On mislabeling abuse as 'illness'

In 2006 I published a very simple paper with Erika Setzu, Fiona Lobban and Peter Salmon. It was simple because all we did, in essence, was interview people about how they had ended up in mental health care. One quote is worth repeating at length:

Client: “I started to hear voices, but they were not nice voices, they were horrible.”

Interviewer: “Did you recognise them?”

Client: “It was the man that abused me … I met this man that was a builder, in construction, you know? And he said that he wanted to give me a job, but they were all lies, he was trying to con me. He took me back to his house, he locked the door and he had sex with me. … And then other voices as well. I went to … hospital and the nurses were very good to me.”

Interviewer: “When you went to hospital what did they say it was wrong with you?”

Client: “Schizophrenia, paranoid schizophrenia.”

Interviewer:  “What do you think personally?”

Client: “What do you mean?”

Interviewer: “Do you think it is what you’ve got?”

Client: “Oh yes, that’s what I have got.”

The conclusion in my mind is rather simple. This really does look as if it’s the normal, understandable, human response to horrible trauma … mislabelled as “illness”.

For the avoidance of doubt, I should make it clear that I think that this particular gentleman was wise to have contacted the hospital. This man clearly needs help – hearing the voices of your rapist must be hugely distressing (although also pretty common). And I think the care he received may well have been admirable; he says the “nurses were very good” to him. Many of the staff in mental health units often have the skills necessary to offer effective help (when they aren’t distracted by notions of ‘illness’).  I’m very dubious of the long-term effectiveness of so-called ‘anti-psychotic’ medication – Robert Whitaker’s journalism and Richard Bentall’s science shed considerable doubt on the claims of the pharmaceutical industry. But, in the shorter-term, it may well be the case that low doses of medication can prove helpful, because our emotions and perceptions are, of course, brain-based processes. I’m also pretty sure that individual differences, even genetic differences, can help to explain (in part) why people respond differently to extreme trauma, although I do believe that our experiences in life have a more profound influence.

What I object to is the idea that this experience, and the experiences of many millions more, in any sense resembles an “illness”. 

We need to recognise the pernicious danger of thinking about such experiences as if they were symptoms of ‘illness’ – with the consequent stigmatising attitudes, harmful ‘treatments’ and, equally, avoidance of the key issues; in this case, sexual violence.

We should be ‘creatively maladjusted’ to this creeping medicalization of human distress. As I write this, the American Psychiatric Association is preparing to publish the latest version of its diagnostic manuals – DSM-5. It seems clear that this manifestation of the medicalization of human distress will be more paradoxically illogical, more invalid, more stigmatising, and more pervasively likely to pathologise normal human reactions than ever before.

As proposed, DSM-5 could mean that people who drink more than is good for them could be labelled as mentally ill; meeting the criteria for alcohol dependence disorder. People distressed by the death of a loved-one could be labelled as mentally ill; bereavement no longer listed as an exclusion criterion for the diagnosis of depression. People who, in the opinion of a physician (of course) are seen as “excessively” complaining of pain for which there is no medical explanation could be diagnosed as mentally ill. Children let down by the education system, and who find it difficult to sustain attention in class could – increasingly - be labelled with ‘ADHD’. Women (but not, interestingly, men) who have the temerity to report that their sexual partners do not satisfy them in bed could be labelled as mentally ill – if you don’t experience pleasure during sex, you could well be diagnosed with ‘female organismic disorder’, and, fascinatingly, one’s partner’s sexual performance is not taken into account. And, bringing us ‘round full circle, raping people appears no longer to be thought of as a crime, but as a symptom of ‘coercive paraphilic disorder’.

We need to ensure that alternative voices of reason are heard. People have the right to be concerned. We need to be cool, to be elegant, to be evidence-based and we need to be humane. But we need to make it clear that we are concerned about the consequences of unrestrained diagnostic labelling.