Following on from the debate sparked off by “on the borderline” as well my own philosophical musing on the nature of mental illness and Psychiatry it appears clear to me that Psychiatry obviously involves a theory of mind. This often leads to mental health professionals being accused of playing “mind games” or seeking to control and manipulate patients’ thoughts either with therapy or with mind altering drugs. Psychiatry as a form of social control is a subject that has been written about by Roy Porter (2002) and Michael Foucault (2001) at great length
The mainstream view in Western Psychiatry is that mental illness exists and that it can be objectively described and treated. 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.
We have not always used the language of medicine to describe what we now think of as mental disorder. In earlier times behaviour that we would now describe as an “illness” would has been thought of as immoral, wicked, criminal, evidence of demonic possession, or even normal if a little eccentric. Other behaviours that were labelled as psychological disturbances in the past have now been dropped entirely. The term “hysteria” literally “wandering womb” was a condition thought to afflict only women and was coined by Hippocrates but is now no longer in use. Hysteria described the madness caused by the uterus wandering up the body because it had become light and dry due to a lack of sexual intercourse and compressing the heart and lungs causing suffocation and panic.
Studying other cultures also reveals individuals engaging in certain behaviours that if seen here would be seen as a sign of mental illness but when seen within the context of a different culture are viewed as perfectly normal. It is even possible that some cultures may not even have a concept of mental illness that equates with our own at all seeing mental illnesses in spiritual or religious terms.
Some extreme views see Western notions of mental illness as a social construct relating to our time and place and have likened psychiatry to pseudo sciences popular in the past such as alchemy or astrology. According to Ssasz mental illness does not exists for the same reason that phlogiston or astral influences do not exist, because it is an empirical mistake based on flawed methodology. Western psychiatry’s continued adherence to these outdated concepts is based more on dogma and a pseudoscientific approach than a rational evaluation of social behaviour according to Ssasz.
“The belief in mental illness rests on a serious, albeit simple, error: It rests on confusing what is real with what is imitation; literal meaning with metaphorical meaning, medicine with morals” Szasz(1984)
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, hence mental illness is at best a metaphor used to describe socially unacceptable behaviour. The idea that psychiatry is any way objective is false according to Ssasz because notions of culturally acceptable behaviour and illness change with time and across cultural boundaries.
But is it true that disease by definition can only be physical and if so is the mind a part of the body or separate to it? If the mind is separate to the physical body either in substance or type then what precisely is it and how does a non corporal entity such as a mind effect a physical thing like the body anyway? A non physical mind separate from the body it inhabits while intuitively having some appeal especially to theologians would be for some scientists like trying to play snooker with an imaginary cue ball. Philosophers from Descartes* to the present day are still arguing over these questions while Cognitive scientists and Psycho pharmacologists using the most recent advances in neural imaging have yet to adequately describe the relationship between consciousness, brain chemistry, and behaviour which presumably lies at the heart of a deeper understanding of psychiatry.
Perhaps more importantly we should be asking, is psychiatry an instrument of social control used by those in authority to morally censure the behaviour of those who see themselves as free spirits and thinkers? Or is the business of psychiatry a scientific attempt to help those in emotional distress to achieve peace of mind? Clearly at different times and in different it has, and is, being used for both purposes.
Answers on a post card please.
References
1. Roy Porter (2002) Madness, A brief history, Oxford University Press
2. Michael Foucault (2001) Routledge, New Ed edition
3. Thomas Szasz, (1984) The Myth of mental illness, Harper and Row; revised edition
* Not Descartes he is dead, unless of course he was right all along and the mind is separate from the body and able to survive its physical death.
Even if we assume the mother knows her son will attack her, perhaps she ought to consider spending time away from him
Ah, there speaks someone whose understanding of psychiatry and mental illness is purely theoretical. I hereby bow out of this discussion.
I disagree, and think we all have the right to say whatever we want, providing it is not a threat, or used to initiate fraud.
So essentially, you’re not disagreeing with me – freedom of speech is a qualified right.
@ beakie
“Ah, there speaks someone whose understanding of psychiatry and mental illness is purely theoretical.”
It is not psychiatry and mental illness that need to be understood, but rather basic human conflict. While I do not go along with the idea that families “cause” mental illness, to ignore the fact that psychiatry deals with inter-personal conflict (usually within a family) is totally naive, and doesn’t help us resolve the issues the problems that exist. You may think pointing out that a parent does not have to put up with a misbehaving child (of adult age) is unkind/unfair/whatever, but with regard to psychiatry, it is one big elephant in the room. By pointing out the elephant I am not making fun of tragic situations, and it is weird (to me at least) that so many people think this to be the case. No doubt this hesitancy to state the obvious ties in with the need to see mental illness as a no-fault disease, but that is another story (though probably one closer to the original blog posting).
And even though it doesn’t even matter, I worked for over a year on an adult acute psychiatric ward in the UK, so I have plenty of practical experience. One of the things which struck me was talking to the older staff who had worked at the local asylum, who said that psychiatry back then was much more honest than it is today.
