Cynic’s Guide: How To Be An Antipsychiatrist

I`m not really sure whether my wifes uterus is wandering but I`d be very grateful if someone would incarcerate her for being disobedient.

Great to have you back, Mental

*head asplodes*

There is no such thing as mental ILLNESS. Just mental distress now. Or mental health problems. I have been bitched at for refering to manic depression as an illness instead of a label. Because it’s not serious! Doesn’t fuck up your life! You can CHOOSE not to be manic depressive! Seethe.

This is just f***ing hilarious. Made me laugh out loud. Was having a crappy day, so thanks!

Brilliant!

I guess someone really got to you?!

I really hate the phrase BIG PHARMA. There’s so much dumbness wrapped up in those two little phrase. Not once have I seen anyone who’s ranted about BIG PHARMA suggest an alternative to the ‘private companies motivated by profit’ way of developing pharmaceuticals, or even display any understanding that it might be an issue worth considering if you’re shocked when, for example, BIG PHARMA does something finacially sensible and legally sound, yet ethically troubling.

I have, however, seen an obscene amount of delight when someone makes the connection that BIG PHARMA’s evil, evil anti-psychotics can cause diabetes and BIG PHARMA makes medicines for diabetes, too! It’s a conspiracy!!1!

Actually, I think Ted may have just about convinced me. I am now giving up mental health nursing and becoming a second-rate cultural studies lecturer at a third-rate university.

I shall now devote a whole 5 of my brain cells to Szasz-esque libertarian philosophy. I shall also devote 6 brain cells to chewing cud.

Mmm, cud.

Put Laing and Szazapazzz in a (locked) room with 3 florid, distressed schizophrenics, and call me in the morning. Then we’ll continue this debate.

Is Laing not dead? That would be pretty unpleasant. At least Szasz would probably agree he was looking a bit poorly though

In all fairness to Laing, he never tried to deny the experience of being psychotic, and by some accounts he was supposed to have quite a winning way with people undergoing psychosis.

Szpasz, on the other hand, comes across in his writings as though he’s trying to say, “Psychosis? They could snap out of it if they really wanted to! Pull yourself together, man!”

I’d like to see Szasz try to implement his ideas on the average acute psych ward. He wouldn’t last a week.

Right, I have secured my wife`s uterus to the kitchen sink and her disobedience has, thankfully, subsided. So I`ve had time to read this. Fantastic analysis Mental but I have to question your motivation and understanding of this process.

My family have a story about a great aunt, who I never met, who lost her husband, became lonely and joined a church / cult ( I`ve no idea whether it was the Scientologists ). She followed their teachings and refused to lock her door. She was repeatedly burgled until there was litle left in her home. That`s of no interest to any of you but it`s the closest I`ve ever come to Scientology. I`ve been about but I`ve never met a Scientologist. Was I the only person thinking what the f$%k are you doing when Z went to protest against them the day Wales won the Grand Slam.

The same is true of rabid anti - psychiatrists. They fill my OSB@mentalnurse inbox but I`ve never met one. I`ve worked in two units in the north, one in the south and one in the west but I don`t encounter these people. They`re hardly prominent on Mental Nurse. Ted may come across as a one issue zealot but he`s tenacious and polite, much less inclined to rant or be abusive than I am. Scientologists and rabid anti - psyciatrists have no impact on my life and no impact on my practice.

I can only conclude we`re getting rather too precious. If you study the history of psychopharmacology. If you look at how easily we`re seduced by the latest, trendy psychotherapy. If you look at how we stumble blindly from one nursing model to the next. If you look at all the NHS initiatives we embrace then promptly forget about. If you look at the incessant attempts to reduce nursing to formulae in the policy and procedure tomes. Then Ted can be readily forgiven for concluding we`re a shambles.

He may offend those who are happy with their diagnosis and who consider themselves to be mentally ill but as far as I`m concerned they speak up very well for themselves on this site. They don`t need professionals to take vicarious offence on their behalf.

You also, in your enthusiasm to have a pop at the Daily Mail, fail to offer any context. Ted and the anti - psychiatrists use this strategy but they`re not responsible for it. I don`t know where it originated but I know, without doubt, who are the masters of this black art. Yes, Nu bloody Labour following in the footsteps of the grandmaster Alistair Campbell. This is exactly the strategy used by this government when anyone questions uncontrolled immigration, political correctness, greater European integration without a referendum, the wars in Iraq and Afghanistan and more.

