Duncan Double was once suspended from his NHS trust for "deficient"
practice. In a new book which he co-edits Double argues the suspension
was political, largely because he practiced "critical psychiatry",
an approach refuting the biomedical understanding of mental illness.
The book lays out the foundations of critical psychiatry and its
contributors include the most influential names in this field. In
an interview with Adam James, Double talks candidly about
his suspension and argues it is time traditional psychiatry stopped
seeing psychiatrists such as himself as a "threat".
you or I were so distressed to be referred to a psychiatrist, he
or she is unlikely to assist you in the way of Duncan Double, one
of a handful of vocal “critical” psychiatrists working
in the NHS.
of the medical and scientific validity of psychiatric diagnoses
and benefits of psychiatric drugs, such psychiatrists understand
their patients from, they argue, a perspective which is more humane
and less stigmatising. So, for example, they are less inclined to
diagnose schizophrenia for a patient hearing abusive voices and
prescribe anti-psychotics. Instead, they might try to help that
person understand what their voices represent, and work out ways
to help them control such voices.These
men and women have, in effect, taken over the baton of “anti-psychiatry”,
famously represented by the thinking during the sixties and seventies
of psychiatrists and writers Ronald Laing, Thomas Szasz and David
– as Double learnt - opposing the traditional biomedical thinking
on the nature of mental illness, can carry severe consequences.
Despite being a consultant psychiatrist and honorary senior lecturer
at the University of East Anglia’s medical school, Double
was suspended in 2001 for six month from his NHS job. It followed
GPs raising concerns over how Double was working with suicidal patients.
Double says his employers told him his practice was “deficient”
and “unsafe”, that he needed re-training in “organic
psychiatry” and that he must undergo clinical supervision
for one year. Double says he was told that if he did not agree he
would be disciplined.
Double, the stress brought on by the suspension was "absolutely
horrendous” - for him and his family. Yet, with five years
to reflect, Double is adamant that his suspension – which
was supported by his professional body the Royal College of Psychiatrists
– was political. Double says that psychiatrists like him are
seen as a “threat” by the biomedical hegemony gripping
contemporary psychiatric practice.
Double believes that colleague distrust - and outright anger - towards
him was enflamed by two factors. First, Double had launched an “antipsychiatry”
website documenting the approach of critical psychiatry, and secondly,
he was the psychiatrist of Kay Sheldon who, in February 2001, received
an out-of-court settlement of £58,000 from Norfolk Health
Authority after she claimed she was wrongly diagnosed and treated
[by a previous psychiatrist] for schizophrenia over a 15 year period.
Moreover, Double says that the slurs made against his practice were
never formally investigated. “Basically I was regarded as
different,” Double said. “I was using less medication
than many psychiatrists and was not so concerned about arriving
at diagnoses. In the end the person who the Royal College of Psychiatrists
referred me to for retraining in organic psychiatry refused to do
it because, he said, the whole matter was political.”
about the aetiology of mental illness have raged within psychiatry
and academia ever since psychiatry endeavoured to carve itself out
as a medical discipline in the 17th century. The term “critical
psychiatry” was coined in 1980 by David Ingleby, professor
of intercultural psychology at Utrecht University in the Netherlands.
And what critical psychiatry shares with anti-psychiatry is its
refute that the mentally “ill” have an intrinsic brain
disorder and that physical intervention is of highest clinical importance.
Instead, critical psychiatry – similar to Laingian existential
psychology - attempts to understand (and treat) severe distress
within the “psycho-social” context of a person’s
academia, rigorous debate over such philosophy-of-mind concerns
and implications for practice is both expected and encouraged. Within
actual psychiatric practice, however, such critical views can be
demonised, says Double. In fact, this was something Double learnt
early on in his career. When a trainee psychiatrist in Cambridge
he attended seminars to discuss journal articles. During one seminar
he questioned the traditional medical understanding of mental illness.
