Transcript Mental Health Revolution

Mental Health Revolution
Pat Bracken
RCPsych Oct 28th 2008
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
Che Guevara
Killing Fields of Cambodia
John Gray
• “the world in which
we find ourselves at
the start of the new
millennium is littered
with the debris of
utopian projects”
Copernicus
Kuhn: paradigms
‘when paradigms
change, the world
itself changes with
them’
Technological Approach
Medical
model
Cognitive
approaches
Technological Approach
Language of
Management
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.
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).
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
Why is Technological Paradigm
dominant?
• Cultural support
• Patient expectations
• Underscores professional roles
• Pharmaceutical industry
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’
Why is Technological Paradigm so
dominant?
• Cultural support
• Patient expectations
• Underscores professional roles
• Pharmaceutical industry
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
20th Century Psychiatry
Social
position
Cultural
issues
Focus on
technology of
diagnosis and
treatment
relationships
Ethics and
values
Direction of Revolutionary
Change
Training
priorities
Use of drugs
and therapy
Appropriate
Discourse
research
centred on:
-values/ethics
Service
-meanings/contexts
models
-relationships/power
Challenges to technological
paradigm
• Postmodern culture
• Changing understanding of technology
itself
• Moves away from the embrace of Pharma
Why Revolution is Justified
• Empirical evidence
• Conceptual analysis
• Political reasons
• Ethical imperative
CBT
‘little evidence that specific cognitive
interventions significantly increase
the effectiveness of the therapy’
(Longmore and Worrell, 2007)
Why Revolution is Justified
• Empirical evidence
• Conceptual analysis
• Political reasons
• Ethical imperative
Psychiatry and Philosophy
Why Revolution is Justified
• Empirical evidence
• Conceptual analysis
• Political reasons
• Ethical imperative
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.
Mad Pride in Cork
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’.
Implications for Psychiatry
• Rethinking psychopathology
• A different understanding of expertise
• Training
• Research
• Service developments
Insights from Recovery Literature
1. Recovery often made through paths that
are alternatives to drugs and
psychotherapy
2. Importance of loss of social position that
comes with being a service user
3. Community development approach
Relationship with service user
movement
From Consultation to collaboration