Let me tell you a story.
A couple of years ago, one of my patients was an elderly gentleman in his late seventies. He was living in a nursing home at the time, but because of his history of psychosis, he remained on a treatment order – a requirement by law that if he was to remain outside of a mental facility, he had to have regular anti-psychotic medication every few weeks.
This man was on a treatment order because his disease caused him to have delusions. He misinterpreted what was going on around him, and would not consider that he could be wrong. In his particular case, he was convinced that his next-door neighbour was a paedophile, and he was planning to ambush his neighbour and castrate him. Luckily the police had taken my patient into custody before he got the opportunity. With treatment, my patient had clear thoughts, although needed close supervision. Without his medication, he became confused and violent.
According to a post on the blog Mad in America and promoted by Dr Caroline Leaf, my patient’s diagnosis was spurious, and he was denied his basic human rights by being forced to take medications.
Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. She is also a self-declared expert in mental health, despite not having any professional training in medicine, psychiatry, psychology or even cognitive neuroscience for that matter.
Indeed, if she had any experience or expertise in mental health, she would have recognised the basic factual errors and logical fallacies that riddled the post she quoted from.
Take the quote that Dr Leaf posted on social media. The full quote from the Mad in America post is:
“Despite the fact that no one in history, not even the omnipotent American Psychiatric Association – which produces and profits mightily from the ‘Bible’ of mental disorders — has come up with a halfway good definition of “mental illness,” and despite the fact that the process of creating and applying the labels of mental illness is unscientific, any of those labels can be used to deprive the person so labeled of their human rights. This is terrifying. It ought to terrify those who are so labeled and those who are not, because deprivation of human rights on totally arbitrary grounds is inhumane and immoral.”
This is the same tired, emotionally laden and misleading rhetoric that’s so often barked in fervent paroxysms through the foaming lips of those opposed to modern psychiatric practice:
- There is no good definition of ‘mental illness’
- The American Psychiatric Association is just a profit-driven cabal
- The DSM5 (which the author alludes to as the ‘Bible’ of mental disorders) is unscientific
- Psychiatric diagnoses are unscientific
- Any psychiatric diagnosis can be used as a trigger to force people into unwanted treatments or incarceration
- Therefore psychiatric diagnosis and treatment is against basic humans rights and is inhumane and immoral.
Inhumane and immoral hey? Tell that to my patients neighbour who almost became a eunuch except for that “inhumane and immoral treatment” of my former patient.
Caplan claims just don’t stand up to any rational scrutiny.
- There are lots of good definitions of mental illness … modern psychiatry critics just don’t like them. But take the definition used by the CDC, “Mental illness is defined as … ‘health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.’” There’s nothing wrong with this definition. It describes mental illness and helps differentiate mental illness from variations of mood, thought and behaviour that are part of the everyday human experience.
- The American Psychiatric Association isn’t the only group to have created a classification of psychiatric illnesses. The World Health Organisation publishes the International Classification of Diseases, or the ICD, which is also used for psychiatric diagnosis. Is the WHO an evil profit-driven junta too?
- The DSM, the ICD, and any other system of diagnosis, are simply different classification systems. Over the last century, clinicians have noted clusters of symptoms and have tried to classify them into common groups. How is that unscientific? It’s no different to scientists looking at the different characteristics of various animals and creating a taxonomy, to provide a common system and language for clinicians and researchers across disciplines and across countries.The DSM system isn’t perfect, but what system ever is? As knowledge of neuroscience grows, the classifications are reviewed and tightened in an ongoing process of improvement. If those who oppose the DSM want to come up with something better, they’re welcome to put something forward.
- The old saying goes that medicine is an art and a science. Human beings, as nuanced as we are, often don’t fit into diagnostic criteria as easily as we would like. That doesn’t invalidate the diagnostic criteria or make the process unscientific as critics of modern psychiatry would have us believe, just like an unusual and hard-to-classify form of cancer doesn’t invalidate the other cancer classifications that are well defined. Psychiatry, by it’s nature, relies on verbal report from patients rather than a clean-cut blood test or piece of tissue under a microscope, so at this stage in history, it seems imprecise. That doesn’t make it any less scientific.
