Are we ever going to understand mental health?

I’ve lost count of the articles about the death of Robin Williams that point out that mental illness doesn’t discriminate, while going on to suggest that it does. It doesn’t discriminate, the authors say, because it can touch everyone, rich and poor; famous and unknown – only to go on and write that there are ‘risk factors’, for example, which are more likely among the poorer section of a population. Maybe they understand what they’re saying. Maybe they’ll make their minds up one day. Maybe they’ll just look at the evidence before putting pen to paper, evidence which overwhelmingly points to the fact that mental illness is highly discriminatory and that this, like many misnomers about mental health and the psychiatric system, point to public knowledge and policy that’s in urgent need of some sort of therapy.

Sadly, people seem to lose most, if not all, sense of critical ability when faced with such stories and debates – especially when far too many people get carried away with the death of a prominent figure – and it can be difficult to dispute anything, as such articles are often framed around ideas that dare not be questioned, sometimes in atmospheres which resist deviation, usually to an audience that probably couldn’t accept otherwise, not least in the heat of their moment.

I used to be a bit like that as a patient, comfortable in the nice and cozy system that, little did I know, was doing me more harm than good, totally convinced that I was doing far better than I would without it, fearful of any alternative. Care workers would convince me that they knew me, that I was nice and this and that when ‘compliant’ with treatment, while in reality I was so doped up and useless that I’d be talking like Michael Jackson one minute – head in the clouds, capable of nothing much – then contemptuous of myself for acting thus, not realising that, like with many things, this was a consequence of the treatment I was being subjected to. But, even as I was waking up to the realities of the system and its treatment, research I did in 2011 into social media and mental health would, in the long-run, turn out to be utterly worthless and misguided. Like most people, I’d accepted the dominant views about psychiatry and mental health without question and believed that as long as people with mental health diagnoses could communicate what I thought they needed to with people who needed it, stigma would be addressed and all would be well for mental health, its sufferers and society at large. How wrong could I have been.

I really started to realise how wrong when I came across academic papers – both positive and negative – about the care system itself. The positive papers often didn’t add up but the negative ones tended to fit in with a lot of my experiences as a mental health patient. In the end, I concluded, though not in my final paper, that the best the mental health community, with its current outlook, could hope for would be for individuals to improve the perception of themselves, but themselves alone. There could be no global improvement through improved dialogue for the community via social media or any other media – stigma would remain for the majority, regardless of the efforts made.

But my gradual shift in thinking didn’t end here. I started to read further, beginning with Richard Bentall’s ‘Doctoring the Mind’, an authoritative, convincing and devastating critique of the psychiatric system and how it works on individuals, calling for significant reform. Not only that, though, it also highlighted, through picking apart the misnomers about mental health, how misguided the public debate about it is. It became ever more obvious that the falsehoods which are commonly peddled of faulty genes and chemical imbalances unfairly straightjacket people into a system of thinking that blocks realistic chances of significant improvement by focusing on nature and the individual, dubious conclusions about genetics and brain chemistry, rather than on nurture and the environment, or what we learn and what we’re exposed to. This would lead me further into looking at popular and academic works on toxic relationships, the sociology of mental health, and theories about how our early years are so formative and influential on our later chances of being vulnerable to mental distress.

My experience of the British psychiatric system had begun in 2000. I’d already graduated from university and been on the Internet for quite a few years by then and my approach meant that my views about information and communication – my main interests – were quite well-developed. However, on first being detained on a mental health ward, it immediately felt like going back in time to an approach to human relationships, communication and the handling of information belonging more to feudalism. The patient was the subject, to be questioned and analysed (superficially and often mistakenly). There was a distinct and fixed hierarchy, ultimately based on prestige, with the patient disempowered at the bottom and, at the top, the psychiatrist, perceived by everyone, often including him or herself, to be all-knowing, even about things outside their speciality.

Medical records play a significant role in the psychiatric system and the approach to them can give a fascinating insight into how misguided psychiatry’s approach to relationships, communication and information can be. The patient has to apply – and often pay and always wait – to see them and, if they do, can often be left bewildered at the interpretation of their behaviour, an interpretation which can be bizarre to say the least. Third parties, like family members and other members of the public, can give information to the mental health team that can be detrimental to the patient and can also request that not only is this information withheld from the patient but that they ever even talked to the psychiatric team. The psychiatrist, in turn, can also withhold any information he or she wants to from the patient, if it’s thought the information may be damaging to the patient or if the patient’s knowledge of the information or the source of it may lead the source to be in any danger from the patient – a set of decisions that’s made in no small part on the information that’s already been often unchallengeable by the patient. There are few safeguards in these processes for the patient, aside from having to rely on the psychiatrists skills of verification, something which can’t be guaranteed and which is clearly not good enough when decisions can be made to administer chemicals to the patient which can transform their entire personality and even their environment.

