My interest comes from a personal involvement at a very early age and then during a mid-life crisis. I was epileptic from 10 onwards and diagnosed paranoid schizophrenic from 41 onwards (just around the time of the Iraq War, in fact) – though interestingly the classification used by British psychiatry suggests that:
Similar disorders developing in the presence of epilepsy or other brain disease should be classified under F06.2
Schizophrenia-like psychosis in epilepsy
No matter. In my case the diagnosis has always been firmly full-blown paranoid schizophrenia, my GP politely refusing to contemplate any change. I mention this because of one of the arguments used in the third Observer article linked to above, where a professional in favour of the current system of classification says:
[...] A classification system is like a map. And just as any map is provisional, ready to be changed as the landscape changes, so is classification. [...]
This is clearly not my experience, neither at the time of initial assessment nor in the years that followed that first assault on my sense and sensibility. Meanwhile, in the second half of the article I’ve just quoted from, I find in Oliver James a much more sympathetic voice:
Yet 13 studies find that more than half of schizophrenics suffered childhood abuse. Another review of 23 studies shows that schizophrenics are at least three times more likely to have been abused than non-schizophrenics. It is becoming apparent that abuse is the major cause of psychoses. It is also all too clear that the medical model is bust.
[...] there is a huge body of evidence that our early childhood experiences combined with subsequent exposure to adversity explain a very great deal. This is dose dependent: the more maltreatment, the earlier you suffer it and the worse it is, the greater your risk of adult emotional distress. These experiences set our electro-chemical thermostats.
So does subsequent adult adversity. For instance, a person with six or more personal debts is six times more likely to be mentally ill than someone with none, regardless of their social class: the more debts, the greater the risk.
My own adult adversity was chronicled a couple of years ago in a short story I wrote. You can find this story, if you are of a mind to read it, here. I lay it down as the evidence I still need to provide in order that I might demonstrate I have no disorder except my epilepsy – and no illness except my savage reaction to madness around me.
As a young adolescent I remember something else too. A book called “Sanity, Madness and the Family” entered my life and influenced me in boundless ways. It seemed to hit a raw nerve, and much as semiotics and comparative studies at university later on, opened my eyes to a whole host of new ways of seeing.
Its thesis, if I remember rightly, was that much of what schizophrenics were accused of suffering from involved a series of collusive and horrendously denied acts committed by those who lived with and around them. Films taken of family interviews showed the alleged schizophrenic at the centre of the discourse, with siblings and parents winking at each other around them. In the face of a reality which was never shared it’s hardly surprising that someone might be described as delusional.
At the time of my own diagnosis, only my father had an opportunity to speak to the psychiatrist. My wife, who spent most time with me in the year leading up to my collapse, never had the chance to put across her point of view. Hardly a holistic approach able to contain both biology and society.
The problem with maps, of course, being you can sometimes hold them upside down.
And so we come to my final question: what is the proper task of this complex discipline we call psychiatry? To map and decide disorder, simply and dissectingly? To assume that what we have amongst us are people who suffer from incomplete bodies, broken mechanisms and disabling biochemistry?
Or, alternatively, enter into a completely different landscape where psychiatrists comprehend that much of what is seen as disorder is in fact reaction and adjustment by perfectly sane beings painfully hurting from painful lives? As James observes:
Britons and Americans have exactly twice the amount of mental illness of mainland western Europeans (23% versus 11.5%). Thirty years of Thatcher and “Blatcher” turned us into a nation of “affluenza”-stricken, shop-till-you-drop, “it could be you”, credit-fuelled consumer junkies. Personal debt – a major stressor for adults – rose from £200bn in 1980 to £1,400bn in 2006. After 1979, the amount of mental illness mushroomed.
Maybe sanity, madness and the family – in its environmental and reactive emphasis – wasn’t such a wild mantra, after all. It’s an old dichotomy, of course – but no less worth revisiting for all that.
Not after the shock to the system which neoliberalism has – more than manifestly – engineered.