Discursive of Tunbridge Wells
John McGowan
2246The British Psychological Society’s report ‘Understanding Psychosis and Schizophrenia’ has challenged many commonly held beliefs about serious mental health problems. While the report has been widely welcomed, it has also prompted questions, particularly focusing on the report’s key recommendation that we move beyond seeing distress as a symptom of disease:
‘services should not insist that people accept any one framework of understanding, for example the idea that their problems are symptoms of an underlying illness.’
This issue has been addressed on this site on a number of occasions and it’s clearly one that arouses strong feelings. The disease-model of modern psychiatry views emotional distress as the result of illnesses or disorders. Treating such problems in this way, as healthcare issues, is often seen as essential for ensuring that people get the help they need, and vital in avoiding inappropriate treatment. In particular, some colleagues have suggestedthat viewing people as ‘mentally ill’ prevents them being blamed for actions for which they are not responsible. Rather than being seen as bad you can be mad (or more accurately sick) and more likely to be treated rather than simply punished. Removing this protection (the argument continues) may even result in people being sent to prison inappropriately. These are clearly serious concerns and deserve careful consideration.
The services you need: care
No matter how often it’s advanced, the idea that a diagnosis ensures that people get the services they need, fails at the first hurdle. Despite the epidemicof psychiatric diagnosis, people with mental health problems are clearly already failing to get the help they need. In the UK, even the Government Minister responsible has suggested that mental health services are ‘stuck in the dark ages’. The quasi-independent Schizophrenia Commission has stated that ‘the message that comes through loud and clear is that people are being badly let down by the system in every area of their lives’. In other words, the current system is failing, and something different is needed.
So how do we ensure that people with obvious and quantifiable needs (themselves intimately associated with their social circumstances) get the help they need without the use of diagnosis? The answer is in the question – we need to address identified problems rather than hypothetical ‘illnesses’. It isn’t complicated: we can operationally define, measure, research, understand and offer help for the specific problems that people identify. Perhaps even more importantly we can also broaden our focus, from individuals to the social challenges that give rise to these problems. We can offer practical help, negotiate social benefits (which could be financial support, negotiated time off work, or deferred studies, for example), or offer psychological or emotional support. There no need to maintain that people are ‘ill’: attention to people’s real problems will offer the most straightforward route to getting them the services they need.
The services you don’t need: prison
So what about the charge that failing to identify distress as illness may result in inappropriate blame and even jail?
The relationship between mental health and criminal justice, particularly imprisonment, is indeed something that we urgently need to think about. The majority of people with mental health problems are neither criminal nor violent, although there is a complex relationship between substance use, mental health and criminal offending. Perhaps because of that complex interaction, it’s also been estimated that up to 90% of the UK’s prison population has some form of mental health problem (with comparable figures in the US). This suggests that the dominant medical model has not kept people with mental health problems (who do not tend to be violent) out of jail.
Having said that, it is important to understand how mental health issues relate to criminality. Clearly the relationship is complex: it simply doesn’t follow that, if you commit a crime and also meet the criteria for a recognized mental disorder, then you can’t be found guilty or sent to jail. To take one simple example; a very large number of people are in prison for drugs offences, and their difficulties with substance use have been recognized and discussed in their trials, often cited as motives for acquisitive crimes. Once sentenced, people are (sometimes) offered interventions to address their substance use. But a diagnosis of ‘substance use disorder’ (a psychiatric condition listed in the diagnostic manuals) simply does not result in people avoiding prison. In truth, holding people responsible for their behaviour is a necessary cornerstone of civil society. Equally, our criminal justice system must take appropriate account of people’s personal and social circumstances. I’m not saying we should ignore people’s very real mental health problems and their possible relationship with offending. But I am saying that a diagnostic ‘disease model’ does not, in practice, help very much. Instead, we need to understand a little more about the functional relationship between mental health and personal responsibility.
Who (or what) is to blame?
