Anti-psychiatry Research Articles

From Interiority to Intimacy: Psychoanalysis and Radio in Twentieth-Century France

From Interiority to Intimacy:Psychoanalysis and Radio in Twentieth-Century France Judith G. Coffin (bio) In 1967, Radio Luxembourg recruited Menie Grégoire, well known for her journalism, her expertise on “women’s” issues, and her keen interest in psychoanalysis, to host an audience write- and call-in program on the airwaves. Her radio-therapeutic conversations quickly displaced the advice-from-experts programs and family radio dramas that had been staples of Radio Luxembourg since the end of World War II. Radio Luxembourg was a privately owned “radio périphérique”; its shows were produced in Paris, cabled to Luxembourg, and broadcast out. The program reached deep back into France. By 1970, nearly 2.5 million listeners were tuning in to Grégoire, and thousands of them were writing and calling her program. With the systematizing ambition of a social scientist, Grégoire saved and classified the letters she received (nearly one hundred thousand over fifteen years) and took notes on the telephone calls (around sixteen thousand), aiming to create in the process something like a chart of her interlocutors—what one sociologist calls a “geography of the interior” (Ecrits et Cris de la vie, 6, 35; Maréchal, 218).1 Historians can mine Grégoire’s archive for testimony on countless subjects, from provincial culture to the reverberations of 1968 and the changing politics of sexuality. Her notorious 1971 confrontation with gay activists during a live broadcast from the Salle Pleyel in Paris became a French Stonewall, a flashpoint for gay liberation and the whole anti-psychiatric movement.2 But the program was above all a phenomenon of radio and radio’s history. Virtually all the aspects of Grégoire’s enter-prise—her psychoanalytic self-presentation, the audience-participation format, the letters from listeners, and the careful archiving of those letters in the name of sociology and audience research—represent a bundle of ambitions and projects that were central to radio for most of the [End Page 114] twentieth century. Examining even one part of it, as I do here, namely her conception of radio as a psychoanalytic “adventure into the interior,” reveals remarkably enduring conceptions of radio’s power and purpose and throws into relief the historical moments that reshaped those conceptions. It has been more than a decade since Vanessa Schwartz’s influential and compelling “Walter Benjamin for Historians” underscored the centrality of the image to Benjamin’s conception of modernity and summoned historians to turn toward the visual. As Schwartz herself points out, the transformations of culture, human perception, and experience that Benjamin pegged to modern times in “The Work of Art in the Age of Mechanical Reproduction”—a felt collapsing of distance sensory vulnerability, new and more distracted forms of reception, the reconstitution of art as an “object for simultaneous collective experience” and a “change in the mode of participation” in culture—were attributed by many, including Benjamin, to audio as well as to visual media and technologies (1723; Benjamin, 222–23, 228–29).3 Moreover, the qualities that Benjamin’s contemporaries (for reasons we will discuss later) attributed to the auditory in particular—suggestiveness, vulnerability, and interiority—were no less central to the modern self or constitutive of modernity (Connor). Radio proved a powerful magnet to twentieth-century modernists. Radio studios drew in artists and writers from the French surrealists to Benjamin, Carpentier, and Beckett. The “new mental world created by radio” seized the imaginations of modernists in the social sciences, whether psychology, psychoanalysis, sociology, or critical theory. The Princeton Radio Research Project, founded by Paul Lazarsfeld in 1937, attracted an eye-popping array of thinkers, including Hadley Cantril, Gordon Allport, Theodor Adorno, Max Horkheimer, and Rudolf Arnheim; the Radio Research Project is but one example of the multidisciplinary fascination with radio and the psychological, political, and commercial possibilities it presented. Not surprisingly, interpreting twentieth-century modernism’s interests in radio as well as, more broadly, communication, sound, hearing, and listening has proved an enormous project, and studying radio’s significance has helped to fuel what deserves to be called a “sonic boom” across the humanities and social sciences. I am interested here in Grégoire’s conception of radio as a distinctively...

