Wednesday, January 5, 2011

Mental Illness: poorly researched, often misdiagnosed, and a source of attack

By Carol Goar, Toronto Star, January 5, 2011
Looking beyond the official statistics, there is abundant evidence in the courts, in emergency rooms and prisons that people are misjudged, hospitalized and punished at a vastly disproportionate rate. In fact, the Ontario Human Rights Commission highlighted the issue in its 2009-10 annual report. “Mental illness is a hidden disability,” it said. “In workplaces, housing or services, where the need to accommodate people with physical disabilities is understood, there is often reluctance or even refusal to accommodate people with mental health disabilities.”

Chief commissioner Barbara Hall wants to know why. And she wants to develop policies that address the real-life experiences of people with mental health disabilities.
For the past month and a half, the commission has been collecting personal stories from individuals who have faced discrimination in finding or keeping a place to live; finding or keeping a job; getting services such as social assistance, education or health care; and having access to shops and restaurants because of a mental disorder.
It intends to use what it learns to identify systemic problems, to set standards and to explain to employers and landlords in clear, specific terms — with examples — how they are required to treat Ontarians with mental disabilities.
Some managers, for instance, appear unaware that allowing employees to make hurtful jokes at the expense of a co-worker with depression is prohibited under the Ontario Human Rights Code. Some business owners are unsure how far they have to go to accommodate people with mental disabilities. At minimum, the commission will offer them guidance.
"Guidance" and "standards" are necessary, and are an important aspect of the work of the Ontario Human Rights Commission. However, it is in changing attitudes that a more permanent solution lies.
There is something primally physical, primally empirical, primally extrinsic about our public attitudes. And, while the Canadian 'mosaic' has made progress in accommodating what appear to be physical differences, we still consider hidden differences differently.
There is a long history of 'boogey-men' or worse, evil gods, the satanic, about the state of mental 'imbalance' even though we do not know what constitutes mental 'balance' nor just how fragile it is, and how easily it can be replaced with 'imbalance'. Anything we do not understand is, by definition, too complex for our inclusion in our 'normal' capacity to define it and to cope with it. We have 'done' similar things to "God"...by both extremes, elevation and desecration, sacralizing and demonizing.
At the core of our social attitude to mental illness is the "medical model" of the practice of medicine, in which the training and the diagnosis and the treatment are all based on finding the "illness" or in the case of the physical, finding the broken bone, or the tumor, or the infected intestine, or the blocked tube in the ear, or the blocked veins and  arteries in the circulation system and then administering some intervention to reconstruct the broken bone, or to remove the tumor or to attack it through chemotherapy and/or radiation, or to prescribe some medication that will address the "problem."
So far, so go. However, it seems that there is a case that can be made that the "mind" as opposed to the physical "brain" is not so adaptive exclusively to physical interventions, although, God knows, the medical profession is determined to find a new chemical equation  every day by which to make the "brain" work more adaptively. We simply want, both for ourselves and for others, that we/they "fit" into the social patterns of the family, the school, the soccer/hockey/baseball/football/basketball teams. Anything that strikes us as "aberrant" or different from what is considered normal raises "red flags" among coaches, among educators, among parents (although they may be later to think something is amiss) and immediately we seek out some kind of intervention to "bring the child back into line" of normalcy.
If we were more courageous, and more imaginative and less risk averse, we would be far less quick to seek to remedy behaviour or attitudes that we do not "like" or that others find "unacceptable". A good example, is the epidemic of ritalin for ADHD in male children in North America over the last twenty years. Control of the classroom, while important, must never trump the child's health and wellbeing, and the teachers need to be far better educated on the norms of male biology, and male hormones and male psyches, and male learning curves.
We have a compendium of mental illnesses, compiled by the psychiatric community, in its professional wisdom, all of the participants bearing the acronym "certified" by the medical board of the state or province in which these doctors practice. It is call the DSM-IV (The Diagnostic Statistical Model). This book is considered the holy writ of mental disorders. Unfortunately, many of the presenting stories of real people do not easily fit into some of the tighter definitions of the text. And when the attending psychiatrist is asked about the relationship of the "condition" to lifestyle, to diet, to work stress, to relationship tensions, to genetic background...there is often an askance look on their face, and the acknowledgement that "we do not really know all of those answers, and we are still studying those relationships."
