Does Mental illness exist?

Firstly, reading this, I’ve learned that hysteria was thought to be caused by needing a good …um, seeing to. Interesting concept. These days it is usually someone who is uptight and bad tempered who needs some personal attention (to be polite).

On a more serious note, be careful E, this post is calling out for us to be bombarded by that cult/religion that I shall not name.

I believe people working in the field of Mental Health should regularly consider if they feel the persons symptoms are socially unacceptable or whether or not they are actually causing harm to anyone. (amongst other things)

I think it is very important to remember that psychiatry and Mental Health is far from an exact science, but this is where we differ from medicine and have to remember to treat each person as an individual and not a set of symptoms.

Szasz has also drawn attention to DSM which started out with relatively few psychiatric conditions but now lists well over 100 (as well as abandoning certain “disorders” long the way such as the infamous homosexuality category).

Are these additions simply new “diseases” that we have never noticed before ?

Any neurologist will tell you that pathophysiology can be proved objectively at least for certain organic brain diseases, yet (to date) this has never been the case for schizophrenia.

I’ve heard it said that psychiatry stands or falls by the credibility of the schizophrenia hypothesis, and that schizophrenia is the “grave yard” of medical research.

Laing used the analogy (when thinking about schizophrenia) of a musician continually playing out of key with the rest of the orchestra until the majority of players could no longer ignore the dissonance (obviously this particular lot were not fans of Stockhausen).

Of course ,just because you can’t prove something today does not mean that tomorrow will be the same - personally I suspect that psychotic disorders have an underlying organic component, certainly the effects of LSD induce hallucinations, etc…..at least that’s what I’m told (coughs).

Oh dear….. It’s all very well for Thomas Szasz and the like to sit around pontificating about the finer philosophical, metaphysical and spiritual points of whether or not there is such a thing as mental illness.

I, on the other hand, have to live with my illness every damn day of the year. Yes, I think my bipolar “problem” is an illness. It’s not part of my personality: for example, I’m an extroverted, positive, optimistic person, but not when depressed.

Medication plus the right lifestyle choices make the thing go away most of the time. My illness is caused by a malfunctioning brain and is something I don’t want, don’t like, and is not part of my “person” as far as I am concerned.

I have no time for mind-body dualism either.

I’ve had the experience of having strong suicidal thoughts and compulsions, having a cup of coffee, and the effect of the caffeine is to completely remove these thoughts. Caffeine has also made me hypomanic in the past. Caffeine effects some of the same neurotransmitters as anti-depressants, it’s worth noting.

I agree that it really sucks that the only thing that seems to work for psychosis is large quantities of olanzapine, a substance you’d have to work pretty hard to persuade me to take; and that it only works half the time. This is the real problem, isn’t it?

Personally I used to be very much into the whole anti-psychiatry school of thought. Nowadays I feel like I’ve come out the other side, and that many of the anti-psychiatry arguments are just as simplistic, dogmatic and philosophically flawed as the psychiatric paradigms they claim to refute.

A couple of points:

Ssasz (1984) says that mental illness does not exist by definition because disease means bodily disease and the mind is not part of the body,

Personally I’d say that the idea of a mind-body split is increasingly untenable in the age of modern-day neuroscience. Anyone who wishes to deny that the mind comes from the body might wish to observe the changes that take place in the mind from altering the brain physically or chemically (e.g. by sticking an ice pick through the frontal lobes, or by drinking a bottle of whisky.)

Here’s a question I’ve never been able to fathom: why is it that if Szasz thinks the mind is separate from the brain, does he not seem to think that learning disabilities are an artificial social construct too?

A relativist view however would argue that what we call mental illness is not an absolute transcultural or temporal fact and that descriptions of abnormal social behaviour change across time and geographical boundaries.

But the problem with that argument is that it only looks at the *social behaviour*, and not at the actual *experience*. Where in that view does one fit the experience of, say, hearing voices constantly demeaning you, or being unable to shake out of your head the feeling that your neighbours are inserting thoughts into your brain?

As for the plethora of DSM categories, I’d say the point of them is to name and categorise these experiences and behaviours rather than to “discover” them per se. Admittedly we could conceivably name them in other ways (e.g. “messages from God” instead of “psychotic episode”) but that other way of naming it therefore ought to expect to be equally scrutinised and criticised, and should be able to make its case for why that would be a better way to name it.

God, I used to be such a good little RD Laing fan. I’m such a bloody traitor to my younger self.

I think the notion of eccentricity is interesting; it appears to be a mild form of mental illness that is largley ignored because it doesn’t tend to cause the ’sufferer’ or society any problems. I think this is where mental illness becomes a reality rather than a social construct; as DeeDee says, it is the suffering caused to the individual (or the danger presented to those around them) that suggests it is a fact. Even if you take away societies judgements and stigma, people hearing distressing voices will still be ill.

I don’t know if any of that actually makes any sense tho…

cellar> “feel like shit” ergo sum :).

excreto ergo sum?

Z> cheers

A relativist view however would argue that what we call mental illness is not an absolute transcultural or temporal fact and that descriptions of abnormal social behaviour change across time and geographical boundaries. A broken arm may be a broken arm in 14th century Florence and in the Kalahari desert of today, but ideas of madness vary considerably between these times and places.

