What is your Opinion of Psychiatric Diagnosis?

This is an important paper written by Steven Coles and colleagues about psychiatric diagnosis. What do you think? Have your say!

What is your Opinion of Psychiatric Diagnosis?

What is your view on psychiatric diagnosis? Should the diagnosis of schizophrenia be abolished as the Campaign for the Abolition of the Schizophrenia Label wish? For both those working in mental health services and those on the receiving end, how important is diagnosis to your life? There are many different views on psychiatric diagnosis from fierce advocates to those who decry the practice. A number of survivors, academics, professionals, and service users have criticised diagnosis. However, within mental health services psychiatric diagnosis remains dominant. Psychiatrists (and other professionals) claim they use diagnosis to understand people’s experiences, behaviour and distress.  Diagnosis shapes how services are organised, who will be helped and how services will support or “treat” people. Psychiatric diagnosis also has a major impact on whether people are detained against there will in hospital – the civil liberties of people with a psychiatric diagnosis are at a greater risk than anyone else in society (other than suspected terrorists). Diagnosis influences whether people are forced to take major tranquilizers (“antipsychotics”), and whether they receive financial benefits.

Despite the immense controversy surrounding diagnosis, my experience is that the debates around diagnosis are not openly discussed between staff or with people using (or forcibly brought into) mental health services. Psychiatric diagnosis has become an everyday and often unquestioned part of mental health practice. Is this simply because critics of diagnosis have weak arguments? Is it because the scientific basis of psychiatric diagnosis is so strong? Is there no alternative? A group of Clinical Psychologists working in East Midlands Adult Mental Health Services have looked at the issue of psychiatric diagnosis and written a position paper (Coles & SPIG, 2010). They conclude that “psychiatric diagnosis does not meet its scientific and expert claims” and does not deserve to be so dominant in mental health services.

The East Midlands group highlighted a number of negative effects of psychiatric diagnosis. They note that diagnosis places the cause of difficulties on the individual; the group feel more attention should be paid to people’s life experiences, such as abuse, poverty, discrimination and disempowerment. The position paper also observes that the language of diagnosis is barrier to communication between staff and people using services. Furthermore, diagnosis is not aware that it is based upon dominant western (often male) ideas of what is normal, and ignores that other cultures and subcultures might have different or a broader idea of what is normal. The paper also notes some modest alternatives to moving beyond diagnosis (for access to the document see www.bps.org.uk/dcp-sigpr/publications-%26-documents/publications_home.cfm).

The East Midlands Paper is accessible at the above link, as well as on the Hearing Voices Network website. The group is hoping to open up a debate around diagnosis and would welcome people’s thoughts on the paper and on diagnosis. The East Midlands paper suggests that the current dominance and use of diagnosis is part of the problem and not part of the solution as psychiatry claims. What do you think? What is your experience of diagnosis?

References

Coles, S. & SPIG (2010).  Position on Psychiatric Diagnosis. East Midlands: Psychosis and Complex Mental Health Special Interest Group

Steven Coles

Clinical Psychologist

steven.coles@nottshc.nhs.uk

The Hearing Voices Network – “The Freedom to Hear Voices”: The Hearing Voices Movement

Psychology, Mental Health and Distress is a groundbreaking new text from John Cromby, David Harper and Paula Reavey. Whereas other texts are structured by diagnostic categories and are biologically reductive, this book places biology as well as the experience of distress itself in its social, cultural and historical context.

 Key Features:

  • Offers a wealth of case stories to portray the reality of living with distress and stimulate class discussion 
  • Fully informed by current experimental, qualitative and theoretical psychological research including research into hearing voices
  • Includes a chapter authored by those with first-hand experience of mental health services, ensuring your students understand the nuances of this emotionally charged and often controversial topic

Features additional contributions by renowned figures including Professor Richard Bentall, Professor John Read, psychiatrist and researcher Joanna Moncreiff and campaigner and Chair of the Hearing Voices Network, Jacqui Dillon among others.

See link for further information: http://www.palgrave.com/products/title.aspx?pid=280329

Download flyer: CrombyHarper&Reaveyflyer

 

Bad Things That Happen to You Can Drive You Crazy!

I’m feeling elated after an amazing evening at Mount Holyoke College in Massachusetts. The event, sponsored by Mount Holyoke College Department of Psychology and Education, the Western Massachusetts Recovery Learning Community, and the Freedom Center was attended by about 150 people  – students, academics and people from the local community – some as far away as Boston, Connecticut and Pittsburg. The auditorium was packed with people hungry for an alternative to the pharmaceutically driven, biomedical model which dominates so heavily in America.  Many were inspired when they heard Ron Coleman and Paul Baker speak late last year and there is a growing momentum for the development of the Hearing Voices Network in America. Change is happening.

