In 2004, I was asked to contribute to the Academy of Ideas Letters on Liberty series on the subject of mental health. Somewhat paradoxically, my argument was that while we must always err on the side of liberty, there are times when, due to mental disorder or incapacity, restricting someone’s freedom can be justified even if they have not committed a crime.
However, we must always be aware that the interplay between psychiatry and society often reveals the social and political prejudices of the time. For example, in 1851, Samuel Cartwright detailed a ‘mental disorder’ he named drapetomania, which was said to afflict black slaves who fled captivity. Cartwright’s theory was widely mocked by some but embraced by others as an explanation as to why slaves wanted their freedom. They couldn’t consider that they wanted to be free, so it must have been a disease causing them to abscond.
In the former Soviet Union, political dissidents were often labelled mentally ill – with one dissident being told ‘your disease is dissent’. It was not until 1973 that the American Psychiatric Association voted to declassify homosexuality as a mental disorder. It was 1992 before the WHO followed suit and removed it from the tenth edition of its International Classification of Diseases.
These examples, and there are many more, illustrate the societal prejudices of their time around race, political ideology and sexuality. For example, the dropping of homosexuality was less due to advances within psychiatry and more to do with the changing social and cultural climate and the work of gay activists.
This is why we must always be careful of how the mental health debate is framed and what interventions are seen as justified in the present period. In Escaping the Straitjacket of Mental Health, I argue that we are witnessing a broadening of what constitutes a mental health problem that does little to help those who require professional support. It promotes the notion that we are all perpetually vulnerable and unable to cope with the travails of everyday life without guidance from some form of therapeutic expert or life coach. This expansion not only risks increasing demand on already overstretched resources, but it can also undermine resilience by making people assume that some form of expert help is required, and hence undermine the roles of active coping and non-professional support. Being sick, rather than being seen as unusual and temporary, is now held to be normal, life-long and has become a badge of identity for many people today.
The 1960s and 1970s saw many critics of psychiatry gain prominence, many of whom, such as Thomas Szasz and R.D. Laing, psychiatrists themselves, objected to a medical outlook that saw mental illness as akin to physical disease. For Szasz, the mind – like the economy – could only be sick in a metaphorical sense; sufferers were experiencing ‘problems in living’, not a medical illness. Such critics were often referred to as the ‘anti-psychiatry’ movement, a term I personally dislike. I prefer ‘critical psychiatry’, as that allows us to acknowledge that psychiatry has a part to play within the mental health field, but also allows us to critically analyse contemporary theories and practices given the power professionals hold over their patients and the way societal influences, as detailed above, can be extremely problematic.
Such powers include being able, subject to certain criteria being met and the agreement of other professionals, to detain patients in hospital against their will and/or restrict their freedom in the community. These powers are contained in the Mental Health Act and Mental Capacity Act. While they should always be used as a last resort, they can be justified in ways that uphold sovereignty of the political subject. As I argue in my ‘Letter on Liberty’:
That paragon of liberalism, John Stuart Mill, recognised the need for psychiatric intervention in particular cases. After all, in addition to the harm principle, Mill states that his doctrine of individual freedom should apply only to human beings in the maturity of their faculties, which precludes children and others unable to take care of themselves. So, in cases, for example, where someone is severely psychotic or suffering from dementia, psychiatric coercion, constraint and intervention is not a violation of individual autonomy because the subject, at that point in time, is not autonomous in any moral sense.
These powers must always be subject to scrutiny as they can all too easily be overused or misused. However, a more serious threat to our freedom today is the way we are encouraged to view our problems through a psychological prism, and in the process entrap ourselves in a particular way of looking at the world, our place within it and how we can change it for the better.
The irony is that the current wave of therapeutic entrepreneurs may achieve what psychiatry failed to do, eradicate mental disorder. Not by curing it, but by expanding its definition in such a way as to make it meaningless.
Ken McLaughlin is speaking at the Battle of Ideas Festival on Sunday 20 October. For tickets to the Festival, with a special 20% discount for CapX readers, use the code CAPX24 at checkout or visit this link to book.
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