May 10, 2007

Why We Are So Obsessed With Culpability vs. Mental Illness


As the thesis of this blog states: psychiatry is politics. 

I'd like to offer an idea for consideration.

The reason there's so much give and take about whether Cho was ill or not, and whether he was culpable or not, has to do with what psychiatry actually is: the pressure valve of society.

Our society does not have a good mechanism for dealing with poverty, frustration, and anger.  I'm not judging it, I'm not a left wing nut, I'm simply stating a fact; ours is not a custodial society, and it does little to "take care of" (different than help) these people.

So it has psychiatry, it fosters psychiatry, and it creates a psychiatric model in which these SOCIAL ills can be contained.

The inner city mom who smokes daily marijuana to unwind, with three kids who are disruptive, chaotic in school, etc-- society has really nothing to offer her.  But it can't let her fester, because eventually there will be a full scale revolution.  So it funnels her and her kids and everyone else like her into psychiatry.

Whether she "actually" has "mental illness" or not is besides the point.  Without the infrastructure of psychiatry, hers would be an exclusively social problem with no solution.  But with the infrastructure of society, her problem is no longer a social problem, and no longer the purview of the government (or fellow man, etc)--it is a medical problem.

Consider that one of the fastest ways for this woman to get welfare-- and ultimately social security-- is for her to go through psychiatry. 

So, too, the angry, the violent, the frustrated... 

Hence, discussions about whether mental illness reduces culpability are red herrings. It's about reducing culpability, it's about reducing society's obligation to deal with it.

Society is basically saying this (I'll quote myself):

...if they're poor or unintelligent, we will never be able to alter their chaotic environment, increase their insight or improve their judgment.    However, such massive societal failure can not be confronted head on;  we must leave them with the illusion that behavior is not entirely under volitional control; that their circumstances are independent of their will; that their inability to progress, and our inability to help them isn't their (or our) fault; that all men are not created equal.  Because without the buffer psychiatry offers, they will demand communism.



Your troubling assessment i... (Below threshold)

May 10, 2007 4:09 PM | Posted by Jason Thompson: | Reply

Your troubling assessment is astute. Psychiatry has become the lens through which the United States views its societal shadow, as if the locus of the nation's problems can only ever be considered in terms of the individual.

A case in point: last year, I was discussing the future of the DSM with Carl Bell, a psychiatrist at the University of Chicago at Illinois, who seriously entertains the idea that racism could be classified as a mental illness. Similarly, I note in a 2005 article in the Washington Post that doctors in the California correctional system have "treated" racism in some prisoners as symptomatic of a "delusional disorder" and prescribed anti-psychotic medication with some purported impact on the racist behavior.

The ironic subtext of this reflexive psychopathologizing is that the real delusion at work here lies less in the patient's brain than the doctor's dogmatic insistence on a medical solution to sociological problems. It's almost as if, during the Great Depression, psychiatrists decided to treat the starving jobless masses on the streets for a psychotic work aversion.

Admin's response: though how could a person/patient think otherwise, when all of medicine is telling him that it is entirely a medical problem? And treating "racism" is not even the most preposterous example. consider that identifying an inmate as mentally ill is the primary means of delaying their trial in an already overbooked court system. Right to a speedy trial guaranteed by the Constitution? Well, uh, maybe... oh yeah, he's not competent to stand trial... commit for 60 days, then re-evaluate...

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I demand a true democracy.<... (Below threshold)

May 10, 2007 4:33 PM | Posted by Alison: | Reply

I demand a true democracy.

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LOL I was with you there un... (Below threshold)

May 10, 2007 9:36 PM | Posted by D Cootey: | Reply

LOL I was with you there until the end.

In my experience when dealing with mental illness and culpability on my blog, I have found that there are many people only too happy to be told that their disfunction is not their fault. They dutifully ingest pharmaceutical cocktails prescribed by professionals, complain about the side-effects, continue on with their lives, but never improve.

