Postpsychiatry: Rationality and the Individual Self Remain
Postpsychiatry: Rationality and the Individual Self Remain
Bracken and Thomas’s1 account of a possible “Postpsychiatry” contains
a statement of what they see as major flaws in contemporary psychiatry.
They suggest that a preoccupation with “rationality and the
individual self” is “waning” and see any such preoccupation as a flaw.
However they fail to suggest any convincing alternative theoretical
framework to replace it. However much one sees their case example as
presenting a “contextualised” psychiatry it can also be seen as
fundamentally respecting their patient’s “individual self” and having as a
central aim the restoration of her “rationality”.
At the heart of this debate lies the extent to which severe mental
illness can interfere with an individual’s capacity. Recent considerations
of the need for reform of mental health law emphasise this as the central
factor that should inform management, with a clear recognition that where
capacity is lacking an individual’s rights need to be clearly protected 2.
The aim of psychiatry is to restore individual agency (which is
clearly linked to capacity) where this has been impaired by mental
disorder. Respect for reason and individual personhood are central to
this, as well as consideration of the way mental disorder, and its
treatment, can affect a person’s ongoing sense of self, or individual
narrative 3.
There have been sophisticated considerations of the social basis of
personhood 4, and there is ongoing debate about where the individual
begins and the group ends 5. This work should not be seen as divorced from
the extraordinary everyday problems faced by your average mental health
worker, even if at first it may seem a world away. It is part of the
essential conundrum facing every mental health worker of balancing the
complex interactions between agency, biology and personhood that lie at
the heart of psychiatry’s attempt to help every patient.
The recent incorporation of the Human Rights Act into British law
also needs to be clearly recognised before the individual is forgotten by
psychiatry 6. This clearly relates to an individuals rights before the
law, emphasising again how the centrality of personhood has been too
easily sacrificed by Bracken and Thomas in their flight into
postpsychiatry.
Dr Dan Beales, Specialist Registrar in Forensic Psychiatry, Edenfield
Centre, Mental Health Services of Salford (NHS) Trust, Prestwich Hospital,
Bury New Road, Manchester, M25 3BL and Ashworth Hospital Authority,
Merseyside.
Email: dan@danbeales.freeserve.co.uk
1 Bracken P and Thomas P. Postpsychiatry: a new direction for mental
health. BMJ 2001; 322: 724 –727.
2 Department of Health. Report of the Expert Committee: Review of the
Mental Health Act 1983. London: Stationary Office, 2000.
3 Roberts G and Holmes J (eds). Healing stories: Narrative in Psychiatry
and Psychotherapy. Oxford: Oxford University Press, 1999.
4 Burkitt I. Social Selves: Theories of the Social Formation of
Personality. London: Sage Publications, 1991.
5 Dahal F. Taking the Group Seriously: Towards a Post-Foulksian Group
Analytic Theory. London: Jessica Kingsley Publishers, 1998.
6 Macgregor-Morris R, Ewbank J, Birmingham L. Potential impact of the
Human Rights Act on psychiatric practice: the best of British values? BMJ
2001; 322: 848-50.
Competing interests:
No competing interests
22 April 2001
Dan Beales
Specialist Registrar in Forensic Psychiatry
Edenfield Centre, Mental Health Services of Salford (NHS) Trust, Manchester, M25 3BL
Rapid Response:
Postpsychiatry: Rationality and the Individual Self Remain
Postpsychiatry: Rationality and the Individual Self Remain
Bracken and Thomas’s1 account of a possible “Postpsychiatry” contains
a statement of what they see as major flaws in contemporary psychiatry.
They suggest that a preoccupation with “rationality and the
individual self” is “waning” and see any such preoccupation as a flaw.
However they fail to suggest any convincing alternative theoretical
framework to replace it. However much one sees their case example as
presenting a “contextualised” psychiatry it can also be seen as
fundamentally respecting their patient’s “individual self” and having as a
central aim the restoration of her “rationality”.
At the heart of this debate lies the extent to which severe mental
illness can interfere with an individual’s capacity. Recent considerations
of the need for reform of mental health law emphasise this as the central
factor that should inform management, with a clear recognition that where
capacity is lacking an individual’s rights need to be clearly protected 2.
The aim of psychiatry is to restore individual agency (which is
clearly linked to capacity) where this has been impaired by mental
disorder. Respect for reason and individual personhood are central to
this, as well as consideration of the way mental disorder, and its
treatment, can affect a person’s ongoing sense of self, or individual
narrative 3.
There have been sophisticated considerations of the social basis of
personhood 4, and there is ongoing debate about where the individual
begins and the group ends 5. This work should not be seen as divorced from
the extraordinary everyday problems faced by your average mental health
worker, even if at first it may seem a world away. It is part of the
essential conundrum facing every mental health worker of balancing the
complex interactions between agency, biology and personhood that lie at
the heart of psychiatry’s attempt to help every patient.
The recent incorporation of the Human Rights Act into British law
also needs to be clearly recognised before the individual is forgotten by
psychiatry 6. This clearly relates to an individuals rights before the
law, emphasising again how the centrality of personhood has been too
easily sacrificed by Bracken and Thomas in their flight into
postpsychiatry.
Dr Dan Beales, Specialist Registrar in Forensic Psychiatry, Edenfield
Centre, Mental Health Services of Salford (NHS) Trust, Prestwich Hospital,
Bury New Road, Manchester, M25 3BL and Ashworth Hospital Authority,
Merseyside.
Email: dan@danbeales.freeserve.co.uk
1 Bracken P and Thomas P. Postpsychiatry: a new direction for mental
health. BMJ 2001; 322: 724 –727.
2 Department of Health. Report of the Expert Committee: Review of the
Mental Health Act 1983. London: Stationary Office, 2000.
3 Roberts G and Holmes J (eds). Healing stories: Narrative in Psychiatry
and Psychotherapy. Oxford: Oxford University Press, 1999.
4 Burkitt I. Social Selves: Theories of the Social Formation of
Personality. London: Sage Publications, 1991.
5 Dahal F. Taking the Group Seriously: Towards a Post-Foulksian Group
Analytic Theory. London: Jessica Kingsley Publishers, 1998.
6 Macgregor-Morris R, Ewbank J, Birmingham L. Potential impact of the
Human Rights Act on psychiatric practice: the best of British values? BMJ
2001; 322: 848-50.
Competing interests: No competing interests