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An Interview with Pat Bracken, MD, Ph.D. on Post-Modern Psychiatry and the Social Context of Trauma

David Van Nuys, Ph.D.
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Pat Bracken, MD, Ph.D.In this episode of the Wise Counsel Podcast, Dr. Van Nuys talks with Pat Bracken, MD, Ph.D., a psychiatrist who holds doctoral degrees in both medicine and philosophy. Dr. Bracken is known for being a critical of mainstream psychiatry, so the interview starts there. Essentially, Dr. Bracken expresses concern that in the rush to become more "empirical" that resulted in the ascendency of the modern pharma-centered biologically-anchored psychiatry paradigm, psychiatry has lost interest in addressing important philosophical and existential questions having to do with the validity of core assumptions of that field. Among these questions are the nature of a patient's experience of meaning (as in the meaning of life) and (more specificaly) its relationship to how best to treat patients who suffer from trauma. In Bracken's view modern psychiatry views mental diagnoses such as PTSD as individual problems to be fixed through application of various techniques such as medication and cognitive therapy. His own experience working with traumatized Ugandans in the wake of the Amin regime suggested differently to him, namely that in some cases it best to focus on restoring societal and cultural order. Doing so will result in individual healing in a way that cannot necessarily be brought about through the individual application of healing techniques to to those persons who are most visibly suffering. By repairing the fabric of reality for traumatized individuals, you help restore their sense of the meaningfulness of life in a way that cannot be accomplished by treating them in isolation.

Dr. Bracken cites the philosopher Martin Heidegger as inspiration, but I (Dr. Dombeck) find that his views are echoed in the perspective of the systems theorists and family systems approach to psychotherapy which remain contemporary, at least in social work circles, in spite of the current dominance of the cognitivist perspective. Another, more ancient figure who should be mentioned in this context is psychiatrist Harry Stack Sullivan whose early 20th century writings are intimately concerned with the essentially social nature of identity.

David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.

On today's show we'll be talking about the Critical Psychiatry Network and their critique of trauma with my guest, Dr. Pat Bracken. Pat Bracken, M.D., Ph.D., works as a consultant psychiatrist with the West Cork Mental Health Service. He's also Clinical Director of that service. He trained in medicine and psychiatry in Ireland and in Birmingham, England. Between 1987 and 1990, he worked for the Medical Foundation for the Care of Victims of Torture on a project in Uganda. His M.D. degree was awarded for a piece of research that looked at how one village had been affected by wartime violence in that country. He's also carried out consultancy work for Save the Children in Liberia, Sierra Leone, and Nepal. Dr. Bracken also has a background in philosophy and gained a Ph.D. in this subject from the University of Warwick in 1999. He was Professor of Philosophy, Diversity, and Mental Health at the University of Central Lancashire between 2006 and 2008. He co-edited the book Rethinking the Trauma of War with Dr. Celia Petty, published in 1998. His own book, Trauma: Culture, Meaning and Philosophy, was published in 2002, and with his colleague, Professor Phil Thomas, he published the book Post Psychiatry: A New Direction for Mental Health in 2005.

Now, let's go to the interview.

Dr. Pat Bracken, welcome to Wise Counsel.

Dr. Pat Bracken: Thank you very much, David.

David: It's good to have the opportunity to interview you here. One of my listeners, a social worker in Oregon, recommended that I interview you based on her reading of your 2005 book, Trauma: Culture, Meaning and Philosophy. So before we jump into it, though, our listeners might be interested to know that I'm located somewhere just north of San Francisco; you're in Cork, Ireland, right now. Is that right?

Dr. Pat Bracken: Yes. I'm in the beautiful county of Cork. I actually live and work in what I regard as one of the most beautiful places on the planet, West Cork. We're down near the sea and with mountains rolling down to the sea, it's a very, very lovely place to be. It's 6:00 on a northern evening here, and it's blue sky. Trees outside my window are turning yellow and brown. So it's a nice scene.

David: It sounds lovely, and it's 10:00 in the morning here and a bright, crisp blue sky, and Ireland is one of my favorite places, and I've been there in and around Cork, so I can picture it as you describe it. So let's get into our discussion here. Your writing has been critical of much of current psychiatric practice. Let's begin with your broad critique and then later on in our discussion, I'll be interested to kind of narrow it down to trauma and PTSD, okay?