Of course, up until fairly recently epilepsy was, to many Hmong people, an attack by an evil spirit. In South Korea, hypothermia and suffocation are the result of sleeping in a room with a running fan. In 19th Century New England, tuberculosis was evidence of vampirism. Until the elightenment, the cause of tooth-ache in most of Europe was held to be tooth-worms. In the early 1980’s Gay-Related Immune Deficiency became Acquired Immune Deficiency Syndrome and a couple of years later became not just a syndrome but the eventual consequence of HIV.

A broken arm may be a broken arm everywhere, but that’s not true even for all other kinds of injuries. Female genital mutilation is pharaonic circumcision elsewhere.

Is tarantism caused by the bite of a spider? Were the dancing mania outbreaks in Europe between the 14th and 17th centuries religious hysteria, ergot poisoning or both?

All our views of illness and injury are mediated by socio-cultural ideals and norms. So is the process of deciding whether something qualifies as an injury or an illness. I’m fine with relativism, but relativists should at least apply their relativism consistently.

Cellar said:

“Even if you take away societies judgements and stigma, people hearing distressing voices will still be ill.”

and I disagree. If someone chooses to see their voice-hearing experience through the medical paradigm, then that’s one thing. But there are many other paradigms and ways of understanding something like voice-hearing, whether or not it is distressing the person. Many members of the HVN (Hearing Voices Network) work with a trauma model for voice hearing and unusual beliefs, but ultimately they are most interested in each individual being supported and encouraged to come to their own understanding of their experience. I want to help people make sense of their internal world for themselves, for their sake, not for mine - start where they are at I say, not with the agenda of a medical or any other “authority”. Each individual is the best and only expert on themselves.

that’s what i think

The Myth of Thomas Szasz

peskystudent>

I see what you’re saying: in some instances of psychosis there is a case to be made that some of the suffering is caused by attitudes to the sufferer, plus the available medication turns you into a perfect sphere and isn’t always that effective. I know there’s a controversy about the best way to help a psychotic patient and not everyone thinks medication and/or suppressing the psychosis out of existence is the best way.

However, although I know the majority of hospital patients are suffering from psychosis, the vast majority of sufferers of mental illness never go near a hospital inpatient unit and suffer from non-psychotic disorders: depression without psychosis, hypomania, anxiety, panic disorder, eating disorders - all of which just make life really miserable regardless of social attitudes and fit quite readily into the illness model (well, except the hypomania, unless you’re a bank manager).

And if any well-intention Szasz fan comes my way and tries to relieve me of my lithium tablets on the basis that poor little me is not ill and just needs some therapy / society to be a bit more caring I will run them over with a bulldozer :-).

Peskystudent said:

“I want to help people make sense of their internal world for themselves, for their sake, not for mine”

I agree completely with that. And I do see where you are coming from. I think what I was trying to say (in my confused way) was simply that people do hear voices, and that this is not ‘normal’ (arghh, can opened, worms everywhere!) by which I simply mean that the majority of people don’t. Would these people consider themselves ill if society didn’t tell them they were? Possibly (probably) lots wouldn’t (most likely the ones with the nice voices). But I do believe that a lot of people who have horrific things going on in their head are objectively ‘mentally ill’. I do agree that the medical model is not the only thing that can help, if it helps at all.

Personally, if I committed a serious criminal ofence and was condemned to a cell for 23 hours a day I wouldn`t have the time to read Szasz and the like. I`m much more interested in what you think, E.

We`re still grappling in the dark as to the nature of mental “illness”. We don`t understand the question so it`s hardly surprising we struggle with the answer. We just have to keep doing our best starting with simpler potential solutions first. Pontificating about the ideas of Szasz gets us pretty much nowhere.

As for whether psychiatry is a form of social control ?. Of course it is, but only for a minority. The overwhelming majority of those in mental distress seek help. As for the remainder I look at it this way. If you asked me to be Defence or Home Secretary I would bite your hand off, I know exactly what I would like to do. If you asked me to draft a new Mental Health Act, I would be washing my hair. It`s the devil`s own job. That`s why I`m never critical of it. Sometimes you just have to get on with it and make the best fist of things that you can.

USA still have the highest numbers of ADHD in stimulant therapy. I have highlighted it on my webpage about ADHD. Even at the current level of 80%, it is still very high. The other little known one is that in Boston area hardly any Ethnic Chinese are on SSRIs.

I think the debate is lost if we include every single condition. But we do need to be wary of what is behind the need to diagnose certain conditions. Dare we mention ED? Why are the adverts in America showing young couples with such problems? Or was it oveuse of SSRI anyway.

