So What is Mental Disorder? Part 2: The Social Problem

Joanna Moncrieff, MD
79
1909

The ‘problems of living’ that Szasz identifies as being referred to as ‘mental illness’ are, in his view, the inevitable consequence of the ‘moral conflict in human relations’ (1970, p 24).1 For Szasz, therefore, mental disorders are patterns of conduct or behaviour that are not just baffling or eccentric, but are identified as problematic by the group or society in which they are embedded. So one way to understand ‘mental disorder’ is to ask what sort of social problems are referred to in this way. In other words, what social functions do services for people with mental disorders fulfill?

Here are some further examples (in addition to the one described in the previous blog in this series) of the sort of situations that occur frequently in mental health services:

A young man becomes increasingly obsessed with religion. He can’t concentrate on his studies and has to drop out of college. He starts screaming and shouting about God in and outside his house, and at one point he pins his terrified mother to the floor, shouting at her to confess her sins. He then drags his sister out of the house still shouting and the police arrive and apprehend him.2

A professional woman with three young children starts to become increasingly preoccupied with writing poetry, to the extent that she loses interest in her children and in the ‘practical details of living’. She starts to express the idea that there has been a world catastrophe that she is responsible for, and she describes feeling afraid but also having a sense of importance. She talks to an imaginary companion, but has no desire to communicate with real people. She is admitted to hospital in a ‘rigid catatonic condition’.3

A man starts to believe there are evil spirits in his house and that he needs to decontaminate it. He starts lighting little fires in the house, and then lights a large fire in the garden, which burns down the whole garden and might have spread to the house or neighbouring properties had the neighbours not called the fire service in time.

Following retirement and the death of his wife, a man becomes depressed and stops looking after himself. Gradually he does less and less until he is found by his children in a state of advanced self-neglect. He is admitted to hospital and then a care home, where he is reliant on full-time care for several years.

In the last blog in this series, I suggested that some forms of mental disorder involve a loss or alteration of normal reasoning processes. Although this is distinguishable from the consequences of brain disease (not simply a depletion of abilities, as described in another previous blog), the cases described above illustrate how the social consequences can be similar. Like some cases of brain disease, the behaviour we refer to as mental disorder can render the individual unable to look after themselves, or liable to behave in ways that others find disturbing.

As I have described in another earlier blog, we can learn much from looking at history. In particular we see that these sorts of problems have beset society for centuries, and we can perhaps also learn something from the ways in which former communities dealt with them.

One of the first formal systems for looking after people who were unable to get by was the English Poor Law, which was first passed under the Tudors. This consisted of a bureaucratic system centering on the local church or Parish. Parish officials administered the Poor Law, collecting taxes (rates) and distributing the proceeds to local people who needed assistance. Recipients included families of people who were unable to earn a living or fulfill other familial duties due to physical illness, frailty or a mental disorder. The officials were also charged with maintaining social order. If an individual was felt to pose a danger to the community, and the family could not guarantee the community’s safety, the Poor Law officers could, for example, arrange for a neighbour to keep the individual securely locked up until such time as they had recovered.4

There was also a county-level system charged with keeping order administered by locally appointed Justices of the Peace — later called magistrates. Justices of the Peace could, in extreme cases, forcibly remove someone to a local prison or prison-like facility (e.g. a House of Correction). The local rate payers had to pay for this, so it was generally used as a last resort, and people were brought back when they could be.

These systems involved contentious decisions about the rights and entitlements of individuals, balanced against other individuals. They were accepted while communities were still small, and people knew their neighbours, but started to break down with industrialisation and urbanisation in the 19th century. These developments created rising numbers of dispossessed migrants, who lacked a family network to support them, and as the financial burden of caring for the poor increased, rate payers became increasingly disgruntled, convinced they were being swindled by hordes of idlers.

The idea of mental disorder as a disease starts to take hold in the context of changing attitudes towards poverty. In place of the traditional view of poverty as the inevitable consequence of a hostile and uncontrollable nature (drought, famine etc), the emergence of capitalism recasts it as a failing of the individual. French philosopher, Michel Foucault, echoing Marx and Weber’s analyses, traces how attitudes to madness were transformed in response to the emergence of Protestantism, and the beginnings of capitalism. As industrial production starts to emerge, hard work and discipline become the cardinal social virtues. Any condition that threatens to contaminate the work ethic must be corrected.5

workhouse inmates
Men chopping wood in the workhouse, 1892

Thus the English Workhouse was designed to deter people from seeking state assistance, and once they had, to ensure they were inculcated with the values of hard work and discipline, which they were assumed to have lacked. The Victorian asylums were an integral part of the Workhouse system, designed to care for poor people who could not tolerate the harsh conditions of the Workhouse, or whose behaviour was disruptive to Workhouse routines.6

In this context, madness, previously viewed as an interesting, if inconvenient, manifestation of humanity, comes to be seen as a social problem in need of correction. A ‘cult of curability’ emerges,7 with the new asylum system hailed as the solution that would teach the mad the error of their ways.

