That's a fair tirade I've just written. It's somewhat antipsychiatry which, I admit, I am too.
But I must balance the argument. I've picked certain examples which I hope provoke an internal debate in the reader. This is meant to be mind expanding stuff. This is all about concepts and I've avoided getting bogged down in the language.
Now let me write for psychiatry. This is also one of the facets of the machine which is the mental health system. It is a good thing, one borne of compassion.
Before psychiatry existed there were just the problems of what society did to the disadvantaged. The Industrial Revolution saw many human types get a better quality of life but the inequality gap widdened. Those who were worst off became so much more worst off.
A social problem came to exist. The mad and what to do with them. Madness is as complex a concept as mental illness but it had a terrible price in those days. The reality was many of the mad were outcast, excluded, homeless, living in poverty and total pariahs in mainstream culture as the Industrial Revolution took hold.
Society had explanations and systems to deal with madness. The Church provided them. Its power waned during the Industrial Revolution and the systems replaced the function with psychiatry but in the inbetween stage there were many ills wrought upon the mad.
The mad ship...or ship of fools?...I've never known in that term relates to the boat the forefathers of America sailed on...the Mayflower or something. The mad ships is what I'm talking about. Towns would get the mad together then put them on a boat and push them out to sea with little care for their lives. Those mad ships lucky enough to make it to the next town would have more mad people crammed onboard before they were once again pushed out to sea.
Exclusion was a far greater problem. The mad did worse than even the untouchable Indian sub caste, a caste at the cultural hierachy which sat at the bottom of Indian culture.
Psychiatry's inception was a bless, though perhaps the blessing is one in disguise or perhaps "into the frying pan and into the fire" are better descriptions.
Before psychiatry fully came into existence there was a series of laws which aimed to help the poor and outcast. These created the asylum system. A lot of old leper colonies became used to house the mad.
The word mad is not a popular one, at least for those who have no mad pride, but it relates to a concept. The concept is broad but it relates to a group of people initially unified by concepts such as exclusion, poverty and a subjective temporary social judgement of abnormality. The judgement is the severity or nature of the degree of abnormality.
Before the psychiatric labels there was the result of mental illness. The result is the prognosis. Here's what I mean. Back then a person who was intensely miserable was difficult to handle. There was no explanation of mental illness.
Let's say they didn't wash nor take care of themselves, though sad thoughts, didn't eat much, had few friends and was incurably unhappy. After a while people would stop caring about them. There was no idea of mental illness so it was left to unadulterated human compassion and sadly is in short supply. The depressed person - to use today's term - would be jobless and hard to put up with. Without mental healthcare or welfare they may end up homeless and starving to death on a street corner.
This is what was happening before the asylum system and psychiatry came into being. The outcast became looked after in the institutions and the caretakers of these instituions, eventually, became psychiatrists.
It was the first prepsychiatrists who brought together the idea that the mad were not mad. They were ill. It was an illness which caused their being to be judged as abherrant and abnormal. It was just like dementia. Dementia was already established to be an organic brain illness and it was associated with a change in behaviour to one which was considered undesireable. The mad exhibited undesireable behaviour and so they must be ill too. Their behaviour was a result of a biological illness - a true medical illness - which had certain symptoms.
With the removal of choice from the individual by using the idea that their actions were the result of a biological illness created something important: the privilege of the invalid. A lot of people may not like this phrase and I'm sure there's a better one. I happened across the concept, and the term, when dipping into the work of Thomas Szasz.
Mental illness comes with many things. One of them is the forgiveness and compassion. As I explained the idea of mental illness is fundamentally based on biological differences and a prognosis.
The prognsosis forms part of the privilege of the invalid. The root of the privilege of the invalid and the root of the medicalisation of behaviour is strongly rooted in the biological, specifically the biomedical, paradigm. What I mean is the strict adherence of mental illness to biological causes is where the modern privilege of the invalid is extended to the mentally ill. They're ill. That's the point. Other paradigms require different understandings to hijack and formalise the aspect of the privilege of the invalid.
I've not spoken about the psychosocial paradigm of mental illness...or perhaps mental health problems is a more appropriate term to use to align the concept with the lingua franca. And I'm not going to. I'm going to talk about something which I'm afraid to admit I know little about.
In fact I don't know much about much. My meanderings in mental health are meant to be points to consider and debate. I do know a lot more about mental health than the average person but in a sense I don't, in a far higher sense.
What I understand least well is the prognosis aspect of the medicalisation. This is defined by a negative outcome or life course on measures of clinical outcomes and social outcomes. I'm not sure if social outcomes is merely analogous or fully synonymous with social disability.
It's the aspect of social disability rather than the bastardised psychiatric measures I'm most interested in but the consensus understanding is poorer clinical and social outcomes are a bad thing which advances in mental health practice seek to remedy.
I'm talking about the exlusion and discrimination and stigma and reduced life expectancy and high rates of poverty and unemployment and all sorts of other bad things which are associated with mental illness.
These are bad things. These are things an advanced society would wanto to protect citizens from. This is what psychiatry does for the mentally ill. For all its bad things mental health treatment, in theory, is meant to affect those outcomes. It is, in theory, meant to reduce the burden of disability the individual has to suffer.
Severe mental illness is shit. It is a life of shit. About 5% of people diagnosed with schizophrenia kill themselves because life is shit. They account for 20% of the completed suicide rate. This is the impact of the burden of disability and it's why schizophrenia and other severe mental illnesses are considered akin to severe physical disabilities.
This measure of disability and the work to overcome it is a good thing. It makes things better for the worst off. It saves lives. It keeps people out of poverty.
It doesn't do it for everyone though. The privilege of the invalid is extended to the mentally ill just like those with physical disabilities but there are still poor and disadvantaged people who are not extended this privilege. They are on state welfare rather than the higher rate for medical welfare. If the non-mentally kill or do any other serious crime then they will not have the privilege of the invalid to protect them either.
Let's work through a simple example. A child who spends time in a childrens home or foster home is likely to do less well in life. Some may be diagnosed mentally ill and others won't. They still suffer the same prognsosis. Or most of them do. I'm doing a bit better than most of them. My time was short though. Others have spent large parts of their childhood without a family.
These children who are looked after by the state are not automatically labelled mentally ill. They're supported to adulthood through the social services system but only those labelled mentally ill are assigned any extra treatment.
About three years after I was briefly looked after in a childrens and foster home(3-4months in total. Not much more) I was programming for a European Space Agency project, admittedly at a very junior level.
My outcomes might be different and for those labelled with mental illness and given the privilege of the invalid they would get more social support which would hopefully boost their life outcomes. Those who don't get a label but survive the trauma of being looked after by the state and all the things which might lead to the situation...in adulthood they're left to fend for themselves.
The privilege of the invalid is an interesting concept.
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