And it gets worse. Inspector Gadget, who I admire greatly, wrote a very different but strangely similar post some time ago. Where our political masters lead public sector management follow. This is the strategy used when rank and file police officers challenge targets, harassing motorists blah, blah, blah. I`m sure our colleagues in the NHS have seen it too.

If you think that in regard to this strategy Ted and the anti - psychiatrists are the problem you`re way off mark.

Still nice to have you back though.

Terrific post mental.

Perhaps you will forgive me for being a tad pedantic but Laing disavowed the term anti-psychiatrist (which was coined by his mate, and fellow psychiatrist, David Cooper) claiming “I have never called myself an anti-psychiatrist (Wisdom, Madness & Folly, p8).

Personally (while not being an advocate of Laing, or “Laingian”) I think this passage (from WM&F) sums up his overall position quite well, and , in fact, still seems relevant today, at least judging by the concerns regularly expressed on this blog.

“Within 2 years of carrying out my duties as a clinical psychiatrist I came to the painful realisation that I would not like to be treated the way my own patients had to be treated.
I would not like to be locked up on the psychiatric ward under observation.
I could not believe that the drugs, the comas (insulin coma therapy), the electric shocks I was expected to prescribe and administer were the great recent advances in psychiatry I was trained to believe they were.
But maybe I had got it all wrong - the psychiatrists who were doing what I was supposed to learn to copy did not seem to be uncomfortable about what they were doing.
Was I at the fuzzy beginnings of a clinical paranoid psychosis” (p9).

Laing claims that psychiatry (as a branch of medicine) is unique because:
“It is the only branch of medicine that treats patient in the absence of known physical pathology”.
And “the only branch of medicine that treats conduct alone in the absence of signs and symptoms of illness of the usual kind” (p2).
Needless to say it is the only branch of medicine that treats people against their will.

It is still impossible to find easy answers to the conundrums that so preoccupied our infamous Scottish pish-head, so while it might be easy to dismiss the man, it is not so easy to dismiss the value of some of his observations ?

I`m happy now. My wife`s uterus is contentedly confined. We`re tolerant of Ted and the anti - psychiatrists, unperturbed by Scientology and we`re all disciples of the Daily Mail.

Don`t recede too far into the shadows, Mental.

*tosses OSB a week’s worth of copies of the Guardian and ducks*

Great post - the Nazi references, you just can’t get away from them! Godwin’s law expands to other themes..

“I could not believe that the drugs, the comas (insulin coma therapy), the electric shocks I was expected to prescribe and administer were the great recent advances in psychiatry I was trained to believe they were.”

I am not arguing for or against the concept of mental illness in an all or nothing fashion when most people prefer to argue that way. But where is “insulin coma therapy” now and do we still use ECT for schizophrenia. Yet people could have been compulsorily given those.

Think about it too, how come we can Section Anorexia Nervosa and what would happen if Anorexia Nervosa is voted out by the APA and removed from DSM V (like they did with Homosexuality in 1973 from DSMII). I will tell you what will happen, a third will be cured by their parents, a third will be going to expensive clinics or “farms” and the rest will earn big money as models. Mental illness like scientific truth has one thing in common: what the top scientist/psychiatrist believe in at the time. A lot of the time money comes into play: think global warming and ”Carbon Trading then ED and the drugs for it. No nothing should follow the All or Nothing rule.
The Cockroach Catcher

A wonderful read, Mental Nurse! Very enjoyable. But such wonderful rhetoric does not sit too well with the facts. First, the lumping of Szasz and Laing together shows that the term “anti-psychiatrist” does not explain very much at all, and is basically useless. Some of the text is (very) correct and on those points I agree with you, so I will restrict my comments to some of the relevant points of disagreement.

“Other PLANK arguments include “what gives you the right to say what is right or wrong”, “you need ‘ill’ people to keep you in a job”, “he is not ill he is in an impossible situation and expressing it in a socially different way”.”
Those three arguments are pretty fair points. 1) What *does* give you the right? 2) This is literally true. The extent of its direct/indirect influence is up for discussion. 3) Again, possibly literally true. I would add that the “socially different” way usually involves annoying those around them.

