Part 9 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.
Links to:
Who are "people"?
DR LANGFORD: You see, people think that physical health is perfectly scientific, that patients fall into neat, valid little boxes, that there are tests that give yes/no answers for every condition. Anyone who tells you these things has not worked in general medicine.
Sure, some patients fall easily into boxes; big heart attacks, massive strokes, overwhelming chest infections…but most patients have a collection of small problems, all in the ill/not ill grey area, which add up. This is why when our elderly relatives are admitted to hospital, the doctors tell us things like “maybe a small stroke” or “a small heart attack but we’ll treat him for an infection just in case”. It’s nonsense to say that big hearts attacks aren’t real because lots of people have small ones…we just have to be wary that illness isn’t a precise concept anywhere in medicine – psychiatry is not alone in this.
Reality check:
Do people who criticize psychiatry give a frak about correlation co-efficients?
Do people who criticize psychiatry expect psychiatry to be perfect or scientific?
Do people who criticize psychiatry want psychiatry to take responsibility for the deaths it has caused, the lives it has mangled?
Are people who criticize psychiatry angry about (well-meant, by all means) humiliation, discrimination, dehumanisation, abuses of psychiatric power, and psychiatry's narrow-minded blindness to lived lives, experience, dignity, intelligence, civil rights and autonomy?
Are people who criticize psychiatry angry about psychiatry's penchant for jumping to conclusions and sticking to first impressions?
I can only speak for myself, and I am angry. Calmly angry, but angry at what correct and legal psychiatric labeling did to me, and what it has done and is doing to others:
From Compliance to Activism: A Mother’s Journey
During his first involuntary admission to Western State Hospital at age 18, Siddharta was asked what he thought had caused his psychological troubles. According to physician notes, Siddharta described being falsely charged and convicted for stealing a girl’s coat at age twelve. He described the instability of growing up amidst the turmoil between his parents. And he described being raped by a male drug dealer – an incident that Cindi had never heard about. It happened shortly before his crisis at age 17.
However, apart from these initial notations, Cindi says she found no other indications in Siddharta’s medical records that his care providers ever developed therapeutic strategies for her son’s emotional issues. Instead, Siddharta’s primary problem was identified simply as “schizophrenia,” and the prescribed treatment was psychiatric drugs.
Cindi says his providers apparently did not report this sexual assault of a minor to police, as was required by state law. Is it possible that the psychiatrist thought that the rape was merely a hallucination produced by Siddharta’s schizophrenia? “Well, everything else he said made sense,” replies Cindi. “If you really wanted to look, to see what would cause all this, [the reasons] were there. But if you wanted to look and see a mentally ill black boy, that’s what you saw.”
Requoting you, Dr Langford: " ... we don’t have to start from square one with everyone that comes through the door. So mental illness is a useful concept.
"Mental illness" was not a useful concept for Siddharta. What could his life have been like if psychiatrists had started from square one and found him before they stuck a schizophrenia label on him?
"Mental illness" was not a useful concept for Siddharta. What could his life have been like if psychiatrists had started from square one and found him before they stuck a schizophrenia label on him?
The power of psychiatry …
Please correct me if I am unfair: Psychiatry has the power to override basic civil rights, humiliate, incarcerate, intimidate, label and dehumanise, pathologize dissent, autonomy and responsibility, influence the legal system and influence the way GPs, medical specialists, other mental helpers, work and welfare and social services behave towards people who need help.
And more than any other medical speciality, psychiatry has the power to ignore information about harm it does, and it has the power to blame its mistakes on the "illness" of its patients.
In that sense, the concept of psychiatric illness is very useful to psychiatrists. But is it real?
Please correct me if I am unfair: Psychiatry has the power to override basic civil rights, humiliate, incarcerate, intimidate, label and dehumanise, pathologize dissent, autonomy and responsibility, influence the legal system and influence the way GPs, medical specialists, other mental helpers, work and welfare and social services behave towards people who need help.
And more than any other medical speciality, psychiatry has the power to ignore information about harm it does, and it has the power to blame its mistakes on the "illness" of its patients.
In that sense, the concept of psychiatric illness is very useful to psychiatrists. But is it real?
DR LANGFORD: Every speciality changes its classification of illnesses every few years, as we learn more about illnesses, but only psychiatry gets abuse for doing so. How high your blood pressure has to be to be high changes every 5 minutes, we used to have bronchitis and emphysema but now we have COPD, the stages and groups of cancers changes every few years. Making categories more accurate is important and I look forward to seeing them improve with time.
