Psychiatry, a medical specialty that deals with the detection and treatment of mental illness, has undergone a major crisis in recent times due to the emergence of various questions about the characteristics of its knowledge and practices.

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

Where does Critical Psychiatry come from?

One of the most recent antecedents is the conference of the Critical Psychiatry Network held in Bradford England in 1999, where the need to promote a radical transformation in our approach to mental health problems was discussed ; this has been endorsed by thousands of professionals around the world, mainly through academic publications, but also through political mobilization.

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

Although antipsychiatry and critical psychiatry are movements that arise at different times, what they have in common is that they reject the pathologization of human heterogeneity and maintain the commitment to transform psychiatric care.

Finally, this trend has been driven by different associative movements in the first person, that is, groups managed by the users of psychiatric care services. For example, the British collective Hearing Voices Network, which rejects the traditional psychiatric understanding of this experience, and seeks to eliminate the stigma and strengthen mutual aid groups.

The above is subsequently articulated with the rights paradigm that has been formalized since 2006 in the International Convention on the Rights of Persons with Disabilities approved by the United Nations, 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 people and of psychiatric practice itself, in such a way that it is possible to reform it.

More specifically, we can follow Philip Thomas (2013) to list five topics of discussion that emerge from Critical Psychiatry: 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 where psychiatry develops and acts, the problem of coercive practices, and finally, the theoretical and philosophical basis of psychiatric knowledge and 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 every so often (some of them each time the same diagnosed population manifests itself against being considered sick or disturbed, for example, what happened with homosexuality which until only the second half of the last century was no longer 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 clinical trials, statistics and manuals that provide generic information about a given condition.

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

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

3. The context of psychiatry

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

Psychiatric practice itself is found within a social context, which means that in the diagnosis and in the care relationship, ideologies and forms of relationship are reproduced; and that psychic suffering is more than an individual experience, it is an experience that has to do with the conditions of possibility or vulnerability of the environment itself.

4. Coercive practices

Among the strongest criticisms of psychiatry since the last century are forced psychiatric internment and containment 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 the paternalism intrinsic to clinical practice to stigmatizing attitudes or explicitly aggressive practices).

In many contexts, alternatives have been promoted, ranging from the closure of psychiatric hospitals or gradual de-medicalization, to the creation of community centres and the strengthening of mental health that is promoted in a more collective and less coercive manner.

5. Theoretical and philosophical basis of psychiatry

Critical Psychiatry questions the mind-body dualism that underpins traditional biomedical psychiatry, as well as the biological ideology that reduces mental health and illness to the molecular sciences of the brain.

This last makes them consider a series of social demands where psychiatry was positioning itself as the only or the best solution to understand people’s problems; which often translates into the omission of affective, social or economic deficiencies promoted by social structures.

Finally, given that attention to mental health problems is a globalized phenomenon, despite having been generated and driven by 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 made of traditional psychiatry. For example, social sciences such as anthropology, social psychology or sociology in Latin America have recently researched community-based forms of health care (including mental health), as well as pre-Hispanic ways of understanding what we currently call “disorder” or “mental illness”; on a par with the shortcomings of institutional care and more traditional mental health services.

Bibliographic references:

  • Critical Psychiatry (2018). Psychiatry in transition- Critical Psychiatry Network 2017 conference report. Retrieved April 17, 2018. Available at http://www.criticalpsychiatry.co.uk
  • Hearing Voices Network (HVN). (2018). The aim of the network. Hearing Voices Network for people who hear voices, see visions or have other unusual perception. Retrieved 17 April 2018. Available at https://www.hearing-voices.org
  • Nmucia (2017). About (unsettling) evidence-based medicine (By Germán Barrios). Platform No Thank You. Recovered April 17, 2018. Available at http://www.nogracias.eu/2017/01/29/acerca-de-la-inquietante-medicina-basada-en-la-evidencia-por-german-barrios/
  • Ortiz, A. (2013). Towards a critical psychiatry. Editorial Group 5: Spain
  • Thomas, P. (2013) What is Critical Psychiatry? Mad in America: science, psychiatry and social justice. Retrieved April 17, 2018. Available at https://www.madinamerica.com/2013/01/what-is-critical-psychiatry/
  • Thomas, P. (2013). What is Critical Psychiatry? Retrieved April 17, 2018. Available at https://discapacidades.nexos.com.mx/?p=113#_ftnref1
  • Vásquez, A. (2013). Anti-psychiatry. Deconstruction of the concept of mental illness and criticism of “psychiatric reason”. Nomads. Revista Crítica de Ciencias Sociales y Jurídicas, 31: http://dx.doi.org/10.5209/rev_NOMA.2011.v31.n3.368
  • Desviat, M. (2006). Antipsychiatry: a critique of psychiatric reasoning. NORTH Mental Health, 25: 8-14
  • Moncrieff, J. (2005). Psychiatry and the pharmaceutical industry: who pays the piper? Psychiatric Bulletin, 29: 84-85