Dr. Pat Bracken: Okay, yes.

David: So in broad terms, what is your critique of psychiatry?

Dr. Pat Bracken: Well, I guess my critique emerges - I'm 51 now, and I went straight into psychiatry from medical school back in 1982, so I've been in this business for quite a while. And what attracted me to the world of mental health was its complexity and, in many ways, its difference from other parts of medicine, which seemed a lot more concrete and that. As a medical student, I was fascinated by talking with people who experienced different states of madness, distress, alienation, etc. And I was fascinated by the different approaches that were available, from psychoanalysis to behavioral approaches, to biological approaches. There seemed to be a… it was an intellectually challenging area, and there were a lot of debates and discussions going on at that time in the early '80s about what would be the best way to approach the phenomena that we generally regard as mental illness.

And I guess what I've become aware of is that psychiatry's gone a period of narrowing its horizons, if I could put it like that. It's become very focused on a narrow range of ideas, largely biological ideas but also some cognitivist approaches. And it seems to have become a bit less interested in some of the fundamental questions, the philosophical, the questioning approaches that I think were available around the 1970s and early '80s and that.

And I guess I'm kind of seeking a return to what I would call an engagement with crucial thought. I think we've kind of lost that, and what I mean by that is a valuing of the ability and the necessity of thinking critically about our own assumptions, about our own history of our profession and its ideas - where they came from. And, in fact, being able to face the fact that, in many ways, our interventions in people's lives in the past and even now are in many ways destructive and not experienced as helpful by very many service users.

So that's kind of a long-winded answer to your question, but my interest in critical thinking and critical approach to psychiatry comes from my own personal work in the area. I guess I've also become very interested in the emerging user movement and the ideas that have emerged within that across the world. And service users in psychiatry are throwing up some very, very interesting ideas about the nature of their experiences, not just in terms of their experiences of madness and distress, but also their experiences of services and those services that are set up to help them.

David: Well, this is a wonderful introduction that you've given us so far. And you're not only a physician, but you also have a Ph.D. in philosophy. So I'm wondering what was it that triggered - I think you got the philosophy Ph.D. some time after being a physician, and if I'm right about that, what triggered that move and how has your training in philosophy impacted your perception of psychiatry and yourself as a psychiatrist?

Dr. Pat Bracken: Yes, I've always had an interest in philosophy, and I guess it would be hard to work in the area of the mind and its difficulties without sometimes being attracted to philosophical ideas, because while psychiatry has been grappling with the nature of mind and mentality for the last two or three hundred years - and psychology, of course, is a relatively recent discourse - philosophy, going right back to the ancient Greeks, has been grappling with the nature of mind, the relationship of mind to reality, etc., for literally hundreds, thousands, of years. So there's a long tradition that I think we, as physicians and practitioners in this area, ignore at our peril.

So I've always had an interest in philosophy. I think when I started to seriously read philosophy, what I became interested in was the work of what would now be regarded as, I guess, post-modern thinkers, that is a group of philosophers who've started to interrogate the legacy of Enlightenment, that great cultural shift in Western thought happening in the 17th into the 18th century, where people in the Western world, and Western Europe in particular, started to move away from believing that truth was something that would be delivered through Revelation, through the Word of God or holy scripture, or through something that would be found by turning to the past, to the work of the classics.

The Enlightenment involved a focus on reason and it became the idea that we would find truth not by looking through holy books or through the classics, but we would find truth by using our reason, and the whole Enlightenment was a turn towards reason. And I think that's had a profound effect on how we started to experience ourselves in the world and led to very many very positive developments. But what post-modern thought in the last 40 years or so has started to do is to say, look, okay, this was a great movement, but there was also a downside in this; there was also a loss involved in this; and there are also some dangers with just becoming very focused on reason. And I found that a very, very interesting idea, and I think it informs some of my own grappling with the nature of psychiatry and some of the difficulties I see in the relationship between psychiatry and service users.

