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Is Anti-Psychiatry Ideology Dangerous?

Part 1: Why the extremism of anti-psychiatry can undermine legitimate issues.

To say that anti-psychiatry is a contentious topic would be an understatement. For me, and for other evidence-based health-care advocates, discussing it publicly has invited both online trolling and harassment. But when it comes to health, silence is not an option: Scientists and health professionals are ethically responsible for promoting established science and evidence-based health care.

In this vein, I decided to discuss the topic of anti-psychiatry openly with some esteemed colleagues. I was also recently interviewed by Vice Senior Staff Editor, Shayla Love, for her article, "The Movement Against Psychiatry." With her permission, what follows is Part 1 of the transcript of our interview (Part 2 can be found here).

It is important to strongly emphasize that anti-psychiatry is an ideology: It is not about any one person. Health care practices demand divorcing ideas from people so that claims can be scrutinized and evidence-based health-care advocacy can be fulfilled.

Can you briefly introduce who you are and what you do?

I am a doctoral-level clinical psychologist and Adjunct Assistant Professor at the University of Calgary. My day job involves full-time clinical work in the Canadian public sector where I work in a tertiary care, specialized concurrent disorders outpatient clinic. What that means is that I provide psychological consultation, assessment, and treatment services to people who experience moderate to severe simultaneous addictive and psychiatric disorders.

And so what that looks like at our clinic is that I regularly supervise clinical psychology students/residents, I run a variety of group therapy groups, I provide individual psychotherapy, I provide case management, and I work within the context of a wonderful interdisciplinary team that consists of psychiatrists, consulting addiction medicine physicians, nurses, nurse practitioners, other psychologists, social workers, and occupational therapists.

Academically, I’m also an Adjunct Assistant Professor in the Department of Psychology at the University of Calgary, which essentially involves participation in research endeavors as well as participation in the training of clinical psychology students.

Most recently, I’ve been interested in topics related to science communication and health misinformation in popular media, especially with respect to addiction and mental health. As such, I’ve been regularly contributing to various media outlets, such as Psychology Today and Scientific American.

When did you first hear about antipsychiatry? Was it through reading someone's writing? Through a colleague or school? What was your first understanding of what it meant, and what was your reaction to it?

I probably first encountered anti-psychiatry ideas in both undergraduate and graduate school in the context of coursework related to the nature of psychopathology and the history of psychology, as well as the history and philosophy of science more generally. I can distinctly recall reading Thomas Szasz’s The Myth of Mental Illness and being extremely intrigued by its counter-narrative. In my view, it becomes glaringly obvious to serious students of clinical psychology that the nature of psychopathology reflects an intersection of biological, psychological, and sociocultural phenomena—and it’s interesting to read extreme arguments that hyperfocus on and favor one aspect over the others.

Source: Pixabay

How would you briefly define antipsychiatry now? Has this definition changed at all for you since you first heard of it?

I consider modern anti-psychiatry to be a potentially dangerous disinformation campaign that aims to tear down the discipline and deter treatment-seeking. Those who espouse anti-psychiatry ideology often lay charges against the very existence of psychiatric disorders and the wholescale efficacy of psychiatric medications. In this way, anti-psychiatry differs from helpful scientific scrutiny—instead, it attempts to offer moralistic and ideological criticism.

While the definition itself hasn’t changed much over time, I would argue that the early days of the movement actually helped psychiatry to appropriately self-correct towards the more humane and scientific discipline that it is today, whereas its modern form exists largely as an unorganized shell of what it used to be outside of mainstream medicine.

It seems to me (still as an outsider) like there's a spectrum of opinion within antipsychiatry. Some suggest that all of psychiatry is misguided and harmful, while others appear to mostly oppose involuntary holds or medication. Can you talk about this more extreme side of antipsychiatry and whether or not you think this represents the majority of the movement today?

It is certainly the case that anti-psychiatry is not a clear-cut, black-and-white, categorical thing, but rather might be said to exist as a set of heterogeneous ideas where common themes emerge that could be harmful to patients. The often seen extremism of anti-psychiatry is tragic because it undermines legitimate issues that warrant attention, such as patient autonomy, over-diagnosis, over-treatment, and the importance of risk-benefit in full informed consent of medications. Instead, what is often seen, for example on social media, is that these important topics are often lost in positions of extremism where psychiatry is inaccurately marked and tarnished as more harmful than helpful, and any voiced benefits derived from psychiatric conceptualizations and medications are chastised.

I spoke with one psychologist who found that working with very mentally ill people, like those with psychosis, challenged his notion of antipsychiatry. Do you relate to this? How does antipsychiatry explain these severe conditions, like schizophrenia?

As part of my day job, I can definitely relate to the experience of being humbled by the treatment of severe psychiatric disorders, such as schizophrenia. I don’t think it’s a coincidence that many who propagate anti-psychiatry sentiments have limited experience in the treatment of severe psychiatric disorders, which often involves medication management and collaboration with psychiatry. Anti-psychiatry positions cannot effectively offer and account for an understanding of severe psychopathology because they only offer incomplete truths. Anti-psychiatry positions are often hyper-focused on sociocultural contributions to psychopathology at the neglect of the psychological and biological, which reflects their postmodern philosophical underpinnings. In other words, it’s hard to explain schizophrenia if you don’t think it exists.

What do anti-psychiatrists propose as treatment instead of psychiatry for both the mildly and severely mentally ill?

That’s a good question. I don’t know the answer. I suppose they might say that not all mental health concerns require medication assistance—but this is a sentiment that I not only agree with, but that I would also not consider to be a strictly anti-psychiatry position because it equally falls under the purview of psychiatry. The many excellent and well-trained psychiatrists that I know remain vigilant about over-diagnosis and over-treatment; they are patient-centered and evidence-based; they practice conservative prescribing and de-prescribing when appropriate; and they constantly preach "skills over pills." At the severe end of psychopathology, the use of psychiatric medications can be life-saving, and withholding their use based on misguided ideology is a life-threateningly terrible idea.

How distinct do you feel critical psychiatry is from anti-psychiatry? Are there lessons critical psychiatry can learn from antipsychiatry, or no?

I think the distinction between critical psychiatry and anti-psychiatry is reminiscent of the distinction between vaccine-hesitant and anti-vaccine: The distinction is nebulous and the terms are more similar than different. If I were to sympathize with the distinction, I would say that critical psychiatry is more organized and probably less extreme, though I don’t think that it offers any new insights beyond which psychiatry has not already readily acknowledged and incorporated (e.g., risk-benefits of full informed consent of medications). Most of critical psychiatry is ideological rhetoric and when it makes an attempt at scientific criticism, it is often of low quality.