(Submitted as an e-letter responding to Duncan Double’s BJPsych article ‘Twenty Years of the Critical Psychiatry Network‘. The article will not be open-access in the future, so please let me know if this link expires.
the e-letter is lightly edited here [mainly to remove a repeat of ‘but’]. After several weeks it was published.)
Duncan Double tells us that the CPN is an embattled minority trying to push back against the ‘mainstream’ who hold that ‘mental illness is brain disease’, but the only evidence he cites for most ordinary UK psychiatrists holding such views is Sami Timimi’s memoir.
He does not mention that the CPN is officially approved and promoted by the Royal College of Psychiatrists’ leadership, through the CPD module written by its co-chairs Hugh Middleton and Joanna Moncrieff: http://www.psychiatrycpd.co.uk/learningmodules/criticalpsychiatry.aspx
The reality is that the CPN is very much part of the psychiatry establishment’s failure to address long-term decline in NHS spending on mental health and learning disability services, from around 25% of the total health budget decades ago, to 11% today. The latest ‘Five Year Plan’ trumpets ‘a real increase’, but closer examination shows the commitment to be a mere 0.1%, well within the margin of error: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
As with ‘Critical Psychology’, the common factor of the range of views within the CPN is a commitment to anti-diagnosis purism (http://www.criticalpsychiatry.co.uk/docs/LanguageOfDisorder.pdf), hence the repeated employment of the ‘brain disease’ strawman by its members.
Dr Double stresses ‘minimising the use of coercion’ and ‘helping people improve their social situation’, but his solution of a ‘non-eclectic’ biopsychosocial approach seems Utopian, given his failure to call for adequate funding of community-based services.
For failure on mental health and learning disability funding by the psychiatry establishment and one of its ‘fronts’, see my piece on ‘Asylum Magazine‘.
For further evidence that the CPN is far from critical of establishment psychiatry, see this polite ‘debate‘ between Joanna Moncrieff and internationally prominent Pharma-psychiatrist Carmine Pariante, which barely touched on Pharma-psychiatry enmeshment, and completely avoided the smears and abuse of people concerned about ‘Prescribed Harm’ by Dr Pariante’s close Pharma-psychiatry colleagues.
In the last two weeks Dr Moncrieff has declined to confirm whether she still claims the CPN are ‘dissidents’:
I had to miss a session on The Two Cultures, at last month’s Literature and Science conference in Oxford, because I was myself speaking in a parallel session (see previous entry).
Never having read CP Snow’s original 1959 lecture before, I did so, and was struck by several things which seem to have been filtered out in the huge amount of media and academic commentary it has spawned over the last five decades.
Barely having made a few opening remarks, Snow the promoter of science and scientists puts the boot in to ‘literary intellectuals’ by saying that uncritical admiration for fascist sympathising poets such as WB Yeats, Ezra Pound and Wyndham Lewis was an important cause of Germany’s extermination program in the Second World War.
Well, I happen to have looked at some rather large books on the historical causes of the Holocaust recently, and they did not mention Yeats, Pound, Lewis, or any other poets. That doesn’t necessarily mean that Snow was wrong, of course, but his judgement does not seem to have ‘stood the test of time’.
When he talks about scientists, Snow mostly mentions physicists, such as the atom-splitting Nobel-Prizewinning Rutherford, who he had known personally. Perhaps that just reflects how the wider role of science was discussed in the 1950’s, but it’s interesting that having mentioned the Holocaust and its causes, Snow does not make any point about the very dodgy biological and medical science of Nazi Germany, or the rather less dodgy (and also quite often Nobel-Prizewinning) biomedical science which meant that Britain had little resembling an extermination program itself.
I’m fairly sure that Bad Science, rather than allegedly Bad Anglo-Irish-American Poetry, was more prominently in the minds of those who thought up the Final Solution. To some extent this relies on hindsight, as it was only in the 1980s and 1990s that the British Historian Michael Burleigh more fully outlined the importance of German biomedical eugenics, sterilisation and ‘euthanasia’ of the mentally and physically disabled, as necessary steps which then led to racial genocide.