“Please note Thomas Szasz’ link to Scientology.”
On a strategic level, Szasz may be mistaken in associating with CCHR. But if they both reject coercive psychiatry as a violation of human rights, then there is no disagreement on this single issue. You might think “with friends like those..”, but that’s a different issue. I myself am not so sure of Scientology’s motives, since it seems to me that they speak out against psychiatry because it represents unwanted competition - ie “don’t save your soul with psychiatry, but with Scientology”!

“A particularly fabulous argument is to compare Nazis and the Mental Health system. Like here.”
There are, in fairness, many parallels between (UK) state psychiatry and the Nazis. It was an ironic shame that one poster (I forget who) earlier implied I was into eugenics.

“The mental health system is only there to control social undesirables that can not be easily imprisoned.”
Whether or not that is the “true” aim of psychiatry, I think we can all agree it does a pretty good job at it!

“Labels Used By Psychiatrists and what they really mean.”
Quite accurate really. Except the Mental Health Act is hardly undemocratic. The problem (for mental patients) is that it is! The power to define words is of massive significance, and it is a shame so many anti-psychiatrist-types go around shouting “labelling” without really getting the point.

“PLANK: Do you lock them? / Mental: Yes, at night to keep out riff raff, Daily Mail readers and gigantic moths.”
Oh come on. It is really not good form to dismiss the point that innocent people are detained in buildings in such a fashion.

“They enjoy using these powers to remove the rights of patients without rhyme or reason, used at the drop of a hat.”
It’s not like they have a problem with it though is it? If they did, they wouldn’t be there. It is fundamentally true that psychiatrists like detaining people more than they dislike it.

“Mental: Sometimes we have to use physical coercion, legally sanctioned, to ensure a patient takes their medication or in an emergency situation.”
Coercion is the use of force or the threat of the use of force. Given that psychiatrists have the law to back them up, it is undeniable that the majority of psychiatry today is actually or potentially coercive. The “emergency” argument is disingenuous at best.

“Make a big deal of the rights of people in a democratic society. ”
People in democratic society do what the majority want them too. In reality, neither the majority nor the minority are correct on the basis of them being the majority or the minority, but because their argument is better.

“Redefine words”
Psychiatry has done more than most to redefine some common words in recent decades - disease, illness, addiction, etc - so it is odd you suggest it a tactic of the “anti-psychiatrist.”

I am sure you all know who Karl Menninger is. Before he died, he wrote to Thomas Szasz: “I think I understand better what has disturbed you these years and, in fact, -it disturbs me, too, now. We don’t like the situation that prevails whereby a fellow human being is put aside, outcast as it were, ignored, labeled and said to be ’sick in his mind.’ … I am sorry you and I have gotten apparently so far apart all these years. We might have enjoyed discussing our observations together. You tried; you wanted me to come there, I remember. I demurred. Mea culpa.”

Ted.

@ zarathustra

“I’d like to see Szasz try to implement his ideas on the average acute psych ward. He wouldn’t last a week.”

Which ideas are these? If psychiatric coercion were repealed, each patient would be free to leave, or not, as they so desired. If you mean asserting that there is no medical evidence that any mental illness is associated to bodily pathology, then we’re all (not just me!) waiting for evidence to the contrary. Your comment suggests to me at least that you are unfamiliar with Szasz’s ideas. To be fair, some on this board are familiar, but just don’t like it (this is understandable)! At least oldschoolboy (sort of) likes me!

Ever heard of “discombubulitis praecordia”, Ted ? (see p46, ‘The Great Cholesterol Con’, by Malcolm Kendrick).

Nowadays, it’s the condition commonly referred to as a heart attack.

Surprisingly (given the likely body count) it took until 1926 before James Herrick published the first medical account of acute myocardial infarction.

And the moral of the anecdote is ?
Absence of evidence is not evidence of absence.

Which ideas are these? If psychiatric coercion were repealed, each patient would be free to leave, or not, as they so desired.

And how many of them would be fished out of the river the following morning?

Some of the commenters on this board (specificallly DeeDee Ramona) are adamant that being sectioned saved their lives, and that they’re grateful to the mental health services that did it. You have nothing meaningful to say to such people.

