Madness Contested: An Outstanding Book

The book Madness Contested has recently been published by PCCS Books.  It’s a collection of articles, edited by Steven Coles, Sarah Keenan, and Bob Diamond.

The book is a remarkable piece of work.  It covers just about every contentious concept in the present “mental illness” debate, and brings to bear an abundance of new insights and up-to-date research findings.

There are 21 articles plus an introduction by the editors.

Here’s the name of each article with a brief quotation from each:

Introduction:

“We believe the dominant ideology in mental health services has restricted our collective and individual conceptualization, discourse and action regarding madness.”

1.  The Persistence of Medicalisation: Is the presentation of alternatives part of the problem?  Mary Boyle

“…the more we point out the explanatory emptiness of diagnoses, the more we encourage people to ask for and expect different kinds of explanation.” (p 19)

2.  Paranoia: Contested and contextualized.  John Cromby & Dave Harper

“We have suggested that intensely distressing episodes of paranoia should be seen as habits of felt thinking and action acquired in response to events in the social world.” (p 33)

3.  Meaning, Madness and Marginalisation.  Steven Coles

“Those who are eventually considered mad by society have suffered some form of marginalization and disempowerment in their trajectory to madness, either relationally, socially, materially, or culturally.” (p 43)

4.  From Constructive Engagement to Coerced Recovery.  Alastair Morgan & Anne Felton

“Organisational culture and a fear of being blamed is recognised as a barrier for staff to supporting individuals to take therapeutic risks…creating tensions for promoting risk taking and ultimately recovery.” (p 69)

5.  Mental Disorder and the Socio-ethical Challenge of Reasonableness.  David Pilgrim & Floris Tomasini

“Thus social contingencies and specific social norms define when unreasonableness is deemed to be pathological, is sometimes ignored, and sometimes even socially valued.” (p 85)

6.  The Pharmaceutical Industry and Mental Disorder.  Joan Busfield

“Whilst it can be argued that this widening of the boundaries of mental illness helps to enable those with mental health problems to get the treatment they may need, equally it can be argued that it facilitates the pathologisation of individuals, locating the problem within them, and helping to ensure that the social and environmental factors that often give rise to their mental states and behviour are largely ignored.” (p 107)

7.  Clinical Psychology in Psychiatric Services:  The magician’s assistant?  Steven Coles, Bob Diamond & Sarah Keenan

“One way of exposing some of the iatrogenic effects of the power imbalances and problematic practices within the psychiatric system is to provide a public space to openly debate such issues.” (p 117)

8.  Manifesto for a Social Materialist Psychology of Distress.  Midlands Psychology Group

 “Distress is not the consequence of inner flaws or weaknesses.” (p 123)

9.  Soteria:  Contexts, practice and philosophy.  Philip Thomas

 “The failure of technological psychiatry to improve the outcome for people who experience psychosis, the serious harm associated with the long-term use of neuroleptic medication, and at a fundamental level, the failure of science to explain madness, have resulted in a crisis in contemporary psychiatry.” (p 154)

10.  Recovery, Discovery and Revolution:  The work of Intervoice and the Hearing Voices Movement.  Eleanor Longden, Dirk Corstens & Jacqui Dillon

“The emergence of the service user/survivor movement in the 1980s and 1990s heralded a new level of protest against prevailing medical ideologies and the dehumanizing regimes of traditional psychiatric services.” (p 167)

11.  Experiential Knowledge and the Reconception of Madness.  Peter Beresford

“What can particularly help mental health service users/survivors to challenge existing psychiatric interpretations and develop their own viewpoints and ideas is getting together and working with others with shared experience.” (p 189)

 12.  Service User-led Research on Psychosis:  Marginalisation and the struggle for progression.  Jan Wallcraft

“The opinions and perspectives of those labeled psychotic have often been seen as globally lacking credibility and have been marginalized.” (p 198)

13.  The Patient’s Dilemma:  An analysis of users’ experiences of taking neuroleptic drugs.  Joanna Moncrieff, David Cohen & John Mason

“One respondent taking haloperidol explained that ‘I feel like a zombie.  I can’t think clear and my movement is slow’.” (p 219)

 14.  Speaking Out Against the Apartheid Approach to Our Minds.  Rufus May, Rebecca Smith, Sophie Ashton, Ivan Fontaine, Chris Rushworth & Pete Bull

