Archive Post "The Mad Doctors New Cook Book" Aug 2009

The Mad- Doctor's New Cook Book..........Psychiatry and Globalisation

Aug 31, '09 2:26 PM for everyone

I have been an activist in the politics of psychiatry for almost 30 years.My first (BA) degree was based upon a dissertation called 'The Social Meanings of Schizophrenia' (1983) in which I examined the evolution of psychiatry and mental illness, as a corollary to the processes of industrialisation and urbanisation in the UK and elsewhere.

The same processes have taken place in almost every developed and developing country in the world.

Psychiatry is universal across all mass post-industrial societies and one of the aims of my early studies was to critically review it's progress, in the light of it's history and to attempt to deconstruct one of the most mystified and mystifying activities known to man.

It remains a work in progress at both the practical and theoretical level, so welcome to my world.

Mental health/illness is a topical subject I think, because some of the fundamental rules of the game are presently being rewritten and new perspectives are being woven into the mix. 

One of the most important texts in psychiatry is the Diagnostic and Statistical Manual of the American Psychiatric Association (APA) which is currently under revision in the United States.

The existing Fourth Edition (DSM-IV) is a psychiatrist's cook book with an influence that goes far beyond the borders of America.

It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers. It is a very influential tome.

DSM-IV is a taxonomy of psychiatric conditions and diagnoses and forms one of the two pillars of psychiatric lore, the other great book of global psychiatry is the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) of the World Health Organisation (WHO).

Between them DSM-IV and ICD-10 lay out the foundations of contemporary psychiatry to some less or greater degree everywhere on planet earth.

They are the sacred books of a largely misunderstood and mythologised secular priesthood which is more influential than any religion or political system that exists today.

Here it is important to make the distinction between psychiatry and psychology which are related but very different disciplines, in the area of madness and deviancy they can be competing ideologies, but in clinical practice they are frequently complimentary bedfellows.

This post will by necessity leave out the entire discipline of psychology and the politics of persuasion in which it engages.

For the time being our focus will be upon the medicalisation of madness and the role of psychiatry in not only maintaining the status quo.... but also in defining it.

Something important in the world of psychiatry is taking place at this time and its first appearance is imminent.

The fifth edition the APA's Diagnostic and Statistical Manual ("DSM-V") is currently in consultation, planning and preparation, due for publication in May 2012.

An early draft will be released for comment in 2009.

The mental disorders section of the ICD-10 is the other commonly-used guide, used more often in Europe and other parts of the world.

The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD, although not all codes may match at all times because the two publications are not revised synchronously.

This lack of co-ordination between DSM and ICD causes a slight doctrinal 'wobble' in what is otherwise a seamless world of psychiatric opinion and practice, or at least that is the theory.

The initial DSM-V Research Planning Conference in 1999 was under the joint sponsorship of the two organizations (APA and WHO) to set research priorities. Participants included experts in family and twin studies, molecular genetics, basic and clinical neuroscience, cognitive and behavioral science, development throughout the life-span, and disability.

What these panels and workgroups represent is the coming together of practitioners from various disciplines to produce a global blueprint for all our minds and all of the things that might go wrong with them.

A worldwide eugenics of human thought and action designed to determine what is 'deviant' and by a process of infinite elimination what is 'normal'. 

At the time of writing I am not aware of the planned changes to the DSM, but what I am aware of, is that the revised edition is intended to be a root and branch reform of the practice of psychiatry in America and around the world.

According to the APA itself:-

"The work groups began meeting in late 2007. While the 13 work groups reflect the diagnostic categories of psychiatric disorders in the previous edition DSM-IV, it is expected that those categories will evolve to better reflect new scientific understanding.

With the understanding that some continuity from DSM-IV to DSM-V is desirable to maintain order in the practice of psychiatry and continuity in research studies, there has been no pre-set limitation on the nature and degree of change that work groups can recommend for DSM-V."

What this means is that genetic models (eugenics) which in the words of the APA "better reflect new scientific understanding" have a new potency and prominence in their deliberations, although this orientation in biological-medico models of madness and deviance has been dominant in psychiatry since medicine fought off competing claims on the 'mad business', in the early 19th century.

Eugenics of course is "the study of, or belief in, the possibility of improving the qualities of the human species or a human population by such means as discouraging reproduction by persons having genetic defects or presumed to have inheritable undesirable traits (negative eugenics) or encouraging reproduction by persons presumed to have inheritable desirable traits (positive eugenics)."

The 13 DSM workgroups are a working party on negative eugenics whose work is, as ever complimented by the behavioural and cognitive sciences (the politics of prediction and persuasion) and is closely watched by the pharmaceutical giants (the technologies of suppression and concordance) for commercial opportunities in this developing field.

So something big is happening in psychiatry and that means something big is happening in our lives and the lives of the communities in which we live.

Legitimate authority is being given a new recipe book whereby dissent could be pathologised?

These esoteric little clusters of 'experts' in America are currently engaged in an exercise in global standardisation and DSM-V will be the new Malleus Malificarum intended like its predecessor, to be an aid to political control and social conformity that is so beloved by the world government pundits and fanatics.

The belief in global domination will not be a new category of mental disorder I predict in DSM-V...but an expressed belief that such motives in our politicians and business leaders exist, may very well be.

In fact it already is in the form of the various 'conduct disorders' contained in DSM-IV which like schizophrenia are deemed to appear in childhood or adolescence.

These disorders are seen as a continuum of increasing severity from Oppositional Defiance Disorder (ODD or naughty kid syndrome) to Anti-Social Personality Disorder and further down the slippery slope to full blown psychopathy, 
or sociopathy.... which are more or less the same thing.

