Critical Psychiatry: what is it and what does it claim?

Psychiatry has generated great advances, but it is good to review its limitations.

Psychiatry, the medical specialty in charge of detecting and treating mental illnesses, has undergone a major crisis in recent times due to the emergence of different questions about the characteristics of its knowledge and practices.

These questions have led to the emergence of Critical Psychiatry, a theoretical current that questions the nature of its knowledge and practices.a theoretical current that questions and seeks to reform the practices of psychiatric care. Among other things, it shows that traditional psychiatry has some fundamental limits in the way of understanding and dealing with psychic suffering, which in particular generates ethical dilemmas in the use of its knowledge.

Where does Critical Psychiatry come from?

One of the most recent antecedents is the Critical Psychiatry Network conference held in Bradford, England in 1999, where the need to promote a radical transformation in our approach to mental health problems was discussed. a radical transformation in our approach to mental health problems.This has been subscribed to by thousands of professionals around the world, mainly through academic publications, but also through political mobilization.

In the same vein, Critical Psychiatry has much of its antecedents in anti-psychiatry, a theoretical and political movement driven by mental health professionals that began in the second half of the last century and strongly questioned the way psychiatry operated, especially in Europe and the United States.

Although antipsychiatry and Critical Psychiatry are movements that arose at different times, what they have in common is that reject the pathologization of human heterogeneity and remain committed to transforming psychiatric care. and are committed to transforming psychiatric care.

Finally, this current has been driven by various first-person associative movements, i.e., collectives managed by the users of psychiatric care services. For example, the British collective Hearing Voices Network, which rejects the traditional psychiatric understanding of this experience, and also seek to eliminate stigma and strengthen self-help groups. and strengthen peer support groups.

The above is subsequently articulated with the rights paradigm that has been formalized since 2006 in the International Convention on the Rights of Persons with Disabilities approved by the United Nations, as well as through other documents and reports on the prevention of torture in psychiatry that have been developed in different countries.

Fundamental principles

In general terms Critical Psychiatry seeks to make visible the intersection between psychological, social and somatic relationshipsof both individuals and psychiatric practice itself, so that it can be reformed.

More specifically we can follow Philip Thomas (2013) to list five themes of discussion emerging from Critical Psychiatry: the problem of psychiatric diagnoses, the problem of evidence-based medicine in psychiatry (and its relationship with the pharmaceutical industry), the role of the context where psychiatry develops and acts, the problem of coercive practices, and finally, the theoretical and philosophical basis of psychiatric knowledge and practices..

1. The problem of psychiatric diagnoses.

Critical psychiatry makes visible that the barriers between "normality" and "disorder" are easily manipulated and largely arbitrary. In fact, the number of psychiatric diagnoses the number of psychiatric diagnoses available variesThese appear and disappear and are updated from time to time (some of them every time the same diagnosed population manifests itself against being considered sick or disturbed, for example, what happened with homosexuality, which was no longer considered a mental disorder until the second half of the last century).

Likewise, the scientific bases of psychiatric diagnosis began to be questioned because although organic substrates have been found, the scientific evidence that postulates that mental disorders have a Biological origin and a definitive cure in the same sense, is insufficient.

2. Evidence-based medicine and the pharmaceutical industry

Evidence-based medicine is a concept that refers to medical practice based on clinical trials, statistics and manuals that provide generic information about a given condition.

This has been questioned by Critical Psychiatry, since the causes of mental disorders are non-specific. the causes of mental disorders are nonspecific, and evidence-based medicine may promote and generalize practices that are also nonspecific, but also potentially harmful in some senses, because in psychotherapyand evidence-based medicine can promote and generalize practices that are also nonspecific, but also potentially harmful in some senses, because in psychiatry the practices are par excellence of direct intervention (pharmacological or mechanical).

Also, on many occasions, diagnoses and pharmaceutical treatment are strongly influenced by economic interests. strongly influenced by the economic interests of the industries of the industries in charge of producing and distributing drugs, as well as financing a large part of the training of professionals. This has been much debated in recent decades by an important sector of mental health professionals around the world.

3. The context of psychiatry

The range of psychiatric diagnoses is related to the context in which they are constructed, i.e. the percentage of people to whom certain problems are attributed varies according to the specific population to which they belong.

Psychiatric practice itself is found within a social context, which means that in the diagnosis and in the care relationship, ideologies and ways of relating are reproduced. and ways of relating; and that psychic suffering is more than an individual experience, it is an experience that has to do with the conditions of possibility or vulnerability of the environment itself.

4. Coercive practices

Among the strongest criticisms that have been made of psychiatry since the last century are forced psychiatric confinement and containment practices such as restraints, electroconvulsive therapy and overmedicalization.

Far from being conceived as a technical (and therefore value-free) set, Critical Psychiatry seeks to constantly review the practices promoted and their possible harmful effects. constantly seeks to review the practices that are promoted and their possible detrimental effects (from the intrinsic paternalism (from intrinsic paternalism in clinical practice to stigmatizing attitudes or explicitly aggressive practices).

In many contexts, alternatives have been promoted ranging from the closure of psychiatric hospitals or the gradual de-medicalization, to the creation of community centers and the reinforcement of a mental health that is promoted in a more collective and less coercive manner.

5. Theoretical and philosophical basis of psychiatry

Critical psychiatry questions the mind-body dualism that underlies traditional biomedical psychiatry, as well as the biologistic ideology that reduces mental health and illness to the molecular sciences of the brain.

The latter leads to the consideration of a series of social demands where psychiatry was positioning itself as the only or the best solution to understand people's problems; which often results in the omission of affective, social or economic needs. often results in the omission of affective, social or economic deficiencies promoted by social structures. promoted by social structures.

Finally, and given that attention to mental health problems is a globalized phenomenon, despite having been generated and promoted based on the needs of the European and American context, the current of Critical Psychiatry has had repercussions around the world.

However, this is not the only criticism of traditional psychiatry. For example, in the social sciences such as anthropology, social psychology or sociology in Latin America, community forms of health care (including mental health) have recently been investigated, as well as pre-Hispanic ways of understanding what we currently call "disorder" or "mental illness", along with the shortcomings of institutional care and more traditional mental health services.