Madness, Toothpaste and the Two-Percent Problem

Rough guess: between 2-5% of people writing about madness in the media and online know what they’re talking about.  I don’t include myself in that figure, because I’m still developing my thinking and have quite a bit more to learn about the field, but I’m fast getting there.  The thing is, if it’s only 2%, how come?

What with the fact that psychiatry is heavily about engineering conformity to norms along with what I wrote last time about the copycat element of ‘self-harming’ not to mention the placebo effect involved in anti-depressants’ successes, I can’t help but link in the success of orthodox psychiatry’s powerful position with studies pointing to poorly considered conformity to authority and status.

Indeed, the success of neo-Kraepelin psychiatry’s smoke and mirrors can be equated with the way the toothpaste brands used to sell us their products on TV, with an actor dressed in a lab suit using pseudo-scientific phrases about whiter than white.  What with bio-reductionist psychiatry flying in the face of science, along with the disempowered helplessness of people persuaded by the constructed pathologizing of much ‘normal’ behaviour, not to mention more transgressive thoughts and acts, I have to wonder whether psychiatry’s success in pulling the wool over most people’s eyes is down to little more than disempowerment by misinformation and conformity to what’s seen as a higher order.

It’s easy to stereotype dissenters when you’re living within the confines of traditional psychiatry.  They must be scientologists, they’re in denial, they’re dinosaurs compared with our modernity, and so on.  But, because I’ve been on both sides, now, it should be easier to see the terrain of this debate in better ways.  Going on my own experiences (and having transformed them), then, I’ve often rebelled against the system only to find myself, once medicated, at the disempowering extreme of complete conformity to the norms and values of the system and my locale – both fairly reactionary and conservative – which I’m not ordinarily instep with philosophically.

In your conformity, though, you also face abandoning any argument that risks true analysis and clarity of the true state of affairs by putting such questioning and doubt down to illness in the face of what can be the overwhelming opinion of those around you, especially on mental health wards, not to mention online, in the media and, well, in society in general.  You fail to even begin to realise that there are many ways of perceiving and acting around popular conceptions of causal factors and mental states, pathologized and decontextualised or otherwise.  Sometimes, in desperation and the absence of any understanding of the possibility of better alternatives, you may want to believe in something – anything – and traditional psychiatry increasingly fits the bill, backed by limited perceptions and blatant falsehoods almost everywhere you look.

You maintain what many in the system have long experience of – inadequate reasoning, poor problem-solving skills and other common features of problematic relationships – to reject good arguments and laud the bad, especially when these come in the form of the sales techniques of toothpaste manufacturers.  You sacrifice empowerment over even information by surrendering your mind and senses to the wit of people who don’t tell you the truth about iatrogenic effects, causal factors, how psychiatry really conducts itself across the board from research to treatment, diagnostic irregularities, and so on, but instead give an air of authority and prestige in making many declarations about things of which there’s no certainty on the one hand and make-believe on the other.

This isn’t to say that people who advocate neo-Kraepelin psychiatry are bad people.  I’ve yet to meet anyone in the system who, at some stage, I didn’t think went into the service of people to help them.  But the fact that their work is based on a belief system that flies in the face of reliable science means that what you’ll often find – in the rare moments when there is the chance of effective debate – is the very type of reasoning errors and bogus stunts that can look so reasonable to those who often know little better because of their past exposure to similar ways of arguing: for example, shooting the messenger, giving incomplete evidence, not engaging with arguments when you don’t have the evidence so you don’t have to admit it, ‘Crucible’ logic and the prestige suggestion so heavily involved in also selling toothpaste.

That, by my very rough estimate, merely 2% of people in the media and online actually know what they’re talking about when they discuss madness, could say many things to many people.  To me it isn’t a sign of an open and shut case according to popular opinion (though I could easily become derogatory in arguing that).  Instead, it says that there’s a societal problem around norms, prestige and empowerment (not to mention professional, financial and political interests) which needs an overhaul in radical and creative ways.

Earlier today, I read a tweet by a prominent psychiatrist apparently debunking a theory about madness.  He was wrong in fact and dubious in his casual populism. The temptation was to engage him.  I didn’t bother, partly because of the reasons outlined in this post, but also partly because, despite everything, I didn’t want to just in case I was had, as I also buy toothpaste based on the dubious claims of actors in lab suits.

Thinking the Unthinkable

Last year I was a paranoid schizophrenic.  This year I’m bipolar.  Next year I may be eating cheese on the moon.  However, as is common in traditional, bioreductionist psychiatry, this doesn’t flag up concerns about flawed terminology or diagnostic processes.  Instead it’s seen as a simple shift in diagnosis.

Me and my psychiatric team get along very well.  Unlike many of these therapeutic relationships, it avoids the more creepy elements of a parent-child dynamic that the system can so easily engineer through a combination of dysfunctional former interactions and other disempowering processes.  It wasn’t always this way, but now it’s a healthy, more open one, partly because I’ve worked hard to ensure that’s the case.  That we disagree so fundamentally about just about everything to do with psychiatry is a testimony to what a creative approach to persistence, compromise and workarounds can achieve.

