Friday, 29 May 2015

A Debate in the Huffington Post

I have not kept up this blog very regularly over the last year or two.  Sometimes I feel I have said all I need to say on the subject of mental health, and that by continuing to delve into it I am not doing myself any favours.  An example - during the last few days I have made a few comments on the Canadian Huffington Post, under an article which bemoans the state of 'mental illness literacy'.  The last thing I wrote was in reply to someone who said that I am dangerously trying to persuade people to stop taking their medication, and that 'mentally ill' patients need their drugs in the same way as a diabetic needs insulin. 

I replied that I am not trying to persuade anyone to do anything but that I do believe people should have a choice about their treatment.  The science just does not support the link between psychotropic medication and insulin.  I was once told that I needed my meds like a diabetic needed insulin and I have been free of them for more than fourteen years now without ill effects.

I also said in my comment that I think anyone who is violent should be treated in the criminal justice system and not in the mental health system, regardless of their state of mind.  I am sure that will upset people so I just wanted to explain my thinking here.  (I actually started to write this blog post yesterday but held off from publishing it because I didn't want to upset anyone.  Then I read a comment on another Huff Post piece by Toby Chapman which propounded the same point of view regarding prison v hospital, and which gave me strength).

I understand that people whose loved one has committed an atrocity while psychotic will be convinced that the person could not have behaved in that way while they were in their right mind.  However, in my opinion, it is the fact that the mental health system has become tangled up with the criminal justice system that has caused a lot of the stigma around mental illness, especially schizophrenia. 

If someone commits a crime, as Toby Chapman said, the matter of why they did it is irrelevant - it is how we respond that matters.  The purposes of prison, as I recall from the law degree I took about a hundred years ago, are punishment, retribution and rehabilitation.  Which purpose is uppermost in individual cases, and how the prisoner should be dealt with in prison, depends on the particular circumstances.  Judges are very good at whittling out the facts and dealing with people appropriately. 

I suppose the idea that somebody shouldn't be punished if they are mentally ill makes sense in some ways.  However, many people are mentally ill and are not violent - they shouldn't be treated in the same place as those who are.  It just causes confusion and leads to institutional abuse in hospitals.  People are treated with force when they shouldn't be and this negatively affects their chances of recovery.  Also, the whole 'mental illness' thing is open to discussion and debate - what exactly is mental illness?  How do we define it?  I read a bit about this when I did a Psychology A level recently - it's an interesting subject. 

Only yesterday I saw a small piece in The Times which said that a schizophrenic had been detained indefinitely under the Mental Health Act.  He had stabbed a prostitute in the neck.  The treating psychiatrist said that the man was responding slowly to treatment but that he was worried about a relapse.  He was sent to a medium secure hospital. 

The thing is, in that hospital there will be a lot of other people being treated who have not committed crimes, some of whom have been diagnosed with schizophrenia.  Leaving aside the fact that such diagnosis is a subjective matter, based on observation of behaviour not, as is thought by many people, a scientific process, it is easy to see how stigma developed and is being fed.  (It also concerns me that violent people are only treated in medium secure facilities - surely the public need to be better protected from people like this?  And if the 'schizophrenic' guy does recover, he can be paroled, only if all the necessary safeguards are in place, and only after he has been punished for what he did and rehabilitated, under the same criteria that are used for all criminals).

I know it might seem unfair to imprison a person who acted out of character when they were psychotic.  However, many people are psychotic and do not commit crimes.  Some of these people are provoked by their treatment in hospital - if you have ever seen someone being forcibly medicated, or experienced it yourself, you will know what I mean. 

Also, I met a woman once whose son had been treated in prison and in hospital and she said prison was much more humane.  I trust the criminal justice system to do the right thing by people - the mental hospitals mete out their own version of justice and there is too much opportunity for abuse. 

