This week on MIA Radio, we chat with Professor Peter Kinderman. Peter is Professor of Clinical Psychology at the University of Liverpool, honorary Consultant Clinical Psychologist with Mersey Care NHS Trust and Clinical Advisor for Public Health England, UK. He was 2016-2017 President of the British Psychological Society (BPS) and twice chair of the BPS Division of Clinical Psychology. His research activity and clinical work concentrate on serious and enduring mental health problems, as well as on how psychological science can assist public policy in health and social care. His previous books include A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing, released in 2013.
In this interview, we discuss Peter’s new book, A Manifesto for Mental Health, Why We Need a Revolution in Mental Health Care, which presents a radically new and distinctive outlook that critically examines the dominant ‘disease-model’ of mental health care.
The book highlights persuasive evidence that our mental health and wellbeing depend largely on the society in which we live, on the things happen to us, and on how we learn to make sense of and respond to those events. Peter proposes a rejection of invalid diagnostic labels, practical help rather than medication, and a recognition that distress is usually an understandable human response to life’s challenges.
We discuss:
- What led Peter to his interest in psychology, having initially been interested in physics and philosophy.
- How his academic and clinical work have influenced each other throughout his career.
- Why it is important to challenge mainstream mental health messages, not just as an academic exercise but also for the good of society.
- That it is pretty clear that we currently have a very poor system for responding to emotional distress.
- How we are not offering real-world help for real-world problems.
- That it is vital for us to offer people an alternative framework of understanding to allow them to decide for themselves how best to frame and therefore respond to difficulty.
- That Peter has observed changes in language that are helping to support public realisation that ‘mental illness’ is an idea or theory rather than undeniable fact.
- How a psychosocially-based mental health response might work.
- That Peter’s would like to see psychiatrists treating children to be employed by the authority also in charge of education provision.
- How our hierarchical health system gives doctors enormous power.
- That the Nordic countries have evolved a more socially-integrated and community-based approach, which better integrates health and social care.
- How those that are critical of the illness model are sometimes viewed as ‘deniers of real experiences’, but that this is a mischaracterisation because it is more about understanding those experiences in a different way or using a different framework.
Relevant links:
A Manifesto for Mental Health – Why We Need a Revolution in Mental Health Care
A Prescription for Psychiatry – Why We Need a Whole New Approach to Mental Health and Wellbeing
Thank you Peter,
I was 21 when a mental health label was put on me. An introverted girl who’s lack of appetite, pain and bloating had to be an eating disorder. Counselling and antidepressants were not going to help my particular disease. More mental health labels were added and my very real physical symptoms were medically unexplained symptoms until aged 47. I have not had quality of life. It only takes 1 GP to think and check for autoimmunity. If there’s a high suspicion of a malabsorption illness then further blood tests are needed. I rang my GP practice months later and all I could repeat was I don’t feel very well. Of course I didn’t, my iron and vitamin B12 were particularly low. I got worse and ended up on a neurology ward. I had pronounced tremors, my walk was wide based and I struggled to initiate strides. I even had eye tremors. I was sent home in exactly the same state I had been sent in and told this was an adverse drug reaction to psychiatric medication. I knew better. I was not just a mental health patient who needed a calcium infusion. I knew this was multiple deficiencies, my gut had completely given up. I did not know why. A private dietician pointed me in the right direction and functional nutritionists. I learnt thick and fast about vital amines and minerals.
It takes between 5 and 10 years for any autoimmune disease to be diagnosed. Our own bodies attack us, we are exhausted and in severe pain. Depression or anxiety can be symptoms. Inflammation can be anywhere and when it reaches the brain then yes, psychiatric symptoms can be experienced. Autoimmune diseases are more common in women than men. Some research shows it is due to the XX chromosome. The big problem is, firstly we are women, so taken less seriously in health care. For this particular illness, I have found it very difficult to talk honestly and openly about my inability to control my bowels. Lastly, there is no money for the pharmaceutical companies when treatment is give up gluten and take supplements. Doctors are only taught about drugs. The NHS is a business after all. I really wish psychiatrists remember neurology or their is discipline confusion, they will misdiagnose, mistreat and mismanage. A psychiatrist really should know that the back of the brain is for balance and coordination.
Thank you.
Psychiatry with its invented illnesses and bad links with drug companies needs to be abolished altogether. Psychotherapy helps, fulstop. Psychiatry is a humanitarian crime and has nothing to do with science. Absolutely nothing.