“I remember my psychiatry tutor saying to me ‘this is
dangerous talk’,” remembers Double. “Yet all I
was doing was trying to work out how we should be psychiatrists.”
an austere rebuff to intellectual enquiry can be contrasted to Double’s
“liberating” years from 1989-92, when he was a lecturer
in psychiatry at the University of Sheffield. At that time, the
department of psychiatry was headed by Prof Alec Jenner, co-founder
of the voluntarily-run radical mental health magazine Asylum (which
this year celebrated its 20th anniversary). “Jenner was in
tune with my views, and there was nowhere else in the country that
I could have gone,” says Double.
despite such a positive experience of academia, Double chose to
combine it with continuing a practitioner path. “If critical
psychiatry means anything it should be involved in practice,”
he stresses. And, in what some might see as an intellectual riposte
to the questioning of his practice incurred by his suspension, Double
is co-editor of a new book, Critical Psychiatry; Limits of Madness.
It traces the philosophical, scientific and historical foundations
of critical psychiatry, and Double contributes three chapters. The
other nine are by some of the leading thinkers and practitioners
in both critical psychiatry and psychology. They include a chapter
by Lucy Johnstone, academic director of clinical psychology at the
University of Bristol, who argues that acts of making psychiatric
diagnoses are social judgement lacking medical objectivity. In a
strikingly similar experience to Double, Johnstone says her dissenting
views on psychiatric practice led to her once being hounded out
of clinical NHS work. Another chapter by psychiatrist Joanna Moncrieff,
senior lecturer in social and community psychiatry at University
College, London, critiques the evidence base for psychiatric drugs;
and Phil Thomas, senior research fellow at the centre for citizenship
and community mental health, University of Bradford, co-writes a
chapter arguing that, under postmodernist scrutiny, psychiatry’s
modernist foundations are untenable.
Critical Psychiatry draws out how critical psychiatry is distinct
from anti-psychiatry which, Double argues, eventually became preoccupied
with exploring existential paths to personal enlightenment rather
than pressing for progressive psychiatric practice. Moreover, Double
says that – unlike anti-psychiatry - critical psychiatry is
willing to engage meaningfully in scientific debate over the validity
of psychiatry’s biomedical evidence base. “Critical
psychiatry engages with the data” is how Double puts it. “I
do see myself as a scientist, and I so see my approach as scientific
– not just in an empirical sense, but a broad sense of making
chapter – entitled The Politics of Psychiatric Drug Treatment
- characterises this “broad” enquiry. It examines how
the billion pound pharmaceutical industry has formed an alliance
with a prestige-yearning psychiatric profession and successive British
governments eager to “transform social and legal problems
[of the mentally ill] into scientific and technical ones”.
One consequence, argues Moncrieff, has been the consistent overplaying
of the benefits of psychiatric drugs. After examining the data on
drug efficacy, Moncrieff concludes: “The psychiatric community
appears to have lost the ability to imagine that life with serious
mental illness is possible, and maybe sometimes better, without
decided to document his suspension in Critical Psychiatry in a bid
to convince mainstream psychiatry that it should not judge psychiatrists
like him as a “threat”. He tells readers: “The
aim is that by the end of the book you will be able to decide for
yourself whether critical psychiatry is really such a threat. In
my view, the book will have succeeded it it makes plain the self-deception,
albeit unconscious, of much of biomedical psychiatry, and encourages
instead a more open mental health practice.”
now - as head of a multi-disciplinary community mental health team
in Norwich, a wealth of journal articles and a co-edited book to
his name - Double should have no fear that the validity of his practice
will again be put under the spotlight? Alas, not so. Double remarks:
“If there were power struggles again [within the trust] it
would be an easy thing to open up again.” Being critical comes
at a price.
