I recently read Peter Kinderman’s new book, A Prescription for Psychiatry, which was published on September 3 by Palgrave Macmillan. The overall message of the work is captured nicely in the subtitle: Why We Need a Whole New Approach to Mental Health and Wellbeing. Dr. Kinderman is Professor of Clinical Psychology, Head of the Institute of Psychology, Health and Society at the University of Liverpool, and an honorary Consultant Clinical Psychologist with Mersey Care NHS Trust in the UK.
Dr. Kinderman manages to present a comprehensive critique of current psychiatric practices, plus a well-developed plan for reform in superb, clearly written, jargon-free prose.
The scope and direction of the book can be gathered from the table of contents:
Introduction: The Disease Model of Mental Health: A System in Crisis
1. Get the Message Right: A Psychosocial Model of Mental Health and Well-being
2. Understand, Don’t Diagnose
3. The Drugs Don’t Work … So Offer Real Solutions
4. Promote Health and Well-being
5. Residential Care … Not Medical Coercion
7. Social and Community Services in Local Authority Management
8. Can We Afford It?
9. A Manifesto for the Reform of Mental Health and Well-being Services
Here are some quotes from the text:
“Traditional thinking about mental health care is profoundly flawed, and radical remedies are required. Our present approach to helping people in acute emotional distress is severely hampered by old-fashioned and incorrect ideas about the nature and origins of mental health problems, and vulnerable people suffer as a result of inappropriate treatment. We must move away from the ‘disease model’, which assumes that emotional distress is merely a symptom of biological illness, and instead embrace a psychological and social approach to mental health and well-being that recognizes our essential and shared humanity.”
“We have become so used to thinking of psychological distress as a branch of medicine that we are in danger of no longer really challenging this assumption.”
“Guided by the flawed assumption that distress is best thought of as a ‘symptom’ of an ‘illness’, mental health professionals go on to assume that if a set of symptoms has a name, we know what ‘it’ is, we can talk to ‘patients’ about it easily and we have a recognised path of treatment that will ‘cure’ it.”
“People who are convinced that others mean them harm (with ‘paranoid delusions’, in psychiatric language), and who are very frightened that they are in imminent danger, will often find their fears much less preoccupying and distressing if they take chlorpromazine. That sounds a lot like the effects of opioid street drugs like heroin.”
“…‘mental health’ services simply aren’t caring and effective, the disease-model approaches don’t actually work very well, and social approaches are both most appropriate and most effective.”
“But I cannot conclude that a medical ethos adds anything positive to the experience of residential care. Ultimately, a reliance on chemical restraints is a bad thing.”
“The real change that we so badly need will only come when we move beyond the idea that mental health issues are essentially a medical problem with social aspects, and acknowledge that what we are talking about are essentially social problems. Radical change is needed to ensure that the management, leadership and practices of services reflect this.”
“The medical and psychiatric communities are powerful – with well-established and effective professional bodies, and statutory mechanisms for catching and holding the ears of policymakers. But, despite the likely opposition, this aspect of my prescription will remain – to move mental health care from medical to social management, from the health service to local authority control.”
“Evidence is also accumulating that psychiatric medication can have dangerous adverse effects (side-effects) especially when taken long term.”
“We must offer services that help people to help themselves and each other rather than disempowering them: services that facilitate personal ‘agency’ in psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions.”
We’ve seen a good many critiques of psychiatry in recent years, most of which focus on the notion that psychiatry has “gone too far” in the expansion of its diagnoses, and in the prescribing of psychiatric drugs. But Dr. Kinderman’s primary thesis is much more profound and far-reaching: that conceptualizing emotional distress as a symptom of an illness is simply incorrect, and is also destructive, and disempowering.
The reasoning and evidence for this position is presented in the first three chapters, and the proposed alternative is developed in the remainder of the book. Dr. Kinderman challenges psychiatry’s present attempts to co-opt the recovery movement by transplanting the medical model into the community in the form of “out-patient, hospital-based” teams. Dr. Kinderman argues forcefully that instead “…the correct place for mental health care is within the social care system.” Those of us who have struggled throughout our careers with trying to provide appropriate help to our clients within the context of a medically conceptualized and operated system will readily recognize how critically important this is.
Dr. Kinderman’s statement – “In many ways, the structures within which mental health care is currently located are part of the problem” – will resonate strongly with social workers, case managers, counselors, psychologists, job coaches, etc., in many parts of the world.
In the years ahead, A Prescription for Psychiatry will be seen as a cardinal work in the present debate. I strongly encourage my readers to read it, and spread the word.
I have no financial interest in Dr. Kinderman’s book, or in any books/materials promoted on this site.