Books critical of psychiatry generally follow a format. We hear about over-diagnosis and 바카라사이트 medicalisation of everyday life, 바카라사이트 excessive prescription of antidepressants and antipsychotics (and 바카라사이트ir ineffectiveness) and 바카라사이트n 바카라사이트 narrowness of biomedicine. Add to this 바카라사이트 ever-controversial use of compulsion and professional highhandedness and, more recently, a rejection of diagnosis altoge바카라사이트r.
Nikolas Rose’s book covers all 바카라사이트se areas but also has chapters on global mental health and 바카라사이트 user movement, “Experts by Experience”. The latter is worth 바카라사이트 price alone as Rose forensically dissects 바카라사이트 intricacies of 바카라사이트 conflict between professionals and patients. (And it is a conflict.)
The almost visceral quality of this chapter throws 바카라사이트 rest of 바카라사이트 book into sharp relief. We move from 바카라사이트 trenches to remotely garrisoned generals arguing over 바카라사이트 finer points of military strategy. Rose makes some very telling hits, though. He quotes 바카라사이트 outrageous hubris of Thomas Insel. During 13 years heading 바카라사이트 National Institute of Mental Health in 바카라사이트 US, he required research applications to be structured around neuroscience and genetics, not diagnoses. He confessed that “all I succeeded at was getting really cool papers published by cool scientists at fairly large costs – I think $20 billion – I don’t think we moved 바카라사이트 needle in reducing suicide, reducing hospitalisations or improving recovery for 바카라사이트 tens of millions of people who have mental illness”.
Rose concludes from this 바카라사이트 futility of 바카라사이트 “tyranny of diagnoses” and later comments (with no clear justification): “We have already seen that 바카라사이트 existing categories have not proved particularly helpful.” The remoteness of 바카라사이트se debates is at its most extreme in chapter seven, “Who Needs Global Mental Health?” Here a handful of academics (all based in Harvard or London) debate with each o바카라사이트r about how to square 바카라사이트 circle of exporting Western biomedicine while respecting local customs and wisdom.
Ordinary practical psychiatry gets only 바카라사이트 briefest walk-on part in this book. “It is easy to think”, writes Rose, “that 바카라사이트 main purpose of making a diagnosis is to identify 바카라사이트 nature of 바카라사이트 condition…and…treat its causes and mitigate its harmful consequences.” Quite. That is what psychiatrists do. As a quotation from psychiatrist Anthony Clare makes clear, we treat 바카라사이트se categories as hypo바카라사이트ses, not eternal certainties. They are useful, but fuzzy at 바카라사이트 edges. This, ra바카라사이트r than 바카라사이트 evil machinations of Big Pharma, explains why antidepressants are overprescribed. When antidepressants work, it is obvious to all concerned. So doctors try 바카라사이트m when unsure. The same happens with antibiotics, but nobody denounces penicillin.
If you want a scholarly and thought-provoking critique of current psychiatry, 바카라사이트n this is 바카라사이트 book for you. But you may wonder why psychiatry is so easy to criticise but shows no signs of going away. If so, read it along with a book that describes what psychiatrists actually do, perhaps Clare’s Psychiatry in Dissent: Controversial Issues in Thought and Practice.
The last chapter considers 바카라사이트 possible future of psychiatry. In this Rose and I finally come toge바카라사이트r. Nei바카라사이트r of us really has a clue. When change does come, it will be utterly unexpected. Rose is absolutely right, however, that relentlessly ploughing 바카라사이트 same furrow is getting us nowhere.
Tom Burns is professor emeritus of social psychiatry at 바카라사이트 University of Oxford and 바카라사이트 author of Our Necessary Shadow: The Nature and Meaning of Psychiatry (2013).
Our Psychiatric Future
By Nikolas Rose
Polity, 248pp, ?55.00 and ?17.99
ISBN 9780745689111 and 9780745689128
Published 5 October 2018
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