- The allegation that any psychiatric diagnosis can any be used to deprive the person so labeled of their human rights is utter nonsense. It’s a giant scarecrow – it seems really scary, but on closer inspection, it’s just a tarted-up mound of straw.People are never forced into treatments unless they really are “dangerous to themselves and/or others”. This rule can’t be invoked willy-nilly. There are multiple checks and balances, and a whole school of civil rights lawyers expectantly circling, ready for the whiff of blood in the water (http://www.mhrt.qld.gov.au/?page_id=2 is an example of the process in my home state, but each jurisdiction has their own version).
Caplan rightly pointed out that those with mental illness were less likely to be the perpetrators of violence and more likely to be the victims, but that doesn’t negate the need for protection of the community from those with mental illness who have shown violent intent and no capacity to control their behaviour.
If you want to find a group that really are suffering from inhumane and immoral deprivations of their human rights, then that would be Christians. Around the globe, millions of Christians are oppressed, imprisoned, tortured, raped, and murdered every year.
Time and space preclude a full analysis of Caplan’s post, but what’s really important is that both the American Psychiatric Association and the U.S. Department of Health and Human Services’s Office of Civil Rights, an independent ombudsman, dismissed formal appeals by Caplan relating to her hysterical claims of inhumane forced psychiatric treatment. Dr Leaf conveniently left that out of her social media post.
Instead, Dr Leaf chose to publish one of the most alarming quotes from an article heavy on scaremongering, from a disaffected author on an extremist blog. If Dr Leaf was a real expert on mental health instead of being a self-declared one, she would have easily seen how nonsensical Caplan’s post was.
By posting this quote on social media today, it’s highly likely that Dr Leaf has caused harm to thousands of vulnerable Christians by unnecessarily increasing the stigma and fear of a mental health diagnosis. This, in turn, is likely to lead to these same vulnerable Christians missing out on (drug and non-drug) treatment which would help them rise to their true potential in God and in life, leaving them trapped and suffering in their mental destitution.
Dr Leaf has a track record of misinformation when it comes to mental health. Christians suffering mental illness need more support, not more stigma. It’s time Dr Leaf stepped aside, and stopped making things worse.
Dr C. Edward Pitt 
Dear Dr Pitt, thank you for your correct assertion that Dr Leaf does not have a good enough grip on mental illness, and some of her statements (at least) perpetuate the stigma associated with mental illness (or worsen it).
I must, however, point out that mental health legislation systems worldwide are violent and abusive and do, indeed, contravene patients’ human rights, and severely. I also direct you to studies coming out of the UK in recent years which show that community treatment orders are not an effective way of treating people.
Indeed, all human beings are capable of making decisions about their own health and should be allowed to. To say anything else would indicate a stigma against the group of people you believe to be ‘incapable’ and needing your ‘stewardship’.
I have bipolar and am thoroughly sick of (and extremely angry about) mental health worker violence, abuse, and even stalking. They have driven me to despair many times and have caused further mental ill health in me including severe anxiety, and I have learned to trust no ‘normal’ person. I ‘divorced’ the mental health system but they still sometimes disrupt my life and prey upon me, and it’s rather like having the secret service after me.
I suggest you get down off your high horse and stop thinking you are doing your patients a favour by using force against them.
Dear Lisa,
Thanks for your impassioned comment. Your frustration with the system is palpable, and I’m sorry the system has failed to treat you with the dignity and autonomy that you deserve. I’d encourage you to talk to the civil liberties or patient advocacy services in your local jurisdiction. Intimidation and harassment is not acceptable.
You’re welcome to disagree, but I’m certainly not suggesting that the system is perfect – no system is. However, the system remains in it’s current form because it’s the most functional way of protecting the rights of as many people as possible in our community (at the moment). The systems relating to involuntary treatment are there to protect the patient and the community. Some would argue that it’s presumptive and paternalistic for the medical fraternity to start making judgements about what’s best for a person or what they need, but the pillars of medical ethics always apply. The first of these is non-maleficence (i.e. “first, do no harm”) Next is autonomy on which the process of informed consent is built. Patients are ALWAYS given the right to chose treatment where they have the capacity to provide informed consent. In the jurisdiction where I work, if I think a patient doesn’t have the capacity to consent to treatment AND I think they or the people around them are at risk of harm, then there is an assessment process involving scores of other professionals before they’re given involuntary treatment. There are also appeals processes if a patient disagrees with the decision. So I respectfully disagree that mental health legislation systems worldwide are violent and abusive or that they contravene the human rights of their patients.
