Critical psychiatry is part academic, part practical. Theoretically it is influenced by critical philosophical and political theories, and it has three elements. It challenges the dominance of clinical neuroscience in psychiatry (but does not exclude it); it introduces a strong ethical perspective on psychiatric knowledge and practice; it politicizes mental health issues. Critical psychiatry is deeply sceptical about the reductionist claims of neuroscience to explain psychosis and other forms of emotional distress. It follows that we are sceptical about the claims of the pharmaceutical industry for the role psychotropic drugs in the 'treatment' of psychiatric conditions. Like other psychiatrists we use drugs, but we see them as having a minor role in the resolution of psychosis or depression. We attach greater importance to dealing with social factors, such as unemployment, bad housing, poverty, stigma and social isolation. Most people who use psychiatric services regard these factors as more important than drugs. We reject the medical model in psychiatry and prefer a social model, which we find more appropriate in a multi-cultural society characterised by deep inequalities.
In contrast to most medical conditions like diabetes, tuberculosis and heart disease, no psychiatric condition can be traced to a specific dysfunctional bodily process, excepting dementia, and the occasional neurological conditions that present to psychiatrists. In other words, there is no agreed physical aetiology for psychiatric disorders, although there are numerous and ongoing speculations about physical processes that might be involved.
In addition, despite claims to the contrary, there is no evidence that psychiatric conditions respond to physical interventions in a specific manner, as would be expected on the basis of a disease model. The effects of psychiatric drugs can be explained by the fact that they are psychoactive substances, that produce altered, drug-induced states. These altered states may effectively suppress psychiatric ‘symptoms’. There is no evidence that any class of psychiatric drug acts by reversing or partially reversing an underlying physical process that is responsible for producing symptoms (Moncrieff and Cohen, 2005). Therefore the idea that the behaviours seen by psychiatrists are indicative of an underlying disease is simply an assumption.
Psychiatric diagnosis as a political device