And as euthanasia (or ‘euthanasia’, as the medically-dominated pressure group Care not Killing might still write it) is very much part of today’s public biomedical discourse, I think that a proper updating of Snow’s Two Cultures argument about ‘literary intellectuals’ would have to properly take account of the general shift of public interest in science, away from atom-splitting and towards …(allegedly) disorder-mongering mental health professionals, perhaps?
What does this have to do with a psychiatry blog? Look at just about any character in Dickens (especially from the middle and later period) and there are likely to be hints of psychological problems, at least. In these presentations I will be looking at how different aspects of Franklin’s life and works are alluded to in several of Dickens’ works from Martin Chuzzlewit to Little Dorrit.
12th April 2012, Oxford, British Society for Literature and Science annual conference, ‘Benjamin Franklin’s phrenological presence in Bleak House and Little Dorrit’
6th-8th July 2012, Portsmouth, The Other Dickens Conference. ‘Little Dorrit, letters from America, and biographical tracklaying’
10th to 12th July 2012, Edinburgh, Carlyle Conference. ‘Benjamin Franklin as a Carlylean ‘Demigod’: an under-recognised influence on Charles Dickens’s fiction?’
10-12 September 2012, Queen Mary, London, Emotions, Health & Wellbeing Conference. ‘Phrenology, mesmerism and the reptilian personality in Little Dorrit’
“Health is the primary duty of life”, according to Algy’s domineering aunt in The Importance of Being Earnest; and such is the unhealthy effect of the aunt and other relatives on his mood, that in order to see them no more than once a week, Algy invents a friend who is in such poor health himself that he requires frequent visits.
Earnest was written and first performed in 1894-5. So, appropriate to the last decade of the nineteenth century, during which logical paradoxes were explored by scholars in mathematics and psychology, Algy’s approach to life is both serious (good mental health is necessary) and non-serious (he rather enjoys the deceptions involved) at the same time.
The play involves the eating of cucumber sandwiches, bread and butter, and muffins. Algy eats so much, in fact, that one wonders how well his ‘imaginary invalid’ strategy really works. Were it not for the romantic ending where he gets engaged to be married and then presumably is happy thereafter, concern about Algy becoming obese due to what we might now call ‘comfort eating’ would be justified.
His friend Jack doesn’t overindulge, perhaps because he’s too busy with his own deception of being the carefree Ernest at weekends, while working hard and being a serious magistrate in the week. Unlike Algy, Jack is lucky enough not to have any domineering relatives to hinder his own dutiful pursuit of health. And he’s happy in the end, as well.
Born 200 years ago today, in Portsmouth, what difference did Dickens make, in the nearly-180 years since he started writing fiction and journalism?
Scrooge, Oliver Twist and Fagin are so familiar to us, that it’s perhaps easier to imagine some other writer(s) coming along and filling Dickens’s place on the broad-brush social reform issues, if he had been prematurely taken away by cholera or some other early nineteenth century affliction.
But there are so many other eccentric, strange, mentally unwell and physically disabled characters, who were also very well-known to millions of Dickens’s readers, perhaps even more so after his death, and well into the twentieth century. No other writer of fiction came close to creating awareness of these kinds of human diversity.
Just one example: probably the most severely, clinically, depressed character in Dickens is Bleak House’s Mr Jellyby. He sits with his head “against the wall” and almost never speaks. He’s a failure, and becomes bankrupt.
Illness and death occurs in most Victorian novels, and it is tempting to draw conclusions about the conscious and unconscious motives of the author from who suffers what. I’m uneasy about Dickens’s portrayal of the alcoholic Sydney Carton’s suicidal behaviour in A Tale of Two Cities (1). Dickens himself, in A Christmas Carol, draws attention to the fact that the crippled Tiny Tim “did NOT die”.
And the overwhelming majority of his eccentric and unwell characters do live on, sometimes bizarrely, but never in my view wholly implausibly. Mr Jellyby finds a friend, who talks about himself all the time. Most people would find this friend unbearable, but for some reason Mr Jellyby doesn’t: he listens, and he cheers up. Probably not a complete recovery, but enough to enjoy life again.
