Openmind 142, November/December 2006
If you or I were so distressed as to be referred to a psychiatrist, they are unlikely to assist you in the way of Duncan Double, one of a handful of so-called 'critical' psychiatrists working in the NHS.
Sceptical of the medical and scientific validity of psychiatric diagnoses and benefits of psychiatric drugs, such psychiatrists argue that they understand their patients from a perspective that is more humane and less stigmatising. So, for example, they are less inclined to diagnose schizophrenia for a patient hearing abusive voices and therefore prescribe anti-psychotics. Instead, they might try to help that person understand what their voices represent and work out ways to help them control such voices.
But, as Double learned, opposing the traditional biomedical thinking on the nature of mental illness can carry severe consequences. Despite being a consultant psychiatrist and honorary senior lecturer at the University of East Anglia's medical school, Double was suspended in 2001 for six months from his NHS job in Norwich. It followed GPs raising concerns over how Double was working with suicidal patients. Double says his employers told him his practice was 'unsafe', that he needed retraining in organic psychiatry and that he must undergo clinical supervision for one year. Double says he was told that if he did not agree he would be disciplined.
Yet Double is adamant that his suspension - backed by his professional body the Royal College of Psychiatrists - was political. Double says that psychiatrists like him are seen as a 'threat' by the biomedical hegemony gripping contemporary psychiatric practice. Moreover, Double believes that colleague distrust - and outright anger - towards him was inflamed by two factors. First, Double had launched an 'anti-psychiatry' website documenting the approach of critical psychiatry, and second, he was the psychiatrist of Kay Sheldon (1) who, in February 2001, received an out-of-court settlement of £58,000 from Norfolk Health Authority after she claimed she was wrongly diagnosed and treated (by another psychiatrist, not Double) for schizophrenia over a 15-year period.
Double says that the slurs made against his practice were never formally investigated. 'Basically, I was regarded as different,' he says. 'I was using less medication than many psychiatrists and was not so concerned about arriving at diagnoses. In the end, the person who the Royal College of Psychiatrists referred me to for retraining in organic psychiatry refused to do it because he said the whole matter was political.'
While critical views can be demonised within psychiatric practice itself, says Double, they are habitually encouraged within academia. In fact, Double remembers 1989-92, when he was a lecturer in psychiatry at the University of Sheffield, as 'liberating'. Nevertheless, despite such a positive experience of academia, Double chose to combine it with a practitioner path. 'If critical psychiatry means anything it should be involved in practice,' he stresses. And, in what some might see as an intellectual riposte to the questioning of his practice incurred by his suspension, Double is editor of a new book, Critical psychiatry: The limits of madness (2). It traces the philosophical, scientific and historical foundations of critical psychiatry.
Double decided to document his suspension in Critical psychiatry in a bid to convince psychiatry that it should not judge psychiatrists like him as a 'threat'. He writes: 'The aim is that by the end of the book you will be able to decide for yourself whether critical psychiatry is really such a threat. In my view, the book will have succeeded if it makes plain the self-deception, albeit unconscious, of much of biomedical psychiatry, and encourages instead a more open mental health practice.'
(1) Kay Sheldon was a member of the Openmind panel for many years.
(2) Critical psychiatry: The limits of madness (2006) is edited by Duncan Double and published by Palgrave Macmillan. It costs £50 (hardback).