“If I Could Drive You Out of Your Mind”

The article explores the glorification of madness within the 1960s counterculture. Given the movement’s appreciation for absurdity and nonconformity, it appeared natural that its members would come to applaud mental illness as the ultimate form of rebellion, embracing mad people as a group whose presence posed a collective challenge to “the Establishment.” Some counterculture members went so far as to embrace the anti-psychiatry movement, which sought to de-medicalize madness, and interpret psychotic episodes like spiritual journeys or acid trips. Literary works of the era upended the typical dichotomy of sanity and insanity by positing that it was the mad who better comprehended what was really happening in their society. However, while these works may have made some members of their audience more open toward madness as a concept, they did little to affect beneficial political change to reform conditions for those experiencing their daily reality with mental illness.

The development of the therapeutic community for addictions in Denmark. A short report based on an interview with Hanne Holm Hage-Ali

Purpose– Even though there is much information available with regard to the development of the therapeutic community (TC) for addictions in Europe, little is known about the particular situation in Denmark.The paper aims to discuss this issue.Design/methodology/approach– In order to address this dearth, the methodology of the following historical account is largely based on an interview and personal contacts with Hanne Holm Hage-Ali, current director of TC Opbygningsgården and star witness of the development of TC in Denmark.Findings– In 1971, the Freetown “Christiania”, Copenhagen, where TC Opbygningsgården started up, was based on communal, anarchic and hippie ideas and values. In the beginning, TC Opbygningsgården was not well accepted by TC pioneers promoting the classic hierarchical TC, as it was seen as a social experiment with anti-authoritarian roots. Later, in its turn, it became influenced by TCs Veksthuset and Phoenix House Haga, Norway, which were part of the common European TC movement. At this moment, TC Opbygningsgården functions as a well-accepted member of the European Federation of Therapeutic Communities.Research limitations/implications– The interview revealed information that it is line with current trends in and challenges for TC throughout Europe, as outlined in a recent EMCDDA study: TC in Europe can be considered as “children of the late sixties”; TCs are embedded in the anti-psychiatric movement, existentialism and the promotion of alternative community living; European TC leaders had different origins and professional background; and the TC never belonged to one religion or ideology. The common human value system always transcended the different visions.Originality/value– This paper aims at addressing the dearth in knowledge on the development of TCs in Denmark.

Photography and radical psychiatry in Italy in the 1960s. The case of the photobook Morire di Classe (1969).

In the 1960s Franco Basaglia, the Director of a Psychiatric Hospital in a small city on the edge of Italy (Gorizia), began to transform that institution from the inside. He introduced patient meetings and set up a kind of Therapeutic Community. In 1968 he asked two photographers – Carla Cerati and Gianni Berengo Gardin – to take photos inside Gorizia and other asylums. These images were then used in a photobook called Morire di Classe (To Die Because of your Class) (1969). This article re-examines in detail the content of this celebrated book and its history, and its impact on the struggle to reform and abolish large-scale psychiatric institutions. It also places the book in its social and political context and as a key text of the anti-psychiatry movement of the 1960s.

The Surgical Elimination of Violence? Conflicting Attitudes towards Technology and Science during the Psychosurgery Controversy of the 1970s.

In the 1970s a public controversy erupted over the proposed use of brain operations to curtail violent behavior. Civil libertarians, civil rights and community activists, leaders of the anti-psychiatry movement, and some U.S. Congressmen charged psychosurgeons and the National Institute of Mental Health, with furthering a political project: the suppression of dissent. Several government-sponsored investigations into psychosurgery rebutted this charge and led to an official qualified endorsement of the practice while calling attention to the need for more "scientific" understanding and better ethical safeguards. This paper argues that the psychosurgery debate of the 1970s was more than a power struggle between members of the public and the psychiatric establishment. The debate represented a clash between a postmodern skepticism about science and renewed focus on ultimate ends, on the one hand, and a modern faith in standards and procedures, a preoccupation with means, on the other. These diverging commitments made the dispute ultimately irresolvable.

