Patrick Bracken

Psychological responses to war and atrocity: The limitations of current concepts

Because of the prevalence of wars, political violence and other forms of man-made disaster in Third World countries many individuals and communities suffer prolonged and often multiple traumas. In Western psychiatry certain conceptions of the response to violence and trauma have been developed, including the widely used category of post-traumatic stress disorder (PTSD). We argue that because concepts such as PTSD implicitly endorse a Western ontology and value system, their use in non-Western groups should be, atmost, tentative.

Postpsychiatry: a new direction for mental health.

Government policies are beginning to change the ethos of mental health care in Britain. The new commitment to tackling the links between poverty, unemployment, and mental illness has led to policies that focus on disadvantage and social exclusion.1 These emphasise the importance of contexts, values, and partnerships and are made explicit in the national service framework for mental health.2 The service framework raises an agenda that is potentially in conflict with biomedical psychiatry. In a nutshell, this government (and the society it represents) is asking for a very different kind of psychiatry and a new deal between health professionals and service users. These demands, as Muir Gray has recently observed, apply not only to psychiatry but also to medicine as a whole, as societys faith in science and technology, an important feature of the 20th century, has diminished.3 According to Muir Gray, “Postmodern health will not only have to retain, and improve, the achievements of the modern era, but also respond to the priorities of postmodern society, namely: concern about values as well as evidence; preoccupation with risk rather than benefits; the rise of the well informed patient.”3 Medicine is being cajoled into accepting this reality, but psychiatry faces the additional problem that its own modernist achievements are themselves contested. Consider this: although patients complain about waiting lists, professional attitudes, and poor communication, few would question the enterprise of medicine itself. By contrast, psychiatry has always been thus challenged. Indeed, the concept of mental illness has been described as a myth.4 It is hard to imagine the emergence of “antipaediatrics” or “critical anaesthetics” movements, yet antipsychiatry and critical psychiatry are well established and influential.5 One of the largest groups of British mental health service users is called Survivors Speak Out. Psychiatry has reacted defensively …

Post-modernity and post-traumatic stress disorder

The after effects of trauma have assumed a central role in the discourses of psychiatry and psychology in recent years. Most commentators have looked for an explanation of this explosion of interest in trauma, to developments within psychiatry and psychology. However, it is argued here that important cultural changes in the Western world have produced the conditions in which this interest has come about. The advent of post-modernity has witnessed an undermining of social stability and coherence and a systematic weakening of those cultural institutions which provide meaning and order for individuals. Following trauma, the development of the characteristic symptoms of post-traumatic stress disorder (PTSD) is currently understood to arise from a breakdown of meaning within the victims world. I seek to establish an association between PTSD and the culture of post-modernity. I argue that this connection has important implications with regard to our understanding of the relationship between trauma and culture more generally.

Hearing Voices: A Phenomenological-Hermeneutic Approach

The word “phenomenology” has a number of meanings. In this paper we briefly contrast the different meanings of the word in psychiatry and philosophy. We then consider the work of the philosophers Heidegger and Merleau-Ponty, as examples of what Hubert Dreyfus calls ontological phenomenology, in contrast to an epistemological approach. We present a brief outline of Merleau-Pontys theory of embodiment, and contrast this with the dominant, epistemological (or Cartesian) view of experience. Through the example of a woman who experienced bereavement hallucinations, we try to show how this approach can open up a hermeneutic approach to the experience of hearing voices. An understanding of embodiment can help to counter reductionism, whether biological or social, and dualism (body/mind and mind/society). It is only when we consider the totality of human experience that we can understand its meaning. This has two main benefits. First, it legitimates the claims made by those who hear voices that their experiences are intrinsically meaningful. Second, it can provide a framework for those who work with voice hearers and who are interested in understanding these experiences. In this sense, phenomenology can become a valuable clinical tool.

Challenging the globalisation of biomedical psychiatry

For over 100 years biomedical psychiatry has dominated the way people throughout the western world understand their sadness and distress, despite the lack of empirical evidence that distress has a biological basis. Now, the interests of the global pharmaceutical industry and trans‐national professional elites such as the World Health Organisation and the World Psychiatric Association are extending these biomedical accounts across the globe. This paper briefly describes biomedical psychiatry and its origins before considering how this project is closely aligned to the interests of the pharmaceutical industry. It ends with a call for a new agenda in mental health, driven by the concerns and interests of ordinary people in local communities, and an outline of recent developments in Britain and elsewhere that illustrate this challenge to the biomedical hegemony.

Cognitive therapy, cartesianism and the moral order

Abstract In recent years cognitive therapy has become increasingly popular as a treatment for many forms of mental illness. This therapy is presented as scientific, rational and relatively easy to learn and use. In this paper we seek to demonstrate the particular philosophy of mind at work within the cognitivist framework and the ethical assumptions which accompany it. We conclude by drawing attention to some of the clinical implications of this analysis.

Helping victims of violence in Uganda

We report on a project to assist victims of war and violence in Uganda. The original aim of this project, set up by the Medical Foundation for the Care of Victims of Torture, was to establish a centre for the assessment and treatment of torture victims who had suffered during previous regimes in that country. We found, however, that a specialist centre was not the most appropriate response in a country like Uganda. We argue for the need to respect local initiatives and systems of support and against the notion that there is a single model of care which is universally relevant. Following much investigation and involvement with local personnel, we have developed a programme of training and discussion for health workers, and a service to reach the many women who have suffered rape, and whose suffering has continued, largely ignored.

The rehabilitation of child soldiers: Defining needs and appropriate responses

There is growing international concern that large numbers of children are being recruited to military forces in situations of conflict around the globe, despite the fact that there are principles established in international law specifically directed against the use of children as soldiers. It has been assumed that military experience will have negative psychological effects on children, and several projects aimed at the rehabilitation of such children have been developed. We have had opportunities to examine the situation of child soldiers in Uganda, Liberia and Sierra Leone. In this article we draw attention to some of the conceptual and practical problems involved in this rehabilitative work.

Dualisms and the Myth of Mental Illness

What does it mean to ‘de-medicalize misery’? Does it mean that we should no longer think of states of despair, sadness and madness in medical terms? Does it mean that there is no proper role for doctors in trying to work with and help those so afflicted? And if that is so, then what is to be done about the systems that Western societies have set up to help, such as mental health and primary care services, all of which are predicated on the assumption that misery and madness are, among other things, medical conditions? Are all these to be dismantled? If so, what should take their place? These are not rhetorical questions; they serve the point of drawing attention to the fact that words have important consequence, if we mean what we say.