I didn’t take very long of being more than superficially absorbed in this area of interest before people started recommending I read various mental health related books. Some of them were very general texts like the Willan Handbook of Forensic Mental Health and actually, for me, this became something of a substitute to being able to go on a training course of any relevance at all. There is nothing out there to help you chart your way through murky waters of mental health and policing so this volume with its multitude of chapters by a variety of people from disparate academic backgrounds, including psychiatrists, psychologists and mental health nurses and as well as lawyers was well worth having.
But what you learn when you start piling into this stuff head first is that there are a large number of unresolved significant debates that often appear to become spats between the professions within mental health – and often between particular professionals. As you realise the extent of these spats, the power dynamics going on between the different professions and the evidence upon which many rely for their claims, you realise what a precarious house of cards the whole thing is. But it’s a house of cards into which we can currently compel people with a multitude of vulnerabilities, shut the door and treat them against their will. So inevitably, to an outsider, this can become quite fascinating and I admit I have become quite absorbed by the history of it all.
How on earth did we reach a position where we can force treatment upon people, when even the profession of psychiatry itself cannot agree what is going on? Expand beyond psychiatry to other mental health related professions and we just see the problems growing wider. There is a corpus of people selling books and doing conferences who are basically suggesting that the last fifty years of psychiatry and a drug-oriented model of care, with an acknowledged subordinate role for talking therapy and other psycho-social support, is flawed. Actually, it is claimed to be doing more harm than good.
So I’m genuinely interested: is this correct on any level that is relevant and important to what we’re doing in our society and the role we expect our police to play in delivering that through the use of force?
BIOLOGY, PSYCHOLOGY AND SOCIOLOGY
The first book I came across that started to make me sense a house of cards was Creating Mental Illness by Allan HORWITZ. An American sociologist, his book looked at mental illness and the development of psychiatry from a sociological point of view. The book has various things to say about drugs, pharmacy and efficacy, all from a US perspective and is meticulously referenced. Somewhat inevitably, I came across Richard BENTALL, a British clinical psychologist and Professor at the University of Liverpool. Two of his books, Madness Explained and Doctoring the Mind, are fairly accessible texts and easily understood by a lay person. They question the claims made of mainstream psychiatry about the effectiveness of medication treatments without rejecting them entirely and again, the texts are fully referenced to scientific studies of various kinds.
Most recently, it was recommended I read Anatomy of an Epidemic by Robert WHITAKER – an American journalist and science writer whose journey into the practice of psychiatry and specifically the efficacy of psychiatric medication, was somewhat accidental. Having started as a journalist who had accepted without question the claims of psychiatry about drug treatments, his books chart the method by which he ended up questioning them and I couldn’t help but wonder, why does a journalist feel there is something to write about here – why are professionals in these fields not dominating the market for popular writing on the science behind mental health?
In social media, I have noticed that whenever discussions emerge about psychiatry, drug treatment or coercion in mental health care, mere mention of these figures stirs up a hornets nest. It surprised me, I will admit, the nature and the extent of the personalised spats that emerge but then what these people are saying does strike at the heart of mainstream psychiatry. They all call into question the efficiency of psychiatric drugs over the long-term and BENTALL (as well as many others, including psychiatrists) questions the whole classification system of mental illnesses. Citing studies to back up this claim, including some that were never published, it is claimed that over the long-term, on an aggregate basis, outcomes for patients who are medicated for long periods, for example in excess of three to five years, are actually significantly worse than for patients who were never given anti-psychotic medication at all, or were only given it on a short-term basis.
I hope not to be too pejorative here when I say that the spats were somewhat child-like in their nature. One professional making a claim and others simply saying, “He’s wrong!” or “You’re wrong!” etc., … I could almost sense some people throwing their dummy and their toys out of their pram. Tweeters were being unfollowed and blocked on Twitter and refusing to engage with each other. We see some professionals making highly personalised, dismissive remarks. My temptation was to lock them in a room surrounded by riot police and tell them they’re not allowed out until they’ve worked out how to play nicely whilst actually engaging in the debate for the benefit of the public.
IN THE INTERESTS OF BALANCE
So it got me wondering: is there something missing from HORWITZ or BENTALL or WHITAKER that I’m just not sufficiently educated or trained to see for myself – something missing which enables books to be sold and newscopy spread around but which renders the work fundamentally flawed? One of the criticisms of all three of these authors that is repeatedly made – by critics in psychiatry and psychology – is that these men have selectively cited studies in support of their claims and / or misinterpreted evidence. So I asked the some of the critics what was omitted and what has been misunderstood? … I await their replies. I’ve been unfollowed on Twitter after merely asking some to help an interested policeman understand this stuff, whilst bearing in mind I ditched formal science education over 20yrs ago.
