How ‘Drop the Disorder!’ colludes with the neoliberalism it claims to oppose
(Panel discussion at the 2015 Critical Psychiatry Network (CPN) Conference: (left to right) Dr Joanna Moncrieff MRCPsych, CPN co-chair; Dr Simon Wessely FRCPsych, President of the Royal College of Psychiatrists (RCPsych) 2014-7; (unknown); clinical psychologist Peter Kinderman; Dr Hugh Middleton MRCPsych, CPN co-chair. Most CPN conferences have been reported, with accounts of the presentations, but although the Powerpoint slides were posted on the CPN website, I have been unable to find any report of this one.)
(Dr Wessely is discussed from the 9th paragraph, below)
Funding for mental health services has fallen in real terms over the last six years, and possibly over a longer period. As the editor of Asylum magazine, Helen Spandler, pointed out in her 2016 article, ‘From Psychiatric Abuse to Psychiatric Neglect?’, over the last 2-3 decades we have moved towards ‘the perverse situation where people may have to exaggerate their madness (and emphasise their dangerousness) in order to access or retain services. This is very worrying.’
‘Neoliberalism’ may not have one fixed meaning, but most would agree that cutting state-provided services in order to reduce taxes is a key element. Also, that Margaret Thatcher, more than any other politician, established it at the centre of political discourse from the early 1980s onwards:
The Middle East journalist Patrick Cockburn is an expert in spotting unlikely political alliances, and he wrote this about Thatcher’s 1980s underfunding of ‘Care in the Community’: ‘The psychiatric hospitals were caught in a pincer movement from right and left. The left saw the asylums as being like prisons, whose inhabitants were primarily the victims of an authoritarian system. Films like One Flew Over the Cuckoo’s Nest propagated this attitude. On the right, such views were welcome because they provided respectable reasons for spending less money on the mentally ill and reduced the role of public welfare.’
In my view, calls over the last decade to ‘Drop the Disorder!’ represent a new form of this alliance between the ideological left, for whom treating and even supporting people with mental health problems distracts them from turning to socialism, and the state-shrinking neoliberal right. The beliefs that many such problems are either fictions promulgated by psychiatrists and the pharmaceutical industry (left version) or akin to malingering (right version, more straightforward now that profits on patent-expired psychiatric drugs are lower) are less in opposition than they might at first appear.
The CPN contains a range of leftist views, ranging from simplistic, even avowedly Marxist, ‘anti-neoliberalism‘, to lively cultural critiques, and more subtle approaches in which anti-capitalism is often buried in obscure discussions of Michel Foucault’s later writings on ‘Power’. CPN psychiatrists have mostly taken their anti-diagnosis discourse from ‘Critical Psychologists’, and I will only discuss Peter Kinderman as an example of the latter as he presented at the 2015 CPN conference; but he is probably the most prominent, having recently been president (and vice-president) of the British Psychological Society.
Peter Kinderman recently posted a talk he gave to a local Labour Party, full of lofty aspirations to ‘reduce financial and social inequality’ and promote ‘human rights’. He even had a photograph of Martin Luther King, who he quoted: ‘There are some things in our society, some things in our world, to which we should never be adjusted’. To be clear, I agree with these aspirations too, and with the view that inequality, abuse and trauma are major causes of mental disorder. But I differ in believing that support and psychotherapy will lead to more effective political engagement, not less.
Although he once, in passing, mentions mental health services as ‘under-resourced’, that is contradicted by the rest of the talk in which he implies great improvements can be made at no cost, or even with financial savings: he constantly stresses the claimed need to ‘reject…a diagnostic account of human distress’ but also reject ‘more of the same’ kind of mental health services.
No doubt these calls of ‘more money NOT needed here’ are pleasing to politicians in Whitehall, but also to Peter Kinderman’s local NHS managers in Liverpool.
But what of Dr Simon Wessely FRCPsych, who had become ‘Sir Simon‘ two years earlier, and at the time of the 2015 CPN conference was in his first year as President of the Royal College of Psychiatrists? Like their 1980s predecessors, The CPN and ‘Critical Psychologists’ tend to promote themselves as anti-establishment, so was the 2015 conference a confrontation, an occasion of mutual criticsm? Well, I have I have talked with several professionals and non-professionals who attended, and have been told that it was not. My explanation of this ‘mutual non-criticism’ follows.
Dr Wessely had been recruited to save money by ‘son of Thatcher’ Tony Blair’s government as early as 2001 (interestingly, Peter Kinderman reported a visit to the Department of Work and Pensions (DWP) in the same year). At the ‘Malingering and Illness Deception‘ conference in Woodstock, Oxfordshire, clinicians met both senior DWP staff and private companies whose ‘profits were threatened’ by disabling long-term disorders such as ME/CFS, which Dr Wessely (p.44) had based his research on over the previous decade.