Your comment suggests to me at least that you are unfamiliar with Szasz’s ideas.

Thank you, but I *am* familiar with Szasz’s ideas, and I think they’re fundamentalist tripe.

So, anyway Ted, what do you think of the Mental Capacity Act? No doubt you’ll have considered the manner in which the issue of mental capacity to make decisions is being encoded and all the subtle issues and nuances within this particular law, which is proving so vital in regulating professional ethics.

Because if you haven’t considered such issues, one might think you were just some bullshitter whose intellectual analysis of a highly complex subject begins and ends with a dog-eared book by Szasz, and I’m sure you are not that.

Welcome back Ted

Ted

I am on Holiday at the moment so my wife is fuming that I am out here writing this so I must be brief. I read that piece on natural law that you recommended which if memory serves placed great emphasis on the role of reason in defining what is natural law. Given that “reason” is the first thing to go out the window when what most of “us” would call “mental illness” strikes how does natural law help us decide how to deal with an individual who is for want of a beter phrase psychotic, clinicaly depressed and suicidal?

@ a and e charge nurse

Thanks for confirming there is an is absence of evidence for mental illness. My argument obviously does not rest on there not being discoverable (brain) diseases.

@ zarathustra

“And how many of them would be fished out of the river the following morning?”
I have no idea. But that argument does not rest on mental illness, but instead calls for the coercive detention of anyone who is thought likely to harm themselves. I don’t like the idea of someone killing themselves, but I dislike it less than I do of forcing them to stay alive against their will. In a free society, people are at liberty to kill themselves. It’s one thing to reject freedom for oneself, but quite another to take it away from other people.

“You have nothing meaningful to say to such people.”
Why should I necessarily have anything meaningful to say to such people? If they want to think they have a disease, then good luck to them. Pointing out the difference between a literal disease and a metaphorical disease, or a proven disease and a putative disease might annoy them, but being annoyed isn’t the criterion for what is and what is not a disease.

Obviously, detaining people can make it that bit harder to commit suicide, and so will have saved some lives. But at what cost? Or is one of those issues (like the Iraq war), where any and and all costs are (allegedly) still “worth it.” (This assumes that suicide prevention is on balance a success, which we need not go into here..)

“Thank you, but I *am* familiar with Szasz’s ideas”
That clears that one up then.

“what do you think of the Mental Capacity Act?”
Ah, the old “you’d better know everything about how the current legal framework is written and how works in practice or else you simply can’t argue that locking up innocent people is wrong” trick. Just like the “well I’ve worked in psychiatry longer than you so I’m an expert and you know nothing” trick.

Perhaps you might suggest how the alleged facts of mental illness bear on a declaration of legal incompetence. During my time as a nurse, we had to make sure each inpatient was able to vote in the elections! If this doesn’t strike you as absurd, then I don’t know what to say. Obviously, there are times when people must be declared legally incompetent, but I fail to see what this should have to do with psychiatry and the idea of mental illness.

“intellectual analysis”
I appreciate the recognition..

@ E

Thanks for reading the piece. Apologies to the wife — go and have a nice holiday!

“The madman is not the man who has lost his reason. The madman is the man who has lost everything but his reason”
-GK Chesterton

“I don’t like the idea of someone killing themselves, but I dislike it less than I do of forcing them to stay alive against their will.”

Jesus Ted, but you are a rare eejet. Take your head out of your arse and join the rest of us over here in reality. But do us a favour and stay quiet will you if you do? I’m trying to sharpen my axe here before a murdering spree and listening to your drivel at close quarters would be distracting.

We’re not sitting round in a Students Union bar pontificating about theory here. Were talking about people ending up DEAD. As in, no longer living. Me included.

Philosophical rhetoric when not grounded in reality is nowt but sophistry of the most facile variety.

Z: FYI: actually, I’ve never been “sectioned”. Had it pointed out to me that if I didn’t admit myself informally that I would be: yes. Mostly though, I’m somewhat fortunate in that in episodes of illness I get a window of about a week where I’m rapidly losing my marbles but still able to appreciate that accepting offers of help would be a good idea. With 1 exception (which ended in A&E) that has meant that by the time I got to the “I want to die and no-one is going to stop me” state I was in a hospital. And I knew if I tried to do a runner, the pink form (or green form, in my home country) would make an appearance, so I stayed put.