Like Szasz, Foucault suggests that medical explanations for madness and the medical approach to treatment are grafted onto an older system of social organisation and control. Once medicalisation takes hold, it obscures the underlying functions, but the system remains, in essence, a moral and political enterprise.

Then, as now, the aims of this system are to change or manage behaviour that is inconvenient or socially disruptive. Sometimes the individual welcomes support to change, but often they do not, and there is conflict between the desires of the individual and the interests of the community. This is the core of what psychiatry is about — a system of control and care, inherited from the past, that attempts to balance the needs of individual and community. Psychiatry, and the medical framework it brought with it, legitimated this system at a time when it was being increasingly questioned. The medical framework has then expanded the remit of the service by pulling in other social problems and personal distress that can now be reconceptualised as medical conditions.

In my view, the evidence does not support the claim made by some that the medicalisation of the ‘mental health’ system was brought about by a conspiracy of doctors or psychiatrists.8 The aspiring alienists of the 19th century were not particularly influential, and would likely have had little success if their claims were not consonant with wider political attitudes and interests. Evidence from the early 20th century suggests psychiatrists were skeptical about government efforts to medicalise mental health laws.9 Medicalisation occurred because it was politically expedient, because it provided a simple solution to awkward political problems.

The question of how a modern, caring society should respond to the problems that are associated with madness or mental distress continues to present us with serious challenges. What should be done if someone is unable to sustain themselves? How do we judge if they are really unable, or just unwilling? Do we owe people a ‘duty of care’ even if they don’t want our help? How muddled do people have to be for it to be legitimate to make decisions on their behalf? How should behaviour that disturbs or threatens other people be addressed? Do we have a right as a society to try to prevent individuals from causing harm, even if they have not yet done anything that could easily be addressed by the criminal law (as some argue that societies have always tried to do10)? How do we stop some of the individuals described above, for example, from causing injury or aggravation to their relatives or neighbours?

The criminal law is not adapted to address the behaviour of people who are severely disturbed. Most criminal offences require that the accused has a ‘mens rea’, meaning they can employ commonplace reasoning processes to form an understandable intention of committing a crime, or can recognise the likelihood that a crime will result from a particular act or omission of an act. Where reasoning processes are disturbed, and someone does not initiate actions following usual principles of logical thought (as described in the last blog of this series), they are not regarded as possessing the mental capacity required to take responsibility for their actions. The mental health system can be seen as filling the lacunae of the formal criminal law, but not necessarily in the fairest and most transparent manner.

Of course we also need to ask ourselves what it is about the structure and culture of modern society that may foster or contribute to the problems referred to as ‘mental disorder’. The solutions involve changing the nature of the society we live in, as well as trying to ameliorate the problems themselves. I have no doubt that a society with a more equitable distribution of wealth, with opportunities for everyone to engage in meaningful and valued activities, with structures that enable communities to be inclusive and supportive, would reduce the trauma, abuse and isolation that nurture mental disorder and help people to build the confidence, self-esteem and mutually rewarding relationships that protect against it.

Nonetheless, I think any society, however Utopian, will have to deal with some of the sorts of problems that mental health services are presented with today. I do not have a blueprint for a fairer system, and I think the survival of the mental illness concept is testimony to how difficult the issues are, and how strongly societies and governments want to avoid having to confront them. But surely it is not beyond the capacity of the modern world to think of a better system? And having an open and inclusive discussion about alternative approaches is where we need to start!

Show 10 footnotes

  1.  Szasz T. Ideology and Insanity; essays on the psychiatric dehumanization of man. New york: Anchor Books; 1970.
  2.  Owusu E. My Psychosis Story. AuthorHouseUK; 2017.
  3. Anonymous. An autobiography of a schizopjhrenia experience. In: Kaplan B, editor. The Inner World of Mental Illness. New York: Harper & Row; 1964. p. 89-115.
  4.  Rushton P. Lunatics and Idiots: mental disability, the community, and the Poor Law in North East England, 1600-1800. Medical History 1988;32:34-50.
  5.  Foucault M. Madness and Civilisation. London: Tavistock; 1965.
  6.  Scull A. The Most Solitary of Afflictions. New Haven: Yale University Press; 1993.
  7.  Dershowitz A. The origins of preventive confinement in Anglo-American law part II: the American experience. Cincinnati Law Review 1974;43:781-846.
  8.  Cohen BMZ. Psychiatric Hegemony. A Marxist theory of mental illness. London: Palgrave Macmillan; 2016.
  9.  Unsworth C. The Politics of Mental Health Legislation. Oxford: Oxford University Press; 1987.
  10. Dershowitz A. The origins of preventive confinement in anglo-american law — Part 1: The English experience. University of Cincinnati Law Review 1974;43:1-60.