However, I have also encountered countless others who understand that they as individuals have more control over their lives, emotions, and disfunctions than is popularly believed. They roll up their sleeves and get to work fixing their lives. Some need medication, some don't. But all have very positive attitudes.

I wish I knew how to reach the others who live as victims. Telling people they are culpable is not a very popular message and my blog would be more popular if I didn't pound that point so often, but I believe that culpability empowers us. This flies in the face of a society which needs to believe these people can't help themselves.

Great post. Very insightful. I don't see the Communist angle, however. Perhaps I'm just not used to your sense of humor yet. ;)

Douglas Cootey
The Splintered Mind

Admin's response: Give it time. I see communism everywhere.

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It took me 20 years in the ... (Below threshold)

May 12, 2007 10:47 AM | Posted by Gianna Kali: | Reply

It took me 20 years in the psychiatric system to finally free myself of the delusion that I was a victim. That delusion was imposed upon me by psychiatry and society at large.

I am now freeing myself from psychiatry and my opinions aren't popular either.

And I dare to believe now that I am certainly no victim. I make choices and I thus create my reality. Empowered choices bring an empowered life.

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"Whether she "actually" has... (Below threshold)

May 15, 2007 9:10 AM | Posted by Ardem: | Reply

"Whether she "actually" has "mental illness" or not is besides the point. Without the infrastructure of psychiatry, hers would be an exclusively social problem with no solution. But with the infrastructure of society, her problem is no longer a social problem, and no longer the purview of the government (or fellow man, etc)--it is a medical problem."

It is either viewed as medical problem, or a moral one, or some bizarre and usually self-serving amalgam of the two.

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This is exactly why America... (Below threshold)

May 15, 2007 5:20 PM | Posted by Rich Hudson: | Reply

This is exactly why America's ruling class is so fond of religion: it's a cost-free alternative to psychiatry and communism. When politicians say, "Vote for me because I believe in your god" what they're really saying, on behalf of the ruling class, is, "Redistribution of wealth? Who needs it! The world's going to end soon anyway, and we the faithful will be rewarded with eternal heavenly bliss--so stop eyeballing my piles of gold."

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Brilliant. Hits the nail on... (Below threshold)

July 14, 2007 9:51 AM | Posted by Jason Boyd: | Reply

Brilliant. Hits the nail on the head. I'm a survivor of the system, and have tried (naively) to articulate exactly these points to both practitioners and other "consumers" of psychiatry, to no avail. The net effect of such heresy, ironically, is that I am consistently labeled crazy.

The idea that mental illness itself is a breakdown of normal human functioning under the increasingly abnormal and unhealthy dynamics of society is apparently much harder for most people to swallow than a lot of pills with scant real scientific evidence as to what they are doing, to what underlying systems, and why. In addition to my resentment and anger at having been chemically controlled and sedated while being fed a lie for years (which I always fought against) that I was not in fact culpable for or even fully in control of my own actions, I have been angered by the lack of science and inquiry of the drug-peddlers. *Why* would genes that make people far less functional, less likely to produce viable offspring, and a general drain on the resources of society be increasingly prevalent? If we're treating chemical imbalances, why aren't we spending far more money understanding what causes the imbalances and what those chemicals and pathways are normally regulating in healthy individuals? Why do we allow Big Pharma propoganda to marginalize and silence research showing better outcomes for mental illness in countries that favor integration into community of the ill and do not prescribe experimental drugs? How is it that society is so invested in believing the myth and supporting the pressure valve, sweeping the products of societal decay under the carpet and into the prisons, that it is unable to connect the dots and see how the growing cost of Big Pharma coupled with the systematic disconnecting of people at younger and younger ages from any concept of personal responsibility is ultimately corrupting the fabric of society and spiraling the cost of legitimate health care out of reach for more and more people?

I sound like a crazy person, don't I?

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