“So essentially, you’re not disagreeing with me – freedom of speech is a qualified right.”
I never said it was an unqualified right. Perhaps I could have given a longer response to E, noting that there is, at heart, no right to free speech per se, but instead a right use my body and my property as I wish, so long as I respect the rights of others. The important question to ask when discussing “free speech” is where the speech act takes place. If you are in a crowded cinema, the owners would surely not be ok with someone screaming “fire!”. Likewise, I am sure neither you nor I would want a Scientologist to enter our homes to preach whatever they believe in. The right to speak freely is simply one of many rights I have, in those places where I am permitted to do so.
First off, let me just say,
WOOOOO OVER 100 COMMENTS!!!!!
Now, Ted, if may ask you a question. The two most recent posts that we’ve made have been about an attempt by a mental health service to stop some parents from pathologising their child and a condemnation of the use of psychiatric language by a GP to attack political opponents.
I notice you haven’t commented on either of these posts. Is it because they conflict with your apparent view of us mental nurses as a bunch of Orwellian thought-police stormtroopers?
You may think pointing out that a parent does not have to put up with a misbehaving child (of adult age) is unkind/unfair/whatever, but with regard to psychiatry, it is one big elephant in the room
Mother lives in a council house with her son. Neither of them have anywhere else to go. What do you suggest? She sleeps on the street? And for how long? Presumably for the foreseeable future, if he’s allowed to continue to refuse treatment and therefore continue being a risk to his mother.
You’re being ridiculous, breathtakingly naive and utterly juvenile. I suggest a break from poring over “Foucault For Dummies” and a stroll in the real world.
Ted
“and I find it worrying that you can justify forcing legally innocent adults to stay alive because they are mostly thankful about it later.”
Why not? Do the ends, in this case, not justify the means? Dee Dee certainly seems to think so. I disagree that that allowing the principle of detaining a person, imprisoning them if you will, because they are incompetent to exercise their freedom and a danger to themselves “allows all sorts of violations of human dignity”. It may allow this to happen in practice, and occasionally does, but it does not sanction this in principle and it is the principle we are discussing here. I recognize however the damage that detaining a patient can do to any therapeutic alliance that staff are trying to establish with their patients.
You are right when you say that detaining patients for their own safety is frequently ineffective. Patients can and do find a way to end their own lives while on an acute psychiatric ward even while on 1:1 observation. It shouldn’t happen and doesn’t happen very often but this is not an argument for removing the right to detain patients but for making in-patient settings a safer more therapeutic environment rather than the “holding pens” they frequently are.
I wonder what the effect on the suicide rate would be of removing the right to detain patients? Would it go up, down, or stay the same? Are you arguing that a depressed or psychotic patient who is expressing a desire to end his or her own life is making an informed, rational decision and acting with “free will” (as far as any one can be said to be exercising free will) because most of us here are saying that such patients are not acting with free will which is what justifies our intervention, with force if necessary.
“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.”
Rationality defined by the collective us. Your comment suggests that you think there is no objective view of rationality or reasonableness. The man on the Clapham omnibus would presumably disagree with you and without a collective view of what is rational or reasonable the result would be anarchy. We may disagree on what precisely the definition of reasonable is in any one particular case is but that it exists is surely beyond doubt and does not in itself in principle allow any act of violence. I would say that I am able to understand the reasons a depressed or psychotic person gives for ending their lives I just don’t necessarily agree with them.
“It is a fundamental human right to kill oneself.”
That is a very extreme and frankly untenable position but ultimately a “right” it may be impossible to stop someone from exercising but that does not mean we shouldn’t try and if that requires coercion in some cases then so be it.
@ Mr Ian
“Locking Clunis up for life and then permitting him perhaps to commit suicide – all because”…
What?
Contemporary opinion:
The guy experiences delusions of a paranoid persecutory nature. He enacts to protect himself from falsely held beliefs that someone is going to kill him (which, if such beliefs were held true in reality, is a defence to murder and ergo, in his world, he believes he is acting within the laws of this land). He is found under the M’Naughten rule to lack capacity or mens rea and is detained under mental health law until he is mentally well again and capable of realising what he did was based in false belief and he won’t do it again, m’lud.
Or your opinion: The guy killed someone – lock him up and hope he sees sense and kills himself.
Where are we upholding his right to be free from ailments? Or would you assert that people who get ill have no social right to treatment?
“The concept of mens rea determines that, in order to be culpable, a person must have known that his actions were wrong.”
How do you know he didn’t know his actions were wrong? And even if he didn’t know, it was hardly an accidental murder! All the more reason to lock him up, as a danger to society.
See above.
“Or are you straying into eugenics here now also?”
I find that wholly offensive, and entirely blah blah blah
Yet your assertions that we mental health practitioners who detain people against their will for societal beneficence are abusing their individual rights – is not offensive?