Deinstitutionalization in Italian psychiatry - the course and consequences Part II. The consequences of deinstitutionalization

The Italian mental health care is based on Law 180 (it. Legge 180), also called Legge Basaglia, from the name of the author of the reform, Franco Basaglia. It was adopted on May 13th 1978. The new legislation resulted from the actions of a strong anti-psychiatric movement and it brought about a major change in the organization of psychiatric care. The reform and its consequences were widely studied by the researchers, especially in the United Kingdom and the United States of America. The authors point out many successes of the reform, especially in its beginning. They seek the sources of its failure in a faulty and incomplete implementation. Legge Basaglia completely changed the structure of mental health care in Italy, finally bringing psychiatry back to medicine and the general hospitals, as well as promoting community-based psychiatry. Deinstitutionalization in Italy was not related to an increase in compulsory psychiatric hospitalizations, suicide attempts by the mentally ill, nor did it raise the number of crimes committed by them. It also did not cause common trans-institutionalization, with the transfer of patients to the private sector, as predicted by its opponents.

Lieberman Says it’s ‘Our Time’ for Equity and Fairness in Mental Health

Back to table of contents Previous article Next article Professional NewsFull AccessLieberman Says it’s ‘Our Time’ for Equity and Fairness in Mental HealthMark MoranMark MoranSearch for more papers by this authorPublished Online:12 Jun 2013https://doi.org/10.1176/appi.pn.2013.6b28AbstractThe new APA president cites astonishing advances in psychiatric research and a broad acceptance of the importance of mental health as reasons to be optimistic. This is “our time,” said incoming APA President Jeffrey Lieberman, M.D.—time for psychiatry to seize on its advantages and realize a long-deferred dream of equity and recovery for people with mental illness. David HathcoxSpeaking at the Opening Session of APA’s 2013 annual meeting in San Francisco last month, Lieberman said he was angry about the continued stigma associated with mental illness and disparagement of psychiatry in some quarters.Quoting the 1976 movie “Network,” he said he was “mad as hell and not going to take it” anymore. “Although I saw this movie 37 years ago, I have recently thought about that scene in ‘Network’ because as I view what is happening to the field of psychiatry and all of mental health care, I feel ‘mad as hell, and I don’t want to take it anymore.’ The truth be told, that is why I ran for APA president—because I felt mad and wanted to use all of the power and influence of APA to speak up and stick up for our profession and our patients. “Throughout my career, I have been acutely sensitive to the stigma associated with mental illness, the disparities in mental health care, and the lack of respect toward psychiatry as a medical specialty,” Lieberman said. “I suppose there might have been a time when psychiatry wasn’t as scientifically based as it should have been. But that was then, and now is now. For such attitudes and practices to persist in the 21st century is nothing short of discriminatory and prejudicial.” But persist they do, he said. Lieberman noted that the mental health parity law was signed in 2008, yet no final rule on its implementation has been issued. He added that the recession of 2008 has gutted public mental health systems and encouraged private and voluntary hospitals to cut psychiatric services, as at Cedars Sinai Hospital in Los Angeles, which closed its psychiatry department. “The pharmaceutical industry has all but abandoned the development of novel psychotropic drugs,” he said. “And DSM-5 has become a lightning rod for self-styled critics and the antipsychiatry movement. Mental illness is alternatively feared too much or not taken seriously enough, and psychiatry continues to be a punch line for jokes.”Yet at the same time, Lieberman said, he felt profoundly optimistic about the future. “From a public-health perspective, people and policymakers alike have finally started to realize that brain diseases and mental disorders are among the most important causes of disability in our society,” Lieberman said. “And then there’s the amazing science. The scientific foundation of psychiatric medicine has grown by leaps and bounds in the last 50 years. The emergence of psychopharmacology, neuroimaging, molecular genetics and biology, and the disciplines of neuroscience and cognitive psychology have launched us into the mainstream of medicine and on a course for future growth and success. Though not everyone, including ourselves, is satisfied with the rate of our field’s progress, no one can argue with one simple fact—if you or a loved one suffers from a mental illness, your ability to receive effective treatment, recover, and lead a productive life is better now than ever in human history….“It is for these reasons that despite the lingering effects of stigma and inequity, I say that this is our time, and our time is within our professional lifetimes,” Lieberman said. He urged members individually and collectively to fight for the rights of patients and respect for the psychiatric profession. He pointed out that APA has a key role to play in this process. “APA is our best weapon in the fight for respect and equality both for our patients and our profession,” he said. “Therefore, I am calling on APA to redouble its efforts in representing our profession both inside the Beltway and across the country at the grassroots level of the membership and district branches. This is the time for us to seize the moment, for mental illness to step out of the shadows, for mental health care to be made accessible and fairly reimbursed, and for psychiatry to take its rightful role in the field of medicine.” ■Lieberman was interviewed by Psychiatric News Editor-in-Chief Jeffrey Borenstein, M.D., during the annual meeting. To watch the video, go to http://www.youtube.com/watch?v=mctrZtjvFrU. ISSUES NewArchived