If the profession is uncertain, and the symptoms frequently do not fit the prescribed definitions, and the research continues into the biological evidence of chemicals, hormones, synapses, and the larger questions that might be answered by a closer look at the personal biography are left unattended in many of the "case histories" that inform the practitioners' diagnosis and treatment plan, then we will continue to separate the mind/psyche/unconscious from the physical/biological/anatomical/empirical and even the profession will miss much of the most relevant evidence that could contribute to the full understanding of the situation.
Freud studied the stories of his patients, and it was those stories that led him to his sexual etiology of neuroses. He certainly did not start out with a fixation on human sexuality. Jung broadened the Freudian theory of ego, id and super ego to include a collective unconscious, a Shadow and both an animus and anima, as (albeit theoretical) components of the human psyche. Currently, the emphasis in psychiatric research is on the biological, as one would expect, and the non-empirical research into the unconscious is left to the poets, the philosophers, the artists and the occasional non-risk-averse social and cultural historian who is not afraid to challenge his/her academic colleagues by examining the Jungian archetypes in their historical emergences. (One such beacon of hope is John Ralston Saul.)
More recenlty, James Hillman has pushed the work of Jung forward into what he calls "archetypal psychology" and in his book, Revisioning Psychology, Hillman advocates for much more attention to the biographies of individuals, as streams of light and inquiry into the psychic dynamics that are occurring in any individual. He also posits the notion that far too much emphasis has been placed on pharmaceuticals as more of a need for the profession to establish and maintain its credibility consistent with the "instant gratification" motive of the public.
These insights from Hillman are a welcome arrival on the scene of liberating the study of human behaviour, attitudes, perceptions by including the poetic, the biographic and the Platonic as integral to the exploration, and not restricting the study to the empirical, and to the biological.
However, if there is this much confusion and uncertainty among the professionals, both the practitioners and the instructors in psychiatry and psychology, imagine how the general public must be reeling from the multiple new psychological words and phrases that have made their way into the vernacular of the society.
Many of these words and phrases are not understood, or minimally understood at best, by the general public, and the media continue to pursue reports of really dangerous aberrant behaviour, most often detailing the more gruesome details while omitting the background to the actor's life.
In fact, it is too often that people will throw a word that indicates some kind of mental "defect" at another person, to satisfy a need for power and superiority or perhaps for revenge or out of jealousy. "Oh, he's just bi-polar!" is one such phrase that we hear far too often, when in fact to ascribe such a diagnosis to another person is, or ought to be considered, a criminal act. It is, in fact, a hate crime, coming as it most often does, from a completely untrained, undisciplined and uncertified observer. And yet, how many of such cases actually reach the courts? Very few, if any. For the victim, it is hardly worth the anxiety. For the perpetrator, s/he is let off the hook, and the scenario repeats, only with a different victim.
What has always amazed me is a small observation, that, for the most part, those who throw words of psychic defamation at other people are, themselves, most worthy of some form of psychic intervention. It is as if the fear of psychic disintegration prompts a projection onto another easy and available target, knowing, likely, that there will be no consequences from the victim of the attack.
It is one of the more subtle abuses of power in a somewhat sophisticated society in which many have completed at least one course in psychology, and feel thereby qualified to diagnose others, without the slightest qualm or misgiving.
It is against such abuse of power that we must all be consciously on guard, because if this is being "done" to the innocent, imagine how much more hurtful we are to the hospitalized, in the "psych" hospital, or in the hospital for the criminally insane, or in the group homes for those attempting to re-enter the society from some "maladjustment" syndrome.
And we have not even touched the radioactive subject of the use of psychological diagnosis and attack from the religious and the self-righteous. That is food for another blog, or perhaps for a full book.
Let us all consider just how close we all are to the potential of a psychic "fall" from grace and the resulting public disgrace, and hold both our tongues and our insecurites back from their "unconscious" projection onto others who rarely deserve our "bullets".

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