Sanctimony does not strengthen your argument.
“If coercion is threat or use of force – what is persuasion?”
Coercion is the use of externalised force or actualised punishment/removal of reward.
Persuasion is exactly the same but using the covert and intellectual method.
Or as one of my patients eloquently puts it “Don’t do that verbal ju-jitsu on me”.
“If you are deprived of the capacity to choose”
But this is blatantly false. Bad choice are still choices, even when you, as an outsider, can’t or won’t understand them. The only people depriving anyone of anything are psychiatrists.
Ipso facto; if you are so deluded that you think someone is about to kill you – reasonable force allows for the protection of self – but only in their reality; which is the nature of mental illness.
“I was asking if you think it is fair and just for a family to seek compensation for the foreseeable suicide of a patient who was discharged by a psychiatrist”
Obviously not, because psychiatrists shouldn’t have legal responsibility for their patients. Why did you even need to ask?
Because that’s exactly what society does – they sue medical decision makers – ergo scoiety has determined that psychiatrists are responsible for such protection – not psychiatry.
“There is a law of professional negligence that would suggest society expects the professionals to act differently.”
Society expects does always correspond with what is right. Only a fool would think otherwise. In any case, it is interesting that you omit the word “medical” from the sentence.
Indeed, because as a nurse I am professional liable – yet not medical. Only a fool would consider a nurse ‘medical’. An architect is also professionally acountable for a building structure – yet is not ‘medical’.
“Ted you express a valid argument in some areas and weak in others – as no doubt do I and others within.”
Then why don’t you point them out? I have addressed every pertinent issue you have raised, and have read nothing that suggests my claims are false. You come off as a thorough relativist, and as such I dismiss your lack of principle as a total error.
And I dismiss yours as a total arse.
This argument you present against social construct is based in an idealistic world – in reality, social control policy exists.
In an ideal world it would not, I totally agree. But in an ideal world, neither would we lose the capacity of reason and reality.
In your comments of the son who beats his mother because, perhaps, he thinks she is poisoning him. He should actually be the one to go away as he is not forced to eat her food – or whatever the scenario is. However, the reality of these situations is that:
a) she loves him – he is her son.
b) he loves her – she is his mother.
c) if he was able to sustain threat/control override – he would not hit her. He is unable. Why? Because he is bad? Or because he is ill?
However, to set you at ease, and also for the suicide debate – I actually agree with the concept that taking one’s own life is a fundamental right and that psychiatry is a much abused practice.
However, debating with you is far more entertaining than agreeing with you. And you’re arguments are not as rock solid as I’d like them as they are based on an ideology that ignores the reality.
Some other points you might look at improving in your arguments:
– One year on an acute unit is not really “plenty of experience” – either as in-patient or staff. You embarrassed yourself with that one. Don’t use it again in a professional forum.
– Rape of a wife was lawful back then because it was in keeping with the social construct at that time. Just as detention against one’s will or prevention of suicide is against the social construct of this time. You’ll need to find another way to demonstrate the “errors” of social behaviours – or rather – how they are erroneous. In two generations time I foresee debate about, perhaps, why people are not allowed the freedom of anonymous and libellous speech across the internet without recourse anymore. This society currently permits it. Yet in that time to come, laws will contain, control and modify such behaviours because we will see it as unfair on the ‘victim’. Just as we eventually did for the wife.
It is not about an absolute of rights or wrongs – as these laws are constructed by a society that is a sea of constant change and some of what is permissible now will also be vilified in time to come.
As a close, my latest edict that may be of some use to you in your attempts to change the world -
An old bull and a young bull at the top of a hill spy a herd of cows below. Young bull says “let’s run down and fuck one of those cows”.
Old bull replies “No, lets walk down and fuck them all.”
Learn to walk your arguments my friend.
@ zarathustra
“I notice you haven’t commented on either of these posts. Is it because they conflict with your apparent view of us mental nurses as a bunch of Orwellian thought-police stormtroopers?”
No, it’s because I haven’t read them. The only post on this site I’d read is the one I am commenting on. Having now read the post, it is quite unclear why it is any business of a psychiatrist to be interfering in the life of this chap. From the full post, to describe the situation as “an attempt by a mental health service to stop some parents from pathologising their child” is hardly in context. But even supposing there were some maverick psychiatrist who spoke out against psychiatric coercion – if he still used his legal powers to coerce people, he would be a hypocrite. If it is true that mental health nurses think they are helping people, then they are doing so using a huge arsenal of violence.
@ beakie
“What do you suggest?”
One suggestion is that this issue has nothing to do with medicine, and nothing to do with mental illness. To see why, you need only ask what difference would it make if the (adult) child were not diagnosed a psychotic. Both mother and son would still have “nowhere else to go.” How can you accuse me of being “breathtakingly naïve” simply because I pointed out precisely what the real world is actually like – ie full of struggles with no obvious solutions. One “medical treatment” for the example would be to give the mother a new house, but as yet I don’t think the medical insurance would cover it (But wait! It already happens all the time..).
