Mental Health Revolution

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Mental Health Revolution

• Pat Bracken
• RCPsych Oct 28th 2008

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Mental Health Revolution

• Changing ideas about revolution
• The nature of the dominant paradigm in mental
  health
• Causes of, and justification for, revolutionary
  change
• Implications for our profession

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Che Guevara
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Killing Fields of Cambodia
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John Gray

• the world in which we find ourselves at the
  start of the new millennium is littered with the
  debris of utopian projects

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Copernicus
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Kuhn paradigms

• when paradigms change, the world itself
  changes with them

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Technological Approach
Cognitive approaches
Language of Management
Medical model
Technological Approach
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Main Assumptions of the Technological Paradigm

• The problem to be addressed has to due with a
  faulty mechanism or process of some sort
• The mechanism or process can be modelled in
  causal terms, ie described in a way that is
  universal, a way that works regardless of the
  context
• Technological interventions are instrumental.
  They are not to do with opinions, values,
  relationships or priorities.

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Technical idiom

• Bipolar disorder is a complex, recurrent mood
  disorder, and its impact on everyday life can be
  devastating. Although pharmacological
  interventions remain the primary tool in its
  management, medicines cannot control all aspects
  and consequences of the disorder. Psychosocial
  interventions target issues untouched by
  pharmacological treatments, such as medication
  adherence, awareness and understanding of the
  disorder, early identification of prodromal
  symptoms, and coping skills (Beynon et al,
  2008).

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Modernist Psychiatry

• Primary discourse is technical focused on
  diagnosis and classification, causal
  explanations, evidence-based interventions (EBM)
• Other issues become secondary
• ethics, values and priorities,
• meanings and contexts,
• relationships and power

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Why is Technological Paradigm dominant?

• Cultural support
• Patient expectations
• Underscores professional roles
• Pharmaceutical industry

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Roy Porter

• Indeed, the rise of psychological medicine
  was more the consequence than the cause of the
  rise of the insane asylum. Psychiatry could
  flourish once, but not before, large numbers of
  inmates were crowded into asylums

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Why is Technological Paradigm so dominant?

• Cultural support
• Patient expectations
• Underscores professional roles
• Pharmaceutical industry

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Role of Service-user Organisations in the
Technological Paradigm

• -consultation
• -help with fund-raising and recruiting subjects
  for research
• -their expertise secondary to that of the
  technical knowledge of the professional

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20th Century Psychiatry
Focus on technology of diagnosis and treatment
relationships
Social position
Ethics and values
Cultural issues
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Direction of Revolutionary Change
Discourse centred on -values/ethics -meanings/co
ntexts -relationships/power
Appropriate research
Training priorities
Service models
Use of drugs and therapy
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Challenges to technological paradigm

• Postmodern culture
• Changing understanding of technology itself
• Moves away from the embrace of Pharma

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(No Transcript)
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Why Revolution is Justified

• Empirical evidence
• Conceptual analysis
• Political reasons
• Ethical imperative

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CBT

• little evidence that specific cognitive
  interventions significantly increase the
  effectiveness of the therapy (Longmore and
  Worrell, 2007)

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Why Revolution is Justified

• Empirical evidence
• Conceptual analysis
• Political reasons
• Ethical imperative

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Psychiatry and Philosophy
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Why Revolution is Justified

• Empirical evidence
• Conceptual analysis
• Political reasons
• Ethical imperative

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Ethical

• if we say that we are working to develop
  user-centred services, training and research
  programmes then it is simply unethical to carry
  on as if the user movement did not exist.

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Mad Pride in Cork
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Icarus Project

• we shared a vision of being bipolar that
  differs radically from the narrow model put forth
  by the medical establishment, and wanted to
  create a space for people like us to articulate
  the way we understand ourselves, our disorder,
  and our place in the world.

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Implications for Psychiatry

• Rethinking psychopathology
• A different understanding of expertise
• Training
• Research
• Service developments

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Insights from Recovery Literature

• Recovery often made through paths that are
  alternatives to drugs and psychotherapy
• Importance of loss of social position that comes
  with being a service user
• Community development approach

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Relationship with service user movement

• From Consultation to collaboration