Anyone for critical psychiatry?

An admissions tutor in my medical school interview poured a helping of caution on my wary expression of interest in psychiatry. ‘That often changes after your rotation in it,’ he quipped, as if this was an old medical education in-joke.

Now sampling some ‘real medicine’ as the hackneyed jibe goes, I am still digesting my psychiatry rotation. I am starting to see how psychiatry's relationship with medicine is fraught with unrequited love. The tender issues of identity related to this are all too plain for undergraduate students to see. In his masterful anthropological survey of a London medical school in the nineties, ¹ Sinclair remarks that the stigma attached to psychiatry and the profession's dubious ranking on the hierarchy of specialty ‘sex appeal’ are part of the informal curriculum. That this subtext is so deeply entrenched to show itself to one potential psychiatrist before even starting medical school is a sign of how great a challenge the Royal College of Psychiatrists faces in boosting recruitment.

One approach would be to incorporate an element of critical psychiatry into the undergraduate curriculum. For those at the helm of the profession's recruitment efforts giving space for dissent might seem counter-intuitive. However, such a strategy might resonate strongly with those students whose response to their first experience of psychiatry was largely negative. Encouraging discussion conducive to critical thought might protect against marginalising their experience as nonconformist and so inconsistent with pursuing a career in the specialty. It would allow them to see that their instinctive doubts as to the efficacy of the profession's pharmacopoeia and its biological reductionism are shared and hotly debated by many at the top of the profession. In addition, it might serve as an early lesson in the value of tolerating ambiguity and uncertainty, transforming the clichéd critique of ‘wooliness’ levelled at psychiatry into something richer in possibility.

An awareness of the critical psychiatry movement and the culture war within the profession would give students a more favourable portrait of the specialty's willingness to engage with and accommodate dissenting voices. Undergraduates deserve being granted a broader perspective with which to make sense of their responses to psychiatry and more effectively challenge its epistemological frailties. With a more sophisticated understanding of the forces and philosophical concerns underpinning the profession, those deciding to join its ranks might be in a stronger position to more meaningfully participate in its evolution.