“I suggest a break from poring over “Foucault For Dummies” and a stroll in the real world.”
Where does Foucault suggest that mental illness is a fake disease and that psychiatric coercion cannot be justified?
@ E
“Why not? Do the ends, in this case, not justify the means?”
No. The end is the decision of the individual, and not mental health “experts.” If not, then literally any means justify attempting to prevent people from killing themselves, and I’m not sure you want to go down that road, do you? The means used today and in the past are bad enough already.
“It shouldn’t happen and doesn’t happen very often but this is not an argument for removing the right to detain patients but for making in-patient settings a safer more therapeutic environment rather than the “holding pens” they frequently are.”
I was merely pointing out that you cannot achieve your own stated aims. Rhetoric about a “therapeutic environment” evades the fact that people are locked up. As I said earlier, making prisons prettier doesn’t magically transform them into non-prisons.
“I wonder what the effect on the suicide rate would be of removing the right to detain patients? Would it go up, down, or stay the same?”
I have no idea. But are you really committed to the view that coercive psychiatry, in all its wonderful glory, provides no one with the desire to kill themselves? That would be a bold position to take.
“Are you arguing that a depressed or psychotic patient who is expressing a desire to end his or her own life is making an informed, rational decision and acting with “free will””
Where is the evidence to the contrary? Unless you want to say that people who express a desire to kill themselves are, by definition, mentally ill? You are so quick to “know” that someone who acts in a nonconforming manner has lost their free-will, without any evidence that they have a genuine disease. Nor do you think that such a person ought to be declared legally incompetent, which you should if you want to maintain any hint of consistency. When I worked on a psychiatric ward, we had to make sure the patients were able to vote in the elections! They aren’t allowed outside, but they sure can decide on who should govern the rest of the country!
“without a collective view of what is rational or reasonable the result would be anarchy.”
I am not sure what you mean, because those are three terms which have very elastic definitions. I would say that it is reasonable to let people go about their business until they harm others, which you obviously disagree with.
“I would say that I am able to understand the reasons a depressed or psychotic person gives for ending their lives I just don’t necessarily agree with them.”
So your opinion is worth more than theirs? Some might think that a pretty conceited position to hold. Are you saying that even when you think you understand them, you might still coerce them because you just don’t agree?
“That is a very extreme and frankly untenable position but ultimately a “right” it may be impossible to stop someone from exercising but that does not mean we shouldn’t try and if that requires coercion in some cases then so be it.”
Unless I am misreading the sentence, are you conceding that suicide is in fact a right which can be exercised, but that you simply think you know better?!
@ Mr Ian
“Contemporary opinion: “
At least you know how to repeat what you hear, I’ll give you that. Again, how do you know he believed/believes that?! “Medical examination for mental illness,” or some such nonsense I suppose. Does your entire position rest on the perfectly elastic concept of mental illness?
“Or your opinion: The guy killed someone – lock him up and hope he sees sense and kills himself. “
Why, when “dangerousness” is beyond all reasonable doubt, would you refuse to see and act upon it? And where did you get the idea that I hope he kills himself?
“Or would you assert that people who get ill have no social right to treatment? “
Whatever is a “social right”?
“Sanctimony does not strengthen your argument.”
You implied that I advocate eugenics. Unless you have no knowledge of recent history, for a state mental health employee to accuse some who rejects all coercive psychiatry as a proponent of eugenics is bitterly ironic, and very distasteful. It is not my problem if you find being accused of wrongdoing offensive, but then I’m not the one locking people up and drugging them.
“Yet your assertions that we mental health practitioners who detain people against their will for societal beneficence are abusing their individual rights- is not offensive? ”
But you locking people up [who thereby lose their liberty] for the benefit of society is not my opinion – it is literally what you do! How can you you find *what you actually do* offensive?
“Persuasion is exactly the same [as coercion] but using the covert and intellectual method. “
So if a patient tries to leave a psychiatric ward, the use of physical force is “exactly the same” as you politely asking him to stay?! That must rank as the most inaccurate comment on the thread so far. Even others who propose psychiatric coercion admit the coercive part is pretty important. In any case, if persuasion is “exactly the same,” why do you need coercion? Why not stick to the verbal ju-jitsu?
“…which is the nature of mental illness.”
Perhaps you can enlighten us all in more detail if indeed you have discovered the nature of mental illness.
“Only a fool would consider a nurse ‘medical’. An architect is also professionally acountable for a building structure – yet is not ‘medical’.”
Nurses tend to work in hospitals, ‘where the medicine happens,’ so to speak. Psychiatrists are trained in medicine. It is said that mental illness is is brain disease, and that mental illness is cured/treated by chemicals, etc etc. Did you intend to argue *for* my point that psychiatry is not medicine?
“But in an ideal world, neither would we lose the capacity of reason and reality.”
