POSTPSYCHIATRY: A NEW DIRECTION FOR MENTAL HEALTH
Patrick Bracken, Philip Thomas
BMJ Volume 322 24 March 2001
Response – by Dr Salman Raschid: Convenor of the R D Laing Conference
(The Royal College of Psychiatrists – Philosophy Special Interest Group)
A Few Preliminary Points
A general intellectual flabbiness appears to run throughout the
article – consider one significant instance. Bracken and Thomas equate
current Government policies with a “postmodern health agenda” and go on to
criticise “the modernist agenda in psychiatry”. Such terms as
‘postmodern’ and ‘modernist’ need to be carefully defined, and this can
only be done by putting them into a proper cultural/historical context (a
process which would immediately reveal that they are words of many
meanings).
Incoherence and Contradiction
Bracken and Thomas’s statement of the principles of ‘postpsychiatry’
strikes me as being a ragbag of incoherent ideas. There is one central,
and major, contradiction: their statement that “Postpsychiatry … does not
seek to replace the medical techniques of psychiatry …” negates the rest
of their case – let me explain this. The ‘medical techniques’ of
psychiatry are embedded in medical (or pseudo-medical) power structures,
so that Bracken and Thomas’s postpsychiatry is essentially the
standard/traditional form of psychiatry – entailing the use of medical and
(or pseudo-medical) diagnoses, medication, ECT, admission to psychiatric
units etc and so forth. In other words the medical techniques of orthodox
psychiatry cannot even be understood apart from a particular socio-
cultural matrix.
Phenomenology
Bracken and Thomas’s account of this area (philosophical and
psychological) is one hundred percent wrong-headed. Karl Jaspers did not
work “within the framework of phenomenological psychology developed by the
philosopher Edmund Husserl”. Firstly, there was simply no such framework.
Secondly, Jaspers increasingly minimised the influence of Husserl, and
eventually dissociated himself from Husserlian phenomenology. (In the
almost 900 pages of his General Psychopathology there are only two small
references to Husserl, whereas there are 25 references to Freud, including
four extended discussions.) Thirdly, the ‘phenomenological psychology’
Husserl lectured and wrote about was not an empirical discipline but
rather what we would now call ‘philosophy of psychology’. Finally, and
most importantly, Husserl’s philosophy is not based on the notion that
“the mind is understood as internal and separate from the world around
it.” Husserl had radicalised the Cartesian “interior focusing” through
his theory of transcendental consciousness and the transcendental
reduction so that he eventually became one of the most important fathers
of the idea that in our perceptual experience of the world we are actually
at the world i.e. the table that I am seeing before me (technically the
perceptual noema) is a part of the actually experienced world and not an
image, symbol or ‘internal representation’ (as held by classical British
empiricism).
Antipsychiatry
Bracken and Thomas’s discussion is based on preconceived
stereotyping, rather than upon an examination of the actual
tendencies/movements labelled as ‘antipsychiatry’. Consider their
statement “antipsychiatry argued that psychiatry was repressive and based
upon a mistaken medical ideology, and its proponents wanted to liberate
mental patients from its clutches.” The thoroughly tendentious nature of
this bold declamation is exposed by its curiously self-referential
character (see their note 32 on page 727). There are fundamental
differences in theory (and practice) between – for instance, the American
T S Szasz, the Frenchman Felix Guattari and our own R D Laing.
Nevertheless, none of these approaches has anything to do with “liberating
mental patients from the clutches of medical ideology”.
R D Laing’s work is based upon a most intellectually disciplined base
– that of modern European philosophy (existential-phenomenology). It also
has an important antecedent in the work of the great American pioneer H S
Sullivan (1892 – 1949) – as Laing freely acknowledged. Laing had
demonstrated the social intelligibility of many of the symptoms of
patients medically diagnosed as suffering from ‘schizophrenia’. His
theoretical formulations and therapy (or healing or reintegration) entail
a complete unheaval of the traditional psychiatric set-up (in sharp
contrast to the conventional practice implied in ‘postpsychiatry’).
Laingian psychotherapy and psychosocial (milieu) therapy of psychotic
patients has been demonstrated to be effective: in the distinguished work
carried out in the Philadelphia Association households in London, by Dr
Loren Mosher in America and of Professor Luc Ciompi in Switzerland
University, Bern. This Laingian movement represents a most potent
challenge to conventional psychiatric thinking and practice.
Key References:
R D Laing: The Divided Self (1960) London, Tavistock Publications
R D Laing: Sanity, Madness and the Family (1964) London, Tavistock
Publications
R D Laing: The Voice of Experience (1982) London, Allen Lane
R D Laing: (Review of Karl Jaspers) General Psychopathology (1963/4)
International Journal of Psychoanalysis
Aron Gurwitsch: Studies in Phenomenology and Psychology (1966)
Evanston,
Northwestern University Press
Edmund Husserl: Phenomenological Psychology (Lectures Summer Semester
1925)
(1977) The Hague, Martinus Nijhoff
Karl Jaspers: General Psychopathology (1963) Manchester, Manchester
University
Press
Herbert Spiegelberg: Phenomenology in Psychology and Psychiatry (1972)
Evanston,
Northwestern University Press
Herbert Spiegelberg: The Phenomenological Movement: a historical
introduction
(1984) The Hague, Martinus Nijhoff
Rapid Response:
Postpsychiatry: a new direction for mental health
POSTPSYCHIATRY: A NEW DIRECTION FOR MENTAL HEALTH
Patrick Bracken, Philip Thomas
BMJ Volume 322 24 March 2001
Response – by Dr Salman Raschid: Convenor of the R D Laing Conference
(The Royal College of Psychiatrists – Philosophy Special Interest Group)
A Few Preliminary Points
A general intellectual flabbiness appears to run throughout the
article – consider one significant instance. Bracken and Thomas equate
current Government policies with a “postmodern health agenda” and go on to
criticise “the modernist agenda in psychiatry”. Such terms as
‘postmodern’ and ‘modernist’ need to be carefully defined, and this can
only be done by putting them into a proper cultural/historical context (a
process which would immediately reveal that they are words of many
meanings).
