Over on Lyra's 'Weirdo revulsion' thread, Abigail Blue (who I hope won't mind my quoting her) argued persuasively against psychiatric diagnosis/labelling:
Once someone's been diagnosed with a mental illness, they internalize that label, and become a Schizophrenic, say, instead of a person suffering from schizophrenia.
Being told you're 'mentally ill' is a brutal process, if you believe the diagnosis. It's sort of like being emotionally eviscerated. That sort of inner turmoil tends to show up externally.
...I always viewed my diagnosis as crap, and my supposed illness as a natural reaction to unnatural circumstances (years of emotional abuse). I think that, sometimes, 'mental illness' is a process of coping with really big and unpleasant things, and that coming out the other end as a whole human being is possible.
On Rage's 'Identiopathic Personality Disorder' thread, in the Laboratory, Iszabelle expressed broadly similar concerns:
I understand what they're getting at (kinda), can point at a couple of folks I know: "Do you mean like that?" but I hate how this appears to be another way of pathologizing/marginalizing subcultures and dissenting viewpoints.
Rage, never one to mince words, was blunter in her criticism:
Personality disorders are bullshit. They're the most ridiculous thing around
(I love you, Rage...)
These are only the most recent expression of Barbelith's seeming-familiar (to me, anyway) tendency toward anti-psychiatry. The Anti-Psychiatry sociopolitical movement was most popular in the late 1960s and early '70s; its best-known proponents were R D Laing and Thomas Szasz. Put simply, it was a rejection of the methodologies and underlying assumptions of 'traditional' psychiatry. Laing, in particular, argued strongly against the 'demoralising' process of psychiatric diagnosis, while Szasz went so far as to decry mental illness as a 'myth'. He made a distinction between 'brain' disorders and 'life problems', implying that doctors should have no role in attempting to address the latter.
Personally, I find the anti-psychiatric worldview extremely seductive, with much to recommend it - not least the fact that it maps fairly well onto the 'stop whining and adapt' school of dealing with life problems. In seeking to empower the 'mentally ill' individual (who, argue the anti-psychiatrists, would typically be treated as a blameless-but-powerless object within the psychiatric system) the anti-psychiatry philosophy implies the existence of responsibility on the part of the individual...
... which, anecdotally, would make a refreshing change from the more common air of entitlement in those who present at psychiatric out-patient clinics. As shrinks go, I'm a relatively reluctant prescriber and like to explore other avenues first - self-help groups, counselling, practical (Citizen's Advice Bureau) help with day-to-day stressors. I'd estimate that around eight out of ten people to whom I don't prescribe medication are unhappy about it, feel (and usually tell me) I've short-changed them. Talking to colleagues in General Practice confirms that the pressure to provide a Universal Panacea in tablet form is stronger than ever. Makeover culture: we all want the quick fix.
And therein lies the problem, as I see it, with anti-psychiatry - or, at least, the modern variant. People get stressed, unhappy but don't want to be diagnosed as psychiatrically ill... yet they approach a doctor for help and, more-often-than-not, want that 'help' in prescription form. We reject the stigma of being labelled 'mentally ill' while demanding to be treated (in terms of pharmacology, psychotherapy or other 'support') as if we are. We want to have our cake and eat it too...
Abigail Blue again:
... other than MDs or Psychologists/Psychiatrists, there aren't a whole lot of resources for people who don't want to be medicated or subjected to analysis. I had a really hard time finding someone who shared my opinion that I wasn't ill, rather that I was dealing with something and didn't quite know how to go about it.
It might surprise some to learn that the majority of doctors share those sentiments. In every study of the factors underlying low morale within the medical profession (and GPs in particular), 'inappropriate demands' is up there in the top three collective gripes. Whatever the reason (rise of 'victim culture', media-fed expectation of 24-hour happiness, fragmentation of family and traditional Church/community-based support networks, etc.), more and more people are insisting that their doctors help them cope with the stresses and unhappinesses of modern living. Faced with such unrelenting demand, doctors either dig their heels in and point out the limitations of medicine (difficult, unrewarding, unpopular) or give in and reach for the prescription pad (easier, but contributes to the overmedicalisation of Life In General). No-win.
We don't like the situation either. We know there are precious-few resources out there. We know it's not 'illness' but you've come to us expecting some sort of help, haven't you? We're doctors - what do you want us to do?
To summarise on a more constructive, less 'Us & Them' note:
1) Whose problem is it? How should we, as a society, deal with that mass of suffering humanity which cannot cope, wants 'help', but is not (or does not want to be viewed as) 'ill'? Who should be responsible for providing such help? Can 'paid strangers' ever fill the role of friends, family, loved ones?
2) Do doctors have a role to play? What, and why? |
And thanks for starting this thread: It was getting a little off-topic over there.