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Our Psychiatric Future

Our Psychiatric Future

Nikolas Rose

ISBN: 978-0-745-68911-1 December 2018 Polity 248 Pages


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Our everyday lives are increasingly intertwined with psychiatry and discussions of mental health. Yet the dominant medical discipline of psychiatry remains surrounded by controversy. Is mental distress really an illness like any other, treatable by drugs? Can psychiatrists differentiate between mental disorders normal eccentricities, anxieties or even sadness? Should the power of psychiatrists be challenged by the knowledge of those with lived experience of mental ill health?

In this penetrating analysis, Nikolas Rose critiques the powerful part that psychiatry has come to play in the lives of so many across the world. A series of chapters, each tackling an area of dispute head on, opens wide the terrain of debate addressing issues such as advances in brain science, the politics of Western psychiatry's spread across the globe, and recent evidence of social adversity's role in producing mental ill health. The answers we find to these pressing questions will shape the psychiatric futures that are being brought into existence. Ultimately, this book proposes a radically different future, no less evidence-based or rigorous, and indeed far more attuned to the realities of mental health, and argues that, as a branch of social medicine, another psychiatry is possible.

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  • Chapter One: What is psychiatry?
  • Our psychiatric lives
  • Everyone’s little helpers
  • Many psychiatries
  • Psychiatry defines the boundaries
  • What mental disorder is
  • Psychiatry as a political science
  • The politics of psychiatry
  • Critical psychiatry today
  • OnwardsÉ
  • Chapter Two: Is there really an ‘epidemic’ of mental disorder?
  • ‘The burden of brain disorders’
  • Counting the costs
  • Burden today
  • From ‘mental’ disorders to ‘brain disorders’
  • So is there an ‘epidemic’?
  • Chapter Three: Is it all the fault of neoliberal capitalism?
  • Our unhappy present
  • The factory of unhappiness
  • Social capital
  • Loneliness
  • Stress
  • So is it all the fault of neoliberal capitalism?
  • Chapter Four: If mental disorders exist, how shall we know them?
  • Diagnosis as a social phenomenon
  • Solution One: Define the phenotype
  • Solution Two: Find the biomarker
  • Solution Three: Straight to the brain
  • Solution Four: Beyond diagnosis
  • From diagnosis to formulation
  • Chapter Five: Are mental disorders ‘brain disorders’?
  • Proven by psychopharmaceuticals?
  • Discovered in the genes?
  • Visible in the brain images?
  • So are mental disorders brain disorders?
  • Chapter Six: Does psychopharmacology have a future?
  • How did we get here?
  • The drugs don’t do nothing, but
  • The pipeline is empty!
  • Beyond psychopharmacology?
  • Chapter Seven: Who needs global mental health?
  • Grand challenge: no health without mental health?
  • The debate
  • Beyond the conflict?
  • All our futures?
  • Chapter Eight: Experts by experience?
  • Mental patient movements
  • From ‘on our own’ to ‘nothing about us without us’
  • The politics of recovery
  • A new epistemology of mental distress
  • Have we moved beyond the monologue?
  • Chapter Nine: Is another psychiatry possible?
  • Manifestoes for the future
  • Seven answers to seven hard questions
  • Another psychiatry, another biopolitics
‘Nikolas Rose brings a remarkable wealth of scholarship and experience to seriously difficult questions about mental health – and his inspiring answers suggest original and enlightening solutions. Rose's brilliant analyses provide stunning revelations about practical ways mental distress can be alleviated. Everyone with any stake in psychiatry and mental health should read this book.’
Emily Martin, New York University

‘In another landmark volume, Rose presents the culmination of decades of critical questioning about the reach of psychiatry’s long arms into all our lives, whether we live with mental distress or not. His “Seven Hard Questions” are ones we need to keep asking.’
Sarah Carr, University of Birmingham