Jon Jureidini on Critical and Ethical Mental Health
On the future of mental health
Posted March 10, 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Jon Jureidini
EM: Can you tell us a little bit about Critical and Ethical Mental Health research group, its philosophy and intentions?
JJ: Melissa Raven, Anne Tonkin, and I had been working together and with others over several years to try to counter significant misinformation about mental health and mental disorders. We have argued that such misrepresentation misleads health professionals, the media, the public, and governments, jeopardising the rational allocation of the billions of dollars of taxpayers' money spent on mental health services every year.
One shortcoming was that, although all of us had academic appointments, this work was being done outside the academy (much of it through Peter Mansfield’s Healthy Skepticism). We therefore embraced an invitation to create a research group with the University of Adelaide’s Robinson Research Institute.
The Critical and Ethical Mental Health (CEMH) research group conducts research, teaching and advocacy in order to promote safer, more effective and more ethical research and practice in mental health.
Sadly, but predictably, our main challenge at the moment is to generate funding; but we have been busy and the main output in 2015 was the paper we co-authored in the BMJ with Jo Le Noury, Mickey Nardo, David Healy and Elia Abi-Jaoude: Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence.
EM: What motivates your interest in this area?
JJ: Unhappiness, distress, and stress are inappropriately medicalised, resulting in over-diagnosis and the unnecessary prescription of psychiatric drugs. At the same time, there is inadequate treatment and support for people with serious chronic mental illnesses, and a failure to take seriously the social determinants of mental health.
EM: You are trained in both philosophy and psychiatry. How does philosophy inform your work as a psychiatrist?
JJ: Obviously training in ethics is central to psychiatry; and it doesn’t hurt to delve into the ‘mind-body problem’. But I think the most important thing I got out of my philosophy training was a strengthening of my critical thinking. I’ve always found it reasonably easy to spot weak points or contradictions and tenuous claims, but philosophers are very good at disciplining such critical analysis. I try to practice and teach respectful scepticism – don’t accept things on face value, but don’t reject them just because they don’t look quite right on first inspection.
EM: What are your thoughts on the current, dominant paradigm of “diagnosing and treating mental disorders” and the use of so-called “psychiatric medication” to “treat mental disorders” in children, teens and adults?
JJ: I find diagnosis almost useless in my child psychiatry practice. It is easy to group children into one or other diagnostic category, but this tells us almost nothing about how we should intervene. So all of my treatment decisions are based on a formulation of the child’s problems. It can be demanding to bring together all of the information we have about a young person in a coherent, cohesive and a valid account of how they come to present in this way at this time, but to do so is absolutely essential if we are to reach a meaningful explanation as a basis for any advice or intervention.
I wouldn’t say that medication can never be part of that intervention, but if it is used, it should always be on the understanding that it is not a specific treatment for a specific diagnosis. Rather, it’s exploiting the potentially beneficial effects of a psychotropic drug, based on the judgement that those benefits will outweigh harms. Of course, we have to remember that these harms are not only adverse effects of the drug itself, but the meaning to the young person of being medicated.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
JJ: A small minority of those in emotional and mental distress are suffering from severe psychiatric disorders, and if that description applied to a loved one, I would want them seen by a psychiatrist who took a family-centred approach and was very conservative with medication. In the much more likely scenario that my loved one was suffering from emotional distress that was understandable in terms of their life circumstances, I would first and foremost want their distress to be respected. Anger, sadness, fear, shame, and grief are uncomfortable and sometimes disabling feelings, but they are healthy, and often what the distressed person needs is support and empathic understanding to scaffold them through their distressing experience. I believe that many episodes of distress that are currently diagnosed and treated would be better lived through. The consequences of tolerating pain and uncertainty can be meaningful growth and development.
Jon Jureidini is a child psychiatrist who also trained in philosophy (PhD, Flinders University), critical appraisal (University of British Columbia) and psychotherapy (Tavistock Clinic). He heads Adelaide University’s Paediatric Mental Health Training Unit, providing training and support to medical students, GPs, allied health professionals, teachers and counsellors in non-pathologising approaches to primary care mental health. He is chair of Australian-Palestinian Partnerships for Education and Health, and on the board of Siblings Australia, an organisation that advocates for individuals with ill and disabled siblings.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
To learn more about and/or to purchase The Future of Mental Health visit here
To see the complete roster of 100 interview guests, please visit here: