Postpsychiatry Revisited

Now and again you read something that makes you blink and stops you dead in your tracks. When you realise that the text that provoked this response is something you co-authored and published fifteen years earlier, then it’s a good idea to figure out why.

This is exactly what happened to me a few days ago. Pat Bracken and I are currently writing a chapter on postpsychiatry for a book, so it seemed a good idea to re-read the paper Postpsychiatry we published in the British Medical Journal in 2001 [1]. The first three sentences came like a bolt from the blue; they made me sit up and think. They read as follows:

 

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. These emphasise the importance of contexts, values, and partnerships and are made explicit in the national service framework for mental health.

This was a Proustian moment (without madeleines), one that contrasted the zeitgeist of optimism and hope in which we wrote the paper, with my present sense of political anger and despair. Four years before Pat and I wrote those words John Major’s discredited government had been swept away by a New Labour landslide. I can remember how I felt when I woke up on the morning of Friday 2nd May 1997, red eyed, tired, head buzzing, elated. At work everyone was smiling. It seemed that spring would last forever. Sadly, Blair and the New Labour project curdled very quickly, but there was a sense that persisted until the early noughties that we could make the world a fairer, better place, and that as critical mental health professionals we had an important role to play in making life better for the marginalised, the poor, the excluded.

Our Healthier Nation Foreword

That was the context in which Pat and I wrote a regular column in Open Mind magazine (published by MIND, sadly no longer) under the title Postpsychiatry. This was followed by the BMJ paper, and in 2005, the book [2] (we never quite got round to the T-shirt and DVD). We believed passionately that critical thought applied to the field of madness, mental health and psychiatry would change for the better the plight of those who used mental health services.

As I reflected on my Proustian moment, the full extent of just how much things have changed for the worse became clear. In fact, things haven’t just changed for the worse, but it feels as though the clock has been turned back, a century and a half to be precise. Consider the following:

1.     However you measure it, inequality in society continues to increase. Mad people are disproportionately affected by this.

2.     Successive governments (including Blair’s New Labour) mounted sustained attacks on the benefit system, making the lives of long-term unemployed people unbearable, especially those with disabilities and mental health problems.

3.     The purpose of these attacks has been a political one, to minimise the role and power of the state. This can also be seen in the underfunding of the NHS, and swingeing cuts in central government funding for local government.

4.     We not only have compulsory drug treatment in the community, but here has also been a coercive extension of clinical psychology and other forms of ‘therapy’ (influenced by ‘positive psychology’) into the job centre. The purpose of this is to force people back to work [3].

5.     The notion of ‘recovery’ in its various manifestations has been colonised. In a variety of ways it has been wrestled from the hands of survivors and activists by mental health services, professionals, policy makers, and politicians. What was once a radical challenge to the power and authority of mental health professionals has been watered down and annulled.

If all this isn’t bad enough, then consider the context in which this has happened. Here are just two examples. The Equalities and Human Rights Commission (EHRC) whose job it is to safeguard and protect the human rights of the vulnerable and powerless, mad people, the disabled, black people to name but three such groups, is in the process of being eviscerated by the government. Staff at the EHRC have voted overwhelmingly to strike over a 25% funding cut that would make it impossible for the organisation to function. Nineteen of the twenty-six posts to be lost immediately are held by staff in the three lowest grades. This means that older, ethnic minority and disabled staff will be disproportionately axed [4].

There was a time when charities stood for the interests of the weaker members of society. In the last few days disability activists have called for a boycott of MIND, the charity that once had a major advocacy and activist role in supporting the interests of mental health service users. They have also demanded the resignation of its Chief Executive. They are angry because a senior manager with the charity has been seconded for a year to the Department for Work and Pensions (DWP). Activists accuse MIND of failing to speak out strongly enough on behalf of benefit claimants who have been harmed or even died as a result of the DWP’s detested work capacity assessment [5].

Our Healthier Nation Preface

All this suggests that, despite the rhetoric and fine words, the pretence of political good faith, we have been steamrollered by a political behemoth whose platitudes are parroted down the institutional power chain. They are mimicked by the leaders and opinion formers of professional organizations, as things continue to get worse. Very occasionally the mask slips to reveal a different face. To take one example, a survivor activist, someone I’ve known and respected for many years, brought to my attention that a prominent clinical psychologist recently introduced himself at a conference with the threatening words “it’s not a good idea to disagree with me”.

This exemplifies the hypocrisy and bad faith that trickles down through the institutions from the heights of government. It is bullying, the misuse of power to oppress the powerless into silence, and it symbolises the political culture of our time. If this is how prominent members of our professional organisations conduct their affairs when they think they are not under scrutiny, what hope is there for long-term unemployed people in job centres facing clinical psychologists and therapists who are paid to get them back to work? What hope is there for the whistleblower who sees bad practice and is bullied into silence?

All this raises questions for which I have no answers, at least not at the moment, and it also confront me with a painful personal question. Were Pat and I wrong to set out the agenda that we did in our original postpsychiatry paper – the centrality of contexts, ethics before technology, rethinking the politics of coercion? Damn it, no! Absolutely not. The agenda we set out fifteen years ago is more important now than ever before. The error I made was allowing my naivety to beguile me into believing that writing critically about the world would change it. Change, if it has happened at all, has been marginal. Mad people are still given large doses of neuroleptic drugs despite the evidence that they are harmful. The pharmaceutical industry continues to profit from their sale. Black people are still much more likely to experience coercion than other groups in mental health services.

Maybe the task of postpsychiatry has only just begun, not for my part a naïve, idealistic postpsychiatry, but an angry and political one.

© Philip Thomas

19th October 2016

ALD


[1] Bracken, P. & Thomas, P. (2001) Postpsychiatry: A New Direction for Mental HealthBritish Medical Journal 322, 724-727 doi:10.1136/bmj.322.7288.724

[2] Bracken, P. & Thomas, P. (2005) Postpsychiatry: Mental Health in a Postmodern World Oxford, Oxford University Press.

[3] Friedli, L. & Stearns, R. (2015) Medical Humanities;41:40–47. doi:10.1136/medhum-2014-010622

[4] Equality staff vote overwhelmingly to strike. Public and Commercial Services News 14th  October 2016 accessed at http://www.pcs.org.uk/en/newsandevents/pcscomment/pcscomment.cfm/equality-staff-vote-overwhelmingly-to-strike  19th October 2016.

[5] Mind faces boycott call after policy and campaigns manager joins DWP. Disabled Go News 17th October 2016, accessed at  http://www.disabledgo.com/blog/2016/10/mind-faces-boycott-call-after-policy-and-campaigns-manager-joins-dwp/ 19th October 2016