#ChoosePsychiatry now! But will you have a job in ten years?

As a psychiatry-curious junior doctor (or medical student), you probably know that some patients and ex-patients have always been dissatisfied with their treatment. There has been an ‘Anti-Psychiatry’ movement, supported by a few psychiatrists, and other mental health professionals, since the 1960s.

But you may not know that the UK’s psychiatric establishment, in the form of its monopoly professional body, the Royal College of Psychiatrists (RCPsych), has actually appeased and even encouraged some aspects of ‘Anti-Psychiatry’.

Although RCPsych leaders claim that they have government agreement for psychiatry remaining the lead profession in Mental Health for the foreseeable future, there is nothing legally binding about that assurance, and there will be at least two general elections in the next ten years.

There is evidence that RCPsych leaders are, in fact, ready to let clinical psychologists take over, perhaps quite soon. If that happens then many who choose psychiatry now may never become consultants, or even have a job at all in 2028.

In 2015 Dr Simon Wessely FRCPsych was the guest speaker at the ‘Critical Psychiatry Network’ (CPN) conference, during the first year of his RCPsych presidency. Neither he nor the CPN have written about or publicised this, although it appears that he expressed sympathy for their anti-diagnosis views. A few months ago I obtained some unpublished photographs of the 2015 conference, including one showing Dr Wessely on a panel with Peter Kinderman, past president of the British Psychological Society and author of A Prescription for Psychiatry (2014):


(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.

In A Prescription for Psychiatry, Kinderman states (p 50) ‘In my experience, the system of psychiatric diagnosis is demeaning and dehumanising…Ultimately, I believe there is no place for medical diagnosis in mental health care.’ After his reforms, he proposes (p 47) to ‘leave psychiatry – especially social psychiatry – as a key profession in a multidisciplinary service.’

But without diagnosis, what would psychiatrists actually do? Here the anti-diagnosis proposals become rather hazy. Kinderman and academic CPN psychiatrists such as Dr Joanna Moncrieff (who was Dr Wessely’s MD student) tend to imply that abolishing diagnosis will lead, by itself, to a reduction in medication  but as a backstop they say that some medication will still be necessary on a symptomatic basis.

It may all sound fanciful, but in fact learning disability psychiatry (in which I was an NHS specialist for ten years) has been a testing ground for anti-diagnosis views. The RCPsych has not released figures on consultant numbers, but there has been a marked decline in the number of nurses. Symptomatic use of medication has, if anything, increased.

Peter Kinderman has held a senior management role within NHS mental health services. His updated version of Anti-Psychiatry is attractive to politicians because he claims that he can increase patient satisfaction at no extra cost, or even with a reduction in cost.

Clearly, one saving which can be achieved if use of medication is merely symptomatic, is to get more of it prescribed by GPs, or non-consultant grades. This has already happened in the case of depression: most people treated in the NHS never see a consultant.

Faced with clinical psychologists promising such a mental health Utopia, RCPsych leaders have been reluctant to point out its faults, and have opted for short-term appeasement, allowing investment in mental health services to remain flat.

They have refused to address pharmaceutical industry regulation, conflicts of interest, and hyping of neuroscience in mental health, which continue to be major sources of credibility for anti-diagnosis extremism.

Anti-diagnosis views are actually quite useful for psychiatrists themselves to strategically adopt, when they exclude perceived low-risk conditions such as ADD / ADHD and much ‘borderline personality disorder’ from services.

For relieving the taxpayer in this way, RCPsych leaders have been rewarded with honours and knighthoods.

The current president, Dr Wendy Burn FRCPsych, appears no different. She allowed a CPD module by Dr Moncrieff to be published in February and, very recently, signalled that she would meet with Peter Kinderman’s close clinical psychology associate Lucy Johnstone, despite evidence that Ms Johnstone and other anti-diagnosis psychologists have encouraged abusive criticism, some of which was recently directed at a senior RCPsych psychiatrist:

180919-shit-fab Truthman-LJ180930-Burn-Johnstone-respectful

Having repeatedly raised these issues with the RCPsych leadership over the last few months, and been blocked by them on Twitter from @Choose_Psych, I wish you more luck than I have had in trying to get them to give straight answers.

But if you let yourselves be distracted by their endless variations on how wonderful a mental health ambassador Stephen Fry is; don’t say I didn’t warn you.


About Dr Neil MacFarlane MRCPsych

Independent Psychiatrist providing culturally informed mental health opinion, advice, and a few new facts. Based near London, UK. Main qualifications: BA MBBS MA MRCPsych.

2 responses to “#ChoosePsychiatry now! But will you have a job in ten years?”

  1. Duncan Double says :

    I’m not convinced the Royal College of Psychiatrists has actually “appeased and even encouraged some aspects of ‘Anti-Psychiatry’”. Twice the application of the Critical Psychiatry Network to be a special interest group of the Royal College was turned down.

    I think it’s also a mistake to see critical psychiatry as colluding with reductions in funding for mental health services. I do understand what you mean that critical psychiatry became associated with the rundown of the traditional asylum. And there is a sense in which mental health funding needs to be better spent. But critical psychiatry wants young doctors to choose psychiatry as much as the Royal College of Psychiatrists does, although maybe for different reasons.

    I also think it’s wrong to imply that critical psychiatry doesn’t recognise the value of a medical training for mental health practice. Of course a major reason for consulting doctors is for psychosomatic reasons. Clinical psychologists, of course, don’t have this background in medicine.

    And I think you’re right the debate about psychiatric diagnosis can get a bit confused. The main point is that functional mental illness should not be reduced to brain disease. Too many patients are not being helped to understand their problems in terms of their personal and social situation because of the focus on brain disease.

    i think Simon Wessely got his knighthood for his work on Gulf War syndrome, didn’t he? I’ve never seen Stephen Fry as a “wonderful” ambassador eg. http://criticalpsychiatry.blogspot.com/2016/02/what-does-it-mean-to-say-that-stephen.html and I wish he would do more in his position in MIND.

    I’m only posting this comment because you asked me to via email. i do wish sometimes, Neil, if I’m honest, that your blog posts could be bit more focused. Maybe my comment will help you do so.

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