79 COMMENTS

  1. We could start by disconnecting the need to detain people who are creating problems from the idea of forcing “treatment” on unwilling detainees. What’s wrong with the idea of “keep[ing] the individual securely locked up until such time as they had recovered?” Why does holding someone who is threatening to burn down the house imply enforcing drugs or other violent
    “treatment” on their unwilling bodies?

    • Psychiatrists would say that what is wrong with that idea, Steve, is that they KNOW they have treatments which will make the detainee better, and it would unethical not to administer them to a patient who, after all, does not know what is best for them. And that dishonesty is a problem that absolutely demands a different role, with different powers for psychiatrists. In the panic and distress of the consulting room, they can and do say anything – things like “this serious illness is caused by a biochemical imbalance which is treatable”, and “all the evidence suggests that you cannot recover on talking therapies alone”. I kid you not, this is the NHS in 2018.

      • I did Recover on Talking Therapies alone but you wouldn’t know this from my Records (historical or otherwise).

        Galway, Ireland, November 1980:-
        “..The patient was co-operative well orientated with intact memory. He had mildly agitated psychomotor behaviour. There was no evidence of any florid psychotic features…”
        Admitting Doctor 1980 Dr Fadel

        Galway, Ireland, November 1980:-
        ” ..Presented with aggressive behaviour, paranoid delusions, ideas of reference and auditory hallucinations…”
        Dr Donlon Kenny 1986 – to the UK

        DR WRAY NEWTON MEDICAL, CENTRAL LONDON OCTOBER 2012
        “…Eye contact normal currently functioning, no sign of self neglect
        mildly agitated but no sign of thought disorder…”

        MY COMMENTARY
        I have never had an eye contact problem, I have never neglected myself, and I have functioned completely normally in the 30 years I have been in the UK.

        I was not mildly agitated, I was unhappy with the misuse of my personal information. I have not suffered from thought disorder in my 30 years in the UK.

  2. If you are saying that it has something to do with our present society valuing propriety over freedom I would have to agree with you…but not it.

    You are weighing in in favor of some kind of social control, beyond law, criminal law, it seems to me, and I would not be doing so.

    I see a lot of exaggeration taking place in the name of “mental health”, and, frankly, I would go in the other direction, that is to say, I would downplay the matter rather than turn the problem of problem people into a runaway and thus unstoppable industry.

    What was done? These huge asylums were built to contain, and keep hidden, the problem. Essentially they came to serve as the rug under which society swept it’s unwanted castoffs. If you accept the human about us as a whole, in my opinion, you go in the opposite direction.

    “Supports”, “help”, blah blah blah, “the community mental health system”, much of whining nanny statism, etc., in general, these matters are part of the problem and not part of the solution.

    • For those who physically assault others or commit arson there’s the legal system. Many “symptoms” in the DSM are actually crimes. Or simply rude behaviors.

      Prosecute the offender as a criminal or treat them like you would a less eccentric boor. They will be better treated as ex-felons than “bipolars” or “schizophrenics” so you can’t argue inhumanity.

  3. Emotional suffering and other natural “problems with living” are predominately solved with more social and economic justice. However, this is a far more monumental task than you imply in your article. Our society is often cruel and unjust at the bottom of our “social pecking order;” we lack the will to address social welfare problems far more than the means.

    • “Social welfare problems”? I’m not a fan of the throw money at it, and it will go away theory. I just don’t think it works. Throw money at a problem, and you’re funding it. Now what we’ve got is an entire service industry growing up around the idea of “homelessness” and people not being able to take care of themselves. This industry is doing anything but providing affordable housing, as well as independence and self-sufficiency. What it is doing is perpetuating itself, and the population that it thrives upon, the so-called “needy”. Treat adults like children, and what do you get? Of course, adults who act like children. Treat adults like adults, and once again those adults have rights.

        • That would be great, for a start, but then…

          How about creating a society where all people had jobs? I don’t think we had that even in the 60s.