Incoherence and Contradiction
Bracken and Thomas’s statement of the principles of ‘postpsychiatry’
strikes me as being a ragbag of incoherent ideas. There is one central,
and major, contradiction: their statement that “Postpsychiatry … does not
seek to replace the medical techniques of psychiatry …” negates the rest
of their case – let me explain this. The ‘medical techniques’ of
psychiatry are embedded in medical (or pseudo-medical) power structures,
so that Bracken and Thomas’s postpsychiatry is essentially the
standard/traditional form of psychiatry – entailing the use of medical and
(or pseudo-medical) diagnoses, medication, ECT, admission to psychiatric
units etc and so forth. In other words the medical techniques of orthodox
psychiatry cannot even be understood apart from a particular socio-
cultural matrix.
Phenomenology
Bracken and Thomas’s account of this area (philosophical and
psychological) is one hundred percent wrong-headed. Karl Jaspers did not
work “within the framework of phenomenological psychology developed by the
philosopher Edmund Husserl”. Firstly, there was simply no such framework.
Secondly, Jaspers increasingly minimised the influence of Husserl, and
eventually dissociated himself from Husserlian phenomenology. (In the
almost 900 pages of his General Psychopathology there are only two small
references to Husserl, whereas there are 25 references to Freud, including
four extended discussions.) Thirdly, the ‘phenomenological psychology’
Husserl lectured and wrote about was not an empirical discipline but
rather what we would now call ‘philosophy of psychology’. Finally, and
most importantly, Husserl’s philosophy is not based on the notion that
“the mind is understood as internal and separate from the world around
it.” Husserl had radicalised the Cartesian “interior focusing” through
his theory of transcendental consciousness and the transcendental
reduction so that he eventually became one of the most important fathers
of the idea that in our perceptual experience of the world we are actually
at the world i.e. the table that I am seeing before me (technically the
perceptual noema) is a part of the actually experienced world and not an
image, symbol or ‘internal representation’ (as held by classical British
empiricism).
Antipsychiatry
Bracken and Thomas’s discussion is based on preconceived
stereotyping, rather than upon an examination of the actual
tendencies/movements labelled as ‘antipsychiatry’. Consider their
statement “antipsychiatry argued that psychiatry was repressive and based
upon a mistaken medical ideology, and its proponents wanted to liberate
mental patients from its clutches.” The thoroughly tendentious nature of
this bold declamation is exposed by its curiously self-referential
character (see their note 32 on page 727). There are fundamental
differences in theory (and practice) between – for instance, the American
T S Szasz, the Frenchman Felix Guattari and our own R D Laing.
Nevertheless, none of these approaches has anything to do with “liberating
mental patients from the clutches of medical ideology”.
R D Laing’s work is based upon a most intellectually disciplined base
– that of modern European philosophy (existential-phenomenology). It also
has an important antecedent in the work of the great American pioneer H S
Sullivan (1892 – 1949) – as Laing freely acknowledged. Laing had
demonstrated the social intelligibility of many of the symptoms of
patients medically diagnosed as suffering from ‘schizophrenia’. His
theoretical formulations and therapy (or healing or reintegration) entail
a complete unheaval of the traditional psychiatric set-up (in sharp
contrast to the conventional practice implied in ‘postpsychiatry’).
Laingian psychotherapy and psychosocial (milieu) therapy of psychotic
patients has been demonstrated to be effective: in the distinguished work
carried out in the Philadelphia Association households in London, by Dr
Loren Mosher in America and of Professor Luc Ciompi in Switzerland
University, Bern. This Laingian movement represents a most potent
challenge to conventional psychiatric thinking and practice.
Key References:
R D Laing: The Divided Self (1960) London, Tavistock Publications
R D Laing: Sanity, Madness and the Family (1964) London, Tavistock
Publications
R D Laing: The Voice of Experience (1982) London, Allen Lane
R D Laing: (Review of Karl Jaspers) General Psychopathology (1963/4)
International Journal of Psychoanalysis
Aron Gurwitsch: Studies in Phenomenology and Psychology (1966)
Evanston,
Northwestern University Press
Edmund Husserl: Phenomenological Psychology (Lectures Summer Semester
1925)
(1977) The Hague, Martinus Nijhoff
Karl Jaspers: General Psychopathology (1963) Manchester, Manchester
University
Press
Herbert Spiegelberg: Phenomenology in Psychology and Psychiatry (1972)
Evanston,
Northwestern University Press
Herbert Spiegelberg: The Phenomenological Movement: a historical
introduction
(1984) The Hague, Martinus Nijhoff
Competing interests: No competing interests