But there is no evidence, other than “he did this thing, which thereby proves he had literally lost his reason.” Do you think mental patients should be deemed legally incompetent? My position is in no way committed to some fake “ideal world” scenario, where everyone chooses freedom and responsibility. Bad choices are still choices, and denying that is far worse that admitting it, however much of a social faux pas it may be.
“He should actually be the one to go away as he is not forced to eat her food.”
You’ve lost me.
“Why? Because he is bad? Or because he is ill?”
What *illness* does he have?! If the concept of illness includes bad behavior, which you seem to be saying, then he is one ill man, I agree.
“I actually agree with the concept that taking one’s own life is a fundamental right “
No, you don’t. If you honestly believed that, you would oppose coercive psychiatry (which forces people to stay alive), and you wouldn’t have derided me for hoping that the psychotic killer comitt suicide (which I didn’t even say in the first place).
“One year on an acute unit is not really “plenty of experience” – either as in-patient or staff. You embarrassed yourself with that one. Don’t use it again in a professional forum.”
Can you *be* anymore conceited? And thanks for the “or were you actually a patient..” implication. To know that psychiatry is a sham, you don’t need to spend any time on a psychiatric ward. It is enough to know that people cannot leave as they please. And in any case, a year was plenty long enough to gain a thorough impression of the practical side of things. One can spend an hour working out that it is not a hospital, that patients do not have any real disease, and that those who don’t want to be there are often forced to stay and drugged against their will.
“Rape of a wife was lawful back then because it was in keeping with the social construct at that time.”
You cannot even bring yourself to say that being raped was not a violation of a woman’s human rights. That is a pretty sad indictment, I should think.
Don’t use these arguments again in a professional forum!
Dear Ted-ious
Because that’s what he said.
“If he committed murder, then in our society he ought to be at least detained for the rest of his life. I would allow him to commit suicide, since it would save a lot of money.”
The fact you would “allow” him to commit suicide for the sake of saving a lot of money is not a usual consideration factor in those who wish to take their own life.
Therefore I took it to be why you find his self-killing to be of economical gain to the remaining as promoting not only that people who cost money to the taxpayer ought kill themselves but this is also the original statement that suggeswts you are pro-eugenics – since his “illness” is no defence to you and he ought be condemned for life.
You also imply that *you* allow it, which is representative of your libertarian permissive values of which we should all take on board. Are you not being equally ignorant of those you argue against because you have discounted the views of those people who have actually experienced this and express appreciation for the role of mental health services.
It’s what the society at that time says is everyone’s right.
Yet you will indefinitely lock up someone who is dangerous by nature of a dysfunction of the mind and deny them treatment – simply because they state they don’t want it. Have you ever seen someone with acute paranoia? Or severe anorexia nervosa? Or spend their entire day wrapped in a world of delusional satanic persecution where their worlds are a so confused they can’t even recall their own given name? What would you suggest we do for these sort of people where their capacity to rationalise is compromised by such events?
Generally, I don’t. I enjoy what I do because I do it with the patient and help them to adapt their behaviours so that society may tolerate them better in their community.
However, I find what society does not tolerate as sometimes abhorrent – to expect mental health to lock up survivors of sexual abuse because they act in ways that society cannot tolerate but fall just short of breaking the law (or repeated minor fractions of the law) – is not sometimes acceptable to my own moral standards. But I live with it. Just as I have to live with the idea that you might want to lock up a mentally deranged person indefinitely for a single act of extreme dangerousness. Thankfully, your opinion is no longer current thinking and Bridewell, the 17th century ‘hospital’ built for that exact purpose, has long since closed.
Verbal ju-jitsu is persuasion. It is also coercion. It is presenting my argument to another with a view to changing something about them. Usually this is to change them by manipulating them internally and changing beliefs or opinions. Sometimes this is externally by applying behavioural force.
The theroetical outcome is the same – just the process that is different. Asking someone to remain in hospital when they want to leave requires me to change their desire. Whether that be internal or external is merely a matter of using the required modality. This is why nurses do not like to ‘talk’ patients into staying – but to use the s5(4) provisions because this indicates that the patient actually *wants* to leave and thus leaves an official ‘record’ that they are being held against their choice. To persuade them otherwise is to obviate their previously expressed desires, which is worse for me as it is like putting a wandering demented patient in a sunken net-chair and stating they obviously don’t want to wander anymore cos they stopped doing it.
The nature is well documented by many.
The cause and cure is a little more difficult to discern.
“Tend” to work in hospitals makes them medical is about as good an argument as stating that since only ‘most’ suicidal people actually don’t want to die is not a good enough reason to prevent all.
Nurses also work from several model bases – not just a medical one. Your ignorance of mental health nursing is blatant.
The army teaches this quite a bit. So to the police. Even self-defence classes would teach the use of ‘reasonable force’. It is not a bad choice to defend yourself from perceived threat – but if that threat comes about by events that originate in a dysreality – ie voices; paranoia; delusions – where the threat is not as real as imagined by the individual – there is no crime – but a ‘mistake’.