David: Yes, now, does that post-modern viewpoint involve what's been referred to as constructivism, the idea that we get blinded to some degree by the constructs by which we organize reality, and that, in fact, reality might be more malleable than that?

Dr. Pat Bracken: Absolutely. I think there's a whole very interesting history of constructivism in psychology and in other fields as well. I think, if I could use a metaphor, that the post-modern take on science for me - I'm not anti-science; I believe in science; I'm very interested in it - but it is the idea that science and rationality, while they can illuminate parts of the world and parts of reality for us, they can also obscure.

And if I could use a metaphor, it's a bit like sunlight: that the sun, when it's shining during the day, illuminates reality for us and shows us a world through its bright light. But what we sometimes forget is that that bright light of the sun also obscures the stars that are shining and planets that are shining up there, and it's only when the sun goes down at night, that we can actually see those other lights in the sky. What a lot of people don't realize is that the stars are all up there during the day, but we don't see them because our world is illuminated by the great light of the sun.

And I think what post-modern thought, and my own idea is, is that while science has played a great role in illuminating the world of madness and distress, it has also served to silence other perspectives and other traditions and other ideas and insights. And post-modern thought - and my own idea in what I've developed with my colleague Phil Thomas as post-psychiatry - is the idea of trying to turn down that bright light a little bit, that bright light of scientific approaches within psychiatry, and to start to see that there are other ways of encountering states of madness; there are other forms of knowledge; there are other traditions that may be helpful to us in this work.

David: Well, as a footnote, I can say that as a psychologist, I'm really on the same page with you. Now, you sent me a few of the articles that you've written and that have been written about your work, and there was reference made to the Critical Psychiatry Network, and that sounds key to what you're involved in. Can you tell us, in a word or two, what that's about? What is the Critical Psychiatry Network?

Dr. Pat Bracken: Critical Psychiatry Network is essentially a group of psychiatrists that came together in the UK about 10 years ago. I was working in the north of England 10 years ago, and myself and other colleagues from London and different parts of England, basically, got together. We were concerned about a number of things. One was at the time there was a move by the British government to introduce more coercive mental health legislation, and we felt that there needed to be a critical response to that. But secondly, we were also aware that our profession had become very much infiltrated and aligned with the pharmaceutical industry, and that the marketing activity of the pharmaceutical industry had come to play not a very positive role in psychiatry and shaped a lot of the discourse and diagnostic systems.

And we were critical of that, and we've tried to produce over the last 10 years. We've had conferences, meetings; we've published; and we run a website, as you've said, that tries to make available a critical literature and critical insights into the profession. The third element of it, I guess, is that those of us involved in the Critical Psychiatry Network have been keen to work actively with service user groups of all shades, and that means engaging with people with some radical perspectives and to try and work towards a positive encounter with the radical part of the service user movement. So that, in a nutshell, is where the Critical Psychiatry Network's activity has been.

David: Yes, not long ago on this same series, I interviewed Peter Breggin. I assume you must be familiar with his critique of Big Pharma.

Dr. Pat Bracken: Yes, I am, indeed, and I had the pleasure of meeting Peter when he visited Dublin a couple of years ago. We both spoke at a conference together, and I had the pleasure of having dinner with him, and that was something very positive for me, to meet him.

David: Yes, such a warrior. I haven't met him in person, but he's really been fighting this fight very vigorously for some time. You made some reference to the period of the '70s when there was a critique, and I'm wondering what ever happened to the radical critique put forth by R.D. Laing, and are your views somehow a resurrection of his position?

Dr. Pat Bracken: Well, there are certainly echoes, and I'm just back from a trip to London recently. We have an R.D. Laing conference every couple of years in London now, and the fifth one was held last weekend in London, and so he's still thought about. I wouldn't agree with everything that Laing wrote, and some of his stuff is very wacky, and really, I can't find great use to it.

But what he was about, I think, was essentially questioning what I would call the technological paradigm of mental health, the idea that we should engage with mental health problems as primarily technical problems to be analyzed, classified, sorted, and treated. And what he wanted us to do, I think, was to focus more on what I would call the non-technical aspects of mental health, those questions to do with values, relationships, the question of power, question of meaning and the search for meaning.