“Over this time period I have discovered the process of trying to change psychiatry from within is flawed, because workers are too identified with interests of the corporate institution.” (p 235)

15.  Toxic Mental Environments and Other Psychology in the Real World Groups.  Guy Holmes

“Some come to feel that their life has been wasted.  One man who had been involved with psychiatric services for over 25 years said to me that the only point of his life seemed to be to provide work and therefore pleasure and meaning to staff who were paid to help him.” (p 259)

16.  Redressing the Balance of Power:  Psychiatric medication in Nottingham.  Nottingham Mind Medication Group

“Linking with others has helped to lift feelings of powerlessness and allowed us the opportunity to make social networks and gain social support.” (p 273)

 17.  Ordinary and Extraordinary People, Acting to Make a Difference.  Leicester Living with Psychiatric Mediation Group

“An important theme in our critical understanding of the world is power, and the structures within which it is withheld or asserted.  Language is one such structure and we want to draw attention to words that we find potentially problematic, words such as ‘patient,’ for example, are therefore put in quotation marks.” (p 278)

 18.  Peer Support.  Becky Shaw

“When I was in hospital I received all my help from the other patients and not from the staff which you might have expected.” (p 293)

 19.  A Critical Journey from Involvement to Emancipation:  A narrative account.  Theo Stickley

“There are opportunities to develop new models and approaches that go beyond involvement and that are genuinely emancipatory for people who use mental health services.” (p 313)

 20.  Rebuilding the House of Mental Health Services with Home Truths.  Bob Diamond

 “Clinical psychology must remain open to the critique that whilst it continues to work in this environment it props up the dominant oppressive psychiatric culture.” (p 329)

21.  A Beacon of Hope:  Alternative approaches to crisis – learning from Leeds Survivor Led Crisis Service.  Fiona Venner & Michelle Noad

“As an organization set up to be an alternative to psychiatric services we are fiercely opposed to the use of psychiatric diagnoses.  We pride ourselves on providing a non-medical approach to working with extreme mental distress.  Our philosophy is about being alongside people in crisis, not treating them.  We also believe passionately in the transformative and healing power of human connection.” (p 337)

 SUMMARY

I don’t normally write such lengthy book reviews.  This work, however, is simply outstanding.  If you have concerns about the mental health system, I strongly recommend that you buy it, read it, re-read it, and keep it close.  That’s what I’ll be doing.

DISCLOSURE

I have no financial ties to this book or to any of the books endorsed on this website.

 

  • cledwyn

    I read some of this book, but my interest palled the more I read on. The strange thing is, it is generally with the books not directly related to psychiatry which increase my interest in the subject, whereas most books directly critical of it dampen my enthusiasm, no doubt because I believe that ultimately it is the greatest minds in human history who, having as their subject the study of human nature and human society, furnish far more penetrating insights into the stupidity of psychiatry generally than those books directly critical of it written by minds of inferior talent, who nevertheless think, as is common in our age, that they are the recipients of an age when science is supposedly extending its frontiers ad infinitum and affording insights previously unavailable to the great minds of the past.

    I got pretty bored with this one.

    The article on paranoia was what really attracted me to the book, but I found it disappointing.

    The writer says that, “by paranoia we mean relating to others with mistrust, hostility, and suspicion.”

    A strange definition, given that it actually denotes not merely what the writer says but also that such mistrust, hostility, and suspicion is groundless.

    So, the author believes that this constitutes paranoia?

    Often, one man’s paranoia, is another man’s realism, whose cynicism and mistrust are a product of being able to see that life is a masquerade, a masked ball at which humans parade about in whatever costumes their desires and interests dictate and with which they conceal their true selves and motivations.

    The man who sees this as paranoia usually stands in the same relation to the man who acknowledges the other’s superior insight into the hypocrisy of the world as does the predator to its prey, in that the latter has purchased this insight through bitter personal experience as one who can count himself amongst the ranks of the world’s victims, whereas the former can usually count himself amongst the ranks of the world’s predators, who is so mired and complicit in injustice (which he must of necessity suppress self-awareness of lest otherwise cognisance of his own corruption summons forth the psychological demons that lie in wait for all men who perpetrate evil without self-deception) that, from his ignorant, delusional, and morally depraved perspective, any man who bears witness to and inveighs against the injustice and hypocrisy of the world, displaying a sensitivity to it conspicuously absent from he, then paranoid must he be!

