Not enough people working in mental health and healthcare consider what the mental health system actually is. To the majority its simple healthcare and nothing more and certainly nothing less. There are, however, other perspectives.
One is that it is a formal system of human compassion that perhaps developed because of a lack of effectiveness of informal human compassion and/or as a result of the maladaption of societies to the full or fuller spectrum of the human condition (there would always be outlier extremes that mean the word "fuller" is more appropriate than "full" in practice). So depression is the medicalisation of misery and it is compassionate to help those suffering, often when social systems are either incapable or unwilling. Its caring for the poor, the weak and the outcast.
That's wonderful and lovely and to be lauded rather than lambasted like I usually do.
It is also a clever and perhaps unwitting form of social control and definition of acceptable or 'well' behaviours, emotions, experiences and choices. That it is dressed as healthcare and medicine makes it somewhat more sinister, though this is very much a case of coincidence than design. This is a good example of Hanlon's Razor (also know explained as Cock up theory)
Never attribute to malice that which can be adequately explained by stupidity
Some history
Lets take the obvious example of this critical view, the demedicalisation and destigmatisation of homosexuality over the latter half of the 20th century. In 1973 (check this) the American Psychiatric Association and later in 1992 the World Health Organisation removed homosexuality as a psychiatric disorder. It can now be seen as neither healthcare nor compassion when people were told that their sexuality was an illness, that there was something wrong with them, that they were ill. It can be seen as immoral to 'counsel' them out of their behaviour and way of being, to sometimes medicate and incarcerate. It seems worse when its the medical system doing it.
There was no malice. It was just cultural and social stigmas that were drilled into psychiatrists like they are drilled into everyone else. But it does mean that mental health can pathologise things that shouldn't be pathologised. Another simple example of this is the old diagnosis of draptomania - the diagnosis given to slaves who kept on running away.
The question I have is what else is incorrectly described as a mental illness?
An obvious answer to me is psychosis, unshared perceptions, hearing voices, schizophrenia and madness.
Unshared perceptions (the broad term I choose to use to encompass all of the different descriptions) is a heavily stigmatised experience except in certain religious, spiritual and cultural contexts. Reporting hearing voices used to mean immediate hospitalisation in the 1970s, a situation that was exploited by Rosenberg in the famous "Thud" experiment. This was where people who didn't hear voices reported doing so and were immediately hospitalised to show how psychiatrists pathologise normal behaviours and misdiagnose the 'normal'.
I've started to disclose - to open up, or "come out" to use the language used in sexuality. Some people may have been afraid that I was going to attack them. Some people may immediately have thought I was weird or even insane. Some people who have know me for decades may have found themselves unable not to distance themselves because of the unusualness of my experience of consciousness.
It is an intensely distressing and confusing experience but rarely do I see the compassion or understanding. I don't expect it because I understand that few people will be compassionate to something they do not understand, and often something that they have not experienced. Just like with homosexuality.
And just like homosexuality there is an awakening stage where someone goes from (...and I have to choose my words carefully here because I was about to use " being 'normal'" in the context of mental illness and " being heterosexual" in the context of sexuality) a shared or consensus reality definition of what is consciousness and reality to an altered, unusual or simply different state of consciousness or reality. It is one of the most intensely frightening, destructive, painful and torturous processes and one that adjectives lack ability to describe. A term I have heard used as an alternative to psychotic episodes is "ego death" and that speaks more of the destruction of the past sense of ego and individuality that comes with this process.
The stigma is harsh. The self-stigma harsher. It proliferates so deep that many can not see it. Few people are willing to come out and its still a dangerous thing to do to a doctor. The consensus understanding of this experience is poor, though many would know the experience of an inner conversation or dialogue, a committee in their head, the inner critic or simply the voice in their head that they never speak about.
Its in this sense that there's a sense of 'normal' - many people experience an inner voice but they don't call that hearing voices, schizophrenia or psychosis. Many don't notice this and perhaps there is a stage of development (or simply an alternate experience of consciousness) between the observation of an inner voice as part of a person's consciousness and a lack of awareness of that inner voice as part of a person's consciousness. There is another stage or alternate experience of consciousness which I is one I experience where the thoughts in my head are not my own, i.e. in my stream of thoughts that I used to consider my entire consciousness or me "I" there is now an awareness that there is an "I" somewhere in that stream of consciousness and there are other thoughts not of that "I", and that those are coming from another source or place. I experience this as thoughts though they could be describes as voices - I don't. They are not auditory hallucinations in the sense that I am hearing something false or imagined with my ears or any aural pathway.
Weird aint it?
Some of my thoughts aren't my own. There is an "I" but its probably not what the reader would consider. They're also coming from another place or entity - another consciousness or consciousnesses that aren't 'me' and can control me. I converse with and am influenced by this other consciousness/s.
In essence, I am mad and crazy. I can use those words because I use them without a sense of the pejorative. They are the historical definitions that describe my experience but I don't agree with those views. This is a different experience. It may be an alternate state of consciousness and one that existed throughout the history of humanity, from the experience of the Oracle of Delphi through to Abraham in the Bible or more recently Joan of Arc. It has been suggested that it was an experience shared by Abraham Lincoln, Winston Churchill and Mahatma Gandhi.
There are consequences to society and well as to the individual, and its the risk of suicide rather than homicide that's the most important to understand and 'treat' in a healthcare context. It is often treatment without understanding because the practioners have not been through the experience themselves and can only guess from external behaviours. It also leads to outcomes based upon those behaviours rather than what may be considered a useful, humane or moral way to deal with an unusual experience of consciousness that a society is not ready for.
Outside the medical system it suffers the societal stigma and that is the great challenge to shift. Aeons of prejudice deep-rooted through 'developed' societies across the world embeds public pathologisation of this normal experience.
Is it the new gay?
Fuck yeah.
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