Acompanhante terapêutico: caracterização da prática profissional na perspectiva da análise do comportamento

O Acompanhamento Terapêutico é uma atuação clínica nascida dos movimentos político-ideológicos da Antipsiquiatria. Boa parte da literatura tenta construir um perfil para o acompanhante terapêutico a partir do seu surgimento e contexto histórico. Entretanto, ainda não se chegou a um consenso científico, apesar de existirem alguns fatores característicos. A prática diversificada dificulta a identificação das variáveis e,consequentemente, a construção de um conceito definitivo. Com o objetivo de caracterizar o acompanhamento Terapêutico sob a perspectiva da Análise do Comportamento, fez-se uso de descrições do trabalho desse profissional. Foram participantes treze acompanhantes terapêuticos, de ambos os sexos, atuantes na cidade de São Paulo, submetidos a uma entrevista semiestruturada. Os resultados foram analisados em quatro dimensões de análise, as quais foram desmembradas em categorias e itens. Notou-se, diante dos dados, que o perfil do Acompanhamento Terapêutico está em constante mudança e que caracterizá-lo implica a observação de variáveis aqui discutidas.

Addiction Diagnoses as Involvement Controls

There is a long, though now dormant, dispute between sociology and psychiatry. The most famous antagonism came with the antipsychiatry movement, which sought to disqualify mental illness explanations as “false,” as naïve and simplistic objectifications of complex interactional processes. Effectful as this antagonism was, it effectively pulled up walls between psychiatry and sociology that remain visible today. A contemporary sociological appraisal can transcend this conflict by resuscitating old insights generated by Erving Goffman, who famously stated that did psychiatry not exist, we would have to invent it (1971). To Goffman, as to pragmatists at-large, meanings are social products. That not only applies to the biomedical vocabulary, but also to any vocabulary critics wish to put in its stead, making the constructionist argument toothless for critical purposes (cf. Fish 1989). Rather than debate their truth or falsehood, pragmatists focus on the social contexts and situations in which they arise and on what is achieved by them in these concrete situations.Psychiatric categorizations of people can then be reframed as a tool to mend broken situations where sociation was in severe disarray in ways that protect valuable social realities: placing the causal source of the disarray in people’s bodies provides a clear pinpoint for influence work. It is often a last effort to affect actors whose justifications have retreated into “internalisms” such as “feelings” that became unreachable for other social negotiations of meaning or those who have changed behavior in ways that make them unpredictable or predictable in unwelcome ways. This is not an abstract unpredictability or unwelcome predictability, but one only to those who expect different roles from them.This dynamic is well visible in the case of what the biomedical model now calls “Internet addiction.” The paper will apply Goffman’s work on mental illness as a disturbance of the order of “place” to this contemporary expansion of the diagnostic canon. Place is here negotiated via time: “Internet addiction” is ascribed to those whose priorities concerning their time management worry, sadden and anger others. These others define their relationship and other activities functional to that relationship (i.e. concern with professional and social duties) as “high priority” and seek to enforce this priority over other uses of time that they mark as “useless,” as “a misdistribution of time.” The illness vocabulary is thus a practical tool to socially control and enforce “correct” time-management when other tools fail.

