It's about the overdiagnosis of black men with schizophrenia spectrum
disorders. Though the establishment knows this is a problem there seems
to be nothing done to change it. And there's little effort to make
things better. This makes me sad and angry and hopeless but in the face
of it all I have to keep trying so I've made what apology I can and
written this to him.
"
I'll try to make my point better, one I've been working on for far too long.
In the New Horizons consultation the overdiagnosis of schizophrenia in
black men was noted. If I remember right the document also noted the
problem doesn't happen in the West Indies. I think the Mental Health
Foundation may have noted similar things in one of their reports but I
can't find it on their website. I think they used a case studt of
someone disagnosed with schizotypal personality disorder who used to
work at Mind but who went back to the West Indies and didn't receive a
diagnosis. I think there may be other examples because when I spoke to
Sarah Teather MP when she was canvassing in Brent she seemed to be aware
of this problem too. If I remember right there's also something in the
NICE schizophrenia guidelines - in the appendices - about the problem of
the overdiagnosis of black men.
Bentall offers significant arguments for the lack of validity and
reliability of the science. I'm sure Moncrieff would make similar
arguments about the diagnosis of schizophrenia. Mary Boyle wrote a whole
book on it (Schizophrenia: the Scientific Delusion?). Metzl adds further
fuel to the fire. Breggin's book Toxic Psychiatry and others have called
into question the safety of medication as a 'treatment'.
It is not truly treatment because it doesn't heal the supposed
biological problem and may, in fact, make it worse. NICE also accept the
biopsychosocial model but this admission means it's not an illness. The
psychiatric model based on Bleuler's reconceptualisation of Kraeplin's
concept offers significantly less value in understanding the individual
schizophrenic than Jung's idea of an inward facing mental state (and the
diametric opposite of hysteria on this scale) as described in the paper
from which he wrote Psychological Types, in my opinion and if my memory
serves me. The diagnosis itself has also changed over the last century
to serve purposes different to what it was conceived to describe.
If you consider it from my viewpoint, that one major aspect of mental
illness is about enforcing cultural and social norms and consider some
of the historical ills of psychiatry as well as see it as a replacement
for religion using the new dogma of absolute truth (science though
really in psychiatry it should be strictly called pseudoscience), then
there is a significant injustice happening to all schizophrenics but
most of all to black men. Of any race and gender I would suggest they
have the worst experiences in NHS mental healthcare though, admittedly,
asylum seekers may have even worse problems as may addicts.
The injustice is medication and forced treatment. Antipsychotics are
dangerous and cause real illnesses. Clozapine is by far the most
dangerous one. Many have died as a direct result of pharmacological
treatment of human types. Many have had their lfie expectancies reduced
by the drugs. This is all done out of altruism but it doesn't mean it is
right or just or not evil.
The NICE schizophrenia guidelines (revised in 2009) still favoured
pharmacological options for schizophrenia. In fact, if memory serves me,
they recommended for only 3 non-pharmocological treatments: CBT, family
interventions and arts therapies. The latter, based on a very basic
understanding of neuroplasticity, may make schizophrenia worse. They
recommended against social skills training, counselling (unless the
patient asked) and supportive psychotherapy. I could lambast these
errors to you another time.
The key thing is there are options for a better quality of life for
black men as well as their choice in treatment. There could be options
for rectifying the social disability problems. I don't know if you've
ever had that feeling of being written off by the healthcare system.
That's exactly what happens to many schizophrenics. (They're a human
type and if you use the language of illness then you take away from
their right to exist.)
Imagine a life without purpose. Imagine a life without community or
friends. Imagine a life devoid of human contact or respect or love.
Imagine living in perpetual poverty and just left to rot on medication
which makes you unhappy. Imagine living with few positive human
experiences, ever. These are just a handful of the problems. This is
what life is like for many schizophrenics and other people with severe
mental illnesses. It's not surprsing the recalculated lifetime suicide
rate for schizophrenia is 5.6%. (it is actually around 10% but many of
the suicides happen during the onset stage so it was recalculated to
exclude these in a significant paper. The rest of the suicides are
probably down to "schizophrenic burnout" which I believe is not treated
by the system. This is what you would feel if your life was worthless
and you still had to keep on living through all the pain of living with
a severe mental illness in 2011. Day after day of unbearable misery will
cause any sane person to want to take their life. Life for many severely
mentally ill people is like torture.)
Can you understand my ire that the National Association for Mental
Health, Rethink and Diverse Minds are not trying hard enough to tackle
this great injustice?
I know I've offered no good solutions to the problem here and I guess as
a campaign issue this is the important thing. It's all well and good
lambasting the psychiatric establishment but without solutions there
will be no change. The establishment, from the literature I've read thus
far, doesn't seem to be seeking these solutions. It seeks more
opportunities to use drugs on an ever-widening spectrum of the human
condition.
Local Mind Associations and Rethink are doing their bit by offering
support groups (some of which follow the dogma of the Hearing Voices
Network), counselling and befriending services but there's more than
this to solve the problems faced by black men every day and what's done
to them in the name of the altruistic treatment of schizophrenia. And
the rest of those with severe mental illnesses.
I saw a program on the BBC about the treatment of stroke patients in the
mid-20th century. Best clinical practice back then was to right them off
just as what happens, in practice, to many black men with schizophrenia
today. One carer decided not to right his father off. He forced him back
to health. He did terrible things like make him walk on all fours like a
dog to be fed from a bowl but this got him out of his wheelchair.
Eventually his father recovered a high degree of function. If I remember
the story right his father died climbing half way up a mountain in Italy
from a heart attack. When they autopsied him they found a large amount
of the connections between his brain and his body had been sheared yet
the rehabilitation had forced his brain to adapt. This capability for
the brain to adapt to damage is what little I know of neuroplasticity.
What I know is today stroke patients have a good chance of recovery and
are no longer written off to die in a wheelchair or bed but this change
was only made possible through rehabilitation services rather than
writing off the individuals.
"
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