How psychiatry became a damage limitation exercise
by Darian Leader, The Guardian
June 21, 2011
...The role of wards as crisis centres has also created serious problems relating to suicide. Risk management means lives cannot be lost, and patients learn to hide suicidal thoughts to facilitate discharge. Yet the more suicide is exorcised as a legitimate choice the greater its weight will become. Eugen Bleuler noticed this early in the 20th century, arguing that hospitals should be less coercive in their approach. This, he argued, would lead to fewer suicides, and later research in New York hospitals proved his point. The more you insist that the person can't kill themselves the more the chances of a suicidal act increase.
It is likewise no accident that today the greatest risk point for suicide is within a week of discharge. Given the failure of most wards to provide therapeutic spaces, what can the patient hope for in terms of long-term care? Faced with a choice between short-term ward admission and a solitary drug regimen, they may feel helpless and terrified.
More beds, less red tape and greater staff consistency are no doubt crucial, but more profound changes are needed in the way we think about "mental illness". There is massive pressure to bring the patient to some notion of a shared reality, returning them to productivity as soon as possible. Mental health services become like a garage where people are fixed and put back on the road, rather than subjects to be listened to.
But once we start listening we might well question our beliefs and prejudices about normality. As old psychiatry recognised, many of the phenomena that are seen to define mental illness are in fact efforts to battle against it. A delusion, for instance, may provide a meaning to one's world, and to try to remove it may deprive the person of a crucial resource.
Bhugra is right that more therapy must become available, but there must be diversity. At present therapies that mimic drugs in their aims clear the field: promising swift outcomes, localised intervention and precise targets, they use the very language of drugs. Yet they all too often buy into a discourse of normality and rehabilitation that ignores the specificity of the patient – and their ways of making sense of their situation.
Mental health services need to learn more from patients, questioning the values of efficiency and autonomy fetishised by contemporary society. As the Canadian psychologist Ellen Corin puts it, they must put aside projects of rehabilitation in order to help foster the processes of reconstruction begun by patients themselves, and this means giving up ideas about what it means to be "cured" or "reintegrated" into society.
by Darian Leader, The Guardian
June 21, 2011
...The role of wards as crisis centres has also created serious problems relating to suicide. Risk management means lives cannot be lost, and patients learn to hide suicidal thoughts to facilitate discharge. Yet the more suicide is exorcised as a legitimate choice the greater its weight will become. Eugen Bleuler noticed this early in the 20th century, arguing that hospitals should be less coercive in their approach. This, he argued, would lead to fewer suicides, and later research in New York hospitals proved his point. The more you insist that the person can't kill themselves the more the chances of a suicidal act increase.
It is likewise no accident that today the greatest risk point for suicide is within a week of discharge. Given the failure of most wards to provide therapeutic spaces, what can the patient hope for in terms of long-term care? Faced with a choice between short-term ward admission and a solitary drug regimen, they may feel helpless and terrified.
More beds, less red tape and greater staff consistency are no doubt crucial, but more profound changes are needed in the way we think about "mental illness". There is massive pressure to bring the patient to some notion of a shared reality, returning them to productivity as soon as possible. Mental health services become like a garage where people are fixed and put back on the road, rather than subjects to be listened to.
But once we start listening we might well question our beliefs and prejudices about normality. As old psychiatry recognised, many of the phenomena that are seen to define mental illness are in fact efforts to battle against it. A delusion, for instance, may provide a meaning to one's world, and to try to remove it may deprive the person of a crucial resource.
Bhugra is right that more therapy must become available, but there must be diversity. At present therapies that mimic drugs in their aims clear the field: promising swift outcomes, localised intervention and precise targets, they use the very language of drugs. Yet they all too often buy into a discourse of normality and rehabilitation that ignores the specificity of the patient – and their ways of making sense of their situation.
Mental health services need to learn more from patients, questioning the values of efficiency and autonomy fetishised by contemporary society. As the Canadian psychologist Ellen Corin puts it, they must put aside projects of rehabilitation in order to help foster the processes of reconstruction begun by patients themselves, and this means giving up ideas about what it means to be "cured" or "reintegrated" into society.