History, philosophy and practical psychiatry

When working in the field of history and philosophy of psychiatry, one will sooner or later be confronted with the sceptical question of whether there is any practical use of such activities for psychiatry – both as a therapeutic discipline and as a continuously growing area of research. This year's history and philosophy section provides the readers with five reviews that address this issue from quite different perspectives, while they share (and, in a way, prove) the basic attitude that theoretical and practical levels of psychiatry are intertwined much more closely than one usually realizes.Focussing on the history of psychiatric institutions, Engstrom concludes that the shift from the carceral narrative of earlier decades to the present interest in the extramural dimensions of psychiatric work should not undermine the need for thorough research into the changing, but still important, roles of institutions. Haack and Kumbier review the literature on the concept of social psychiatry and its multifold, albeit often contradicting, practical consequences, for example, for professional role models or the interplay of different methodological approaches like neurobiological and psychopathological ones. They provide a broad range of perspectives from the 19th century to the reform and antipsychiatry movements in the second half of the last century and to the very recent developments in the interprofessional organization of psychiatric care.The latter aspect is emphasized by Jaeger and Hoff, who summarize and comment on recent articles on the recovery model. This concept, increasingly popular and widely used, but still partly fuzzy, enriches the classical symptom-oriented approach (the medical model, so to speak) by focusing on the patient's (and, not to forget, the relatives’) perspective and initiative. In this case, attention is not so much invited to the historical, but to the ethical and anthropological, dimension of psychiatric work.Two reviews show how intensely, but often implicitly, shifts in theoretical frameworks may alter clinical practice: Millard elucidates the evolving conceptualization of deliberate self-harm in postwar Britain. This is by no means only a matter of theoretical consideration, as it strongly reflects profound changes in the organization of mental healthcare. These changes made the ‘stories behind physical injuries’ accessible and interesting to psychiatrists and researchers. Woodbridge-Dodd's review of recent publications on values-based practice in mental health and psychiatry opens two perspectives: in the first place, she reports on new practical and research options made possible by implementing the dimension of values into basic psychiatric work. In the second place, this approach in itself is debated as connected with certain values, especially with a radical liberal approach – values that also have to be (and, indeed, are) acknowledged and discussed.The section editors hope that readers will arrive at a similar conclusion as they did: the complex interface between the historical and philosophical underpinnings of psychiatry on the one hand and its practical dimensions of diagnosis, therapy and research on the other hand has developed into a stimulating and rich scientific area that successfully operates within and beyond classical methodological or conceptual frameworks. In other words: the practical relevance of these topics for psychiatry is no longer in question.

The Antipsychiatry Movement: Dead, Diminishing, or Developing?

It has been argued recently that the antipsychiatry movement has transmogrified into a patient-based consumer movement. Instead, the author suggests, various activities and ideas that legitimately could be described as antipsychiatry, or, at least, as highly critical of psychiatry, are burgeoning. These activities include the works of intellectual scholars, such as disgruntled psychiatrists, critical social scientists, and humanistic psychologists; the analyses and writings of high-profile and prominent investigative journalists; blogs, Web sites, and social media that communicate a disdain for psychiatry among citizen Internet activists; and the ongoing, well-documented critique of followers of Scientology. The author concludes that a renewed yet amorphous critique of psychiatry is emerging, even though the tarnished name of antipsychiatry is studiously avoided by all. This critique may intensify, given the likely media and public interest surrounding the upcoming release of DSM-5.

Madness Is Civilization: When the Diagnosis Was Social, 1948–1980by StaubMichael E.. Chicago, University of Chicago Press, 2011, 264 pp., $40.00.

Madness Is Civilization: When the Diagnosis Was Social, 1948–1980by StaubMichael E.. Chicago, University of Chicago Press, 2011, 264 pp., $40.00.

