Mad, bad and diseased
Phil Barker takes issue with journalistic and social conventions
I returned home from Japan to find the papers awash with the Mental Health Bill. The Guardian leader on Saturday 11 September was fairly typical, illustrating how supposedly intelligent journalists still fail to understand the nature of 'mental illness'. The leader made a compassionate appeal for 'reason' concerning this 'disease' that (allegedly) affects a significant proportion of the population. (Journalists cannot be blamed entirely for their reification of the 'biological model', given that they have been fed a diet of biological myths and half-truths for generations by medicine and its allies.) The 'disease' that generates the problems that require a Mental Health Act in the first place remains metaphorical, which is why all attempts to 'treat' it or 'legislate' for it remain trapped by semantics. If only our law-makers and their 'clinical' advisers would acknowledge this fact.
If nothing else, the Mental Health Bill illustrates the bankrupt state of contemporary psychiatric medicine, which promiscuously employs terms like 'mental health problems', 'mental illness' and 'mental disorder', as if they all referred to the same thing. If physicians (or leader writers) talked as vaguely, and as often, about problems of 'physical illness' or 'physical health' we might think they were merely disguising their ignorance.
Society has always had members who do awful things, which most people find unfathomable. To attribute the actions of these dangerous or difficult people to some abstract thing called 'mental illness' is no better than blaming possession by demons. Despite its bluff and bluster, psychiatry still can offer no medical test to reveal the 'chemical imbalances' and other 'biological anomalies' that, allegedly, cause such aberrant behaviour. The legalistic and politically correct language of 'disorder' and 'mental health problems' merely reframes, but fails to explicate, these unfathomable phenomena. At some point, opposition to revisions of the Mental Health Act must address the values, philosophy and pseudo-science that supports the legal framework.
The difference between 'psychopaths' who revel in killing or abuse in the name of war, racism, sectarianism, or terrorism and those who do this 'for no good reason' is merely contextual. Any good that the Bill might do, in terms of freeing unfortunate (distressed) people to make choices or be protected against the traditional authority of psychiatry, has been undermined (again) by specious generalisations about the 'mentally ill'. If there are significant numbers of people who threaten society at large, then they must be addressed by mainstream civil or criminal law. To do otherwise risks sanctioning practices not far removed from ducking witches.
People who are viewed as a 'threat' to society deserve fair, compassionate judicial consideration. We already have a legal system that can at least provide the judicial consideration. Our aim should be to reform it to make sure that it is both fair and compassionate. In some countries - France, for example - 'crimes of passion' (which presumably involve some kind of 'mental aberration') are accepted and understood. There is no (logical) reason why our society cannot deal with alleged criminals without taking contextual reports into account. Indeed, we already do this, to a limited extent. Whether or not we need a 'Mental Health Act' is a question that sorely needs addressing.
Attempts to extend the existing Mental Health Act to detain and contain people who have committed no crime (but who are feared - rightly or wrongly - by the community) would take this society some considerable way over the edge of a very slippery, Orwellian slope. In my view, such action itself is not simply contrary to human rights but is, by definition, criminal. We find yesterday's pre-frontal lobotomy abhorrent, but appear to find no difficulty in generating irreversible brain damage through administration of 'antipsychotics'. That a considerable number of the recipients of such toxic chemicals gain no obvious benefit, and that a significant proportion experience risk of cardiac failure, is largely ignored by those who push for greater powers of 'enforcement' of treatment orders.
Regrettably our society, both professional and lay members, has been acculturated in the tradition of doing dangerous things to people 'in their best interests'. We pursue these joint aims of detaining (without trial) 'potentially dangerous' people and forcibly 'treat' others against their wishes, because we have effectively buried any public discourse concerning the legitimacy of the models of madness that feeds the need for such actions.
Phil Barker is a psychotherapist in private practice, Visiting Professor, Trinity College, Dublin, and Honorary Professor, University of Dundee