          Who is served by unemployment? Corporate interests I would think. What do they get out of it? 1. a surplus labor force, the old Marxist thing, growing less important all the time, 2. a scapegoat, 3. deflected scrutiny, 4. increased mechanization, 5. maximized profits, 6. bought politicians, 7. tax cuts for the rich, 8. an aim for philanthropic efforts, 9. a country of suckers, 10. bought institutes of higher education, 11. stiff competition for jobs within the monopolies (stifled competition), 12. gated communities and slum lords, 13, oligarchy (government by, for, and of the rich), 14, disenfranchisement of the vast majority of humanity, 15. elite status and privilege, etc.

          Not to fear, the terminator is coming.

          • I’m not really disagreeing with you but there were societies where everyone had a job. Remember the communist countries where everyone had a job and the results were that the products that were produced were of faulty quality compared to products from supposedly free countries. Even China doesn’t seem to be working under this principle any longer and allows some little experience of free enterprise. What do you think about the programs being tried in some places where everyone is guaranteed a basic income, no matter what and they can do whatever they want with the money?

            I no longer believe in capitalism which has become cannibalistic in many regards due to the corporate interests that drive it so fiercely these days. I seriously don’t know what to believe in at this point. Some places still carry on modified bartering, in smaller communities where I live. They’re kind of experimental at this point but are having some interesting results. But, this obviously is not practical on a national level these days.

          • The argument of capitalism versus socialism aside, ending political corruption in this country is going to be a matter of getting the money out of politics. Corporations should not have been given the same rights as individuals because people are harmed thereby, but it is big money that created this problem in the first place. Big money that has much less influence when election campaigns are paid for in a more democratic fashion, that is, by the people, and not just the rich people.

          • Frank, you might also consider….

            1a) When supply and demand of high enough wages are persistently high, increase the supply of people that will live in groups in a small place and live with less by allowing more H1B visas, and therefore increase the price of education in this country to compete with the new work force and decrease overall wages for jobs requiring higher levels of education.

          • Psychiatry “helps” people in one way by banishing them from the workplace. Disabling people who would gladly support themselves otherwise, forcing tax payers to shell out $$$$$ for the drugs and other crap the shrinks provide. The shrinks are bigger drains on our economy than any welfare recipients.

            Their greed is insatiable too. How many crippled young people are enough Dr. Quackenbush? 20%? 25%? 33%?

            When shrinks rave about all the “mentally ill” not getting the “help” they–the young people–need they are actually filling everyone in on their business goals over the next 5 years. Cha-ching!

          • I think money is earned through “arrangements” and not through “work”. The resources are divided up between interested parties and these would be maybe 15% of the population.

            The other 85% of the population are being reduced down. The middle class are becoming the lower middle class; and most jobs are coming under the influence of mechanization.

          • You are absolutely right, Frank. The Fed starts raising the interest rates whenever the unemployment rate drops below 5%. They say it’s because they’re afraid of inflation, but it’s really rising wages they hate. Recently, the rate has dropped below 5% and rates started to rise a little, but wages remain stagnant, so they’re not too worried. I think this is because most of the jobs available pay crap, but in any case, it’s definitely a conspiracy to keep wages low and profits high.

          • Denmark is a country where everyone is more our less provided for from the Cradle to the Grave. It’s a very competitive country and a very ‘happy’ country.

            But – the psychiatric abuse is supposed to be as brutal as anywhere else.

      • Yes, and that’s frankly very frightening so it’s understandable why we’re more willing to sit here and talk among ourselves all the time rather than getting out and taking power into our own hands. I admit that it scares the absolute bejesus out of me and it shames me that I can’t seem to take that first daring step to actually do something.

          • Oldhead,

            I have made one serious allegation after another on this Website against named professionals. As far as I know, I have the reliable evidence to back up the allegations I have made.

          • To be very clear, “taking power into our own hands” rarely means literally “storming the barricades” or any of the many other stereotypical romantic visions people have of “revolutionary” activity. (I wouldn’t know where to find a barricade if I wanted one.)

            What we do need, for example, are sophisticated, documentable and easily readable educational materials on psychiatric oppression, drugging, etc., and creative ways of putting them in the hands of the masses. Before there is a demand there must be a clear understanding of what we are demanding and why; next there must be an effective way of drawing the rest of society into our perspective. All of this requires serious preparation and research, not just internet chatter.

  4. This article is sickening, truly sickening. What is most sickening is that Moncrieff understands better than most people the terrible harm that is being caused in the name of psychiatry, and yet she still attempts to justify it.

    “For Szasz, therefore, mental disorders are patterns of conduct or behaviour that are not just baffling or eccentric, but are identified as problematic by the group or society in which they are embedded.”

