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Post by Peter on Feb 26, 2016 15:06:29 GMT
This topic is of interest to me. I have read a little around the subject area (books by Richard P. Bentall such as Madness Explained and other works such as Anxious by Joseph Ledoux) who argue either side of the disorder = chemical brain defect argument.
It is an interesting subject matter, especially in light of the fragility of diagnosis for mental health issues, the majority of which have the capacity to be hugely influenced by the patient/client.
A colleague of mine shared with me that their employer once asked them to get a G.P. diagnosis for depression after a workplace incident. The individual was depressed (it later transpired), but was able to answer the GAD7 scale in a systematic way in order to deliberately lead to a low result in order not to cause complications for their career. This is is a significant problem for our work; the subjectivity of mental health diagnosis and the capacity for clients/patients to manipulate the results of our assessment tools.
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Post by Chris on Feb 29, 2016 17:56:21 GMT
Hi Peter, Bentall wrote an interesting piece in The Guardian a few days' ago. His main point is, as most of us knew or suspected full well, most mental illness is a result of misery and not genes. A more interesting facet of his article addressed the recent, updated documentary made by Stephen Fry on the subject of manic depression. The documentary seemed to miss the point and concentrate on a genetic disposition, whereas Bentall made the point that he too attended Uppingham boarding school with Fry and most, if not all, of their respective problems stemmed from the misery meted out there. www.theguardian.com/commentisfree/2016/feb/26/mental-illness-misery-childhood-traumas |
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Post by alison on Mar 1, 2016 11:47:20 GMT
Hi Peter and Chris
I agree that the subjectivity of mental health diagnosis is a complex and multi-layered issue.
The capacity for clients/patients to manipulate the results of assessment tools is an interesting topic. There can be many agendas at play, with regards to assessment tools and the resulting diagnosis - and in my experience it is far from unusual for employers to 'push for' a diagnosis of depression.
I know somebody that was facing a disciplinary at work (public sector job). She was (what the media might call) a 'whistle blower'. Having identified, and raised, a safeguarding issue that exposed vulnerable families to considerable risk of harm.
Her colleagues turned against her. Some weeks later a colleague filed a formal complaint against her in relation to a 'minor' mistake, which she openly admitted to.
Her boss began disciplinary proceedings immediately. The safeguarding issue she had raised was ignored/swept under the carpet.
At a time of harsh budget cuts, this person was fearful she would lose her job - disciplinary proceedings moved very fast.
The Occupational Health Dpt advised this person to go to the doctor to be assessed for clinical depression and that a diagnosis 'might be helpful'.
This person was unsure 'whose side' Occupational Health was on.
She feared a diagnosis of depression could be used as evidence that her 'judgment was compromised'.
However, her Trade Union rep advised that a diagnosis of clinical depression would ensure the disciplinary would be 'put on hold'. She would not face disciplinary proceedings until deemed well enough to cope. It would 'buy her time' and protect her from immediate dismissal.
The focus was absolutely on this person's mental health. Like Chris's reference to Uppingham/Stephen Fry documentary - the issues of the toxic work environment were being missed/ignored.
'In the eye of the storm' this person took her Trade Union reps advice.
She manipulated the assessment tool to ensure a high score. The GP diagnosed clinical depression and prescribed anti-depressants. She never took the medication. She did not feel, nor consider herself to be depressed.
Ultimately, the safeguarding issue was addressed (the boss 'took the glory' for identifying and addressing it). The complaint against this person was withdrawn, the disciplinary never happened.
This individual demonstrated high levels of resilience and coping skills. However, she is left with a diagnosis of clinical depression on her medical and work record. She feels this diagnosis will have a lasting negative effect on her career prospects. She feels powerless to do anything about it and recognizes that any admission of 'manipulating' the clinical diagnosis would raise questions about her character/honesty.
I find the issue of 'relationship between environment/external factors and mental health' of great interest and will post views about that later
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Clare
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Post by Clare on Mar 1, 2016 12:06:28 GMT
Hi Everyone, This topic is really important with the current trends in society (especially the media), it is a hot topic! Thank you Chris for a very interesting article in the guardian. I agree with its content, and a very interesting comment 'A narrow medical approach has been extraordinarily unsuccessful, despite what many people assume. Whereas survival and recovery rates for severe physical conditions such as cancer and heart disease have improved dramatically since the second world war, recovery rates for severe mental illness have not shifted at all' Bentall (2016) www.theguardian.com/commentisfree/2016/feb/26/mental-illness-misery-childhood-traumasIn reponse to Peter's comments, I recently fell into a trap where a client declared mental illness for his court case to receive a softer sentence, it was all pre-meditated with the client manipulating the GP (GAD7 scale) and myself. I am looking forward to exploring these issues during the course. Clare |
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tutor
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Post by tutor on Mar 2, 2016 10:37:54 GMT
Hi Everyone
Some interesting comments and insights.
Tutor
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Post by Chris on Mar 2, 2016 18:26:37 GMT
Looking at the direction of many of the responses here, I think it's worth mentioning the work of psychotherapist and author Nick Duffell, who has written two brilliant psychohistories (Wounded Leaders & The Making of Them) on the effects of the British boarding school system on the psyche of the country, and by extension, the world.
