MADNESS IN THE UK SERIES – PART 1: Medicalising Madness.
By Sue Denim –
Is madness purely a medical condition that can be treated with drugs? Is there really a clear dividing line between mental health and mental illness- or is it not so easy to classify who is sane and who is insane?
– Richard P Bentall from Madness Explained – Psychosis and Human Nature.
Bentall argues in his book Madness Explained – Psychosis and Human Nature, that we need a radical new way of thinking about psychiatric problems – one that does not reduce madness to brain chemistry, but understands and accepts it as part of human nature. This approach raises some interesting questions.
Does the medicalisation of psychological disorders alleviate guilt and responsibility from us, as it potentially makes people passive victims of supposed dysfunctional brain chemistry? It’s all easier to handle if it’s merely brain chemistry, because then it can be fixed by an expert. It can be argued that the people who benefit most from this are the drug companies and expensive private therapists.
There ironically may be a paradox here. The more we are medicalising madness, the more we seem to be seeing the mentally ill alleviated from blame from their health condition, in a way that people say with diabetes or heart problems are not. Individual actions, judgements, and choices are more than likely dismissed as no one’s fault. The mentally ill, in this way, are disempowered. It’s true that people don’t always have control of traumatic life experiences which can impact their disorders, but sometimes they do. What do we say to a diabetic who doesn’t take their insulin or gorges on cake? We give them the responsibility for their own health, and for managing their potentially debilitating conditions. Why don’t we do this as much with people with mental health conditions? And if we have psychological struggles, destructive habits, self-harming behaviours etc. we are potentially not expected to challenge them and change if they are merely impulses reducible to brain chemistry.
An emphasis on faulty brain chemistry also leads to creating a kind of ‘victim’ culture? Don’t we end up relieving people of responsibility if we see them as powerless victims? It’s certainly patronising to rid people of taking responsibility. If there is a proven genetic or chemical imbalance element with serious mental illnesses which are lifelong conditions, does that necessarily make people ‘passive’ victims of their condition to be pitied?
Is it because there seems to be a need to identify people by their mental health condition and create a culture that thrives on victimhood, rather than progress? “I am bipolar,” as opposed to “I have the condition bipolar.”
We never say “I am cancer.”
We cannot avoid the fact that by medicalising a lot of mental health conditions it justifies giving people a quick fix in the form of medication. It saves a lot of time for an over-stretched NHS.
However if the view is that we are victims of brain chemistry why are we then faced with the talking therapy of choice which is ‘off the peg’ Cognitive Behavioural Therapy – CBT. This is again, often seen as much of quick and simple fix as medication. The USP of this therapy is that it works as an attempt to get people to identify and rid themselves of negative thinking that can make them feel bad. (NB quick = cheap.) Disorders that can take over your mind and make you helpless are scary shit. You lose control. obviously we need to try to fix that as quickly as possible. However there is conflicting evidence that expensive drug treatments and simplistic CBT for complex conditions is even helpful. Many long term mental health conditions cannot be ‘fixed’, but can be managed to reduce the impact that they have on people’s lives.
Treatment of altered/distressed mental states, with the emphasis on chemicals, is basically trial and error. Sometimes it just comes down to good luck if the treatment works or not. People go through years of various psychiatrists trying to correct brain chemistry with various drugs, many of which impact more negatively than the episode they are experiencing. Who knows? If left alone, the difficult mental episode may well have passed. Personally, I do benefit from a particular medication, but it took a great deal of time to get here. Accessing a period of more extensive talking therapy with an experienced psychologist also greatly helped. In the current mental health service, the normal waiting time for that treatment is around 18 months. If you can’t afford to pay £50 an hour for a private therapist you can be left in crisis for a needlessly extended period of time.
Progressives in the psychiatric field are attempting to focus more on treating the individual, not the diagnosis, but the system ties their hands. With knowledge increasing about genetic factors and the ability to tinker with individuals’ faulty DNA in order to repair bad genes, the future is looking better in terms of permanent cures of some serious psychological disorders. There are also known simple behavioural tools to help you manage your condition, day to day. The system as it stands is not structured for looking at or encouraging innovation. It is overloaded. People in the field do not get the time to keep up with and act on new developments in the field. We are told mental illness is on the rise, especially amongst young people. Inevitably, if this is true, (and it is not just due to the increase of emotions attributable to mental illness) the system is going to be even more overloaded and is going to get worse. We could be stuck in the rut of continually throwing money at failing Mental Health Services..
Is there an Increase in Mental Illness.
