Angel With A Shotgun

I want to start by acknowledging the emotive and controversial nature of some of my recent postings, both here and via Facebook/Twitter.  I have attracted some criticism and resistance, which I fully expect as it goes hand in hand with having strong and somewhat less-than-conventional views & opinions.  It is true that I sometimes speak in extremes, present things as more black & white than they really are, and make bold statements.  This is because I so strongly feel there are things that need to change radically, and this won’t happen if the status quo isn’t challenged fervently and compellingly.  This is why I write in an emotive and zealous style: my aim is to inspire positive change and innovation, or at least persuade people to think a little differently about certain things. 

The result recently has been what might best be described as an attack on psychiatry in my writing, elements of which may come across as vindictive (or indeed false) to some readers.  I accept this fully, but have no real qualms in light of what I’ve just explained.  I will listen to anyone who has something to say on the matters I write about, which is why I’m always so keen to invite comments on my posts!  I know there are many different perspectives on the things I discuss, and that it would be possible to present more balanced accounts than the ones I offer.  This is not least because the very issues I am passionate about are particularly complex and sensitive ones. 

Most poignantly, I have recently experienced criticism for making the bold claim that, essentially, there is no such thing as mental illness.  I realise now it was unwise to make such a statement in isolation as there is a hell of a lot behind it and it sounds incredibly insensitive (This said, all it takes is a look at a text such as The Myth of Mental Illness by Thomas Szasz or Cracked: Why Psychiatry is Doing More Harm Than Good by James Davies to see where this point comes from).  The post in question was a Tweet reading: “So... If #mentalillness was actually a thing, it wouldn't be called 'mental illness'.  It would just be called 'illness'... #foodforthought”.  The abruptness of this claim was mainly because of Twitter’s less-than-generous character limit for Tweets, but also partially because I indeed intended to make a bit of an unconventional statement to get people thinking. 

What I have to stress, first and foremost, is that this does not mean I don’t see mental health as important, or believe that people in mental distress are in desperate need of help, or that their difficulties aren’t genuine; in fact, these things could not be more opposite from the truth.  I simply see mental health in a different light to the conventional medical one, which unfortunately results in a bit of alienation from my field of work, since the accepted approach is largely medical.  I advocate non-medical approaches, which are seen as dangerous and unsupported by evidence by some of my colleagues.

I have to say that I absolutely, whole-heartedly support the notion of evidence based practice.  Who wouldn’t?  To base care on knowledge of what does and does not work is the obvious way forward.  However, inasmuch as one might criticise ignorance of elements of the evidence base, it is equally negligent to take such evidence at face value.  We should be especially concerned with the presence of ‘publication bias’, which is more prominent in some fields than others, psychiatry and pharmacology included.  Publication bias occurs when those who review a research paper for publication may be keen for a positive result to make the journal more readable, or prefer papers that match their own views & findings, and so on.  It also occurs when researches manipulate their data or change their original research protocol retrospectively to make their hypothesis supported, when their original tests did not achieve this.  

 

There is considerable evidence for the existence of publication bias and this has been shown, for instance, to inflate the efficacy of psychiatric drugs and diminish  their harmful effects.  It has also led to evidence of completely non-medical and very successful approaches to psychosis being hidden.  In case you’re interested, I am taking my facts here from peer-reviewed sources!

If we couple this with the incredibly unscientific basis upon which the diagnostic criteria for mental illness are put together, we have two of the key reasons I largely reject the biomedical model of mental illness.  This post isn’t the place to go into detail about diagnosis (see my post Freedom, and more to come in the future), but I’ll say this small piece for context:  Whereas physical illnesses are discovered by the presence of some sort of physical marker, for the vast, vast majority of mental illnesses, such physical markers are absent and the diagnostic criteria declared by psychiatrists, albeit based on well-founded patterns observed in behaviour, etc. 

The above is why I suggest ‘mental illness is not really a thing’.  As soon as a clear-cut biological cause is discovered for a mental illness, it becomes a physical illness.  In other cases, the ‘illness’ gest removed from the repertoire of psychiatry (homosexuality as a prime example).  Hence, there is no need for the distinction.  Mental distress is a different thing to illness.  It is caused by a combination of many things, such as trauma, environment, socio-economic factors, and perhaps elements of biology.  But the lack of distinct biological markers makes mental illness clearly separate from physical illness. 

For these reasons, I feel psychiatry has gone too far in its medicalisation of mental distress, which is why I am fighting hard for a move towards less medical approaches.  I do not see it as any less important to support and help people with mental health difficulties than any of my colleagues do.  In fact, it couldn’t be more important to me.  Allow me to use some lyrics to illustrate:

They say before you start a war

You’d better know what you’re fighting for

…

I’m an angel with a shotgun

Fighting till the war’s won

I don’t care if Heaven won’t take me back

…

Sometimes to win

You’ve got to sin

Don’t mean I’m not a believer

My motives and intentions are good and pure; I know what I’m fighting for and I know it’s right.  Why would I open myself to criticism, even the possibility of resentment, from people I admire, like and respect if this weren’t the case?  It’s tough, even heart-breaking, to experience this, but I cannot be acquiescent; I absolutely have to do all I can to make things better.  This means perhaps sinning against my own profession, but I do this in the knowledge that what I’m doing is good… a bit like an angel with a shotgun! (Except I’m not big-headed enough to describe myself as an angel!)

It is difficult to explain all this in a way that’s concise and means people will get where I’m coming from, but I hope I’ve gone some way to making my position and the motives behind my actions clear.  I would love to hear from you whether you agree with my outlook or not, and look forward to lots of productive work, debates and discussions with colleagues, friends and new acquaintances in the coming months and years.