    This is simply not true. This supposed summary of Szasz’s ideas regarding mythical mental illness run counter to almost everything that he wrote. Moncrieff’s article begins with a misrepresentation of Szasz, and then a misleading question. I suppose that it’s no wonder that she arrives at such erroneous conclusions.

    It should probably come as no surprise that psychiatrists and mental health workers either dismiss Szasz or try to dilute his arguments. Szasz saw through the nonsense that is disseminated in the name of psychiatry and the horrors that are perpetrated in the name of so-called “mental illness” and “mental disorders.” Karl Kraus saw through these lies long before Szasz. But too few people take the time to read and understand what Szasz and Kraus actually wrote. What we have instead are caricatures of their ideas that are used to hide the very injustices that they opposed. What is so tricky about Moncrieff’s justifications for psychiatric abuse is that she couches her arguments in half-truths. Szasz recognized that the promulgation of the myth of mental illness was a political weapon and a method of social control that had nothing to do with healing or medicine. But did he endorse this concept? No. Just the opposite. Szasz championed liberty and responsibility in opposition to the coercion and force that masquerade as medicine. Moncrieff writes as if the concept “mental disorder” describes some underlying metaphysical reality, but this contrasts sharply with almost everything that Szasz wrote.

    Whether intentionally or not, Moncrieff overlooks the most basic question: “What is mental illness?” Instead, she assumes that “mental disorders” refer to actual social problems, and that there are social functions for “services” for people with “mental disorders.” The tautology ought to be apparent to any reasoning being: mental disorders exist, and services for people with mental disorders fulfill some social function; therefore what social functions do services for people with mental disorders fulfill? And don’t even get me started about the use of the euphemistic term “services.”

    As if this weren’t enough, Moncrieff attempts to support her tautological argument with eccentric examples that are meant to lend legitimacy to notion of “mental disorders.” She claims that these are “the sort of situations that occur frequently in mental health services.” This is simply untrue, and Szasz knew as much. And don’t even get me started about the use of the euphemistic term “services.” Are involuntary incarceration, drugging, abuse, torture, shock, labeling, and slavery services?

    Moncrieff’s first example is particularly dangerous because it portrays religion in a negative light in the way that C.S. Lewis understood long ago. Consider this statement:

    “We know that one school of psychology already regards religion as a neurosis. When this particular neurosis becomes inconvenient to government, what is to hinder government from proceeding to ‘cure’ it? Such ‘cure’ will, of course, be compulsory; but under the Humanitarian theory it will not be called by the shocking name of Persecution. No one will blame us for being Christians, no one will hate us, no one will revile us. The new Nero will approach us with the silky manners of a doctor, and though all will be in fact as compulsory as the tunica molesta or Smithfield or Tyburn, all will go on within the unemotional therapeutic sphere where words like ‘right’ and ‘wrong’ or ‘freedom’ and ‘slavery’ are never heard. And thus when the command is given, every prominent Christian in the land may vanish overnight into Institutions for the Treatment of the Ideologically Unsound, and it will rest with the expert gaolers to say when (if ever) they are to re-emerge. But it will not be persecution. Even if the treatment is painful, even if it is life-long, even if it is fatal, that will be only a regrettable accident; the intention was purely therapeutic. In ordinary medicine there were painful operations and fatal operations; so in this. But because they are ‘treatment’, not punishment, they can be criticized only by fellow-experts and on technical grounds, never by men as men and on grounds of justice.”

    For every 10,000 victims of psychiatric abuse, there may be a case such as is described in Moncrieff’s first example. Even then, such cases are often CAUSED by the effects of psychotropic drugs.

    The second case is almost as absurd as the first one. In any case, a poor woman who exhibits such behavior is only at the beginning of her troubles once she is labeled as “schizophrenic.”

    The third example is also an outlier, and uncommon. For every 10,000 people who are drugged into oblivion by neurotoxic chemicals, there is one person who thinks that he can drive away evil spirits with fire. Perhaps his method was wrong, but what will psychiatry do with such a case? The man is doomed to some form of psychiatric torture.

    Finally, the fourth example is yet another sad demonstration of how psychiatry exacerbates the suffering of innocent people. The man’s wife died! Is anyone so heartless as to believe that mourning and depression might not follow such a difficult experience? Rather than help him through the process of mourning, why did his children dump him off in a “hospital”? Why? Because psychiatry gives people an easy excuse to dispose of inconvenient loved ones.

    Moncrieff then suggests that “some forms of mental disorder involve a loss or alteration of normal reasoning processes.” Anyone who is paying attention can see the tautology: Normal reasoning is healthy, therefore abnormal reasoning is a “mental disorder.” How can we be sure that Moncrieff’s reasoning is healthy or normal?

