Is Stigmatization of the Mentally Ill Justified - Assignment Example

Mental Health and Mental Disorder (Psychosocial Studies degree) “Schizophrenia” as my own example to show how helpful in alleviating the associated problem in Thomas Szazs’s claim that such diagnoses of mental illness viewed as “myth”. Schizophrenia can simply be defined as multifaceted mental ailment. The schizophrenic disorders are characterised in general by fundamental and characteristic distortions of thinking and perception, and by inappropriate or blunted affect. Clear consciousness and intellectual capacity are usually maintained, although certain cognitive deficits may evolve. 1. What is the associated distress? Associated Problems in psychotic Phase are: Reckless or Impulsive Behaviour, Obsessive Thinking or Compulsive Rituals, Prolonged Anxiety, Tension or Worry, Fidgeting, Pacing, or Hyperactivity, Sad or Depressed Mood, Irritability or Hostility, Feeling Worthless or Guilty, Fatigue, Poor Concentration or Attention, Sleeping Problem, Appetite or Eating Problem, Poor Sexual Interest or Ability, Overly Dependent Behaviour and Poor Physical Health. (See his discussion of the two classes of disability. Szasz 1961/1972 p.54). The illness model of mental disturbances with an analysis in terms of meaningful (but perhaps unconscious) communication. Hysteria, for example, is a psychological disorder that manifests itself as physical illness. Szasz describes it as a dramatised representation of the message my body is not functioning well. The mental illness called depression is a dramatisation of the proposition ‘I am unhappy’. (Szasz 1961/1972 p.202) Szasz's main arguments can be summarised as follows: The myth of mental illness: Schizophrenia and other mental disorders are simply semantic artefacts and do not really exist. While people behave and think in ways that are very disturbing, this does not mean they have a disease. Separation of psychiatry and the state: If we accept that 'mental illness' is a euphemism for behaviours that are disapproved of, then the state has no right to force psychiatric 'treatment' on these individuals. Similarly, the state should not be able to interfere in mental health practices between consenting adults. Presumption of competence: Just as legal systems work on the presumption that a person is innocent until proven guilty, individuals accused of crimes should not be presumed incompetent simply because a doctor or psychiatrist labels them as such. Death Control: In an analogy to birth control Szasz argues that individuals should be able to choose when to die without interference from medicine or the state, just as they are able to choose when to conceive without outside interference. Abolition of the insanity defence: Szasz believes that testimony about the mental competence of a defendant should not be admissible in trials. Abolition of involuntary mental hospitalisation: No one should be deprived of liberty unless he is found guilty of a criminal offence. Legalisation of illegal drugs: Although Szasz opposes psychotropic medications; he favours the legalisation of illegal drugs. 1. How was mental illness treated before Szasz’s claim? Three mental illnesses that have received attention from philosophers and psychiatric theorists on the issue of responsibility are schizophrenia, psychopathy, and alcoholism. There are of course many other mental illnesses where the issue of responsibility arises: obvious examples are depression, obsessive-compulsive disorder, manic episodes, paraphilias, and borderline personality disorder. Despite the fact that the various theories of the aetiology and nature of these disorders are very suggestive of ways to understand the responsibility of those with the disorders for their symptomatic behaviour, these and other mental disorders have received surprisingly little discussion from philosophers vis-à-vis responsibility for action. It would not be fair to blame psychiatry for the invention of compulsion. Psychiatry only gained the major responsibility for controlling madness in the 19th century, and society required madness to be controlled long before that. Statutes allowing magistrates to detain mad people were passed early in the 18th century - But before that they could be detained under the common law. William Blackstone (1723-1780) in his Commentaries on the Laws of England wrote that: "It was the doctrine of our ancient law, that persons deprived of their reason might be confined till they recovered their senses." There are two long established reasons for the legitimate use of compulsion against mad people: 1. The protection of society 2. Compassion for the mad person. Blackstone said madmen should not be