Critical Psychiatry; Limits of Madness is published in hardback
on May 19, priced £50, by Palgrave Macmillan (0230001289)
* Critical Psychiatry Network: www.critpsynet.freeuk.com
shortened version of this article was published by the Times Higher
be 'compliant' - as long as it's not just medication
Susanna Wild (requested not to use real name to protect identity),
computer programmer, UK
August 13, 2006
applaud Doube's courage. I was diagnosed as bipolar a year ago at
age 42. I agree that the diagnosis applies to me and feel fortunate
that I became aware of the nature of my problem without undergoing
some of the more obvious and destructive experiences that so many
other patients relate. That said, the impact my symptoms have had
has been considerable and damaging.
accepted medication and conventional treatment for 10 months. I
was fully compliant and cooperative. I followed instructions precisely
and consulted my doctor frequently. Over the course of that time,
my sense was that the cycles of mood and behavior I experience were
not ameliorated by the medication, but that many of the primitive
coping strategies that I'd developed were no longer possible due
to the disorganizing side effects of the medication. Over that period,
I went from a competitively employed person who was deeply troubled,
to an unemployable individual who was unable to think clearly or
function in any area of skill or competency.
went to my doctor and requested a withdraw schedule. I was facing
severe economic circumstances, my savings were gone, I had no private
insurance and I may have been helped by some lingering sense of
what my circumstances would mean to my ability to care for my daughter.
doctor was in deep disagreement with my choice. However, she agreed
to give me a tapering schedule...along with a different perscription
choice. I told her the choice to resume would be made based on the
experience of withdraw, my personal research into the suggested
medication's effectiveness and on my economic ability to support
the medication. As it turns out, even had I chosen to accept the
recommendation, I could not have! afforded it.
was clear of medication in March of this year. My symptoms are still
present, as are my dysfuntional thought patterns and social functioning
deficits. I am again competitively employed in my field. I
am currently undergoing the process of attempting to find legitimate
supportive care for my condition. My feeling is that; as I have
never been in trouble with the law, have never been irrecoverably
financially irresponsible, am not a substance abuser and am able
to function reasonably in society, that I should have the right
to explore options other than medication. I think if my history
included some sort of violence, or if I were to behave in a way
that more than merely irritating to those around me, that the argument
that medication should be a mainstay of my treatment would be more
have asked to maintain contact with my doctor. My feeling is that
this will provide a 'safety net' and motitoring in the event I am
unable to appreciate my symptoms' severity. I have also begun biofeedback
in an effort to control anxiety, attentional issues, and to increase
my sense of self control. I requested a referral for a cognitive
therapist to work on life skills and social issues that I face.
felt this was responsible and had a chance of being helpful. Biofeedback
has been a success...the nurse training me is affiliated with my
doctor's practice and has expressed satisfaction with my progress.
my other request for referral for cognitive therapy has so far been
ignored. And at my recent biofeedback appointment, the nurse took
the opportunity to harangue me about the need to go back on medication.
I asked if she felt my present behavior was in any way inappropriate
or concerning. She said it was not. Yet, she persisted in attempting
to frighten me about what I could expect if I did not resume medication.
did explain my reasoning! and experiences on medication to her.
Primarily I feel that I am functional at the moment and unwilling
to do anything which may impact my employment, my ability to care
for myself and my daughter, or which might worsen my condition.
I explained that the side effects of the medication previously taken
had impacted on those goals seriously. I told her I'd consider her
left feeling somewhat upset. I have significant doubts about my
own perspective. I had hoped that my treatment providers would be
a good 'reality check' for me. But if I am to be given advice based
on theory rather than on observed behavior...it really defeats the
trust I have in when I may need to rely on their judgment to resume
a medication. I also felt belittled and a bit offended.
sense is that, during the phase of treatment where I was medicated,
any loss of function, cognitive impairment, employment impact, etc.
would be considered acceptable so long as I was on the medication.
And, that it is still viewed in this way.
I'm having a crisis of sorts. All the standard medical advice supports
the doctor's view. Many patient experiences do detail very terrible
results for patients that are not medicated. I'd be a fool to ignore
this. Yet, my personal view is that I may not be unreasonable in
trying to seek to be compliant in 'treatment' rather than merely
is very difficult for me to find mention of a physician willing
to guide this process enthusiastically. It is equally difficult
to have to sort out the quackery from things that might actually
help me manage myself more effectively. And, I feel an enormous
lack of self confidence in the matter.
notion that someone might be pursuing a legitimate alternative treatment
paradigm to offer patients seems highly encouraging to me.
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