Issues of free will and personal responsibility have been the subject matter of philosophy for over 4,000 years, and currently exercise jurisprudence, criminology, sociology, neuroscience, and politics as well as psychology and psychiatry. Simple solutions are unlikely. It is clear, however, that the invocation of a ‘mental illness’ is a non-solution to the problem. The traditional argument seems to be that, if somebody with a diagnosed mental health problem commits a crime, then the illness ‘made them do it’. This argument seems superficially to address various issues: if we blame the illness, we don’t have to respond punitively to a person in crisis, and if we cure the illness, we solve the problem. Then the individual can be offered medical care rather then a criminal justice solution.
But this is a simplistic and often unhelpful response. The notion of mental illnesses as entities separable from our social and cultural normative values is a myth. It is a circular argument to identify some aspects of our psychological functioning as ‘illnesses’ and then accord special legal status to them. Moreover this argument is applied inconsistently. The fact that a large proportion (perhaps the majority) of people in the criminal justice system have identifiable mental health problems suggests that, in most cases, these ‘illnesses’ have not, in fact, accorded them special status. At the same time, it’s equally clear that the vast majority of people whose problems do meet the diagnostic criteria for identified mental ‘disorders’ are perfectly able to take responsibility for their decisions, even those related to possible criminal activity.
But if the notion of ‘mental illness’ fails, in truth, properly to address the challenges of the relationship between psychological problems and criminality, what’s the alternative? How should we think about these issues? How can we ensure that people get the help they need and that they don’t get sent to prison when it’s not appropriate?
As in any other situation, people should receive the help they need for their identifiable problems. There’s no need to invoke the notion of ‘illness’ to achieve this – we don’t invoke this concept in other areas of civic society: housing, education, financial help, etc. And we don’t need the notion of illness in order to protect people from inappropriate legal sanctions. In criminal proceedings, we should have the maturity as civilized societies to take all of the relevant psychosocial aspects into account when choosing sentencing options. There is no need to invoke ‘illnesses’ for Courts to understand, and take account of, the psychological and social issues that influenced a person’s behaviour and their state of mind at the time of an offence.
What would be wrong with a model of psychological well-being which accepts that biological, social, and circumstantial factors impact on our actions? In other words, extreme circumstances can affect our judgement. When Courts take account of these issues – for instance, when sentencing someone for a crime – people are presumed to have personal responsibility unless it can be demonstrated otherwise, but the criminal justice system can be flexible. We should set clear and robust criteria for such decisions, and we should use established rules for both legal and scientific evidence. We need scientific expertise to guide the criminal justice system through the complex relationships described earlier. But we don’t require the notion of illness.
So…
So how can we ensure that people with obvious and quantifiable needs get the help they need, including for the social problems that often gave rise to the difficulties in the first place, and avoid inappropriate entanglement in the criminal justice system? For those of us promoting a psychosocial approach, the answer is clear. We need to identify each person’s specific needs and offer them appropriate services. We need to identify the social challenges that give rise to these problems, and work to address them. By appreciating how such factors have impacted on person’s psychological well-being, we would also be able to determine the extent to which their ability to make rational, responsible, decisions have been compromised. Such a determination should be part of any Court’s adjudication, So do we really need the idea of illness?
About the author
Peter Kinderman is Professor of Clinical Psychology at the University of Liverpool. You can follow him on Twitter here. A shorter version of this piece originally appeared on The Conversation UK.