    Or put another way, such a diagnosis is a crutch for those complicit in the world’s evil, and who have a personal investment in the perpetuation of its dominion, to beat victims of it around the head with, and to stop them spoiling the fun of those who wish to revel and luxuriate in Gomorrah’s intoxicating climes without disturbance.

    For this reason, one should beware of a man who dismisses others as paranoid and decries the cynicism, laid on the foundations of bitter experience whereon all true insight into the world rests, of others; he is usually a rascal of the first order, merely taking umbrage at having the blissful repose of his conscience disturbed; at having been reminded of the evil which reflects back to him, as if in a mirror, the disfigured image of his own nature; and at having the wings of his imagination clipped, which desires to be left at liberty to indulge in fantasy and illusion, ignorant of the evil that hitherto operated entirely below the threshold of his awareness.

    It’s no wonder that, given the foregoing, psychiatrists are so eager to dismiss their patients complaints as paranoid, given the Faustian pact they have made with Mephistopheles. They are all part of the same coalition, which accounts for almost the entirety of the human race, which has formed in confederacy against the man of justice, who stands alone against the barbaric hordes, examples of whose moral poverty is to be encountered everywhere in their rudeness; their lack of consideration; their love of making noise just for the sake of being ant-social; their tendency to stare at each others; their lack of taste; their schadenfreude; and their total lack of a sense of responsibility. For example, when someone jumped the queue ahead of me in HMV yesterday in the most unashamed, brazen manner possible, and I gave vent to my indignation, people looked at me as if I was mad, and in this world, alas, that’s exactly what you are to other people if you dare to be more intelligent or ethical than they; mad.

    Our fundamental disposition towards the world, whether it be hostile or friendly, is largely the point at which our experiences and moral character diverge. For example, if a man is comfortable in and friendly to the world, then it is because it is cut to his ignoble requirements, and he is content, like a swine in pigshit, to wallow in its depravity. People who are so constituted are accepting and trusting because they are content with a world no man with a sense of justice would be. On the other hand, hostility is often born of bad experience, and a desire for justice that is continually thwarted by a world in which virtue hides and vice thrives. This hostility, as can be seen amongst some of the more angry survivors of psychiatry and victims of other species of oppression, reaches an even higher pitch when vice dons the rhetorical garb of virtue, as is its wont, and which, when experienced in close proximity, such as in a psychiatric ward, sometimes spills over into violence against the agents of such bile-fermenting hypocrisy, so much does the Tartuffery of your average oppressor rub salt into the wounds they inflict.

    Cynicism about the motives of others is insurance against the betrayal and consequent pain that trust is the guarantor of.

    Nevertheless, the article isn’t too bad I suppose, but it doesn’t represent the radical departure from psychiatric orthodoxy I expected.

    Of course, none of this is to say that those of us who are particularly cynical and distrustful sometimes don’t err on the side of being too cynical and distrustful, but given the way the world is, it is better to err on this side than it is to err on the side of being too trustful.

  • The Right Hon. Cledwyn B’stard

    Both as an addendum to and qualification of what I wrote, I should say that, in the interests of balance, the article, which I just reread, made some very good points (it is usually those things that offend that impose themselves most forcefully upon our recollections of a thing).

    For example, the writer acknowledges that distrust and genuine paranoia do not emerge ex nihilo, nor do they exist in vacuo, but to some extent reflect the circumstances of an individual’s development, but they do not go far enough with this, in my opinion, and instead devote a disproportionate amount of space to the emotional underpinnings of paranoid and suspicious thought, and the notion that these habits of feeling and thought become a problem when they do not fit the situation in which they emerge.

    Of course, there is some truth in this. Even the most intelligent cynic, someone like a Schopenhauer, will sometimes err on the side of being too cynical, and the danger is then that a negative feedback loop is created between the individual and others, nevertheless these kinds of errors that such habits of thought and feeling can lead to do not lead us as further from the path of truth as those who repose too much faith and trust in people, who will err much more often, with disastrous consequences.

    In anticipation of possible criticism or disapproval of my cynicism, no doubt some people will dismiss my jaundiced view of human nature and society with the confidence and conviction inextricably bound up with opinions that come with the weight of popular and expert opinion behind them, and bear the imprimatur of culture and convention.

