Psychiatrist Professor Stephen Lawrie talks about his CoDI show, which explores why he thinks mental illness is needlessly controversial…
Mental illness is stigmatised and controversial. So much so that it dare not even speak its name! We talk these days of ‘mental health’ – a euphemism that allow people to talk about some of the issues, which is probably a good thing, but also reinforces that it is somehow different from all the illnesses we can talk about, e.g. cancer, heart disease etc. Where psychiatry does differ from the rest of medicine is in (generally) lacking diagnostic tests – but, contrary to pervasive myths, our diagnoses are similarly reliable and our treatments are just as effective. Physical illness however gets much more funding for services and research, and more positive press and other media coverage than mental illness. Other doctors criticise psychiatry for being ‘soft’ and ‘unscientific’ while many mental health professionals, journalists and other commentators, especially from arts and humanities’ backgrounds, complain it is too ‘biological’ and inhumane. Some ‘psychiatric survivors’ bitterly criticise the treatment they got, still others that they didn’t get any from underfunded and overstretched services.
My show discusses the controversy behind these attitudes to mental illness and the role of psychiatry, and offers a different perspective. Here’s a brief preview….
Most controversy in mental illness seems to centre around two core issues: whether diagnostic categories have value, and, relatedly, whether treatments work. In 2014, a landmark report in Nature, the worlds’ leading scientific journal, reported finding 108 genetic regions which were associated with schizophrenia. This makes schizophrenia research arguably the most successful such field in the whole of medicine. If this had concerned any other branch of medicine, such as cancer, this would be seen as a major breakthrough. But the on-line discussion about this research degenerated into ridiculous assertions that the researchers were Nazi’s.
If diagnosis is controversial, treatment and, in particular whether it should be pharmaco- or psycho-therapy, is downright contentious. A paper published in the Lancet showed that some patients with schizophrenia did well with Cognitive-Behavioural Therapy. This prompted media headlines such as ‘time to flush the meds?’. While these are probably examples of sub-editors devising catchy headlines to attract reader attention, they fan the flames of controversy.
Some of these problems can be attributed to psychiatry’s sometime ignominious history, but the same could be said about many other parts of medicine. To some extent, some psychiatrists (especially academics like myself) can be blamed for over-stating the value and promise of biological approaches to understanding and developing new drug treatments. Yet even critics such as Andrew Scull in his recent ‘Madness in Civilisation’ acknowledges that we have made some progress. Psychiatrists and mental health professionals must also accept their share of responsibility for failing to communicate the evidence for what they do to the public and their patients.
Damned by association
In my opinion, much of the negativity towards psychiatry can be attributed to the stigmatisation of people with mental illness. Psychiatrists and our practices are partly criticised and damned by association. Patients have to deal daily with relationship, occupational and social problems because of people’s often false assumptions about their illnesses, e.g. that people with schizophrenia are dangerous and incurable, and that people with depression just aren’t trying hard enough. And that in turn can be attributed to a lack of awareness of, or sometimes an ignorance about, the realities of mental illness.
Until you have had to detain someone for their own or others safety it is difficult to appreciate just how ill some people can be. And until you have seen first-hand how someone benefits from antipsychotic or antidepressants in a week or two it is difficult to appreciate how effective treatment usually is. This is why it so important that people hear patients’ stories. But of course, that very discrimination and prejudice makes it difficult for patients and carers to admit to taking and benefitting from treatment. Hence the value of the celebrity disclosure – people who are widely admired are less likely to be tarnished by such confessions.
The fundamental reason – and an opportunity!
But we are still missing the crucial point. We all perceive, over-simplistically, our minds as separate from our bodies; even though we know that physical influences, like alcohol and drugs, can alter our experience. We tend to see mental ills as having mental causes, hence antipathy to genetic and other body-focussed research, and therefore favour talking treatments for them. But both mind and body are in general equally important in understanding all illness.
Ultimately, then, mental illness is so controversial because it is so interesting! It touches on what we are, what makes us human – it concerns our-very-selves! This is a two-sided sword we can turn to our advantage. The subject is so inherently fascinating that educators and writers can retain interest while being balanced.
To explore this controversial topic further, you can book tickets here to see my show, Why is mental illness so goddam controversial?, on August 11, 8.10pm, New Town Theatre.