Professionals are paid to share their wisdom with those who are, typically, less informed. But, when dealing with mental health professionals in the psychiatric arena, it is wise to retain a degree of skepticism about the words spoken by the doctors and nurses commissioned to help reduce human misery and suffering.
During my 33 years of employment within the UK’s mental health services, I witnessed many colleagues, from a range of professions, who strove to alleviate the distress and suffering of the people who sought their help. Some offered humane, person-centred support, recognising that the patients’ emotional and behavioural problems were primarily the products of their life experiences and subsequent – often desperate – attempts to cope with these challenges. In contrast, many others had bought into the dominant bio-medical (‘illness like any other’) approach espoused by traditional psychiatry, thereby instilling an unhelpful and misleading slant to their interactions with service users.
Throughout my career as a clinical psychologist working in the National Health Service, I heard this latter group of psychiatric staff regularly say things, to their patients or to other professionals, which could be classified as invalid, hope-quashing, stigmatising or unethical. Given that the bio-medical approach to human suffering has now been broadly discredited – even many traditional psychiatrists acknowledge the folly of this paradigm – I would expect the frequency of these utterances to be reducing within modern mental health services.
I list below six statements that I heard on a regular basis during my time in the psychiatric system, followed by a brief commentary. Let me know in the comments section whether any of these continue to survive in the lexicons of psychiatric professionals.
- ‘Does the patient have a severe and enduring mental illness?’
As well as conveying undue pessimism about the likelihood of recovery, this question (a favourite of psychiatrists during the weekly multi-disciplinary meeting) assumes there is a clear demarcation between those with a ‘mental illness’ and other overwhelmed, highly distressed people. In addition, the query wrongly implies that psychiatric diagnoses are meaningful.
- ‘Is this illness or behaviour?’
This, rather bizarre, question was often posed when discussing a patient who is chaotic, agitated and challenging. As above, it unhelpfully implies that there is a clear dividing line between the ‘mentally ill’ and the rest of us. Worse still, there are pejorative undercurrents consistent with the idea that people expressing high levels of misery and distress fall into one of two categories, either mad or bad. Typically, what is really being asked is whether the patient’s symptoms fit the diagnostic criteria for schizophrenia, bipolar disorder, major depression (regarded as proper illnesses and the sufferers, therefore, deemed worthy of help and compassion) or that of a personality disorder (regarded as not a proper illness and the sufferer undeserving of help or compassion).
- ‘It would be unethical to withdraw his antipsychotic medication; he has a definite diagnosis of schizophrenia’
I’ve heard this kind of comment from psychiatrists when asked – either directly by the patient, or indirectly by a professional working closely with the patient – to consider the withdrawal of psychotropic medication. As well as, again, unduly assuming that psychiatric diagnoses are valid, it conveys the erroneous message that anyone experiencing voice-hearing or unusual beliefs can only be helped by medication, in the same way that someone with Type 1 diabetes can only benefit from daily injections of insulin. Also, the statement indicates no regard for the informed views of the service users.
- ‘I suspect there may be a lurking depression’
This one I always found rather comical, conjuring up images of some pathological intruder hiding in the folds of the brain, waiting to pounce and thereby incapacitate its host with depressive symptoms [come to think of it, I suspect Ruby Wax would concur!]. The comment – a favourite of biological psychiatrists – is another expression underpinned by the spurious assumption that mental health problems are primarily caused by biological defects.
- ‘If you don’t accept treatment you’ll give me no option other than to section you’
This stark example of misuse of power is commonly heard when a patient is expressing reluctance about taking the medication regime prescribed by the psychiatrist. Whether or not a person can be legitimately detained under a section of the Mental Health Act should be determined solely on the basis of the presentation – in the UK legal framework, the assessed level of risk and the presence of a ‘mental disorder’ – not whether the individual is willing to comply with the doctor’s treatment plan.
- ‘We’ll keep on tweaking the medication until we get it right’
What this usually means in practice is that the dose of the current drug will be increased in stages until it reaches the maximum permitted (sometimes well beyond this upper threshold). If the sought-after improvement is not realised, another drug will be introduced, either instead of or in addition to the original one, and the incremental increase in dose will start again. As with example 3, the false assumption underlying this practice is that some form of biological treatment is essential to achieve recovery. Furthermore, when this ‘tweaking’ continues over a long period of time, any noticeable improvement that does occur is immediately credited to the medication rather than any of the multitude of other factors – life events, relationships, community engagement, talking therapy – that could be influencing the person’s wellbeing.
I am keen to discover to what degree these utterances persist in day-to-day practice. Maybe those readers who are still involved in mainstream psychiatric services, either as a service user or a professional, could let me know via the comments section.