Let’s talk about a mix up that doesn’t seem to disappear: being critical of psychiatry is often deemed the same as being against psychiatry. It’s almost as if people who ask questions about how the profession is organised, want to eliminate the whole psychiatric field. And that is a misconception.

Critical of psychiatry: Maintenance is not degradation

Criticising something doesn’t is not the same as demolishing it. It actually means maintaining it. It’s an activity – a verb – that keeps our profession relevant, and up to date. We examine assumptions, listen to new voices, adjust our language, and keep building things. Not to push them over, but to get better at what what we aim for: helping people give meaning to their suffering and disruption, and make recovery possible.

Being critical of psychiatry has brought us a lot. Our perspectives on recovery have grown, we are taking trauma more serious, and are more open about medication and tapering. Over and over we see the same pattern: new ideas are created, are regarded with suspicion at first,  and then slowly make their way into the core of psychiatry.  The only way this process is hindered, is if we do listen to the criticism, but don’t actually change the way we do things. Because that creates ‘fake participation’: it seems inclusive, but our language, decisions, and results remain unchanged.

Cocreation can change our course

That’s why the term participatory assimilation is so important in my opinion. It describes a subtle mechanism: you invite people with lived experience to participate in research and design. You let them talk, and help brainstorm, but their perspectives and ideas are ultimately shaped by your existing frames. Everyone happy, box ticked, but still, their actual ideas are essentially ignored. The friction, that could really teach us something, disappears. And that’s a real shame, because it is exactly that friction that can help us progress in our profession. If we claim that we are cocreating, we have to dare to let that cocreation change our course. Otherwise being critical of psychiatry is just for show.

Conflict makes things visible

Something that can help us achieve this is epistemic pluralism: acknowledging that there is more than one way of looking at things – applying professional, scientific, social, and experience based knowledge. It’s not a little footnote we add to the medical model, but real polyphony. When using this model, experience based knowledge doesn’t have to be ‘taken over by scientists’, or assimilated to be of use. It can ‘coexist’ with science based knowledge, and be of equal importance. And sometimes they clash, but that’s good. That clash shows us where we are too close-minded and invites us to ask more questions.

Searching, learning, and finding purpose together

Essentially this means we are going to organise things differently. We need to make expectations and people’s jobs more explicit: who advises, who decides, and when does that shift? We decide which assumptions are not negotiable, and which ones are. We use language that describes the source: if someone thinks hearing voices has a spiritual meaning, we don’t automatically translate that to ‘identity development’, but we let that frame of mind play a part in the research question, design, and outcome.

We make time to reflect on power, and for occasions when the plan has to change because our combined knowledge suggests something different. We also acknowledge other institutions, like recovery academies and networks of peers; not just to obtain useful data, but as equal partners.

Doesn’t that raise concerns? It certainly does. It requires us to make our professional certainties temporary and testable. It means we sometimes have to say: ‘We don’t know – let’s find the answer to this together.’ But let’s be honest: this is how psychiatry started. As an exercise in searching together, learning together, and finding purpose together.

Let’s give it a try!

So: Criticising psychiatry is not the same as being anti-psychiatry. It’s actually being passionate about psychiatry. Participatory assimilation help us recognise the trap that is fake participation. And epistemic pluralism sends us in the right direction to avoid that trap, and really work together. We should let knowledge gained from experience change our way way of thinking.

If we allow that to happen, psychiatry will grow, and become more relevant to our current way of life.

translated from Dutch by SGM Taplin