Sunday, 30 June 2013

Madness and Mentalism

I've no idea, as I start writing, where this post is is going.  I'm seething inside at something a friend (I'll call him 'Q') said last night.  It echoed an attitude I have encountered in mental health professionals.  Q is thinking about becoming a mental health nurse, which means I should really try and make him understand... although I did try to point out the gaping flaws in his argument/attitude at the time. 

We were talking about a mutual friend ('P') in the context of this friend needing mental health help. 

The comment I objected to was about P not really being 'mad' as (apparently) his symptoms don't present in quite the same way as someone who
really has them.  Not that he has different symptoms, but that his symptoms are someone not genuine.  At first I was intrigued by this, and questioned how 'real' symptoms would differ; assuming Q had experience of this in his care role.  However, it turned out he had no experience, and was simply judging based on a preconceived and uninformed idea of 'madness'.  The implication was that P was entirely responsible for his actions, and should be left to get on with it and “sort himself out” without needing any support. 

This takes us to the 'mad vs bad' debate that lies where mental health and the criminal justice system collide.  (For more on this, see the excellent blog by Mental Health Cop.)  Is someone 'mad' and deserving of sympathy and help, or 'bad' and to be punished for their actions? 
In mental health care, the mad/bad construct is also very relevant, although less to do with punishment (hmm...!) and more about whether someone is 'mad' enough to receive help/a certain level of help, or whether they are capable on their own.  Phrases like 'attention-seeking' are bandied around at this point.  There's also issues around retaining a level of independence, although this seems to be used largely by professionals to refuse all support, rather than in the context of appropriate support and treatment.  A bit like refusing to throw a lifebelt to someone who's drowning because they should be able to swim, rather than throwing them the lifebelt they are screaming for and then teaching them to swim for next time.  Anyway, I digress...  The mad/bad idea can be more helpfully reframed as 'mad, bad or sad', and in this context, if P isn't 'mad', he is most certainly 'sad', so he is surely deserving of support anyway! 

What really annoyed me about dismissing P's symptoms and difficulties in this way was that it relied upon a completely stereotyped and stigmatizing view of what a 'mad' person is like.  Q actually pointed out that P isn't constantly displaying symptoms and can interact with others in a perfectly ordinary way (ignoring the fact that P doesn't socialise when unable to, and his problems manifest in odd episodes of a few seconds to a few days).  A 'mad' person, according to Q's viewpoint, should be obviously identifiable all the time.  As if there is a massive difference between 'normal' and 'mad' people, rather than just people, who sometimes hurt a lot or get messed up by life.  Sadly, the opposite of being dismissed as not needing help is often being placed in the box marked “severe and enduring”, medicated, and removed from any meaningful use of the word 'recovery'. 

Another issue was summed up by something else Q said: that P is, apparently, “just a mad person”.  Yes, that does directly contradict the above, which is why mental health professionals and would-be professionals should think through this stuff before passing judgement!  Anyway, the comment was made with the implication being “he's just a mad person, why are you bothering with him?”  As if he somehow didn't deserve to be helped as I'd help anyone else, as if the issues he faces don't matter as much, or that problems are to be expected and ignored as natural consequences of being “a mad person”. 

This attitude is unfortunately apparent within the mental health system.  It's evident in the lack of support or sympathy given to (at least some) service users when catastrophic events have pushed their mental health over the edge.  Events like becoming homeless, finding out your partner is cheating on you, or losing a friend to suicide, barely nodded at before the anguish and pain is dismissed as merely a symptom of poor mental health.  It's all linked to 'mentalism', which is connected to 'ableism'.  Without going into too much detail, this sums up what I'm getting at: 
mentalism at one extreme can lead to a categorical dividing of people into an empowered group assumed to be normal, healthy, reliable, and capable, and a powerless group assumed to be sick, disabled, crazy, unpredictable, and violent.  This divide can justify inconsiderate treatment of the latter group and expectations of poorer standards of living for them, for which they may be expected to express gratitude.
The discrimination can be so fundamental and unquestioned that it can stop people truly empathizing (although they may think they are) or genuinely seeing the other point of view with respect.  (Source: Wikipedia)

Sometimes these mental health gurus (snigger) go one step further and actually use distressing life situations as diagnostic indicators.  Things like having a 'chaotic' lifestyle or relationship difficulties can be viewed as resulting from personality disorder, and the resulting distress can also be passed off as a 'symptom'.  (This is dodgy territory, littered with self-fulfilling prophecies.)  The individual had no support in coping with their – quite legitimate – distress, or with improving their situation, and is in fact blamed for their own misfortune.  Even if the difficulties they face do go hand-in-hand with their mental health issues, it doesn't make them any less difficult or traumatic (retraumatization is also an issue).  Instead, it merely highlights the urgent need for treatment and ongoing support. 

So, going back to the “just a mental person” comment, does that mean we shouldn't help P as these problems are 'only' a result of mental illness?  Should we leave him to suffer in a downward spiral and then assuage any twinges of guilt by suddenly changing tack and declaring him 'sane' and thus responsible for the situation?  
I don't think so! 
When you consider the prevalence of trauma in the development of mental disorders, and that the stigma surrounding them can be more debilitating than the original symptoms, it's obvious that society (that's us!) needs to take responsibility.  Not only is it grossly unfair to ignore the plight of individuals who are already suffering, it's also blindingly counter-productive.  If someone is treated as a 'loser', a 'weirdo', or an 'attention-seeker', is isolated, denied opportunities and forced to live in stressful and/or traumatic circumstances, their mental health is more likely to get worse than better.  Refusing to help those who are suffering, dehumanizing and even blaming them, not only perpetuates the cycle of trauma and disadvantage, it also shows a twisted lack of humanity. 
And that is the scariest psychological symptom out there.  

**Since I started writing this post I've had a chat with Q and he's 'seen the light'!  Or something.  Which means I should probably be slower to judge (or quicker to write...!)**