Tuesday, November 29, 2016

Definition of mental illness

I have been thinking about the definition of mental illness by Dinesh Bhugra, Antonio Ventriglio and Kam Bhui which I quoted in my previous post. Dinesh and Antonio Ventriglio would be seen as representatives of social psychiatry (eg. see their article). Kam would be seen as a representative of cultural psychiatry, being a Professor of Cultural Psychiatry and Epidemiology. It concerns me than modern social and cultural psychiatry are apparently diluted versions of biomedical psychiatry.

Mental illness is not merely a "socially elaborated" state. Proper social and cultural psychiatrists would recognise the psychosocial origins of mental disorder.  They should not merely be talking about incorporating "sociocultural dimensions of individual experiences and distress as life story narratives" into diagnostic and management frameworks. Understanding these narratives can provide reasons for mental health problems. However helpful the perspective of McHugh & Slavney may be, there are problems with it (see previous post). Talking about getting "social psychiatry at the core of our clinical practice" (see article) won't happen if "neurophysiological or chemical alterations in body or brain functions" are seen as the cause of mental illness. I'm all for recognising the need to "reclaim professionalism and renew our contract with society", but we don't need genomics and epigenetics to tell us that psychiatric disorders are caused by psychosocial determinants. Transcultural psychiatry should not encourage a biomedical model of mental illness for all mental health systems worldwide (see previous post).

I've said before (eg. see previous post) that psychiatry needs to be more thoroughgoing in adopting a sociopsychobiological model of mental illness. In the last chapter of my Critical psychiatry book, I showed that Julian Leff, who represented social psychiatry for a previous generation, still upheld the biomedical model (see extract). It seems the present generation of social psychiatrists are no different. 

1 comment:

Chrys Muirhead said...

I've always believed that mental illness was caused by psychiatry therefore when I got caught in their net after experiencing psychosis, due to traumatic childbirth twice, menopausal transition once, I escaped the life sentence by tapering the drugs and making a full recovery. Three times.

I've helped other family members resist mental illness even when they have chosen to remain on the drugs which were forced in. Some of us got off the drugs, sooner or later. Those of us who got off within the year of being made to conform fared better, physically and mentally. Even in 1978 when first engaging with psychiatry, following painful, induced birth of second son, I had it in mind to get off Chlorpromazine within the year. And so I did, when living in South Lanarkshire. Same again after painful, induced birth of third son, November 1984. More traumatic treatment which included forced internal examination, one week after childbirth, being held down by 3 nurses, my husband a witness.

These demonstrations of force in psychiatric settings made me an even more determined unbeliever in mental illness. I would not voluntarily swallow their pills. They would have to coerce me. Then I would taper when my strength returned, shaking dust off my heels, get back on with life. The "recovery movement" tempted me back in to mental health matters, in 2008 proper. Since then I've had to take up cudgels on my youngest son's behalf, following major psychiatric abuse in February 2012, Stratheden Hospital, Fife. Locked seclusion room, no toilet, in the dark, for hours on end. Sub-human treatment. Confirming my lifelong held belief that mental illness is caused by psychiatry, affecting everyone who works in/engages with the system. It's madness.