So in the absence of replies, I thought I’d try to do something for myself. What could I read that might amount to the other point of view – or another point of view – something that amounts to a defence of psychiatry as currently seen. There doesn’t seem to be as much around but further reading suggestions would be gratefully received in the comments section below. The year 2013 did see the publication of a book by Tom BURNS called Our Necessary Shadow: The Nature and Meaning of Psychiatry and I’ve also resorted to social media and various bloggers to try to look at things from the other side of the fence. What I found either seemed highly partisan – the online equivalent of psychiatrists stamping their feet – or highly selective. Tom BURNS repeatedly claims in his book that “anti-psychotics work”, quickly acknowledges that there are side effects to them, “as with all drugs” and moves on.
I was really looking for the debate to be engaged on the levels that WHITAKER or BENTALL tried to do. Especially if these blokes are in some way the enemy of reason. They take the time and trouble to explain why they claim that anti-psychotics don’t work over the long-term, they acknowledge benefits in the short-term and do not claim that all use of medication is bad. I wanted to see the opposite claim made in detail, not just that it be made and be taken for granted. Why are these writers wrong, precisely?
It was whilst looking for psychiatrists to argue back that I ended up coming across the work of Joanna MONCRIEFF whose books are currently in my “to read” pile. But it turns out that she is also widely criticised as an academic and practising psychiatrist because she writes about the ineffectiveness in the long-term, of anti-psychotic and neuropharmacological therapies. I have sensed frustration with her, from other psychiatrists who just seem to accuse her of somewhat banging on. And on. She’s recently blogged about how her efforts to have the Royal College of Psychiatrists debate research which suggests the ineffectiveness of anti-psychotic medication in the long-term has been rejected. Why wouldn’t such debate be welcomed?
WE NEED A RICHARD DAWKINS
So I haven’t got a bloody clue what is really going on and this is largely because no-one is sufficiently explaining it, in accessible terms. And yet I am expected to quietly acquiesce to physically coercing people into a system that declines to explain itself in accessible terms. I don’t need it dumbed down, just stripped down to something consumable because I haven’t got the time to sit in medical libraries trying to decipher countless medical studies over decades – I wouldn’t know where to start.
If Joanna MONCRIEFF is wrong, just tell me why. I don’t need her to be slagged off, just her work critiqued. I am decently educated in a general sense and can be trusted to identify bias and motivation for myself. Actually, that’s my area of work as I deal everyday with people who tell lies and advocate a particular position to secure advantage. So just critique the evidence, put forward your positions in plain language and I’ll have a crack at it myself.
There are loads of things in this world that I’m interested in which are usually the domain of experts. Aspects of life that you would probably need to devote your education and professional existence to if you were to try to achieve any real kind of competence. I rather suspect issues connected to the definition, causation and treatment of mental health problems is one such thing and obviously, I’m a bit busy being a policeman and I didn’t really stick in at school otherwise I wouldn’t have just finished a NIGHT shift. I’m also interested, for what it’s worth, in evolution, economics and philosophy but I haven’t got the time to devote my life to any of those things, either – I rely, to some extent at least, upon certain experts bringing this material forward and allowing me an insight by explaining it clearly in clear terms. You could think about various writers for these subjects, but Richard DAWKINS is perhaps the best example of someone who has allowed a scientifically complex subject to become accessible.
We could do with someone like that in mental health and I don’t know whether actually WHITAKER or any of the others may be that person because the vitriol with which their output has been received is too concerted to dismissed out of hand – but at least they’re trying. Say what you want about Richard DAWKINS on his adventures in atheism but his scientific credibility on evolution seems to stand up and his ability to explain it in speech and writing is obvious.
Maybe the science of mental illness is not ready for that yet – who knows? But most of the propositions in mental health that we should be interested in seem eminently testable – what are short and long-term recovery rates for diagnosed patients both with and without the use of medication against a background of proper psycho-social support? It strikes me we should know this if we’ve reached the stage of coercing other human beings into systems of care that force things upon them, very physically, if need be. And as a policeman, I’d like some kind of reassurance that I’m not being taken for granted to coerce people into a system that some claim does more harm than good, especially since the critics of that viewpoint seem either to lack answers or they are not coming forward to explain them in terms patients can understand.
I’d be jolly grateful if someone could just tell me, what the hell is actually going on?!
Winner of the Mind Digital Media Award.