Sunday, March 17, 2013

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.


  1. I am fascinated to read such intelligent thoughts from a Professor of psychology. To criticise one's own profession, takes courage. To seek change, is admirable.

    It would appear to me, that the majority of disorders, are merely a reflection of how humans deal with pain effects, and coping-mechanisms.

    Rather than explore the causalities, and put emphasis on changing the perception, and behaviour, of an anxious or distressed person, he or she is labelled with an often unhelpful diagnosis of mental illness. A diagnosis which remains on one's medical records indefinitely.

    Undoubtedly, a drastic comparison, however, being diagnosed with mental-illness bares similarity to being diagnosed with cancer. It is considered ongoing. Even if we prevail in fighting it, we live with the notion that we are not cured, rather, 'in remission'.

    There is no line drawn under mental-illness. If you have suffered depression, or anxiety as a result of trauma, or abuse, the causalities are not emphasised in your medical history. Rather the effects. Leaving a vast majority of the population vulnerable, due to the notion that mental illness cannot be cured, rather, managed.

    The implications of this are worrying. The most common form of defence in criminal and family courts, for perpitrators of abuse, is to discredit victims based on the notion that due to having suffered anxiety, or depression, present, or past, victims are not credible witnesses.

    Diagnosis also leads to unemployment. I believe that if fewer people were labelled with mental illness, and more emphasis was put on determining the causalities, and therapy (instead of labels and medication) it would lead to greater productivity.

    Many deemed with mental disorders, are offered medication, and a piece of paper that exempts them from day-to-day life, and work. Should a person suffering with social anxiety be offered the equivalent to a 'get out of jail free card' by their G.P, a legitimate excuse not to have to have to face-their-fears, it's likely they will embrace it! Understandably. Obviously avoidance is not the solution to social anxiety. It exasperates the problem, leading to further problems such as depression, and agorophobia.

    Those who live restricitve lives, tend to focus on their problems, and cannot see past them, because their lives have no substance. People who feel stuck become depressed, de-motivated, further anxious, and are likely to develop obsessive compulsive tendancies.

    In response to the DSM5...

    I wonder, how long before those who pray, and talk to God in church, are considered schitzophrenic?

    Or those who cannot give up their morning coffee, considered to have addictive personalities?

    How many of us can truly say we are not addicted to something? Be it affection, love, achievement, endorphins.

    In a society that scrutinises labels, whilst shopping for food, considering what book to next read, and scrolling through reviews on the internet about products. How accurate are these labels? How much faith do we put in them? Did not so long ago, consumers confuse horse meat to be beef? Could a poor review about a product, not be biased? Perhaps the opinion, or marketing strategy of a competitor, or person/s with a grievance? Could not a book with a fantastic cover, and synopsis, contain dull reading?

    Labels can be useful, as can medication be. I feel, however, both should be used as a last resort. Considering the implications.

    While-ever mental illness has the possibility of suggesting indefinite mental fragility, perpitrators of abuse, including in positions of authority, will always exploit it.

    I will continue to read your blog with great interest!

  2. I meant to add parentheses to the second paragraph. It would have made more sense.

    'how humans deal with pain (effects, and coping mechanisms)'

    I wonder if my correcting this may be construed as perfectionist disorder?!