Diagnosis

and

Treatment

When discussing political questions, some writers, activists, and pundits on the left continue to operate within a thought-action binary, propagating some version of the idea that "there is a time for theory, and a time for action." When dealing with the question of madness or "mental illness," no such binary exists: every attempt to identify, deal with, or solve a problem of mental health is simultaneously a normative and theoretical decision. Efforts to immediately "deal with the practical issues" of madness or mental illness bypass the essential: 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. If we do not resist their naturalization at all times, 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 the atomized, white, able-bodied, morally-upright, and working male citizen. 

To date, there is no universally accepted method of establishing the presence of a mental disorder, nor is there any consensus around their boundaries, definitions, or status as pathology. Fads emerge and recede every year. What happened, after all, to all the "idiots," the "hysterics," and "monomaniacs?" 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 as it already has been in Korea and Japan.  Even though they are so fluid and transitory, 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. Direct force aside, a diagnosis alone is destructive of alternative (and especially threatening) epistemologies: Nat Turner, for instance, could today have been diagnosed as psychotic, since we know he could not have received prophesies foretelling revolt, instead he must have had excessive dopaminergic activity. This is not a fully hypothetical example as the revolting enslaved and abolitionists were deemed insane by the psychiatric establishment. 

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.
China Mills. Decolonizing Global Mental Health: The Psychiatrization of the Majority World.
o Suman Fernando. Mental Health, Race and Culture.
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 Robert Whitaker. Mad in America.
Han Kang. The Vegetarian.

Treatment recommendations differ in the extreme, nor are there any real metrics for when they "work." The same diagnosis could elicit talk therapy, ECT, and a prescription drug. 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? Even within the limited bounds of symptom management, it is not possible to say that modern drug treatments have been successful: they rarely perform better than placebos and they have long-term destructive effects on the body. Is a treatment deemed a success when the afflicted feels it was or only when their presence becomes tolerable to those around them? 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?

A more concrete lens looks less at whether the treatments "performed well" (as this is not a standardized or simple metric) and more at what they were intended to do and their immediate effects. It is clear to us today that the asylums were not places of healing, but zones for disappearing and segregating people, but 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 correct the apparently faulty brain chemistry that causes psychosis; they tranquilize. 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. When does a treatment "work" and for whom?

Get in Touch