Critical Psychiatry: what is it and what does it claim?

Psychiatry, the medical specialty that is responsible for detecting and treating mental illnesses, has gone through a crisis important in recent times due to the emergence of different questions about the characteristics of their knowledge and practices.

Critical Psychiatry has emerged from these questions., a theoretical current that questions and seeks to reform the practices of psychiatric care. Among other things, it shows that traditional psychiatry has some fundamental limits in the way understanding and dealing with mental suffering, which specifically generates ethical dilemmas in the use of its knowledge.

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Where does Critical Psychiatry come from?

One of the most recent precedents is the Critical Psychiatry Network conference. Critical Psychiatry) held in Bradford England in 1999, where the need for promote a radical transformation in our approach to mental health problems; to which thousands of professionals around the world have subscribed, mainly through academic publications, but also through political mobilization.

Along the same lines, Critical Psychiatry has many of its antecedents in antipsychiatry, a theoretical and political movement promoted by health professionals. that began in the second half of the last century and that firmly questioned the way in which psychiatry operated, especially in Europe and the United States. Joined.

Although anti-psychiatry and Critical Psychiatry are movements that emerged at different times, what they have in common is that reject the pathologization of human heterogeneity and remain committed to transforming mental health care.

Finally, this current has been promoted by different associative movements in the first person, that is, groups managed by the users of the care services psychiatric. For example, the British collective Hearing Voices Network (Hearing Voices) who reject the traditional psychiatric understanding of such an experience, also seeking to eliminate the stigma and strengthen mutual aid groups.

The foregoing is subsequently articulated with the rights paradigm that has been formalized since 2006 in the International Convention on the Rights of Persons with Disability approved by the United Nations Organization, as well as through other documents and reports on the prevention of torture in psychiatry that have been developed in different countries.

fundamental principles

In general terms, Critical Psychiatry seeks to make visible the intersection between psychological, social and somatic relationships, both of the people and of the psychiatric practice itself, so that it is possible to reform it.

More specifically, we can follow Philip Thomas (2013) to list five topics of discussion that emerge from Psychiatry. Criticism: the problem of psychiatric diagnoses, the problem of evidence-based medicine in psychiatry (and its relationship with the pharmaceutical industry), the role of the context in which psychiatry develops and acts, the problem of coercive practices, and finally, the theoretical and philosophical basis of psychiatric knowledge and its practices.

1. The problem of psychiatric diagnoses

Critical Psychiatry makes visible that the barriers between “normality” and “disorder” are easily manipulated and largely arbitrary. In fact, frequently the number of psychiatric diagnoses available varies; these appear and disappear and are updated from time to time (some of them every time the same diagnosed population demonstrates against being considered sick or deranged, for example, what happened to homosexuality, which until barely the second half of the last century ceased to be considered a mental disorder).

Likewise, the scientific bases of psychiatric diagnosis began to be questioned because although organic substrates have been found, the scientific evidence that postulates that mental disorders have a biological origin and a definitive cure in the same sense, is insufficient.

2. Evidence-based medicine and the pharmaceutical industry

Evidence-based medicine is a concept that refers to medical practice based on the clinical trials, statistics, and manuals that offer generic information about a condition determined.

This has been questioned by Critical Psychiatry, since the causes of mental disorders are non-specific, and evidence-based medicine can promote and generalize practices that are also unspecific, but also potentially harmful in some senses, because in psychiatry practices are par excellence direct intervention (pharmacological or mechanics).

Likewise, on many occasions the diagnoses and pharmaceutical treatment are strongly influenced by economic interests of the industries in charge of producing and distributing drugs, as well as financing a large part of the training of professionals. This has been highly debated in recent decades by an important sector of mental health professionals around the world.

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3. The context of psychiatry

The range of psychiatric diagnoses is related to the context in which they are made, that is, it varies the percentage of people to whom certain problems are attributed according to the specific population to which belong.

The same psychiatric practice is within a social context, which means that in the diagnosis and in the care relationship, ideologies are reproduced and ways of relating; and that mental suffering is more than an individual experience, it is an experience that has to do with the conditions of possibility or vulnerability of the same environment.

4. coercive practices

Among the strongest criticisms of psychiatry since the last century are the internment forced psychiatric hospital and restraint practices such as restraints, electroconvulsive therapy and overmedicalization.

Far from being conceived as a set of techniques (and therefore free of values), Critical Psychiatry seeks to constantly review the practices that are promoted and their possible harmful effects (from intrinsic paternalism in clinical practice to stigmatizing attitudes or explicitly aggressive practices).

In many contexts, alternatives have been promoted that range from the closure of psychiatric hospitals or the gradual demedicalization, to the creation of community centers and the reinforcement of mental health that is promoted in a more collective and less coercive.

5. Theoretical and philosophical basis of psychiatry

critical psychiatry questions the mind-body dualism that underlies traditional biomedical psychiatry, as well as the biologist ideology that reduces mental health and illness to the molecular sciences of the brain.

The latter causes a series of social demands to be considered where psychiatry was positioning itself as the only or the best solution to understand people's problems; which many times it translates into the omission of affective, social or economic deficiencies promoted by social structures.

Finally, and given that care for mental health problems is a global phenomenon, despite having been generated and promoted with Based on the needs of the European and American context, the current of Critical Psychiatry has had repercussions around the world.

However, this is not the only criticism that has been leveled at traditional psychiatry. For example, in the social sciences such as anthropology, social psychology or sociology in Latin America, the forms of community health care (including mental health), as well as pre-Hispanic ways of understanding what we now call "disorder" or "disease". mental"; along with deficiencies in institutional care and in more traditional mental health services.