For me, a psychologist is bound to run into problems if s/he wishes to jump paradigms without proper consideration of epistemology, or if s/he wishes to consider the ethics of forensic intervention whilst completely ignoring Foucault (among others). This article exemplifies such an approach.Kinderman argues that the medical model, based on notions of disease, and embodied in the now-ridiculed DSM, would be best replaced by a ‘psychosocial’ CBT-style model. The idea is that this latter approach might allow the experts to determine who is ‘mad’ and who is ‘bad’, and to allocate treatment or punishment accordingly. The elementary point that is missed here, of course, is that treatment is the punishment, especially when we are dealing with coercive psychological ‘therapies’. Prison deprives the subject of liberty, and cages and disciplines bodies. Treatment of the psychosocial variety, whilst superficially more ‘humane’, wants to take this discipline one step further, into the domain of the soul.How could such an obvious point have been missed? The answer, I believe can be found in the psychoanalytic theory of discourse.The medical-pathology model belongs to scientific, academic discourse. Its critics quite rightly observe that beneath the preoccupation with empirical data, objectivity and the like, there lies a clear will to mastery (of those subjected to it). At its extreme, this leads to psy-clinicians reifying diagnosis in a manner that is practically delusional, and I mean this in quite a precise sense. It imposes some limits on clinical practice, however, since it necessarily orients this practice to subjective suffering (here rebaptised as ‘pathology’).The ‘psychosocial’ and CBT discourses, however, are between the scientific and those discourses which can be called capitalist, or neoliberal. Kinderman makes clear – the object of intervention in his vision is always ‘quantifiable’. In contrast to the categorical approach of traditional medicine, his is a numbers game. Truth in postmodern capitalist discourse is a defunct category, and one sees this clearly both in Kinderman and in the Understanding Psychosis project. What is true is what ‘works’ according to the clinician, or what pleases the affect of the subject, or what can be negotiated and bargained on. Happiness and reason are effectively one and the same, Nietzsche, Schopenhauer and Kierkegaard be damned! Here we no longer find patients, but consumers, or ‘service users’. Here the role of ‘services’ is not merely to address suffering but also to act as a prophylactic. Far from limiting its jurisdiction to the negative goal of banishing of pathology, the psychosocial approach is a positive one, aimed at ‘resilience’, ‘enhancement’ and all-round efficiency. It should be obvious that this discourse, when compared to the medical-scientific, supports more intervention rather than less, since its remit is totalising, and not limited to hypothetical pathology. And this is exactly what we find, since the use of SSRIs and CBT is practically ubiquitous whenever one is dealing with ‘treatment’ in a forced or forensic setting. Ultimately, the medical expert qua doctor is replaced with the neoliberal ‘life-coach’. It is no coincidence that the paradigm in question was founded by failed psychoanalysts of the 1960s, but only really reached its potential in the era of Thatcher and Reagan, of deregulation, self-regulation, and case managed deinstitutionalisation.It should be clear that merely abolishing the concept of illness, whatever the salutary epistemological effects this produces, does little to improve the ethical and political dimensions of psy-intervention. For this, you need a paradigm outside of both the medical-scientific and the neo-liberal/CBT model, and burning a copy of the DSM – whilst reasonable, in itself – does absolutely nothing to achieve this.
Peter Kinderman seems to be arguing that it doesn’t matter if an experience is classified as resulting from disease, illness, disorder, or a response to circumstance (genetically mediated or otherwise). People who have “obvious and quantifiable needs” should get the help they need with social challenges which may have led to the difficulties in the first place. They should have someone to talk to so they can make sense of what has happened. Removing the category of illness doesn’t remove distress, doesn’t mean people shouldn’t be helped. This makes a lot of sense.Much has been said about the problems with diagnostic categories and with naïve reification to biological entities. You have disease D if and only if you have symptoms S1, S2, … Sn. Why do you have those symptoms? Why of course it’s because you have disease D. I think we can safely conclude, along with many others, that this is circular. An argument that we “need” diagnoses to care for people is unconvincing.Should we completely throw away what has been collected in diagnostic tomes, however flawed? I don’t think we should.One complaint about DSM and ICD is that they cover all aspects of human experience. Most of us can find a diagnosis in there, especially if interpreting the descriptions broadly. But in many ways this is a strength –when naïve reification is eliminated. Denny Borsboom, Angelique Cramer and others have done important work extracting the individual complaints (e.g., loss of interest, thinking about suicide, fatigue, muscle tension) which make up diagnoses and modelling how they relate to each other (Borsboom, Cramer, Schmittmann, Epskamp, & Waldorp, 2011; Borsboom & Cramer, 2013). The individual descriptions and their interrelationships might gain in meaning when stripped of their diagnostic group.Describing the sorts of situations people find themselves in and how they feel is crucial for conducting research and helping build up evidence for what works. When is talking therapy helpful? When might it make more sense for people to work four days a week rather than five? When should a focus be on interpersonal problems and who should be involved in sessions?[continues…]