‘Sans teeth, sans eyes, sans taste, sans everything:’ resourcing mental health services for older people

For mental health services in the UK, older people are frequently defined as being over 65 years, although most people at that age are by no means old in terms of health, attitudes or behaviour. Systematic development of old age psychiatry services began during the 1970s with a handful of psychiatrists who had seen the benefits of active treatment. Almost immediately, these barely emerging services were hit by the financial effects of the oil crisis. By contrast, economic stability in the 1960s had allowed the more established disciplines of geriatric medicine and ‘general’ psychiatry to make some headway in creating modern clinical services. For example, as a proxy measurement of service development, in 1968 there were 178 geriatric medicine consultants compared to about 6 in old age psychiatry. For psychiatry, there were other influences generating change, such as the anti-psychiatry movement which was strongly focussed on younger people. The needs of mentally ill older people were largely overlooked, and lagged behind in terms of resources. There are good reasons for having dedicated old age services. First, the incidence of the various dementias begins to rise steeply at around 65 years, so clinical teams need specific skills to ensure accurate diagnoses and appropriate support and treatment. Second, as people age they are increasingly likely to have multiple diagnoses which require expertise to manage them alongside the mental illness. Third, discussion among mental health staff indicates that the agegroup of patients with whom they wish to work is important to them. Usually, general adult psychiatrists do not desire to work with older people, nor old age psychiatrists with younger. Lack of enthusiasm about your patient group does not make for good therapeutic relationships. Fourth, negative responses from the medical profession generally towards mentally unwell older people have become deep-rooted over the decades. For example, 70 years ago an editorial in a respected medical journal commented: ‘All sympathy and desire to help seem to vanish. Nothing but irritation and an impatient desire to discharge the patient ... exists’. Forty years ago, old age psychiatrist Professor Tom Arie noted that many doctors and social workers ‘cannot formulate a “psychogeriatric problem” in any other terms but as to the need to get it instantly off their hands.’ Recent experience as a liaison psychiatrist on medical and surgical wards suggests little has changed. For treatment, many older patients will be best served by specific old age services because of physical frailty, confusion, co-morbidity, and social and psychological factors, but some may benefit from services used mainly by younger people. Thus, despite the need for psycho-social treatment options beyond the confines of traditional old age facilities and activities, the other reasons indicate that specific old age services have a valid clinical rationale. Age appropriateness is sometimes misunderstood to be age discrimination. These points indicate why specific services are to the patients’ advantage and are no more discriminatory than having dedicated children’s services. Clinical benefits of providing dedicated mental health services for older people are well recognized. They are reflected in the peer-reviewed DECLARATIONS

Evidence‐based electroconvulsive therapy

Evidence‐based electroconvulsive therapy

A Critical Nursing Perspective of Pharmacological Interventions for Schizophrenia and the Marginalization of Person-Centered Alternatives

Today psychiatric-mental health nurses are witnessing the newest incarnation of a critical movement in psychiatry. Not since the antipsychiatry movement of the 1960s and 1970s has there been such a...