Just stumbled on this which I found interesting, didn’t catch the program tho..

http://www.psychminded.co.uk/n.....ist001.htm

Rufus May is my inspiration.
The film, “The Doctor Who Hears Voices” is still available to view on 4 on demand, or from Rufus May’s website.
Here is another article about the film, followed by a number of comments, one of which is me writing under another pseudonym! If you can be bothered to read all of that, you can play a fun game, guessing which comment came from me!!!

http://www.newstatesman.com/200804240032

Now, in the words of the conclusion of my latest completed essay:

“In summary, it has been demonstrated that psychiatric diagnosis is not a value-free practice, and that the locking of a person’s mental and emotional experiences into a medical belief system can have deleterious consequences for the person thus classified. Believing that people are “mentally ill” or “disordered” leads to a separation between staff and patients and justifies a range of treatments as well as the stripping away of the diagnosed person’s human rights to freedom, dignity and respect. Problems are taken out of their wider context and instead understood as arising from the “disordered” individual. The person’s own interpretation of events is devalued and dismissed, while the subjective feelings and opinions of professional “experts”, who erroneously consider theirs to be a completely objective “scientific” stance, are taken as the only “truth” of the matter.
Through researching and considering these issues, I have realised how markedly my own personal belief system and underlying values clash with those of individuals who subscribe to the medical model of mental and emotional difference and distress. This investigation has helped me to clarify my own beliefs and values: these are strongly aligned with the core beliefs and values of the service-user movement, especially the “Hearing Voices Network” and the work of a number of inspiring professionals, carers and survivors of psychiatry. For example, May (2007) believes in working in the person’s reality, respecting a variety of explanations for someone’s experiences, and creating therapeutic and social spaces where different beliefs about the nature of reality are accepted. He maintains that helping people describe their experiences in their own terms (e.g. feelings of dread, hearing voices, dissociation, panic, despair) is more respectful than trying to fit a person’s experiences into a diagnostic category. Likewise, I believe that people should be allowed to understand, describe and explain their personal experiences in their own way and thus be supported to “write their own story”. Every individual is the best “expert” and the highest authority on themselves, and their treatment and care should be provided according to their own individual agenda, in line with their particular value base and belief system.”

- Dee Dee, I hope you’re getting that I truly do fully respect your approach to your experiences. Choosing to see yourself as suffering from a mental illness is a perfect example of an individual asserting their right to understand their experience in whatever way makes most sense and is most useful for them. I would fully support you in taking your lithium, and I believe it is here that psychiatry has a role - in helping those who chose to view their world through a medical paradigm to get the best drugs to treat their condition.

The trouble as I see it is that psychiatry, rather than being one of a number of options, sits firmly at the top of a hierarchy, with other professionals’ ideas somewhere in the middle and the individual’s concerned right at the bottom. Why not let people chose for themselves what paradigm to work with, why impose one and let it dominate the whole of mental health care provision?

BTW all those references to Szasz and antipsychiatry… I hope you’re beginning to see that what I’m talking about is way beyond Szasz (who I happen to think is a bit of an idiot to be honest). This is something Beyond the psychiatry - antipsychiatry debate.

peskystudent:

“Why not let people chose for themselves what paradigm to work with, why impose one and let it dominate the whole of mental health care provision?”

I’m gonna guess…money? Sounds expensive. Shouldn’t be an issue but you know it’s going to be.

Also, not all people having these experiences are going to be ‘experts’ able to ‘write their own story’. Those that can, of course, should. A number of people in crisis are not going to be able to choose a method of treatment they think will suit them; a lack of understanding, not wishing to take responsibility, a belief and trust (however misguided) that the doctor knows best?

I met Rufus May a couple of times. Nice man, very clever. But good heavens was he annoying. Chip + Shoulder : Blind Monomaniacal dislike of much of the mental health system. Baby, Bathtub and Water.

I think you see what I mean.

What!?

Re peskystudent at 10.37

You state: “In summary, it has been demonstrated that psychiatric diagnosis is not a value-free practice, and that the locking of a person’s mental and emotional experiences into a medical belief system can have deleterious consequences for the person thus classified. Believing that people are “mentally ill” or “disordered” leads to a separation between staff and patients and justifies a range of treatments as well as the stripping away of the diagnosed person’s human rights to freedom, dignity and respect. Problems are taken out of their wider context and instead understood as arising from the “disordered” individual. The person’s own interpretation of events is devalued and dismissed, while the subjective feelings and opinions of professional “experts”, who erroneously consider theirs to be a completely objective “scientific” stance, are taken as the only “truth” of the matter.”

I very much agree with you. With different practitioners Mrs Carr’s perceptions have been challenged and rarely, if ever, accepted. This might be standard and accepted practice but the effect of this process was that Mrs Carr lost all confidence in her views on any subject.

If one’s every perception is challenged what does one have left but a valueless shell dependent on others to interpret the world and one’s innermost thoughts? Therefore, what may be intended as a constructive process to realign one’s thinking process is actually a hugely destructive process. Certainly that is how Mrs Carr was affected.

Below is an extract from a previous post of mine which dscribes one such example of non-acceptance:

“Mrs Carr was given an appointment …….. - and she came away feeling as though she had been abused - psychologically. She came away having been abused.

Imagine being healthy and facing this. How can one respond other than saying, “I can see that theoretically there might be a part of me which is wanting to make it difficult but I don’t think this is the case and I’m not aware of this.”?

Now how is one who is struggling going to react?

