The use of psychiatry as a means of social control is becoming apparent in preventive medicine programmes for various mental illnesses. These programmes are designed to detect children and young people who have divergent thinking and behavioural patterns and get them into treatment before their supposed mental illnesses develop. In Australia, as part of the National Mental Health Strategy, programmes have recently been initiated which are aimed at the early detection and treatment of psychosis in young people. Clinical guidelines for best practice in this area describe the risk factors and signs which can be used to identify young people who are in need of prophylactic drug treatment to prevent the development of psychotic conditions such as schizophrenia. (See Chapter 9.)
Unfortunately, even official human rights watch-dogs like the Australian Human Rights and Equal Opportunity Commission seem to be unaware of the harm that might be done by encouraging the early diagnosis and treatment of mental illness. A 1993 report by the Commission on human rights and mental illness claimed that:
"Conduct disorder and other disruptive behaviours are a source of considerable morbidity in child and adolescent mental health with problems occurring in 3.2–6.9 percent of young people … Prevention of conduct disorders in childhood and adolescence, or their early and effective treatment, is of special significance given the great personal, social and economic costs produced by antisocial behaviour and other disorders."[17]
Conduct disorder is specifically confined to children and adolescents, and some psychiatrists believe it is a precursor of schizophrenia.[18] According to DSM-IV, ‘The essential feature of Conduct Disorder is a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated.’[19] Staying out late at night despite parental prohibitions is one of the signs. The text-book recommendation for treating this kind of waywardness is dosing with haloperidol,[20] a high-strength neuroleptic drug used for treating schizophrenia.
The Human Rights Commission's report was particularly enthusiastic about the early diagnosis and treatment of schizophrenia:
"Psychiatrists working with general practitioners in an English community have been able to detect the earliest signs of schizophrenia—and with education, supportive interventions and short-term psychotropic medication—prevent the onset of an episode … Obviously this research must be repeated and tested in different settings, including Australia, but these early findings are encouraging and warrant urgent attention."[21]
The Commission is implying that it might be useful to screen the general population for 'the earliest signs of schizophrenia'. But if this screening were to be carried out, and people with the 'earliest signs' were coerced into preventive mental health programmes, the effect would be to lower the community's tolerance level for individual differences in thoughts and beliefs. The current tolerance level is only crossed when a person demonstrates the degree of individual difference indicated by the symptoms of psychosis. But in the absence of any laboratory tests for schizophrenia, the ‘earliest signs’ are simply minor deviations from expected norms in speech and behaviour. Children and adolescents who are thought to be in need of discipline, and people marginalised through unemployment and homelessness, might be particularly vulnerable.
Unemployment and lower socio-economic status have long been closely linked with schizophrenia. Researchers found during the Great Depression of the 1930s that the rate for treated schizophrenia was nearly three times higher in the slum areas of Chicago than in the most affluent areas. Modern psychiatrists believe that ‘it has become so common for schizophrenics to be out of work’[22] that unemployment has become one of the main indicators of the disorder. US-based dissident psychiatrist Thomas Szasz has argued that youth unemployment is a major risk factor for receiving a diagnosis of schizophrenia.[23]
DSM-IV defines a mental disorder as a condition that ‘causes clinically significant distress or impairment in social, occupational, or other important areas of functioning’.[24] This suggests that a psychiatrist charged with making an assessment of an unemployed person might begin with the assumption that the person’s ‘occupational impairment’ indicates the presence of a mental disorder in need of diagnosis. This approach is reinforced by more specific advice on how to identify schizophrenics: ‘Many individuals are unable to hold a job for sustained periods of time and are employed at a lower level than their parents (downward drift).’[25]
Another authoritative diagnostic manual, the World Health Organisation’s ICD-10, has a description of schizophrenia that might be even more threatening for unemployed people. One of the ICD-10 sub-types of schizophrenia is called ‘simple schizophrenia’ and the following diagnostic guidelines are given to identify it:
"Simple schizophrenia is a difficult diagnosis to make with any confidence because it depends on establishing the slowly progressive development of the characteristic ‘negative’ symptoms of residual schizophrenia without any history of hallucinations, delusions, or other manifestations of an earlier psychotic episode, and with significant changes in personal behaviour, manifest as a marked loss of interest, idleness, and social withdrawal over a period of a least one year."[26]
It should be noted that this sub-type of schizophrenia doesn’t require the usual signs of psychosis. It is quite likely that the description of ‘simple schizophrenia’ would easily fit a great number of people who have been forced to adapt to the experience of long-term unemployment.
Unemployment is now at chronically high levels in most parts of the world and, apart from the link with schizophrenia and other mental diseases, there is also a traditional tendency to view unemployed people as a socially destabilising force, in need of control. Unemployment for 15-19 year olds in Australia hovers around 20 per cent.[27] This means that at any given time about 20 per cent of the youth workforce could be said to suffer from the psychiatric symptom of ‘occupational dysfunction’. The assumed link between mental illness and unemployment is now so deeply entrenched in contemporary thinking that the Human Rights Commission's report on mental illness naively repeated claims that ‘more than 50% of unemployed young people suffer from depression’.[28]
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[17] Human Rights and Equal Opportunity Commission, Human Rights and Mental Illness, p. 855.
[18] Kathleen McKenna et al., pp. 636–45.
[19] American Psychiatric Association, op. cit., pp. 85–6.
[20] Harold I. Kaplan and Benjamin J. Sadock, Synopsis of Psychiatry: behavioural sciences, clinical psychology, pp. 798–9.
[21] Human Rights and Equal Opportunity Commission, op. cit, p. 857.
[22] Richard Warner, Recovery From Schizophrenia, pp. 35, 132.
[23] Thomas Szasz, Cruel Compassion: psychiatric control of society’s unwanted, p. 145.
[24] American Psychiatric Association, op. cit., p. 7.
[25] Ibid., pp. 277–8.
[26] World Health Organisation, The ICD-10 Classification of Mental Disorders and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines, p. 95.
[27] Philip E. T. Lewis and Paul Koshy, 'Youth employment, unemployment and school participation', p. 42.
[28] Human Rights and Equal Opportunity Commission, op.cit., p. 846.