Will Self, Psychiatry and the Stigma of Distress

posted in: counselling, psychiatry, psychotherapy | 0

I read with great interest the Will Self article about psychiatry, in particular psychiatrists as drug pushers. Psychiatry has been the focus of much critique often being portrayed as inhuman in its treatment of people and whilst much of this seems justified I am concerned that Self’s perspective on psychiatry leads to further stigma of those who have experienced mental distress.

Responses to Psychiatry

A few years ago I spent time at the Philadelphia Association (PA) which was originally founded by opponents of psychiatric practices which at that time (1960s) included lobotomies and electro-convulsive therapy. The PA’s approach was to work psychoanalytically with people individually and through living in shared houses that could support people in a way that recognised them as human beings rather than dehumanising mental institutions. The PA’s approach represented an important, but limited critique of psychiatry. Psychiatry, since the early critiques has greatly changed and now predominantly relies upon pharmacological approaches to treat mental distress and it is this that Self takes as his focus. Self questions the difference between a psychiatrist and a drug dealer:

his [Self’s psychiatrist] “treatment” of me consisted of prescribing Temgesic, a synthetic opiate, as a substitute for the heroin I was more strongly inclined to take. So, he undertook this role: acting, in effect, as a state-licensed drug dealer; and he also attempted a kind of psychotherapy, talking to me about my problems and engaging with my own restless critique of – among many other things – psychiatry itself.

So for Self it seems there is little difference between a drug dealer and a psychiatrist; although one would wonder whether their motivations are different; for instance one hopes that a psychiatrist’s motivation is to treat people in a way that is helpful and curative which we would not ascribe to a drug dealer. Ascribing motivations can be a tricky business at the best of times especially for those portions of the ‘psy’ professions whose training does not include their own therapy. Unlike counsellors and psychotherapists (with an appropriate training) who have learnt through their own therapy to question themselves and their motivations the medically and diagnostically focused psychiatrists and clinical psychologists have no requirement to undertake such exploration. This becomes further complicated if we draw a distinction between our motivation or what we think we do and what we actually do.

For many people psychiatry imposes treatments that affect our biology, for instance through treating chemical imbalances with drugs. This approach sees suffering as mechanical and not necessarily about the way people experience and exist within the world; although it seems that regardless of how misguided Self’s psychiatrist may have been that he attempted to mix both approaches. An early and originally unpublished work by Freud attempted to work out the relationship between perception, experience and our bodies in order to theoretically work out how psychology impacts biology and vice versa; however Freud was not able to fully workout his project for a scientific psychology. Today it seems increasingly that we continue to be trapped within a mind-body dualism where thinking beyond these and not reducing one to the other is extremely difficult.

The recent work by James Davies that Self references highlights how the development of psychiatry (in the US) has increasingly shifted from biologically determined diagnosis towards behavioural classifications defined by committee and that these have proliferated to gain maximum benefit from medical insurance. As Self states, perhaps cynically:

it isn’t a function of scientific acumen identifying hitherto hidden maladies, but of iatrogenesis: doctor-created disease. So, while it may well be general practitioners who do the doling out, psychiatrists are required to legitimate what they are doing and provide it with the sugar-coating of scientific authenticity. It’s a dirty, well-paid and high-status job – but someone has to do it, no?

Perpetuating Stigma of Distress?

For James Davies the stigma of biological illness is more severe than that which relates to our social-cultural context, this claim is not evidenced and from my own clinical work and experience I don’t think the two things can necessarily be measured for a comparison. People can feel profoundly alienated from their own body where biological understanding is accepted, they may literally feel at war with themselves. Those people who feel like social-cultural reasons have ’caused’ their suffering often wonder what made them suffer when “others had it worse”. People express their experience through many different types of stories some of them perhaps are more suited to a biological narrative of psychiatrists whilst others are more suited to a social and cultural understanding. Given the debate around psychiatry we could be forgiven in thinking that these are the only two ways of thinking about suffering, but ultimately these are just two perspectives among many.

Will Self seems to question the very notion of psychiatry whereas James Davies sees it relevant to ‘illnesses’ with a biological cause. What worries me about Self’s view is that it seems to have the capacity to further stigmatise people who suffer from mental distress. There continues to be a great deal of stigma surrounding mental ill health and distress already with many campaigns originating from MIND and SANE that attempt to combat this. For Self the implication is that for those who seek help from a ‘professional’ such as a psychiatrist are putting their ‘faith’ into a kind of pseudo-science and that if it works it does so in spite of itself.

I have worked with many people for whom the drug treatments they have been prescribed have been extremely important in allowing them to feel that therapy was a viable option for them, that they could then benefit from talking to someone. Whilst it is possible to site varying statistics to prove or disprove the effectiveness of drug treatments (and talking therapies), psychotherapy with its focus upon being in a relationship with a person prioritises the exception rather than rule. It is also a place to question the stories we tell ourselves about our suffering, distress and mental illnesses so that we can think and talk about it and possibly change it; it certainly isn’t a place to arbitrarily impose one perspective (the therapist’s) over another‘s