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.