tag:blogger.com,1999:blog-4037164460976910904.post3282670041129642301..comments2024-03-18T05:23:40.725-07:00Comments on Peter Kinderman's blog: Times of Change and Opportunity: Towards a psychological model of mental health and well-beingProfessor Peter Kindermanhttp://www.blogger.com/profile/13996851837282115404noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-4037164460976910904.post-3379827214283787192014-08-19T08:03:41.260-07:002014-08-19T08:03:41.260-07:00Thank you for shining a light on the failings of p...Thank you for shining a light on the failings of psychiatry. As a survivor, I appreciate your courage. Clinicians need to focus on the intimate and social struggles of individuals and fight against the greedy and malevolent direction of Big Pharma. http://memorycloset.blogspot.com/2014/01/informed-consent.htmlAnonymoushttps://www.blogger.com/profile/03954034597282425630noreply@blogger.comtag:blogger.com,1999:blog-4037164460976910904.post-15226485538986312432014-08-18T16:22:36.602-07:002014-08-18T16:22:36.602-07:00Thanks for suggesting that I post. This is the fir...Thanks for suggesting that I post. This is the first time I have commented on a blog, so forgive any breaches of etiquette.<br /><br />So;<br /><br />One issue with your manifesto is that it isn’t what you say it is; you claim it is a prescription for psychiatry, but actually it’s a prescription for society, as seen in “Article 8: we must establish the social prerequisites for genuine mental health and well-being.” The aim is to prevent “states of distress” (which in some but not all cases might be regarded as “illnesses”) by preventing their causes; causes such as inequality, gender violence, intolerance, discrimination, neglect and sexual abuse. Who could criticise such a goal? The difficulty is, that although mental health services could contribute to this endeavour, can they really take a lead role in really bringing about such massive changes? Even if we accept that they can, how is ditching the concept of diagnosis actually going to make this process work? There does not seem to be any direct connection between the two.<br /><br /> “Article 1: services should be based on the premise that the origins of distress are largely social.” As a coal-face psychiatrist I disagree that there is enough evidence to say that the origins of the majority of “states of distress”/illnesses are social. But the main issue about Article 1 is; does that matter? Even if it were true that social causes are the main determinant of mental distress/illness, what difference would that make? Are the difficulties in modern mental health services really due to diagnosis and the medical model? If we were to dispense with these concepts, would life really be any better for patients? If mental health services were better-resourced, more efficiently delivered, promoted positive risk- taking rather than risk management, based on evidence but not compromised by protocols, and were not hamstrung by short-term outcomes and perverse incentives; then would it matter whichever model were ascendant?<br /><br />Some other comments;<br /> “Article 5: services should offer care rather than coercion.” I think what the substance of what you have to say on coercion is wise, and actually rather brave, given what must be the antipsychiatry stance of many in your audience.<br /><br /> “Article 7: mental health services should be under local authority control.” I disagree; look at what happens when public health in the UK comes under local authority control.<br /><br />I see essentially two themes in your manifesto. The first is the theme of attacking the social causes of mental disorder; by creating a fairer, more equitable and more humane society, ills such as domestic violence, abuse and neglect would be reduced, and so would the states of distress that can arise from them. It is impossible to disagree with this, although I add that even if these sources of adversity disappeared completely, we would unfortunately still have mental disorder. The second is the theme of dispelling the medical model. This is a less compelling argument, but more importantly, it appears to be bolted on to the primary theme.<br /><br />As users and workers in mental health services, we clearly have our part to play in building a better society. But have we any more influence on society in these contexts than we have as individual citizens? One story that affected me recently was that of Ariane Sherine http://t.co/cVAQPG2bmf. Sharing and acknowledging such experiences may do more to improve society than what we can do in our involvement in mental health services; although clearly acting ethically and compassionately in all contexts will promote the social change which, as you have correctly identified, is urgently needed.Sam Wilson @swiljhttps://www.blogger.com/profile/00577118406349682026noreply@blogger.com