Diagnosis
and
Treatment
When dealing with the question of madness or mental illness, no binary between thought/action or idea/practice can exist: every attempt to identify, deal with, or solve a problem of mental health is already grounded in a normative and theoretical framework. Efforts to immediately "deal with the practical issues" of madness or mental illness seek to bypass the unspoken essentials: because the problem of madness is tied to deviation from a norm, one cannot talk about it or even begin to act without reference to a norm. Where do such norms typically come from? If we do not possess the means to resist their naturalization, we cede ground to some iteration of the dominant norms of our time. For those of us who live in the United States, normal is by-and-large measured against typified versions of an atomized, white, able-bodied, morally-upright, and property-owning or working male citizen.
To date, there is no universally accepted method of establishing the presence of a mental disorder, nor is there solid consensus around their boundaries, definitions, or status as pathology. Fads emerge and recede every year. Today, some Western psychiatrists and neurologists are even arguing that schizophrenia, the most consistent and clear example of mental illness for the last 150 years, should be scrapped or altered as it already has been in Korea and Japan. Fluidity and change is not unique to psychiatry in medicine. However, receiving a label can result in one's freedom of movement, choice, and civilian status being revoked. This is why self-advocates in the psychiatric survivor movement like Judi Chamberlain have held that mental illness is not "an illness like any other." Unlike routine treatments for the common cold, even a voluntary hospital admission for mental illness can turn into an involuntary commitment. Psychiatric diagnosis is not a simple fact about a person, but something to be embraced or contested, that is to say, a site of struggle.
Bibliography and Resources to Learn More
Recommended books
o Three Hundred Years of Psychiatry, 1535-1860: A History Presented in Selected English Texts. Edited by Richard Hunter and Ida Macalpine.
o Hussein Abdilahi Bulhan. Frantz Fanon and the Psychology of Oppression.
o China Mills. Decolonizing Global Mental Health: The Psychiatrization of the Majority World.
o Suman Fernando. Mental Health, Race and Culture.
o Jonathan Metzl. The Protest Psychosis: How Schizophrenia Became a Black Disease.
o Outside Mental Health. Edited by Will Hall.
o Gary Greenberg. The Book of Woe.
o Anna Kavan. Asylum Piece/I am Lazarus.
o Han Kang. The Vegetarian.
Articles, sites, guides
o Sasha Durakov Warren. Mental Health, Madness, and Psychiatry Study Guide, 2nd Edition. Units 1-5.
o Mad in America.
o Asylum Magazine
o Antoine S. Johnson, Elise A. Mitchell, Ayah Nuriddin. Syllabus: A History of Anti-Black Racism in Medicine
o Vanessa Jackson. "Separate and Unequal: The Legacy of Racially Segregated Psychiatric Hospitals."
o The Eugenics Archive.
o Disability History Museum. Psychiatric Disability.
o Hearing Voices USA.
o Madness Radio Podcast.
o Gary Greenburg. "Inside the Battle to Define Mental Illness."
Treatment recommendations differ in the extreme, nor are there agreed upon metrics for when they "work." The same diagnosis could elicit talk therapy, ECT, and a prescription drug. One can surely say when they feel better, calmer, or happier (and therefore bear a different relationship to the field), but how does one know for sure when they are "normal"? Generally, this is taken to mean that symptom expression has decreased, but this is fraught. Has one's madness or "illness" actually changed, or just one's relationship to specific attributes and characteristics? Is a treatment deemed a success when the person afflicted feels it was or only when their presence becomes tolerable to those around them? Contending directives give rise to polarized uses of the same treatment, and therefore different outcomes. Erving Goffman's contention that "If the mental hospitals in a given region were emptied and closed down today, tomorrow relatives, police, and judges would raise a clamor for new ones; and these true clients of the mental hospital would demand an institution to satisfy their needs" forces us to ask how and when treatment is said to "work." What approaches arose in the wake of the asylum to satisfy the needs of the "true clients" of the asylums?
It is a commonplace to many today that the asylums were not places of healing, but zones for disappearing and segregating people, and yet their original proponents thought such segregation was in itself therapeutic. While antipsychotics are now reflexive treatment for psychosis, they were originally lauded as a way to quell disruption on the wards. Their name is a misnomer: they were not developed and invested in because they corrected the apparently faulty brain chemistry that causes psychosis; they tranquilized. Today, they used most widely in prisons, nursing homes, and on "troublesome" (though non-psychotic) children. Speaking generally, mainstream psychiatry has oscillated between a pessimistic and an optimistic outlook on treatment for centuries. Innovative treatments of the past (water treatments, shock therapy) were once thought to help reduce suffering for the mad person, but each, in times of overcrowding or symptom management, has also been used to tranquilize and punish the unruly; managerial tools (drugs) of the past have become therapies. The history of psychiatric diagnostics and treatments is anarchic. The question of when a treatment is said to "work" and for whom remains open. "No one knows" is the answer to the question of madness, forcing the concerned to openly and critically take up these questions as their common lot with humility and rigor.