Good comments from all but I pirmarily pose this to doctors who agree with some.
“changes in thinking”;- this is a natural state of being. A physical illness is also natural but psyche changes are more natural, as PK stipulates, they happen for a reason. Hence, I’m sick of prescribing drugs I know do harm.
Conditions which make children ‘unhappy’ to a bad degree are, we now know, dangerous.
BUT WE HAVE THE SOLUTIONS.
We have all been perplexed and these states are all ‘natural’.
Human ’emotion’ changes with the seconds of living. This can be termed: being alive, having been born.
‘distress’ it is certain, is also a feature of every human psyche. In fact there is a psychiatric term when we do not possess this.
If we are never distressed, the label might be worse.
The best talkers, often in powerful positions, are mostly not the best thinkers. The two mostly oppose oneanother, but not always. I agree it’s easy to talk our way through life, but in the end – what do we achieve?
What I like about Peter Kinderman is that he is prepared to offer ‘Psychology’ as a reasonable replacement for ‘tranquillisers’ which in the long run have been proven not to work.
I didn’t get on with ‘medication’ (it disabled me and nearly killed me). But I did quickly recover from what was at that stage diagnosed as “Severe and Induring Mental Illness” with the help of a careful drug withdrawal and basic ‘Psychology’.
But, any qualified ‘Psychologist’ should be able to genuinely recover a ‘Chronic Schizophrenic’ in the same way.
A lot of prescribing doctors don’t even know what AKATHISIA is. They wouldn’t even recognise the term.
Thank you both for this valuable discussion: “Why We Need A Revolution in Mental Health Care”.
The American Psychiatric Association Definition reads:
“Mental illnesses are health conditions involving changes in thinking, emotions or behaviour associated with distress, and problems functioning in social, work or family activities”.
Whilst welcoming your observation that prescribers are now of the belief that they have “always known that there are side effects to antidepressants”: – Might knowledge, awareness, and skill in the differential diagnosis and management of SSRI/SNRI – (and other prescription drug) – induced AKATHISIA be further enhanced?
AKATHISIA-awareness and prompt recognition may be an area where greater prescriber knowledge could achieve significant improvement in patient-outcomes and life-chances in those experiencing this common and life threatening Adverse Drug Reaction. (ADR).
I perceive that for many, or even for most of us (physicians): — Might it be out-with our belief systems, –
(out-with our medical training and out-with our Continuing Medical Education (CME) – and hence, our clinical experience) – to understand and to accept that we can prescribe a trusted drug in good faith, and that this can so rapidly, profoundly and dramatically change the recipient’s personality, emotions, thoughts, feelings and behaviours?
(This is a personal perception, of course, – I may be wrong).
In addition to intense and increasing agitation, pacing, aggression and writhing restlessness, the emergence of risk of violence to self and/or others; these diagnostic features of akathisia are exactly those used to “define”- to “diagnose” (and to label for life) – alleged Mental Illness.
(As defined above).
These overwhelming changes are those which families and loved ones are devastated to observe when AKATHISIA rapidly emerges on initiation, during withdrawal, or on changing an SSRI, SNRI or other precipitating drug/s.
I have seen intense akathisia apparently misdiagnosed as “psychotic depression”.
Subsequent enforced, multiple, psychotropic drugs exacerbate AKATHISIA and enhance the risk of Serotonin Syndrome and Neuroleptic malignant syndrome.
The resulting Physical, Psychological, Social, Economic and Relationship Injuries are lifelong.
Such diagnostic error is irreversible.
The label becomes labels, and the sequelae are “for life”.
Hence: – Might we also need a revolution in fastidious differential diagnosis, and an absolute commitment to meticulous differentiation of serious psychotropic adverse drug reactions from serious mental illness, however difficult this may be?
I recall visiting a secure psychiatric hospital many years ago.
As I looked for the person in charge of the ward I felt a gentle tug on my arm. I turned to look into a young man’s face. A face portraying fear of such intensity that I can still see and feel it.
“I don’t belong here – can you help me” he quietly said.
Anosognosia or Adverse Drug Reaction. ???
I will never know.
Dekker (2017) observed:
“In order to achieve a just and learning culture when care has not gone as expected or planned, three questions should be asked”:
* “Who is hurt”? * “What do they need”? * “Whose obligation is it to meet that need”?
Might it now be pertinent to ask these questions in the context of AKATHISIA?