Sunday, August 18, 2019

Comments by Beyond Care

Showing 3 of 3 comments.

  • These are very apt existential questions which I was confronted by by my experience of neuroleptic drugs. What is it which makes us human, normal, meaningful; and what identifies us individually and collectively.

    I—although I hate the current psychiatric paradigms—believe that the treatment of mental conditions is, in principle, a medical matter.

    I also believe that the mind is physical, by analogue to renal filtration. The kidney is the anatomic entity; the filtration the physiologic. Brain: anatomic; mind: physiologic.

    I completely agree with you that nosologists of the mind need especial caution in unyieldingly making clinical that which is not clinical. I would say that that which is clinical is ‘that which does not best accord *our* purposes out of the available options of alternative bodily states’: i.e.: I broadly agree with Hacker. It is biologists’ modus operandi to find generalities (I suppose nomothetically) manifesting within nosology’s insistence on trying to find an absolute rulebook of what are diseases and what is health.

    In non-mental medicine, there is greater consensus upon what bodily states are not conducive to our purposes. However, as you so exactingly identify, the mind is part of our unique identity. Therefore, unforgivingly insisting on a list of ‘good’ and ‘bad’ mental states/traits is dangerous and duplicitous.

    I think the future of nosology should rather than rule upon what is a diseasing condition and what is an easing condition; it should list each condition with what the prognoses of each are; and what treatments can be deployed to cause a potential condition, maintain a condition, or reverse a condition. In non-mental nosology, this might seem pedantic because of broad consensus. But, potentially, someone might want, say, mild osteoporosis or osteopenia if being lighter would help with his/her occupation (maybe needing to be carried/lifted). As long as ability to consider this fully is demonstrated, this is his/her right, in my opinion.

    It is in mental nosology where this subtler difference in definition is manifest more clearly. If someone wishes to decrease his/her anxiousness, because the person himself/herself has identified it as not purposeful for his/her identified plans, then it is legitimate, I believe, to seek advice on how we know, as a species, to reduce anxiousness. Conversely, an, e.g., disinhibited person might seek to increase anxiousness as an inhibitory process.

    If someone cannot consider whether his/her mental state is problematic, then, I believe that it is legitimate to enforce treatment. But the Mental Health Act does not recourse to what is currently referred to as ‘mental capacity’. Just severity and ‘appropriacy of treatment’. A nonconsenting even-capacitous patient with a severe-enough condition loses his decision’s being honoured by doctors. Even if the person has capacitously opted against identifying the condition as diseasing or against treatment for another reason.

    The other legitimate justification is risk to others publicly, e.g. infectiousness or dangerous behaviour.

    You quite incisively identify the conundrum ‘is disease the person or separate from him/her?’ If the person has sought help in modifying his/her mentality, then, one can separate it from himself/herself as an ego-dystonic trait. If the person cannot consider this fully, then, once the incapacitating factor (e.g., drug, psychotic episode, delerium, unconciousness) abates, even the person might dissociate his/her identity with the beliefs (or in the case of unconsciousness: not consenting, because unconscious) which stopped the person consenting to treatment.

    Where a person able to fully consider whether his/her mental or otherwise state is how he/she wants his/her body (and I include the mind with the rest of the body) to be and is not directly affecting others adversely (i.e., without consent or unlawfully), then that bodily state is not diseasing him/her, so cannot be separated from him/her. This is the case, I opine; however extreme/severe it may indeed be

    So, in summary, I do include the mind as part of the body, and psychiatry as a legitimate branch of medicine; but only with the qualification that the medical model be adapted to put the person the lead purposive determiner of what he/she regards as a diseasing/easing state.

    As Hacker opines, disease undermines the beholders purposes, but I would say, as a person rather than of the person’s kind, from a moral perspective (of how things ought to be [normally])—although spotting nomothetic universalities in how people identify different conditions as easing or disrasing is legitimate as a describing scientist, not prescribing individually these labels onto individuals.

    Thank you for the thoughtful, thought inspiring article. I suspect I might still further think about, contemplate about, and consider its compelling topics over the next few days.

  • I chose to respond to the need identified by Mr Perry to bring together a multifaceted social, cultural, and political analysis with my own multifaceted considerations. Unfortunately, the pseudoscientific psychiatric ethos is somewhat of a ‘Gish gallop’—it calls for a thorough rebuttal drawing together all contributory factors.

    Unfortunately, ‘Gish gallopers’ enjoy ‘tldr’. A few snappy lies, misinterpretations, and fallacies require a lengthy rebuttal. This is how psychiatrists can snack on pharma soundbites, but tldr rational analysis of the cherrypicked literature.

    A challenge of opponents of discrimination based upon mental individuality (in all its forms) is how to rhetorically respond to ‘Gish gallops’. One response is to walk away from a Gish galloper, such as a psychiatrist … but they have taken that option away from some of the people whom they supply their, erm, art. So we are drawn into having to engage pseudoscientific psychiatrists. Or, perhaps, thinking aloud, should we instead organise a boycott en mass, where psychiatrists are just ignored by their captives? Would that even be a moral request? Would it succeed? Would it be fair to some of the distressed people to expect this of them, or is my fear patronisingly infantilising distressed people away from their own agency?

