How are we to make sense of madness and psychosis? For most of us the words conjure up images from television and newspapers of seemingly random, meaningless violence. It is something to be feared, something to be left to the experts. But is madness best thought of as a medical condition? Psychiatrists and the drug industry maintain that psychoses are brain disorders amenable to treatment with drugs, but is this actually so? There is no convincing evidence that the brain is (...) disordered in psychosis, yet governments across the world are investing huge sums of money on mental health services that take for granted the idea that psychosis is an illness to be treated with medication. Although some people who use mental health services find medication helpful, many do not, and resist the idea that their experiences are symptoms of illnesses like schizophrenia. Consequently they are forced into having treatment against their wishes. So, how do we make sense of this situation? Postpsychiatry addresses these questions. It involves an attempt to rethink some of the fundamental assumptions of mental health work, showing how recent developments in philosophy and ethics can help us to clarify some of the dilemmas and conflicts around different understandings of madness. Throughout, the authors examine the conflicting ways in which politicians, academics, and mental health professionals appear to understand madness, and contrast this with voices and experiences that are usually excluded - those of the people who use mental health services. They then examine the power of psychiatry to shape how we understand ourselves and our emotions, before considering some of the basic limitations of psychiatry as science to make madness meaningful. In the final section of the book they draw on evidence from service users and survivors, the humanities and anthropology, to point out a new direction for mental health practice. This new direction emphasises the importance of cultural contexts in understanding madness, placing ethics before technology in responding to madness, and minimising 'therapeutic' coercion. (shrink)

Because psychiatry deals specifically with ‘mental’ suffering, its efforts are always centrally involved with the meaningful world of human reality. As such, it sits at the interface of a number of discourses: genetics and neuroscience, psychology and sociology, anthropology, philosophy, and the humanities. Each of these provides frameworks, concepts, and examples that seek to assist our attempts to understand mental distress and how it might be helped. However, these discourses work with different assumptions, methodologies, values, and priorities. Some are in (...) dispute with one another. At various times in the history of psychiatry, a particular form of understanding has become dominant and worked to marginalize .. (shrink)

It has often been emphasised that psychiatry is still an ‘expertise’ and has not yet reached the status of a science. Science calls for systematic, conceptual thinking which can be communicated to others. Only in so far as psychopathology does this can it claim to be regarded as a science. What in psychiatry is just expertise and art can never be accurately formulated and can at best be mutually sensed by another colleague. It is therefore hardly a matter for textbooks (...) and we should not expect to find it there. This quotation indicates that Jaspers was immersed in a major debate in nineteenth century philosophy of science: the Methodenstreit. His dismissive comments about the ‘art’ of psychiatry set the .. (shrink)

Introduction : the times they are a changin' -- Doing their best -- Values, evidence, conflict -- What counts as evidence? -- The miracle drug -- The battle for acceptance : defining the relationship between medicine and the world of madness and distress -- The ring -- Foregrounding contexts : what kinds of understanding are appropriate in the world of mental illness? -- Losing Peter -- Mind, language, and meaning -- Beetles -- Ethics before technology : is 'treatment' the best (...) way to think about mental health work? -- Narrative and the ethics of representation -- Meaning and recovery -- Citizenship and the politics of identity -- Are you local? : responding to the challenge of globalization in mental health -- The veil. (shrink)

This chapter argues that the modernist agenda, currently dominant in mainstream psychiatry, serves as a disempowering force for service users. By structuring the world of mental health according to a technological logic, this agenda is usually seen as promoting a liberation from "myths" about mental illness that led to stigma and oppression in the past. However, it is argued that this approach systematically separates mental distress from background contextual issues and sidelines non-technological aspects of mental health such as relationships, values, (...) and meanings. This move privileges the gaze of the expert doctor who is trained to understand distress in terms of psychopathology. But, as this move empowers the doctor, it disempowers the service user. In part this is because the priorities of modernist psychiatry are generally at odds with the interests and concerns of services users, particularly those who see themselves as survivors of the mental health system. The chapter examines the implications of this for the psychiatrist's role in working with survivors towards recovery. (shrink)

