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"Alternatives Beyond Psychiatry"





The first question raised by a book titled "Alternatives Beyond Psychiatry" is this: Why do we need alternatives? What is wrong with the "care" that mainstream psychiatry provides? While there are many answers to that question, first and foremost we can look at one startling statistic, and that is the rise in the number of people disabled by "mental illness" over the past 50 years.

The modern drug-based paradigm of psychiatric care dates back to 1954, when chlorpromazine was introduced as the first antipsychotic medication. This, or so psychiatry would like us to believe, kicked off a great leap forward in society's care of the "mentally ill." Psychiatric researchers are said to have made great strides in understanding the biological causes of mental disorders and that has led to the development of ever better drugs for treating them. Yet, here is what all this "progress" has wrought: in the United States, the rate of the "disabled mentally ill" has increased nearly six-fold in the past 50 years, from 3.38 people per 1,000 population in 1955 to 19.69 people per 1,000 population in 2003. Since the introduction of Prozac (1) in 1987—and this was the first of the second-generation psychiatric drugs said to be so better than the first—the number of so-called disabled mentally ill in the United States has been increasing at the rate of 150,000 people per year, or 410 people newly disabled by "mental illness" every day.

Other countries that have adopted a drug-based paradigm of care, such as the U.K. and Australia, have also reported a great surge in the number of people disabled by mental disorders in the past 50 years. This interesting fact leads to only one conclusion: mainstream psychiatry's paradigm of care has failed. It has not proven to be an approach that helps people struggling with mental distress of some kind—depression, anxiety, manic thoughts, psychosis, etc.—recover and get on with their lives. Instead, it has proven to be an approach that increases the likelihood that such people will become chronically ill.

We desperately need to think of alternatives to that failed paradigm of care. That is a big challenge, and yet the contributions in this timely and much needed book all ultimately point to a common starting point: if we want to help those struggling with their minds, we can start by thinking of them—as the Quakers did when they rebelled against mainstream psychiatry in the late 1700s and early 1800s—as "brethren." Not as people with "broken brains," but simply as people who are suffering. From that conception, a whole world of "care" follows. What does everyone need to stay well? Shelter, food, friendship, and something meaningful to do with his or her time. Any society that provides such care and support, along with a message of hope—that people can recover from whatever mental distress they may be suffering—makes a good start at providing an effective alternative to psychiatry.

There are chapters in this book that tell of such programs. There are proven alternatives to psychiatry, programs that have a track record of helping people get better. And there are reports of ways of coping with madness on an individual level. This book hopefully will encourage many, many other such efforts to take root and flourish.


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"Alternatives Beyond Psychiatry" is a collection of reports and approaches from non-, anti- and post-psychiatric everyday life in different countries and provides an appraisal of individual and organized alternatives and measures that point to a need for structural change in the system. This is a book of practice and ideas, more personal than generalized. It offers suggestions, highlights contradictions and problems, and shows positive examples and models but does not provide easy answers.

Our alternatives beyond psychiatry are far removed from the academic remains of the '68 generation; nor are they a reform-oriented variant of Italian psychiatry, social psychiatry or community extensions of psychiatric institutions. Instead, alternatives beyond psychiatry are truly innovative, initiated and carried out by critical professionals and independent (ex-)users and survivors of psychiatry, the real experts in the psychiatric domain, dedicated to the right of self-determination, physical inviolability and social support.

Alternatives beyond psychiatry originate from an undogmatic and humanistic movement. Accordingly, the texts in this book are filled with a contrarian spirit and the fundamental conviction that (1) psychiatry, as a scientific discipline, cannot do justice to the expectation of solving mental problems that are largely of a social nature, (2) its propensity and practice to use force constitutes a threat, and (3) its diagnostic methods obstruct the view of the real problems of individuals.

Furthermore, the texts in this volume describe a commitment to (1) developing adequate and effective assistance for people in emotional difficulties, (2) safeguarding civil rights in treatment on a par with 'normal' patients, (3) joining forces in cooperation with other human rights and self-help groups, (4) use of alternative and less toxic psychotropic substances and a ban of electroshock, (5) new ways of living with madness and being different—with as much independence from institutions as possible, and (6) tolerance, respect and appreciation of diversity at all levels of life.

This book has been published without any financial support from sponsors. We have no connection to the pharmaceutical industry and to organizations that are dependent on them, nor to Scientology or other sects and dogmatists of whatever color. Beyond health, nothing is more valuable than freedom and independence.

We would like to express our heartfelt thanks to the many supporters who have provided valuable ideas, translated, corrected, and illustrated, in particular Arno Hessling, Christine Holzhausen, Craig Newnes, Darby Penney, David Oaks, Katy E. McNally, Kerstin Kempker, Martin Urban, Mary Murphy, Paula Kempker, Pia Kempker, Rainer Kolenda, Reinhard Wojke and Tricia R. Owsley.