Dr Joanna Moncrieff had been Dr Wessely’s MD student, and she had been interested in welfare as a drain on public spending even earlier, in 2000, when she published a paper warning that mental disorder-based ‘sickness benefits increasingly represent disguised unemployment‘. In 2016, a crack in the CPN’s ‘Drop the Disorder!’ consensus appeared when Dr Phil Thomas MRCPsych criticised another Moncrieff paper, which suggested that ‘to reduce benefit levels‘ was a valid primary aim for mental health services. Dr Moncrieff’s defence (below the Thomas critique, linked above), which started by irrelevantly stating that ‘almost all the data is already in the public domain’ and went on to repeat anti-neoliberal platitudes, was unconvincing.
Over the last 2-3 months I have come to the view that the CPN’s critique of the pharmaceutical industry is usually secondary to their concern about the ‘overmedicalisation’ of mental health:
Dr Moncrieff failed to respond to my point in this tweet. Since then, she has been silent about antidepressant hyping from the Maudsley Hospital/Institute of Psychiatry (where she did her MD), and about the overpromotion of ’emerging evidence’ claims from a leading psychiatrist employed half-time by GlaxoSmithKline (GSK) since 2005, who is active on a key RCPsych committee with Dr Wesseley. So has Peter Kinderman.
The selective criticism of pharmaceutical company behaviour by the CPN and ‘critical psychologists’ appears to go back, at least, to 2012, when there was little protest at the knighthood given to Andrew Witty, GSK’s CEO, for ‘services to the economy and the UK pharmaceutical industry’ (not for health), despite a $3 billion fine for overmarketing which was later confirmed as substantially ‘criminal’ and as partly relating to two antidepressants.
The CPN/’critical psychology’ alliance tends to claim sympathy with people who have difficulty withdrawing from antidepressants and benzodiazepines, but does not point out that medical supervision and support of such withdrawal is under financial pressure from their state-shrinking influence. Some ‘drug harmed’ people, who have been abused and shamed by another RCPsych ex-president, Dinesh Bhugra, as inventing or exaggerating ‘bizarre’ symptoms, partly motivated by ‘the incentive of litigation’, have noted a parallel between their experience and that of people with ME/CFS. Dr Moncrieff appears never to have commented on her former supervisor’s clinical area of interest, ME/CFS, but she has criticised patients’ self-advocacy as media-driven: ‘having a mental health problem has almost become a badge of honour among some sections of the popular press and numerous celebrity memoirs’ (p.77).
The unreported 2015 meeting between the CPN, Peter Kinderman, and Dr Simon Wessely shows that the post-Thatcher neoliberal state has found it useful to support a small but influential group of ‘Drop the Disorder!’ mental health professionals. In future Blog pieces I will explore aspects of this collusion further, and show how mental health diagnosis can be distorted and misused, sometimes oppressively, but is not inherently flawed as claimed by the CPN/’critical psychology’ alliance.
Dr Simon Wessely after his presentation. Dr Moncrieff in the centre. Peter Kinderman (partly hidden) in the front row.
Added 20th January 2019: My earlier piece ‘Pillshaming is Real‘, is also relevant.
I am still waiting for Duncan Double (who seems to be a rare example of a politically centrist, or perhaps apolitical, diagnosis-sceptic) to back up his various responses:
DD links here to the 2014 Nutt & Bhugra Lancet article (I tweeted back that I didn’t agree I was ‘turning the tables’, and that I had deliberately avoided the ‘stigma’ issue):
In a later piece I will try and find some good evidence (although it seems obvious to me) that flat/reduced mental health funding leads to overmedication because that is cheaper than support and psychotherapy:
Added 5th June:
From the co-author of ‘The Dangerous Rise of Therapeutic Education‘ (2008), which argues that a wider ‘therapy culture’ is in itself harmful, and tends to distract from those who need specialist intervention. There is an update, including Mindfulness, in a 2015 Youtube video.
From @AkikoMHart (Mind in Camden, @HVN_England, @ISPSUK) who is currently looking at Dr Wessely’s MHA review. And also @RITB_
My response to @RITB_ was that ‘A Disorder for Everyone’ and ‘Power Threat Meaning Framework’ closely overlap in content and aims with ‘Drop the Disorder’.
From a Sheffield Humanities Professor who has written about the limitations of his own NHS psychotherapy. I would read (and agree with) his 2008 book chapter as arguing for less dominance of ‘scientistic’ CBT, and comment that Foucault and Heidegger (the latter un-named but present in the frequent use of ‘being/becoming’) are fine to explore in and out of therapy but in the wider context are useful for neoliberal state-shrinking.
CPN stalwart Duncan Double (see above) seems to be defending ‘Drop the Diagnosis!’ as being the only true path to Mental Health Utopia:
And finally, a response from the editor of Asylum Magazine, whose Twitter profile starts with ‘Politics of Mental Health’. Perhaps I misread her ‘From Psychiatric abuse to Psychiatric Neglect’ piece as calling for more Mental Health services funding?