How best to treat mental illness?

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How best to treat mental illness?

Post  eddie on Sat Oct 08, 2011 4:17 am

What Is Madness? by Darian Leader – review

A new manifesto on how best to treat mental disorder

Jacqueline Rose
guardian.co.uk, Thursday 29 September 2011 10.00 BST


Illustration by Clifford Harper/Agraphia.co.uk

It is often assumed that Freud's most disturbing idea was that of sexuality, the idea that we are all perverts in our dreams. In fact, far more difficult for the professions of mental health in the 20th and 21st centuries is the concept of the unconscious, the suggestion that there are regions of the mind we can never fully control. Psychoanalysis starts from the premise that we are freighted with a form of knowledge we cannot bear. It takes time and a great deal of patience on the part of patient and analyst to navigate the quicksands of the soul.


What is Madness?
by Darian Leader

Psychoanalysis is not an exact science. Nor, even though Freud never relinquished a partly scientific vocabulary, would it wish to be. It could not be further removed from the drug-based treatments for mental disorder which have turned the drugs industry into one of the most profitable in the UK, or from cognitive behavioural therapy (CBT), the government-sponsored therapy of choice – 6,000 CBT therapists to be trained over the next four years. In No Health without Mental Health, its February policy document, the Department of Health advocates "evidence-based" therapy which allows "session by session outcome monitoring" with service reports to be placed in the public domain (a bit like rankings for hospitals and schools). Success will be measured predominantly by employment rates. In his introduction, Andrew Lansley acknowledges that unemployment is a key factor in precipitating anxiety disorders and depression. With the jobless rate currently above 2.5 million and rising as a direct result of the most vicious cuts and fiscal restraint since the 1920s, it seems fair to say that the government, by its own account, is provoking the problem it is trying to cure.

Darian Leader is best known as elegant populariser of French psychoanalyst Jacques Lacan. He is also one of the most effective campaigning voices against these developments in the treatment of mental disorder. "Gone," he writes in this important new book on madness, "is the idea of a complex psychic causality or even of an interior life." An "ethical reversal" based on an illusion – the belief that internal life can be objectively measured – has usurped the role of sensitivity to human speech. Today, as people are increasingly seen as resources to be bought and sold on the market, the individual is being emptied of her or his unconscious mental life. A first CBT interview will grade levels of depression on the basis of a questionnaire. In a wonderful moment in Ali Smith's latest novel, There But For The, a character at a dinner party starts shouting at another guest about CBT. Six sessions will sort her out, only "she shouts it, like a mad person, and she shouts it over and over, she has said it about six times". Perfectly, Smith conveys that there is something mad about a form of therapy whose vocabulary – get a grip, get CBT – possesses such frantic conviction. For Leader, such conviction is one of the chief properties of paranoia. The sufferer knows what is wrong with the world and sees it as their goal to put it right. As well as reflecting the ugly market-led ethos of the times, going for results in the realm of mental disturbance could be seen as a form of collective insanity in itself.

Freud is above all associated with the analysis of neurosis, but as analyst Michael Eigen has long pointed out, psychosis is at the core of his vision – the superego is a sadistic tyrant, the infantile ego hallucinates its missing pleasures, the id suspends all laws of space and time. In fact, for psychoanalysis too much sanity is an affliction. It is central to Leader's argument that delusion and sanity cannot be neatly separated. One of his most disturbing concepts is that of "quiet madness", a form of madness that no one would have any reason to suspect. Before he went on his murderous rampage in Norway, Anders Behring Breivik – nasty Islamophobe as he was – was to all appearances a normal if not model citizen. For the common view of madness, his outbreak might, paradoxically, be something of a relief. We prefer our mad people to be violent, although, in fact, more people are killed by drunks than by the insane. Leader is presenting us with a challenge. That we recognise there is such a thing as madness – there is not the slightest gesture here to the view that no one can be classified as insane – but equally that madness is part of us each and every one.

More important, what looks like psychotic breakdown may instead be the result of a collapse in the carefully nurtured delusional system which has allowed the psychotic to live at relative peace both with the world and with her or himself. For Leader, after Freud, delusions are a form of creativity or restitution, a sign that the psychotic is trying to give shape to the chaos or invasiveness inside her or his head. In Henry and Patrick Cockburn's Henry's Demons, the celebrated father-and-son story of Henry's breakdown, the son insists – despite the harm he does to himself and throughout whatever drug-induced stupor inflicted upon him – on the beauty and integrity of his visions. He has simply entered a different world (it is important, too, that his inner voices become a regular feature only after he is first institutionalised).

The last thing, therefore, treatment should aim to do with severely disturbed patients is to crash in and rob them of their delusion or snuff out their minds with drugs. With paranoid patients, any such intervention is likely to be experienced as an assault. For Leader, the question the analyst should be asking is not how can I cure or help the psychotic, but what use can she or he make of me? One of the strongest impressions conveyed by this book is the immense respect Leader feels for his patients. Above all he wants to listen. In the words of one of his patients: "I have to make you into a hearer."