[… continued from above]DSM-5 includes a chapter on “Other conditions that may be a focus of clinical attention” (American Psychiatric Association, 2013, pp. 715–727). It’s brief, making up only about 2% of the book, and should be expanded, however, it seems relevant to a psychosocial approach and could perhaps be combined with other descriptions of predicaments and problems. Example problems include:- High expressed emotion level within family- Spouse or partner violence- Inadequate housing- Discord with neighbour, lodger, or landlord- Problem related to current military deployment status- Academic or education problem- Social exclusion or rejection- Insufficient social insurance or welfare supportSo, "DSM" is not synonymous with "biological". There is again plenty to be built upon, despite its problems.Kinderman argues that practitioners “can offer practical help, negotiate social benefits (which could be financial support, negotiated time off work, or deferred studies, for example), or offer psychological or emotional support.” It was great to see specific examples. Medication also likely has a place, especially when the mechanisms of action are conceptualized in a drug-centred way rather than keeping up the pretense that they cure a disease (Moncrieff & Cohen, 2005). I think we all should be doing more to elaborate how a meaningful psychosocial approach can work in practice.ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91–121. doi:10.1146/annurev-clinpsy-050212-185608Borsboom, D., Cramer, A. O. J., Schmittmann, V. D., Epskamp, S., & Waldorp, L. J. (2011). The small world of psychopathology. PloS ONE, 6(11), e27407. doi:10.1371/journal.pone.0027407Moncrieff, J., & Cohen, D. (2005). Rethinking models of psychotropic drug action. Psychotherapy and Psychosomatics, 74, 145–153. doi:10.1159/000083999
I find this discussion a bit facile. As anyone who has ever been sectioned will know, being in a psych ward can be every bit as bad as being in jail, especially if you are subjected to forced meds and the brutality of restraint and seclusion. Let's also not forget that being sectioned counts as an arrest. Neither is having a psych diagnosis an easy option – it will remain with you for life no matter how hard you try to get rid of it, whereas a criminal record becomes 'spent'. Arguably too, the ignorant lay public is better disposed towards ex-cons than to the so-called mentally ill.Reply
On the critical psychiatry blog this post was mentioned, and I left this comment there in response to this issue, so when I quote, I'm quoting what was said on the Critical Psychiatry blog….
"The point is that what is designated as mental illness may lead to mental incapacity." Absolute crap. Incapacity means incapable, and if you were honest with yourself, your ONLY evidence to go on is thus far demonstrated behavior. I have not become a millionaire yet. That does not mean I am incapable of becoming so. Before I quit smoking, I had not yet demonstrated that I could do so, once I did, my capacity to do so was proven. There were times when I believed I was Jesus Christ. The fact that I no longer do, proves I had the capacity to stop believing that. If some quack, had labeled/libeled me as "incapable", or not having the "capacity" to stop believing that, during the time I was still believing this, it would be nothing but an unproven claim. Paraplegics are verifiably suffering from walking incapacity. Just because someone yesterday, today the day they commit a crime, and tomorrow believes something you find bizarre, doesn't mean they are like an Alzheimer's patient. "People who are psychotic may not make the most rational of decisions because of their mental illness." I don't see any reason to accept the premise that just because your mob invented a word, "psychotic", that this is some absolute fact about some "state" they are said to be in. "may not make the most rational of decisions because of their mental illness." This is circular logic at its worst. Why are they not making decisions you consider rational? Because of their alleged "mental illness". Why do you say they have a "mental illness"? Because the decisions you don't find to be rational. The only evidence for the "mental illness" is the very behavior calling the behavior an illness purports to explain. And what is "rational"? Is getting a tattoo on your face rational? Is wife swapping rational? Is voting Tory rational? Is invading Iraq rational? Is getting silicone bags implanted in your breasts rational? Is working yourself to death and dying 3 years into a retirement you looked forward to all your life rational? Are the billions of people that believe in a deity making a rational decision? Is slicing off 40% of the penile skin of newborn baby boys rational? Is being embarrassed by your bad teeth rational? Is holding a rabbit's foot at the slot machine in Las Vegas rational? Is buying a lottery ticket rational? Is the cultural practice of men wearing a piece of fabric tied around their neck rational? Is caging millions of people for doing drugs rational? Is a shotgun wedding rational? Is giving the police tasers rational? 11 February 2015 at 21:19Anonymous Anonymous said… "Crimes, including homicide, may be committed for psychotic reasons." I've read tens of thousands of sources and lived through the extremes of mind that get called "psychosis", and the fact that this is the first time I've read the phrase "psychotic reasons" doesn't bode well. What is a "psychotic reason"? A reason you find bizarre and alien? People believe things. They act on these beliefs. Beliefs don't come handed down from the fully formed homo sapiens body into the world as either "psychotic beliefs" or "not psychotic beliefs".