Compare with a late night garage attendant who is threatened by a man with his hand in his pocket saying “I have a gun. Give me your money” – and the attendant then takes opportunity, out of fear for his life, to assault the individual who then dies. In the robber’s pocket they discover a packet of polo mints and nothing else. Is the attendant culpable of murder, manslaughter or acting, albeit in false belief, to preserve his own life using reasonable force and, ergo, not liable for prosecution? Or should he have waited til the robber shot him to prove he had a gun?
“Mental Patients” are deemed, on an instance by instance basis, to be legally not responsible for the behaviours they commit by definition of mens rea. This does not make them unable to determine financial affairs or who to marry – which are other legal rights of determination. This also does not mean there is no cause for concern about potential future behaviours. However, the process by which we determine this perceived ‘risk’ is developing and, in my opinion, is very imperfect as we know mental illness (by itself) is no more a predictor of risk of dangerousness than listening to rap music. This is not the thread for dangerousness discussions tho. I refer you to any one of the many we have had elsewhere in this forum.
I wish.
The compromised ability to judge for and to control oneself – there is much debate in the realms of behaviour; psychopathy; mental illness.
Someone with diabetes who gets a low blood sugar level is likely to act aggressively (due to adrenergic effects) – this is the pathology of the behaviour that is well documented and researched – is diabetes an illness or just a behavioural act?
Should a person with diabetes who acts violently be incarcerated or given sugar?
If we didn’t know about the link between diabetes, hypoglycaemia and violence – rest assured we would still be coercing patients into taking sugary drinks whenever they got angry – because in some we’ve noticed it stops the violence.
You really are an arrogant prick.
I agree with suicide when someone has capacity and rationality. Euthanasia is a concept I have argued for. Assisted suicide is adebate I have spoken out on in support.
But you just think anyone who says – “I wish I was dead” should then be offered KCl without demonstrating any consideration of the precautions and concerns that have been expressed by BOTH sides of the debate into how to be assured that this irreversible process is the true pervasive decision of the individual and not a defective or abnormal representation of someone who is merely reacting to an environmental, biological, situational or other temporary and reversible event.
Oh dear.
First I am conceited because I consider your one year in an adult acute ward to not constitute ‘plenty of experience’ – (which it does not)…
And then I imply you may have been a patient because I do not simp[ly assume you are staff.
For some reason this is taken offensively by you – which bespeaks of how you view ‘patients’ of acute mental wards as perhaps being unable to construct a valid argument? I will let Mandy Lifeboats respond to that particular degradation of character.. and I would recommend a jockstrap and box be worn.
Those who experience mental healthcare, in your condescending view, appear to have little validity in your arguments. How is it so that you dispel the opinions and experiences of those who have actually lived this ‘oppressive’ mental healthcare regime.
Yes.
You should think.
It would help the debate.
The fact I do not mention something – does not mean it is not considered – merely not pertinent to the debate.
So just in case I forget to mention it – you’re an egotistical and arrogant assumptive ignorant individual who bases an argument solely on theoretical construct which is patently limited by your experiences and knowledge and displays a very low level of understanding of the moral considerations for both sides of the issue.
Dear Ted-ious
(oops – did some syntax error thing) here it is again without the missing third person…
**“Contemporary opinion: “
At least you know how to repeat what you hear, I’ll give you that. Again, how do you know he believed/believes that?! **
Because that’s what he said.
**“Or your opinion: The guy killed someone – lock him up and hope he sees sense and kills himself. “
Why, when “dangerousness” is beyond all reasonable doubt, would you refuse to see and act upon it? And where did you get the idea that I hope he kills himself? **
“If he committed murder, then in our society he ought to be at least detained for the rest of his life. I would allow him to commit suicide, since it would save a lot of money.”
The fact you would “allow” him to commit suicide for the sake of saving a lot of money is not a usual consideration factor in those who wish to take their own life.
Therefore I took it to be why you find his self-killing to be of economical gain to the remaining as promoting not only that people who cost money to the taxpayer ought kill themselves but this is also the original statement that suggeswts you are pro-eugenics – since his “illness” is no defence to you and he ought be condemned for life.
You also imply that *you* allow it, which is representative of your libertarian permissive values of which we should all take on board. Are you not being equally ignorant of those you argue against because you have discounted the views of those people who have actually experienced this and express appreciation for the role of mental health services.
**“Or would you assert that people who get ill have no social right to treatment? “
Whatever is a “social right”?**
It’s what the society at that time says is everyone’s right.
**“Sanctimony does not strengthen your argument.”
You implied that I advocate eugenics. Unless you have no knowledge of recent history, for a state mental health employee to accuse some who rejects all coercive psychiatry as a proponent of eugenics is bitterly ironic, and very distasteful. It is not my problem if you find being accused of wrongdoing offensive, but then I’m not the one locking people up and drugging them.**
Yet you will indefinitely lock up someone who is dangerous by nature of a dysfunction of the mind and deny them treatment – simply because they state they don’t want it. Have you ever seen someone with acute paranoia? Or severe anorexia nervosa? Or spend their entire day wrapped in a world of delusional satanic persecution where their worlds are a so confused they can’t even recall their own given name? What would you suggest we do for these sort of people where their capacity to rationalise is compromised by such events?