Ted

I do like you. I like everyone who puts their point of view forward, it`s sad that so many people read blogs and don`t contribute. I also have an inclination to side with the under dog. Most importantly though, I`m a bit like you, I`m not overly comfortable in grey areas, most things are black and white to me. But even I can see the grey expanses here.

The aetiology of mental illness / distress remains a mystery. We focus on dopamine and seatonin when it has yet to be determined how many neurotransmitters there actually are. 10,000 people are currently detained under the MHA, it can`t be wholly inappropriate in every case. Our resident intellectuals, the Charge Nurse ( who is rationality personified and impartial to a degree ), Z and E disagree
with you. The poorly schooled who don`t make time to read Szasz and Laing ( ME ) fail to be convinced by your assertions. Finally, and most importantly, the patient group aren`t comfortable with your argument.

Perhaps it`s time to reassess my friend.

@ DeeDee Ramona

As I pointed out above, the idea that people must be protected from killing themselves is a difficult position to uphold. Not only in that it doesn’t require the idea of mental illness at all, but also by assuming that being alive is the highest value. So, is it just suicide that ought to be coercively prevented, or all bad decisions? If just suicide, what justifies the distinction? If not, then..

You may disagree with the political theory, but I find it helps to have one which is consistent and be honest and up front about it. The same old “all theory, no practice” rebuttal is terribly misguided. I have had quite a few friends spend time in psychiatric wards, and worked there myself. And having never been diagnosed as mentally ill, I can certify that I am definitely living in reality.

Ah, the old “you’d better know everything about how the current legal framework is written and how works in practice or else you simply can’t argue that locking up innocent people is wrong” trick.

No, I wouldn’t expect you to know *everything* about the current legal framework that we use. Just *something* about it - what the latest developments are, some sort of basic knowledge of the Mental Capacity Act.

For example, you might be willing to make reference to the sorts of mental capacity decisions that might be discussed under that particular act, such as…

Perhaps you might suggest how the alleged facts of mental illness bear on a declaration of legal incompetence. During my time as a nurse, we had to make sure each inpatient was able to vote in the elections! If this doesn’t strike you as absurd, then I don’t know what to say.

Yes, that sort of decision. And no, it doesn’t strike me as absurd, because the Mental Health Act only covers detention and treatment and doesn’t take away other rights, such as the right to vote. However, the decision-specific and time-specific way in which the Mental Capacity Act codifies mental capacity decisions enables us to work on issues on a case-by-case basis…Feel free to stop me if you haven’t a clue what I’m talking about.

Anyways, as OSB says, you haven’t convinced the people who’ve read Laing and Szasz, you haven’t convinced the people who haven’t, and you haven’t convinced the people who use mental health services. So who does that leave for you to try to convince?

Did someone say “Axe”, and “Murdering Spree”? Can we duet? Let us test Ted’s philosophy in a real life situation… But seriously, can anyone who’s spent time with a schizophrenic really turn around and say “Societal Construct”. And what about post-partum psychosis? Was my sister-in-law just trying to express herself in a non-standard way when she picked up the knife and tried to rid the world of the devil she’d just given birth to? Hmmm, the ideas work well with something like autism, but otherwise…

@ zarathustra

I never expected to convince anyone, because most people believe with all their hearts that mental illness is real and that coercion is justified (not only in psychiatry, but in every aspect of our society). It is my opinion that despite the good intentions of mental health nurses, and the many valuable inputs they provide for people who are often not having such a great time, that mental illness a cruel sham which negates human freedom and responsibility. I await the day when underlying body pathology is found for some of the conditions now called mental illnesses (and psychiatrists have to explain why the voluntary basis for medical treatment should be wholly abandoned), but I won’t hold my breath. I’m off for a cigarette, on account of my nicotine dependence.

Ted - I suppose restraining a child from running out in front of a speeding car could be construed as a form of “coercion” ?
But I doubt if even you would argue that “freedom” should be permitted in all circumstances ?

Or what if a demented 80yr old decides to wander out of a nursing home in the middle of the night during sub-zero weather conditions - what then, are you seriously suggesting that this individual should be free to exercise complete self-determination (even if it means freezing to death ?)