There are people in prison for the rest of their lives for bombing abortion clinics. They had beliefs, that you and the majority of people wouldn't call rational. There are people living in resplendent wealth on Texas ranches guarded for life by the Secret Service who have made "rational" "non psychotic" decisions to cause the deaths of hundreds of thousands of Iraqis. There are countless people sitting in a prison cell because of a non-deliberated snap decision to lash out and stab their wives to death because they believe they were cheating on them. Some of them did so without any evidence that any infidelity was taking place. They must live with that mistake for the rest of their lives. If I harmed someone when I believed I was Jesus Christ, which I didn't, but if I did, that was still me committing those acts, those were still my beliefs I would have acted on. I don't want an apartheid justice system where I am dehumanized and considered an "ill" human and denied my right to equal treatment under the law just as if you had bombed an abortion clinic based on your "irrational" beliefs (if you were that way inclined). A judge, or a jury, as Thomas Szasz always said, should be able to look at all the circumstances and show mercy. I think that having an overall legal framework of "the people various quacks say are not responsible are not responsible" is chaos. "It is generally accepted that it is wrong to punish a person deprived, even if only temporarily, of the capacity to form a necessary mental intent that the definition of crime requires." Don't pretend for a SECOND that the people found not guilty by virtue of unproven psychiatric brain disease, are not punished ten times harder than people who get off with mere prison. Being sentenced to INDEFINITE forced drugging, having your brain raped and prodded daily, by psychiatric quacks, IN ADDITION TO being locked in a building, is far more punishing then being merely locked in a building called a prison.
Like someone who has been to 70 weddings but never been married, I wouldn't expect you understand states of mind you've never experienced. Yes, decision making can be very intense, rapid, and cascading while in such a state, but if someone punches you in the face because he believes you're part of the MI-5 plot, that is still someone, a real, actual, adult citizen with rights and responsibilities in a society, acting on their beliefs. They can come to regret their behavior and be embarrassed by it later, and so can the abortion clinic bomber, or the reformed Jihadi. Or the guy who was wrong about his wife cheating on him. Being wrong about something but acting on it, especially if acting on it in a dangerous way, still sends society the message you're a dangerous person. They are going to want to lock you up. Trust is lost. This is a tragedy, yes. But you seriously err, if you think for a second that rather than being sentenced to a finite sentence and being given time to reflect on your actions, and pay your debt to society, people would be better off being handed over to your psychiatry quack prison instead, where you can fill their head with all sorts of disempowering myths about how they only thought what they thought or believed what they believed "because of their mental illness". Give me liberty or give me death, give me prison over being handed over to the mental healthists, or give me death."People should be presumed to have a sufficient degree of reason to be responsible for their crimes unless the contrary can be proved."I don't think you can prove it at all. As Szasz said, incompetent people are incapable of committing complicated crimes. Picture the staggering difference in complexity, between an elderly dementia patient lashing out at a nurse with a flailing arm, and a young, fit, healthy, angry, hateful, man, training with machine guns for months and picking the perfect time to publicly gun down as many people as possible. The sheer amount of hiding from the police, and coordination that even goes in to the many cases of women hiding dead babies, speaks to the cognizance and competence of criminals. If you can pull off a complicated crime, you are responsible, even if you, find the reasons people give for their actions to be "psychotic reasons".