**“Yet your assertions that we mental health practitioners who detain people against their will for societal beneficence are abusing their individual rights- is not offensive? ”
But you locking people up [who thereby lose their liberty] for the benefit of society is not my opinion – it is literally what you do! How can you you find *what you actually do* offensive?**
Generally, I don’t. I enjoy what I do because I do it with the patient and help them to adapt their behaviours so that society may tolerate them better in their community.
However, I find what society does not tolerate as sometimes abhorrent – to expect mental health to lock up survivors of sexual abuse because they act in ways that society cannot tolerate but fall just short of breaking the law (or repeated minor fractions of the law) – is not sometimes acceptable to my own moral standards. But I live with it. Just as I have to live with the idea that you might want to lock up a mentally deranged person indefinitely for a single act of extreme dangerousness. Thankfully, your opinion is no longer current thinking and Bridewell, the 17th century ‘hospital’ built for that exact purpose, has long since closed.
**“Persuasion is exactly the same [as coercion] but using the covert and intellectual method. “
So if a patient tries to leave a psychiatric ward, the use of physical force is “exactly the same” as you politely asking him to stay?! That must rank as the most inaccurate comment on the thread so far. Even others who propose psychiatric coercion admit the coercive part is pretty important. In any case, if persuasion is “exactly the same,” why do you need coercion? Why not stick to the verbal ju-jitsu?**
Verbal ju-jitsu is persuasion. It is also coercion. It is presenting my argument to another with a view to changing something about them. Usually this is to change them by manipulating them internally and changing beliefs or opinions. Sometimes this is externally by applying behavioural force.
The theroetical outcome is the same – just the process that is different. Asking someone to remain in hospital when they want to leave requires me to change their desire. Whether that be internal or external is merely a matter of using the required modality. This is why nurses do not like to ‘talk’ patients into staying – but to use the s5(4) provisions because this indicates that the patient actually *wants* to leave and thus leaves an official ‘record’ that they are being held against their choice. To persuade them otherwise is to obviate their previously expressed desires, which is worse for me as it is like putting a wandering demented patient in a sunken net-chair and stating they obviously don’t want to wander anymore cos they stopped doing it.
**“…which is the nature of mental illness.”
Perhaps you can enlighten us all in more detail if indeed you have discovered the nature of mental illness.**
The nature is well documented by many.
The cause and cure is a little more difficult to discern.
**“Only a fool would consider a nurse ‘medical’. An architect is also professionally acountable for a building structure – yet is not ‘medical’.”
Nurses tend to work in hospitals, ‘where the medicine happens,’ so to speak. Psychiatrists are trained in medicine. It is said that mental illness is is brain disease, and that mental illness is cured/treated by chemicals, etc etc. Did you intend to argue *for* my point that psychiatry is not medicine?**
“Tend” to work in hospitals makes them medical is about as good an argument as stating that since only ‘most’ suicidal people actually don’t want to die is not a good enough reason to prevent all. You’re using the same argument against yourself.
Nurses also work from several model bases – not just a medical one. Your ignorance of mental health nursing is patently clear.
**“But in an ideal world, neither would we lose the capacity of reason and reality.”
But there is no evidence, other than “he did this thing, which thereby proves he had literally lost his reason.” Do you think mental patients should be deemed legally incompetent? My position is in no way committed to some fake “ideal world” scenario, where everyone chooses freedom and responsibility. Bad choices are still choices, and denying that is far worse that admitting it, however much of a social faux pas it may be.**
The army teaches this quite a bit. So to the police. Even self-defence classes would teach the use of ‘reasonable force’. It is not a bad choice to defend yourself from perceived threat – but if that threat comes about by events that originate in a dysreality – ie voices; paranoia; delusions – where the threat is not as real as imagined by the individual – there is no crime – but a ‘mistake’.
Compare with a late night garage attendant who is threatened by a man with his hand in his pocket saying “I have a gun. Give me your money” – and the attendant then takes opportunity, out of fear for his life, to assault the individual who then dies. In the robber’s pocket they discover a packet of polo mints and nothing else. Is the attendant culpable of murder, manslaughter or acting, albeit in false belief, to preserve his own life using reasonable force and, ergo, not liable for prosecution? Or should he have waited til the robber shot him to prove he had a gun?
“Mental Patients” are deemed, on an instance by instance basis, to be legally not responsible for the behaviours they commit by definition of mens rea. This does not make them unable to determine financial affairs or who to marry – which are other legal rights of determination. This also does not mean there is no cause for concern about potential future behaviours. However, the process by which we determine this perceived ‘risk’ is developing and, in my opinion, is very imperfect as we know mental illness (by itself) is no more a predictor of risk of dangerousness than listening to rap music. This is not the thread for dangerousness discussions tho. I refer you to any one of the many we have had elsewhere in this forum.