Personal Recovery and Mental Illness: A Guide for Mental Health Professionals

Back to table of contents Previous article Next article Book ReviewsFull AccessPersonal Recovery and Mental Illness: A Guide for Mental Health ProfessionalsStephen Thielke, M.D., M.S.P.H.Stephen ThielkeSearch for more papers by this author, M.D., M.S.P.H.Published Online:1 May 2011https://doi.org/10.1176/ps.62.5.pss6205_0569AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Personal Recovery and Mental Illness: A Guide for Mental Health ProfessionalsSladeMike; New York, Cambridge University Press, 2009, 288 pages, $68Did you ever consider, as a mainstream provider, that you were inadvertently doing harm, that your treatments were toxic, that you were treating symptoms rather than people, or that your work might be categorized with Nazi atrocities, the slave trade, and Apartheid? If not, then you will not likely be convinced by this book's claims that recovery will solve most of the problems with modern mental health services. The author, a psychologist and health services researcher at King's College London, while arguing five rationales for recovery (epistemological, ethical, effectiveness, empowerment, and policy) rails against current practices, in particular medications. As he describes the replacement of first- by second-generation antipsychotics, “The winners from this arrangement are pharmaceutical companies, who make more money, and those who prescribe, whose status is enhanced. The losers are patients.”Editor's note: Recovery is an enigmatic concept in contemporary psychiatry. Most practitioners in the public sector know they should be involved in assisting individuals with serious mental illness to move toward recovery, but most do not know exactly what that means. The reviews in this month's issue are of books that provide the bases for understanding recovery and its place in the evolution of the relationships in the lives of people with serious mental illnesses.The book illuminates an innovative, promising, and well-researched model of treatment, personal recovery, but the straw man of mainstream psychiatry provides much of the fuel for its flame. In the process, it caricatures psychiatry, and I envisioned a cabal of pill-pushers hunting out opportunities to subordinate marginalized people. The book, while distancing itself in principle from the antipsychiatry movement, intimates that the real problems are not mental illnesses or symptoms but psychiatric diagnoses and treatments. Yet I doubt that any mainstream provider would disavow the tenets of recovery, such as that “People with severe mental illness are people” and that the primary goal is “better mental health, regardless of mental illness.” Almost everyone I know who works in mental health tries to live up to these ideals. Yet the author seems convinced that they are antithetical to mainstream practice. The book seeks to convince, crystallize, and catalyze thoughts around the theme of recovery, but it tacitly works to dismantle and undermine the current system, too.The book sustains a surprisingly prescriptive tone, using lengthy bulleted lists and tables to enumerate all the steps needed to restructure services and change interactions with patients. It would be impossible to follow a large number of these suggestions for improving mental health services. The case studies (largely from Australia and Europe) are interesting and inspiring but often do not map well onto systems and practices in the United States. Many of these recovery-based programs incorporate mainstream approaches, too, and they seem to work well in concert, which raises the question of why we need a reversal of many clinical assumptions to make progress.When I was a resident, I met Mark Ragins, M.D., and was inspired by his accounts of engaging people sincerely and creatively and his vision of recovery. He made me want to use recovery approaches as a way to become a better psychiatrist. This book posited me instead as part of an intractable problem, the old guard that awaits overthrow. Readers who are already convinced of the insensitivity and illogic of the status quo will find this book a touchstone and call to arms, but those who hope to make incremental improvements will be put off by its antagonism.The reviewer reports no competing interests.Dr. Thielke is with the Department of Psychiatry and Behavioral Sciences, University of Washington, and the Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle. FiguresReferencesCited byDetailsCited byNone Volume 62Issue 5 May 2011Pages 569-569 Metrics PDF download History Published online 1 May 2011 Published in print 1 May 2011