It is fundamental to a Lacanian understanding of psychosis that something in the world of meaning has been breached. Usually, language just about holds to its rules, fixes the world into some kind of symbolic network, and passes without too much trouble between the one who is speaking and the one who is addressed. In psychosis it fragments or takes on grotesque, inflated proportions, voices emanating from nowhere or from God. Even in these deformations, however, there is something we might recognise. After all, language first comes at the infant as voices against which there is no defence.

For Leader it is a matter of "basics" that meaning fails when the function of the father has not occupied its proper place. Without it, the child is bound to a maternal register, awash in a sea of plenty with no get-out clause, a world in which the child can believe it is everything for the mother (as well as the reverse). In such a world, there is no symbolic register because the father has not intervened to mark the place of the third, he has not imposed his "phallic law". Leader's commitment to this account, which comes from early Lacan, seems to be utterly untroubled by the feminist critique it has received – I found myself wincing as he blithely described the need to subject the mother to a "force" beyond her, to "carve" up the world of meaning, and "pin down" her desire. He is surely right that the verbal tapestry of psychotic language tells us that somewhere such breakdown is precipitated by our relationship to words. But he is too formulaic. As he himself observes, it is a characteristic of delusion to be unswervingly convinced by your own system of belief. There are other ways of thinking. "I've formed the opinion," writes performance artist and painter Bobby Baker, "that psychosis is a metaphor for extreme suffering."

I missed in this book the detailed case histories from his own practice, presumably omitted for reasons of discretion. Strangely, given his insistence on listening, the three main cases are Lacan's Aimée, Freud's Wolfman and Harold Shipman on the basis of court transcripts and reports. I also found myself wondering, given the intensity of commitment, the number of patients he refers to, what life is left for the analyst.

Leader deserves every support in his efforts to stop the insane, soul-destroying vocabularies on offer from filling the available mental space. Provided we remember that psychoanalysis can flourish only against the grain. It is always a "plea for a measure of abnormality" – the famous book title of analyst Joyce McDougall. As she put it, the day psychoanalysis no longer questions the established order of prejudices, "it will have ceased to fulfil its function".

The Jacqueline Rose Reader is published by Duke University Press.

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Re: How best to treat mental illness?

Post  tatiana on Sun Oct 09, 2011 2:36 pm

medication.

and some thing else that i cannot remember the name of but it is similiar to role modelling....


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Re: How best to treat mental illness?

Post  Guest on Sun Oct 09, 2011 2:50 pm

...there are degrees of madness.

Some make life colourful, some kill it. They call for different responses...(i shudder to say 'treatments', being colourfully mad myself. I was prescribed lithium once, in the early days of its use. I'm not against the use of medication to correct a chemical imbalance in the brain, but I feel strongly about using medication lightly...but no doubt my view is shaped by the experience with lithium...who wants to be a 'walkie'...even to escape pain?)

I must dash now...drinking beer in the dry-season's radiant heat is making me confessional Rolling Eyes

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Re: How best to treat mental illness?

Post  Guest on Sun Oct 09, 2011 6:47 pm

I told my psychiatrist I posted on an internet forum (when I posted on er). I think he said people at internet forums do no good because they don't have you in front and they avoid telling you the truth (like you can be doing something harmful to yourself and they won't tell you). He also said that it's not unusual that those people are mental or kind of.

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Re: How best to treat mental illness?

Post  Guest on Sun Oct 09, 2011 7:08 pm

There should be meds compatible to alcohol. I don't even remember where I spent last night...

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Re: How best to treat mental illness?

Post  tatiana on Sun Oct 09, 2011 7:11 pm

asdf wrote:I told my psychiatrist I posted on an internet forum (when I posted on er). I think he said people at internet forums do no good because they don't have you in front and they avoid telling you the truth (like you can be doing something harmful to yourself and they won't tell you). He also said that it's not unusual that those people are mental or kind of.

be assured isa,
i am a real person, i have lots of experience with mental illness (in other people, not me).....and while we are not actually meeting face to face, believe me sometimes that is not always the best way anyway.....

they won't be able to help you if you are hurting yourself...as in they cannot actually touch you....
but often it is better not to touch a person when they are having an episode.....(especially if they have ASperger in them)

words are sometimes less psychically treatening.......if you understand that.

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Re: How best to treat mental illness?

Post  Guest on Sun Oct 09, 2011 7:38 pm

I think he meant that they can avoid you, your problems and they won't feel guilty because it's just the internet. That a friendship or whatever developed through internet is not really real. They don't have to deal with you in a real level.

But it's true words can be better than a face to face experience. And sometimes you just need to talk to a stranger.

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Re: How best to treat mental illness?