"But, in some cases people do appear to have acted irrationally because of mental disorder in committing their crime."Key word is APPEAR, and I'd add this "appears to be the case to you", you, trained all your life to see "mental illness" at the slightest whiff of seemingly isolated irrationality in individuals, groups, whole societies, get a pass from your gaze though, for no good reason that I can see. And again, the above quote is another one of psychiatry's circular logic fests."Why'd she act irrationally?""Because of her mental disorder""Why do you say she has a mental disorder?""Because she acted irrationally"The explanatory value of such a statement is nil, except in cloud psychiatry land, where inventing an "illness" conception of the alien extremes of life has been acting as a permanent tumor in psychiatrists' ability to reason for hundreds of years.Maybe it is psychiatrists, that have a "mental incapacity" to see beyond their own quackery."Whilst I agree that mental health services should not insist that people accept that their problems are symptoms of an underlying illness,"Only when you come to understand why that paragraph reads to me exactly like the following, will you understand…My translation….Whilst I agree that Iran's religious police should not insist that people accept that their problems are the result of being haram, they should accept that their beliefs are haram, and we still need a religious police ActIran's religious police, and Britain's psychiatrists literally live in a completely different version of reality to me, one where it is taken as a given that "haram" or "psychosis" are things they can be the arbiters of, and quite frankly Mr. Double, it is the most tyrannical, oppressive, violent, scary, sickening, absurd conceptual system I have ever had the displeasure of becoming acquainted with, and the notion, the reality, that I'm subject to laws written by psychiatrists based on psychiatry's ideology, is utterly obscene to me, that it is something I will go to my grave never accepting and never forgiving.
The very fact that you can with a straight face say that there is a "service" that reserves the right to smash its way into my life, or divert me against my will from the criminal justice system's checks and balances, built up over centuries since the Magna Carta, in favor of some 5th rate pseudoscience having the power to define my "capacity" or otherwise, is quite simply utterly on par with what I imagine it is like living in fear of being rounded up in Saudi Arabia.The fact that someone like you, someone who stumbles and falls over his own slipshod logic "irrational because of mental illness, mentally ill because of irrationality", the fact that someone like you has the power to sign a piece of paper and violently flood my bloodstream with drugs, simply will not do.I truly wish, that your religion, psychiatry, would be separated from state, separation of all churches and state, because you people truly have no conception of how utterly life destroying one of your forced conversions can be.Which brings us full circle, to who should be punished and when. Psychiatrists don't intend, don't have the mens rea, to decimate innocent lives, but they do, nonetheless. Their absurd hubris, and global fanaticism and "illness" labeling and "researching" causes immense harm, but they are not held accountable.When a war criminal, finds himself in the Hague, or at Nuremberg, and still, throughout his imprisonment, doesn't "agree" that what he did was wrong, we still hold him accountable.Psychiatry has killed many people I feel a kinship with through shared experience, it has destroyed many innocent lives that I have witnessed, it nearly destroyed mine.Will the fact that psychiatrists are acting on false beliefs, and the fact they only wanted to help, wash the blood off their hands? I don't think so.Ask not is the insanity defense valid, ask is the "we believed these people were ill" defense valid.I remember every thought and decision I made during the times you would have slapped me with the "psychosis" label. Someone claiming that I have "incapacity" or had "incapacity" simply on the basis of how "strange and irrational it looked to the outside observer" is offensive, dehumanizing, and the true tragedy of it all is, you can't even see how in an effort to build a humanizing, compassionate thing into the law, the very fact you people are willing to violently break the will of the person you claim as the target of your compassion, basically means your profession crosses human rights lines that utterly, utterly destroy any good intentions you may have had. It's the mark of the psychiatric fanatic, and I've pondered this for years and I've come to the following conclusion…Anybody that would stab a syringe into the body of someone who is locking eyes with your soul and pleading for their very lives not to be injected, is not fit to be in a courtroom in any other place than the dock.Psychiatry, with its centuries of violent oppression against its "patients", posing as all concerned when someone who stabs someone commits a violent crime.The very psychiatrists that give "expert" testimony in a stabbing case, are themselves, people who wield sharp steel in aggression.A psychiatrist testifying in a kidnapping case? is someone who has spent a career locking innocent people in tiny rooms.Whether it is the abortion clinic bomber, the Jihadi beheader, the troubled mother who drowns her kids in the bath because of a belief it will please God or Satan, or the psychiatrist that sections and forcibly drugs, rapes the brain, of someone for believing something strange, people in all walks of life, across the whole of humanity, show us man's inhumanity to man.
