Part 6 of my comment on Dr Alex Langford's argument in favour of the diagnosis of mental illnesses
There is some recycled material from earlier blog posts.
I will be adding relevant links as I find them.
Edited may 30th
Links to:Edited may 30th
Definition of "Stigma" from Oxford Dictionaries:
: a set of negative and often unfair beliefs that a society or group of people have about something
But "mark of disgrace" seems to be a better fit for society's attitude to people with mental problems.
So why not call it discrimination? ": a set of negative and often unfair beliefs that a society or group of people have about something"
Or prejudice? ": an unfair feeling of dislike for a person or group because of race, sex, religion, etc."
Is the word "stigma" used in other contexts? I haven't seen "the stigma of dark skin colour", for example. And "the stigma of mental illness" is just as discriminatory and prejudicial. More about this further down.
DR LANGFORD: Using the word illness, not just “problems”, ensures that society treats people with mental illnesses with the respect they deserve; not just lazy, peculiar, and malingering.
Could you please link to evidence that using the words "mental illness" ensures that society treats people with respect? That looks like a Nirvana Fallacy to me. Reality check:
1) The psychiatric idea that the word "illness" will remove stigma demonstrates a frightening ignorance of basic human nature. Susko writes:
... for mainstream culture, disease, illness, chemical imbalance, and genetic defect have only a pejorative meaning. Where productivity and "survival of the fittest" are heavily valued, disabled people or those who drop out of the work force are stigmatised . The concept of a "diseased mind" carries connotations that are doubly negative. Not only does it evoke disability, but it arouses fear - and implies that a person is not responsible for his or her mind, or is difficult, unpredictable, and potentially violent. The net effect is a marked lowering of the individual's social status.
2) The side-effects of many psychiatric drugs are not only horrible for the persons taking them, but often visually stigmatizing … it is easy to see that “they have a diagnosis”.
JAKE: 3.00 A lot of people don’t want to take anti-psychotics (...) I've seen people develop diabetes very young, I've seen people very bloated, I've seen stiffness, a lot of people complain about apathy, difficult in concentrating, depression, these kind of symptoms. You see people with Parkinson's disease kind of symptoms, shaking, tongue is flicking in and out, and that's from the antipsychotics and it's irreversible. So people have quite good reasons to object to these drugs. (...) once the person objects to the drugs, they will be forced into taking the drugs. And there's not really much negotiation.
3) There are many psychiatric drugs amongst the Top Ten Legal Drugs Linked to Violence, so society links "mental illness" to violence.
4) The word “disorder” is in itself stigmatizing as a description of mental symptoms. When someone has post-traumatic stress disorder, wrongness is automatically linked to the person, and not to the events that caused stress.
I just can’t wrap my mind around this: Using the word “disorder” to tell people that they have a mental illness that is nothing to be ashamed of, it’s just like diabetes or any other physical illness.
How can any amount of anti-stigma campaigns neutralize the wrongness that this word conveys?
: a confused or messy state : a lack of order or organization
: a state or situation in which there is a lot of noise, crime, violent behavior, etc.
medical : a physical or mental condition that is not normal or healthy
Full Definition of DISORDER
1 : lack of order <clothes in disorder>
2 : breach of the peace or public order <troubled times marked by social disorders>
3 : an abnormal physical or mental condition <a liver disorder> <a personality disorder>
Examples of DISORDER
The mayor is concerned that a rally could create public disorder.
... problems of crime and social disorder
Millions of people suffer from some form of personality disorder.
Related to DISORDER
Synonyms
chance-medley, confusion, disarrangement, disarray, dishevelment, chaos, disorderedness, disorderliness, disorganization, free-for-all, havoc, heck, hell, jumble, mare's nest, mess, messiness, misorder, muddle, muss, shambles, snake pit, tumble, welter
Antonyms
order, orderliness
Related Words
anarchy, lawlessness, misrule, riot; knot, snarl, tangle; labyrinth, maze, web; maelstrom, storm; bollix, clutter, litter, mishmash, shuffle; hodgepodge, medley, miscellany, morass, motley
Near Antonyms
method, pattern, plan, system
5) Some psychiatric diagnoses, like “Narcissistic personality disorder”, are extremely stigmatizing. From the 2014 ICD-10:
“A disorder characterized by an enduring pattern of grandiose beliefs and arrogant behavior together with an overwhelming need for admiration and a lack of empathy for (and even exploitation of) others. Personality disorder characterized by excessive self-love, egocentrism, grandiosity, exhibitionism, excessive needs for attention, and sensitivity to criticism.”
Dare I write that I have have been "helped" by psychiatrists who showed "egocentrism, grandiosity, exhibitionism, excessive needs for attention, and sensitivity to criticism"?
In my cognitive frame, these behaviours are symptoms of societal harm, and the diagnosis locks the person with the symptoms into a permanent story where they cannot take responsibility for their destructive behaviour.
I am trying to understand the difference between "mental illness" and "brain disease" in your frame. And I keep thinking of Christians who talk about a good and loving God without rejecting the vindictive and punitive God of the Old Testament. You wrote that "diagnosis doesn't mean 'brain disease'". But aren't the psychiatric diagnoses that you are defending based on the medical model of brain disease?