Communication between the patient and the psychiatrist is often limited to effectively running off a checklist of symptoms in order to form a (highly disputable) diagnosis and, if thought necessary, to medicate. Again, this is often within the framework of information which has already been obtained via third-parties in a process with few safeguards for the individual, meaning that it’s often likely that the psychiatrist will merely rubber stamp what information’s already been given to them, regardless of what the patient says. Even if the patient’s to be effective, they’d have to guess who said what and, if the information’s unreliable, convince the psychiatrist of this, which is likely to elicit the diagnosis of paranoia (even if the patient is right, the psychiatrist can judge that the information given was given in the patient’s best interests, so, because the patient questioned that, this can also be diagnosed as paranoia). Understandably, then, whenever the patient’s questioned, most times there’s little opportunity for them to address potentially faulty information, the psychiatrist calls all the shots and the treatment is framed in a way that empowers everyone but the patient, a process which can have the knock-on effect of not only subjecting the patient to dubious treatments, but also to alienation and frustration that may be seen to require further ‘interventions’.

It can easily boil down to a situation where you can have treatment imposed because some Tom, Dick or Harry’s said such and such. A problem with this is that the system tends to assume without question that third-parties are entirely innocent, having no malicious or dubious motives for providing the information they give, something I know first-hand to be false. Believe it or not, there’s more than enough people who’ll willingly use a mental health diagnosis against someone in a dispute, even for quite petty reasons and, when you consider that many people in the system come from families with emotional difficulties where such behaviour could easily be used as a form of subjugation, you have the potential for the system to compound abuse within families and other social groupings.

Alongside all this is a logic that’s often breathtaking to witness in person. Down the years, I’ve come to call it the ‘Crucible logic of psychiatry’, as it echoes the bizarre use of faulty logic, bad evidence and fanciful conclusions in Arthur Miller’s play. For example, if you disagree with the processes or decisions involved in your ‘treatment’, you’re argumentative, lack insight and the whole psychiatric team can turn against you, viewing you as hostile to such an extent that the whole institution reflects this view, characterising it, as psychiatry tends to characterise things, so that it appears intrinsic to the personality of the patient, without context, as if it came from thin air.  If you disagree with or refuse treatment, you’re also not ‘compliant’ and can be forced to ‘accept’ it, after which, the whole psychiatric team can instantly be your best friend, satisfied that you’re now instantly healthier because you’ve accepted the ‘right’ course of action.

The whole framework is loaded to ensure that the psychiatrist’s prestige, logic and system wins the day, regardless of how bizarre, unrealistic and inaccurate it may be. You could even point to a wealth of scientific evidence against a decision or false proposition, but it’d be to no avail. The system’s ultimately about power and prestige, rather than solid science, so the psychiatrist’s decision is final. If the science says an aspect of psychiatry is faulty it’s not, because the psychiatrist says so and that’s that. The usual outcome, often encouraged by care workers, is that patients just take their meds to get the psychiatrists off their back, because there’s really no other option. Psychiatric wards are, sadly, full of excessively deferential people who’ve been made that way by a lifetime of hardships, often not least disempowerment, so the situation doesn’t always reach that stage, but sometimes it does and, although there’s tribunals which are supposed to be a safeguard against the excesses of the system, and though these sometimes work, a determined psychiatrist can deliberately mislead them, with the full collusion of the care team, despite the fact that this is supposed to be illegal – again, something I’ve witnessed first-hand. But who’s going to argue? The patient? The risk you take with such psychiatrists is that you then face a situation where, should the system haul you in again, you could be detained in a worse hospital, with even fewer safeguards. Better to take ‘your’ meds, drop all objections and be on your way, however wrong and detrimental to reform you know this process to be.

From here, then, medication’s usually administered, medication with no track record of substantial long-term success, as it merely dopes people up to suppress them and fails to address the environmental issues and strategies to deal with them that led to the problems in the first place. A realistic approach to all this can lead people to adopting better thinking and coping strategies that are more realistic and stand a better chance of success because you’re dealing with the real world, not the suppression of it which, with meds, always risks being maintained or, at best, submerged for a time. Many people who do figure out that something isn’t quite right with the whole thing come off meds but lack the understanding to address the real issues. It’s not unusual that they’ve become so persuaded deep down by the dominant view of mental health that they can soon find themselves faced with the unresolved issues yet again (which can become ever worse the more the system’s seen as a convenient way by some people to deal with interpersonal issues) and then in the system once more, bottom of the heap, defeated and demoralised.

So, my experience of the system, as I’ve written, began in 2000. Despite having to be released because the original team who came to detain me had made too many ‘mistakes’ and didn’t want this and other more important inconsistencies exposed to a tribunal at the time, I was eventually, and willingly, medicated on the basis of third-party statements I knew to be hogwash, but with a concerted effort to impose them. When I say ‘willingly’, though, it was because I thought that if I took medication, the approach to information and communication would change, but it didn’t. It remained archaic. I was put on quite a high dose of anti-psychotics (Olanzapine, at that time the latest ‘wonder’ treatment), which doped me up, made me obese, depressed and with very bizarre thoughts which, along with the evident pointlessness of the approach to what had gone on plus the fact that I was not in sufficient control of my own thinking, meant that me withdrawing from them was almost inevitable.

