I fell into psychiatry because talking to people, being allowed into their thoughts, and helping them regain order from chaos, was the part of medicine that appealed most to me during medical school. The increasingly procedural nature of the other specialties was interesting, and challenging in different ways, but the talking seemed more me.
Then I actually became a psychiatrist, and found out how modern Western society views and uses psychiatry.
Ill or Disordered?
An illustration can be found in the NSW Mental Health Act. A couple of revisions ago the lawmakers added a provision for people who are “mentally disordered” as opposed to “mentally ill” (in the Act these are legally defined terms, by the way, not medical language). Mentally ill in the Act is someone with psychiatric symptoms (delusions, hallucinations, thought disorder, seriously disordered mood) who poses serious potential risk to him/herself or to others. It’s arguable whether harm should really be the second criterion, and some argue for lack of capacity – but harm it is at the moment. In any case, the person must have psychiatric symptoms (or at least you suspect strongly they have those symptoms) to be detained under those provisions in the Act.
The point is that shrinks shouldn’t be able to force someone to have treatment simply because he or she is psychiatrically ill – any more than they could be forced to have treatment for their diabetes, for example.
So what’s this “mentally disordered” provision? I hear you ask. Doesn’t the mentally ill provision cover everything that should be the business of psychiatry? Well … Yes. Yes it does. But apparently our society doesn’t agree (or at least our lawmakers don’t). The “mentally disordered” provision covers people who might not have any psychiatric symptoms, but they are currently so “disturbed” that “care, treatment and control” are desirable to prevent harm to that person or others.
Care, treatment … Or control. Control of people not psychiatrically ill, because they pose a risk of harm to themselves or to others. So who might that include?
Ever been intoxicated?
Angry at your partner, or ex?
Yell and scream at them, perhaps saying something ill-advised? (intoxicated, remember)
Watch out, because the cops might just drag you off to see the men in white coats. Yes there is a disclaimer that we can’t invoke the MHA simply for being intoxicated – but the effects of intoxication on behaviour are apparently fair game.
Is it just drunks/drug users? Well not necessarily. Intoxication is a common one, but it’s not all that pops up under this provision. Domestic disputes get brought in, relationship break-ups, antisocial violent individuals ….
Basically it appears to me this provision is a way of sweeping away “undesirables”. And what about political dissent and protest? In the few years I’ve been with my current team, we’ve had a number of referrals from Ministers’ offices. The referred individuals have been angry, ringing a lot, or writing many angry letters, or hanging around and haranguing them/their offices through the days. While protest should not be violent, if someone is, it’s hardly a psychiatric problem.
Well, Soviet Russia might disagree, but is that really what we want to base ourselves on??
And it’s not just the Mental Health Act/compulsory detention (I won’t say compulsory treatment; if they’re not ill, what would we be treating?). It flows on into everything we do, and widens the scope of “mental health services” to a truly uncomfortable degree.
Case in point: in addition to those already on our boards, three more people have come onto our list this morning who all appear to have drug abuse and undesirable behaviour, rather than anything else – anything psychiatric.
I understand the desire to control some of this behaviour. I do not however think the proper way to do that is by involving doctors – thereby trying to pass off undesirable behaviour as an illness state.
And you know what else? If you or someone you care about develops a psychiatric illness (and you’re not really dangerous) you might not get proper care, because the mental health service is so busy dealing with all this non-psychiatry.
So good luck, and here’s hoping you stay well.
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Thought provoking post Raf.
That was the aim
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I deal with people all the time who have been abducted and assaulted with drugs on the pretext that they have a mental illness. But that’s crap. They are actually the subject of malicious and vexatious complaints made by people who really do have something to hide. The person I’m dealing with at the moment is asking me, “If the cops can’t charge me I should be left alone.” I’ve had some very harsh words to say to his shrink who has now released the guy from his CTO. Otherwise the guy was likely to become a lifelong wreck under the influence of depot Risperidone. And he’ll probably never recover satisfactorily from the assaults he’s had to endure over the past several years.