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Models of Madness

John ReadDr John Read is a Senior Lecturer in Psychology at the University of Auckland, New Zealand and Editor of Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia.

by John Read

Mental health services around the world are largely based on the assumption that being upset or disoriented is a sort of condition like medical illnesses. Here in Australasia, we imported this perspective from overseas, actively suppressing more holistic Maori and Aboriginal understandings about human distress. We did so despite numerous studies that show that recovery rates from "mental illness" in "underdeveloped" countries are far superior to those in "advanced" societies.

Nowadays, more and more problems are being redefined as "disorders" or "illnesses," supposedly caused by genetic predispositions and biochemical imbalances. Life events are relegated to mere triggers of an underlying biological time bomb.

Thus, feeling very sad has become "depressive disorder." Worrying too much is "anxiety disorder." Being painfully shy has become "avoidant personality disorder." Beating up people is "intermittent explosive disorder." Excessive gambling, drinking, drug use, or eating are also illnesses. The same applies to having too little food, sleep, or sex. Our Diagnostic and Statistical Manual of Mental Disorders has 886 pages of such illnesses. Unusual or undesirable behaviors are called "symptoms" and the labels are "diagnoses."

Our children are labeled, too. Being bad at math has become "mathematics disorder." Ignoring other people’s feelings (once called being naughty) means that the child is suffering from "conduct disorder." If this includes getting angry at grownups, he or she (usually he) has "oppositional defiant disorder."

A "diagnosis" frequently in the news is "attention-deficit/hyperactivity disorder." The "symptoms" include fidgeting, losing things, talking excessively, and difficulty playing quietly or taking turns. Of course some children sometimes have problems. But does anyone help them? Perhaps it sometimes conceals the causes, while locating the problem entirely within the child, who is often stigmatized as a result.

Indeed, making lists of behaviors, applying medical-sounding labels to people who manifest them, and then using the presence of those behaviors to prove that a person has the illness in question is scientifically meaningless. It tells us nothing about causes or solutions.

How did this simplistic, certainly unscientific, and frequently damaging approach gain such dominance?

First, it is tempting to avoid facing the painful events in our lives that might be the cause of our difficulties. If we just accept the diagnosis on offer, nobody is to blame. Nobody needs do anything differently – except take the tablets. We were just unlucky enough to get the "illness."

Second, a model of individual pathology is invaluable to politicians. They don’t need to spend money on prevention programs to address the psycho-social problems –overwhelming stress, poverty, discrimination, child neglect and abuse, and loneliness, to name but a few – that research has repeatedly demonstrated play a large role in undermining mental health.

Third, exciting developments in technologies for studying our brains and genes have created the hope that we are about to discover the biological causes of, and solutions to, human misery and confusion.

Finally, a new player has entered the nature-nurture debate. The pharmaceutical industry, fueled by our desire for quick fixes, has effectively deployed its considerable power to promulgate the notion of "disorders" and "illnesses" in all domains of our lives. The fundamental purpose of drug companies is to produce profits for shareholders. Naturally, they encourage us to diagnose eating, sleeping, or feeling too much (or too little) as illnesses requiring a chemical cure.

Having listened for 20 years to people unfortunate enough to be labeled "schizophrenic," considered to be the most extreme form of "mental illness," and having subsequently researched the causes of hallucinations and delusions for ten years, I believe that the public understands madness better than we experts.

Surveys of public opinion all over the world find that most people believe that emotional problems, including those deemed severe, such as hearing voices, are primarily caused by bad things happening to us rather than by faulty brains or genes. The public also favors psycho-social approaches, such as talking to someone and getting advice, or help finding friends or a job, rather than drugs, electro-shocks, or admission to psychiatric hospital.

Some experts, however, dismiss these views as "mental health illiteracy." They continue to insist that mental illness is an illness like any other, despite many studies showing that the more we adopt this medical model, the more prejudiced and frightened we become.

Mental health services should offer something more than having our feelings chemically suppressed, or having our children’s difficulties sitting still controlled by amphetamines (which, apart from teaching children that problems are best solved with drugs, stunt growth by an average of one centimeter per year).

A wide range of effective treatments are available that don’t cause weight gain, sexual dysfunction, diabetes, memory loss, or addiction. Funders and policymakers who keep up with the relevant research are slowly beginning to introduce more talking therapies (such as cognitive therapy and trauma-focused counseling), more alternatives to hospitalization, more culturally appropriate services, more family-focused therapy and, most importantly, more genuine consultation with service users about what actually works.

If these new treatments aren’t used more frequently, this isn’t because they don’t work. The main obstacle is that they won’t increase the profits of drug companies, on which, in the absence of adequate government funding, our professional organizations, conferences, journals, research, and teaching institutions have become so dependent.