Has psychiatry gotten abuse for changing its classification of illnesses? I haven't noticed that, but I have noticed that the DSM-5 is being criticized for repression and narrow-minded silliness.
Linking to someone who has read it:
Diagnosis and the DSM: A Critical Review by Stijn Vanheule
The DSM-5: A Dystopian Novel by Sam Kriss
Linking to someone who has read it:
Diagnosis and the DSM: A Critical Review by Stijn Vanheule
The second chapter focuses on how the DSM-5 takes context into account and discusses the kind of entity the DSM considers mental disorders to be. The main argument I make is that in the DSM the context of the individual (i.e., the life history, social circumstances, and cultural background) is thought to play only a minor moderating role in relation to symptom formation and expression. Moreover, as the manual follows a sign-based logic it coheres with the assumption that biological irregularities lie at the basis of mental distress. In this way the DSM cultivates a rather naïve essentialistic view of mental disorders, which is certainly not supported by relevant evidence.
The DSM-5: A Dystopian Novel by Sam Kriss
Sections like those on the personality disorders offer a terrifying glimpse of a futuristic system of repression, one in which deviance isn’t furiously stamped out like it is in Orwell’s unsubtle Oceania, but pathologized instead. Here there’s no need for any rats, and the diagnostician can honestly believe she’s doing the right thing; it’s all in the name of restoring the sick to health. DSM-5 describes a nightmare society in which human beings are individuated, sick, and alone.
I have been reading the mental illness sections of the ICD-10, and there I also find "a nightmare society in which human beings are individuated, sick, and alone".
And in social media I find professional denial of oppression and dehumanisation:
Which I consider quite natural, as I do not think that "oppress and dehumanise" is in the job description of people in helping professions. Therefore I choose to assume that they have the very best of intentions, and I ask:
What does psychiatry create?
And in social media I find professional denial of oppression and dehumanisation:
Which I consider quite natural, as I do not think that "oppress and dehumanise" is in the job description of people in helping professions. Therefore I choose to assume that they have the very best of intentions, and I ask:
What does psychiatry create?
- It creates filters that block out society's war on the vulnerable ... and this filtering creates suppression and oppression of people in pain.
- It creates humiliation and dehumanisation of the people it is helping.
- It creates CATCH-22.
- And it creates defenses against responsibility for its actions.
… and the desperation of individual psychiatrists
DR LANGFORD: Let’s be clear on another thing – psychiatry is not “growing out of control”, “medicalising normal emotions” – you only need to read the headlines about the shameful ways our services are being cut to see that.
Being told that psychiatry has a lot of power might seem meaningless to a frontline psychiatrist like you, who is trying to do a good job in a sector that is eroded by budget cuts.
And I have some questions:
Are budgets being cut because politicians believe that psychiatry is “growing out of control” and “medicalising normal emotions”?
I have been searching for the context of "growing out of control" and couldn't find anything. Who is accusing psychiatry of this?
I have been searching for the context of "growing out of control" and couldn't find anything. Who is accusing psychiatry of this?
What do psychiatrists do to reality check and double-check if post-traumatic stress, anorexia and other eating problems, obsessive-compulsive behaviour, deficits of attention, paranoia, symptoms of border violations, depression, hallucinations and weirdness etc are natural reactions before they medicalise?
Respectfully giving you something else that you have done: You created a tangled mess in your next sentence.
Who are "some people"?
Respectfully giving you something else that you have done: You created a tangled mess in your next sentence.
Mental health is being suffocated, and our patients with it, because it is seen as less deserving because some people are still willing to get up on stage and tell you that they don’t believe mental illness even exists.
Let’s see …
Since you mention "get up on stage": are you accusing your opponents in the debate at the Dana Centre of suffocating mental health and your patients?
Are psychiatric budgets being cut because other mental help professions disagree with the diagnostic frame of psychiatric illness?
Do you have evidence that your opponents at the Dana Centre insist that dementia or autism, which you call mental illnesses, are “mental problems”?
Are people like me, who prefer to deal with our mental problems without psychiatric help, suffocating mental health and psychiatric patients?
Do you have evidence that mental health care is seen as less deserving because psychiatry is being criticized?
Seems to me that mental health care is seen as less deserving because politicians couldn't care less about “the mentally ill”. Maybe they, like the general public, have been influenced by psychiatry's well-meant and misguided othering?
Seems to me that mental health care is seen as less deserving because politicians couldn't care less about “the mentally ill”. Maybe they, like the general public, have been influenced by psychiatry's well-meant and misguided othering?
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