    Moncrieff is right about one thing, however. We CAN learn a lot by looking at history. But the lessons to be learned are the precisely the opposite of those that Moncrieff suggests. The history of psychiatry is riddled with lies, deception, coercion, abuse, torture, and even murder. Compared to the suffering that psychiatry has caused, the supposedly abnormal behavior of a few eccentric individuals has done relatively little harm to anyone at all.

    I can also appreciate this paragraph: “Like Szasz, Foucault suggests that medical explanations for madness and the medical approach to treatment are grafted onto an older system of social organisation and control. Once medicalisation takes hold, it obscures the underlying functions, but the system remains, in essence, a moral and political enterprise.” But how does medicalization take hold? Szasz explains in many of his works how the old system of persecution by false priests and clergymen has been passed on to the modern false priests of the false religion of psychiatry. Doctors and psychiatrists have taken the place of the clergy. Is this something to celebrate or perpetuate? I think not.

    But psychiatry is not just about changing or “managing” the behavior of those who are deemed socially unacceptable. Psychiatry is about DEFINING what is or is not socially acceptable. Furthermore, the tyranny of psychiatry brings almost all human behavior with in its scope and grasp.

    The core of psychiatry has everything to do with coercion, force, control, dominion, and torture and nothing to do with “care.” It is not all inherited either. Many innovations and oppressive measures came about during the rise of psychiatry. Moreover, what on earth can possibly be meant by the notion of a “caring society.” “Caring” societies are the most dangerous. After all, it was the Nazi’s who “cared” for the Jews. Slave masters “cared” for their chattel slaves. Is this the kind of “care” that is needed?

    “What should be done if someone is unable to sustain themselves?” Please allow me to quote C.S. Lewis once again: “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.” The only “duty of care” that we should be worried about is our duty to take care of ourselves, our families, and our neighbors. We have no duty to torture, abuse, drug, incarcerate and label those whose behavior we find objectionable.

    “How muddled do people have to be for it to be legitimate to make decisions on their behalf?” Moncrieff’s arguments in this article are as muddled as anything I have ever read, but she is free to believe and to write as she wishes without intervention from any thought police. As muddled as it is, no one has any right to make decisions on her behalf.

    As far as preventing individuals from causing harm… that is supposedly what laws are for. When laws are broken, and crimes committed, there ought to be just penalties attached. But for heavens’ sake, leave innocent, law abiding citizens alone!

    “Do we have a right as a society to try to prevent individuals from causing harm, even if they have not yet done anything that could easily be addressed by the criminal law (as some argue that societies have always tried to do)?” NO! What is this? Minority Report? Before the rise of psychiatry, at least in the United States, a person was innocent until proven guilty. Now, under the tyranny of psychiatry, people are guilty until proven innocent. I don’t think that Moncrieff should be arrested for writing this article, so why should other innocent people be presumed guilty?

    “How do we stop some of the individuals described above, for example, from causing injury or aggravation to their relatives or neighbours?” A better question might be, how do we stop psychiatrists and mental health mongers from their tyrannical rule over the lives of innocent people? As Szasz often pointed out, psychiatry inculpates the innocent and exculpates the guilty. With the insanity plea and other measures, psychiatry has made it more difficult for people to be held accountable for their actions. Psychiatry is the opposite of freedom and responsibility. Is is slavery and justification for criminal behavior.

    “Of course we also need to ask ourselves what it is about the structure and culture of modern society that may foster or contribute to the problems referred to as ‘mental disorder’.” That’s easy. PSYCHIATRY invents and perpetuates the very problems that it purports to resolve or to cure. PSYCHIATRY is responsible for promulgating the myth of mental illness along with all of the train of abuses that follow in its wake. And no amount of utopian speculation will solve the problem. Psychiatry IS the problem. No alternatives are needed. Psychiatry must be abolished. Slay the Dragon of Psychiatry.

    • Fantastic summary of Szasz. Joanna distorts his views and she uses Szasz’s reference as a sort of tip of the hat to alternative thinking while maintaining the status quo. Why do people claim to represent Szasz distort his views? He couldn’t have written more clearly. Never asks man for his honest opinion when his living depends on doing the opposite.

        • Szazs looked at “psychiatry” as inherently coercive because it’s based on lies. Honest–sometimes brutally–he did not care for liars.

          He counseled people by encouraging them to be honest with themselves and not to build their lives on a lie.

          I liked his idea that a man who hears a voice telling him to kill his wife and obeys that voice actually deceived himself. He caused himself to hear a voice because his marriage was unhappy and he didn’t like alimony. Of course he could just be lying to the court too; he never heard any voice, but wanted a lighter sentence.

