London Metropolitan University Nov 09

Saturday, 02 April 2011 12:05

A Brief History of the Ideas and Practices in Psychiatry in the UK

I am an Australian clinical psychologist who came to England in 1968. I took my first degree in psychology at Sydney University and my PhD from Sheffield University. I have written a number of books, the latest of which is called Why We Lie. It will be published by HarperCollins in May 2010. We lie in many different ways. One very popular form of lying in public life and in the professions of psychiatry and psychology is to call something by a name that doesn't actually reflect the truth.

When in 1957 there was a very bad accident at the nuclear reactor called Windscale, the methods of working at Windscale didn't change a great deal but the government changed the name of the place to Sellafield and hoped that people would forget what actually happened at Windscale. I was working at St John's Psychiatric Hospital in Lincoln when in 1984 the managers decided to change the name of this unpleasant, unhappy place to 'The Mental Health Trust'. The hospital didn't change, just the name. When in the 1980s passengers and patients were being renamed - they were now 'customers' - the words 'mental health' began to be used in all the places where 'psychiatric' or 'mental illness' used to be used. Thus we now have a mental health system, while people who would in previous years been told they had a mental disorder or mental illness are now told they have 'a mental health problem'.

In the 1970s a number of people who had managed to survive many years as a psychiatric patient began calling themselves Survivors of the Psychiatric System. This name was not a lie but an accurate representation of what they were. They had been very lucky to survive. Some of these Survivors had been given the diagnosis of schizophrenia, an illness that psychiatrists regard as an incurable. However, these people demonstrated in their own lives that it is actually possible to recover from schizophrenia. They began what became known as the recovery movement. Unfortunately, psychiatrists and other mental health professionals have colonised the recovery movement, much in the way the British in the 19th century colonised countries in order to create the British Empire. Psychiatrists had always talked about 'managing' a patient's schizophrenia or depression in the way that a medical doctor talks about managing a chronic illness such as diabetes or epilepsy but, in colonising the recovery movement, psychiatrists substituted the word 'recovery' for their word 'managing', despite the fact that recovery from an illness means that you no longer carry the burden of that illness. Managing a chronic illness means that you have a burden from which you can never be free.

The history of the psychiatric/mental health system is a tragic history because it demonstrates how little we understand ourselves. Human beings are very intelligent in understanding the objects around us but, when it comes to understanding how we operate as individuals, we are very stupid. If we did understand ourselves, I would not have to begin my lecture by explaining all this to you. You could have been taught all this at school, but children who understand how they operate as human beings are children who think for themselves, question what their teachers tell them, and are never unthinkingly obedient.

A summary of what you need to understand about yourself follows this paper. The early chapters in my last two books, What Should I Believe and My Dearest Enemy, My Dangerous Friend which is about siblings, contain an account of what neuroscientists now know about how our brains do not show us the world but create guesses about the world. Everything you perceive is a guess. These guesses form predictions about what will happen. Sometimes your predictions prove to be quite accurate. Sometimes they are wrong.

When our ideas about the world are not quite accurate we make adjustments to our ideas. This is the process we call learning. However, sometimes we discover that we have made a major error of judgement. There is a serious discrepancy between what we thought our life was and what it actually is. You will have had this experience at least once in your adult life and many times when you were a child. It is an ordinary, common experience. Yet both psychiatrists and psychologists ignore it or turn it into some kind of pathology. Psychiatrists talk of 'panic' and psychologists talk of 'trauma', but they will not talk about an experience that they themselves will have had many times. For them it was so frightening that they are too frightened to talk about it. Yet this experience and the ways we try to avoid this experience are the central feature of every film and play you have ever seen and every novel you have read. Because you know, though you may not be aware that you know, what this experience is, the story you are being told grips you.

This is what you know, though may not know that you know.

Remember when you were living your life, thinking, 'This is me, this is my life, and that's what my future will be,' and one day you discover that you have got it wrong. The person you were going to spend your life with is no longer available to do that, or the career you planned is not going to happen. Or perhaps you had grown up believing that, if you were good, nothing bad would happen to you or your loved ones, and then something bad happened. Remember how you felt, how you were shattering, crumbling, perhaps disappearing. Remember the terror you felt?

If you understood that it was some of your ideas falling apart, you would have had to confidence to say to yourself, 'This will pass. I just have to bear this uncertainty until I can create ideas that better reflect my true situation.' But if you did not understand this, your self-confidence will vanish and you feel helpless and alone. You might try to hold yourself together by resorting to a desperate defence of, say, blaming yourself for the disaster, but then you find yourself in the terrible prison of depression.[1] Or you might become very obsessional, or you might try believing that you can run away from what is frightening, and so you become very, very busy.[2] 

In this state you are likely to encounter people who do not understand what the experience is that you are going through. Instead they see you as being mad. Most religions have the tradition of explaining madness being attacked by demons. Intensely cruel methods were used, and, in some places, are still being used, to drive the demons out of the person. When in the 18th and 19th centuries doctors wanted to take over the lucrative asylum business, they invented all kinds of physical causes.[3] Some psychiatrists continue to claim that depression is caused by a gene and/or by a biochemical change. Yet geneticists point out that all genes do is express different proteins, while psychiatrists like David Healy show that there has never ever been any scientific evidence to support the belief that a biochemical change causes depression.[4] 

However, there is a massive amount of scientific evidence that severe mental distress leads us to behave in ways that are called mad, and that this severe mental distress arises from the way we live our lives and the society we live in. For instance, when in 1965 I was doing my Diploma in Clinical Psychology, I was told, correctly, that only young women became anorexic. If a young man presented with anorexia, the anorexia was a symptom of schizophrenia. In those days you were lucky if the man in your life had a bath and a shave, and put on a clean shirt when he was taking you out. Twenty years later men's magazines were telling their readers how they should look and smell, and, lo and behold, there are now many young men who are anorexic.

Psychiatrists have always been inventing mental illnesses, but now this has become an extremely lucrative business with the authors of the Diagnostic and Statistical Manual (DSM) working closely with the pharmaceutical industry. Everyone can find a diagnosis that applies to themselves in the DSM. If nothing else, you qualify for Personality Disorder Not Yet Identified. If ever you've been depressed, you're in the DSM under Major Depressive Disorder in Complete Remission.

Despite all this activity, the greatest advances in our understanding of mental disorders have come, not from mental health professionals, but from those who used to call themselves survivors but now call themselves users of the psychiatric system. They were the people who showed that a psychiatric diagnosis need not be a life sentence. Some of them showed that hearing voices is not a symptom of a mental disorder but a form of auditory memory that at least one third of the population experience. Of those who hear voices, only those people who voices speak to them in very unpleasant ways become psychiatric patients. This year the First World Congress on Hearing Voices was in Holland. You should in the course of your training read some of the literature on Hearing Voices and attend at least one hearing voices group. 

The history of the psychiatric/mental health system is a history of cruelty comparable with the history of slavery. Please, when you work in the mental health system, do not continue this history of cruelty. Always remember that every person who has been told that they have 'a mental health problem' is a fellow human being, and, even if you cannot do anything useful for that person, you can at least be kind.

These notes accompanied a lecture given on 3rd November 2009 entitled 'Living with Mental Health Treatment and Support'

[1] Dorothy Rowe Depression: the way Out of Your Prison 3rd ed, Routledge

[2] Dorothy Rowe Beyond Fear 3rd ed, HarperCollins

[3] Andrew Scull Museums of Madness Penguin

[4] Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression (2004) ISBN 0-8147-3669-6