Dorothy Rowe

OpenMind - Journal of the mental health association MIND

November 2002

RECOVERY AND ILLNESS IN THE PSYCHIATRIC SYSTEM

Dorothy Rowe

I am old enough now to be an historian of the psychiatric system. Ask me how it has changed since 1965 and I can tell you.

I first encountered the psychiatric system when I went to work as a liaison psychologist linking Sydney schools and the children's ward in a psychiatric hospital. This hospital had recently been built, and was simply an array of single storied wards, all light, airy and clean, set in large grounds overlooking the Parramatta River. This place did not prepare me for the horror of Middlewood Hospital in Sheffield, nor the other psychiatric hospitals I came know only too well after I arrived in the UK in 1968. All of these were dark, miserable, dirty prisons, where their inhabitants, the patients, were shown very clearly by the buildings themselves and by the staff that they were the scum of the earth.

I wrote about these horrible places in my book Beyond Fear which was published in 1987. By then I knew that all those forms of mental distress which psychiatrists called mental disorder had the same cause - that the person had lost all self-confidence and had found that he and his world were falling apart. These mental disorders were actually desperate defences where the person tried to defend himself against annihilating fear. I also knew that most of the evil in this world comes not from wickedness but from stupidity, usually the stupidity of well-meaning people who believe that they know what is best for other people.

It was such people who designed and built the asylums, crowded them with distressed people, ignored the causes of this distress, and proceeded to humiliate and degrade these helpless individuals. Such treatment was the absolute opposite of what these distressed people needed.

Most of these prisons of degradation have now closed, and the buildings which have replaced them are, on the whole, relatively clean, light places, but, as contributors to Openmind have recorded, patients are still being treated with little respect and dignity, and this has not helped them to regain their self-confidence.

By the time I set about writing the second edition of Beyond Fear many of the people who had been so mistreated by the psychiatric system were fighting back. I think this is wonderful. We should always fight against being degraded and humiliated because, if we do not, we become maimed, crippled, even destroyed as a person.

At last people who are too distressed to speak up for themselves have advocates who understand how they feel and how obtuse and difficult, even cruel, the psychiatric system can be. Users of the psychiatric system have now become a significant political force. Many of the institutions within the psychiatric system have come to understand that it is politically correct to invite a user to join certain committees. This is still very much at the token level, but token users can do what token women and token blacks have done, get a toe-hold in the system and change it.

Users have challenged the drug regimes in psychiatric care and insisted that the system should include an increasing availability of different kinds of therapy. Marius Romme had a very wry way of telling the story of how his patient Patsy Hage forced him to take account of the meaning of her voices, and thus to set in motion the Hearing Voices movement, the biggest change in the care of people diagnosed as schizophrenic since Kraepelin announced that he had discovered dementia praecox.

The dogma of psychiatry, which is as immutable, unquestionable and holy as the dogma of the Catholic Church, stated that schizophrenia was a life-long disease and that endogenous depression could be cured only by physical means. When I worked in Lincolnshire psychiatrists there would refer people with a diagnosis of schizophrenia or endogenous depression to us psychologists with the message, 'Dorothy, as a last resort, could one of you see this patient.' This meant, 'Take this troublesome patient off my hands.' If, as we often did, we reported back some months later to the psychiatrist to say that this once deeply distressed patient was now leading an ordinary, happy life, the psychiatrist would immediately make a retrospective diagnosis. The patient had had a transient drug-induced psychosis or a mild reactive depression.

There are now too many people who have extricated themselves from their particular hell for psychiatrists to be able to perform this dishonest trick effectively, though many of them still try to do so. Some of these people who have saved themselves, people like Ron Coleman, Brian Davey and Rufus May, have written publicly about what they did. A large number of other such people have written to me privately to tell me about their life, how they have changed and what helped them. It was never drugs that had helped but talking to people and working out things for themselves. From the experiences of so many different people I can now say that there is no mental disorder which has to be a lifelong illness.

