Posted by Mark H. on November 10, 2000, at 20:51:55
In reply to Does Mental Illness Exist? Feedback Requested!, posted by pullmarine on October 29, 2000, at 21:18:59
"When [mental illness] involves violating the rights of others, nonconformity with social norms or values must be curbed or stopped with various measures, criminal law being one example."
(Quote from Stevens' "Does Mental Illness Exist?")
I've enjoyed reading everyone's contributions to this thread. The above excerpt is at the crux of this issue for me.
I believe that "Does mental illness exist?" is the wrong question, because it assumes there is a sweeping yes-or-no answer with far-reaching implications in both medicine and law.
The author cites familiar examples of cultural and personal differences being pathologized by psychiatry. To his list, I would add dissidents in the former Soviet Union who were declared "mentally ill" and imprisoned for disagreeing with the Communist Party line as a gross abuse of the label.
But in the other direction, the "mental illness doesn't exist" direction, there are countless equal abuses, especially now in the United States, where for economic reasons most of our publicly supported in-patient mental health facilities have been closed, and even floridly psychotic individuals are warehoused in prisons that rival the medieval "insane asylums" in their deprivation and total lack of care for people who are incapable of caring for themselves.
I think we need to ask, "Who asks the question, and why?" (I mean this rhetorically, pullmarine; I'm glad you raised the issue.)
One group, the Scientologists, are one of the most outspoken and adamantly anti-psychiatric organizations in the United States. Since they are also notoriously litigious, I won't speculate on their reasons, except to say that they offer a very expensive alternative that would benefit greatly if psychiatry and psychopharmacology were banned. Follow the money.
Likewise, pharmaceutical companies have an enormous interest in promoting the use of their products, which necessarily includes finding the maximum number of conditions for which a medicine can be used (lucky for them if an anti-depressant helps people stop smoking and also reduces chronic pain, for instance). Again, just follow the money.
The war on drugs is a multi-billion dollar a year industry in itself. Criminalization of self-medication, especially by politically less powerful minorities, is big business by any standard. Why is law enforcement so universally reluctant to adopt a medical model of addiction and drug abuse? Again, follow the money. If forfeiture revenues make up 10% to 30% of your department budget, would you be for or against continuing to define drug use as criminal?
There is a man, a truly evil man in my opinion, who testifies in court cases all over the country, who has never met a murderer who he could not convincingly prove to a jury was "legally sane." It's just a job for him -- a very well paid job -- to misuse logic so that frightened juries can send lunatics to prison on a technicality. Even the former head of the FBI's Behavioral Sciences Division believes this man has gone too far on some occasions.
Historically, the lower classes self-medicated with street drugs. The upper class expected their doctors to make them feel well, regardless of the cause. For those of us who are middle-aged, we can well remember that not that long ago the vast middle class was expected to "suck it up" and go to work, well or ill, and to go through life mostly untreated for mental and emotional ailments.
That has changed -- there are millions of us who refuse to use illegal drugs, who have given up alcohol and even caffeine abuse, but don't think we should suffer without treatment just because we aren't rich or poor. In time, some of our notions will prove folly, while others will be accepted as "it was about time you guys figured out how to get some help for that."
In the end, it doesn't matter whether mental illness exists or not, as long as individuals are free to experiment with improving their lives in a private, secure and legal relationship with their doctors, and with the reasonable assurance that their treatment will be respected and covered as it is for any other "complaint." For now, that freedom is best respected by retaining a fairly broad definition of mental illness.
Just within the last couple of weeks in the Times, there were articles on new gene research showing multiple links with specific chromosomes for schizophrenia. Thank heavens!
All of the psychoses are profoundly disabling. When such disability exists, the question becomes whether to treat people who have them as ill and therefore deserving of compassionate care or as criminals to be locked away in concrete cubicles, forgotten and unmedicated. Since in our hard and cruel times this question has been increasingly answered in economic terms, it is good to note that finally people are beginning to notice that we cannot afford our prisons either, and that perhaps a more humane approach doesn't have to cost any more.
Thanks for reading my thoughts,