@DeeDee Ramona

“And if any well-intention Szasz fan comes my way and tries to relieve me of my lithium tablets on the basis that poor little me is not ill and just needs some therapy / society to be a bit more caring I will run them over with a bulldozer”

But Szasz, unlike every single other person in the psychiatric field, believes that adults should be free to consume any drugs they wish. This charge is quite wrong-headed.

@article

“is psychiatry an instrument of social control”

Of course it is. This is painfully and undeniably obvious, given the legal powers existing to detain/drug/etc those designated as mentally ill. Once psychiatry rejects coercion, it can begin to claim that it helps those in “emotional distress.”

Pesky> I know you aren’t trying to be condescending but your comment above comes across that way.

You say: “Choosing to see yourself as suffering from a mental illness is a perfect example of an individual asserting their right to understand their experience in whatever way makes most sense and is most useful for them.”

Now, if what you mean is that this view is specific to psychosis, that’s a different story. But psychosis is only a small percentage of mental illness, albeit most of the hospital inpatient population.

OOPS. Forgot to remove the italics…

Where does Autism fit in the medical or non-medical model? We perceive the world differently. We process sensory information differently. We think differently. And as a result we don’t function as well in society as you “Normal” people. These aren’t philosophical issues; my problems aren’t an academic construct that will go away when beaten with Professor Existential’s latest thesis published in The Journal for Dumb People Who Think They’re Cleaver Because They Use Made-Up Words.

Or think they’re clever because they can spell “Clever”

For Dee Dee Ramona

“, on the other hand, have to live with my illness every damn day of the year. Yes, I think my bipolar “problem” is an illness. It’s not part of my personality: for example, I’m an extroverted, positive, optimistic person, but not when depressed.”

I associate with this statement.

I am an extrovert, used to be an optimist and and try to be pro-active. I think there is a strong element of the analytical about me. That can help when problems can be solved but some problems go on and on and on. And sometimes the problems relate to things that are out of my control. Frustration sets in. More so when dealing with under resourced, debatabely trained or possibly varingly motivated and capacitated, staff within MH services.

Dealing with one’s own illness is difficult enough (especially when it is mostly medication intolerant) but dealing with the illness of someone else in the family makes it paranoia city.

I dunno whether the clinical terms are accurate. I guess they are as accurate as any under funded and cinderella appendage of the system can be (although I assume those what make the classifications get paid big bucks for doing so) but having a diagnosis is one thing and for those delivering services, treating everyone who has a diagnosis effectively is another. For those on the receiving end, well it can be a total nightmare because ultimately they are the people living, as you so aptly put it, day in and day out with the effects of the illness.

“is psychiatry an instrument of social control”

Why shouldn’t it be? Social controls have to exist to benefit society at large, at times these controls will override the rights of individuals. I’ve known very few people who have been detained for trying to kill themselves (for example) who have not understood and accepted why detention was used.

They may not have liked it (who would?), they may have felt there were other options that could have been tried first or earlier (a possibility).

Many of the people we work with, whatever their label, ill, distressed, differently normal etc make decisions that they would not have the ability to regret if they were allowed to carry them out. In many years of nursing I can think of one person who remained unhappy that we did not appreciate her right to take her own life.

@dazedandconfused

It is good that you confirm psychiatry to be a political arm of the state, and not a medical specialty. However, arguing that individual rights need to be trampled on to benefit society at large is difficult, and I find it worrying that you can justify forcing legally innocent adults to stay alive because they are mostly thankful about it later. This principle allows any and all sorts of violations of human dignity, and is, in any case, not effective against those who actually wish to take their own lives. For those who don’t, the game of psychiatric coercion is something enjoyed by both patient and professional. Further, it is in my opinion somewhat conceited to believe that mental health professionals are responsible for the “cure” of their patients. When I worked on an adult psychiatric ward, I found that the opportunity to take time out from life for a week or more, with food and shelter provided, was a major factor in the “recovery” of the patient.

Sincerely,
Ted

“I find it worrying that you can justify forcing legally innocent adults to stay alive because they are mostly thankful about it later. This principle allows any and all sorts of violations of human dignity, and is, in any case, not effective against those who actually wish to take their own lives.”

Ted> that’s bollocks. I’m still here thanks to the nice people in the hospital who wouldn’t let me leave to go jump off a bridge or whatever on the various occasions I have been an inpatient.

I have no desire whatsoever to end my life other than when at the very worst point of a depressive episode. Without help from my local hospital I’d be dead by now.

“In many years of nursing I can think of one person who remained unhappy that we did not appreciate her right to take her own life.”

well now you’ve met 2!

I will never accept the right of any professional to interfere with my right to liberty, including the right to take my own life, even if this decision is taken whilst in the middle of a major depressive episode. I would willingly sign any number of advance directives to that effect. The fact that my wishes on this issue are not respected simply means that I refuse to work with mental health professionals and any contact i do have with them is strictly controlled, in the sense that i always lie about suicidal ideation and always will.

Yes this means my illness is largely untreated, but for me, no treatment at all, is preferable to any treatment that potentially interferes with my right to liberty.

If i were a danger to anyone else (i’m not) then i would accept your right to intervene, (i do have a social conscience!) but only in these circumstances.

