Postpsychiatry: a new direction for mental health

Abstract

Government policies are beginning to change the ethos of mental health care in Britain.The new commitment to tackling the links between poverty, unemployment, and mental illness has led to policies that focus on disadvantage and social exclusion.1 These emphasise the importance of contexts, values, and partnerships and are made explicit in the national service framework for mental health. 2 The service framework raises an agenda that is potentially in conflict with biomedical psychiatry.In a nutshell, this government (and the society it represents) is asking for a very different kind of psychiatry and a new deal between health professionals and service users.These demands, as Muir Gray has recently observed, apply not only to psychiatry but also to medicine as a whole, as society's faith in science and technology, an important feature of the 20th century, has diminished.3 According to Muir Gray, "Postmodern health will not only have to retain, and improve, the achievements of the modern era, but also respond to the priorities of postmodern society, namely: concern about values as well as evidence; preoccupation with risk rather than benefits; the rise of the well informed patient." 3 Medicine is being cajoled into accepting this reality, but psychiatry faces the additional problem that its own modernist achievements are themselves contested.Consider this: although patients complain about waiting lists, professional attitudes, and poor communication, few would question the enterprise of medicine itself.By contrast, psychiatry has always been thus challenged.Indeed, the concept of mental illness has been described as a myth.4 It is hard to imagine the emergence of "antipaediatrics" or "critical anaesthetics" movements, yet antipsychiatry and critical psychiatry are well established and influential.5 One of the largest groups of British mental health service users is called Survivors Speak Out.Psychiatry has reacted defensively to these challenges and throughout the 20th century has asserted its medical identity.6 Although the discipline survived the antipsychiatry movement of the 1960s, fundamental questions about its legitimacy remain.7 We argue that the well publicised failure of community care and the UK government's response (in the form of the national service framework) make it essential that we re-examine critically psychiatric frameworks.In this article we develop a critique of the modernist agenda in psychiatry and outline the basic tenets of postpsychiatry-a new positive direction for theory and practice in mental health.8 Summary pointsFaith in the ability of science and technology to resolve human and social problems is diminishing This creates challenges for medicine, particularly traditional psychiatry Psychiatry must move beyond its "modernist" framework to engage with recent government proposals and the growing power of service users Postpsychiatry emphasises social and cultural contexts, places ethics before technology, and works to minimise medical control of coercive interventionsPostmodernity provides doctors with an opportunity to redefine their roles and responsibilities