    To the optimism of such people one need only oppose the history of the human race, the fact that man is the only animal who tortures and torments others for the enjoyment of it, and the additional fact that man is such a predator to his fellow man, and comprised of such base appetites and instincts, that we need the state and its subsidiary institutions to impose a semblance of justice on society, given that justice and respect for the rights of others do not issue from the inner nature of the average man himself, who only respects force and power, hence the fashionable form of bully-worshiping in modern society, that is, the adulation of sports stars.

    One could also oppose to this the way people behave in crowds.

    Without these aforementioned institutions, and instead trusting to reason, ethics and man’s so-called innate goodness, society would soon descend into anarchy, and the civilized values we cherish would be displaced by the laws of the jungle.

    Recognition of this helps to demystify the paranoia and suspicion of some people, which, as I say, is the suspicion of the prey who feels the gaze of his predators trained upon him.

    The question should be, given what the average man is, given how many predators there are lurking in a man’s environment, why should he trust anyone?

    As Schopenhauer pointed out, cats understand this in their deep-rooted suspicion of humans, a suspicion that exhibits more insight and wisdom than is to be found in all the heads of the optimists.

    The only thing that keeps man’s inner demons at bay is force, not his capacity for reason, not his innate goodness, and not his so-called sense of justice. This is why I am opposed to anarchy, because without law and order, and the judicious use of force (but certainly not psychiatric force), the strong would merely devour the weak.

    True, the upholding of civilized values cannot eradicate the baseness of human nature, it can only force it underground, from where it seeks means of expressing itself through culturally accepted and surreptitious channels, or by cloaking itself in myth and rhetoric.

    The examples of this are numerous. Attacking an opponent with a psychiatric diagnosis is one means through which man’s baser instincts, and his malice and spite, express themselves through surreptitious and deceptive channels.

    In civilized society, the depravity of human nature has to don various masks if it is to escape scrutiny and punishment, but this certainly doesn’t deter it. Intolerance, the desire to persecute heretics, and to control others, for example, conceal themselves behind the prevailing morals, values and standards of the age, as can be seen with political correctness, the fashionable form of censorship called internet moderation, and, of course, forced psychiatry.

    Self-interest hides behind altruism. Oppression behind humanitarianism.

    The only thing that really stays a man’s hand in his conflicts with others is awareness of the presence of a system of law and order, otherwise people would be killing each other left, right and center, because conflict stirs up a diabolical concoction of instincts, passions and appetites that only the threat of force can contain.

  • zabelisa

    But people are killing each other right left front and center… why can’t you see that? Even with that structure in place, the legal system does not prevent harm, it enables it. Especially when you look at how much power corporations and banks have. The silent killer is stress, where do you think that comes from? People can no longer manage their own lives because we live in a broken society where nothing makes sense. We live in an era of the nanny state and the nanny in the sky – go figure. People have given up on their freedoms in order to be protected. Of what I am not sure. From what I can tell so far is that the people in power create problems and then come back with their solutions claiming it is for the greater good, for our protection or that it is good fro the economy. I doubt we’ll ever see any improvement in my life time unless a great number of us wake up and decides that it is enough instead of going along wit the program.

  • cledwyn bulbs

    To understand the term “madness”, and all the synonyms thereof, it helps to look at when and wherefore it is used. One obvious reason for its usage is when between the normative principles, as concerns the rational behaviour of a society, and the behaviour of the individual, there is a lack of correspondence, inflexible, as men are, in the conviction that the conventions of their society are founded on the firm ground of reason, and thus accordingly that any deviation therefrom constitutes an aberration attributable to the work of unreason.

    Despite the frailty of our knowledge, men tend to possess a disproportionately large amount of faith in the infallibility thereof, leading to the lack of sceptical distance between men and their ways, customs and conventions required if men are to judge them correctly, and wherein the source of so much error and injustice is to be found.

    The average man uses as the touchstone for ascertaining the reasonableness of a behavior or a belief the degree of its alignment with his own.