You may well be correct to adopt a healthy scepticism about the pervasive nature of psychiatric interventions but perhaps we can still agree that sometimes it might be sensible to inhibit freedom ?

Others experience similar moral (and professional) concerns when it comes to a psychotic teenager who is threatening to jump out of a window - of course, psychosis is an unquestionable phenomena, ask anyone who has tried LSD.

Ted - do you think it would have been appropriate had psychiatric staff intervened to prevent this 8yr old boy from hanging himself ?
http://www.dailymail.co.uk/new.....andad.html

I await the day when underlying body pathology is found for some of the conditions now called mental illnesses (and psychiatrists have to explain why the voluntary basis for medical treatment should be wholly abandoned)

Why should such a pathology lead to any such dilemma?

There are already mental disorders that have a recognised physical pathology e.g.

- Alzheimers Disease
- Vascular Dementia
- Pre-Ictal/Post-Ictal Psychosis

The fact that we have (some) understanding of the physical pathology behind those conditions hasn’t stopped us calling them mental illnesses or applying the Mental Health Act.

This circular argument is becoming increasingly tedious. Can we move on to something else, something Teed might actually have some knowledge of and be able to contribute in a more positive fashion about because he clearly has not one single iota of knowledge about mental illness.

Perhaps what we have here Beakie is a microcosm of the mental health system itself ?

A sane man (Ted) trying to communicate in an insane world ?

Of course the angry mob try to brow beat any dissidents into accepting a consensual view of (their) reality ?

As Charles MacKay remarked :
“Men it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly, and one by one”.
(Memoirs of extraordinary popular delusions and the madness of crowds).

Incidentally, where is Mr Ian- I anticipate a very long post from him, and soon ☺

This may be on the fringe of the current debate. But Legionnaire was first declared to be “mass hysteria”. People were dying from such hysteria! Then the psychiatrist who declared such was himself carried out on a stretcher presumably suffering from the same hysteria. Then the little bug was found. That was not in the middle ages: July 1976.

The Cockroach Catcher

Sorry I’m late. I was taking photos of E and his missus on holiday.

Firstly, congrats to Mental - tho it did take some doing - the sleeping tiger awakens - which means Ted of course. The quasi-predictability of human behaviour (in which risk, and many other psychological functions are based) once again rings true.

And thirdly, who says we need to have a second after a first? What right does anyone have to say how *I* count? Just cos it’s generally accepted by the whole world - accept me - that 2 follows 1, does not make it right. I shall count how I choose.

Fourthly, the arguments appear nothing more than semantics and rhetorical.

Szazs is not anti-psychiatry - he is anti-coercion.
I too hold some concern for the force of the psychiatric movement.
If a baby is cold are we justified to microwave it until it feels warm again on the outside?
The problem exists - mental illness/dysfunction/distress; whatever - cognitive functioning and processing can become impaired in some people and it changes the way they might otherwise behave.
I don’t think this gives us the automatic right to supplement or adjust their neurotransmitters. But then, neither does the Mental Health Act. It qualifies the occasion to be “a danger to self or others”.

Before I agree too far with Ted;
“It is fundamentally true that psychiatrists like detaining people more than they dislike it.”
This is an absolutely unqualified statement and does not ring true in my experience. Indeed, I cannot slow down my current Consultant at the moment. He is keen to discharge every admission as soon as possible - without any risk management strategy or post discharge support plan. Unfortunately this means our discharges often re-present within weeks.

“It is my opinion that despite the good intentions of mental health nurses, and the many valuable inputs they provide for people who are often not having such a great time, that mental illness a cruel sham which negates human freedom and responsibility”

The semantics of mental illness; health and even “treatment” are what seem most at contention. Someone “not having such a great time” will suffice for me as someone who is not at their mental optimum and ergo is often defined as ‘mentally ill’ or dysfunctional or distressed. The words are very much the least of my concerns.

Where I seem to agree with Ted is that coercive psychiatry seems to exist simply because the State says it can. However, I accept the reasoning that State has given to permitting this - as it protects people from other people.
I do not think the MHA should be used as demonstrated in Szasz “Myth of Mental Illness” to incarcerate a farmer who refused to give up his land then pulled a shotgun on the visiting authorities who were serving notice on him for compulsory purchase. He was proven to have the legal right to that land and no one had actually bothered to check his side. This was abuse of the powers by another authority.
I am also amused by the story of the psychiatrist who answered a call for a home assessment of a dementing old lady and determined the woman needed to be admitted - only to find out he’d gone to the wrong address.