The obvious question to ask is “what is normal and what is mad?” If we broaden the definition of a word to encompass a wider spectrum of conditions it will inevitably lead to a rise in the number of those conditions. Are we jumping out of the frying pan of ignorance about mental illness into the fire of over medicalisation? Are we actually discovering or simply making up new psychological disorders? I worry that the answer to both these questions may be a resounding “yes!” In other words, I worry that some of what are called psychological disorders today, in the past would have been seen as ordinary everyday emotional struggles. We all learn from experience and build emotional resilience, when we deal with those struggles, head on. I fear that in the future, our climate of medicalisation may prevent this. And this climate will make things more difficult for people who suffer from actual mental illnesses that are not the product of this overreaction.
Here is a list of possible psychological disorders that could obviously help “Raise Awareness” of the different mental health conditions people can suffer from. The compilers state:
While we have attempted to make this a complete list, there are often psychological disorders that we are not aware of. If you see that we’re missing something, please contact us and let us know.
This will blow your mind.
There are so far none starting with W, X, Y or Z, but as they invited us to let them know if some are missing, maybe we could go with,
‘W- ondering if all this is pretty sinister’ disorder
‘X-rated expletive expressions regarding psychiatric disorder list’ disorder.
‘Z- ero tolerance for psychic control culture’ disorder.
I potentially have at least 25 of these disorders, but I stopped reading when I got to self-defeating personality disorder. I am not sure how I am going to cope.
When are we actually mentally ill?
An essential part of life’s journey is learning how to cope emotionally with life’s ups and downs; pressure and stress, broken hearts, and even the effects of mind altering substances and no sleep. In some cases, people believe that if we have any difficult feelings at all, we are instantly suffering from mental illness, and we should wear this as a badge.
Today it sometimes seems we should all apparently be living in a Disneyland state of mind or there is something wrong. This is simply delusional and totally unfair, on young people in particular, who are on that extremely emotionally rocky path through puberty and into adulthood. This does more psychological damage than the difficult thoughts and emotions they are trying to deal with. Are our young people being raised in a culture where it is quite easy to be labelled mentally ill, even when you aren’t? “Awareness Raising about Mental Illness,” as a cultural necessity to break stigma, has made many young people hyper aware, paranoid, or panicking, regarding their own mental health. Hence the production of “snowflakes.” Arguably we have moved away from kids being allowed to experience distress, come out the other side, and build resilience. These days, kids are encouraged to make relentless demands about how they want to be treated and seen by others; demands that sometimes are incompatible with free speech or due process. It can be argued that certain whiny and censorious young people are far too molly-coddled and indulged. These young people use the protection of their mental health as an excuse to shut up people who say things they don’t want to hear. I have no doubt that this sometimes happens for those from more cosseted and privileged environments and is an undesirable outcome.
The problem though with any generalisation about young people is that we risk judging everyone the same, in virtue of what demographic group they belong to. We should remember that most young people do not have the luxury of the whiny indulgence of those labelled ‘snowflakes.’
The Backlash – ‘Therapy Culture?
Some folk from older generations are very cynical, angry and outraged because they believe we are now living in this ‘Therapy Culture.’ Many of these folks argue we should not have any help to maintain mental health in Education Establishments for example because, “I’m alright Jack. I had a tough life and I never had any help. These kids need to toughen up. If they can’t cope, they shouldn’t be here.” With help and support you should be there if you are as intellectually capable as others. You may have to navigate more hurdles than most but you can do it without a patronising attitude from people who know nothing. As a mature student, I could not have achieved a Masters degree without the support of the University Mental Health support team.
Here’s the thing. In my own, and many other’s experience, long-term mental illness starts post-puberty, and normally kicks in sometime in-between your teens and your early 20’s. If I had known at that young age what was going on, and been able to access help, I would not have spent so many years ‘getting out of my head,’ trying to escape my mind, feeling different to everyone else but ignorant as to why. I would not have lurched from crisis to crisis. I would not have left a path of destruction behind me during a manic episode for example. I would not have had to endure months of debilitating depression and social isolation without feeling like I was just a worthless piece of shit. Most young people with addiction problems, or serious drug and alcohol use are self-medicating a dysfunctional mind in order to cope. When those coping mechanisms become habits to fall back on lives get ruined and you cannot function. People living on the streets, not able to hold a job down and continually trapped in a cycle using any mind changing substance they can to escape, do not on the whole do this as ‘a lifestyle choice.’ People trapped in their homes without the tools or knowledge to manage debilitating conditions are the invisible casualties of the, “just snap out of it brigade.” These people could have benefitted if they knew what was going on. Some would obviously not whatever information was available, but that does not mean we should not make sure therapy is available in young people’s formative years.
So in my view the casual catch-all use of the word ‘therapy’ in this conceptual phenomenon is not helpful. There has to be distinctions made. Access to appropriate Mental Health Therapy in educational institutions does not necessarily produce “snowflakes”. If it is doing it’s job it should produce resilience. Any of us that has tried to access any kind of effective talking therapy, to unravel our tangled and dysfunctional mind which is impacting our everyday life, will know these distinctions too well. If some of the resilience producing therapy was available at school and university, it could be life changing. The debate about how this is managed and what is appropriate is up for grabs.
