conclusions but I'm going through it again.
What I understand so far is psychiatry was incepted to treat a group of
people. These people were decided to have a medical condition with a
biological cause just like dementia. Previous to psychiatry these people
weren't called mentally ill. It was a guy called Emil Kraeplin who
applied the physical model of meidicine to mental illness very early on.
He wrote what was the first generally accepted diagnostic manual.
This is one of the most influential paper in the UK on rhe issue. It's
consistently one of the most viewed papers at the British Jounral of
Psychiatry online. It's not a pleasant paper to read if you have a
personality disorder or any sympathy for people with the diagnosis.
The distinction between personality disorder and mental illness
Kendell, R. 2002
http://bjp.rcpsych.org/cgi/content/full/180/2/110
This is a significant paragraph on the definitions of illness and
disorder. Even research psychiatrists find themselves muddled when
approaching this problem.
"
The most contentious issue is whether disease, illness or disorder (like
the World Health Organization, I regard these terms as roughly
synonymous) are scientific or biomedical terms, or whether they are
socio-political terms which necessarily involve a value judgement.
Physicians have generally maintained, or simply assumed, that they are
biomedical terms, while philosophers and social scientists have
generally argued that they are inherently socio-political, but this is
not invariable. The American physician Lester King asserted long ago
that 'biological science does not try to distinguish between health and
disease... health or disease are value judgements' (King, 1954).
Conversely, the philosopher Bourse has argued that 'disease, the
theoretical concept... applies indifferently to organisms of all
species. That is because... it is to be analysed in biological rather
than ethical terms' (Bourse, 1975). I myself once argued that disease
ought to be a biomedical concept (Kendell, 1975), but subsequently
became convinced that value judgements were probably inescapable
(Kendell, 1986). The issue has attracted much attention in the USA in
the past decade, mainly in response to the publication of a closely
argued analysis of the concept of mental disorder by Wakefield (1992).
"
His idea of a mental illness iswhat is regarded by mental health
professioanls as a true mental illness but there's a debate around that
issue. What makes dementtia praecox a true mental illness is what
defines a mental illness historically. This is known as the ostensive
definition and is explianed in the paper.
"
Ostensive
Lilienfeld & Marino (1995) maintain that mental disorder is an ostensive
or Roschian concept, implying that the term can only be understood by
considering the prototypes of mental disorder. If this argument is
accepted — and it is not easily dismissed — it is impossible even in
principle to determine whether personality disorders are mental
disorders, because mental disorder is inherently indefinable. The only
criterion is whether personality disorders are sufficiently similar to
the prototypes of mental disorder (schizophrenia and major depression,
perhaps), and similarity is obviously open to a range of
interpretations. It is important to note, though, that both the World
Health Organization and the American Psychiatric Association include
personality disorders in their classifications of mental disorders,
without explanation or apology, and have always done so, which implies
that both bodies do regard them as sufficiently similar to warrant
inclusion. The fact that some forensic psychiatrists see close
similarities between personality disorders and schizophrenia, both in
the extent of the disturbance of personality involved and in their need
for treatment (Blackburn et al, 1993), is also relevant.
"
It's the definition that makes mental illness a mental illness rather
than anything else such as a mental health problem. It means it's
definitely a disease to be treated by doctors and to be extended the
"privelidge of disability" but language and concepts have changed over a
century.
As the author explains using language like "socio-political" concepts,
mental health is also synonymous with behavioural and social control. It
is a system that encodes prejudice about normality and abnormality into
medicine. A slave who runs away from their master, a master who feeds
and clothes them, must be mad because it is abnormal ration for a white
doctor to think these sub-humans would want more than what their owner
gave them. I'm guessing that this sort of thinking was behind the
diagnosis of drapteomania, the diagnosis given to slaves who kept on
running aaway. Homosexuality was a mental illness because it was decided
to be abnormal. Unmarried mothers in the UK in the middle of the 20th
century were mentally ill. All of these examples have nothing to do with
any biomedical problem per sse. They were socio-political problems which
were dealt with outside any legal framework such as in crime.
The idea of mental illness as a form of behavioural control and
enforcing the norms of the largest social group or tribe is not commonly
noted. People don't understand that psychosis, depression and all the
other mental states in the mental health system may not be illnesses but
things that are just unwanted in whatever time. The example of
homosexuality was a 'condition' which moved from being a crime to being
an illness to be acceptable and eventually it will become understood as
normal around the world. The illness didn't disappear like in the case
of leprosy. . The illness in society changed and recognised the
individual as normal. The 'illness' was healed by people accepting a
person's difference.
I'm strongly against the socio-political concept because it's got
nothing to do with medicine. The use of medical professionals - people
who take the Hippocratic Oath - means it is harder to criticise than an
honest system which says, "psychiatry treats things which aren't crimes
like they're crimes", "psychiatry tries to brain wash people into acting
and behaving how psychiatrists feel is normal and acceptable" or
something similar. The honest would result people campaigning against
the use of an electrically induced seizure to treat something that's not
really an illness, because unless it's geniuinely an illness inducing a
seizure and damaging a person's mind is a crime.
It's sad that most people simply accept that mental illnesses are really
illnesses and all the things that happen in the name of mental
healthcare is an attempt to treat a genuine disease. It isn't. it's
treating people who are simply adjudged by someone else to be too
different for this world.
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