Critical Psychiatry: toward an ethics of scientific and clinical knowledge
(pour la version française, cliquez sur "français" dans le coin supérieur droit de cette page)
Critical Psychiatry is a rapidly growing field of research and clinical practice that aims to reconsider the economic, social, and administrative interests that influence the provision of mental health care. Starting from an ethical foundation and a critical reading of the scientific literature, this branch of psychiatry attempts to bring to light certain dogmas of the practice of psychiatry, with the aim of creating space for innovation and improved patient care. Adopting a vision that brings together neuroscience, philosophy, sociology, history, and anthropology, Critical Psychiatry provides a new perspective on problems in mental health and the clinical issues of our time. Given the growing interest in this stream of current and future psychiatry, it is crucial for Quebec's clinicians to have a forum in which they can gain exposure to it.
This event, aiming to provide an introduction to the issues of critical psychiatry, will bring together experts of the field for a day-long symposium. The symposium is open to all residents, physicians, researchers, and other professionals in mental health who are interested by this ethical and clinical reflection. After the conference of experts, the day will conclude with a round table during which the audience and the speakers will be able to exchange regarding current and future perspectives of critical thought in psychiatry, and mental health in general.
Welcome, one and all!
This day is organized by members of the Network for Critical Reflection in Psychiatry (Réseau pour la réflexion critique en psychiatrie (RRCP)), composed of residents in Psychiatry from all the medical faculties in Quebec*. We extend our sincere appreciation to our partner organizations, which have allowed us to provide a space for open and free reflection, independent from industry funding (partner logos are found at the bottom of this page).
Residents, students, and other professionals: $45
*The cost includes coffee, snacks, as well as lunch.
Alain Denault received a doctorate in philosophy from the Université Paris-VIII and is the program director of the International College of philosophy in Paris. With several publications to his credit, including "Mediocracy: The Politics of the Extreme Centre", he is interested in the influences of neoliberalism and large corporations on political bodies, public institutions, and on the practices of professional organizations.
Swapnil Gupta, MD, MBBS, is a psychiatrist and adjoint professor of psychiatry at Yale university. In the last several years, she has developed an expertise in the field of deprescribing. She currently develops online training, directed towards clinicians, that addresses the possible solutions to polypharmacy.
Mona Gupta, MD, is a consult-liaison psychiatrist at the University of Montreal Health Centre, an adjoint professor at the University of Montreal, and a researcher. She is interested in the ethical issues surrounding clinical practice and published, in 2014, a book entitled "Is evidence-based psychiatry ethical?"
Sandra Steingard, MD, is a psychiatrist, a clinical professor at the University of Vermont, a member of the board of directors of the "Foundation for excellence in mental health care", and serves as the medical director of the Howard Centre, a community resource centre that integrates multiple mental health programs in Burlington, Vermont, USA. Among other achievements, she is known to have implemented "Open Dialogue" treatments for people struggling with psychosis in her community.
|8:30 - 9:00||Welcome and registration|
|9:00 - 9:15||Opening lecture|
|9:15 - 10:00||Presentation, Dr. Mona Gupta|
|10:00 - 10:30||Questions and discussion|
|10:30 - 10:45||Coffee break|
|10:45 - 11:30||Presentation, Dr. Sandra Steingard|
|11:30 - 12:00||Questions and discussion|
|12:00 - 13:00||Lunch|
|13:00 - 13:45||Presentation, Dr. Swanil Gupta|
|13:45 - 14:15||Questions and discussion|
|14:15 - 14:30||Coffee break|
|14:45 - 15:30||Presentation, Dr. Alain Denault|
|15:30 - 16:00||Questions and discussion|
|16:00 - 17:00||Round Table|
1, Quelles différences entre le suicide et l’aide médicale à mourir? Dre Mona Gupta (conférence en français)
Dans son préambule, la loi fédérale sur l’aide médicale à mourir (AMM) affirme « que le suicide constitue un important enjeu de santé publique qui peut avoir des conséquences néfastes et durables sur les personnes, les familles et les collectivités. » Quels sont les liens conceptuels et éthiques entre le suicide et l’AMM? Cette présentation va explorer cette question en prenant en considération le rôle particulier de la psychiatrie devant les personnes suicidaires.
2. Slow Psychiatry: A way forward for the profession, Dre Sandra Steingard
Goal and learning objectives: at the end of this talk, listeners will:
Dr Steingard will begin her talk by highlighting some fundamental critiques of modern psychiatric practice. She will describe the concept of drug-centered vs. disease centered psychopharmacology. She will also introduce need-adapted treatments. She will propose that an integration of these two approaches can help psychiatrists practice in a more humble, transparent, and democratic manner.
3. The Application of Deprescribing to Psychiatry, Dre Swanil Gupta
Goal and learning objectives: At the end of this talk, the participant will be able to:
Deprescribing has been defined as the “reduction or cessation of potentially inappropriate medications in situations where existing or potential risks outweigh existing or potential harm, taking into consideration the patient’s medical and functional status and preferences”. This intervention was originally described in geriatric medicine where patients are at risk for serious consequences from drug-drug interactions. Psychiatry with its history of treatments with questionable efficacy and serious side effects, forced hospitalization and coercion is well-poised to receive and implement an intervention like deprescribing. In fact, deprescribing is a critical need in psychiatry to address the escalating use of polypharmacy, to restrict the use of medications to situations when they are clearly indicated, to shift the focus of treatment to psychological and social factors and last but not the least, to make the patient and equal partner in his own care. It is important to remember that deprescribing, by no means, is a withdrawal of care and in fact may be a more time-consuming intervention that the continuation of medications. Thus, in psychiatry, deprescribing has the potential to streamline medication regimes, minimize side effects, and cut costs, the process may also improve patient adherence and strengthen the relationship between the patient and the prescribing professional.
Keeping these goals and justifications in mind, we propose using the framework of shared decision making to implement deprescribing in psychiatry. We also expand on the steps of deprescribing to include psychosocial interventions and management of withdrawal symptoms. Finally we will discuss some of the major limitations and barriers to the implementation of deprescribing and how to overcome them.
4. De l'économie psychique à l'idéologie marchande, Alain Denault, Ph.D. (conférence en français)
Sous-titre: Retour à Georg Simmel et Sigmund Freud
La présentation porte sur les écrits métapsychologiques de Sigmund Freud entre 1900 et 1915 ainsi que les intuitions correspondantes de Georg Simmel ces mêmes années. Ils permettent de concevoir les liens unissant les modalités d'organisation de la vie psychique et les discours intéressés autour de l'argent, de la profitabilité et de l'intérêt financier.
*Organizing comittee members (alphabetical order): Antoine B.-Duchesne (R4, UL), Lucie Boucher (R5, UdM), Pascal Chavannes (R1, UdM)Anakim Gallant (R2, UdM) Laurence Jobidon (R4, UdM), Dany Lamothe (R5, Sherbrooke), Mathieu Leblanc (R4, Sherbrooke), Antoine Perreault (R3, McGill), Quentin Perreault-Lapointe (R3, UL), Sarah Pham Thi Desmarteau (R5, Sherbrooke) Anne St-Cerny-Gosselin (R3, Sherbrooke), François Trottier-Duclos (R5, UdM), Kyle T. Greenway (R2, McGill)