OCR Psychology A Level Book 2 sample

‘Mental illness’ is a metaphor The idea that mental illness is not a medical problem goes against what is generally agreed by the public and by the medical profession. People say ‘ But I know so-and- so who was diagnosed as mentally ill and turned out to have a brain tumour. ’ Such a view doesn’t challenge the metaphor, it verifies it. If the patient was found to have a brain tumour that shows he was misdiagnosed—he didn’t have a mental illness, he had an undiagnosed bodily illness. Such a process of biological discovery has led to various forms of ‘madness’ being identified and treated as a somatic disease, such as beriberi (caused by a vitamin B-1 deficiency) or neurosyphilis (an infection in the brain due to untreated syphilis). If all the conditions now called mental illnesses proved to be brain diseases, there would be no need for the notion of mental illness and the term would become devoid of meaning. However, what actually happens is as new ‘unusual behaviours’ are discovered, they are referred to as a ‘new’ mental illness rather than a physical illness with behavioural symptoms, leading to an ever-increasing list of disorders. Key research Alternatives to the medical model Topic 3 Thomas Szasz (2011) The myth of mental illness: 50 years later. The Psychiatrist , 35, (5), 179–182. The specification requires that you know one piece of key research for each topic. On this spread we take a look at the key research by Thomas Szasz on the myth of mental illness. For the exam you need to be able to link the key research to the topic (alternatives to the medical model) and link the key research to methodological issues and debates. These links are considered on the next spread. Fifty years of change in US mental healthcare In the 1950s no one felt it was the role of national government to provide healthcare. Most people with mental illness were considered incurable and they were kept in state governed mental hospitals. Some patients sought help voluntarily and those who could afford it could seek private treatment. Since that time, the formerly sharp distinctions between medical hospitals and mental hospitals, voluntary and involuntary patients, private and public psychiatry have blurred into non-existence. Now, 50 years on, mental healthcare is the responsibility of the government and is thoroughly medical and political. The focus for mental health professionals is on legal responsibility to prevent the patient being a danger to themselves or others. There is no legally valid non-medical approach to mental illness, just as there is no legally valid non-medical approach to measles or melanoma. Mental illness—a medical or legal concept? Fifty years ago, it made sense to claim that mental illnesses are not diseases. It makes no sense to do so today. There is no debate about what counts as mental illness because mental illnesses are defined by political and economical criteria. ‘Disorders’ such as homosexuality are no longer considered disorders, and attention-deficit hyperactivity disorder has appeared as a mental illness. This highlights how mental illness is not a real phenomenon because, if it were, it could not change so readily. The politicalisation of mental illness means that those in power have determined that mental illness is like any other physical illness. For example in 1999, Bill Clinton said ‘ Mental illness can be accurately diagnosed, successfully treated, just as physical illness ’, and the Surgeon General David Satcher (1999) agreed ‘Just as things go wrong with the heart and kidneys and liver, so things go wrong with the brain ’. These assumptions that mental illness is a diagnosable disorder of the brain are not based on scientific research. It is a deception, or a naïve revival of the humoral theory of the Greeks. Szasz admits that his argument is not based on scientific research either—rather his point is to show that the concept of mental illness is just a metaphor — in other words ‘mental illness’ is just a phrase that is used to supposedly represent something that is a real physical alteration. As there isn’t anything that is real the concept cannot be proved or disproved using scientific research. ‘Mental hospitals’ are like prisons—people labelled with mental illness are placed there involuntarily, and are treated like prisoners rather than receiving treatment for their illness. The psychiatrists act as judges rather than healers. Based on this, traditional psychiatric viewpoints of science, medicine and treatment should be discarded, and replaced with considerations in terms of morals and laws. Background and aims In 1960 Thomas Szasz produced an essay and then a book titled The myth of mental illness in 1961. In both he challenged the medical model , and claimed that modern psychiatry rests on a fundamental conceptual error—that unwanted behaviours are seen as mental illnesses with a physiological basis and, like physical illnesses, are able to be treated with drugs. Instead the people we now call ‘mental patients’ are active players in their real-life drama not passive victims of physiological processes they can’t control. Aims Szasz’s aims were to: • Challenge the medical concept of mental illness. • Reject the psychiatric treatments that are justified by this approach to mental illness. • Stop using terms such as ‘psychoses’, ‘neuroses’ and ‘mental illnesses’ and instead think of individual behaviours that disturb or disorient others or the self. • Reject the image of patients as the helpless victims of pathobiological events outside their control. • Stop coercive psychiatric practices which are incompatible with the moral ideals of free societies. Note that this article is not a ‘study’ as such—there is no sample, procedure or results. Rather it is a summary of Thomas Szasz’s research and opinion. Watch clips of Thomas Szasz arguing his point. He is a very interesting and motivational speaker. You can find a particularly good one here: tinyurl.com/yavuts7w Szasz (2011) on The myth of mental illness Chapter 1: Issues in mental health 44