And I think that insight that Laing had, that essential insight, is something that I would be very in tune with, and I've written about the idea of moving away from a primarily technical paradigm, moving beyond that in our encounters with people with mental health problems.

David: Well, let's begin to narrow it down a bit now and focus on trauma, and I believe you refer to what you call the trauma industry. What are you getting at there?

Dr. Pat Bracken: Yes, I guess my own work in the area of trauma started when I, as a young psychiatrist, I was recruited to work on a project in Uganda, in East Africa. This was back in the mid-'80s after the Milton Obote regime had fallen and Uweri Misavaini had come to power, and there was a lot of positive hope about Uganda, and a number of organizations put some money into providing support for people who had been tortured in the country. And I was recruited by an organization called the Medical Foundation for Care of Victims of Torture, who were just starting to operate in London at that time, and this was their first project in a developing country.

And it was a great eye opener to me. I went armed with my concepts of post traumatic stress disorder and other ideas from psychiatry, and I was landed right in the middle of a whole country that had been traumatized and gone through the horrors of war, and torture, at that time, was almost synonymous with Uganda through the evils of Idi Amin.

And what I found, basically, was that the concept of PTSD that I had going there with me, which is a very individualized and technical kind of diagnostic framework - and framework to encounter people who had suffered trauma - that that was simply inadequate to the complex reality that people were living that was deeply enmeshed in culture, society, economics, religion, and things like that.

So I recoiled a bit from using the concept of post traumatic stress disorder very easily in my work there, and I worked with other people to try and focus less on the individual who'd been through a traumatic experience and working individually with that person through some kind of psychotherapeutic technique, and work more towards re-establishing the social context in which people can recover.

If I could narrow it down, David, my insight was that people recovered from terrible violence to the extent that their social world recovered, and sometimes you could do them more harm by focusing on their own individual ideas, cognitions and emotions in isolation from that social world, and this was particularly the case, I felt, in a very social society, a very socially orientated society like I encountered in rural Africa.

Now, my skepticism and my doubt about the usefulness of PTSD emerged, as I say, very practically in that context. But what I started to become aware of - and this was in the late '80s into the '90s - was a growing enthusiasm on behalf of Western practitioners to bring the idea of PTSD and therapeutic programs centered on PTSD to the developing world without any great thought of the great cultural, social, and other difficulties there would be with that move. I saw people arriving and never having been in an African country before and starting to teach people about psychology in a two-week course and then disappearing off again and feeling that they'd done some good. And my sense of that was that this actually could be profoundly undermining of local traditions of healing and support and that, which were not focused on an individualized PTSD orientated approach, but were deeply bound up with religious, cultural, social, family dynamics and discourses.

So, I guess I've become a bit skeptical of the great move, sometimes done with very, very laudable motives, but it's the move to bring, if you like, the benefits of Western psychology to people in the developing world without any great thought being put into how that will articulate with their whole cultural way of dealing with life and its difficulties.

David: Well, one thing that what you've said has triggered for me on a smaller scale are situations of these mass shootings, for example, as happened in Columbine. And then mental health professionals have come in and have tried to work with the community. And I know we had a situation like that here some years ago. We had a fellow who went off his head and killed family members and a whole bunch of people in this region, and another psychologist and I realized how traumatized the local community was, and so we, just on our own hook, called a public meeting and invited people to come so that they could talk about their feelings. And so I see that on a small scale as an offshoot of what you're talking about. I also had the privilege of interviewing a very interesting guy by the name of Edward Tick, who's written a book on dealing with veterans, war veterans, and he takes a very broad view. I wonder if you've met him. He tries to bring in Native American rituals to help these vets redeem their souls, so to speak. Have you encountered his work at all?

Dr. Pat Bracken: Edward Tick, T-I-C-K?

David: Yes.

Dr. Pat Bracken: I haven't. I can't say that I have, but that's very interesting. But I haven't encountered his work.

David: Yes, do search out his book. I think you'll really like it. Now, I also interviewed Edna Foa. She is professor at the University of Pennsylvania and evidently…

Dr. Pat Bracken: Yes, I'm more familiar with her work, yes.