In the new DSM-V the pathologisation of dissent is likely to be beefed up with learned (but not undisputed) bio-genetic theories, that will form a circular logic and become a self-fulfilling prophecy in the way that previous psychiatric diagnoses like 'schizophrenia' or 'bi-polar disorder' have taken on cultural meanings that entirely ignores the fact that  200 years ago.... neither disorder existed.

Just as psychiatry has always been a necessary adjunct to modernity and urbanisation (i.e.life in anonymous societies of 'strangers' -mass culture).... so the new DSM-V is intended to be a framework for the rationality of globalisation - so the first lesson is 'conspiracy theorists' watch out.

This may sound like a dire prediction I know, and it would I think be folly not to take these developments seriously for their social and political implications, but after almost three decades of research and practice in this field they do not frighten me any more than what is already in place does.

I work in the hidden world of mental health crisis intervention on a 24/7 and 365 night and day service in what is more or less a secret and unknown profession.

In England for example, it is commonly believed that people are compulsorily detained under a section of the Mental Health Acts (1983 and 2007) on the decision a two doctors, this not true (although 2 medical recommendations are required in most cases) psychiatrists DO NOT make applications to detain people against their will for assessment or treatment under the British Mental Health Act..... I do.....and people like me, who practice the arcane art of the Approved Mental Health Professional (AMHP)... more, or less invisible agents in all media accounts of people being "sectioned" under the Mental Health Act here.

For many years now I have worked in agencies and with people whose responsibilities it is to implement and interpret mental health law in this country  24/7.

I am duly endowed with the powers of a police constable to remove mentally disordered people to a designated place of safety and am legally responsible for the entire co-ordination and implementation of that process from start to finish. I can  for example obtain and execute warrants to enter someone's property (by force if necessary), if I have reason to believe that a mentally disordered person is being neglected or mistreated therein.

I equally am empowered by statute to instruct the police in this regard and if anyone were to impede me in my work, they would be committing a criminal offence.

My job involves weighing up the evidence (including the medical evidence) and to make decisions with regard to depriving individuals of their liberty, in the interest of their own health and/or safety and also for the protection of others.

I am an agent of social control and I take my duties very seriously, although around 80% of my work is not statutory and the bulk of what I do is to provide crisis intervention services, plus follow up support to people in various forms of emotional distress, acute anxiety, psychosis, low mood, suicidal and self harming behaviours and other forms of risky conduct likely to result in untoward outcomes.

The job I do produces an end product, which is a detailed risk assessment, a related mental state assessment and a crisis management plan.

I work closely with psychiatrists, psychiatric nurses and allied professionals; the police, GPs, accident and emergency departments, the ambulance service; adult and child protection agencies, housing providers, the voluntary sector, substance misuse agencies, relatives, carers and most of all people deemed to be mentally disordered by themselves.... or by any of those agencies already mentioned above.

But 99% of the population have very little idea of what we AMHPs do.... if they know we exist at all?

The point of this post is to warn and to reassure in equal measure.

Psychiatry is powerful and deeply political, there is no doubt about that and the country should be aware of people like me and other practitioners of these secret arts, but the simple truth is that the vast majority of people I see at work, are at the time throwing themselves at the psychiatric system, which incidentally has a number of secondary gains for those deemed to fall within its remit.

There is even a small group of people who for whatever reasons, have made a career out the 'sick role' and for whom being detained is a sort of badge of honour and a valued inclusion in their CV as a 'professional patient'.

Negotiations with such people (often in the early hours of the morning) is a commonplace part of what I do, which is as much about keeping people out of the grip of psychiatry (where it isn't appropriate) as it is about facilitating their entry.

If we fear the power of psychiatry we already have the makings of an antidote to that power, but like all fears ....information and understanding is the key to our liberation from irrational and excessive anxieties.

Knowing how the system works is an important part of any understanding of course and most people, including the majority of people who use the services themselves, do not understand the roles of the people they encounter within them.

More important though is to understand that whatever DSM-IV says now, or DSM-V eventually says in the future..... and however the WHO's ICD-10 identify the characteristics of the disorders they describe, a discourse and a debate is taking place, which is not all about conformity and control, and where the locus of power is not always where it appears to be, but also where the motives of practitioners never (or hardly ever) exactly match the ideological blueprint incorporated in the institutions intended to deliver mental health interventions.

Psychiatry as I have said above, is a political activity, but it is not yet, a totalitarian one with a single eugenic mission... and from what I see at the coalface, there is no immediate prospect of that happening in the UK at least..... in no small measure due to the great profusion of countervailing laws and practice orientations underlying the purpose and delivery of mental health services today in an unequal relationship with Big Pharma.

Personally I doubt that DSM-V will make very much difference to the way I practice in the foreseeable future.

It is such issues as poverty, income maintenance, housing policies, human rights legislation and advocacy services which are the real drivers of change in the industry that employs me. The mental health trade is more like an intersection of winding lanes than a one way street I think.

The only rule of thumb in this global mind game is that things are very rarely what they seem to be at first sight.

In the trade this is called the 'presenting problem', a metaphor for an often complex web of life events leading up to a crisis situation.

I'm afraid that the presenting problem of the future of DSM-V is all I have the space for here right now, the public consultation has started in America for those US citizens interested enough in the subject to want to participate in the discourse.

It is your mind they are discussing after all.   

A Point of View.
      

Tags: psychiatry, crisis work, mental health, dsm-v, spychiatry

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