    I should draw my post to a close now, before I rant another long post!

  • Thank you, Matt Perry for the earnest article.

    I believe that there is an equivocation in the article and subsequent comments between the population of people who are diagnosed as ‘mentally ill’ with the population who are actually mentally ill. This is the cause of discrimination based upon mental diversity. The disparity—which I’ll explain—between the diagnosed ‘mentally ill’ and the actually mentally ill (often the diagnoser: abstract society) is the cause—the cause—of the discrimination against minority and/or politically-nonexpedient diversity of the mind. This disparity in catagoric identification between those who should be identified and those who are actually correctly identified mentally ill causes discrimination (so-called sanism).

    Huh?! Let me explain, then try rereading my introduction.

    My point above is that our mentally ill society does not want to improve its group mind, so—in its laziness—scapegoats individuals’ mental healths based upon political expediency. Sometimes these scapegoats minds are ill—others—and often, are not. Moreover, those scapegoated are declared ill, sometimes because they have ‘mal’-adapted in ways which might actually politically heal (and I do not believe that ‘heal’ is a metaphor) the group mind. For example, people with ‘unusual beliefs’, or people who challenge wrongly accepted othodoxies are sometimes declared ill by psychiatrists or culture.

    One big contributor to group mental illness is textual advertising. Advertisements propagate unrealistic perfectness based on the false promise that the advertised product is all that is missing to obtain the portrayed perfection. We need to be primed to a sense of illness at ease in the spirit (mental disease, if you like), in order to be susceptible to advertisement. Adverts prey on promising to fix our sense of not being at ease—all I think disease literally means, at its simplest—in order to promise the alleviation of this sense of disease.

    Those that don’t adapt well to this toxic economy are unpersoned.

    To resolve the debate about terminology, we need to first resolve ideology. The ideas are not defined, so how can we define their terms?

    Disability and disease attract discrimination and shame. When gay-rights movements correctly identified that being gay is not an illness, the rhetoric about whether their mistreatment would have been okay were being gay to really be a disease got lost. The assumption is that mistreatment of gay people was wrong, only because it is not really an illness.

    I believe that we need to not repeat this: we need to be careful that our argument is not ‘discrimination based upon mental individuality is wrong because mental individuality is not a disease’; but that our argument is ‘discrimination based on individuality of mind is wrong, just as is discrimination against the diseased and disabled; and discrimination based upon mental individuality is wrong also when the diversity is not clinical, or not clinical, but called clinical as an insult which exploits societal prejudice against the diseased and disabled.’

    We could design a new nosology which prescriptively defines disease (not necessarily wrong, and something that I am interested in), but that would be a guide for discussion rather than the DSM’s ’mental-offences’ statute. But, for arriving upon moral imperatives, I think that the person should be empowered to take ownership of deciding whether their suffering in their life is ill (unuseful or counterproductive to spiritual growth), or productive to spiritual growth. If someone wants to change a suffering or minority mental response to something, then that should usually uphold—if someone regards a suffering or other inexpedient response as a healthy response, then, providing they have the freedom to consider this, that should always uphold when it does not affect other people who don’t want to be affected.

    Therefore we need to be clear whether we are taking about mental diversity in general, minority mental diversity; and most pertinently, whether we are taking about people with mental states they regard very unhelpful, people who have mental states they on the whole are content with (including healthy suffering), people who are content in their minds, but oppressed based upon pseudoscientific mental nosologies, and, don’t forget: people who are suffering mental illness, but who have not been diagnosed by the currently pseudoscientific psychiatry because their suffering is not politically inexpedient (their suffering is usual, but not healthy, or not regarded strange). The latter group might object, perhaps popularly, to being called mentally ill, especially for those not culturally regarded strange; but they are discriminated against by sanism just as much, because they will not seek treatment. Of course, this would not be the pseudoscientific psychiatric treatment peddled by the pharma-monopolised psychoscientists who currently call themselves spiritual healers (psychiatrists).

    This latter group, the societal majority, would instead, under sanism, keep on trying to fix their sense of illness at ease (they might not be fully aware of) by resorting to drugs, junk food, poor communication gambling, unambition in their careers, working in a rut, … or becoming a practitioner of pseudoscientific psychiatry: all things big business can advertise and sell us.

    Perhaps try rereading my introductory paragraph, to see if it’s discursiveness is clearer now in light of the rest of my post.

    BTW, I am not against advertising per se, but I am against its very toxic forms, prominent and pervading in the mass-media. Advertising which respects it’s audience is vital for market democracy. However, such advertising only works on evoking mature and healthy reasoning and emotion; which would destroy the interests of big business’ sales—those that currently pivot the balance of power in the economy.