We disagree, but we might as well not, because the results are essentially the same.  I’m on medication for life.  To them it’s because of an underlying disability.  To me, it’s because I was put on medication that I didn’t originally need, but which my brain cannot now manage without, a medication that’s even known to cause significant brain damage.

The origins of this state of affairs, to me, were social and psychological, though they sound biological, too.  Epigenetics essentially worked against me, as did a lack of specific psychological skills in a social environment that was not only made up of intense stress, but also designed to build on it (the ‘tl:dr’, ‘shit happens’ scenario).  Although that sounds like a biopsychosocial model, it’s primarily about nurture, not least the epigenetic part.

Psychiatry’s essentially about conforming to norms, though ironically, with treatment which doesn’t tend to like context, preferring to isolate issues as within the body and mind of the individual.  But what specifically are these issues?  Well, they’re whatever psychiatry says they are, regardless of what the science actually says.  Therefore, if you enter any gathering of people who work in or use mental health services, you’re likely to hear myths spread as if they were part of miraculous religious conversions, like chemical imbalances of the brain, neurological disorders and genetic flaws, even though such beliefs are inaccurate and damaging.

Originally a believer in sociology and the idea of context (sociology and psychiatry don’t get along) this was blasted out of me in my first encounters with the local mental health hospital.  This, along with medication and persuasion centred all the problems I encountered as internal, thus denying context and any chance of real-world solutions based on a full picture.  The results were catastrophic – I conformed to the psychiatric norms and those of my intensely conservative social environment, which led to prolonged and severe mental illness with numerous symptoms, most of which I’d not had before.  As I’ve written elsewhere, I eventually reversed the tide by reintroducing a grounding context and returning more to a coherent, stable character.  But it took a chunk out of my life I could have made better use of.

However, there lies one of the problems.  I conformed to a set of scripts about diagnoses, symptoms, and so on, that you can see repeated by far too many people who don’t question what is going on and why.  We know that the phenomenon of ‘self-harming’ is – and I wish there was a more diplomatic way of putting this – little more than copycat behaviour.  That’s historical fact, so we have a whole load of people conforming to a damaging behaviour because they’ve essentially been told that this is how people at the extremes of the system alleviate internal pain.  We know the positive effects of anti-depressants tend to be down to the placebo effect, so what does that say about our current thinking around, and conformity to, ideas of ‘depression’, not least the more meaty terms from the DSM, psychiatry’s bible, which I’ve read being called ‘The Book of Insults’ and with good reason?

It’s well known in some circles, though not popular knowledge, that psychiatry is not only based on bad science and thinking, but also that society as well as the system is in need of reform.  At the moment, we’ve got a bad system propping up a dysfunctional society.  We need reform, too, in the skills we need to navigate life, but that doesn’t mean we’re somehow inherently flawed and that reform doesn’t matter.  However, most people are sidetracked into arguments, debates and initiatives that maintain the status quo and are, if anything, detrimental to public health, all things considered.  And, when the blurb to initiatives suggests a radical approach, it’s usually a sign to look closer at the wording.

No-one in the system, until very recently – though, funnily enough my relationship with most workers in the system is excellent – ever told me about the importance of key contextual factors – race, class, culture, economics, political influences, etc.  They frequently gave me worldly anecdotal advice on how to live life according to their personal norms but always within the framework of traditional psychiatric thinking, on subjects they were often unqualified to comment on professionally and with a worldview that taught me nothing of how to negotiate a healthy relationship with, and understanding of, my environment.

Since November, I’ve been looking more into mental health.  It’s thrown up some fascinating theoretical standpoints and interesting initiatives – many of which even call into question the functioning of traditional psychiatry – but still nothing that practically goes far enough.  What this research has done, if anything, is highlight that there are very few certainties around the subject of madness, aside from the knowledge that most things are uncertain.  Clinical psychiatry may deal with false certainties because of understandable constraints and limitations, but this shouldn’t be good enough to protect it against the reforms it urgently needs, even while – because of its powerful position in society – it doesn’t need to enact anything.

Meanwhile, most people are left in a form of limbo they have little idea about, living according to a set of narratives that they fail to fully grasp.  Are we really allowing such a flawed system to influence how we think and feel and react so much and with so little supporting evidence?  Seems so.  The good thing for me, at least, is that in having looked at anti, critical and pro-psychiatry material, I’ve reached a point where I’m personally comfortable with the service I receive, I understand my options, and I’m not wrapped up with concerns over stigma, discrimination or ideas about symptoms because I know that to be so concerned about things no-one really knows much about would be foolish and because the service is ultimately based on nothing more than rough and deeply flawed guesswork.

The main frustration, though, comes from knowing there’s other people who could benefit from appreciating such uncertainty, acting accordingly and helping to drive reforms that could comprehensively work, rather than, sadly, being little more than their master’s voice in so very many ways.