@DeeDee Ramona

Which part of my post is “bollocks”? That people have an inherent right to liberty? If a person doesn’t actually want to kill themselves, then they need no help (and certainly no coercion) from anyone else. Do you apply your preferred rule apply to everyone else, or just yourself? If the former, what gives you such a right, and if the latter, how do you justify the double standard?

@jono

I appreciate your integrity.

Ted.

Getting a nosebleed thinking about liberty.

My friend took their life a few weeks back. Would I prevent them their right to take their life “No” but I would like to think everything that could have been done to try and prevent that was done.

When I write this, I acknowledge that families aren’t always close or necessarily care for each other. Not many people have this ‘extended/community’ network in place.I acknowledge that services are patchy and people aren’t always provided with or able to stay in safe places because they need to.

I appreciate that if things are unbearable then that is how they are. It oculd change for the better but it might not.

And I guess I feel and think how I feel and think now because, not knowing the whole story, my view is that my friend was let out of acute care to kill themselves with little support at home.

Would like to think I could have helped but there is only so much anyone person can do, particularly if they are already up to their neck in shit.

And if people have the right to die, then I think people should have the right to decent and appropriate care!

“An inherent right to liberty”

Also a social construct. Rights only exist when recognised by society at large. I do accept that the mental health system can be seen as a means of social control. I do not accept that this is it’s primary purpose in any way shape or form.

Statistically if 99% of people the system has stopped from killing themselves are happy with that then yes I believe society does have a right to over ride the liberty if individuals.

Better to save a life than to allow one to be taken.

I am sure there *may* be exceptions. That some people have ‘rational’ reasons for suicide. Chances are they probably would not end up in the psychiatric system or being successfully treated by it.

@dazedandconfused

“Rights only exist when recognized by society at large.” Incorrect. But I agree that rights are only respected when they are recognized by society at large. This preference for positive rights over natural rights is totally erroneous, in my opinion, and leads to precisely the problems we are discussing here (ie, psychiatry). Eg, that some people may have a rational reason for suicide - who is anyone to define what someone else does with their body, and ultimately, their life? If you are basing your argument on statistical percentages of “lives saved,” then I fear your argument is unprincipled and counter to the facts. I still think that people who propose psychiatric coercion believe it to be helpful, but every single theoretical and practical experience of my life has taught me that it is always and everywhere wrong, and against human dignity.

MandyLifeboats,
I’m sorry to hear about your friend. That is really really sad.

Dee Dee,
I am really (honestly and not meant patronisingly at all) glad that hopsital stays and medication have helped you come through suicidal times. It would be an emptier and blander board without your contributions. And, just to say, I also have stays on psych ward and meds to thank in part for saving my life a few times. I know it may sound surprising considering what I write about, but I do respect and am grateful for the good work that goes on within the system. I just think there’s more that we can do, a lot more.

Peskystudent

It is really really sad but the one thing you can say about suicide is “it is final” (at least for the person who took their life).

For those left behind it is something else.

some of us left asking unanswerable questions.

Your concern is appreciated :>)

Thanks for the debate Ted Having a great time.

Suicide, as other commenters have said, is never just affecting the individual. It always affects those around them. Depressed people can come to believe that they are worthless and no one care about them, this is a symptom of their illness. When someone dies, particularly by their own hand, it leaves a gaping hole in the lives of others, like a raw wound that never heals. Will to survive is strong in people. It is held to be a truth that willingness to kill oneself is a sign of a serious imbalance in a person’s life. Society’s system for dealing with this is via the mental health system.

If I was sat in an office with a patient wanting to leave who had a perfectly rational appearing reason for self destruction and no other indicator of mental health issues I would, each and every time, get them assessed for detention; if I could not keep them safe any other way. This is not only a legal duty but an ethical (or is it moral?) one. We must protect life.

There are too many people who successfully kill themselves every year:

http://www.statistics.gov.uk/c.....sp?id=1092

We need to try and save those who do come near the system and we have a chance to help.

You are right it may be against human dignity (may!) but far better to have your dignity offended than to be dead.

Oh great the post has been nicked by the Scientologists:

http://11thoutlawpsychiatry.bl.....ww_16.html

dazedandconfused - The fact that suicide affects other people isn’t a good reason to intervene. All kinds of choices we make affect other people, sometimes negatively. That doesn’t automatically make them wrong.

Nor do I think that a willingness to kill oneself is automatically a sign of any kind of imbalance. Sacrificing yourself ‘for the greater good’ has always been a laudable act in most cultures. Killing yourself to protect vital information from the enemy is a pretty common theme in war movies and is regarded as a heroic thing to do. It’s almost certainly happened in real life, although I’m not going to do the research to come up with any actual examples.

Most people also think that terminally ill people should have the right to die with dignity (although the law lags behind public opinion). Their suicides are not generally regarded as a sign of mental imbalance - after all, it’s very easy to empathise with someone not wanting to spend their final few days in pain.

Another example - Thích Quang Duc, the Buddhist monk who famously burnt himself as a protest against the treatment of Buddhists in Vietnam. Usually regarded as a martyr, not ‘imbalanced’.

