By Charles Hanson November 1, 2008
Source: Inside Time
Photo Source: Unsplash, Gasper Zaldo
I pose these questions for there does seem to be a lack of agreed definition between so-called ‘experts’ and none more so than in the court arena where experts from different sides of the judicial process will differ in diagnosis so that the defence, which might argue a diminished responsibility plea in the case of a murder indictment, will pull out all the stops to persuade the Court and the jury that the defendant suffers from a mental illness; with the support of a well paid psychiatrist. This expert will advance an argument of schizophrenia, for example, which renders the defendant’s culpability to be reduced and rather than murder, the offence amounts to manslaughter, whilst the prosecution will rebut the defence with their own expert psychiatrist who will argue that the defendant does not present with symptoms of schizophrenia but personality disorder, which makes him or her liable and therefore guilty of murder.
There is nothing unusual in this scenario, for it frequently happens within our Court system in the same way that a prisoner who has had an unfavourable psychology report, especially if parole is an issue, will often seek through his or her solicitor the obtaining of an independent report from an independent psychologist who is always likely to report more favourably on the prisoner.
It is unlikely that toxicologists or experts on poisons would be tolerated in the Courts if one of them reported that he had found a large dose of poison in the body of a deceased person whilst another stated he found none by the same procedures. Yet this is the sorry state of affairs which is tolerated once psychiatrists and indeed psychologists enter the field of diagnosis or assessment, and especially so in the area of their dealing with offenders.
Defining mental illness is such a totally different matter to diagnosing and defining any physical illness that I wonder whether a mental health problem should actually be described as an ‘illness’, for a diagnosis is often arrived at by a psychiatrist on the basis of what he is told by the patient. There are no pathology tests that can arrive at such a diagnosis, no blood sample, no X-Ray, no biopsy, urine sample or any physical or biological tests that can determine mental illness, although these are all investigative procedures in the diagnosis of genuine physical illness for example cancer, diabetes, heart disease and so forth. Is mental illness therefore a disease of the brain?
If that were true, then surely it would be a physical illness and subject to physical interventions and perhaps surgery; something which is the remit of neurologists and not psychiatrists who, whilst medical doctors first and foremost, carry out no surgical functions or procedures and who are little more than pill-pushers who also engage in talking cures.
Is mental illness or a mental disorder a disease of the mind perhaps? Which raises the question: what is the mind and what part of the brain does it lie in? Of course it is nonsense to suggest that the mind is anything other than the way we think and function and has no physical being.
In medicine, strict criteria exist for calling a condition an illness or a disease and the cause of the symptoms or an understanding of their function must be proved and established. Chills and fevers are symptoms. Malaria and typhoid are diseases. Diseases are proven to exist by objective evidence. Yet no mental ‘diseases’ have ever been proven to medically exist.
People do experience problems and upsets in life that may result in chaotic and disruptive behaviours; sometimes very serious both to the person experiencing it and often to others; but to represent these troubles as illnesses or diseases is both misleading and medically false.
It is also misleading to claim that some 90% of the prison population, or nine out of 10 prisoners, suffer from some kind of mental illness, mental disorder or drug addiction in any event such figures would require mass screening to have any validity.
Today, it appears that there is no aspect of behaviour that does not fall within the broad symptoms of so-called ‘mental illness’; psychiatry and to a large degree psychology seem to cover every symptom with criteria and labels explaining the most minor emotional or behavioural fluctuation.
The Bible of the psychiatric industry, and that which psychology relies on for labelling people, is the Diagnostic and Statistical Manual of the American Psychiatric Association, whilst another, the International Classification of Diseases of the World Health Organisation, is often used by some psychiatrists and psychologists.
Interestingly, the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association started life in 1952 with 112 entries. Today that has tripled, so that we have such so-called disorders as the lack of numeracy skills (mathematics disorder, code 315.1), poor essay writing skills (disorder of written expression, code 315.2), inability to read (code 315.2), if your child does not do as he or she is told (oppositional defiance disorder, code 313.8), with sibling rivalry disorder, non-compliance with treatment disorder, nicotine withdrawal disorder, disruptive behaviour disorder, caffeine intoxication disorder and so many more that it seems the whole human race is afflicted with some disorder of one kind or another.
At one time, homosexuality was one entry in the DSM listed as a sexual disorder until political and lobby group pressure resulted in its removal, so from being an illness/disorder, overnight it was no longer a disorder or worthy of treatment.
The 112 original entries in 1952 suddenly became 163 entries by 1968 with another 61 listed in 1980, increasing to 253 by 1987, until in 1994 it had reached 374 mental illness and disorders. And how were they arrived at and how did they find their way into what has become a dubious manual? They were simply voted in by a show of hands by members of the American Psychiatric Association. To suggest that these entries were somehow the result of scientific discoveries of new so-called mental illnesses or disorders is both false and misleading.
I agree with the thrust of the arguments about mental illness in the article: ‘What’s the difference between being unhappy and being unwell?’ by Seaneen Molloy in the October 2008 issue of Inside Time. Here the writer breaks down so succinctly what is and what is not mental health problems, and I say ‘problems’ rather than ‘illness’ for a fluctuation in mood, emotion or experience does not make an illness or disorder which many prisoners are sometimes so eager to seize upon as though it excuses their offending behaviour. Likewise, those who promote such a narrow view of mental health problems that it becomes almost sacrilege to argue that, far from being an illness or disorder, the person affected has usually chosen a lifestyle and therefore the consequences of his or her behaviour; the remedy in most cases lies in their hands and not through an onslaught of mind altering medication, which serves only to relieve the symptoms but not the causes; which again lies in the patient’s hands.
For sure, those prisoners who choose to latch onto a medical solution to life’s problems do so at their peril, for it is clearly known amongst the professionals that there are many negative stereotypes perpetuated by the media etc., especially so in respect of long-term prisoners and none more so than the notion that someone is ‘dangerous’ because of mental health problems. What comes out of this is a higher level of scrutiny when considering parole etc., for that prisoner, who is more likely to be assessed in a more negative manner with the question of risk being given a significantly higher score. And even where the prisoner has undergone therapy, I am minded to recall the one time Governor of Grendon, Tim Newell, who wrote in ‘Murderers and Life Imprisonment’ that … ‘those who had been at Grendon were more closely looked at and scrutinised and seen as more of a risk by the Parole Board, irrespective of the treatment outcome, simply because of the reason the prisoner chose to go to Grendon in the first place’.
The same is likely to be true of those who enter the Dangerous and Severe Personality Disorder (DSPD) units which, like Grendon and other therapeutic communities, are entirely voluntary placements. In conclusion, I would argue that the degree of those who suffer genuine and well established mental disorders is significantly lower than the figures bandied around by prison reformists and other bodies, who would have us believe that there is an epidemic of mental illness and disorders amongst prisoners and that we should turn our prisons into one big asylum; and of course that would amount to both punitive and medical control and considerably more oppression than we already have.
How can a mis-diagnosis impact your health? How should the health industry be regulated againist false medical claims? Why?
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