Calling someone mentally ill is an insult

I put my images up on Facebook and someone made some vile comments on the photos I took of people protesting outside Westminster. It made me very angry.

I did something dirty. I offered them my compassion and suggested they were mentally ill and needed clozapine. I made other veiled insults.

I didn't think about what I was doing. It was pure rage and instinct or whatever. I don't do stuff like that. I'm straight and direct. Something took over as the crimson blurred my vision.


It's important though. Calling someone a diabetic wouldn't have been an insult though there are perhaps other physical illness that may be used as an insult.


Perhaps if I'd said they had a mental health problem that might have been better if I didn't want to insult them or I thought that they were distressed which was why they were projecting their anger on these protestors. That dirty part of my psyche, the part that's usually hidden from civilised society, made sure I lashed out with the worst thing I could say to a person: I think you need clozapine.


From the case studies of clozapine patients in America it is an insult.

another rant on psychosis's mispathologisation

Some people believe mental distress or mental health problems or mental illness or madness to be an illness and that's the truth of the situation. Others consider the truth is that they're only illness because people call them illnesses, i.e. they are a false construction but real because people believe in them and they have real consequences (though these may be due to society, its maladapted systems and the morals of the time).

Heard of drapetomania? Its worth a google. Its an old diagnosis given to slaves who kept on running away. They were ill weren't they?

There's another piece of the history of mental illness also worth noting. In the Seventies the American diagnostic criteria (DSM) finally removed homosexuality as a mental illness and in the Nineties the WHO finally removed it from their criteria (ICD) which is used in the UK.

So a century ago people said that being gay was an illness and that they should be treated. Now you might be one of those people who still consider it an illness in which case my point is going to fall on deaf ears. Hearing voices, unshared perceptions, schizophrenia, psychosis and their ilk are not illnesses per se.

They can be thought of as illnesses but in the same way that skin colour could be called an illness, so my brown skin may be a disadvantage and I could paint myself white and be less 'ill'. I hope that makes sense: its an illness only as a non-real construct of society.

That's evidenced by a famous study conducted by the World Health Organisation in the Seventies which showed that outcomes for schizophrenia were better in the developing world than the developed world. There are many hypotheses to explain this seemingly paradoxical result. One is the other cultures have different interpretations to the experience of madness and don't use the medical paradigm of neurological brain dysfunction to be treated by antipsychotics and these produce better results. I'm not sure what the situation in 2010.

I've heard that mania is destigmatised in Spain. Hearing voices has a number of interpretations around the world. There are examples in the West too, for example many of the stories in the Bible are of people who heard the voice of god and its easy to see that the story of Abraham could be seen today as a story of a schizophrenic. Goth culture considers depression ok. Black rappers like Dizzie Rascal consider being "bonkers" a good thing. I've had an experience of revealing a previous bipolar diagnosis at a writing group and being told I was lucky.

But in the UK the general stigma of unshared perceptions is as deep rooted and pervasive as the stigma of madness itself. Its one I've seen even amongst antistigma campaigners. Its the thing we don't talk about in public. Its the thing that we associate with axe-wielding psychos and not great artists and thinkers. Its weird and its mad.

Its not surprising. The experience is incomprehensible if never having lived it. I have to admit that some psychiatrists have a modicum of understanding but many still dogmatically see the experience as illness.

The experience that leads to a diagnosis of schizophrenia is also one of the most distressing. Its sad that its often not recognised. Studies have shown up to a 10% completed suicide rate. The pain and suffering is like a rending asunder of everything you knew was real before, the very perceptions trusted from birth become unreal and yet more real at the same time. The very foundations of identity and consciousness are shattered. Terms like "ego death" are more elucidating. That's why it can be seen as an illness because mental healthcare may be necessary to treat the distress but not to tell the individual that there's something wrong with them. If they choose to believe that then its up to them.

This may all sound like an interesting and fairly abstract conversation but there's a harsh reality. Calling it an illness means it can be dogmatically treated like an illness. Its better than the past where unshared perceptions could be diagnosed as as possession, witchcraft or heresy (or canonisation if the voice hearing experience agreed with the paradigm of the Church).

In 2010 it invariably means antipsychotic treatment. Antipsychotic medication reduces life expectancy. Its one of those things the doctors don't tell people. They're an easy treatment to give and forget that a human being is more complex than biology. NICE's guidelines for schizophrenia recommend against therapies like supportive psychotherapy and counselling, preferring medication and CBT. Sadly its an improvement on previous guidelines and there are a a handful of other recommendations for therapies but scant few for the most disabling and distressing mental illness. Drugs are always the first options and they're an easily solution. They're cheap too whereas talking therapy is expensive.