David: Yes, she's regarded as sort of the go-to expert, but really, she's very embedded in the cognitive model, and I think you're critical both of the cognitive model and also what you refer to as the medicalization of trauma.

Dr. Pat Bracken: Yes. Where my own book - the Trauma: Culture, Meaning, and Philosophy book - came from was, if you like, I combined my work in Africa and my difficulty with the easy use of the concept of PTSD and therapies that flowed from it. I combined that with my interest in philosophy, and I started to - because a lot of psychology of trauma focuses on the loss of meaning that goes if someone… When someone experiences a very traumatic event, it can have the effect of shaking that person's world to the core, to the point that they actually start to wonder what it's all about, what is the point of engaging with this world if a world can throw up such horror for you personally or for your loved ones. You know, what is the point of it? And Ronnie Janoff-Bulman, in particular, has foregrounded this issue of meaningfulness and the shattering of what she calls fundamental assumptions about the nature of the world after a traumatic experience.

Now, that brings in the question of meaning. How is a world meaningful for us? Where do we get a sense of order and purpose and coherence in the world in the first place that it can be shattered? Now, the traditional cognitivist's answer to that is to start talking in terms of schemas of some sort, that we have different layers of schemas. We have different kind of programs running in the back of our mind which bring that sense of order to us. Now, I'm doubtful about that, and I became interested in a more phenomenological approach to meaning and the meaningfulness of the world.

And I became interested in the work of the German philosopher Martin Heidegger, who talked about this whole area of meaning from a very, very different approach. And he argued that the way in which the world shows up for us as meaningful and coherent is not something that can actually be grasped as a thing at all. It's a sense of coherence that emerges in some complex way from the nature of our embodiment, our physical embodiment as creatures and our culture and our cultural history. That somehow, that coming together and our practical involvement with a world of things and objects and places and people somehow or another, through that, we live in a world that has a sense of coherence, order, and meaning.

And that's the background against which any particular object or individual or idea or whatever shows up. Any particular object, any particular thing in the world, is always showing up as meaningful in relation to some background sense of order. And what Heidegger was getting at was that that background sense of order is not a thing in itself at all. If I could use an analogy here, it's a bit like if you think of a game of chess, and you've got all your pieces on the board - the knights, the kings, queens, the pawns, etc., they all have their roles and functions and relationships - but all of that only makes sense in relation to the checkered board that lies underneath them. And if you were to take away that checkered board, then the coherence of the pieces and their functions all falls apart.

David: That's a nice analogy. I like that.

Dr. Pat Bracken: And what Heidegger was getting at was that sense is, that checked board of our lives if you like, that background sense of meaningfulness, is not something that you can grasp. You can't grasp it in the way you'd analyze a piece of furniture or a book or even an idea or whatever. It's something elusive that kind of squirts away from us as we get near to it. And that, to me, was a profound insight, because what he was saying is that that background sense of coherence is something that's generated by our activity in the world, by our working in the world through our culture, through our bodies, through our hammering and our activity. It's not something that we get psychologically, if you like - do you know what I mean? - as a set of concepts or schemas. It's actually some kind of coherence that emerges, as I say, from our embodiment and our enculturement in an active world.

Now, if you bring that to bear on the world of trauma, well then, if what happens through some very traumatic event is that a person starts to lose that sense of coherence - if you were dealing with a traumatized people like I was encountering in Uganda - then really the idea was to focus not on the contents of any individual's psychology or cognitions, even though that was important sometimes to talk with people, obviously, but to pay more attention than has usually been the case to re-establishing that background sense of coherence and purpose and meaning. And that was to do with re-establishing an economy, a culture, if necessary helping religious practices to get re-established and working and working for people. And in that context, the individual psychology of people also starts to move on.

David: Well, who were you working with, then, to do your interventions in Uganda?

Dr. Pat Bracken: Well, basically I worked there for three years, and I struggled. I was with a small team. We struggled; we debated; we looked at what we were doing; we tried different things, and it just didn't seem the right place for a white psychiatrist to be doing individual work with traumatized people. And so we tried to get the project more focused on supporting local people, doing various activities and different…

For example, we supported a women's project that supported women who had been raped in the wars there, and this was a very low-key, supportive project that kind of helped them to develop a sense of self worth, that brought people together so that somehow they could overcome the shame of the experiences. They'd also had a very practical purpose in that they started to develop a little rotating economic fund whereby they could help each other buy animals and develop their families. There was also a cultural aspect to it: they started to develop - a number of the groups; they were all different - but some of them started to develop little theater pieces in which they would reflect and present a representation of the war and the difficulties that people went through, etc.

