Influential when it was published during the 1970s, how relevant is Anthony Clare’s Psychiatry in Dissent today? We discussed this book last night at the Maudsley book group, and were joined by Prof Robin Murray, and friend and colleague of Clare.
Clare, a clever and urbane Irishman, was one of the first to take on the arguments of ‘anti-psychiatrists’ such as Thomas Szasz and R. D. Laing. Although Clare was still in psychiatric training when Dissent was published he found himself propelled into the limelight as a spokesman for the profession. This was something that Prof Murray said caused some resentment at the time, not least because Dissent is, in places, quite critical of contemporary senior psychiatrists.
After the passage of years the book is notable for both what it does and doesn’t include. The first two chapters of the book are perhaps the strongest. They explain the concept of psychiatric illness and the process of diagnosis, both of which have undergone little change. Also still relevant is Clare’s critique of the Rosenhan experiment . This is an interesting, but methodologically flawed, study. Controversy was raging about it in the mid-70s and its results are still cited uncritically today.
There’s no mention of ADHD, PTSD or bipolar spectrum – these didn’t ‘exist’ then. A similar book written today would need to address controversy of the efficacy of SSRI antidepressants. There is a chapter on psychosurgery, something of a non-topic now, and already on its way out during the 1970s. The 40s, 50s and 60s had seen lobotomy used for a wide range of presentations from schizophrenia to migraine.
The final chapter “Contemporary psychiatry” is notable in that in many respects it echoes many of the problems of psychiatry today, as if nothing has changed: poor recruitment to the specialty and under provision of services.
Towards the end of his life Clare talked about updating Dissent, but a heart attack intervened. It would be nice to have a contemporary critique of psychiatric practice aimed at the layman – a modern Psychiatry in Dissent is sorely required today.