allowed out to the terror of the king's subjects. It seems, therefore, that his main concern was to protect society. Some examples of madmen being confined for their own good from the 17th century will be found in Hunter and Macalpine's collection of historical documents Three Hundred Years of Psychiatry. They quote the case of a man in 1654 who had fallen into a sullen, sad, melancholy and would not go indoors or eat or bath. His neighbours discovered that his head had become infested with maggots and decided something had to be done to help him. They forced him into a house and paid a woman to dress and take care of him. The local magistrates ordered that the costs should be paid from public funds. (Hunter and Macalpine 1963 p.140) 3. How helpful is Thomas Szazs’s claim towards the treatment of mental health? Szasz regards the medical model of mental illness as an ideological justification for coercion. It is a way of excusing violence against mental patients by representing it as treatment. Szasz says that compulsory psychiatry cannot be justified medically or morally. It is a crime against humanity (Szasz 1972/Summary), and it undermines a free society. "The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warranty." (Mill 1859 quoted Szasz 1971, pp 349-340). Mill made an exception for those without the full use of their reason. Szasz does not. According to Szasz, it is a precondition of a free society that we do not force help on one another. Psychiatrists and their allies have succeeded in persuading the scientific community, courts, media, and general public that mental illnesses are phenomena independent of human motivation or will. The core concept of mental illness--to which the vast majority of psychiatrists and the public adhere--is that diseases of the mind are diseases of the brain. The equation of the mind with the brain and of mental disease with brain disease, supported by the authority of a large body of neuroscience literature, is used to render rational the drug treatment of mental illness and justify the demand for parity in insurance coverage for medical and mental disorders. If we accept the idea that the diagnoses of mental illnesses refer to real diseases, we are compelled to accept them as diagnoses on a par with those of bodily diseases, albeit the criterion for what counts as a mental disease is completely different from what counts as a bodily disease. For instance, in Psychiatric Diagnosis, Donald Goodwin and Samuel B. Guze, two of the most respected psychiatrists in the U.S., state: "When the term `disease' is used, this is what is meant: A disease is a cluster of symptoms and/or signs with a more or less predictable cause. Symptoms are what patients tell you; signs are what you see. The cluster may be associated with physical abnormality or may not. The essential point is that it results in consultation with a physician." According to these authorities, disease is not an observable phenomenon, but a social relationship. Diseases are physico-chemical phenomena or processes--for example, the abnormal metabolism of glucose (diabetes). Mental diseases are patterns of personal conduct, unwanted by the self or others. Psychopathology is diagnosed by finding behavioural, not physical, abnormalities in bodies. Disease qua psychopathology cannot be asymptomatic. Changing the official classification of mental diseases can transform non-disease into psychopathology and psychopathology into non-disease (i.e., smoking from a behavioural habit into "nicotine dependence"). In short, medical diseases are discovered and then given a name, such as acquired immune deficiency syndrome (AIDS). Mental diseases are invented and then given a name, such as attention deficit disorder. 4. How was mental illness treated after Szazs’s claim? There were a lot of drugs for treatment of mental disorder but not without side effect. The most common side effects that may occur with Risperdal drug, in the treatment of BIPOLAR MANIA either alone or in combination with a mood stabilizer (Valproate or Lithium) are: sleepiness, muscle stiffness, restlessness, tremor, indigestion, nausea, abnormal vision, muscle aches, dizziness, runny nose, diarrhoea, increased saliva, stomach pain, and urinary incontinence. In the treatment of SCHIZOPHRENIA: anxiety, sleepiness, restlessness, tremors, and muscle stiffness; dizziness, constipation, nausea, indigestion, runny nose, rash and rapid heartbeat. Studies suggest an increased risk of elevated blood sugar-related side effects, and sometimes potentially fatal, in patients treated with this class of medications, including RISPERDAL. Some people may need regular blood sugar testing. Food and Drug Administration (FDA) for