I get associations to the geocentric model of the universe; the image here is from a Wikipedia article on Johannes Kepler:
From a context of my life and experience, the braincentric concept of mental illness is just as muddled as this drawing ... and your thinking about this also gets muddled too - like when you wrote that:
It’s quite strange, quite sad I think, that after decades of anti-stigma campaigns, work by charities like Mind, so many confessions of mental illness and progressive government policies that some people still doubt mental illness even exists.In part 2 I asked: "Why did you use "confessions", with its judgmental undertones of wrongness, shame and embarrassment, instead of a neutral word like narratives?"
It's qute strange, quite sad, that a psychiatrist uses the word "confessions" in the same sentence as "anti-stigma campaigns".
The following paper has information about professional prejudice:
Caseness and Narrative: Contrasting Approaches to People Who are Psychiatrically Labelled by Michael A. Susko
Caseness and Narrative: Contrasting Approaches to People Who are Psychiatrically Labelled by Michael A. Susko
With naming comes a transfer of ownership of the person's mind and body to the professional.What Susko call "caseness" is my reason for rejecting the concept of psychiatric illness. And substituting "brain disease" with "mental illness" does not remove that.
When you write that the concept of mental illness "allows them to learn about their difficulties and help themselves", there is an assumption that this frame of mental illness is the one and only frame.
What about those of us who are cannot or will not join you in this frame?
The question is not, “What is the best definition of a mental disorder?” The question is not, “Is the DSM-5 definition of a mental disorder better than the DSM-IV definition of a mental disorder?” Those are absolutely not the right questions! The first and only question is, “Do mental disorders exist?” The phenomena certainly exist. The birds and bees exist; pain and suffering exist. But birds do not prove the existence of Gods and pain does not prove the existence of mental disorders. Let us not play the game of debating the definitions of non-existent things. Let us move right on.As I see it, the concept of mental illness is a belief system, useful for people who fit into it, in the same way that religious concepts are useful to people who fit into them. I have no need to convert others to my non-belief, I just expect respect for it ... both in religious frames and in psychiatric frames. And I give myself the right to notice when non-belief is not respected.
In part 1 mentioned ignorance about frames as one cause of psychotherapeutic dehumanisation. My word for "caseness" is "story invasion", and to me, the well-meant invasion of psychotherapeutic stories reopen earlier wounds of societal dehumanisation and invasion.
My experience, and the experience of others, has been that psychiatrists (and other psychotherapists) invade us with an explanation of our difficulties that has been filtered through their cognitive frame. Like the therapist who told me in the 1970s that I just had to "stop believing those feminists". Luckily that one did not have the power to influence the health services with his explanation of why I rejected his help.
Here are some links to information on psychiatric illness and stigma. I'll be adding to them as I find more information, and if anyone knows of research that shows that the concept of mental illness removes stigma, I'll be pleased to add that too:
Harold A Maio: We no longer talk about 'the' Jews. So why do we talk about 'the' mentally ill?
Mental health stigma: convincing my mates I was still 'me' was almost impossible
CBC: Stigma of mental illness a 'disturbing' trend in workplace
Is Being “Sick” Really Better? Effect of the Disease View of Mental Disorder on Stigma Mehta, Sheila; Farina, Amerigo (The discussion is on page 11-13)
Ben Goldacre in the Guardian:
A genetic cause for ADHD won't necessarily reduce the stigma attached
Scientists who believe that labelling mental health problems 'an illness' will reduce prejudice may find the opposite is trueEffects of a Chemical Imbalance Causal Explanation on Individuals’ Perceptions of Their Depressive Symptoms
Joshua J. Kemp, M.S.a, James J. Lickel, Ph.D.b, Brett J. Deacon, Ph.D.a,
- Depressed participants received a bogus test of their neurotransmitter levels.
- Participants received a chemical imbalance (CI) or no CI causal explanation.
- The CI explanation did not improve self-stigma (blame).
- The CI explanation worsened perceived self-efficacy and prognostic pessimism.
- Medication was more desirable than psychotherapy when a CI explanation was given.
Returning to this:
DR LANGFORD: Using the word illness, not just “problems”, ensures that society treats people with mental illnesses with the respect they deserve; not just lazy, peculiar, and malingering.
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| canva.com |
And in that frame no one has to “read psych journals to see the science used”, they can think for themselves and connect information about societal harm to their own observations and experience.
It is so beautiful, that lightbulb moment when a "normal" person suddenly realizes that a weird schoolmate or neighbour, colleague or relative just has visible symptoms of something harmful that happened to them.
And in my frame there is no need to know what happened.
Something has caused the harm, and the responsibility for that belongs to the cause of the harm.
And the person who carries the harm owns responsibility for dealing with it - hopefully with respectful, constructive help from professional mental helpers who have the guts "... to stay unsettled in order to look at, not past or beyond, the subject. To stay in the not knowing and trying to know with the subject ..." (LEANH NGUYEN)
It is that simple. And that difficult.
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