And in the context of doing all those different things, they also talked with one another and talked with the social worker who we had employed there, a local woman who herself had gone through some terrible experiences in war, so she knew what it was like from the inside. And very gently, she would help people to talk and to communicate and that. But the primary focus was not about taking someone away from the group and sitting down with them and doing some kind of cognitive processing, which is the usual orientation of PTSD orientated projects. The point of the project, of something like that, was to work socially with people, culturally with people, practically with people, to start establishing a meaningful background sense to their lives, and in that context, to start helping people to move on from where they were previously.

David: That's very helpful. That really helps ground what you've been saying and give us a clear picture. Let me throw this at you: as a result of our involvements in Iraq and now Afghanistan, the U.S. will be dealing with an unprecedented tidal wave of PTSD victims. Imagine that President Obama hires you as a consultant with some millions of dollars. What would you do, or what would your recommendations be for our system?

Dr. Pat Bracken: Are you talking about people in… Afghanis or Iraqis? Are you talking about soldiers and that?

David: I was thinking of the soldiers, actually.

Dr. Pat Bracken: Of the soldiers, yes, okay. Well, my own feeling is that they shouldn't have been in Iraq in the first place, but that's neither here nor there. The fact is that there are a lot of people coming back, and I think what is a major problem for the military now is how you deal with psychological injuries, if you like, caused by involvement in combat, because traditionally this would have been seen as something that the military didn't have to deal with. It was something that almost there was a sense in which if you suffered anxiety and depression after, you'd leave the military and go away and deal with it some other way. But now, there is a growing sense that the military actually has a responsibility towards people.

I'm not sure what the answer is, to be honest, and I'm not sure that I would necessarily be the best person to take on a role like that. But I would be focusing, I think, as I would in general psychiatric work, with the importance of work, the importance of people having a background sense of purpose and meaning in their lives, and that can be generated through sometimes religious involvement, but also through creative practices like art, like poetry, like music, like drama.

Work, as I say, is extremely important in having a sense that you're productive and involved in the social world through work. You're earning a living; you're contributing through leisure time pursuits, etc. I see these in general mental health work in the service I work with here, which is general adult mental health service. I see these things not as secondary issues to some primary concern with doing real mental health work, but I see these things as the mental health work and very important. And in the context of that, then, you do individual work with people, but it's always within that broader sense that you're actually working to re-engage those people with the social world that they're a part of, because people don't heal on their own. That's my general, if you like, insight from this kind of work.

David: Yes. What you're saying makes a lot of sense to me, and again, I'm thinking of Edward Tick, who I mentioned earlier, and what you've been saying about the importance of meaning and being able to put things in a meaningful context. And part of what he does in group work is - working with veterans, if I recall correctly - is to invoke the archetype of the warrior and have them see themselves… instead of seeing themselves as criminals, when they return to society, there's not that sense of being honored for the service that they've rendered, and so putting it in the context of this, if you will, time honored role of the warrior, that that can be somewhat healing.

Dr. Pat Bracken: I agree, and I think that there is something profound in that, because what that is doing is it's saying to someone, "Yes, you're suffering. Yes, you're going through some awful experiences. But there is a positive way of engaging with these. There is a value to these. You endure this now because you fought for something that you believed in" - well, hopefully, people believed in. And that's where the warrior… that only makes sense in a tradition that there was a value on the activity of being a warrior, that that was prized by the society and looked up to. You know what I mean?

David: Yes, right.

Dr. Pat Bracken: So that if you suffered in that context, it was seen as a meaningful suffering, whereas if you're doing a job for the military that you don't particularly believe in, and you see them as rubbish anyway…

David: And a large part of your society, perhaps, doesn't value as well.

