Saturday, April 09, 2016

Appendix to above

This post has been made as an appendix to the above post. I'm looking in more detail at the quotes Vaughan Bell used to try and justify his argument that critical mental health demeans people with organic brain disease.

The first quote is from Kinderman et al:-
such approaches, by introducing the language of ‘disorder’, undermine a humane response by implying that these experiences indicate an underlying defect
Here the authors of the quote are arguing that mental health problems should not be seen as disorders or pathologised, as they are better seen as understandable responses to difficult circumstances. I do understand what the authors are saying but I have commented before that such a way of viewing mental health problems may be potentially misleading (eg. see previous post). Generally the implication of identifying a mental health problem is that the person's reaction has been maladaptive. This is why the person has gone for help.

Although there is this debate about whether mental health problems should be seen as illness or disorder within the critical mental health movement, I don't see how this quote supports Bell's argument that people with brain disorders are being demeaned by a critical mental health approach. The quote is not talking about people with brain disorders - in fact, it's saying that mental health problems are not brain disorders.

The second quote that Vaughan Bell gives is from Mary Boyle:-
The idea of schizophrenia as a brain disorder might offer further comfort by distancing ‘normal’ from disturbing people. It may do this by placing disturbing people in a separate category and by suggesting uncommon process to account for their behaviour…
Bell seems to have problems with the idea of "distancing". What Mary means is that reducing mental health problems to brain disease may be a way of protecting others from the pain the person is experiencing. Surely this is correct. Again, this quote isn't about people with brain disease.

The third quote is from Lucy Johnstone:-
The fifth category… consists people suffering from conditions of definitely physical origin… where psychiatric symptoms turn out to be indications of an underlying organic disease… medical science has very little to offer most victims of head injury or dementia, since there is no known cure…
Here, Lucy is talking about people with brain disorders. What she is saying is correct that medicine in the literal sense can't cure organic disease. What she goes on to say, which isn't quoted, is that behavioural and social interventions are what is needed. Again, this is correct and isn't being demeaning of people with organic brain disorders.

The final quote is from Doing psychiatry wrong:-
To be sure, these brain diseases significantly affect mental status, causing depression, psychosis, and dementia, particularly in the latter stages of the illness. But Andreasen asks us to believe that these neurological disorders are “mental illnesses” in the same way that anxiety, depression, bipolar disorder, and schizophrenia­ are mental illnesses. This kind of thinking starts us sliding down a slippery slope, blurring distinctions that must be maintained if we are to learn more about why people are anxious, depressed, have severe mood swings, and lose contact with reality.
This quote is saying there is a difference between organic psychosis and functional mental illness, which is correct (eg. see previous post). Again, this isn't demeaning of people with organic brain disorders.

3 comments:

vaughanbell.net said...

Some comments on the quotes:

“such approaches, by introducing the language of ‘disorder’, undermine a humane response by implying that these experiences indicate an underlying defect.”

The author believes that i) introducing the language of disorder and ii) implying there's a deficit, undermines a humane response. How do you think this sounds to someone with mental health problems and epilepsy? Or with TBI? Or with Huntingdon's disease? It don't think it undermines a humane response unless you think it is more difficult to be humane to people with brain disorders.

“The idea of schizophrenia as a brain disorder might offer further comfort by distancing ‘normal’ from disturbing people. It may do this by placing disturbing people in a separate category and by suggesting uncommon process to account for their behaviour…”

The author thinks that the concept of brain disorder might offer comfort by distancing 'normal' from disturbing people. Strikes me as a weird and somewhat prejudiced thing to think about people with brain disorder. Only true if you believe that the concept of brain disorder necessarily distances people.

“The fifth category… consists people suffering from conditions of definitely physical origin… where psychiatric symptoms turn out to be indications of an underlying organic disease… medical science has very little to offer most victims of head injury or dementia, since there is no known cure…”

Firstly, this is just a straight-up falsehood. 'Underlying organic disease' as the author describes it, can indeed by cured on occasion, as anyone who has had their bacterial meningitis cured by antibiotics, their epilepsy resolved by brain surgery or their aneurysm clipped, among many other treatments, could tell you. Not all effects can be completely resolved, and some are left with permanent difficulties, however, but the idea that brain disorders are 'incurable' is Victorian era prejudice that simply doesn't reflect the important treatments and massive functional improvements that modern rehabilitation focused services can achieve.

When we're taking about psychiatric symptoms arising from neuro problems, contrary to what the author says, they can be treated by standard mental health treatments, or through treating the neurological disturbance. e.g post-ictal psychosis can be treated by treating epilepsy. So hopeful optimism for some people with mental health problems but ill informed pessimism for people with brain changes.

“To be sure, these brain diseases significantly affect mental status, causing depression, psychosis, and dementia, particularly in the latter stages of the illness. But Andreasen asks us to believe that these neurological disorders are “mental illnesses” in the same way that anxiety, depression, bipolar disorder, and schizophrenia­ are mental illnesses. This kind of thinking starts us sliding down a slippery slope, blurring distinctions that must be maintained if we are to learn more about why people are anxious, depressed, have severe mood swings, and lose contact with reality.”

An amazing quote really. If you have a 'brain disease' this doesn't tell us about why people get anxious, depressed etc. But people with 'brain disease' are people too. If you include everyone under the banner of 'people' of course they all tell us something about why people get depressed, anxious or have other mental health problems. Another example of people with brain disorders being put in a different 'other' category.

So all of these quotes assume or imply there is something 'other' or less human about people with brain disorder. The last one is completely explicit about it.

A simple test about what the critical mental health literature makes of people with neurological conditions: produce some critical mental health writing that speaks positively of people with brain disorders and includes their mental health problems as part of understanding mental health problems as a whole.

McAllister Craig said...

How my son was cured from psychosis.
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Duncan Double said...

Sorry, Vaughan, your post has been sitting in a spam channel until I spotted it today. As I said in another comment, your emphasis on neurological conditions has been helpful. I think the point is that reducing people's mental health problems to an underlying brain problem may prevent an appropriate response and distance those trying to help from the pain they're experiencing. I agree organic conditions can be treated sometimes and of course toxic confusion usually improves once the acute medical condition has resolved. But Lucy was talking about brain injury and dementia. I know you find it difficult to see a distinction between organic and functional illness. But this difference is real and does not mean that critical psychiatry is saying there is "something 'other' or less human about people with brain disorder".