Paliperidone Extended-Release (ER) Tablets, an investigational extended- release, once daily, oral medication for the treatment of schizophrenia by Janssen, L.P., a wholly owned subsidiary of Johnson & Johnson. The trade name for the marketed product has not yet been determined. The paliperidone ER filing is based on an extensive global clinical development program that involved more than 1,600 patients in 23 countries. Regulatory submissions are expected to follow for paliperidone ER in other countries. Schizophrenia affects more than 2 million Americans and 800,000 British and is characterized by symptoms such as hallucinations, delusions, social withdrawal and a diminished capacity for organized thought. .5. Support and Criticism of Szazs’s claim (Mental diseases are behaviours). No one believes that love sickness is a disease, but nearly everyone believes that mental sickness is, and virtually no one realizes that, if this were true, it would prove the non-existence of mental illness. If mental illnesses are brain diseases (like Parkinsonism), then they are diseases of the body, not the mind. A screwdriver may be a drink or a tool, but it would be foolish to do research in the hope of discovering that some cases of orange juice and vodka are hitherto unrecognised instances of carpenters' implements. Contemporary American is so thoroughly psychiatrised that it is quite useless to demonstrate the logical-linguistic misconceptions inherent in the claim that "mental illness is like any other illness." Unless people are prepared to defy the combined forces of the state, science, medicine, law, and popular opinion, they must believe--or at least pretend to believe--that mental illnesses are brain diseases; scientists have identified the somatic lesions that cause such illnesses; and psychiatrists possess effective treatments for them. So long as there are no objectives, physico-chemical observations shown to be causally related to depression and schizophrenia, the claim that they are brain diseases is unsubstantiated. In the absence of such evidence, psychiatrists rest their claim that these major mental diseases are brain diseases largely on the contention that drugs keep the disease processes "under control." The absurdity of this claim lies in its own consequences. If we restrict the concept of treatment to a voluntary relationship between a medical practitioner and a competent client, then a coerced medical intervention imposed on persons not legally incompetent is, by definition, assault and battery, not treatment. Psychiatry is thus a systematic violation of this legal-political principle, one that is especially odious because most persons treated against their will by psychiatrists are defined as legally competent--they can vote, marry and divorce, etc. Regardless of psychiatric diagnosis, the typical mental patient is entitled to liberty, unless convicted of a crime punishable by imprisonment. If that patient breaks the law and is convicted, then he or she ought to be punished for it as prescribed by the criminal law. In a free society, a person ought not to profit from psychiatric excuses or suffer from psychiatric coercions. In Szasz's view, this should not be possible. For decades, what he calls his "passion against coercion" has driven him to denounce involuntary mental hospitalisation, while his insistence on individual responsibility has made him a dedicated opponent of the insanity defence. If someone commits a crime, Szasz says, he should be punished, not "treated." But if he has not violated anyone's rights, he should be left alone, no matter how bizarre his behaviour. In contrast to Szasz's orientation, an advantage of the illness model is that it de-stigmatises the mentally ill. Szasz, Laing and others who hold theories that involve psychodynamic and family dynamic causation stigmatise the patients and their families, putting counter-productive guilt and blame on them. Such theories stigmatise these patients as being "crazy" or "anti-social" or "deviant" and their families as "schizophrenogenic" or "dysfunctional." References 1. Language and Thought in Schizophrenia – Thomas S. Szazs 2. The Myth of Mental Illness….Thomas S. Szazs 3. The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric and Repression – Thomas S. Szazs. 4. Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock and Biochemical Theories – Peter R. Breggin. 5. Insanity: The Idea and its Consequences – Thomas S. Szazs. 6. The Untamed Tongue: A Dissenting Dictionary – Thomas S. Szazs. 7. Surviving Schizophrenia – E. Fuller Torrey, MD 8. Schizophrenia: Symptom and Management at Home, Department of Psychiatry, University of Toronto; John F. Thornton and others. Read More