My talk, entitled: “Bad Things That Happen to You Can Drive You Crazy! Understanding Abuse, Trauma, and Madness and Working toward Recovery”,

(see this link for further information: http://www.mtholyoke.edu/news/stories/5682743)

seemed to really resonate with others experiences and many people were clearly questioning the adequacy of a biomedical model to make sense of and respond to human distress.

I began by reading ‘A Tale of An Ordinary Little Girl’ and then spoke about the groundbreaking work of the Hearing Voices Movement, its success in many other parts of the world and our intention to revolutionise the way societies think about hearing voices and other unusual human experiences. I ended by stressing the imperative to take collective responsibility for the ills in our societies, to become aware of the dominant ideologies that redefine reality and to challenge oppression, power, social norms and inequalities. I appealed to everyone to join the last great civil rights movement – fighting for the rights of those labelled as mentally ill.

As always, a number of survivors came up to me afterwards and thanked me for telling ‘their’ story. Lots of people wanted to find out more about how they could get involved in the movement, meet with others, start groups. People are impatient for a paradigm shift in the way we understand and respond to human suffering which is now, long overdue. Many are in anguish. Fortunately, there are already some fantastic Hearing Voices Groups running in the area, with several new groups in development. I left feeling proud, inspired and grateful to be part of such a wonderful, powerful movement for change in the world.

There is still so much work to be done. First, it’s time for a bath and then bed.

Mad In America

I’m off to America tomorrow to help spread the word about the pioneering work of the Hearing Voices Movement. On Monday I will deliver the first session of the ‘Starting Hearing Voices Groups Training’ at the Western Massachusetts Recovery Learning Community. It will be great to be a part of these important developments particularly as Gail attended the very first Hearing Voices Group Facilitation training that I ran in London back in 2005.

This training looks to continue the positive momentum of the Hearing Voices Movement in the United States, with the primary purpose of training people to start their own Hearing Voices Groups in the local area. I will be facilitating the training along with Oryx Cohen, Director of the National Empowerment Center’s Technical Assistance Center and former Co-Facilitator of the RLC Hearing Voices Group in Holyoke and Gail Hornstein, Professor of Psychology at Mount Holyoke College, Co-Facilitator of the RLC Hearing Voices Group and author of Agnes’s Jacket.

On Tuesday I will be interviewed by a filmmaker about my work, meet with members of the Recovery Learning Community in Worcester before going to deliver my presentation at Mount Holyoke College entitled –

Bad Things That Happen to You Can Drive You Crazy! –

Understanding Abuse, Trauma, and Madness and Working toward Recovery.

See this link for further information: http://www.mtholyoke.edu/news/stories/5682743

On Wednesday I will travel to Framingham where I will give a presentation at Advocates, Inc.

Before I fly back home on Thursday evening, I will meet Robert Whitaker, author of Mad in America and Anatomy of an Epidemic. Bob has agreed to speak at a fundraising event for the Hearing Voices Network when he is in London in November – watch this space for further info!

From Vicarious Trauma to Transformation

I’ve just got back from delivering a 2 day training course with Eleanor Longden on Abuse, Trauma and Dissociation, to 35 mental health professionals in Shrewsbury. I was really struck by people’s willingness and commitment to staying with some really difficult material. We spoke about the importance of having good support and the need to take really good care of ourselves when working directly with trauma, to protect us from the effects of vicarious traumatization.

Vicarious trauma, the process of change that happens because you care about other people who have been hurt, and feel committed or responsible to helping them, can lead to changes in your psychological, physical, and spiritual well-being. When you identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience. Your commitment and sense of responsibility can lead to high expectations and eventually contribute to your feeling burdened, overwhelmed, and perhaps hopeless. Vicarious trauma, like experiencing trauma directly, can deeply impact the way you see the world and your deepest sense of meaning and hope. Vicarious traumatisation is not the responsibility of clients. Organisations that provide trauma-related services bear a responsibility to create policies and work settings that facilitate staff (and therefore client) well-being. Each trauma worker is responsible for self-care, working reflectively and engaging in regular, frequent, trauma-informed supervision. There are many ways of addressing vicarious traumatisation. All involve awareness, balance, and connection.

Beyond vicarious traumatisation lies vicarious transformation. This is the process of transforming one’s vicarious trauma, leading to spiritual growth. Vicarious transformation is a process of active engagement with the negative changes that come about through trauma work. It can be recognized by a deepened sense of connection with all living beings, a broader sense of moral inclusion, a greater appreciation of the gifts in one’s life, and a greater sense of meaning and hope. Vicarious transformation is a process, not an endpoint or outcome. If we can embrace, rather than fending off, other people’s extraordinary pain, our humanity is expanded. In this receptive mode, our caring is deepened. People who have suffered trauma and abuse can feel that we are allowing them to affect us. This reciprocal process conveys respect. We learn from trauma survivors that people can endure horrible things and carry on. This knowledge is a gift we can pass along to others.

Due to popular demand we will be offering further courses this year on Abuse, Trauma and Dissociation in Nottingham, Cork and in London. See events section for further information.