So really, it’s not a willingness to kill yourself that’s a sign of ‘a serious imbalance’, but a willingness to kill yourself without a reason that other people can understand.

That said, I think mental health services are usually right to intervene. It’s just this idea that the Horror and Awfulness of suicide provides a mandate that seems absolutely wrong to me.

@dazedandconfused

“Suicide, as other commenters have said, is never just affecting the individual”
Of course, this point is undeniable. But it only indirectly impinges on others. It is often sad, etc, but so are many things. Legislating against suicide is absurd, and reduces liberty significantly, for everyone.

Are you a mental health professional? Why do consider persons in an office “patients”? Why is your subjective opinion on what other people think is a good course of action for themselves a justification for coercing them indefinitely? You are right that it is a legal duty, but no one is not forced to work in the field. Saying it is a moral/ethical duty assumes the conclusion, and while I agree that life is worth protecting, I cannot agree that it is worth protecting at all costs. There is no sense in which “too many” people kill themselves, for it is up to the individual to decide. It is absolutely an offensive to human dignity to coerce someone in the name of cure/care, especially when killing oneself is made so much more difficult with the illegality of drugs which do the job effectively.

I too am enjoying the discussion somewhat. And I am glad we have the ability to talk in this way, and not prisoners of psychiatric slavery.

Thanks chimp. Enjoyed your comment. I did think about doing some of the exceptions but did not want to go off on a tangent. Your point about people with terminal illnesses is a good one, though I would perceive that to be more about control over an unavoidable death. But point well taken.

You’re not from outlawpsychiatry are you Ted?

I would consider people in the office to be patients because from a previous thread that is what most people receiving mental health care wish to be called. If an an individual wanted me to refer to them as a client, service user, consumer, customer or whatever I would happily use any of these terms.

I would disagree with your comment. There is every sense in which too many people kill themselves. Every life lost, without necessity or a full life lived, is … is … ummm can’t think of a metaphor to described how bad it is.

And no I do not believe it is up to the individual to decide if they are not in full possession of their rationality. A life lost in error can never be brought back. Well unless you believe in zombies but I do not think they count As previously stated the vast majority of people have been glad to have been prevented from killing themselves. Even if they disagreed with the methods. A few exceptions change nothing.

Society has always reserved the right to intervene in the lives of individuals when it is necessary.

And no suicide does not ‘indirectly’ impinge on other people it directly affects all those left behind. Often sad? ‘Gaping hole’ I think I said. Not sad. Grief, bereavement and pain.

This might not be enough reason in itself to work to prevent suicide. Justification to intervene is based on the fact that the majority of people saved from killing themselves are thankful.

Good enough for me.

Mental Illness does not retain any exclusivity in the realms of social control and the law.
The Public Health (Control of Diseases) Act 1984 permits “a magistrate may order that a person who is suffering from a notifiable disease, or any other disease to which the section has been extended, shall be removed to hospital.”
When we discuss social control of those with a less conveniently diagnosed condition - it is not the illness we are assessing - but the risk of something to someone else. Like communicable disease, there are high chances of some diseases causing widespread damage - just as some behaviours might also. Mental illness itself is not ‘communicable’ but the symptoms can effect others - sometimes fatally.
Mentally ill or ‘differently normal’ people are still not well understood by the social masses and there is much to debate on the reality of ‘danger to self or others’ and how we react out of fear rather than respond by considered debate to individuals and events.

In suicide, there are those who enact in an unstable state of mind who later acknowledge this was a desire of imbalanced thought. How can you rectify this if you permit everyone to take their own lives at their own behest? It’s a bit like being found not guilty just after the death sentence was carried out.
Society likes to think of itself as humane and our anthropological theories lean us towards life being a better existence than death.
I do believe that people have the choice of their own life but it is far easier to forbid people to commit suicide and get a few wrong who live than to permit all and be wrong on so many who die.

As for the existence of mental illness, and not disagreeing with DeeDee’s (and many others) philosophy, but wanting to dissect the issue; I believe it is a case of experience as to how it effects one’s life - in the psychological. Yet, having said that, if Lithium helps to re-balance things - then the underlying condition is not psychological - but perhaps neurobiological.
Mental illness exists in two planes:
1. The way it effects function and behaviour - which is where we have social controls
2. The underlying causality - which will probably be caused by the physical brain not working as it should rather than any non-physical aetiology
(Of course, some brains are perhaps meant to work the way they do - Van Gogh, Spike Milligan, etc otherwise we wouldn’t have geniuses - and these people tend to be better accepted amongst society for their ‘contribution’ to that same society. If you have little to offer outside your immediate connections, you’re more likely to receive less grace and favour from wider society.)
So I would agree that mental illness does exist - but it is a dichotomy that is misrepresented by calling ‘ how we socially controls of dodgy behaviour’ as ‘treating mental illness’. The two are very separate issues and the social controls we apply are in reaction to the behavioural fears rather than the fact someone thinks differently (not everyone mentally ill gets hospitalised - including major psychoses).
I would also agree that maintaining a social ignorance around mental illness allows society to pretend not to notice and continue it’s permissive restrictions against those who simply think differently - even if they’ve done nothing wrong.

