As psychiatry and the mental health mainstream progressed battles over language began. What had been called mental illness needed to be called something else. This wasn't because people didn't consider it an illness nor for any conceptual shift which required new language. It was done for sensitivity and other politically correct motivations.
The paradigm of mental illness is where the privilege of the invalid is rooted. In the modern day it is more complex of course. Today Not Guilty by Reason of Insanity and diminished responsiblity are protocols of the medico-legal framework - the mental health and criminal justice laws in this case - extend the privilege of the invalid to the mentally ill that commit serious crimes. It is why the severely mentally disabled are on medical benefits at a higher rate than standard state welfare. It is why a person who has depression and can't come in to work has to say they well unwell and they use a sick day.
I have my own views on this but I'll put them aside for the moment. The term became stigmatised with time. I don't know the factors of this. The inception of mental illness may have been a way to reduce the fundamental stigmas and prejudices which created the poor outcomes for people before the creation of psychiatry and the asylum system; I'm talking about the symptoms themselves rather than the diagnostic labels attached to homogeneous (actually often heterogenous) types.
What I'm talking about is how and why the mentally ill are mental health problematic. Bear with me a bit here.
Mental health problems is a term which was meant to be less stigmatising than mental illness and this is the sole reason it has become the preferred term.
It is perhaps more accurate too but this isn't why it became a commonly used term. The people who promopted its used would not like what I have to say about the meaning which comes from the words themselves.
The mentally ill are problematic. It is the symptoms which, in whatever culture or at whatever time in history, are not suitable or disliked. It is very hard to put into words.
Let's take a manic depressive. In a high phase they'll be a lot of fun to be around but if this tips into hypermania they lose touch with reality - and this is madness. Their lows can be hard for people to deal with because those lows can be time consuming and burdensome for some to deal with. Behaviour can be grating or abrasive. Or the person can withdraw from social contact and those who knew them in the high might not understand. Returning from those highs and lows can be difficult when people don't understand.
Problematic is not a scientific concept. It is temporary social disadvantage because of a set of behavioural characteristics which are a product of a person's psychological profile and life experiences. This is mental health problems as a definition aligned with the psychosocial model as I understand it.
A cluster of behavioural symptoms, I.e. a strict clinical diagnosis, works by noting behaviours and internal experiences. A diagnosis of mental illness works by looking at actions and internal reality then applies judgements.
The psychiatric labels are meant to accurately determine a type. Once this type is established it should follow a negative and predictable life course (approximately). A diagnosis fundamentally means the doctor expects you to do worse in life...yeah....tough ain't it...I've had 4 diagnoses from the 6 psychiatrists I've seen in my lifetime.
And the studies sometimes show this validity and reliability, which are the two psychiatric terms for the concepts of accurately determining type and the type relating to a predictable negative life course. They show the label often does predict the person will do less well in their life on the outcome measures used in mental health.
But they don't when you start comparing the prognosis in international studies nor the prevalence rate. The WHO IPSS is a very well regarded piece of research. It compared schizophrenia outcomes in different countries and it did long term follow up on the research subjects. It was well designed to ensure high inter-rater reliability (a lot of the time psychiatrists don't agree on the diagnosis).
On 2 year, 5 year and I think 10 year followup the results were not what you might expect if you'd never heard of the study. People in the West did worse than people in poor, developing world nations.
There's a lot which can be interpreted from this result and a lot of work has gone into it. Let me consider the result and mental health problems.
The aspect of the worse outcomes is related to social and cultural factors. They're what influence the levels of poorer outcomes. People who are equally problematic...or equally ill...have different outcomes based on a quantity which is somethijng likle "how much a system disadvantages someone who is different."
This last paragraph may be a jump ahead of where I want to be in this discourse. I have a very tough hide when it comes to words and concepts butsomething which seems to be a theme in what I'm writing relates to the journey I've had to make.
Concepts are pure things. Subjective judgements call them good or bad, as I have done earlier in this work. To admit to being problematic is a harsh thing. There may be a psotivie way to look at the same thing.
Sent from my smartphone
No comments:
Post a Comment