OCR Psychology A Level Book 2 sample

Changing perspectives on human life and illness The view that mental illness is a myth is not a new insight, and has been questioned for many centuries; it just seems that way now because we have replaced an old religious- humanistic perspective with a dehumanised pseudomedical one. This medicalisation of the soul began in late 16th century England. Shakespeare’s Macbeth illustrates this. Lady Macbeth is overcome with guilt for committing murder and goes ‘mad’—she is anxious, unable to eat, rest or sleep. Her husband sends for a doctor to treat her but the doctor’s response is ‘ More needs she the divine than the physician ’, suggesting that her issue can be resolved by religion rather than medicine (Act V, Scene 1). Shakespeare’s insight that the mad person must treat themselves (see caption above right) is both profound and obvious. Profound because we all experience a strong desire to help someone who is distressed. It is obvious because, if Lady Macbeth’s suffering is a consequence of internal experiences (hallucination), then the remedy must also be internal (self-conversation). By the end of the 19th century, the medical conquest of the soul was secure. Today it is the physician who cures the soul. Mental illness is in the eye of the beholder The behaviours we call mental illnesses are not medical illnesses. When a person displays disturbing or disturbed behaviours we medicalise them and search for ways to treat the ‘problem’. In principle, the medical treatment of physical illness requires patient consent. Bodily illness does not deprive a patient of their liberty but mental illness does, a grave violation of their basic human rights. If mental illness is seen as a myth, it is foolish to look for the causes and cures of such fictitious ailments. Diseases of the body have causes, such as infectious agents or nutritional deficiencies, which can be cured or prevented. People with mental diseases, on the other hand, have reasons for their actions that must be understood. When treating physical disease (pathology), the important part is the area of the body that requires treatment—the feelings of the person/ patient are relatively unimportant. In contrast, the practice of medicine as a human service sees the patient’s feelings as supremely important. This emphasis on the importance of the person and their feelings is because medicine is guided by the ethical principle Primum non nocere (first, do no harm). The patient is free to seek, accept or reject medical diagnosis and treatment. Psychiatric practice is different. Here the basic principle is that the mentally ill patient may be dangerous to himself or others and therefore the duty of the psychiatrist is to protect the patient from himself and to protect society from the patient. Disease is an actual phenomenon, it can be demonstrated by, for example, taking someone’s temperature. In contrast, the diagnosis of a patient’s illness is a judgement made by a doctor, in the same way as the estimated value of a work of art is the judgement of a certified appraiser. Having a disease is not the same as being a patient—disease is the actual phenomenon, being a patient is what comes after the diagnosis. Not all sick people are patients and not all patients are sick. However, physicians, politicians, the media and the public confuse the two. Revisiting The myth of mental illness Critics continue to understand that The myth of mental illness was a radical effort to recast mental illness from a medical problem into a linguistic-rhetorical phenomenon (i.e. the way mental states are described). On the other hand there was support from non-psychiatrists, such as Richard Vatz and Lee Weinberg (1994) who agreed that the vocabulary used in psychiatry and science are incompatible. They go on to say that psychiatry, without reference to the medical model, is a method of social control which violates freedom and autonomy. Having an illness does not make an individual into a patient One of the worst assumptions of psychiatry is that if someone is labelled as mentally ill, then they require some form of treatment, whether they choose the treatment or not. This leads to two radically different ways of treating mental illness: • Curing or healing by using conversation, for example undertaking therapy. • Controlling or coercing patients forcefully, which has been authorised by the state. In the past, when social practices were dominated by religion, people accepted religious justifications for coercive treatments. Today people accept medical justifications, ‘ This is how, some 200 years ago, psychiatry became an arm of the coercive apparatus of the state .’ A hundred years ago psychiatrist Eugen Bleuler argued that people with schizophrenia should be able to define and control their own lives; psychiatrists should not deny them their liberty to take their own lives. Ironically the opposite happened. Bleuler’s (1911) invention of schizophrenia led to the ‘longing for non-existence’ becoming a medical condition which led to the creation of the pseudoscience of ‘suicidology’ and contributed to landing psychiatry in the moral morass in which it now finds itself. Biographical notes Thomas Szasz (1920–2012) was born in Hungary in 1920 and moved to the USA in 1938. For most of his career he was Professor of Psychiatry at the State University of New York. He is regarded as one of the leading moral philosophers of the 20th century. In his lifetime he wrote 36 books and countless articles—but remains most famous for The myth of mental illness . background The conflict between the medical and humanistic view of mental illness dates back many centuries, as expressed by Shakespeare in his play Macbeth : Macbeth: Cure her [my wife] of that. Canst thou not minister to a mind diseas’d, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain; And with some sweet oblivious antidote Cleanse the stuff’d bosom of that perilous stuff which Weighs upon her heart? Doctor: Therein the patient Must minister to himself . (Act V, Scene 3) check your understanding 1. Briefly summarise Szasz’s view of the medical model of mental illness. 2. In what way is mental illness a metaphor and a myth? 3. Use Shakespeare’s character Lady Macbeth to illustrate Szasz’s view of the medical model of mental illness. 4. Explain the view that ‘not all sick people are patients and not all patients are sick’. 5. What does Szasz mean by the medicalisation of disturbed or disturbing behaviour? 6. How does Szasz propose people with mental illness should be treated? 45 Key research: Szasz (2011) on The myth of mental illness