Ted, Even as a survivor of suicide I do have some sympathy for your standpoint. When I lost a loved one feeling that they had a right to self determination helped me to come to terms with what had happened. Thankfully, I have never contemplated suicide but if I did I`m not sure that I would welcome state intervention.

I suppose the type of legislation you are asking for exists in Switzerland but as with the current Mental Health Act I wouldn`t want responsibility for drafting that type of law.

Regardless, you won`t sway me, either as a human being or as a nurse, with your argument. I`m not prepared to assist in suicide and if I encounter someone attempting to take their life I`m not going to turn my back. I just can`t.

By the way some of your argument is starting to get a bit outlandish. Who are the authorities of “psychiatric slavery” likely to curtail this discussion ?.

@dazedandconfused

“You’re not from outlawpsychiatry are you Ted?”
No, and I don’t know who/what that is. But even if I were, would it make any difference to my arguments?

“I would consider people in the office to be patients”
I am all for voluntary name calling (patient and doctor, etc), but if none of the persons in the office have a demonstratable illness, it seems peculiar to call them patients. Of course, they might like to think of themselves as such, but you do not have to play along, do you?

“And no I do not believe it is up to the individual to decide if they are not in full possession of their rationality”
Rationality defined by whom? This type of thinking is wrongheaded, since it assumes that you can understand the reasons others give, and that you are entitled to intervene based on your disagreements. So what if people are thankful afterwards? As I said before, that principle allows literally any act of violence, and is totally unacceptable. I would be interested to know if you would accept advance directives rejecting psychiatric intervention, even if signed when “mentally healthy.”

“Society has always reserved the right to intervene in the lives of individuals when it is necessary.”
This doesn’t mean it is legitimate!

“And no suicide does not ‘indirectly’ impinge on other people it directly affects all those left behind.”
It is indirect in that unless you own, to some extent, the life of someone else, then it is not your place to forcibly intervene if they want to end things. So if you happy with assuming that you have an ownership claim over the lives of everyone else, then fine. But in my opinion, that is an impossible position to argue for.

@ Mr Ian

“Mental Illness does not retain any exclusivity in the realms of social control and the law.”
Thank God for that!

“an unstable state of mind”
According to whom?! How is such a thing defined?

“if Lithium helps to re-balance things - then the underlying condition is not psychological - but perhaps neurobiological.”
So if by ingesting a substance I later subjectively feel better, this proves I had (have?) a neurobiological condition?

Other than that, I can not understand what you are saying. It sounds like a rehashing of various contemporary psychiatric nonsenses (mad/genius, “probably be caused by the physical brain not working”, etc). Sorry to be a little blunt, but I’ve heard these groundless defences of psychiatric coercion too many times to let them go without comment.

@ oldschoolbaby

I am glad you have some sympathy for my position. However, I am not proposing any legislation, but rather a lack of legislation. Without mental health laws, psychiatric coercion would be illegal. And nothing I said implies that assisting or ignoring a potential suicide is morally praiseworthy. All I am saying is that coercing somebody is unjustifiable. As for my outlandish argument, I meant that such a discussion would not be possible if I were to be confined to a mental institution. A thought: do such places now provide internet access to those who want it? If so, there is plenty of scope for making information available on how to escape. Or would such sites be banned? Anyway, enough for now..

In the absence of law anarchy prevails. I still love the Sex Pistols but anarchy is not something that sits comfortably with me. I undeerstand that any one time 10,000 people in the UK are detained under the Mental Health Act. Do you think that every section should be rescinded immediately.

You paint a very dark picture. The NHS is a bit of a shambles, it is hardly the Fourth Reich. I work on an open ward, you don`t need a masterclass from a Colditz survivor to “escape”, you can amble off at your leisure. The internet is a barely policed global entity, sites can`t be banned. And as for internet access we`ve squandered £12,000,000,000 on an IT system and have nothing tangible to show for it.

To Ted

“an unstable state of mind”
According to whom?! How is such a thing defined?

According to the norms of social behaviour and thinking. I agree that just because someone thinks in a different way does not mean they are wrong - but if they behave in a way that is outside acceptable parameters then this is non-conforming to what society expects and can tolerate. If this is your wish, go live in another society.

“if Lithium helps to re-balance things - then the underlying condition is not psychological - but perhaps neurobiological.”
So if by ingesting a substance I later subjectively feel better, this proves I had (have?) a neurobiological condition?

“Perhaps” is a kind of operative word here, suggesting the causation may be neuro. It may be endocrine or it may be hepatic. Essentially I was suggesting physical imbalances can cause changes to thinking processes. Just try constipation for another example. The action of Lithium remains unknown. As do most psychotropic medications. This is one reason I am reticent of (yet accepting of the place for) psychopharmacology.

“Other than that, I can not understand what you are saying.”
It is not a groundless defence to suggest the chemicals in the brain aren’t working right. Or perhaps the anatomy is screwed. Or even the subjective experience of the individual was extreme and damaging. All are potential factors to someone developing a pattern of thinking and, ergo, behaviour that is outside the average norms and patterns.