In retrospect, had the approach changed and I’d not been given medication, the situation could have been resolved quickly and I’d not have needed the care system again. However, the psychiatrist I assigned to at the time had made up his mind that there was information that I couldn’t have access to because he (mistakenly) thought I couldn’t handle it.  Meds followed. Then my withdrawal gave me more complications than even being on the meds had given. In the years to come, I went so far and so deep at times that it’s a wonder to me even now that I ever pulled out of most of it. The first time was the worst, though. So extreme were the thoughts and ideas I had that the shock of it all took about 7 years for me to even begin to recover from properly. That shock, along with consequentially repeated admissions, treatments and ‘non-compliance’, would send me on a cycle as a decontextualised ‘revolving-door patient’ that pushed me further into the transformation of my personality, mind and environment that the initial shock had brought about.

It was only through properly understanding the context of mental health, my personal history and my environment that I started to regain anything like what I’d lost. It’s only been through realising the faults of psychiatry, those in my environment and my adaptation, plus potential solutions to it all that I’ve regained anything like my former way of thinking, being and relating to the world. It’s entirely at odds with psychiatry’s current approach, but I’m cool with that because, however popular mainstream ideas about psychiatry are, they’re misguided and there’s a bulk of solid evidence to back that up. This way is realistic because it’s based on how things are which has led to an approach of partial acceptance of some things I can’t change, along with strategies to address how other things can and need to be. It never did need medication, it just needed an imaginative and intelligent approach that psychiatry just didn’t do. I knew there was a better, more modern way back in 2000. I do even more so, now.

My situation now is that I have a diagnosis – one of the big ones – that I’m just not buying, not only because I don’t believe in the diagnostic process, but it doesn’t even add up according to psychiatry’s own standards, so mangled has the process been. My psychiatrist once said to me ‘You don’t believe you’ve got a mental illness.’ I kept quiet, but when I was younger I’d have just told him the truth: ‘I don’t believe in mental illness as you see it’. Easy. I’m still on meds, but mood stabilizers, with a view to coming off them eventually, even though it’s tough once those chemicals are in your system and despite the fact that I don’t know how I’m going to get my psychiatrist to buy that one. He’s not a bad fella and I’m trying to work with him on a strategy that should work, even while he abides by one that never has. To be fair, he does let me try to do things my way, but it’s ultimately an empty gesture: he’s insistent that there’s only one way (his) and, even though he never says much of consequence to my face, I’ve become something of an expert in finding out what he thinks from the very third parties he uses to try to find things out about me, the knowledge of which suggests he’s humouring me until it all goes wrong and he can implement his strategy, despite a long record of failure. His biggest problem with me is that his way is based on medical records that are about as accurate as my CV needs to be and, as should be obvious by now, there’s nothing whatsoever I can do about that. He’s locked in with that Crucible logic and he isn’t getting out, not without significant reform. Meanwhile, when I’m not in the middle of another reduction in ‘my’ meds – it’s a drawn out, occasionally bumpy, but often steady ride – life ticks along quite nicely, as it should.

The psychiatric system’s a mess, only some of which I’ve pointed to here. Not all psychiatrists are the same and some are good at what they do, but the system itself is wrong, so even the good ones can’t do much. It’s the same with many of the treatments on offer and the general ideas about mental health, adaptive strategies and the environment. That most of us tolerate this mess is because most of us know little better. Often we’ve been persuaded by the media, with false information and bad thinking, not least of horror stories which seem to have no alternative. But all this isn’t only the media’s fault. Most of us are at it, even most sufferers. The very system of psychiatry, as it tends to work, is a stigmatising system itself, with problematic and detrimental ideas about normality and difference that are rooted deep in our culture, now. The tragedy here, then, is that most people within it are fighting to improve and spread the understanding of ideas that will only ever result in discrimination, but they’ll just keep doing it until they start learning how and why most of them are misguided, while those who do know better – those who are speaking and writing about the realities of all this – need to improve their communication of the shortfalls of and alternatives to our approaches to mental health with the public, the media and policy makers.

What I’ve seen in my years of being a patient and what I’ve learned while a student and beyond is that our ideas towards mental distress, including diagnoses, incarceration and medication are often doing more harm than good. The fact that so many people in the system buy into it and its limited and mistaken definitions of success, to me, points to nothing more than an indictment of how far off the mark public knowledge is about these issues. A problem with that is that many people, especially sufferers, cling onto these ideas, at times vociferously, despite the conflicting evidence that’s out there if only they’d look. A solution for them is to do this: to actively learn more about the context of mental health as it is, to see how the role of the environment and their strategies towards it have affected their lives, and where they really fit in that environment. This is a good, first step to fighting for something better for the individual and the wider society, a part of which is the discrimination that’s all too real in the lives of the majority of mentally distressed people, whether they can see it yet or not.


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