Moving on from stigma

Pausing on the concept of stigma to try and build upon ways of knowing about what we need to know, it is worth acknowledging the breadth of approaches beyond any simple or false dichotomy of the world owned by mainstream psychiatry versus it’s anterior and posterior oppositions.  In other words, although we know that even within psychiatric circles there is incredible disagreement there have also been formal currents since the 1960s such as: anti-psychiatry, alternative psychiatry and critical psychiatry.  In fairly recent times, and as noted elsewhere, the Royal College of Psychiatrists have even spent considerable time and effort on various media campaigns aimed at combating stigma.  

A fixed or determinate definition of stigma that people as individuals face might mislead any multi-faceted enquiry more than it assists, as if somehow the thing to be explained was more important than the on-going act of explanation of this, and other (observable) phenomena alongside other things we think to be real but cannot depict in words.  If you want to know more about enquiries into the theme of stigma then Erving Goffman’s 1963 work is widely renowned, referred to, discussed and available.

The history though, of attempts to understand what appears now as another spectre looming over the known human world, commences prior to this I believe; but let's start with the simple contention from chapter 2 of Rogers & Pilgrim’s ‘Sociology of Mental Health and Illness’ that from the 17^th century, largely European notions of other-worldly demons are used gradually less and less to explain and account for mental turmoil.  Where medical explanations arise, Foucault’s ‘possibility’ of psychiatry can be inserted, and as we reach the 19^th century Rogers & Pilgrim note that

“The early days of psychiatry in the 19^th century were heavily influenced by eugenic considerations- [and] it was assumed that a variety of deviant conducts could be explained by a tainted gene pool in the lower social classes.”

Class may be beyond our remit for this post, but needless to say that all actions do have a social context just as various factors in diagnostics in turn feed into living statistics and are almost impossible to remove from the historical process by an observer.  Jean-Paul Sartre is one individual whose existential inclination is said to try and look at the connections of socio-economic structures with the inner lives of individuals. 

And of his ilk?  Please do be aware of the critical theory embodied in the 20^th century Frankfurt School of Max Horkheimer, Herbert Marcuse, Theodor Adorno, Walter Benjamin and so on; in as much as their materialist Marxian-Freudian enquiries can help us.

To come at things from the perspective of an individual is difficult.  The synthesis of materialism and idealism is elusive in the real world just as in all of our small but ever expansive minds.  When it comes down to disagreements over the connections between individual words, such as illness, in relation to what we can detect and what we know too; then perhaps a step back is needed. 

My take on the theme is that the hypothetical spectrum from wellbeing to illness, if seen as a continuum, raises the question of at what point the balance is tipped towards illness?  The continuum may be a helpful way of viewing things, but the spectrum that ends in ‘illness’ may raise objections from many.  Psychoanalysts perhaps, may be amongst those who adhere to the view that we are all neurotic to the extent that may make us ‘ill’ someday, or some days- or neurotic some days at least.

In a token defence of the continuum model above, perhaps we need to point not just to the medical model but to the legal status of certain loose definitions of insanity in order to say, that with the best of intentions, we could temporarily conclude that nobody is ever ‘ill’.  The late Thomas Szasz, most famous for his ‘Myth of Mental Illness’ (1960), went to great lengths to challenge the 'illness' model.  

It does seem that in many circumstances his message can be accepted.  But think then, of the terms ‘not very well’, or ‘poorly’ and ask if these are any better for a person with visible signs of unknown malaise?  Terminological substitution is all that happens in some circles.. Not to mention the hermenutical extensions of known physical ailments being definitionally non-existent by the same logic that Szasz applies.

The previous point about legal status is relevant because if both a psychiatrist, or series of psychiatrists, in conjunction with various legal agencies such as healthcare assessors (for state benefit purposes) or perhaps employment tribunals or even courts of law, deem a person to be ‘ill’ and we deem them be ‘not ill’ then there is a problem.  Although a dialectical model of logic can say that they are perhaps both ‘ill and not ill’ the real world may have trouble keeping up. 

One cannot both reside in prison and be geographically free to roam, or work full time and volunteer full time simultaneously- unless of course we extend this example to ridiculous lengths.  Similarly, one cannot both be sacked and quit, although compromises could be sought.

It would seem reasonable to surmise briefly that we are very much on structural terrain which is non un-politicised.  The once feminist contention that the ‘personal is political’ can illuminate a world-view where high-politics (of statecraft and macro economics) perpetually disengages from the low-politics of body and interior aspects of mind.  We can’t really say that just because it's flawed to view issues of mental health in individualised terms that individual circumstances and even thoughts are irrelevant.  Even a utilitarian could agree that if enough people have neurosis or psychosis then there must be substantial shifts in accommodation of need.  

Where language is concerned R D Laing once pointed out the concern of a lack of adequate terminology to describe those nether regions of the brain which we all tread through each day and night.  Where misnomers such as ‘illness’ abound, is it currently better or worse to take away the one thing that may protect the rights of a potentially vulnerable individual?  Ah, I hear you say, ‘but if it feeds back into our self-understanding and is used as a basis to disable parts of the brain chemically over time, are we not all, well, kind of doomed?’

Without wanting to become sarcastic, I believe that the development of the human brain has taken more years than the development of neuroleptic medication.  In conjunction with-  and in opposition to-  other brains, our adjustments to the world continue on (despite recent headlines made elsewhere. In fairness, David Attenborough does acknowledge our on-going cultural evolution article here).  It seems plausible perhaps to say that if alcohol, caffeine, nicotine and other substances are included, most people use drugs of some sort. 

Where prescriptions are concerned, the proportion of us on powerful mind altering substances may or may not rise but; and excuse the purposeful double negative- this can’t have no long term effect.  The impossible magic pill to fix or regulate all aspects of necessarily organic and dynamic brain chemistry is a matter for stories and films alone, but if we carry on as we are,  without it one day we are truly damned.

Disney's Mickey Mouse as the Sorcerer's Apprentice

 

During recent times, it has been brought to our attention that the chair of the Diagnostic and Statistical Manual IV committee Allen Frances, has decided, for his efforts and sins, that medication has too large a role.  Now that DSM V is about, this leading US psychiatrist has made a significant statement.  It does need to be noted that more prescriptions are made in the US than in Europe to date, but areas for hope should always be incorporated into monologues and hopefully discussions too.

Practically once more, a good friend of mine once said that ‘society has the work:fun ratio all wrong’. Depending on how one sees both work and play, there are certainly issues to do with emphasis on economic (narrowly conceived) output (measured finitely and rationally) in relation to specie-al wellbeing.  Either as individuals or not, with enough of us in play, it may be necessary to move beyond complaining of unfairness based on historically subjective notions obtaining objective status against which present notions of equity are deemed too subjective and narrow..- and on towards some more rigorous conceptions.

Considering the wide reach of serious ‘mental health issues’- in the UK and beyond what does the future of health care look like?  What roles and space for talking and communication can be in-built and do we all need therapy?  Furthermore, what is a reasonable working day or week now, given consistent difficulties for some and also the lack of full employment for all amidst recurrent issues of growth, which regularly falls below David Harvey’s recent assertion that capitalism requires growth to be maintained at around 3% of gross domestic product in order to survive.

It’s not possible to extend this much now, but needless to say that of course, everyone struggles sometimes.  All I would suggest is that fighting illusory or real mental demons is different (if not separate) to having practical based problems.  The point is also, examples such as psychosis now brings increased problems for some people - and even if you conquer your great inner personal challenges you are then required to exist and compete in an imbalanced social world where the battles you have fought may mean next to nothing to anybody else.