separate but I'm not sure? The paradigm of illness can only be applied
if it's a biomedical problem but there is no sound proof that there is
genuinely a biological deficit (i.e. it could be a difference rather
than a deficit). In Sweden they are careful to use the term disorder
instead of illness because of the lack of proof they are illnesses. The
biomedical model has waned some but as it wanes so does the use of the
idea and concepts of illness.
The prognosis of reduced occupational and social outcomes is one of the
most amazing bits of science ever. It does what astrology and other
forms of future-telling did. It estimates a person's worse life course
based on a cluster of behaviours, at least in DSM, and it works.
Regardless of the biological-basis of behaviour, consciousness and
emotion there are certain ones which are associated with a worse life
course. This is essentially the social model of disability I think.
There is an idea that illnesses are real things and mental illnesses are
less real or not real in a physical sense. The reduce outcomes are a
product of a malformed society, one which seemed to advantage people who
are robot-like and considers any deviance for normal as something which
is a reason for a poorer life.
Homosexuality is a good example where it was pathologised using the
paradigm of illness and all that comes with it but eventually the
psychiatric profession and the rest of society progressed to accepting
it as normal. Though biomedical evidence can be applied to say that
homosexuality is abnormal this is misuse of evidence. The homosexuality
campaigners way back in the 60s and 70s made very clever arguments which
challenged everything about the medicalisation of sexual preference. So
they turned the genetic studies at the time around. A genetic factor
meant that homosexuality was part of the human race at a basic level. It
was part of our code and that's what the evidence showed. People who
were homsexual in a time when it was considered abnormal would have
suffered worse lives. For example a person who acted camp might be
considered homosexual so excluded by 'normal' people in the same way
people with schizophrenia are today. They could be incacerated before
homosexuality was medicalised just as some people with severe mental
illnesses are incarcerated by psychiatrists today (place under section
but given no treatment nor there exist any evidence-based treatment
which works).
Another piece of evidence which supports the idea that it is a malformed
society which causes the reduced outcomes are the World Health
Organisation studies like the IPSS (International Pilot Study of
Schizophrenia) and others. These massive, high quality international
studies used the most rigorous psychiatric methods at the time. They had
the most amazing result. People with schizophrenia in the developing
world were doing better. The are countries with tiny psychiatric systems
but their society's were different to post-Industrial Age developed
world nations like the US and UK.
In a sense this sort of means even if they ever properly prove the
biomedical hypothesis the result for healthcare is that there's still a
signifcant part of the disability caused by society. Doctors don't
change society though. They change individuals. They don't lobby for
disability law so all public buildings need lifts and wheelchair ramps.
There almost needs to be a new profession: society doctors. A profession
which aims to heal the disorder in society which causes the poorer
outcomes for people with severe mental illnesses and other disabilities.
If as Foucault sort of says the idea of illness is a construct of
society then treating the individual, as is expected of doctors, is the
wrong way to go about things. It's easy and convenient now that there's
medication to continue the Great Confinement which hides madness from
the world so makes it even more abnormal when it is experienced (this
may also be partially responsibile, in my opinion, for how developed
world nations offer better prospects for severe mental illnesses: these
illnesses were never hidden from their societies through the creation of
the asylum system removed the mentally ill's presence from visible society).
The only thing in mental health with is changing society in the UK is
the Time to Change antistigma program. Thins lie the Disability
Discrimination Act have had little impact in reducing mental health
inequalities. The mental health lobby are usually happy enough patting
themselves on the back for some pointless little victory on use of
language but, in the main, are either bought into the medical model or
ineffective. They're ineffective because it's a great challenge and
they're successful if they promote the mainstream model of change of the
individual because it's popular. They're also a bunch of amateurs who
don't use much science in what they do nor have any professional status
or ethics other than what are laid down by the Charities Commission.
In a sense I might consider that this sort of work should be done by the
Royal College of Psychiatry. But they're spending most of their time on
stuff that's all about labelling more people, incarcerating and coercing
more people and using treatments which kill people, some of which don't
even have a proper evidence base. They were not invovled in the
commissioning of the Time to Change programme, the only program of its
size, though they may have commissioned significantly smaller scale
anti-stigma programmes in the past.
The New Horizons mental healthcare strategy proposed a cross
departmental attitude to mental health and a shift in government focus
to gross domestic happiness. Though the team knew little of the concepts
of mental health this shift may be an opportunity to create more society
changing measures rather than people changing ones.
Society changing needs a real shift in thinking in mental healthcare.
It's why I think it needs to be lead by the creation of a profession
just as psychiatry was created 200 or so years ago to deal with the
problem of the outcast. It's inception without the understanding of the
error of society in mental illness meant mental illness got worse. As
the mad were hidden the less mad became the outcast. As they too
disappeared the mildly mad became outcast and labelled. Today we have
large swathes of the human population pathologised and suffering worst
outcomes than ever before. This is because society changed the wrong way
because of psychiatry.
It's why I think the movement for changing society needs to be
independent of the profession which attempts to change the individual.
The former, in practice, doesn't understand or apply the latter.
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