Mental Health — a brief Critique by a Mental Health Worker

If you are feeling the strains of life, if you are beginning to feel you cannot cope, or if you become aware that you see existence differently from other people, then watch out as you may find yourself in the clutches of a psychiatrist. Such characteristics may be considered symptoms of mental illness and, whereas you are free to accept or reject the advice of a doctor if you surfer from a physical illness, this right may be removed from you in the case of a disease of the “mind.” Although the 1959 Mental Health Act made treatment for mental illness on a voluntary basis possible, there are still over 10,000 individuals in Britain compulsorily detained in mental hospitals against their will. Beware unruly, aggressive behaviour as, if you are apprehended by the police, Section 29 gives leeway for you to be detained for 72 hours in mental hospital on the order of a mental health worker, temporarily overcoming the necessity of court action. Whether a short-term or long-term stay, the “care” of the individual in hospital involves the removal of control of life from that person; during that time existence will be regulated and regimented by hospital staff.

It is easy to fall into the trap of believing that what is being dealt with are “faulty brains” and that the “mental” person must immediately be guided totally by others before they cause damage to themselves or the public. However, we must look at the assumptions underlying this approach to insanity, the dangers to every individual in society arising from these assumptions, and also the power that medics have over the destiny of so many lives as a result.

Social Definition . . .
What is meant by “insanity?” The general model used is the medical one. The individual is said to be sick, with a disease of the brain. As a consequence the term “mental health” has been coined and this in turn results in a whole set of reactions towards the insane man or woman (such as sending them to a doctor who specializes in brains, putting them into hospital, and treating them with drugs or surgery) which are not necessarily correct.

This approach is often completely presumptuous, probably arising from the growth of psychiatry through the roots of medicine rather than psychology. Although “mental” behaviour may be an obvious result of brain malformation or brain damage (in which case the behaviour tends to be of a specific type), in a vast proportion of cases of disturbance, no physiological/structural abnormalities are to be found in the disturbed person. Classification of individuals as suffering from a particular mental syndrome is based almost completely on the individual’s behaviour, including responses to other people, the ideas expressed, the ability to hold down a job. and the patterning of results on “intelligence” tests. In other words, the definition of insanity is based on comparing individuals’ behaviour with the behaviour shown by the general population. So it is a social definition and cannot be the objective phenomenon that is claimed, but is subject to the prejudices and ideologies of the professionals involved in the field of mental health.

If the insane individual is the one who deviates from the normal what is meant by “normal” must be considered, as there is a great range of behaviour shown by members of society. Normality is behaviour that is generally tolerated throughout society, and the normal person is the one who has managed to survive in society with an acceptable balance between the development of his potentialities (including personality, intellectual and physical traits) and the conditioning by which his abilities are directed into socially acceptable functions (including such behaviour as being able to chat in the local).

. . . and Social Judgement
If, like Laing, you view the normal as sick (but see SOCIALIST STANDARD, August 1972), what criteria have you for dealing with deviants from the “normally abnormal?” Bourgeois psychology indicates time and time again that present-day society is not one that permits individuals to fulfil their potentialities but one that inhibits people’s full development. Work by John Holt and Paul Goodman shows this process at work in the school setting where children’s creativity, inquisitiveness and desire to learn is progressively stilted as they become socialized to a regime that thwarts originality and praises tactics where “correct” answers are provided without any understanding. This in turn reflects a wider conditioning where the “correct answer” is conformity to the requisites of capitalism; individuality means individuality within strict limits; to stretch beyond these is to become insane or criminal.

This is not attempting to exalt those in mental hospital, for their existence is often a miserable one. But questioning the very nature of normality and the conceptual — and practical — approach to abnormality exposes not only the inadequacies of the care for the “insane”, but also reveals a danger to every one of us. In Russia intellectuals are confined in mental hospitals and people are quick to condemn this. Yet this is only an extreme form of the attitude of those in the West: those who do not “fit in” must be locked away. Where are the boundary lines between the mad and the sane? Are you sure you belong to the population considered normal?

Let us consider those unfortunate individuals who find themselves in mental hospital. Removed from a bewildering world of insurmountable problems they may feel happier in the protected environment of the hospital where life is organized for them, where they only have to obey the staff. Alternatively, they may be further confused by their removal from a world they know to this strange environment. Whichever the case, evidence indicates that the longer the time the individual remains in “care”, the less chance there is of them leaving. For institutionaldzation works itself upon the inmates who, devoid of opportunities to run their own lives, learn behaviour that is inapropriate for the outside world and so become greater misfits. Goffman gives a good analysis of this process in Asylums and indicates how the inmate can be reduced to an obedient moron who is quiet and always follows the rules. From my own personal experience, when working in a mental subnormality hospital (in many ways identical to a psychiatric hospital), it was blatantly obvious that the person who attempted to assert himself in any way suffered great social recriminations and punishments with withdrawal of privileges. This type of individual, probably with the characteristics to survive better than other patients, is unlikely to be allowed out of the hospital by those in authority as they consider such behaviour to be “bad” — and so the hospital becomes a prison.

What’s it all About?
People “outside” show little interest in the mental hospital and, possibly due to this, doctors are left free to give E.C.T., drugs and brain surgery despite very inadequate knowledge of the consequences of these actions. The patient has no means of self-protection, and this is an uncaring society — which is possibly why many people are in mental hospital anyway.

The problems are many and knowledge very limited. Certainly those individuals suffering from “mental syndromes” require support, care and understanding from the community in order to learn how to cope with life rather than to be rejected and locked away. But one cannot help being sceptical about this being possible in a society where most people are in some way “mentally sick”, which places so many pressures upon everyone that time is too precious to concentrate on helping “social inadequates”, and where everyone has a multitude of their own problems.

JUDY