Dr. Pat Bracken: Exactly, exactly. And if you come back, especially from a campaign like Vietnam, where people are spitting at you, well then, you're going to hold that experience inside. It's not going to be experienced as any way meaningful; it's going to be horrible. I sometimes use another analogy or comparison to get this point of meaningfulness and how the meaning of suffering is so important. I don't know if you've ever been in a labor ward with a partner or wife…

David: Yes, I have.

Dr. Pat Bracken: So this will make sense to you. I challenge people sometimes when I'm teaching: think of two rooms where there's blood and guts and screaming, and the bright lights and pain, sheering pain. I think of one context - the torture chamber, where someone is at the mercy of someone else and pain is inflicted upon them, terrible pain and scars, and they come away from that - it's something awful that has happened. And often those people never recover from that. It's experienced as a terrible psychological hurt and, just as we've been talking about, it can shatter any sense of purpose and meaning in the person's life.

Now, you contrast that with a labor ward, which is also a room where there's blood and guts and terrible shouting and screaming and pain and scars, but my experience of my wife going through four births - and she suffered in all of them - was that within two or three days with a new baby on her lap, all of that somehow disappeared very quickly. In other words, the positivity, the meaning of the pain that she went through in terms of giving birth actually had the effect of making that pain and suffering something that could be incorporated pretty quickly into her life, whereas the lack of meaning or the negativity associated with the pain inflicted in the torture room is often something that a person will carry with them indefinitely.

David: That's a great illustration and discovered in the process that I also am a father of four, so we have something in common.

Dr. Pat Bracken: Okay, indeed.

David: You know, this is a good place for us to wrap it up, I think, unless you have any last points that you'd like to leave our listeners with.

Dr. Pat Bracken: No, it's been great, and I hope it's of some use to people. The book is Trauma: Culture, Meaning and Philosophy. If people are interested in some of my other stuff, I've done a more recent book called Post Psychiatry, and that's widely available as well. That's done with my colleague Phil Thomas, and that's a more general book about the state of current psychiatry.

David: Excellent. Well, Dr. Pat Bracken, thanks so much for being my guest today on Wise Counsel.

Dr. Pat Bracken: Thank you, thank you, David.

David: I hope you enjoyed this interview with Dr. Pat Bracken. I think it's good to hear a dissenting voice like his because it can serve as a corrective to the herd instinct of those in the mainstream. If you haven't already listened to my interview with Dr. Peter Breggin here at Wise Counsel Podcast, it's a good companion piece to this interview. I'd also recommend my interview with Dr. Ed Tick, author of War and the Soul, who you heard me mention in this interview several times. You will find my interview with Dr. Tick as number 109 on my other podcast series at Finally, you can learn more about the Critical Psychiatry Network, of which Dr. Bracken is a member, by going to their website at

You've been listening to Wise Counsel, a podcast interview series sponsored by

If you like Wise Counsel, you might also like ShrinkRapRadio, my other interview podcast series, which is available online at Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.

Links Relevant To This Podcast:

    • The Critical Psychiatry Network, of which Dr. Bracken is a member, maintains a website at Many of Dr. Bracken's writings are linked from here.

About Pat Bracken, MD, Ph.D.

Pat Bracken, MD, Ph.D.Pat Bracken, M.D., Ph.D. works as a Consultant Psychiatrist with the West Cork Mental Health Service. He is also Clinical Director of this service.

He trained in medicine and psychiatry in Ireland and in Birmingham, England.

Between 1987-1990 he worked for the Medical Foundation for the Care of Victims of Torture on a project in Uganda. His MD degree was awarded for a piece of research that looked at how one village had been affected by war time violence in that country. He has also carried out consultancy work for Save the Children in Liberia, Sierra Leone and Nepal.

Pat also has a background in Philosophy and gained a PhD in this subject from the University of Warwick in 1999. He was Professor of Philosophy, Diversity and Mental Health at the University of Central Lancashire between 2006 and 2008.

He co-edited the book Rethinking the Trauma of War with Dr Celia Petty, published in 1998. His own book Trauma: Culture, Meaning and Philosophy was published in 2002. With his colleague, Prof Phil Thomas, he published the book Postpsychiatry: A New Direction for Mental Health in 2005.