The treatment of people with mental health challenges
Social history of psychiatric treatment
In the nineteenth century, the dominant view was that mental health challenges were the result of an ‘inferior gene pool.’ This view was challenged by the results of World War One when British officers, who generally came from Britain’s ‘finest stock’ returned home with shellshock.
In the twentieth century, Western psychiatry developed an eclectic mixture of somatic (bio psych) and conventional (talking therapies) treatments.
Critical appraisal of psychiatric treatment
There is broad and unresolved tension between somatic and conventional modes of treatment. All treatments have been criticised for iatrogenic effects. That is, the unwanted and/or unexpected side effects. There has also been criticism regarding the ineffectiveness of many modes of treatment in actually ameliorating distress.
Why have physical treatments tended to dominate?
- Medicalisation of psychiatric ‘abnormality.’
- Psychiatrists aligned with mainstream medicine in the 1960s when institutions were being closed. This impacted on the emphasis on physical treatments due to medicalisation.
- Physical treatments are legitimised by the profit motive.
- Physical treatments are cheaper than labour intensive talking therapies.
- There is a link between psychiatry and social control.
- Psychotropic drugs and marketing by pharmaceutical companies have positioned physical treatments as the preferred approach.
Benzodiazephines have been used for treating depression, anxiety, insomnia, agitation, seizures, muscle spasms and alcohol withdrawal.
But they are addictive, they only control symptoms for around 10 days, and they have withdrawal symptoms, such as panic attacks and insomnia.
The first generation were introduced in the 1950s, while the second generation, known as atypical antipsychotics, were introduced in the 1990s. Both types block dopamine pathways in the brain. Negative effects are common, and according to some theorists, their continued use, despite the negative effects, highlights the issues of professional dominance and labelling.
Two types of iatrogenic effects arise in psychotherapy:
- Deterioration effects where symptoms get worse during the normal course of therapy.
- Personal abuse by unethical practitioners who exploit their power.
The moral sense of ‘treatment’
At one end of a spectrum of psychiatric services is enforced detention, while on the other end, are outpatients who visit their therapists on a voluntary basis. In the middle are patients who are treated through a mixture of voluntary and involuntary approaches.
What separates those two ends is the question of free choice.
Who is psychiatry’s client?
One of the issues around psychiatry is whether the identified patient is the actual client of the psychiatric service. When a person’s liberty is removed through legislation, clearly some party other than the patient is being served.
The question of informed choice
To understand whether of not genuinely informed consent takes place in psychiatric services, we need to ask the following five questions:
- Are the patients aware of themselves?
- Do those assumed to be aware of themselves use that awareness to act morally?
- Are patients supplied with professional and comprehensible information?
- Are patients subjected to pressure or coercion?
- Is consent to specifiable actions offered to patients?
It would appear that psychiatric practice is problematic on all five points.
Professionals may override the need to seek consent if they believe that the patient lacks insight into their condition; however:
- Insight is defined in a circular way.
- How does the psychiatrist know for sure when a person is aware or not?
- A patient may be aware of some things but not of others because no one can be truly aware of everything relevant to their existence at all times. Because of this, how can psychiatrists actually specify what insight means?
The above highlights that, collectively, psychiatrists have not acted morally in relation to the needs and vulnerabilities of patients. So, professionals, who assume themselves to be aware of themselves, do not act morally thus failing the second criterion.
The third, fourth and fifth criteria are well-known to be problematic areas within psychiatry, so I’m not going to unpack that here.
The social distribution of treatment
One of the paradoxes of psychiatric treatments is that it inverts the ‘inverse care law.’ The inverse care law refers to the phenomenon of those in the greatest need, as a result of a socially created illness (physical illness), having the poorest access to the healthcare system. The opposite is true for mental health care systems. In light of the stigma attached to mental health services and the role of psychiatry some of the time in coercive control, it is not surprising that some social groups are more vulnerable to the receipt of services than other social groups.
This is part of a series of summaries that I am doing in order to revise Sociology of Mental Health. It won’t be shared on social media, but anyone is welcome to read these posts if they would be of interest.
If you would like to read more, most of this information came from this book.