Mental Health is not a science. Nor is it of any interest to the Govt - excepting where they might be able to increase the workforce by CBT for people with neurotic depression.
However, and I have met the so called ’scientologist’ types - Victory Outreach was their name at the time and they frequently ‘took in’ recently discharged patients - only to soon have them off their medications and the most frequent ones were those with secondary drug abuse issues who then required to go get their fix by robbing local houses. The place was closed down around the same day as the unfortunate fire within.

Truth is - mental illness; madness; distress - is still the taboo and no one really gives a fuck.
Govt want votes so they protect the public who read the Daily Mail and are scared by silhouetted man in stripy blue shirt looking out of window.

The reality is that psychiatry does not need to be educated or emancipated by or from itself - we need a society that more readily accepts those who are ’socially different’ and are prepared to spend the time to check in on Mr ‘PTSD after the Gulf and now I’ve got voices from smoking so much dope’ next door to make sure he’s got enough food for the week; or Ms single mum with 4 kids and living on benefits who wouldn’t mind someone to come round and have a cuppa once in a while just to break the insanity; or when Miss ‘I got raped by my grand-dad for 7 years up until I was 11 years old and it’s kinda tuff to live with myself after that’ - who gets so distressed by the memory that she explodes in fits of (wholly justifiable and explicable) rage - smashing herself and her world up around her, until she’s over that bout and wants someone to listen to her while she sobs and believe her when she says she’s hurting.

What would be nice is that they didn’t need to be lumped into a hospital because their friendly neighbour or family or significant other was able to cope with the dysfunction to life. But usually they just don’t know how or cannot sustain the emotional trauma.

Ted; if you are happy to pay enough taxes for each of these 10,000 people to have 24/7 care at home from those who can provide that care non-judgmentally and without tiring - I am all for a non-coercive mental health system.

[word count was a little light.... so to keep A&E contented..]

Ted: “I have had quite a few friends spend time in psychiatric wards”

Perhaps if you’d been a better friend, they wouldn’t have?

Or perhaps you just weren’t skilled enough to meet their needs?

Or are you suggesting the mental health system just picked them up as trade was slack at the time?

Everyone wants it better - but until things are different it will remain the same.

Incidentally, on the origins of mental illness - I have never met an in-patient who did not display some form of life-dysfunctioning without a life-related reason for it. Be that drugs, stress, childhood abuse, organic disorder or just plain cannot cope with life anymore by themselves.

Coercive psychiatry is the modality applied to those who perform outside of social expectancies, secondary to psychosocially explicable reason, in a way that compromises the moral expectancies, and is considered for the general beneficence, of that society.

Those without a psychosocially explicable reason for their morally unacceptable behaviour are prisoners.

I love these kind of debates. It is just like Wimbledon, except without the grunting noises and the uniforms. Plenty of balls though.

@ cAsAcambs

“But seriously, can anyone who’s spent time with a schizophrenic really turn around and say “Societal Construct”.”
If you want the criterion of disease to be “spending time with a person,” then fine. But admit that this is more than a long way from the identification of disease as a malfunction of the body. Sure, people diagnosed as mentally ill often act crazy as anything - I’ve spent enough time with them! - but this is not quite the sort of evidence a medical scientist would require to add schizophrenia to long list of diseases in a textbook of pathology.

@ a and e charge nurse

“I suppose restraining a child from running out in front of a speeding car could be construed as a form of “coercion” ?”
“Or what if a demented 80yr old…”
I appreciate the thought, but I am not talking about children, nor adults with proven bodily diseases. I am talking about otherwise legally competent adults who are a) innocent of a crime, and b) have no (relevant) diagnosable bodily disease. This is the standard psychiatric patient (of course, this is becoming less true as the remit of psychiatry expands, but that is another story..).
Also, there is no reason to place speech marks around “coercion”. Unless you are suggesting it is a myth? I’ll assume we can ignore the “do you hate children?” question.

“psychosis is an unquestionable phenomena, ask anyone who has tried LSD.”
I never denied that some people act crazy, and that taking drugs can cause you to lose your mind.

