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History shows there has been no shared view about the purpose of psychiatry between psychiatrists, patients and their relatives. In previous centuries, disagreement by patients was seen as proof of unreason. Now that in most countries patients live mainly in the community, this assumption is not tenable. Current and former patients often lobby and carry out research, some with the help of non-governmental organizations (NGOs). They legitimately claim their own perspectives on care and treatment. Many argue that much of existing psychiatric research is invalid as patients were excluded from its creation. In the UK, research carried out by academics and NGOs with input from service users demonstrates that acute hospital care is often anti-therapeutic and damaging. Many patients have written about disrespectful treatment when they were in crisis or psychosis and researchers have supported their views that standard treatment and diagnosis on first admission can be unhelpful, even making things worse and leading to long-term patienthood. Studies report that patients do not feel listened to by staff. On the other side of the coin, where staff do listen, this is valued.Professional attitudes to mental illness, diagnostic systems and confinement laws are slow to respond. A diagnosis of mental illness still incurs loss of social status and employability, which discourages seeking help. Critics conclude that diagnostic labels can be counterproductive or unreliable. Some show that a high proportion of patients have undiagnosed trauma or abuse. Others argue that mental health crises are often related to spirituality issues, yet this is overlooked within biomedical discourse of psychopathology.A new trend involving personal/collective self-advocacy can be identified in the work of service users, arguing that life experience is under-rated in biomedical discourse and that real understanding of mental health problems must be based on listening to the views and life histories of patients. Some service users are setting up peer services such as drop-ins and crisis support. Self-advocacy discourse is a profound historic challenge to models based on professional expertise and power. Person-centred psychiatry must take on this conceptual challenge.
Special Section: Conceptual Bases of Psychiatry for the Person