At the centre of his thesis lies the concept of The Rational Man Project, which is his name for an extremist Cartesian view of the world. The pitfalls of this are that extreme Cartesian logic involves compartmentalising / separating / simplifying / objectifying - any problem or matter is reduced to its basic components - vague, ambiguous or contradictory ideas are discarded. Unfortunately, this means extreme Cartesian logic is incapable of dealing with paradox or complexity. What is more paradoxical or contradictory than the exploration of unconscious processes through psychotherapy?
To quote Duffell on the neuroscientific findings related to this: "...the hyper-rational mindset operating within individuals stimulates unbalanced left hemispheric brain activity, which 'prefers' to focus on inanimate objects rather than living subjects".
No wonder so little progress has been made since the war... public school psychiatrists educated to the Rational Man model are incapable of understanding the problem in the first place, let alone finding solutions... or indeed wanting to.
The public school Rational Man system was devised to enable the British to run its empire. It is much easier to order people around if you view them as objects and not individuals. I think this is an extension of the system / philosophy adopted by the Normans when they invaded Britain.
Now I jump to quoting Erich Fromm: "Our contemporary Western society...is increasingly less conducive to mental health, and tends to undermine the inner security, happiness, reason and the capacity for love in the individual; it tends to turn him into an automaton who pays for his human failure with increasing mental sickness, and with despair hidden under a frantic drive for work and so called pleasure. Let us beware of defining mental hygiene as the prevention of symptoms. Symptoms as such are not our enemy, but our friend; where there are symptoms there is conflict, and conflict always indicates that the forces of life which strive for integration and happiness are still fighting. The really hopeless victims of mental illness are to be found among those who to be most normal. Many of them are normal because they are so well adjusted to our mode of existence, because their human voice have been silenced so early in their lives, that they do not even struggle or suffer or develop symptoms as the neurotic does. They are normal not in what may be called the absolute sense of the word, they are normal only in relation to a profoundly abnormal society. Their perfect adjustment to that abnormal society is a measure of their mental sickness. Their conformity is developing into something like uniformity. But uniformity and freedom are incompatible. Uniformity and mental health are incompatible too... Man is not made to be an automaton, and if he becomes one, the basis for mental health is destroyed."
So the individual who comes to you exhibiting signs of mental distress, is actually sane - fighting the poison of the insane collective... struggling unconsciously with the indignity of being reduced to an object.
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Post by alison on Mar 3, 2016 9:44:19 GMT
Thank you for such an interesting post Chris. And for the reminder about Nick Duffell's work, which I've read before and find fascinating.
I couldn't agree more with your last sentence, and it's very helpful to read this in the context of the Fromm quote.
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tutor
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Post by tutor on Mar 6, 2016 6:39:21 GMT
Hi Chris
An interesting post.
Tutor
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Post by Chris on Mar 6, 2016 13:32:18 GMT
Thank-you, Alison. I think my last sentence sums up a lot of my view on the whole subject of psychotherapy: the "neurotic" ones are the interesting ones, the complex individuals chafing under the yolk of simplistic conformity. How can you be anything other than congruent, unconditional & empathic with such fellow-travellers?
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Post by liliana on Mar 8, 2016 18:52:42 GMT
Hi Everyone,
Sorry to come so late into this very interesting discussion about psychopathology and the approach to mental health by the professionals and by society.
This is indeed a ‘hot topic’ as Clare mentioned in an earlier post, and in my opinion, if it is going to remain ‘hot’, this is truly great news. Because at least now there is a sustained interest and focus on mental health, and that is good because it brings awareness and opens the window for educating people about mental illnesses. It also puts under the spotlight how our mind works and what could happen when its balance is disturbed. Labelling in relation to mental illnesses won’t be such a problem anymore if there is an increasing focus and understanding of what that actually means and how that affects the individual and his family, friends, workmates, neighbours, the NHS, etc.
The public perception of normal and abnormal in terms of mental health is getting challenged far more than in the past, but still not enough in my opinion. I am glad to see how the media show an increasing interest in these, and I hope to see more professionals involved in a large-scale debate about the health of our mind, and I am sure that all of us will benefit from this. I admire those people that come forward to talk in the open about their troubles with mental health, as famous as Stephen Fry, or unknown people that simply talk about their ordeal in getting help for their mental illness on the NHS. It is an act of courage in a society that still thinks that it’s better to keep quiet and isolated if you are just not well in your head. But times are changing and an informed public dialogue on this topic is becoming vital. Since fewer people are ashamed nowadays to talk about their damaged heart after a heart attack or their diabetes, or their cancer, it should be the same with unbalanced minds. And as people are more interested and aware of the causes and treatment of physical conditions, they could become more knowledgeable and empathetic with regard to mental issues.
Liliana
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tutor
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Post by tutor on Mar 10, 2016 7:40:50 GMT
Hi Liliana
Welcome to the group.
I agree this is a hot topic.
Tutor
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