Not all therapy is the same as that being indulged in by overly self-obsessed and narcissistic teens. Nor is it the same as self-help aimed at people who generally have lots of money and admire Gwyneth Paltrow. That’s a thriving business and it is not synonymous with many other kinds of essential talking therapy treatment. Dismissing all therapy with disdain, amongst murmurings of accusations of mollycoddling, displays a lack of knowledge of what hurdles other people have to jump through to actually get any kind of therapeutic help if they cannot afford at least £50 an hour. Painting all therapy users with such a broad brush is more than a little cruel.
Mental health treatments are varied as in all medical conditions, and ideally involve a combination of talking therapy and drugs. Diagnosis of particular conditions is not an exact science, and people should be treated as individuals, not by their diagnosis. Maybe that is the kind of awareness and knowledge that those churning out disdain for ‘Therapy Culture’ need for starters. By adopting a simplistic either / or approach to any subject, you may temporarily feel a kind of ‘self-soothing.’ Having a black and white narrative to adopt about such a complex subject however can make you blinkered and cause you to experience extreme cognitive dissonance when challenged. That gets the old cortisol kicking in and really is bad in terms of making you think clearly. Irrational fears kicks in if your simple beliefs are questioned. I do have empathy for people who do that. Living with that mind-state is not easy. Maybe they just need to listen to Steve Hillage and chill out themselves?
The brain is the most complex and influential organ in our bodies. If it breaks down and malfunctions, causing all sorts of electrical circuitry blowouts, misfiring synapses and chemical chaos, it can be pretty serious. Most of us know what that feels like to some extent. Intensely altered mind-states can be induced by choice, in the form of recreational drugs and alcohol. They can also be induced by traumatic life experiences or by a particular genetic disposition. They can make navigating the world of good judgement, rationality and generally not fucking, up nigh on impossible.
We are human beings, after all.
We all go through periods of mental distress. We all deal with distress in different ways. Each of us have our own tried and tested coping strategies. Not all of them are useful or healthy. We get through stuff as best we can. We make mistakes and sometimes learn from them, or sometimes repeat them over and over again. Some of us have far more self-awareness than others. Some are self-obsessed. Some have an urge to find themselves. They believe you can only do it in a place where there’s good sunsets and you have a decent mantra to chant. Some of these people are totally deluded. We all lose the plot. Trying to find your one true self will leave you on a hive into nothing. It would be more effective to accept we are complex and actually have what is more like a community of selves who pop up when we need them, and help each other out. These states of mind are all part of being a human being. The reasons that someone’s brain misfunctioning could seriously impact their life, cause what we call mental illness, psychological disorders, madness, and insanity, are certainly complex.
Mental health is a good thing to aspire to, and is important. We should definitely educate people who have not experienced a serious psychological disorder, about how living with a debilitating mental condition can impact your life. However, it is also very important to remember that for each person with a diagnosed condition, the way it affects them is different, because no two humans are the same.
People are often misdiagnosed. This can sometimes impact their life more than any supposed mental illness. A diagnosis such as paranoia for example can be handed out on a misinterpretation of someone being deliberately provocative and a bit of a button pusher. Misinterpretations of what people actually mean, and therefore what their particular mind-states are, seem rife. What a patient says, is often exasperated by ridiculous questions and the patronising tones they meet from clinicians.
Because of the notion that everyone now has a potential mental health condition, people are often flippant about serious conditions and the diagnoses that make them manageable for people. Bipolar is not just “mood swings.” It is not a desirable condition to have because it is fashionable. It does not raise your social standing, unless you move in the circles where being a victim of anything is revered. It is that reverence of victimhood that actually seems to be the problem.
We are all individuals. After all, we acknowledge that people without mental illnesses have different abilities and temperaments. Some people thrive on stress, some love routine. Some want to lead, others prefer to follow and not have any responsibility. Some love power and hierarchy, others thrive in more co-operative work situations. Some can more easily set off on career paths that suit them and hopefully reach their potential in the field they thrive in. Many have to make do with just getting money to put food on the table however they can manage, and never get much beyond survival mode. A lot of it just comes down to luck. People who manage a mental illness should not be treated differently in that regard.
The tendency is often to lump the “Mentally Ill” together as some kind of oppressed IDENTITY group, that even people who aren’t seriously ill want to join.
This is part of the MADNESS IN THE UK series interrogating the issues surrounding the subject of Mental Health and Mental Illness. My knowledge and experience has evolved out of managing a long-term mental health condition. It has been much more difficult to write about this than I thought, as it has necessarily made me focus on one aspect of myself that I do not want to be identified by. I manage my health condition and it is part of who I am, and a bloody cross to bear at times. We all have crosses to bear. This series is a starting point for some new conversations and ideas for reframing the subject matter, and offering some explanations and solutions for some of the prevalent issues.
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