Last month’s radio programme about lobotomy (1) is interesting because it slightly departs from the usual historical scripts, which are: evil psychiatrists used lobotomy as a destructive form of social control, or well-meaning but weak ones rubber-stamped the decisions of others, such as Nurse Ratched in One Flew Over the Cuckoo’s Nest.
It emphasises that the inventor, and two of the main promoters of lobotomy were in fact not psychiatrists. Politician and neurologist Egas Moniz started the ball rolling. Then, American neurologist Walter Freeman, and the British surgeon Sir Wylie McKissock, both continued to do thousands of operations despite evidence for uncertain therapeutic results.
Historical radio and TV programmes about the bad aspects of the old asylum system (which I don’t advocate returning to, but will say it was always underfunded) are often a means, I think, of deflecting attention from current NHS mental health failings. Other occasional broadcasts about the mental health systems of second- or third-world countries generally have the same function.
At least this one is a little different. However, it seems to me that there is a clear parallel between lobotomy and another kind of invasive operation for a serious behavioural (and often psychiatric) disorder today.
Although obesity surgeons are not household names (yet), there has never been a proper trial of gastric banding or the more serious procedure of partial gastric reduction, despite thousands of operations being done annually (2). The rush to surgery is delaying the development of new non-surgical treatments, and the application of at least one recently developed and partially tested treatment (for obesity-linked ADD / ADHD).
The programme-maker did not draw attention to this obvious parallel. Was he or his boss warned off by England’s Department of Health, which for much of the last decade had surgeons both as chief medical officer and as a health minister? Or was it (perhaps more likely) BBC self-censorship?
BBC journalists don’t themselves seem to believe, any more, that the “licence fee” protects their independence because it is supposedly “not a tax”. But they continue to resist the suggestion that their work should be subject to the Freedom of Information Act.
So ordinary patients who have experienced poor results, infections or other complications from bariatric surgery, may never be able to discover the extent of any such BBC collusion. The same goes for relatives who, following one of the thankfully few deaths directly caused by bariatric surgery, may take a retrospective interest in how this surgical descendant of lobotomy was promoted.
(2) See my previous pieces on obesity: https://drnmblog.wordpress.com/category/obesity/
Drafted 2nd December; final version 8th December
I went back to school myself yesterday, starting an MA in Victorian Studies at Birkbeck College, part of the University of London. This follows on from my last blog piece, because quite a few other “Dickens obsessives” have done this course, and some of those teaching on it seem to acknowledge similar afflictions…
Many of my patients, especially those with ADD / ADHD, have thought about picking up where things went wrong in their own education. This may mean going back to do a similar course to the one which they dropped out of; or deciding that was the wrong choice anyway, and studying something quite different.
Although I have dropped out of a couple of courses myself in the past, I’m pretty sure it won’t happen this time. To some extent this is because I believe that I understand my own mild ADD tendencies better (1): my nineteenth-century interest is not an “obsession” in the clinical sense of being related to obsessive-compulsive disorder (OCD), but more of a recurrent ADD / ADHD “hyperfocus”.
I am obsessed by the novels of Charles Dickens, although this is a mild-to-moderate rather than a severe obsession, because I have not read any of them more than two or three times. Nor have I properly read more than a small fraction of the dozens of biographies and book-length critical studies published since Dickens’ death in 1870.
The recent riots in London, after the riots in Paris of a few years ago, got me thinking about Dickens’ descriptions of mob violence and mob rule in A Tale of Two Cities. The capture and execution of French aristocrats by the revolutionary Government provides an opportunity for the alcoholic and morally ambiguous lawyer, Sydney Carton, to do something unselfish for once.
I usually disagree with the view that Dickens is an overly sentimental writer of fiction, in the sense of false or distorted emotions being used for propaganda (for example, to promote a non-progressive view of the role of women). But this charge may be correct when it comes to Carton’s fate in the novel: in helping an aristocrat (who he happens to physically resemble) to escape, he deliberately gets himself imprisoned.
