1. Human Rights and The Medical Containment of Deviance

The problems of truth and justice associated with forced psychiatric treatment aren't confined to schizophrenia. There is a widespread trend in developed countries to expand the use of psychiatric coercion by medicalising various forms of mental and behavioural deviance that were formally considered problems of character, intelligence, morals and discipline. Children and adolescents are particularly targeted in this expansion. Under the headline, ‘Doctors could soon prescribe behaviour-controlling chemicals to pre-teens against their parents’ wishes’, a recent report in a leading British newspaper describes the growing reliance on psychiatric drugs to control the behaviour of children.

More than three-quarters of a million children could be given drugs to control their behaviour—against their wishes and those of their parents. The spectre is raised by legislation planned by the government to give more powers to psychiatrists.
    Mental-health workers are warning that the new legislation is being drawn so widely that doctors will be given the right to drug children just because they have a difficulty with math or spelling.
    The concern over the legislation follows alarming evidence that tens of thousands of schoolchildren with mild
behaviour problems are being drugged with Ritalin—dubbed the ‘chemical cosh’ or ‘kiddie crack’—simply in order to control them.
     In England, the number of prescriptions for the mind-drug Ritalin—which is given to so-called ‘hyperactive’ children to improve concentration—has shot up from just 3500 in 1993 to 126,500 in 1998.
    The UK is rapidly following in the path of the US, where a report last week showed that three million children—one in every 30—are now being given Ritalin. Children as young as two are being given mood-altering drugs, including anti-depressants.
    The new legislation will give far greater powers to psychiatrists to give compulsory treatment in the community to both adults and children.[1]

Surveys have supposedly demonstrated the need for expanding psychiatric powers by uncovering mental illness in epidemic proportions in a number of countries. A recent survey of South Australians found that more than one quarter of them were in need of psychiatric attention. The researchers claimed that 26.4 per cent of 1009 ordinary rural adults had mental illnesses, and that 11 per cent had two or more disorders. A similar study in Christchurch, New Zealand found that 20.6 per cent of the general population had mental illnesses, and two studies in the United States found rates of 20 per cent and 29 per cent.[2]

The South Australian study found that only 4.2 per cent of the people with mental illnesses had seen a psychiatrist or psychologist in the previous twelve months, and it agreed with US researchers that ‘most community residents are not treated for their psychiatric problems’. Blame for this was aimed at general practitioners who are thought to be under-diagnosing mental illness.

But the findings can be interpreted in an entirely different way. Of 1009 people there were eleven people who acknowledged they had mental problems and who sought specialist treatment for them. A further 255 people were diagnosed with mental illnesses but were not receiving treatment. From the medical point of view these 255 people should receive treatment. But these same people apparently disagree and seem prepared to cope with life in their untreated state. If they were not coping without treatment they would have already come into contact with psychiatry as either voluntary or involuntary patients.

By finding more than a quarter of the population to be mentally ill, when these same people are willing to carry on with life as they are, the South Australian researchers have raised an interesting question. Are we living in a society that is quite literally part mad, in which a quarter of the population are unaware that they have already developed mental illnesses, and where the rest of us appear unwilling to acknowledge that soon it might be our turn? Or is there something wrong with the diagnostic techniques used by the researchers? Is there something about the way psychiatry is practised that predisposes psychiatrists to find mental pathology where ordinary non-medical people might find foolishness, stupidity, aggression, laziness, drunkenness, boorishness, unhappiness, self-doubt and numerous other character faults that affect most people at some time or another, making us unpleasant company, but which do not really distinguish us as having diseased minds.

This non-medical approach is sometimes referred to as the ‘moral model’ to distinguish it from the medical or psychiatric approach. In a discussion about the differences between the moral model and the medical model, Ronald Leifer has observed:

When the moral model is used to explain human behaviour, it is assumed the person has the capacity for free choice and is responsible and accountable for his or her actions. The medical model, on the other hand, is deterministic and explains human actions in terms of antecedent causes. These causes may be biochemical, social, psychological or historical.[3]

The South Australian survey shows the huge gap that exists between the medical view of the community’s state of mental well-being and the community’s own view of itself. This confirms sociological research which has found that ‘lay beliefs are often quite distinctive in form and content’ to clinical medicine.[4]

[1] Anthony Browne, Health Editor, ‘Doctors could soon prescribe behaviour-controlling chemicals to pre-teens against their parents’ wishes’.

[2] John R. Clayer et al., ‘Prevalence of psychiatric disorders in rural South Australia’, pp. 124–8.

[3] Ronald Leifer, ‘The Medical Model as the Ideology of the Therapeutic State’, pp. 247–58.

[4] Gareth Williams and Jennie Popay, ‘Lay Knowledge and the Privilege of Experience’, p. 118.