’s belief
system?
Brain pathology as the basis for mental
illness
Avoids complicated metaphysics
Provides professional respectability
Has scientific ambition of elucidating the
cause of mental illness
What is psychiatry’s belief
system?
Brain pathology as the basis for mental
illness
Avoids complicated metaphysics
Provides professional respectability
Has scientific ambition of elucidating the
cause of mental illness
Based on faith, desire and wish
fulfilment rather than logic
John Haslam as historical
example
Insanity is "a
corporeal disease".
John Haslam as historical
example
"[T]he various and
discordant opinions,
which have prevailed in
this department of
knowledge, have led
me to disentangle
myself as quickly as
possible from the
perplexity of
metaphysical mazes."
John Haslam as historical
example
"[F]rom the limited
nature of my
powers, I have
never been able to
conceive . . . a
disease of the
mind."
John Haslam as historical
example
Mental illness is "the
peculiar and
exclusive province
of the medical
practitioner" (his
emphasis)
Historical foundations of
modern psychiatry
Wilhelm Griesinger
Historical foundations of
modern psychiatry (cont)
Wilhelm Griesinger
Mental pathology
and therapeutics
(original German
edition 1845)
Historical foundations of
modern psychiatry (cont)
“Mental diseases
are brain diseases”
Historical foundations of
modern psychiatry (cont)
“Mental diseases
are brain diseases”
“It is only from the
neuropathological
standpoint that one
can try to make
sense of the
symptomatology of
the insane"
Historical foundations of
modern psychiatry (cont)
Baron Ernest von
Feuchtersleben
Historical foundations of
modern psychiatry (cont)
Baron Ernest von
Feuchtersleben
The principles of
medical psychology
(originally German
edition 1845)
Historical foundations of
modern psychiatry (cont)
"The notion, mental
disease, must be
deduced neither
from the mind nor
from the body, but
from the relation of
each to the other."
Historical foundations of
modern psychiatry (cont)
"Psychopathies have no
seat; they are combined
constitutions which
appear in the
disturbance of these
functions by which the
mind is manifested, that
is, in the collective
personality."
Examples of the
biopsychological approach
Examples of the
biopsychological approach
Adolf Meyer's psychobiology
Examples of the
biopsychological approach
Adolf Meyer's psychobiology
George Engel's biopsychosocial model.
Examples of the
biopsychological approach
Adolf Meyer's psychobiology
George Engel's biopsychosocial model
Arthur Kleinman's cultural perspective
Examples of the
biopsychological approach
Adolf Meyer's psychobiology
George Engel's biopsychosocial model
Arthur Kleinman's cultural perspective
Biopsychological paradigm has always
competed with the dominant biomedical
model.
Synthesis of critical
psychiatry
Synthesis of critical
psychiatry
The threat of anti-psychiatry taints the
restatement of the biopsychological
paradigm
Synthesis of critical
psychiatry
The threat of anti-psychiatry taints the
restatement of the biopsychological
paradigm
Psychiatry does not need to be justified
by postulating brain pathology as the
basis for mental illness.
Synthesis of critical
psychiatry
The threat of anti-psychiatry taints the
restatement of the biopsychological
paradigm
Psychiatry does not need to be justified
by postulating brain pathology as the
basis for mental illness.
This view is acceptable
"Psychiatry is naked," the child said.
Psychiatry could not admit to that. It thought it better to continue the
procession under the illusion that anyone who couldn't see its
clothes was either stupid or incompetent.