Scull's Dilemma

Abstract

Few psychiatrists now take a lively interest in the social sciences, and few social scientists listen to what psychiatrists have to say. For the handful who do, the widening gap between the two fields of knowledge is regrettable, for we have much to learn from each other. The gap seems to have grown for two reasons: psychiatrists, increasingly occupied with pharmacotherapy, have drawn closer to general medicine, and there is comparatively little interest in the social therapies which seemed to offer so much promise back in the 1950s. The open-door system was a success, and so was the idea of community care, even if the practice left much to be desired. Incidentally, these developments destroyed many of the interesting experiments in group dynamics which were at one time a feature of mental hospital life. Social workers, once seen as allies, went off on their own in the new, powerful and largely incomprehensible Social Services Departments, where they had many other tasks to occupy them. Sociologists became shrill and hostile. Many psychiatrists ceased to read sociology after the publication of Goffman's Asylums (Goffman, 1961) because it seemed that sociology was off on some kind of egotrip which was deeply antithetical to their own professional experience. People who talked about “madness” instead of “mental illness”, rejected diagnosis as labelling, and regarded mental patients as victims of a capitalist plot were (and are) difficult to talk to. One of the distinguishing features of mental health reform over the past 200 years has been its apolitical nature—people of all political views could agree on what seemed essentially a matter of common humanity. Suddenly it became highly politicized, both in theoretical terms, since the new analysis was basically neo-Marxist, and in the action of pressure groups in the Civil Liberties lobby. Confused by the Right to Treatment, the Right to Refuse Treatment, the Right to Information and the Right to Confidentiality, most psychiatrists have (wisely in the circumstances) kept their heads down and got on with the job.