**“He should actually be the one to go away as he is not forced to eat her food.”
You’ve lost me.**
I wish.
**“Why? Because he is bad? Or because he is ill?”
What *illness* does he have?! If the concept of illness includes bad behavior, which you seem to be saying, then he is one ill man, I agree.**
The compromised ability to judge for and to control oneself – there is much debate in the realms of behaviour; psychopathy; mental illness.
Someone with diabetes who gets a low blood sugar level is likely to act aggressively (due to adrenergic effects) – this is the pathology of the behaviour that is well documented and researched – is diabetes an illness or just a behavioural act?
Should a person with diabetes who acts violently be incarcerated or given sugar?
If we didn’t know about the link between diabetes, hypoglycaemia and violence – rest assured we would still be coercing patients into taking sugary drinks whenever they got angry – because in some we’ve noticed it stops the violence.
**“I actually agree with the concept that taking one’s own life is a fundamental right “
No, you don’t. If you honestly believed that, you would oppose coercive psychiatry (which forces people to stay alive), and you wouldn’t have derided me for hoping that the psychotic killer comitt suicide (which I didn’t even say in the first place).**
You really are an arrogant prick. Oppositional defiant disorder springs to mind with a sprinkling of narcissistic personality throughout.
I agree with suicide when someone has capacity and rationality. Euthanasia is a concept I have argued for. Assisted suicide is a debate I have spoken out on in support.
But you just think anyone who says – “I wish I was dead” should then be offered KCl without demonstrating any consideration of the precautions and concerns that have been expressed by BOTH sides of the debate into how to be assured that this irreversible process is the true pervasive decision of the individual and not a defective or abnormal representation of someone who is merely reacting to an environmental, biological, situational or other temporary and reversible event.
**“One year on an acute unit is not really “plenty of experience” – either as in-patient or staff. You embarrassed yourself with that one. Don’t use it again in a professional forum.”
Can you *be* anymore conceited? And thanks for the “or were you actually a patient..” implication. To know that psychiatry is a sham, you don’t need to spend any time on a psychiatric ward. It is enough to know that people cannot leave as they please. And in any case, a year was plenty long enough to gain a thorough impression of the practical side of things. One can spend an hour working out that it is not a hospital, that patients do not have any real disease, and that those who don’t want to be there are often forced to stay and drugged against their will.**
Oh dear.
First I am conceited because I consider your one year in an adult acute ward to not constitute ‘plenty of experience’ – (which it does not)…
Now you too have worked out mental illness – tho I have to actually prove how I understand the ‘nature’ – you have simply ‘worked out’ it’s not a disease.
And then I imply you may have been a patient because I do not simply assume you are staff.
For some reason this is taken offensively by you – which bespeaks of how you view ‘patients’ of acute mental wards as perhaps being unable to construct a valid argument? I will let Mandy Lifeboats respond to that particular degradation of character.. and I would recommend a jockstrap and box be worn.
Those who experience mental healthcare, in your condescending view, appear to have little validity in your arguments. How is it so that you dispel the opinions and experiences of those who have actually lived this ‘oppressive’ mental healthcare regime. You must have balls of steel to put them out there with such an
inadequate experience, knowledge and understanding.
**“Rape of a wife was lawful back then because it was in keeping with the social construct at that time.”
You cannot even bring yourself to say that being raped was not a violation of a woman’s human rights. That is a pretty sad indictment, I should think.**
Yes.
You’re right.
You should think.
It would help the debate.
The fact I do not mention something – does not mean it is not considered – merely not pertinent to the debate.
So just in case I forget to mention it – you’re an egotistical and arrogant assumptive ignorant individual who bases an argument solely on theoretical construct which is patently limited by your experiences and knowledge and displays a very low level of understanding of the moral considerations for both sides of the issue.
One suggestion is that this issue has nothing to do with medicine, and nothing to do with mental illness.
Which is a stupid suggestion.
To see why, you need only ask what difference would it make if the (adult) child were not diagnosed a psychotic. Both mother and son would still have “nowhere else to go.”
And you would doubtless still be engaging in victim-blaming.
How can you accuse me of being “breathtakingly naïve”
Because you seem to have no appreciation of how the real world operates, and seemingly, only a purely theoretical understanding of your fellow human beings.
Anyway, this is rapidly becoming the online equivalent of laughing and pointing at the unpopular boy in the playground – any chance of closing comments on this thread, z?
@ Mr Ian
I give up. All your arguments have persuaded me, and I thank you for bespeaking me your true insights into medicine, mental health, politics, suicide, and all the rest.
@ beakie
Yes, probably what you said.
And on that note, I think I shall agree with Beakie that it is now time to close this comments thread.
Wow, 114 comments. Is that a record for us?