Postpsychiatry and postmodern psychotherapy: Theoretical and ethical issues in mental health care in a Polish context

Abstract

The article reconstructs postpsychiatry's core propositions and briefly describes its theoretical background and assumptions. It also presents chosen aspects of postmodern psychotherapy, which seem to be in many ways similar to postpsychiatry's ideas. Although they are drawn from different inspiration, postpsychiatry and postmodern psychotherapy seem to come to similar conclusions, especially regarding the role of the patient in the therapeutic process, the meaning of psychiatric diagnosis, and the importance of the institutional, cultural, and social contexts in mental health practice and research. The paper also aims to place postpsychiatry and postmodern psychotherapy in a Polish context, focusing on the ethical challenges faced by psychiatry and showing that some of postpsychiatry's ideas and solutions to contemporary problems were already present in the Polish psychiatric literature of the 20th century. It also contains a brief description of the Polish social and historical context of psychiatry, as well as key aspects of the Polish legal system that relate to mental health and seem to reflect the nature of biomedical explanations of mental distress. It concludes that the model of psychiatric care postulated by "postmodern" approaches seems more ethical and scientifically and philosophically grounded and promises better treatment results than the "traditional" biomedical model.

From Mental Health Industry to Humane Care. Suggestions for an Alternative Systemic Approach to Distress

“…What is crucial is that diagnoses could be considered to be the primary source of stigma, self-stigma, power imbalances within the psychiatric system and an excuse for forced treatment and violations of human rights that effectively produce second-class citizens [ 93 , 94 ]. Some studies suggest that using another terminology, e.g., psychosis instead of schizophrenia, could be beneficial and reduce stigma and discrimination [ 95 ].…”

“…It is possible that this stress, even according to the stress-vulnerability model, can lead to worse outcomes playing the same role minority stress does for the LGBTQ population [ 98 ]. Framing mental distress not as a deficit or a “malfunction” but as primarily a sign of human potential and opportunity to grow, as in Kazimierz Dąbrowski’s theory of positive disintegration, could mitigate this stigmatizing and self-stigmatizing effect [ 94 ].…”

Boundaries of Stigma. Anti-Stigma Campaigns as Social Control and a Source of Self-Stigma

“…This is even more likely to occur when the "essence" in question is perceived in terms of inherent biological differences between the "normal" and the stigmatized. This basically dehumanizes mental health patients as sub-human faulty machines and provides a legal justification for forced treatment (Stupak & Dyga, 2018).…”

Przez kwasową psychiatrię do kwasowego komunizmu. Renesans psychodeliczny w psychiatrii jako szansa na zmianę paradygmatu

“…W Polsce -podobnie jak w wielu innych krajach -decyzja o leczeniu bez zgody lub zastosowaniu środków przymusu bezpośredniego (jak np. pasy i kaftany) opiera się de facto na subiektywnej ocenie personelu, a raport Najwyższej Izby Kontroli i tak wykazał, że reguły te są nagminnie łamane (Stupak i Dyga 2018) Chotkowska 2019). Oparta na takim przekazie strategia przeciwdziałania stygmatyzacji i autostygmatyzacji może mieć skutek wręcz odwrotny do deklarowanego.…”