    Another reason for the word’s currency in human society is its immense serviceability in our conflicts with others, the use to which it can be put as a rhetorical device by which we can calumniate and discredit an opponent, one which shares in the advantage of which ultimately all insults partake; to wit, that even the most vacant head can avail himself of them, because the use of the brain (the space vacated by the departure of which from the head of such individuals allowing all sorts of inanities to take up residence there) is by no means required to insult an opponent (not literally of course), hence the reason why it prevails in popular debate.

    To locate the origin of the foregoing usages, a historian or anthropologist whose learning commands a much wider view of the entire span of human culture and history than that which I could furnish is required, but given that one finds abundant usage of these terms in the works of Shakespeare (wherein consists perhaps some of the most trenchant, insightful observations of human nature and society) for the very purposes whose general features I have endeavored to enumerate, elucidate, and elaborate upon in the foregoing paragraphs, it can safely be said that this is a tradition whose roots extend into the remote past.

    The play, “Timon of Athens”, is illustrative in this regards. It is basically a journey into the heart of cynicism and misanthropy, though inflected by the Bard’s nobility of soul and human warmth.

    The titular hero finds himself surrounded by “glass-faced” flatterers (so-called because, in trying to inveigle themselves into the favour of Timon, whence they can empty his coffers, they reflect back to him, as if in a mirror, his own moods and opinions to this end) whose charity goes unreciprocated when he is in need of its requital by the parasites arrayed against him who purport to be his friends and who abandon him at the first whisper of adversity.

    Thereupon he resolves upon a vengeful course of action, inviting his erstwhile flatterers to a banquet at which he serves them only with water and exposes their villainy. With this done, he thenceforth repudiates the company of his fellows.

    Apart from its insight into the worldly cynicism its protagonist epitomizes, and the sense of betrayal and abandonment of which it is born, the play also affords insight into the service into which the lexicon of lunacy is traditionally pressed, which I will discuss in my next post, time permitting me to go no further at the present moment.

  • cledwyn goodpuddings

    Continuing where I left off, when the protagonist avenges himself on his false-friends who have rewarded his charity with betrayal, they accuse him of madness.

    His vengeance is a protestation against the injustice of humanity, and few things expose one to the particular species I discourse upon herein than to confront a perpetrator of some act of evil or injustice with evidence of his wrongdoing, because few things incline a man towards the usage of said calumny as being so confronted. This is what Shakespeare satirizes in plays like Timon and Hamlet, whose eponymous protagonists are the most infused with their creator’s own genius and intelligence, yet who are dismissed as mad by those around them.

    Blinded by their self-love and self-interest to the particulars of their characters wherein resides their moral turpitude, his erstwhile flatterers resort to the tradition-honored expedient of dismissing Timon as mad, absolving themselves thereby of any responsibility for his distress and allaying any subconscious stirrings of guilt.

    The play beautifully sheds light on the injustice to which the term lends itself. Timon is tarred with the mad-brush precisely because he is the bearer of truths inconvenient to a world with a vested interest in their suppression.

    This is also satirized and dramatized in “Hamlet”. In the play, the world-weary protagonist seeks vengeance upon the murderer of his father. Although he observes the conventions of madness the better to achieve his purpose, even when he affects this “antic disposition”, it is through him that the truth is spoken, not those who rest secure in the knowledge that he is mad.

    Both his observance of said conventions and his natural behavior elicit accusations of madness from those around him who, consistent with what I have been saying, either think him crazy out of ignorance or out of strategy.

    Coming back to Timon, the explaining away of a person’s distress and anger, with a world that is an ever-replenishing source thereof, on the presumption of madness, is beautifully laid bare in a scene in “Timon of Athens” where Alcibiades, though sympathetic towards the eponymous protagonist, responds to Timon’s rage, out of ignorance of its springs no doubt, saying, “pardon, sweet Timandra, for his wits are drowned and lost in his calamities”,

    Here, the lack of correspondence between the worldview of Alcibiades and Timon leads the former to assume madness in the latter. What Shakespeare couldn’t have foreseen was the birth and rise of an institution that would literally institutionalize this error of presuming the existence of madness in a person just because of this lack of correspondence of which I write, an error I would surmise whose roots are to be found in the pervasive assumption of the possession of a degree of knowledge greatly disproportionate to the meagre measure we actually possess. To borrow from Hamlet, there are more things in heaven and earth than are to be found in our worldview.

  • cledwyn

    That should be “particular species OF CALUMNY I discourse upon herein…”