Follow Up Questions To My Psychiatry Rant

"You said that mental health workers treat and drug patients when they feel threatened, and asylums are mostly to make the public feel safe and to protect "us" from "them" and that we should be more worried about what's good for the patient as well. But what about patients who really are dangerous or unpredictable?

How should they be treated or restrained, as opposed to patients who aren't dangerous, and as opposed to criminals who aren't mentally ill?"

This all depends on what we mean by "treatment" and "dangerous." To draw an analogy that is quite pertinent here in the UK at the moment, we can look at the problems posed by paedophilia. Much of what we are witnessing is a media generated "epidemic," but we cannot deny that paedophilia does present our society a series of problems. An age old debate about any criminal or anti-social behaviour is that of the "mad or bad" dilemma. Someone who murders 17 people can be thought of as being pretty bad and requiring punishment or we can say that he must be mad to do such a thing, as certainly no normal person would choose to kill 17 people. Therefore, he must be mad and requires treatment.

Our gaols are euphemistically called "correction facilities" or "reformatories" where the criminal is made to face his crimes and reform according to the standard expected by "society" but certain dilemmas occur where the criminal feels more than justified for doing what he did. He might even have a sense of injustice about his own treatment at the hands of the judicial system that detains him. A classic and current case is that of one man, Tony Martin, who was convicted of murder (subsequently reduced to manslaughter) who shot and killed a recidivistic burglar who was burgling his property, again, with an accomplice (who was also shot and wounded by Martin).

To get parole and early release Martin must convince the parole panel that he has genuine remorse for his "crime". This remorse is the indicator that the "justice system" has done its job and the prisoner can be justifiably released.

R.D Laing tells the anecdote of the schizophrenic who denied that he was Napolean and the polygraph indicated that he was lying.

There is no doubt that there are some people out there who are both frightening and dangerous to other people's safety. Whilst the knife-wielding madman high on crack is the most impressive upon our sense of safety, we cannot ignore the daily dangers to our very planetary survival invoked daily by our beloved politicians. I'm not sure if we will ever have a universally consensual method for dealing with these problem people but many methods have been explored and suggested. Science fiction writers have explored many methods of dealing with dangerous and anti-social people, one novel approach is that of total memory deletion. The person's entire identity and personal history is removed and they simply start again, ready to be moulded into a model citizen. Other approaches include diathermy to the neurological pathways that enable aggression in order to render the person passive and without aggressive drives. Advocates say that although this might appear to be a horrific "cure", is this any less horrific than leaving the person intact and languishing inside the abuses of a high security penitentiary?

The same reasoning has been applied to the problem of paedophilia. Whilst physical or chemical castration has often been thought of as a favourable solution to the obscene behaviour, critics point out that to do so removed the responsibility of the actions away from the person and places the emphasis purely on the state of his gonads. With the violent offender, we would 'blame' defects in his limbic system. In this model, reform, regret and remorse are deleted out of the equation, we'd say these facets just are not possible for someone with such an affliction.

This model is increasingly brought into question with the popularisation of the notion that paedophilia is a sexual "preference" and is not a sexual deviance and so therefore it cannot be "treated." However, to frame such behaviour in clinical terms will invariably deny the victims and members of culture the understandable and justifiable outrage and need for revenge when potentially the safety of the hive is threatened is such ways. What is interesting is the much marketed fear of "anarchy" if we don't let our State owned judiciary administer justice as it wishes. What is impressed upon us time and again is that to take the law into one's own hands will never be tolerated by the State, we must leave it to the professionals. The effect of this however, is a total disempowerment of citizenry, who's participants will fail to intervene when someone is being raped, or will step over the vagrant tutting to themselves that maybe "someone" should do something about it. We have broken apart culture and created an autocratic society.

The proof of motivation has long been a legal principal in our legal system. Many an armed robber has attempted to escape the death penalty by arguing that he never really intended the gun to fire. Premeditation is seen as the worst aspect of any crime, and as such incurs the highest penalties. Accidents are often forgiven in criminal courts, but of course in our increasingly litigious societies, accidents can be very expensive indeed.

There seems to be a common thread throughout all legal systems of "punishment" - we want the punishment to fit the crime, despite various religious doctrines urging our tolerance and forgiveness. It's an interesting paradox that the most religious cultures generally invoke the severest and often cruellest penalties upon their "criminals." Kill them all and let God sort them out, I guess can often be a guiding principal.

I have previously drawn parallels between electroshock "treatments" and the electric chair "punishment". It is interesting that electroshock is given to bring the depressive or psychotic back into our reality or at least our version of it, whilst the convict about to be fried in the electric chair is given the last opportunity to repent and confess to a religious figure, thus bringing him back in "the fold" prior to his extermination. It's worth noting that the hideous punishments for witchcraft in days gone by were aimed at literally burning the evil out of the hearts of men. The body was punished to liberate the soul, again, the opportunity to "confess" was always given prior to extermination.

The similarity between this and psychiatric care is remarkable. What we effectively are asking of the psychotic for him to confess that his belief and behaviour are all wrong and that he accepts our version of doctrine and belief. This confession must be genuine felt and meant or it simply doesn't count, we scrutinise his very psyche for his deception, for a false confession is symptomatic of something far worse than simply a denial. We will torment him with therapy and drugging until he finally breaks and bends to our will. For the psychotic, his salvation lies in his willing acceptance of our own folly and to add insult to injury, we almost expect him to be grateful to us for our all our labours upon his soul.

As for the person who we feel to be genuinely dangerous and unpredictable, who knows what the solution is. One thing I do believe though, is that we should at least be honest about what we are doing with them. How many times have I seen detained patients forcibly medicated because they are "ill" when in fact the only reason that they are being forcibly drugged is that they scare the living shit out of the staff. A sedated maniac is much easier to handle than a fully conscious one.

"I was interested to hear that homosexuality used to be considered a mental illness. Amazing how that's changed! What do you foresee as other changes in definition of mental illnesses? Will we keep adding more diseases, like oppositional disorder, or will there be fewer illnesses, or both?"

I'm a great believer that "laws create criminals" and that as we tighten the reigns on what we permit as social deviancy, we will create more social deviants. The biggest drive in the invention and labelling of psychiatric disorders is that of drug response. The original diagnostic criteria list for depression was not a list of symptoms for depression, but was actually a list of criteria of behavioural features that were influenced by the tricyclic drugs.

For example. Let's say the drug "A" influences 10 behavioural features, and drug "B" influences two of these features and six others that are different. We compare the patient's "symptoms" with each of the lists and the one that has the closest match is the drug we give the patient. This model was an attempt to aid doctors find the right drug for the right illness in a time when so many new drugs were being developed and a guide for standardisation was seriously needed by the medical profession.

It wasn't too surprising then that these lists started to be seen as diagnostic protocols. Here's a good one: let's take 1000 children that teachers don't like. Let's have the teachers draw up a list of the behavioural features that are most disliked. Then, if we medicate these children with drug "X" and draw up a list of the most commonly recurring behaviours that are influenced by the drug, we now have the criteria for a new diagnostic label. Not only that, we have a ready made drug just waited to be unleashed onto the unsuspecting and consuming public.

My prediction for the future when it comes to psychiatry is not a positive one. Until people are more prepared to better educated both themselves and their children and not believe that it is the responsibility of the State to give this education, the State has free reign to offer whatever indoctrination they see fit. It's time for people to maybe wake up and pay attention.