WHAT FUTURE FOR PSYCHIATRY?
In the previous two editions I have described the work of National Perceptions Forum and the situation of mental patients under the psychiatric system and in society. National Perceptions Forum, perceptionsforum.org.uk, is an organisation run by and for those with severe mental illness which used to be supported by Rethink. Its activities always were largely autonomous. The focus in these articles is on patients who fall into this group of whom I am one. In this article I shall try to look forward to a better future for their treatment and social situation.
There is a lot of focus on semantics nowadays and the belief that more euphemistic names for people who are variously disadvantaged makes things better. While I would admit that labels attract stigma it does not take long for new ones to do the same. The repossession of stigmatising language by those stigmatised however can neutralise its impact for them and embarrass others who might regard them in a bad light.
There is a growing culture amongst patients and alternative networks have developed and continue to do so, if not alternative societies. Alienation is so marked however that the latter comes close to being reality. There remains a very real disjunction between “them” and “us”. Part of the future which would be desirable would be to start closing the gap. One of the things which makes this difficult is that the normal people tend to want to be in charge thereby driving the patients back into their own world, if you will pardon the use of this expression. Although there are efforts made to set up situations where this is not the case they are perceived by some to be contrived and circumscribed nevertheless by the normal people who have set them up. It is not easy to get a level playing field. Indeed it is nigh on impossible unless the patients have their own power bases, their own societies from which they can reach out. The alternative is in varying degrees the colonisation of them by the “normal people”. We are a long way from losing this tension and all being equally part of the same networks.
I am very much in favour of networks set up and run by patients and “survivors”. There are other networks besides National Perceptions Forum which function autonomously, a notable one being Mad Pride which campaigns for the right to be different and an end to oppressive psychiatry. It is a very extravert organisation and holds good-humoured events in public. There needs to be more done to combat the inaccurate perceptions rife in society about what “mental illness” is and the people who get classed as suffering from it.
Is it possible in the foreseeable future or even completely desirable to make mental patients normal? Although psychiatry would have it otherwise “normality” is to a considerable extent a contrived concept which is culturally variable and has a political dimension in that it represents the sort of people the state or the establishment want in society. The narrower their aims the more people one could expect to be taken out of society and “normalised”. While there are many aspects of “mental illness” which I would concede are real problems I also think there is a lot of narrow-mindedness towards it. There are growing numbers of people being classed as mentally ill in some degree. Does this tell us something about the way society is heading? It is not possible to make everybody fit a particular mould.
The paradigm of madness needs to change. The present day obsession with the idea of normality needs to be relaxed. Psychiatry needs to change in some fundamental ways. The culture is still based around the idea that if you are deemed to be mad you have to surrender your right to self-determination, completely in a mental hospital, and in varying degrees outside it. The result is dehumanising. Psychiatry needs to stop treating people as specimens, objects, and recognise that its alienating stance is not scientific. Distancing itself does not enable it to observe us objectively. We are very aware of its presence and that is enough to affect the way we behave. It needs both to engage more with us and accord us rights. Psychiatry needs to properly recognise that we are sentient beings and treat us as such. The extent of reliance on the use of mind-numbing and dangerous drugs makes one wonder how much psychiatry is really an agency for social control and how much real therapy there is in it. It can be soul-destroying while putatively offering help.
There are many reports of abuse and brutality in psychiatry ranging from disrespectful speech up to and including deaths which give rise to suspicions of manslaughter and murder. Few of the reports of major abuse get any air time and almost invariably do not result in convictions. The supposed unreliability of the testimony of those whose minds are discredited is a strong candidate to explain this. This can be cited both as evidence of fictitious reporting and conversely facilitating cover-up. Psychiatry is to a great degree unaccountable. This needs to change. These things are well-known in the mental health service user and survivor movement.
Psychiatry needs to go back to the drawing board and shed its archaic culture handed down from generation to generation of well-meaning new recruits. Less reliance should be made on physical treatments and more effort put into understanding people who are different in some ways. More personal types of care need to be given to those whose minds are in some way traumatised. There needs to be more space and facilities in hospitals, if they are to be called such, and more human input. This might then lead the way for society to come to accept those who previously it locked away and threw away the key.