I don’t agree with your premise that “all human beings are capable of making decisions about their own health and should be allowed to”. That’s an over-generalisation. I could name plenty of examples of categories of people who are not capable of making decisions about their own health, but specifically from a mental health perspective, there are mental illnesses that deprive a person of the insight and cognition required to give informed consent. This is not a value judgement nor does it imply stigma or involve paternalism, it is simply a statement of fact.
I apologise if it seemed (or still seems) like I am on a high horse – I’m not at all, nor do I use any form of force or coercion. I always do my best to apply the best knowledge and care to every need of every patient. For the record, I think involuntary treatment is extremely rare. Out of the thousands of patients I’ve seen over the years, I can count on two hands the number of patients I’ve referred for involuntary treatment. This is why I find Dr Leaf’s arguments so appalling, because they present a distortion of reality.
To conclude, I say again that I’m sorry about what you’ve been through, and I acknowledge the mental health system does fail some people, but by and large, the system respects the fundamental human rights of the people in its care and the needs of the community.
I sincerely hope you’re able to find resolution to those injustices.
All the best to you.
Dear Dr Pitt,
Thank you for your reply, which is pretty much entirely inaccurate and patronising. In fact, as you SHOULD be aware, under mental health legislation worldwide people with mental illnesses have fewer rights than criminal offenders and conditions in psychiatric wards are worse than in jails. I do look forward to your explanation of how this actually helps people with mental illnesses – it should be enormously entertaining.
I apologise for the cynicism but mental health systems worldwide represent nothing more than quite severe persecution of disabled people. I have been treated like an incapable idiot by the mental health system all my life and am far from that, having lived and worked independently in five countries and being multi-awarded in my field of expertise. Nevertheless if I have had a bout of poor mental health or even if I am just ‘found out’ as having a mental illness, the mental health system has always been there to make things much, much worse for me – that is their sole contribution to my life so far – given the legal position of people with mental illnesses, how could it not be? Mental health systems and the well-meaning ‘normal’ people who call them have made my life much, much harder than it has needed to be. I have already struggled for years to become highly-competent in my chosen field/s whilst living with the pain of the mental illness, and I have succeeded. Recovering from the horrific traumas inflicted on me by the mental health systems of the world has been much harder than coping with the actual illness.
Good day to you, Sir.
You are also aware, Dr Pitt, I presume that hundred, if not thousands, of psychiatric patients have been beaten to death (‘death during restraint’) by mental health systems worldwide over the centuries? Heaven knows what the actual number of dead is.
As for this constant obsession psychiatrists have in promoting the notion that psychiatric patients are violent in order to justify removing their rights, as you know, mentally ill people are much more likely to be the victims of violence than the perpetrators, and most mental illnesses are caused by family abuse. These abusive families then collude with the mental health system which further abuse the victim/patient. That people with mental illnesses are in fact not much more violent than they are is probably a minor miracle, given what they are put through. And as you know, the typical mental health ‘consumer’ is passive and female, and has been put through heaven-knows-what-horror.
Lisa,
I’m sorry that you would misinterpret my comment to you as patronising. I was being forthright and sincere. The abuse of power is not acceptable in any form, but abuse perpetrated against you or anyone else does not mean the broader system isn’t needed or helpful for the majority. I can understand why you would react out of your pain, but respectfully, I think your various statements and conclusions are either incorrect or not broadly representative. I doubt you’ll agree with me given your previous comments. While you’re welcome to hold whatever opinion you like on my views or me personally, this is not the forum for an emotionally-charged discussion where personal offence is likely to be taken. Thus, I will not be taking this discussion any further, something which I’m sure you’ll interpret negatively, but I believe this is the most appropriate action to take.
All the best to you.
Pingback: Where are all the shepherds? | Dr C. Edward Pitt