Musings of a phenomenologist

Science, psychiatry and random musings

Psychiatrists are agents of social control… aren’t they?

Posted by soveda on September 23, 2008

On the 3rd of November the 2007 amendments to the 1983 Mental Health Act will come into force.

Why should I care? I hear people cry, well I’ll tell you at tedious length!

As many of you know there have been moves to create a new mental health act (for England and Wales) but these have turned into amendments to the current (1983) Mental Health Act, these amendments also impact on the 2005 Mental Capacity Act. I will explain why this is important I promise. Here is the actual act, it is a rather lengthy PDF, sorry. (The Mental Capacity Act is available on this page).

Why did we need a new act? Well the rationale was that the previous act was ineffective in safeguarding the rights of patients who lacked capacity but were passive (see here and here). There were concerns about “revolving door” patients (e.g.: Christopher Clunis and other care in the community stories) and the management of potentially dangerous people with personality disorders (see the Michael Stone case). The media reports in both these cases was typical of the way the media treats mental disorder and it would be surprising if the government hadn’t taken notice…

So what is the problem? The Bournewood case was a wakeup call to the psychiatric profession and has led to (we hope) better practice, no one could disagree with better community care and support (could they?), and we should lock up all potentially dangerous people… Well shouldn’t we?

The title of this post is deliberately provocative, over the years psychiatry has been seen or represented as a way to keep the populace under control. Here is a current example:  The Antipsychiatry Coalition and more historically, the anti-psychiatry movement have expressed their concerns. One rather fervent group that expresses concerns about psychiatry is the Church of Scientology, I will not editorialise but I trust people to make their own decisions from the information they can find. If you input “psychiatry social control” into a search engine you get this, I followed 10 links from my search and found 9 that were negative towards psychiatry.

Lets cut to the chase, bad things were done in the name of psychiatry, the support for patients in the community may not be as good as we would like and mistakes have been made and will be made again. What is psychiatry for? I was under the impression that the role of psyciatry in the modern world was to help to aleviate the mental distress of people with treatable mental disorders and help individuals to live their life to the fullest of their abilities, even if those abilities are severely limited (e.g. in dementia). I have not met any psychiatrist who sees their role as that of a jailer.

The amendments to the mental health act have made some changes that need to be pondered. Now, in order to be considered for detention under the act you need to have a “mental disorder” defined as:

Any disorder or disability of the mind

That’s the whole definition in the act, there is now no specific exclusion for “sexual deviancy”, this means that theoretically someone who was a paedophile could be detained for that reason. The definition of mental disorder now more clearly encompasses “personality disorders”, this is combined with a change to the “treatablility” criteria for detention. Previously when detaining someone under the mental health act the “treatability” of the condition was part of the assessment and the lack of apparent “treatable” mental disorder would be a bar to detention (see here) however the new guidance is this:

In the Act, medical treatment for mental disorder means
medical treatment which is for the purpose of alleviating,
or preventing a worsening of, a mental disorder or one or
more of its symptoms or manifestations.

Purpose is not the same as likelihood. Medical treatment
may be for the purpose of alleviating, or preventing a
worsening of, a mental disorder even though it cannot be
shown in advance that any particular effect is likely to
be achieved.

So treatment has to have the purpose but not the likelihood of alleviating or preventing a worsening of mental disorder… I don’t see how this is treatment in the usual sense of the term!

So, is the expectation now for psychiatrists to lock up potentially dangerous people and give them treatment that will not help but does keep them off the streets? Are psychiatrists going to be expected to detain all paedophiles when they finish their prison sentences, or even divert them to secure units rather than prison?

I suspect that there will be some resistance to any of these ideas but watch this space…

I realise I haven’t even started on the care in the community issue (Community Treatment Orders if you want to read up on them) or the Deprivation of Liberty safeguards (not in themselves a bad idea) but I’ve gone on for long enough already. I will blog on the others points in due course.

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One Response to “Psychiatrists are agents of social control… aren’t they?”

  1. Monk said

    I had missed this altogther. Good Grief! So it is in my interest to avoid any mental health services in case they decide to lock me up. Lucky I have a touch of avoidance allied to my anankastic traits.

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