Kitty Holland wrote in The Irish Times this week about the case of a girl, pregnant and suicidal, who was detained under the Mental Health Act after her psychiatrist ruled out the abortion the girl wanted. Many would argue that a suicidal child should not be put through the physical and emotional stresses of pregnancy, which tax fully grown women who are pregnant by choice.
A termination may not “fix” a mental illness, but an unwanted pregnancy, with its hormonal fluctuations and sense of one’s body being invaded and future decided, can certainly worsen one.
The girl thought she was going to Dublin to get help in the form of a termination. Instead, she was sectioned – imprisoned in a psychiatric facility. Due to luck and good practice of the District Court judge in the case, the girl was appointed a guardian ad litem (despite the fact this wasn't mandated), who had the child assessed by a second psychiatrist who judged there was no evidence the girl suffered from a mental health disorder. She was subsequently released.
I remember holding her hand as she screamed that the roof was falling in on top of us.
This incident highlights several worrisome issues, but perhaps the least discussed is the conspicuous nature of psychiatry, and definitions of mental illness in general.
My grandmother was sectioned when I was about 16 , though it was with family support. She had become psychotic after a lifetime of very severe depression. As a child, I both pitied and feared her.
Her malaise would quickly turn to aggression if you weren’t extremely careful, and she was often abusive. This time, however, was different. I remember holding her hand as she screamed that the roof was falling in on top of us. I tried to comfort her, knowing that I could not say anything to convince her she was wrong.
A brain illness is not the same as a mental illness
Once she was sectioned, she was essentially the creature of her psychiatrists. They forcibly subjected her to course after course of ECT (electroconvulsive therapy), despite our family refusing to grant permission for the procedure (it made her worse).
She was detained for more than a year, and we watched as they threw various combinations of incredibly strong psychiatric medications at her to see what would stick. Sometimes, they made her more psychotic. One combination made her catatonic for three weeks.
Once when I visited her there, she told me the doctors were evil and were trying to kill her. While that was clearly a paranoid delusion, I didn’t blame her for associating her doctors with negativity. Their treatment was entirely an exercise in trial and error (that is how psychiatry works) and she suffered for it.
Only about 40 per cent of people on selective serotonin reuptake inhibitors (SSRIs) report they help their depression
At 18, I was myself diagnosed with severe depression. The doctor consulted the version of the Diagnostic and Statistical Manual (DSM) in use at that time, declared I had five of seven listed symptoms of depression, and so I was depressed and should be medicated. Simple as that.
While the symptoms of chicken pox indicate an underlying cause (a virus), the symptoms of depression are a set of behaviours with a label slapped on. The underlying cause is not understood or tested for. It is not “a disease”.
Brain vs mind
A mind is not the same as a brain. A brain illness is not the same as a mental illness. Dr Thomas Szasz – a psychiatrist who wrote a famed critique of his profession in the 1960s – made some interesting points on this.
Until 1980, the DSM described homosexuality as a mental illness. How we define "madness" or mental disorder is caught up with culture and politics in a way that purely physiological illnesses are not.
Even the theory that depression is caused by a chemical imbalance in the brain is just a theory – and not universally accepted. A mind is not a brain.
There is nothing to say that medical treatment of a mind is effective at all. Only about 40 per cent of people on selective serotonin reuptake inhibitors (SSRIs) report they help their depression. Leaving room for the placebo effect, that is far from conclusive.
Sometimes, psychiatric intervention is the best course of action for an ill person. However, we commit an error by considering this area of medicine to be subject to the same rigorous standards of falsification as other fields.
In reality, we understand very little about the true nature of mental illness. This should be at the forefront of public consciousness.
If you have been affected by anything in this article, help and support is available. Please call Samaritans’ 24-hour helpline: 116 123 for immediate support