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Introduction
An area of discussion and research that is of particular interest to me is the social construction of mental illness in contrast to medical models. The COVID-19 pandemic has helped to bring this way of thinking more into focus, as normal social circumstances have been decimated due to lock downs and social distancing.
It will be helpful to understand that the context in which I work is as the manager a user-led community mental health provider. It is important to say from the outset that social constructionism informs the philosophy of the organisation.
My views about mental health are quite controversial. I mean that I do not believe the brain chemistry and gene theories. There is nothing in these that convinces me that they or other medical or biological theories are responsible for, or meaningfully contribute to, deterioration in mental health.
Holding this point of view depends on whether you think about mental illness as a medical disease in the same sense as chronic obstructive pulmonary disease (COPD) or Coronary Artery Disease where there are tests and samples to be taken, to be analysed and prove that criteria are met, or something else.
In the mental health world, it is all a bit different. There are no such tests. Instead, there are diagnostic manuals (American Psychiatric Association, 2013; World Health Organization, 2010) that enable suitably qualified people to compare observations against. Definitions and classifications have changed over the years, however, and appear to be based in culture and morals.
Critical psychiatry
In recent decades, high profile commentators (Barker and Buchanan-Barker, 2005; Bentall, 2003; Szasz, 1976) have begun to consider mental health in terms of being caused by psychological and social factors. These factors such as being isolated, being victims of abuse, divorce, retirement, long term physical illness, employment stress, bullying – we call these the social determinants of mental health and there are very many of them. Critical psychiatry challenges the traditional model that is paternalistic and controlling (Hopton, 2006; Thomas and Bracken, 2004), instead of suggesting that interpretation and pluralism permits people to bring the meaning of their experience to the foreground, contrary to the traditional medical view of “this is what your problem is”.
Critical psychiatry considers that psychiatry should be more...