We are very grateful to both Matthew Ratcliffe and Thomas Szasz for taking the time to read and respond to our paper. Ratcliffe is broadly sympathetic to our efforts and provides a very convincing argument against mind–body dualisms by drawing on work from the phenomenological tradition. His comments extend rather than challenge our central thesis. Szasz, however, is dismissive of our position. As a result, most of our response is directed to his commentary. Ratcliffe uses the work of van der (...) Berg to make the case that any easy distinction between bodily and mental illness or suffering is false to our lived reality as human beings. Of course, in the day-to- day world of contemporary medical practice .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.2 (2002) 187-188 [Access article in PDF] Listening to Foucault Patrick J. Bracken ERICA LILLELEHT'S INTERESTING PAPER combines philosophy, history, service analysis, and social commentary. The philosophical themes are below the surface, implicit rather than explicit. As such the paper echoes the work of Foucault himself. The subjects of his books and other writings ranged from histories of madness and psychiatry, hospitals and medicine, prisons (...) and punishment, to sexuality and ethics. But these were clearly more than histories. In doing what he initially called archaeology and later genealogy, Foucault was writing about different dimensions of how the Western world has come to understand what it is to be human. In Foucault's hands history becomes philosophy. The essence of his work is an invitation to question the project of Enlightenment. However, his interrogation of the legacy of Enlightenment is far from a rejection of reason as has sometimes been claimed. Rather it represents a realization that there are different forms of reason, none of which can claim a place of privilege over others. Foucault challenged the idea that we have to choose to be for or against Enlightenment (Foucault, 1984).Of central concern for him is the idea that knowledge and power imply each other and cannot be separated. This, of course, is anathema to both Marxist and liberal analysts who hold out the idea that truth and ideology are mutually exclusive. The assumption is that if we get the starting point of our analysis right, the truth ("pure and simple") will emerge. For Foucault there are "regimes of truth," discourses through which certain things can be said and statements can be judged as true or false. Such regimes are social products, bound up with the economic, cultural, and political realities of their times. This is not some sort of mindless relativism nor a nihilistic advocacy that, when it comes to knowledge claims, "anything goes." As human beings in an imperfect world we have to struggle continuously toward a better understanding of ourselves and the make-up of this world. As individuals, we have to continue to debate and argue about ideas, facts, and the nature of knowledge. We have to present evidence, argue our case, and prepare to be contradicted as well as supported. This is not in question. Instead, what is involved here is recognition that there is no neutral asocial, acultural, or apolitical vantage point from we can judge the validity of one position over another. Foucault's work nurtures a healthy skepticism of those who claim to have found such a vantage point.Importantly, he rejected the idea that power is always repressive in its nature: working to silence, obscure, and suppress. Particularly in the modern era power is more characteristically productive. Its operations are bound up with the ever-multiplying discourses we produce about ourselves. While increasing scientific knowledge about the human condition appears to represent progress, listening to Foucault means coming to appreciate that things are a great deal more complex. The title of Lilleleht's paper reflects this. At [End Page 187] a time when there is a great deal of talk about "progress" in the area of mental health, her analysis is opportune. Unless we pay attention to the micropolitics of clinical encounters we are at some risk of simply endorsing new forms of professional power. In one light, the psychiatric rehabilitation approach of William Anthony and colleagues appears obviously progressive. It does not depend on the "medical model" and the use of medication and seems genuinely committed to the idea of empowerment. However, with the sort of sensibility engendered through an encounter with Foucault, other issues come into view. Beneath its focus on skills and training we see a very clear normative framework centered on the idea that the person with psychiatric problems should be guided and trained toward fitting in with "his or her particular environment." At stake here is the assumption that the deficit is in the patient. It is he or she who needs to change. Herein lies the issue of power: who is in control of the way in which... (shrink)

We are very grateful to Mona Gupta and Peter Zachar for their commentaries on our paper. In our view, the main challenge for both commentators is this: do they have empirical evidence to refute our rejection (on evidence-based grounds) of the primacy of the current technological paradigm in psychiatry? Although opinions may differ about our choice of the philosophical tools we use to interpret the facts, unless there is good evidence to contradict our basic premise, their arguments will fail to (...) reach the evidence-based medicine (EBM) gold standard that they support. We do not believe their commentaries present any empirical evidence that contradicts our critique. Before we respond, we wish to stress two .. (shrink)