    • There are some rare cases of “religious zealots” who act like Joanna’s example. I have never met one personally–because they are RARE. Talking to a clergy member who would tell them how wrong this behavior is might help more than psychiatry.

      Actually all of her examples are extremely rare. Maybe 1 out of 1000 get inducted into the “mental illness” hall of fame start out this way.

      Most enter through one of two doors. They act very eccentrically–freak people out–and get “treated.” Others start out with real problems. Emotional problems, not organic. They seek out a shrink in desperation and receive “help” in the form of lies, neurotoxins, lies, imprisonment, and more lies.

      The freakish extremes need help. But I wish Joanna Moncrieff and others would acknowledge that most do not fall into this category.

  5. MH is a business which dovetails with other business such as the alcohol business or the SSRI, benzodiazepine etc etc… drug business. Destruction is now incentivised under cover of effective media deception. You are part of that business. As an individual (the word – or near to – you use about 10 times) You have a choice: Do something else, you do not.

  6. To be fair to Moncrieff, I acknowledge that she has written one of the best books on psychotropic drugs that can be found anywhere. She has thoroughly researched and effectively exposed the fraudulence inherent in the pharmaceutical industry. Her book “The Bitterest Pills” belongs on the shelf with the great works in the antipsychiatry canon. My critique of Moncrieff’s arguments is in no way meant to reflect a critique of her person. In fact, Moncrieff has already done a very valuable service for psychiatric survivors by writing “The Bitterest Pills.” Her arguments in this particular article, though fallacious, also render a valuable service to psychiatric survivors by demonstrating just how difficult it is to defend the pseudo-scientific enterprise of psychiatry, along with its hoaxes and deceptive terminology, such as “mental illness” and “mental disorder.”

  7. I don’t like this anti-psychiatry thing…
    I like the szasz thing –anti-coercive psychiatry…
    am I understanding szasz correctly..

    and doing away with the words mental illness
    is a problem for a lot of us that are suffering
    from who knows what…we do not know causes…

    • I would suggest that you call it whatever you want to call it. It’s your personal and unique experience so only you can put the title to it. It’s time that we tell our own stories in the words that we choose to use, period. If you want to call it “mental illness” that’s fine but I suggest that maybe you consider finding your own unique way of talking about and describing what you experience. We are the only experts that exist about our own lives, period.

    • little turtle, are you familiar with any of the work on trauma?

      if you are looking for some ‘well travelled’ or ‘researched’ or ‘professionally understood’ understandings of difficult experiences, of the kind that often get’s called ‘mental illness’. There are a lot of explanations in the trauma field that can make a lot of sense.

      Bearing in mind that the idea of “trauma” isn’t about a particular experience or event, or set of experiences so much as how it affected or was felt by the person. It’s also understanding that ‘trauma’ can be ‘relational’ – ie it can be relationships that hurt, but it can also be (sometimes very well meaning and loving relationships) that weren’t able to provide help in making sense of emotions and difficult life-situations.

      If we think about being a kid, a big part of growing up is about learning to understand our emotions and how they are affected by different situations. When we’re kids, all experiences are new experiences and we often need a little time or a chat with some friends or a grown up to help us feel safe and make sense of them. As we make sense of them, we can often transform them.

      The reason I don’t like the term ‘mental illness’ or ‘mental disorder’ is that it takes some experiences that are about our feelings or our thoughts – experiences that can be genuinely perplexing and frightening for some of us – and tells us not to learn to try and take-apart, understand and make sense of these experiences so we can ‘integrate’ them into our life-story to know them (and ourselves) better. And in doing so maybe transform them. Instead, it leaves our emotions and thoughts as ‘symptoms’ of some undefined (and undefinable) thing – rather than inviting us to understand them and make sense of them in safe and supportive space, that doesn’t require us to label them – though of course we can if we want to.

      For me, I understand my own difficult past experiences as sort of ‘knots’ of emotion – being able to have the luxury of kind and sensible ‘adults’ (who work in various ‘helping professions’) to support me in ‘untying’ those ‘knots’ – learning what I’m bothered about and how to deal with those feelings (and the situations that caused them) has been really awesome. Someone else might find a really different way of understanding their experience. But ‘knots of emotion’ and choosing to work with helpful others has been mine.

      What has been really cool about the journey is that – as I untie my ‘knots’ the things that other people (who I would never work with anymore) previously would have called ‘symptoms’ transform completely. Not all at once, but little by little. The ‘patterns’ have been completely changing. I’m returning to a time before anyone told me the word ‘disorder’ where I actively interacted with myself, my philosophy and my emotions in an ongoing and adaptive way to chose the person that I want to be. Not being overrun by emotions I don’t understand but learning to understand the ‘backlog’ of emotions that went ‘unheard’.