Since the stigma is so high there's no public outcry about the deaths of so many people with this experience. When the evidence comes out about the number of older people dying prematurely when taking antipsychotics for dementia (which is not psychosis but shows antipsychotics used as a chemical cosh) there's a small public outcry. When the public see the figures on people dying from "killer" clozapine nothing happens. This is drug that's used to treat treatment resist

There's a long conversation to be had about what is normal and what is to be considered pathological but I've already rambled long ennough. One more study I'm afraid and that's it.. This one is one of my favourites. Its know to some as the "Thud" experiment. People who didn't hear voices said they did and were immediately hospitalised. When they got in they said they didn't hear them anymore but once they were in their behaviours were pathologised and they were given diagnoses of schizophrenia in remission. (http://web.archive.org/web/20041117175255/http://web.cocc.edu/lminorevans/on_being_sane_in_insane_places.htm)

UK jury-based law courts are unjust

I didn't realise that people with a diagnosis (or specifically those who have recieved treatment. I'm unsure of the law) were excluded from jury service.

The justice system is meant to be fair and it isn't when huge sections of the population are excluded from serving as jurists because at some point in their life they have experienced a certain condition that may or may not have impaired their decision making capabilities. Its one of those idiotic social stigmas that has made it into the legal system and caused disadvantage through incompetence rather than malice (Hanlon's Razor again).

This unintented way that mad people are disadvantaged by society is a black mark on the UK legal system. A jury that doesn't represent the full spectrum of humanity is like a sample of the population that isn't correctly stratified yet it is construed as being representative. It means that there is an implicit lack of understanding of emotional and behavioural health. It means that every legal decision made by jury against a person with a diagnosis is potentially unfair.

There already exists a stigma from reciept of a diagnosis. Depression may be less stigmatised now but schizophrenia carries a high public stigma. People who have suffered these experiences understand the complexities of the human experience better than those who have lived ordinary lives.

It means people who have shown the symptoms of mental illness or mental health problems are misunderstood and disadvantaged by a legal system that depends on the fairness of the decision-making system at its very core. Yet by excluding mad people - because that's where I assume the legislation came from, the fear of the mad or the expectation that a single incidence of mad behaviour somehow makes that person forever lack decision making capability and judgement - from jury service the legal system is biased towards the old paradigm of normality.

Practically it means that emotional problems, behavioural problems and psychosis are misunderstood by jurists. Its means that people who go through these symptoms which are described as illnesses are still treated the same way by the law, very much like in a recent case where the Chinese executed a man suffering from mental illness (http://www.reprieve.org.uk/akmalshaikh).

There are some instances where decision making systems used a jury of peers rather than a jury of laypeople. The proponents of trial by a jury by peers would be mortified at the idea that people with mental illnesses are tried by people who supposedly have never been through those difficult times in life's journey.

Perhaps the reason that people with mental health problems are excluded from jury service is because it is true that a person who loses their capacity once or even on a periodic basis is incapable of ever making a good decision, even when they are in a more stable frame of mind. I think that's utter bollocks but I guess that's because I'm a bit mad and am incapable of making a good judgement.

Is antistigma mental healthcare for the social model

Mental healthcare has traditionally focused on change of the individual.

It is only in recent times that antistigma has become part of mainstream mental healthcare. It is over the last decade that we have seen the increase in programmes that aim to change the construct, i.e. society and its view of 'normal' and stigmatised 'ill health'.

This seems a shift in the paradigm that will have impact on mental health and illness. Reducing the stigma of extreme or unusual experiences of consciousness can reduce the suffering caused by the stigma and discrimination. It can reduce the isolation and maintain support networks in times of crisis. It can reduce the social exclusion that often results from mental crisis or ill health. It can reduce the time to detection and increase insight by education of the public.

In reducing stigma and the barriers it creates this modern movement can actually reduce illness by helping make society more accepting of it and able to see the positive in the people who were once view as pariahs.

There are always dangers in these changes, the same as the changes achieved through mental healthcare focused on the individual. Simply put, there is always negative outcomes through change and often it is not accepted or noted. CBT is akin to brainwashing in that they both attempt to reprogram an individual by changing thinking patterns and behaviours; clearly CBT is done with an ethical approach, however this does not mean it is not without some of the dangers of CBT.

Through that line of thought there may be dangers in the antistigma movement that are unforeseen and perhaps unforeseeable. An example of destigmatisation gone awry is the example of personal debt that become rapidly destigmatised over the late twentieth century. This has lead to pervasive debt as a need of the economy and only recently has the misery of this come to the fore. Its links with mental ill health and suffering are beginning to be explored. During the recession the impact of bad debt will be affecting more of the population and bad debt has also been partially causal in the recession itself.

The risks of the antistigma movement are hard for me to see. Is it simply that the world will become more mad or more accepting of madness and eccentricity and laziness (to use old terms) and there will be no repercussions? I doubt that. Those behaviours may have been stigmatised for a reason, however I believe those reasons have passed. Homosexuality may have been stigmatised for a reason that procreation was necessary for the continuation of the species and a basic need for centuries. Things changed and people who were different from the norm could be accepted because the need for the stigma no longer existed.

What need is there for the stigma of mental ill health? Perhaps nothing today. But before....

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....I tire of this line of thought. Its quite hard to think like this and communicate it. I also wonder are these musing really worth the effort they take?