An additional battle

I thank Paul Whitby for his kind words about my work (Letters, The Psychologist, October: 'The wrong battle?'). However, he appears to be unfamiliar with some aspects of it.

I am no more a fan of manageralism than he is. As we noted in the Power Threat Meaning Framework: '.....managerialism and the target culture in general....(leads to) undermining professional experience and intuition, increasing defensive practice, and taking the focus away from direct care towards time-consuming and expensive administrative tasks (Drury, 2014; Boyle, 2011). Opening up services to market forces speeds up the demoralizing process of constant change, along with fragmentation of services, and managing, monitoring and measuring at the expense of actual work with service users (Verhaeghe, 2012)' (p.290, PTMF Main document). As we also noted, managerialism relies on psychiatry, and some versions of psychology, to prepare the ground by dividing people's problems into neat, if wholly unscientific, categories which can be quantified for target-driven purposes such as payment by results. 

Critics of the medical model of psychiatry are not so much fighting the 'wrong' battle, but an additional one. The two equally misguided systems feed off each other. There was, as Paul says, a hope that devolving some of the power from psychiatrists would open up the field to more holistic care. This has not happened, because the same ways of thinking are deeply embedded in other professions, including our own. I would argue that we are now seeing yet another unhelpful trend; the apparent desire to acquire, if necessary though self-diagnosis on TikTok, a diagnostic label of some kind. The battles are multiplying, although they have common roots. We must engage with all of them.

Lucy Johnstone,
Consultant Clinical Psychologist