Copyright: Project Syndicate, 2006.

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In a Mass Conformist Corporate State, Language is the great deceiver. For example, if the corporate state openly claimed that Cultural Assimilation was the goal of policy, and there were signs that a percentage of non English speaking people were experiencing mental health issues, than the person with the identity crisis or health issue, could point to an outside physical source. But within a Mass Conformist Multicultural Society, a person suffering from an identity crisis can not point to anything, the person becomes atomized, and the person has no way of addressing a social issue. If the state keeps manipulating the language the individual looses the ability to understand his situation, for example, Australia is a Multi Cultural Society.

Now what exactly does Multi Cultural mean? How can you have a Multi Cultural Society and a Mass Media? How can you have a Multi Cultural Society within a dominant institutionalized class? The language is ambiguous; when the language is ambiguus the individual has no protection. This is a very serious problem, language hides the issues.

In a Multi Cultural Society under the Social conditions of Corporate Mass Conformity, the dominant Culture and Class can exist within symbols that are part of their identity or pseudo identity. But on the other hand under the same conditions an ethnic minority is forced to either assimilate, or to live outside his culture, because culture is dynamic and needs to be transmitted. Now how does the culture of an ethnic minority get transmitted with no institutionalized process? The answer is it can’t, so the individual has no language to express his real life situation, the individual assimilates. The atomized individual has only himself to blame, he has no way of pointing to any outside forces. My observation is that what was once the problems of indigenous and minorities, is now spreading to a much larger proportion of the community.

Anxiety, depression and

Anxiety, depression and ADHD do exist; the persons having these conditions can become quite disabled.  People need to fit close criteria before they can be diagnosed with particular condition.  Most people feel blue at some time or another, but that's not clinical depression.  Children might be hyperactive but they do not necessarily have ADHD.  For a child to be diagnosed with ADHD their hyperactive behaviour needs to be occuring constantly at home, at school, and in the community.  The difficulty with ADHD is that it shares the same symptoms as some other conditions; for example, a trauma induced disorder. 

Medication is a useful means to help people with severe mental disorders along with counselling.  In many cases medication is not necessary and Cognitive Behaviour Therapy or some other form of counselling can be effective. 

Clearly environmental matters need to be taken into account where they are evident to help people overcome their mental health issues.   The locking up of children in Detention Centres will have a severe impact on many of them in their lives in the future. The mean "Work Choices" legislation has the potential to create stress for numerous workers when wages and conditions are reduced at a time when costs are rapidly increasing.  So while the family environment may have an impact on mental health; macro issues beyond the control of individuals can also have an impact.

The rate of depression in the community is increasing; and it is interesting that the idea of a "fair go" is fading; being superceded by "I'm alright Jack."

So long as the right person gets the pill.

There is a lot of truth in all this and serious questions must hang over the issue of thousands of kids now lining up daily for their medical fix in schools, camps and homes in the developed world.

Many childrens' behavioural problems in fact stem from issues within the home itself, not from within the child. Dysfunctional family environments do not as a rule produce happy, well adjusted children and it is these early deficits that can cause many of their later problems in life. Rarely is medication a fix, but that is the first resort of most professionals I know.

But I have sat as an advocate of sorts in enough court hearings, tribunals and so forth for the mentally unwell to know that every case is different. Not all mentally unwell people come from dysfunctional homes, far from it. 

Without treatment regimes involving medication, some would simply not be alive, while for others medication clearly has nothing to offer.

I suspect there are few families with a mentally unwell person in their midst that have in fact not tried every possible way of helping that person to recover. Sadly many give up twenty or more years of their own lives in pursuit of that recovery for their loved one. At least ten percent finish up standing over a grave.

But, it is true, the medical profession will resist any notion that new, and indeed some old, alternative treatments might work, as the recent program on the Dore method clearly showed. Full marks to the Parkes Council for being prepared to give it a try. While the professionals sprout the usual caution, as one person commented, if you are not prepared to try it, then how can you know it does not work. Of course there are charlatans out there who will take the most vulnerable for a ride with claims that have not been proven. But if families can come forward and point to children who have shown real benefit from a program, then who are they to say, 'don't waste your money'.

Parents with children in crisis, will try anything. That is of course what makes them vulnerable. But we should not underestimate them. From my experience they are also very well informed. Simply because they are desperate to find a solution for their child. If they fail, it is usually not for want of trying.

Oppositional defiant disorder! Yes, this guy has quite a point.

But if there is a problem with a child, then make sure I say that any pills handed out are given to the right person. If a child is raging at an acoholic parent,  then...?

I have no comment to make

I have no comment to make except that it has become astonishing to read such common sense about these issues.

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