The proof that people can recover from mental disorder should be cause for universal rejoicing, but, as far as the psychiatric system is concerned, it has not happened. This system has many well-practised techniques for ignoring or denying all evidence for recovery, beginning with the denigration of R.D. Laing's work in the 1960s. Psychiatrists who, like Laing, criticise the system are treated by the system in the same way that every powerful religion treats its renegades. Laing cannot be burnt at the stake or made the object of a jihad, but he can, and is, spoken of as, 'Poor Ronnie, such promise, such a terrible waste.'

Peter Breggin, author of Toxic Psychiatry and a psychiatrist of tremendous courage, has endured an unbroken stream of abuse in the USA for his exposure of the dangers of the drugs used in psychiatry. When on the rare occasions he lectured to psychiatrists in the UK, he found that their response was the same as that of parents who physically chastise their children, 'What else can we do?'. This is a rhetorical question which demands the answer, 'Nothing else.'

The largest volume of research evidence that recovery is possible from all the mental disorders comes from cognitive therapists, but such research is never presented as a refutation of the medical model. Though most cognitive therapists are psychologists they take their lead from Aaron Beck, a professor of psychiatry who has always been very careful not to upset his colleagues by publicising the fact that, while depressed people treated only with drugs and ECT are unlikely to recover in their lifetime, depressed people treated with cognitive therapy can get better and stay better for the rest of their life. Beck does not want to follow Thomas Szasz and Loren Mosher into the wilderness. (Szasz rejected the idea that schizophrenia is an illness, while Mosher resigned from the American Psychiatric Association (APA), saying that it had become the American Pharmacological Association.) As a result cognitive therapists are taught to regard the Diagnostic and Statistical Manual (DSM) as their bible. I despair of my profession when I see psychologists labelling, distancing and denigrating their fellow human beings with all the enthusiasm of a trainee psychiatrist wishing to please his consultant.

The DSM had grown from a simple list of the forms of mental distress which prevent an individual from living an ordinary life (ie., depression, phobias, mania, obsessions and compulsions, schizophrenia) into a massive volume which classifies every kind of human behaviour as a mental disorder, whether or not it is a natural reaction to the situation in which a person finds himself. It is natural to feel anxious when we doubt that we have the ability to deal with the situation confronting us, but in the DSM such anxiety is considered to be Generalised Anxiety Disorder or Anxiety Disorder Not Otherwise Specified. We all subscribe to that old saying, 'All the world's mad except me and thee, and even thee's a little mad,' but in the DSM the oddness of our friends becomes Personality Disorder Not Otherwise Specified.

Herb Kutchin and Stuart Kirk's book Making Us Crazy, which won the Mind Book of the Year Award in 2000, leaves the reader in no doubt that the DSM is a political, not a medical document, a bid for territory and power. The committee of the APA which decides upon the contents of the DSM can eradicate a mental disorder with the stroke of the pen, and create a new one, usually one for which the pharmaceutical industry can immediately find a 'cure'. No psychiatric drug can cure, but these drugs can reduce awareness of pain and fear, and thus give a distressed person a breathing space. Unfortunately, aggressive marketing by the drug companies has meant that many people, facing situations which naturally lead them to be anxious or sad, are offered drugs to blank out the very emotions which they need to feel in order to work their way through the situation.

Life is difficult and no one has it easy for all their life. What we all need to understand is that, in any difficult situation, there are the actual events AND our interpretations of these events. Sometimes we can change some of the events, but always we can change how we interpret the events. Mastering the situation, that is, recovering control of our life, is achieved by changing in beneficial ways those events which can be changed, and by changing our interpretations to ones which give us self-confidence, courage and optimism. People have always known this. Recovery is simply the gaining of wisdom.

Dorothy Rowe - "Beyond Fear" second edition, HarperCollins, £12.99