Peter Stastny and Peter Lehmann


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Review by Paul Hammersley

Psychiatry as a science has had a profound political element from its infancy. For example many commentators, notably Masson [1], have suggested that Freud's reversal of his original belief that 'hysterical illness' was rooted in genuine childhood trauma, was politically rather than scientifically driven. Similarly, attempts to eradicate serious mental illness through manipulation of the gene pool that formed the driving force behind the eugenics movement in the early part of the last century mirrored extreme political views of the time from both the left and right wings of politics [2]. Once again, in the 1960's and 1970's critical views of psychiatry emerged [3,4] which corresponded with the prevailing liberal and anti-establishment zeitgeist. However the response was vigorous promotion of the biological model of psychiatry from the mainstream medical establishment and the pharmaceutical companies, which has been described by Bentall [5] as the second coming of biological psychiatry. This led to the absolute dominance of the medical/biological model of psychiatry, a situation that has persisted for the last thirty years. Such a one sided promotion of a disease model of serious mental illness, with medication as the only possible 'cure' has seen the exclusion of more holistic and humanistic approaches, and created an intellectual argument resembling the biblical battle between David and Goliath.

Orthodoxy is once again being challenged. Alternatives to psychiatry are back on the agenda, with one crucial difference. On this occasion the agitators for change are not disaffected professionals, but dissatisfied mental health care consumers many of whom feel that traditional psychiatry failed them, and that their recoveries have taken place outside of it.

Not even the authors themselves would claim that this is a balanced book; 'balancing' would be a better description. They present a refreshing wholly one sided view that will delight some and infuriate others. The book takes the form of forty-one brief essays and conference speeches from mainly European and service users and radical practitioners. Some of the essays take the form of life narratives and recovery stories; others are descriptions of specific recovery organisations such as Loren Mosher's famous Soteria project, whilst other essays cover specific topics such as the use of advanced directives or effective involvement of families.

The editors take as their starting point an unequivocal stance that modern psychiatry does not work, evidenced, in Robert Whitaker's "Preface," by the fact that since chlorpromazine was synthesized and introduced in 1954 the rate of 'disabled mentally ill' in the USA has increased nearly six-fold from 3.38 people per 1,000 population in 1955 to 19.69 people per 1,000 population in 2003. Furthermore, since the introduction of Prozac in 1987 the number of 'disabled mentally ill' has been increasing at the rate of 150,000 per year. This is a powerful argument. Whilst research into physical disease has led to huge improvements in outcomes in conditions such as breast cancer and HIV; psychiatry appears to be going backwards, and at an alarming rate. Following cautions about psychiatric drugs and treatments, Editors Peter Stastny and Peter Lehmann offer a volume of alternatives "beyond psychiatry."

The strength of this book is the diverse source of its contributors. Ninety year old Dorothea describes seventy years in the German psychiatric system which included involuntary sterilisation but ended in recovery and a determination to help others – a powerful testament to human resilience! Two other essays in this anthology stand out: Peter Lehman and Maths Jesperson's contribution, 'Self Help, Difference and User Control in the Age of the Internet,' shows how and why consumers groups will become significant players in the future shaping of psychiatry. Marc Rufer offers an eighteen page summary of the position of alternative theorists, 'Psychiatry: Its Diagnostic Methods, Its Therapies, Its Power,' that is destined to become a classic and by itself is worth the cover price of the volume.

The main weakness of this book is an absence of data. These are opinion pieces, a fact addressed in an excellent contribution from Jan Wallcraft, 'User Led Research to Develop an Evidence Base for Alternative Approaches.' While this weakness is obvious, overconfidence in 'data' can also be dangerous. A recent meta-analysis in the UK of the effectiveness of new generation anti-depressants concluded that they were equivalent in effectiveness to placebo if 'buried' negative findings from randomised control trials were included in the analysis [6]. This 'data' was only available because of a new freedom of information act

Psychiatry is about to experience fundamental changes that will not be driven by research chemists or neurobiologists. Politics and social justice have returned to the discussion. Consumers and service users that we claim to help recover are unhappy with what they are being offered, they are motivated and they are getting organised.

If memory serves me correctly, David beat Goliath.

This is an important book
About the author

Paul Hammersley is the Programme Director for Post Graduate Studies in cognitive behavioural therapy for psychosis at Manchester University's COPE Initiative in The United Kingdom. He is also an active therapist specialising in CBT for individuals experiencing severe psychological problems following traumatic life events. He has been widely published and has lectured extensively. 2006 along with Professor Marius Romme from Holland and The UK Hearing Voices Network, he founded CASL (The Campaign for the Abolition of the Schizophrenia Label.)