To clarify, I accept that ‘mental health’ legislaation is largely a form of social control and not benevolence to the ’sufferer’ or ‘presenting in a way I don’t understand why’. I have written here before on similar lines of social street cleansing by use of the Vagrancy Act back around 1700. I’m not sure how far read you are on the development of concepts of Parens Patriae and the eschewing dichotomy of State Control vs Individual Autonomy over the last 3 centuries. It is a slowly balancing area and exists as an ongoing and imperfect debate, just as much as we debate how to resolve the issues of those justifiably on welfare and those malingering; those who deserve to go to jail and those who deserve compassion for their crimes; those who have a right to treatment and those who do not and even those who have a right to smoke and those who do not. There are equally strong arguments on both sides and each is balanced by the sense of self-determination against human kindness and tolerance.

I am happy to tolerate anyone’s right to self determination as long as it doesn’t interfere with my rights too.
Taking one’s own life is the ultimate in self determination - but there are times where such a decision can be against the rights of others - of a child to have a parent; a spouse - after 40 years of servitude to her husband - to have her partner’s pension to exist on; or a parent’s right to at least see their child grow into an adult before they make that ultimate decision. Or might all these others be permitted to kill themselves without concern or consideration for those that are left behind?

@ oldschoolbaby

“Do you think that every section should be rescinded immediately.”
Certainly. If those previously detained wanted to leave, they would be free to. If they wanted to stay, there would be no need to force them to.

“The NHS is a bit of a shambles, it is hardly the Fourth Reich”
No, but it is somewhere along the road to it. The Nazi emphasis on public health should be read and understood, but is either ignored or rejected out of hand.

“I work on an open ward, you don`t need a masterclass from a Colditz survivor to “escape”, you can amble off at your leisure.”
I worked on an open ward too, but to imply (not that you necessarily did) that the persons on it were wholly voluntary is wrong. Psychiatric coercion is always present, either directly or indirectly (ie, “if you stay on the ward, we won’t section you,” etc). Sites can easily be banned, but in any case, the powers of psychiatrists are easily seen if you attempt to talk about issues like those raised by Thomas Szasz, and they can and do reject anyone who disagrees with them. Often the patient has a “lack of insight,” or simply makes the mistake of trying to intellectually argue with someone with the privilege of locking them up and drugging them.

No Ted coming from outlaw psychiatry would not make any difference to your arguments, they would remain bad arguments. Coming from outlaw psychiatry would suggest you were impervious to debate though

Name Calling: Yes I do. If a person in my care wants me to call them a patient (or whatever) then yes I really do have to call them a patient or I am disrespecting their preferences over something I have to need to. If they wanted me to call them Napoleon or Jesus I would do that as well. This in no way would suggest I believe they are either of these people.

Rationality Defined: Cultural norms, subjective experiences etc define what is normal. Like it or lump it this is the way things are.

http://en.wikipedia.org/wiki/Tom_Leppard

The above gentleman is not normal. The vast majority of the population do not get themselves tattooed to look like cats and then live in the Scottish wilderness. This is not a negative value judgement against the man it is a statement of fact. Other societies may have different definitions of what is normal. Generally though allowing people to take their own lives while not being fully rational is considered a very bad thing. Individuals taking their own life at all is considered to be a bad thing (chimps exceptions noted ;).

Thought Experiment: Mr Smith comes home to his penthouse apartment. Finds his youngest child dead. Overcome with grief goes to fling himself of the balcony. Would you intervene? I certainly would.

I would certainly take advance directives into consideration. They are limited though. I believe they do not allow people to effectively commit suicide by proxy.

Society’s interventions are legitimate as long as they are legal. If enough people do not like it they can campaign to get the law changed or move somewhere else. A difficult freedom to put into practice but an option. By accepting the benefits of living in a particular society it is implicit that you accept the rules & responsibilities of living in that society. If I in sound mind and full rationality went to join the Scientologists I should have no cause to complain as they relieved me of all my money and ability to think independently.

Suicidal Effect: No I disagree. It does directly affect others. We are not simply individuals. If some chap living off the land on his own island with no contact with outsiders at all chooses to kill himself then fair enough. It would not affect anyone else. Most people though live a degree of a shared life, as part of a group (family, friends, neighbourhood, etc) By interacting with others we share our lives with them and help define our own. Ownership is not an issue, cheeky Ted with your Red Herrings By committing suicide a person leaves a life shaped hole in all of these groups.

Psychiatric Slavery: had loads of conversations like this in psychiatric units with almost anyone that would listen. One of the perks of the job.

Detention generally does not interfere with someone’s right to communicate with others. Most people I know bring their mobile phones into the wards. As OSB said escaping is often not very hard. You either lie to the staff about your intentions with a degree of convincingness or just walk calmly towards the exit. Most places have an open door policy.

Ted> Oh good Lord, if there’s one thing more annoying than the anti-psychiatry bunch screaming that the mental health system exists purely for the prepetration of , it’s when one of them comes along and condescendingly pats me on the head and decides to enlighten me as to the error of my ways.

Your prose reads like the kind of theoretical drivel spouted by college students who have discovered libertarianism and are in love with a theoretical principl