NOW, in direct response to this actual blog post, not the critical psychiatry commentary on it, I am struck as other comments have been, by this…"get the help they need"I'll take prison any day, over being sent to a locked building that someone is too dishonest to call a prison, where they will give me "the help" that they think "I need". The coercive "helper" is so deep into his righteousness that whether the target of the "help" finds said "help" helpful, or even considers such "help" worth calling help, has never mattered, from Bedlam to here and no doubt into the future."Oh I'm helping you" they say, "Oh you're not in a prison" they say, as they lock the door. "This argument seems superficially to address various issues: if we blame the illness, we don’t have to respond punitively to a person in crisis"Such a bizarre world. One in which locking people in a building against their will and even raping their brain with forced drugging, "is not punitive if we say its not punitive". Those who don't believe it is punitive, feel free to call 999 and say something bizarre, threaten suicide, or whatnot, whatever it takes, if you've got nothing to fear, if you don't being brain raped by the goon squad would feel "punitive" or punishing, go right ahead get yourself some first hand experience.Or agree to the following. Some time in the next 90 days, you consent for me to invade your home, and spirit you away to a solitary confinement cell, that I'm going to cynically call "seclusion", I'm then going to invade your body on the molecular level, you consent to this happening sometime in the next 90 days, on a night, of my choosing, while you're trying to sleep soundly in bed. Oh but its not "punitive" and "inappropriately" winding up with the right to own your own brain intact in a standard prison cell, rather than being brain raped in a psychiatric prison cell, is just the worst thing that could ever happen. How could we ever let people go to prison and be left alone to read a book with a mind free and clear of drugging in a prison cell, the inhumanity of sending those we believe have inferior biology to prison! Oh! Will somebody get them the "help that they need" and forced face-time with someone who has "read the research". God forbid. Give me prison any day of the week. In the debate about what locked building to send people to, one thing prisons don't do much of at all, that psychiatry MOSTLY does, is lock up people who haven't broken any law at all. There is no limit to the messianic fervor of the person willing to "help" someone against their will.
I love your comment Fay. I wish the entire world was filled with people that think like you do.
I'd rather get the death penalty than the biopsychosocial penalty. Can you imagine being sentenced to the indefinite forced "care" and "help" of such life-coach re-programmers? Every day, getting up, in the locked building which according to them isn't a prison, and being forced to generate whatever garbage they wanted to hear from you, like Clever Hans, day after day after day after day, the "I'm better now, I think I'm ready to be free" of old, replaced with "I have fewer quantifiable needs now, you've given me the help that I needed, thank you, you saved my life, I am ready to be free now, can I go back out into the world now Sir?""Not until we've finished offering you appropriate services"An offer they can't refuse.
In the ideal world a complete shift would happen. We would look at mental wellness programs in jails and prisons. Some would probably have me stoned and quartered for suggesting this. Imagine a mental wellness program for murders and rapists. As mental health practitioners, we are concerned about the ethical treatment of prisoners. Whether "mentally "Ill" or not we need a culture of wellness. Not really a welcome idea prisons? Whatever label they come under prisoners need a chance to be "well" and productive members of society. Whether we throw out the label or not we need increase protective factors so we can stop the revolving door of prisons. From a funding standpoint keeping the label of "Illness" may benefit us so that we can shift programs to "wellness". That jails and wards are just weigh stations, that they provide meaningful transition to community resources.
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See my post and comments on my critical psychiatry blog