Peter Chadwick and dysfunction

Peter Chadwick and others raise the issue of the direction from which psychiatry is coming. We live in a postmodern world and that has enabled the practice of considerations beyond the assignment of diagnoses to treat dysfunctions, deficits and disorders. Before the postmodern era, in the post-World War 2 climate of the full employment economy, the welfare state, and the Cold War, there were certainties all around. There was certainty in mental health care, that sufferers would be housed in asylums and be subjected to the medical model of treatment, which sought to identify dysfunctions and to attempt a cure.

Peter is critical of this stance. As are other likeminded writers from a professional perspective, which is part of Peter's standpoint. Psychologist and psychiatrists such as Jerome Carson, Frank Holloway and Glen Roberts have all modified their view of the patient away from the medical model. They promote ideas such as the recovery model, and this would not have been possible in the old post-war era of the medical model, which emphasised exclusively that mental illness was a deficit condition where the prime activity was to affect a cure of a biological condition. Even pharmaceutical companies include people today who do not subscribe to that belief. Articulate service users including Gordon McManus also recognise that their future does not lie in promoting a view of mental health, that seeks only to identify and deal with negative symptoms. In fact Gordon's definition of recovery is that after effective treatments have been found to deal with symptoms, there is necessary the establishment of a meaningful life and a new identity. Such a scheme would never have been facilitated by the mental health regime prior to the postmodern era with its community care and person centred philosophy.

So the bracket of dysfunction, deficit, disorder, and the drive to find a cure, has been superceded by practice that aims to integrate the individual into society. Along with that goes Richard Bentall's speculation that mental illness is on a continuing spectrum with everyday life. Aspects such as that around 10% of people have experienced hallucinations and other symptoms, without having a diagnosis, means that there is not a cut-off where pathology kicks in, a separate condition from sanity. So the 1% of the population with schizophrenia are in fact included in the human condition, and human nature can be understood from the experience of the mentally ill.

Perhaps the prime benefit of discarding the dysfunction paradigm is that recovery and other future models that value sufferers as individuals, can be put in place. There is a place for dealing with unhelpful symptoms, but that is surely not the end of the role of mental health care. A meaningful life and a new identity demand caregiving beyond that.