Intended for healthcare professionals

Ward Round

The psychiatric protection order for the “battered mental patient”

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1449 (Published 18 December 2003) Cite this as: BMJ 2003;327:1449

re: your own worst enemy

Dear Sir,

This correspondence does not intend to adhere to the implied claim
that ‘all psychiatry is bad’. However,
I suspect that psychiatry, as a discipline, if it is not careful, will
eventually become most ridiculed over its adherence to one theme: that of
‘somatization’. Presently, sufferers of Myalgic Encephalitis (also called
Chronic Fatigue Syndrome) are increasingly subject to medical negligence
or even abuse because the huge body of international bio-medical evidence
is ignored, especially in Britain, in favour of an unfortunately
incomprehensible, incoherent and empirically inadequate theory.
’Somatization’ and its companion terms (‘Hysteria‘, ’Psychosomatic’,
’Psychogenic’ even ’Neurasthenia’) appear to be part of a ‘Gothic Revival’
(1) in psychiatry, in which words such as ‘hysteria’ are used by certain
psychiatrists without irony, as if the tide of academic critiques of
that branch of psycho-analysis had never happened.

What is worse, the idea that an illness is ‘all in the mind’ is often
based on what can only be described as ‘sexist’ notions, as the term
‘hysteria’ and its companions are most often applied to women, (2) and
also, in the case of ME/CFS, to children and their carers, again, mostly
women. The empirical inadequacies around the Munchausen’s Syndrome By
Proxy diagnosis of mothers of Sudden Infant Death Syndrome victims (in
the news recently), for example, apply also to many young ME/CFS
sufferers and their carers. (3). Even worse, the categorisation of an
illness as being psychosomatic also means a further categorisation of an
individual as ‘deviant’ rather than ‘ill’, so that they are denied
sympathy, support, and even benefits they are entitled to (and this
happens to many other sufferers of illness classified as 'mental').
Categorised as ‘deviant’, the ill then suffer increasing social exclusion
and material inequalities. As far as I can see, medicine’s role in this
categorisation of deviance and its effects has not yet been adequately
explored or critically reviewed within its own field, and this is a
serious problem that needs to be addressed.

The main problems with somatization theories is that they cannot be
either proven or disproven, (a la Popper), and therefore are not very
‘scientific’ at all. Whereas most theories in the ‘social’ sciences or
humanities have to abide by this disclaimer, some practitioners of
psychiatry, amnesiac as to the origins of their discipline, seeing it as a
‘medical’ or ’natural’ science, usually never bother. But they REALLY
should. Instead, in relation to ME/CFS at least, flawed, unsubstantiated
theories have been uncritically adopted and treated as ‘fact’, even
against the already substantial (and substantiated) body of bio-medical
evidence which continues to grow. In this respect, psychiatrists are not
alone:some paediatricians and even General Practitioners have been guilty
of this.

The material effects of such sloppy ‘science’ has had two main
(though not the only) consequences for ME/CFS sufferers: Firstly, the
medical impairments of the illness have often been ignored and left
untreated, and many sufferers therefore become severely disabled, their
physical health absolutely devastated and their chances of a restoration
to good health uncertain at best. (4) Secondly, children in particular
end up victims of institutional abuse (though this can happen to adults
too). In the case of children, they may be forcibly removed from their
concerned parents and subjected to draconian ‘treatments’ (5) that could
also, quite easily, be termed abuse, and for which the need for legal
protection from psychiatry as described by Szasz would apply. The capacity
for abuse of institutional power appears to have increased enormously, and
this is becoming most evident in the fields of health care and
particularly psychiatry. How such problems are addressed will determine
the future of such disciplines, as far-reaching demands for justice from
those who are faced with or survive such institutional abuse are
inevitable, and this will lead to a critical review of medical practice,
both from other disciplines, and society at large.

FOOTNOTES

1. This term was first suggested to me by a colleague whose interest
lies in the historical cultural constructions of women‘s illnesses.

2. One exception to this is the categorisation of psychosomatic to
Gulf War Syndrome Sufferers, in which male soldiers form the majority.
However, I have seen their suffering categorised as being similar to
‘shell shock’, or post-traumatic stress disorder, for which many men were
executed in World War 1, yet another example of how any form of suffering
can be categorised as ‘deviant’.

3. Here I part company with Szasz somewhat as his analysis of the
family as a source of abuse is rather generalised in the above article and
does not take into account dynamics of power within the family itself, for
example.

4. Hooper, M. Marshall, E.P. Williams, M. “What is ME? What is CFS?
Information for Clinicians and Lawyers, 2001 (Document available on
www.meactionuk.org.uk)

5. See, for example, accounts of these in the following: Michell, L.
“Shattered: Life with ME” (Thorsons, London, 2003), and Walker, M.
“Skewed: Psychiatric Hegemony and the Manufacture of Mental Illness in
Multiple Chemical Sensitivity, Gulf War Syndrome, Myalgic Encephalitis and
Chronic Fatigue Syndrome” Slingshot Publications, London, 2003.

Competing interests:
Carer and Social Scientist studying the cultural myth of 'mind over matter'

Competing interests: No competing interests

29 December 2003
Angela Kennedy
Social Science Lecturer
Open University