I have been thinking of returning to study recently. It has occurred to me that a relevant subject for a thesis might be how people who have not committed crimes are deprived of their liberty in mental hospitals, outside the judicial process and outside any proper legal review.  I have long thought that this is a human rights issue.  At the same time I could research how the law could be changed so that all criminals are treated the same, not differently because they are 'mentally ill'.  'Mental illness' is easy to feign and easy to conceal.  It is such a nebulous concept.  (As was shown by the famous experiment in which a group of professional people feigned symptoms and were duly incarcerated in hospitals but then were not released when they said they felt better.  I would look up the name of this experiment, but I don't want to be writing this for too much longer.  Was it Laing who masterminded it?  I am sure lots of you out there will know!)  

I don't know if I have the stomach for all this though.  I have just spent an hour or so re-writing this and replying to other people on that original Huff Post piece, then reading and responding to another one by the same author.  It seems to me that too many people refuse to see the other side of the argument when it comes to mental health issues.  I have read a lot of literature on this subject and come to my own conclusions, but other people will have had their own experiences and will never agree with my point of view, however I put it. 

In some ways it seems to be a waste of my time - although actually I have enjoyed the intellectual side of the debate.  Also, because I have had to sit at the kitchen table with my laptop, there has been a lot of interaction with the kids during this hour - my younger daughter has come in with her revision and her music and she has been playing me clips of Pitch Fever 2, which she saw at the cinema the other day with friends.  Her company has made me laugh and distracted me from the nastier comments online (some people get personal about all this, it would be better if we could all discuss things civilly and kindly).   

I do think that the mental health system and its interface with the law needs a huge shake up and that I would be well-placed to do some proper academic research on the subject.  I have been reading some academic papers and books over the last week and I had forgotten how much I enjoy thinking and writing about legal matters.  It has been a long, long time since I took my degree (although not quite a hundred years) and I am surprised that some of it is slowly drifting back to me.

So what do you think, everyone?  Do I go back to study?  Might I be able to make a difference?  Or should I just keep battling on with the fiction (I must have started ten novels in the last few months, haven't finished any of them, but maybe, you know, one day...?)

All advice gratefully considered.       


  1. Great post, Louise, about a subject close to my heart. The MHA represents legalised discrimination, and I'm also a strong advocate of your viewpoint that everyone should be prosecuted if a crime has been committed, irrespective of mental health problems - I too trust the Courts to take into consideration all mitigating circumstances. Regarding the other side of the coin, no person with mental health problems and capacity to make their own decisions should face compulsory detention if they have committed no crime.

    As far as where you channel your writing energies, does it have to be an either-or? I'm enjoying your book (I'm up to p179) and I'm confident you'd be an asset should you use your law degree to challenge the current fundamental injustices around the MHA.

  2. Hi Gary. It's certainly an interesting subject, I agree re compulsory detention. Unfortunately, capacity is a difficult thing to prove or disprove, once you are in hospital. Even now, I sometimes think that once people know I have a diagnosis, they hear everything I say through a 'mad filter'. Thanks for your input, I'll see how things go and keep everyone posted (I seem to change my mind about my career every other day at the moment, but yes, hopefully I can juggle a few things!)

  3. Sometimes the antipsychotic drugs can turn a patient violent. Clozapine is one of them. My niece had never been violent until she was put on clozapine. She attacked then her mother with a knife. I don't consider her a criminal. Although her mother had made her life a misery for years, she was never violent towards her until she was put on Clozapine. Luckily a friend restrained her. It makes you wonder though who is really to blame in this case.

  4. Yes, the anti-psychotic drugs can have horrible effects. Also, the way people are treated in mental hospitals can be de-humanising and cause them to react violently. Being forcibly medicated is absolutely brutal, there is no question in my mind about that, and it is so often done unnecessarily. I am pleased that your niece did not commit a crime - but I do believe that if she had done, and was then treated in the criminal justice system she would receive justice. People treated in the mental health system are so often victims of injustice - the power in mental hospitals lies in the wrong hands. The mental health system is such a muddle - so many people flounder unnecessarily and it is all so sad.