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Ideas about mental health and mental illness have changed over the last twenty years. Some old ideas like ‘chemical imbalance’ and ‘a gene for this and a gene for that’ linger on despite the fact that research has shown that these ideas are not hypotheses but myths. There is now a general acceptance of the idea that mental distress can be relieved by talking to a listener who has no vested interest in the situation which gave rise to the distress. The media take this idea for granted, but many members of the media fail to grasp what the talking therapies are, and speak of counselling as being a kind of unguent which is poured over some unfortunate person, as in ‘the victims were counselled’. No one would willingly talk to the media about being psychotic because the media, and many members of the public, still regard anyone diagnosed as schizophrenic as being a potential axe murderer. Yet prominent figures now speak openly of their depression, and pop stars seem to regard as obligatory a drug habit followed by a period in a fashionable psychiatric clinic. Politicians speak most sympathetically about the necessity for good mental health care, though the money for such a service rarely follows through. But, in all, when it comes to mental illness, everyone’s heart is in the right place.
Or is it? Despite all the changes for the better, the notion that madness is some strange thing that can fall upon an unwitting individual at any time is as strongly held as ever. The language in which we talk about madness might have changed, but the belief in that strange, wilful, sinister, mysterious force is still in the minds of most people, including the minds of those who ought to know better. To be seen to be mad is still regarded as being alien, no longer a full member of the human race. The Royal College of Psychiatrists and MIND, the National Association for Mental Health, have run a campaign aimed at removing the stigma of madness, or, in current terminology, ‘having a mental health problem’, while some sections of the media have a stylebook setting out what language may or may not be used (the Guardian stylebook bans ‘offensive and unacceptable terms such as “loony, nutter, psycho and schizo”’). However, little seems to have changed in private attitudes. Despite the courageous work by members of the user/survivor movement, the term ‘mental health problem’ is taking on all the negative connotations of ‘mentally ill’. Writing about the report issued by the National Institute for Clinical Excellence (NICE) following their study ‘Mental Health and the National Press’,1 the journalist Lynne Eaton summed up NICE’s results with, ‘Some of the reports about people suffering mental illness, particularly news stories, contain a level of discrimination that would be deemed unacceptable for most other social groups (except, perhaps, Gypsies and asylum seekers).’2
In their report, NICE recommended that mental health professionals be prepared to inform the press about mental health issues. However, the language used by the majority of mental health professionals is itself suspect. In 1987, when the first edition of Beyond Fear was published, psychiatrists spoke of mental illness. In the intervening years the word ‘illness’ has disappeared from the diagnoses used by psychiatrists, though not from their general discourse, to be replaced by the word ‘disorder’. When I first came to England in 1968 and worked in psychiatric hospitals there were only five basic mental illnesses, namely, schizophrenia, manic-depression, anxiety and phobias, obsessions and compulsions, and depression. The behaviours associated with these diagnoses are very distinctive and found in all societies and throughout recorded history. Many of the psychiatrists I worked with had their own idiosyncratic diagnoses for people who could not be fitted into any of these categories. At Middlewood Hospital (a Sheffield psychiatric hospital now mercifully closed) a favourite diagnosis was ‘Irish’. Over the years the idiosyncratic diagnoses of American psychiatrists were pooled and the more popular ones were presented in what is now a vast tome, the Diagnostic and Statistical Manual (DSM - Revision IV) which covers all the ways we can behave when faced with a very difficult situation. We are all in the DSM, at least once. Psychiatrists have medicalized life, and, in so doing, joined forces with an international business comparable in size, wealth and power with the arms trade and the oil business - the pharmaceutical industry.
Psychiatric ideas of mental illness and mental disorder are based on ‘the oversimplified medical model that forms part of the culture of psychiatry, the “illness-treatment-recovery model”’ which the retired psychiatrist David Whitwell calls ‘naïve psychiatry’. This ‘focuses on short-term improvements in symptoms as a main target for intervention. Although its origins are over fifty years old, and it reflects an outdated concept of what it is to recover from mental illness, it is still very much in evidence.’ In his many years of work in acute psychiatry, David Whitwell came to see that, ‘The claims made by professors of psychopharmacology and the drug companies for their products were never fulfilled in practice. The new clever therapies never seemed to produce the transformations they promised. And as time went on I could see less and less value in the elaborate systems of diagnosis and classification that are so central to psychiatry… I became more aware of the power and effectiveness of the non-specific factors which help people recover.’3
‘Naïve psychiatry’ may still be flourishing but so is naïve psychology. If this psychology were water it wouldn’t wet the soles of your feet. When I read much of the work of my colleagues, whether academic papers in learned journals or self-help books for the general public, I get the feeling that most members of my profession have led extraordinarily sheltered lives, or perhaps in their teens they encountered life in all its crudity and messiness. Recoiling in horror, they comforted themselves with a fantasy of a pleasant, technicolour world where all problems are soluble. To maintain this fantasy into adulthood they had to ignore anything to do with politics. Traditionally, the British Psychological Society (BPS) has viewed politics as distasteful. More recently psychologists in the UK, along with those in the USA and Australia, have come to fear that any interest in the political aspects of their work could threaten their livelihood in a highly competitive market. Such timidity has led to the BPS’s professional journal, The Psychologist, reading like a high-school magazine written by diligent, unquestioning students. Psychologists feel sorry for their clients, but the way most of them talk about their clients, both publicly and privately, reveals that they do not see their clients as fellow adults but as wayward children whom they can teach to live in sensible ways. They present their advice to these children briskly and with authority because they feel it would lessen their standing in their profession and in the eyes of the public to admit to doubt and inadequacy. They seem to have no measure of how naïve they are.
There are those academic psychologists who live in a world of very long words, all of them abstract nouns. To them people are but containers for traits such as ‘sociability’, ‘religiosity’, ‘extraversion’ and ‘introversion’. (In much the same way naïve psychiatrists see people as mere containers for ‘depression’ or ‘schizophrenia’.) Psychologists discover these abstract nouns by giving groups of people questionnaires about what they do. Their answers are reduced to numbers, and these numbers are put through some statistical processes to see how the answers clump together in different groups. These groups are given abstract nouns as names, and these names are regarded as being ‘factors’ or ‘traits’ which explain why people behave as they do. Thus, these psychologists know that you don’t have dinner with your friends because you like to see them but because