On his way to the guillotine, he speaks one of Dickens’ best-known lines: “It is a far far better thing that I do, than I have ever done”.
But is it? Carton’s supposedly noble action can be seen as promoting the idea that alcoholics are inferior beings who cannot change their personalities or behaviour, and do the rest of us a favour when they choose to die. Such was the hybrid of mistaken science and morality which developed in the last decades of the nineteenth century, and went even further in twentieth-century Nazi Germany.
The novel could easily have been written differently, with Carton revealing his true non-aristocratic status, backed up with a hidden physical attribute or some other identifier. Dickens had been the leading English novelist for decades, and had the skill to produce any number of original, plausible and memorable plot-lines based on Carton’s keeping, or at least trying to keep, his head.
This post was drafted by 2nd September, and published at DrNMblog.wordpress.com on 6th October
One of my past teachers is to be awarded the Nobel Prize for Medicine today.
Professor Robert Edwards, who developed In-Vitro Fertilization, gave an annual series of seminars on embryology to about a dozen Cambridge students specialising in physiology. I was a member of the 1982-3 class, when Edwards was a prominent public figure; not only as a scientist, but also because of his decision to publicly discuss the ethical aspects of IVF in a very proactive way.
Unlike other aspects of the course, where we did experiments on rats, pigs, cats, and ourselves, there were no “practicals” in embryology. So the seminars were, to be honest, a bit dry and theoretical. The realities of fertility only became apparent when I was a clinical student in obstetrics and gynaecology, a couple of years later.
But on one occasion, Professor Edwards’ partner, the pioneering obstetrician Patrick Steptoe, came to tell us about the early days of IVF in Oldham, and we heard also about how they overcame opposition from the various establishment bodies of the day. The scientist and the clinician both loosened up and brought the subject, appropriately enough, to life.
Books “should, like alcohol, dissolve barriers”, according to the literary academic and journalist John Sutherland, who explored the early history of Alcoholics Anonymous (AA) in a short programme last week on Radio 4 (1).
But for some people (including Professor Sutherland himself, sober only through two decades of attendance at AA meetings) alcohol has the opposite effect: “drinking recreated the conditions of childhood. Solitude; myself alone” (2).
Of these two apparently contradictory explanations for excessive drinking (alcohol dissolves interpersonal barriers; alcohol creates an interpersonal barrier), the first has been widely held for decades. “Social anxiety” was seen as a cause of alcoholism (3), and a problem in itself, well before pharmaceutical companies supposedly invented it in the 1990’s (4).
Anyone with the slightest interest in English Literature is likely to have read at least one of Sutherland’s reviews, books, or introductions to classics by authors such as Wilkie Collins and Anthony Trollope. They are invariably well-organised and structured, with a light touch but not at all “dumbed-down”, so achieving their aim of engaging academics and the general reader.
Alcoholics Anonymous has the reputation of having a rather black-and-white view of addiction. This is probably helpful, even necessary, for many people with severe problems, especially those in the early stages of “recovery”.
But this academic abstainer is not afraid to explore complexity or uncertainty. For example, in his Introduction to Jack London’s ‘Alcoholic Memoirs’, he suggests that the “chronic boozer” London later brought his own alcohol intake under control “easily enough”, and then continued to drink in part “socially”, but also because of the creative possibilities gained from alcohol withdrawal (not intoxication) (5).
Therefore, for anyone looking to remove or reduce moderate or mild addictions, a period of solitude spent reading Sutherland’s extensive works is highly recommended, and is unlikely in my view to have any harmful effects.
(1) Available on the BBC’s iPlayer only until 14th November: http://www.bbc.co.uk/iplayer/episode/b00vr78f/The_AA_Bible/
(2) Both quotations are from Professor Sutherland’s British Council Biography: http://www.contemporarywriters.com/authors/?p=auth519D1A75056591DEA5JxLj47A89F
(5) The whole Introduction can be read with Amazon’s “Look Inside” facility. The book’s full title is John Barleycorn: ‘Alcoholic Memoirs’.