Since his student days, psychiatrist
Duncan Double has sought to take the stigma out of mental illness.
But his controversial methods led to his suspension, reports Adam
Duncan Double is one of a handful of "critical" psychiatrists
working in the National Health Service. Such psychiatrists are
sceptical of the medical and scientific validity of psychiatric
diagnoses and the benefits of psychiatric drugs. They argue that
they understand patients from a more humane and less stigmatising
perspective. So, for example, they are less inclined to diagnose
schizophrenia in a patient hearing abusive voices and to prescribe
anti-psychotic drugs. Instead, they might try to help that person
understand what the voices represent and work out how to control
Double's work has not been without controversy. Despite being a
consultant psychiatrist and honorary senior lecturer at the
University of East Anglia's Medical School, he was suspended by his
NHS trust in 2000 for six months after GPs raised concerns about his
work with suicidal patients.
Double was told that his practice was a clinical risk and says he
was advised to undergo retraining in "organic psychiatry" and to
submit to clinical supervision following a confidential
recommendation by the Royal College of Psychiatrists. Double says
his college assessors indicated that if he did not agree, his
philosophy on psychiatry would need to be examined and his
scepticism about the use of medication challenged.
He adds that the stress brought on by the suspension was
"absolutely horrendous" for him and his family. Double believes that
psychiatrists like him are seen as a threat by the biomedical
hegemony gripping contemporary psychiatric practice. Moreover, he
thinks that his colleagues' distrust of him was exacerbated by an
"anti-psychiatry" website he launched to document the approach of
critical psychiatry. "Basically, I was regarded as different,"
Double claims. "I was using less medication than many psychiatrists
and was not so concerned about arriving at diagnoses."
Debates about the aetiology of mental illness have raged in
psychiatry and academia ever since modern psychiatry tried to carve
itself out as a medical discipline in the 19th century. The term
"critical psychiatry" was coined in 1980 by David Ingleby, professor
of intercultural psychology at Utrecht University in the
Netherlands. It takes up the baton of "anti-psychiatry", represented
by psychiatrists and writers of the Sixties and Seventies, such as
Ronald Laing, Thomas Szasz and David Cooper.
Critical psychiatry shares with anti-psychiatry the belief that
the mentally "ill" do not have an intrinsic brain disorder and that
physical intervention is not vital. Critical psychiatry attempts to
understand and treat severe distress in the "psychosocial" context
of a person's experience. Within academia, rigorous debate over such
issues is expected and encouraged. But in psychiatric practice, such
views can be demonised, Double says. He learnt this early in his
career. As a trainee psychiatrist based at Fulbourn Hospital, which
is affiliated to Cambridge University, he attended seminars to
discuss journal articles. During one seminar he questioned the
traditional medical understanding of mental illness. "I remember my
psychiatry tutor saying to me, 'this is dangerous talk',"
Double says. "Yet all I was doing was trying to work out how we
should be psychiatrists."
However, between 1989 and 1992 as a lecturer in psychiatry at
Sheffield University, he had the freedom to explore his views. At
that time, the department of psychiatry was headed by Alec Jenner,
co-founder of the radical mental h alth magazine Asylum.
"Jenner was in tune with my views, and there was nowhere else in the
country that I could have gone," Double says.
Nevertheless, Double chose to combine his academic work with
continuing along a practitioner path. "If critical psychiatry means
anything, it should be involved in practice," he stresses. And, in
what some might see as a riposte to his suspension, he is editing a
book, Critical Psychiatry: Limits of Madness. It traces the
philosophical, scientific and historical foundations of critical
psychiatry, and Double contributes four chapters.
The other eight have been written by leading thinkers and
practitioners in critical psychiatry and psychology. They include
Lucy Johnstone, academic director of clinical psychology at Bristol
University, who argues that psychiatric diagnoses are social
judgments that lack medical objectivity.
Johnstone has had a similar experience to Double's, in which she
says her dissenting views on psychiatric practice led to her leaving
clinical NHS work.
The book draws out how critical psychiatry is distinct from
anti-psychiatry, which, Double argues, eventually became preoccupied
with exploring existential paths to personal enlightenment rather
than pressing for progressive psychiatric practice. Moreover, he
says that - unlike anti-psychiatry - critical psychiatry is willing
to engage in meaningful debate over the validity of psychiatry's
biomedical evidence base.
"Critical psychiatry engages with the data", as Double puts it.
"I do see myself as a scientist, and I do see my approach as
One chapter, by Joanna Moncrieff, senior lecturer in social and
community mental health at University College London, typifies this
It critiques the evidence base for psychiatric drugs and claims
that the billion-pound pharmaceutical industry has formed an
alliance with a prestige-seeking psychiatric profession and
successive British governments eager to "transform social and legal
problems [of the mentally ill] into scientific and technical ones".
One consequence, Moncrieff argues, has been the consistent
overplaying of the benefits of psychiatric drugs. She concludes:
"The psychiatric community appears to have lost the ability to
imagine that life with serious mental illness is possible, and maybe
sometimes better, without (psychiatric) drugs."
Double documented his suspension in Critical Psychiatry
in an effort to convince mainstream psychiatry that it should not
judge psychiatrists like him a threat. He tells readers: "The aim is
that by the end of the book you will be able to decide for yourself
whether critical psychiatry is really such a threat. In my view, the
book will have succeeded if it makes plain the self-deception,
albeit unconscious, of much of biomedical psychiatry, and encourages
instead a more open mental health practice."
But surely now - as consultant lead of a multidisciplinary
community mental health team in Norwich, with a wealth of journal
articles and a book to his name - Double should feel confident that
his practice will not be put under the spotlight again? Not so.
Double remarks: "If there were power struggles [within the trust],
it would be an easy thing to open up again."
Critical Psychiatry: Limits of Madness is published in
June, Palgrave Macmillan, £50.00. Critical Psychiatry Network: http://www.critpsynet.freeuk.com/