Responding to the critics of psychiatry

“We are in the service industry and our purpose is to serve the population, but sometimes we forget this,” according to Prof Sir Robin Murray, Professor of Psychiatric Research at the Institute of Psychiatry in London, UK.

At the College of Psychiatrists of Ireland Winter Conference 2023, Prof Murray delivered a talk entitled, ‘How should psychiatry respond to its critics – with vehemence or conciliation?’.

“Psychiatry sets out to provide care for those with mental health problems, ie, to provide a service to them,” he said.

“Service industries generally survey their consumers to assess their satisfaction or otherwise.  However, the orthodox psychiatric response to criticisms of care has often been to discount sceptics as ill-informed, paranoid, or simply misled. Some psychiatrists have attempted to have dialogue with the critics, not always successfully.”

Prof Murray said that, in the UK context, there was a spectrum of critics.

He told delegates that psychiatry was often criticised for the continued use of electro-convulsive therapy, preoccupation with the minutiae of DSM/ICD diagnoses, excessive use of medications, or compulsory treatment. The critics included pseudo-religious groups, such as the Scientologists, “with whom dialogue was impossible.”

They also includes “radical psychologists” who believed that members of their profession should be chiefly charged with the care of mentally ill populations. However, significant criticism also came from service user groups, and even fellow psychiatrists, among others.

According to Prof Murray, in the UK, service user and representative bodies were less antagonistic than their US equivalents. He also said criticism in the UK has reduced over the last two decades. He suggested this was perhaps due to the passing of legislation, which stipulates that service users must be involved in care models for all disorders, not only psychiatry.

Some psychiatrists have attempted to have dialogue with the critics,
not always successfully

He explained that priority was increasingly being given to the ‘voice of the patient’ when it came to rethinking psychiatry. For example, looking at alternatives to compulsory treatment was important. “There has been an astonishing rise in [compulsory admissions] under the Mental Health Act in the UK.” Prof Murray explained that compulsory admissions had risen from 22,000 in 1982 to 51,000 in 2020. This was the result of an emphasis on risk rather than care. “There is a lot of pressure, and many psychiatrists err on the side of safety,” he argued.

Also, Prof Murray highlighted how cuts to mental healthcare budgets have resulted in a lack of capacity.

Looking at the conclusions to be drawn from these criticisms, Prof Murray said: “There are too few of us interested in the care of the mentally ill to spend time fighting each other.” Some of the questions he said the members of the profession should ask each other were: “Can we win arguments without being offensive or dismissive, and are critics more or less likely to be sympathetic to psychiatry after an encounter with us?”. He stressed, however, that a lot of criticism focused on the ‘brain disease model’ and there was a relative neglect of social factors. Prof Murray also asked whether psychiatry should be campaigning to improve the social conditions in which many patients lived. Another query was whether psychiatrists should play more of a role in talk therapy. He also questioned the widespread prescription of antidepressants, often in primary care.

In conclusion, he said psychiatry should be paying more attention to the views of service users.

Prof Murray pointed out that most service industries spent time assessing what their customers think of their product. “Service industries that fail to provide what their customers want tend to go bankrupt, or be replaced by other providers,” he said.