Personal Recovery and Mental Illness: A Guide for Mental Health Professionals

Back to table of contents Previous article Next article Book ReviewsFull AccessPersonal Recovery and Mental Illness: A Guide for Mental Health ProfessionalsStephen Thielke, M.D., M.S.P.H.Stephen ThielkeSearch for more papers by this author, M.D., M.S.P.H.Published Online:1 May 2011https://doi.org/10.1176/ps.62.5.pss6205_0569AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Personal Recovery and Mental Illness: A Guide for Mental Health ProfessionalsSladeMike; New York, Cambridge University Press, 2009, 288 pages, $68Did you ever consider, as a mainstream provider, that you were inadvertently doing harm, that your treatments were toxic, that you were treating symptoms rather than people, or that your work might be categorized with Nazi atrocities, the slave trade, and Apartheid? If not, then you will not likely be convinced by this book's claims that recovery will solve most of the problems with modern mental health services. The author, a psychologist and health services researcher at King's College London, while arguing five rationales for recovery (epistemological, ethical, effectiveness, empowerment, and policy) rails against current practices, in particular medications. As he describes the replacement of first- by second-generation antipsychotics, “The winners from this arrangement are pharmaceutical companies, who make more money, and those who prescribe, whose status is enhanced. The losers are patients.”Editor's note: Recovery is an enigmatic concept in contemporary psychiatry. Most practitioners in the public sector know they should be involved in assisting individuals with serious mental illness to move toward recovery, but most do not know exactly what that means. The reviews in this month's issue are of books that provide the bases for understanding recovery and its place in the evolution of the relationships in the lives of people with serious mental illnesses.The book illuminates an innovative, promising, and well-researched model of treatment, personal recovery, but the straw man of mainstream psychiatry provides much of the fuel for its flame. In the process, it caricatures psychiatry, and I envisioned a cabal of pill-pushers hunting out opportunities to subordinate marginalized people. The book, while distancing itself in principle from the antipsychiatry movement, intimates that the real problems are not mental illnesses or symptoms but psychiatric diagnoses and treatments. Yet I doubt that any mainstream provider would disavow the tenets of recovery, such as that “People with severe mental illness are people” and that the primary goal is “better mental health, regardless of mental illness.” Almost everyone I know who works in mental health tries to live up to these ideals. Yet the author seems convinced that they are antithetical to mainstream practice. The book seeks to convince, crystallize, and catalyze thoughts around the theme of recovery, but it tacitly works to dismantle and undermine the current system, too.The book sustains a surprisingly prescriptive tone, using lengthy bulleted lists and tables to enumerate all the steps needed to restructure services and change interactions with patients. It would be impossible to follow a large number of these suggestions for improving mental health services. The case studies (largely from Australia and Europe) are interesting and inspiring but often do not map well onto systems and practices in the United States. Many of these recovery-based programs incorporate mainstream approaches, too, and they seem to work well in concert, which raises the question of why we need a reversal of many clinical assumptions to make progress.When I was a resident, I met Mark Ragins, M.D., and was inspired by his accounts of engaging people sincerely and creatively and his vision of recovery. He made me want to use recovery approaches as a way to become a better psychiatrist. This book posited me instead as part of an intractable problem, the old guard that awaits overthrow. Readers who are already convinced of the insensitivity and illogic of the status quo will find this book a touchstone and call to arms, but those who hope to make incremental improvements will be put off by its antagonism.The reviewer reports no competing interests.Dr. Thielke is with the Department of Psychiatry and Behavioral Sciences, University of Washington, and the Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle. FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 5 May 2011Pages 569-569 Metrics PDF download History Published online 1 May 2011 Published in print 1 May 2011

Two views: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Two views: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Spaced-out in Saskatchewan: modernism, anti-psychiatry, and deinstitutionalization, 1950-1968.

On the eve of deinstitutionalization, a group of professionals, including an architect, a psychiatrist, and a psychologist, joined together in pursuit of a middle ground between outright closure of long-stay hospitals and the introduction of out-patient services in general hospitals. Augmented by the use of the hallucinogenic drug LSD, these men produced a trenchant critique of modern psychiatry and the changing mental health system without subscribing to antipsychiatry. Caught among shifting psychiatric paradigms, fiscal constraints, and political pressure to situate mental health within an encroaching system of publicly funded health care reforms, their proposed mental hospital designs failed to stem the tidal wave of post-World War II changes in mental health care.

Teoretiske og ideologiske innflytelser på utviklingen av psykiatrisk sykepleie etter 1960 — en litteraturgjennomgang

The purpose of this article is to give an overview of theoretical and ideological impacts on the development of psychiatric nursing. The chosen method for this review is the resumé format. This has been carried out by outlining the contents of theoretical and research articles in psychiatric nursing journals in the period 1960–2008. Three theoretical influences are prominent in this resumé: The human science influence (humanistic-existential approach; psychodynamic approach), natural science influence (biomedical approach; generalised, decontextualised facts of knowledge) and social science influence (anti psychiatry; psychosocial impacts; holism and pluralism; user perspective). In conclusion, a main concern in the reviewed articles is to present the contribution of psychiatric nursing as complementary to other professions work in order to meet the challenges in the field of mental health services. Consequently, a strong emphasis on multidisciplinary collaboration and cooperation with users are present. The importance of making ideological perspectives explicit is pointed out as having impacts on the modes of care, nursing and treatment of persons with mental health disabilities. The reviewed articles show that the social science perspective has gradually influenced psychiatric nursing both ideologically and practically. Finally, it seems that psychiatric nursing philosophy presents counter-arguments to the emphasis on biomedical research and practice in contemporary mental health care.