@ zarathustra

“The fact that we have (some) understanding of the physical pathology behind those conditions hasn’t stopped us calling them mental illnesses or applying the Mental Health Act.”
True, of course. But using the MHA to detain those with real illnesses and those without hides precisely what distinguihses them. I am in no sense denying that Alzheimers can remove the agency of a person, and that it is a disease that impinges on the mind - ie on the ability of a person to mind, or to act (hence a “mental” illess rather than a viral illness, or whatever). Someone (I forget who, but probably a famous pioneer of psychiatry - maybe even Kraeplin) once observed that some of his patients, whom he thought had a brain disease, did not display many of the characteristics that others with (then) proven brain diseases had. Many of his patients would live for decades after the initial diagnosis, showing no signs of any physical abnormality. There are too many glaring differences between psychiatric diseases and proven brain diseases to lump them all together and conclude that it is valid to coerce those diagnosed as mentally ill.

@ Mr Ian

“Szazs is not anti-psychiatry - he is anti-coercion.”
Correct. All relevant others take note.

“This is an absolutely unqualified statement and does not ring true in my experience.”
No, you miss my point. If someone does something, it is because they prefer doing it to not doing it. Their reasons may be clear or unclear to themselves and/or others, but this is not the root of the point. For example, a psychiatrist prefers to detain people than to not detain people. He may think he is helping them, or whatever. I am not saying the psychiatrist doesn’t try to detain as few people as possible while retaining employment (many may do so), but rather that if a psychiatrist believed that detaining innocent adults were illegitimate, he would resign at once. In short, those who retain coercive psychiatric powers while bad-mouthing psychiatric coercion are hypocrites.

“Ted; if you are happy to pay enough taxes for each of these 10,000 people to have 24/7 care at home from those who can provide that care non-judgmentally and without tiring - I am all for a non-coercive mental health system.”
Translation: Psychiatry is not about medicine, but resolving social conflict. Mental health laws erode personal responsibility left, right and centre, and are a huge net loss for the hopes of solving the myriad problems experienced by those said to be mentally ill. There are thousands of people who cannot or will not function as self-sufficient adults — I have nothing against helping these people, providing that help is defined by the person receiving it, and that they are at liberty to reject all offers they deem inappropriate.

“Perhaps if you’d been a better friend, they wouldn’t have? / Or perhaps you just weren’t skilled enough to meet their needs? / Or are you suggesting the mental health system just picked them up as trade was slack at the time?”
I don’t really know what you mean, Mr Ian, but I’ll try to answer as best I can. Some of my friends who spend time as inpatients oppose the ideas I have come to hold. When it looked like they might be heading for the psychiatric ward, I was able to inform them honestly of what happens in these places. So many people are unaware of the great powers held and used by psychiatry, and this cannot be a good thing. After all, it is not like the profession go out of their way to inform the general public of the facts!

Just last week I was talking to a friend who has spent time as an inpatient, and her analysis was this: that time away was like a little holiday from life, when she didn’t want to take any responsibility for anything. This was to some extent the story given by some nurses to some inpatients (eg “just think of this as a chance to rest, to sort yourself out, and to get ready for the outside world” or whatever). To be sure, there are times when taking a short break from life can be a very wise decision. My point is that adding coercion to that important service can only be detrimental to the very people who desire help.

@Ted
Society will not accept your libertarian views.

It is as simple as that.
But I understand your point - and moreover I subscribe to the theory of it. Much as I do the theory of Mohammed or God or perpetual motion or time travel or “a free lunch”.

It’s a nice idea – but it has no basis in reality. I would like you to example how your considered principles would work in practice.
In return, I will proffer my more considered opinion on coercive psychiatry and hnow it works in my reality….

MHA provisions are made for containing someone deemed a danger to self or others. I see no flaw in the principle that anyone considered dangerous should be removed from the society that would deem them so. This is upholding moral principles through social control. The same principles should be applied to non-mentally ill offenders and in some parts of the world they are. The argument against the individuals human rights are outweighed by societies right to a safe environment. This is the theoretical principle. Sometimes it is over-applied. I will discuss this further below.

Public stigmatism of mentally ill people plays a large role in why our society is less accepting than it perhaps should be – but we (the service) provide what those in powe