Lecture 22: Critical perspective on mental health

Question 1

Problems with the evidence

Answer 1

• ‘Aetiology of most mental illness remains obscure & its treatments are largely symptomatic and generally of dubious efficacy’
• “‘No biological sign has ever been found for any ‘mental disorder’”
• “Psychiatric diagnoses are scientifically worthless as tools to identify discrete MH disorders”
• Increase in mental health problem rates = epidemic of mental illness

Question 2

Problems from the history

Answer 2

• “Psychiatry is the ultimate rulemaker of acceptable behaviour through its ability to specify what counts as ‘crazy’”
• “Psychiatric diagnosis can be understood as functioning as a political device, in sense that it legitimates a particular social response to aberrant behaviour of various sorts”
• Science that reflects norms and values of society at the time

Question 3

Psychiatry bad, Psychology good?: (Bio) medical approaches

Answer 3

• Deals with the ‘illness’
• Problems is within the individual
• Focuses on ‘symptoms’
• Need to categorise, relate findings to theory
• Aims to return patient to previous state
• Staff feelings marginalised/ignored

Question 4

Psychiatry bad, Psychology good?: Psychtherapeutic approaches

Answer 4

• Deals with the person
• Problem seen in relationship/cultural context
• Focuses on meanings
• Need to understand, form a relationship
• Sees opportunity for learning and growth
• Staff feelings acknowledged and supported

Question 5

Problems with therapy I: lack of supporting evidence

Answer 5

• Lack of evidence that therapeutic interventions ‘help’ people more than no intervention
• No specific form of therapy has been proved more effective than another
• A rare, successful outcome in therapy depends on individual personality of therapist
• Despite lack of evidence that therapy ‘works’, the ‘psychologization’ of society continues…
• Potential for spontaneous remission, ‘placebo effect’

Question 6

Problems with therapy II: Dubious efficacy

Answer 6

• Blaming the victim
• De-politicising/ignoring the social
• Therapist misinterpretations
• Power differentials in therapy
• Devaluing of client experience
• (Dubious) training, qualifications, experience
• Dependency
• Length of treatment/cost
• Emotional, physical, and sexual abuse

Question 7

Summary

Answer 7

• Forget your training and avoid being a dogmatic psychologist
• Avoid use of DSM and psychiatrist labels whereever possible
• Avoid biomedical and social reductionism in your encounters
• Avoid essentializing people’s experiences of distress
• Be reflexive: consider how your social class, education etc. may effect your judgements in the clinical setting
• Acknowledge the limits of therapy