The problems of a disease-based model of mental health

Colin Hambrook talks to Joe Kelly about whys and wherefores of psychiatry and psychiatric intervention

I usually avoid the illness tag, preferring the word distress instead. There is no evidence of mental illness as an organic physical brain disease. The disease-based model is founded on very poor science. There is so much dissension – even from within the profession – over the disease-based model, with calls from psychiatrists like Joanna Moncrief advocating for a drug-based model, which takes a more pragmatic view of responding to the symptoms of mental distress with medication.

The fact is that if the science is poor then the outcomes will be poor. And the outcomes are poor. You only have to look at the statistics for the numbers of people who get put on medication and remain under the mental health system for their whole lives. In psychiatry people don’t expect much. Poor performance is intractable. In my experience as a teacher I learnt that if you expect poor outcomes then you will get poor outcomes. If the science was so poor in other branches of medicine there would be an outcry. There would be vigilance.

Thomas Szazz says the whole of psychiatry is coercive. The psychiatrist acts in a parent role. If the patient does something foolish then the doctor becomes responsible. That doesn’t happen in other branches of medicine. Whilst medication may help in the short-term diagnosis are not on a firm footing. I’ve looked at all these things from lots of different points of view. There was a case a few years back when a group of people decided to test the mental health symptom by presenting to psychiatrists as mad. They were duly put on a section and admitted into hospital. Whatever behaviour they exhibited was projected back onto them as a symptom of madness to confirm whatever diagnosis they’d been given. It seems to me that psychiatry is the only area of medicine where its universally accepted that you can blame the patient.

The monopoly pharmaceutical companies hold doesn’t offer a broad range of treatments. The fact that alternative treatments are called ‘alternative’ is ironic from a profession that can’t prove or even agree its methods in the first place.

Somehow psychiatry gets away with it. It fulfils a role for society and for the government. People are kept on a lead with medication. It restricts people in a certain way. Some people say we need more dialogue. People like Jan Wallcraft talk about the need for truth and reconciliation about the abuses perpetrated by psychiatry – as has happened in South Africa.

Overall I feel there is a lack of honesty within the mental health profession. In recent year good practice devised from our experience has been colonised by experts. I feel our ideas have been stolen by wiley professionals: for example RECOVERY. Quality listening is on short supply. Access to talking treatments is never enough whilst access to nasty pills is in plentiful supply. Asset stripping (selling the family silver) is ever evident to fill the financial black hole that the government won’t fill.

I feel that low self esteem is the unspoken symptom most mental health service user/survivors struggle with. This is endorsed by lowering budgets and coercive services. In short we have a care profession that is in hock to its masters the politicians, whilst a lack of power and influence for our people under psychiatric services perpetuates the whole crazy mess.

As a campaigner I realise that we are not very good at defending ourselves. As a movement we are very fragmented. The charity sector is loathe to bite the hand of their funders who often prevent them from campaigning. That’s why I’m working on ‘a new vision of disability’. Disability is so sub-divided which tends to separate people again. It’s a very complicated picture

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