      That’s been my journey, one journey. And one that was only made possible by being allowed to move away from the concept of ‘disorder’ or ‘illness’ – those labels or concepts didn’t help me understand was going on for me, they hindered and insulted me. Whilst I believed I had an ‘illness’ or a ‘disorder’, I was taught to explain all of my emotions as ‘symptoms’ and never go deeper. So I couldn’t find healing. And the word ‘disorder’ always made it hurt, however it was packaged or re-packaged over the years.

      Some people might try to reframe definitions of ‘illness’ and ‘disorder’ to encapsulate things like my experience (and some people are, unfortunately) but others are openly advocating the dignity in recognising that when it comes to thinking and feeling – sometimes it might be difficult, but it’s always ‘normal’ and it doesn’t need a ‘pre-cut’ label (no, not even ‘trauma’) to be imposed on a person against their choosing. Professionals who were trained to ‘diagnose’ and ‘treat’ need to be retrained to learn from those who have been successfully helping people – and from, most importantly, the people they are wanting to assist. It’s not impossible, I’ve met people who are doing it, quite well.

      Everyone’s experience is different, very different. And ‘fitting’ people into ‘categories’ of ‘symptoms’ or even trying to distinguish who has ‘symptoms’ from who doesn’t have ‘symptoms’ is fraught, and unnecessary. Surely it should be enough for someone to say (by their own choosing) that they’d like some help figuring out their life, and get a little help from some good people, who know how to help people feel safe and understood. Thankfully I live in a country that while very far from perfect, has actually started to listen to this, very slowly and a long way to go, but started. And I hope it continues to change.

      We do need to figure out the bureaucracy of how to fund ‘help’ for those who want it, as well as time off ‘work’ for those who need it. But I think the ‘mental health’ explosion has provided us with one thing at least – the recognition that sometimes life (as we have made it in our societies) sometimes overwhelms a human’s capacity to cope. And that this is a really, really common thing (in 2007, 49% of all people in my country in a national census-survey said they had experienced a ‘mental illness’ at one point in their lives). Addressing that involves societal change. And that’s something most people now feel very deeply. So we are well positioned to move forward in a way that doesn’t involve force, torture, harm or ‘medicalisation’.

      My two cents on psychiatry is that non-medicalisation doesn’t mean people with medical backgrounds can’t still learn to be *among those* who are genuinely helpful to others in life. But for many who have been practicing psychiatry that means a lot of ‘unlearning’ and a lot of retraining- and in the meantime a recognition of their current limitations as well as the honest and open recognition of the harm that has been done by past decisions of professional bodies and those who followed them (and at the present time, still do). Including the harm done by labelling and by forced ‘treatment’ (and even – at the very least in comparison to what might otherwise have been offered – voluntary ‘treatment’).

      As well as dropping the ‘medical’ and ‘diagnostic’ model, and learning to provide something entirely different, they also need to recognise that they are one set of “providers”, step down from calling themselves “experts” stop trying to be “team leaders”, or “leaders” at all, and stop practicing rivalry with other pathways towards being in the ‘genuinely providing help and understanding’ field or rivalry with survivors who speak out about what has happened to them and, quite reasonably, oppose it. If a profession genuinely wants to help – let them ‘muck in’ and learn about what others are doing and saying that has actually helped – not fight for dominance, nobody ever thought that was helpful.

      Professions that help people with their life problems don’t need to keep trying to ‘copy’ the ‘diagnose’ and ‘treat’ model of physical medicine – that model often fails in physical medicine too and it has been a colossal failure when it comes to ‘coping with life’s difficulties’ which, let’s face it for many can involve ‘healing from fear, violence, abuse and atrocity’. Unfortunately a lot of psychiatrists know even less about these things than completely untrained individuals, and that needs to change. They aren’t trained even in listening to and understanding any of their fellow human beings, or even themselves. Let alone how to listen to and understand how to help people heal from incredible violence and abuse. Yet that is, unfortunately, a large percentage of their ‘patient’ base.

      There has been dissent *within* the psychiatry field about this for as long as there has been a psychiatry field. There has, also, throughout that history, been the odd psychiatrist who genuinely managed to be part of a support network that helped a person or two completely heal and move on from overwhelming life-related distress. Making that the norm is going to require extreme self-reflection and change on the part of professional bodies and their members. But it’s far from impossible and I hope to see it happen in my lifetime.