Post  tatiana on Sun Oct 09, 2011 7:48 pm

that is most likely what he meant.

and that can happen.

the internet can be tricky

i am just lucky that all of the friends i have made over the net have turned out to be real people

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Re: How best to treat mental illness?

Post  Guest on Sun Oct 09, 2011 11:36 pm

I want to dedicate this song to Moony

geek

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Re: How best to treat mental illness?

Post  Guest on Sun Oct 09, 2011 11:58 pm

A friend once asked me "Why do you try to look normal while other people try to look different?" scratch

The song says the girl likes him to think she's weird. And although I dedicated it to Moony I don't think it's Moony's case. But it's a nice song and she also writes poems that don't rhyme...

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Re: How best to treat mental illness?

Post  Guest on Mon Oct 10, 2011 1:17 am

alien
asdf wrote:A friend once asked me "Why do you try to look normal while other people try to look different?" scratch

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Re: How best to treat mental illness?

Post  tatiana on Mon Oct 10, 2011 1:51 pm

asdf wrote:I want to dedicate this song to Moony

geek

this song reminds me so much of someone i know here at home.
not as weird as he wants me to think.

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Re: How best to treat mental illness?

Post  Guest on Mon Oct 10, 2011 10:10 pm

^
Smile

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Re: How best to treat mental illness?

Post  Guest on Tue Oct 11, 2011 12:02 am

Today's the day of mental illness or something, no?


to you all...

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Re: How best to treat mental illness?

Post  tatiana on Tue Oct 11, 2011 12:08 am

World Mental Health Day

this is what is being organised in my part of the world.
http://www.health.qld.gov.au/mentalhealth/news/mhwweek.asp






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Re: How best to treat mental illness?

Post  Guest on Tue Oct 11, 2011 12:19 am

tatiana wrote:World Mental Health Day

this is what is being organised in my part of the world.
http://www.health.qld.gov.au/mentalhealth/news/mhwweek.asp

...and it looks like a full moon cheers cheers cheers

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Re: How best to treat mental illness?

Post  tatiana on Tue Oct 11, 2011 12:27 am

blue moon wrote:
tatiana wrote:World Mental Health Day

this is what is being organised in my part of the world.
http://www.health.qld.gov.au/mentalhealth/news/mhwweek.asp

...and it looks like a full moon cheers cheers cheers

it is cheers

you might know the people in that link....
Qld government at their most helpful

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Re: How best to treat mental illness?

Post  eddie on Tue Oct 11, 2011 1:10 am

I'm sure that levels of stress and depression must have reached alarming levels in the present global economic crisis: jobs shed wholesale, and remaining staff being required to take on the jobs of former colleagues, as well as performing their present duties.

Management have you over a barrel, of course: if you don't like it, leave. And with the unemployment stats so high, they know you're not going to find another job easily.

Bastards.

Quite a few colleagues I've known over the years- it's a high-stress job- have gone mad.

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Re: How best to treat mental illness?

Post  Guest on Tue Oct 11, 2011 1:15 am

...my trajectory's been the other way.... cheers

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Re: How best to treat mental illness?

Post  eddie on Tue Oct 11, 2011 10:56 pm

blue moon wrote:...my trajectory's been the other way.... cheers

Heh heh heh. Just you wait.

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Re: How best to treat mental illness?

Post  Guest on Tue Oct 11, 2011 10:59 pm

...shaman speak for blue moon is toast?

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Re: How best to treat mental illness?

Post  Guest on Tue Oct 11, 2011 11:00 pm

...only on the blue moon eddie...only on the blue moon Very Happy

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Re: How best to treat mental illness?

Post  Guest on Tue Oct 11, 2011 11:08 pm


...speaking on madness, these are the "Similar topics" at the bottom of the page:


» DSM: Inventing mental illness (documentary)
» alternative options for treatment of mental illness
» Lycanthropy
» Music You're Ashamed to Like
» Gainerfurs - because sometimes being fat is not furry enough


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Re: How best to treat mental illness?

Post  Constance on Wed Oct 12, 2011 5:06 am

blue moon wrote:...there are degrees of madness.

Some make life colourful, some kill it. They call for different responses...(i shudder to say 'treatments', being colourfully mad myself. I was prescribed lithium once, in the early days of its use. I'm not against the use of medication to correct a chemical imbalance in the brain, but I feel strongly about using medication lightly...but no doubt my view is shaped by the experience with lithium...who wants to be a 'walkie'...even to escape pain?)

I must dash now...drinking beer in the dry-season's radiant heat is making me confessional Rolling Eyes

I was prescribed lithium years back, too. Shaking hands, metallic taste in my mouth, lithium poisoning. As soon as the blood test showed it was at a therapeutic level, I'd get sick!

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Re: How best to treat mental illness?

Post  Guest on Wed Oct 12, 2011 5:43 am

...


Last edited by asdf on Wed Oct 12, 2011 6:00 am; edited 1 time in total

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Re: How best to treat mental illness?

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