disorders in different spectrums. A simple but useless summary.
Another paradigm is to look at the mental healthcare system as the
formalisation of human compassion. Depression is intense misery and the
informal systems such as society as individuals and systems outside
medicine don't cope with that very well which is why formal mental
healthcare is necessary and the medicalisation of behaviours that are
undesireable to the consensus at the time. Without the Poor Laws and the
Asylums Act or Lunatics act the mad would have continued to have very
poor outcomes like the Untouchable case in India. They would have been
homeless and outcast by society.
Alternatively, and unknowingly, the movement to medicalise and
hospitalise the mad was also the cause of the problems today. The mad
were removed from society in this act of compassion but the long term
effect was to still exclude this group from the human race. The
situation may have come about in response to the Enlightenment and the
fall of religion and its ways to 'treat' the mad. Foucault calls this
period "The Great Confinement" but he also notes the existence of mad
ships where the lunatics, vagrants and other unwanted were dumped in and
pushed out to sea with enough food to get them to the next town.
Foucault writes a lot about the idea of madness as a construction of
society but not a real thing in the way a broken leg is a real thing.
It's something I agree with. It does not mean it does not exist though.
Severe mental illness, i.e. emotions or behaviours that are
undesireable, stigmatised, taboo or other judgement by society, have an
impact on an individual's life course and using the measures accept by
psychiatry they have a negative impact. Homelessness, poverty, debt,
victimisation, exclusion, poor career outcomes, poor social outcomes,
poor relationships, shorter life expectancy are a few of the consequences.
The idea of illness implies that the illness is something real in the
individual rather than something that is a product of the largest social
"tribe", i.e. the illness is in society rather than the individual. An
example might be the worse outcomes in developed countries for
schizophrenia compared to developing countries (WHO IPSS study I think).
Depression and anxiety are highly prevalent but perhaps because people
have too much to worry about and be unhappy about, or perhaps the
materialistic solution to happiness promoted by consumerist, capitalist
culture is not working (admittedly the UK is an advanced capitalist
culture with strong socialist ideals).
Stigma or ignorance or whatever drives the fundamental social judgements
around what is considered acceptable and what isn't are the cause of the
illness as much as the individual. Possibly my favourite example to
elucidate this is the example of homosexuality which, for much of the
history of psychiatry, was considered a mental illness. The same
theories applied to other mental 'illnesses' of the time were also
applied to homosexuality, the same treatments used (and some rather
horrible ones just for homosexuals) and the patients told they had an
illness. And it would be evidence-based. The British Journal of
Psychiatry has over 60 papers published on homosexuality between 1855
and 1978
(http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1855&tmonth=Apr&tyear=1978&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search
<http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1855&tmonth=Apr&tyear=1978&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search>)
That range is from the first issue to a year after the change in DSM-III
when it was removed. There have been 16 since 1978
(http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1978&tmonth=Dec&tyear=2010&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search
<http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1978&tmonth=Dec&tyear=2010&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search>)
(This is another crappy search and I should use "homosexual" and other
key words to find the correct number of papers.)
Calling it an illness isn't a truth but its a way of understanding (- a
pedagogy?). Admittedly some of the conditions can be seen as an illness,
for example schizophrenia seems to have a biological component to it but
it may not be the same for everyone with a clinical diagnosis of
schizophrenia. The illnessses can respond to "medication" and there are
methods using talking and learning to change behaviour and help people
deal with their emotions. The latter is essential life wisdom though
many people don't see psychological therapies that way.
It can be seen as illness and treated like one. People can be considered
disabled without the social model of disability which has significantly
changed things since the 1970s. Doctor's refer to the "privelidge" of
disability and illness and they've found it hard to extend to mental
illnesses, certainly as the definiton has widened to include less
extreme conditions as mental illnesses to be treated and afforded the
same privelidges. Without them the outcomes for many people would be
much worse.
There is some life pain which is too much for an individual to bear and
no one but an expert can help. Psychiatry provides that expertise.
Medication and talking therapies also aid the suffering. They help
people through their pain and distress. They help people who are unable
to help themselves. It is in this form that the medicalisation of human
behaviours is also the formalisation of human compassion.
A summary should finish with a conclusion. All I know thus far is that
its complicated. It is important to see the truth and see the judgement
of the truth, and that will always be a personal thing which is why its
worth knowing at least both sides. Preferrably more.
No comments:
Post a Comment