09 February 2008

Abuse is not exceptional

This anecdote, by Ruth Gledhill of The Times (via NHS Blog Doctor), doesn't surprise me at all. Except that what I think it illustrates is not what she (probably) thinks it does. She uses the story to criticise the Archbishop of Canterbury's suggestion that Britain should consider incorporating elements of Sharia law.

A few weeks ago, I was chatting to a woman who works in an advocacy role for Muslim women [who are] in the process of being sectioned into mental health units in the NHS. This woman, who for obvious reasons begged not to be identified, told me:

'The men get tired of their wives. Or bored. Or maybe the wife objects to her daughter being forced into a marriage she doesn't want. Or maybe she starts wearing western clothes.There can be many reasons. The women are sent for asssessment to a hospital. The GP referring them is Muslim. The psychiatrist assessing them is Muslim and male. I have sat in these assessments where the psychiatrist will not look the woman patient in the eye because she is a woman. Can you imagine! A psychiatrist refusing to look his patient in the eye? The woman speaks little or no English. She is sectioned. She is divorced. There are lots of these women in there, locked up in these hospitals. Why don't you people write about this?'
Asked by Ms Gledhill if she could provide evidence, the woman allegedly replied: "I can't be identified ... I would be killed. And so would the women."

Shocking indeed. But the point here, as I see it, is not that abuse of 'psychiatry' is unique to Muslims, but that the UK framework (like that of most other nations) lends itself to this kind of abuse. I have little doubt that abuse occurs throughout the British headshrink industry, and is not confined to minorities. Here is another recently reported case.

As for the Muslim community's role here, I think we may be fortunate (in this instance) that some of them seem to have less of a taboo about casting aspersions on professionals than the mainstream British community does. When I wrote my book critical of the medical profession, I came across a number of individuals who had been badly (sometimes horrifically) treated by the NHS in one way or another, but they were usually inhibited about criticising the people involved. ("But they are doctors!") Also, in most cases the person concerned had a friend or relative who was a doctor, which appeared to make it harder for them to consider the possibility that the entire profession is built on dodgy foundations.

The comments to the NBD post demonstrate the usual incredulity, apparently based on the assumption that professional health care workers must somehow have higher ethical standards than the rest of the population. Or, in the case of the professionals themselves, they demonstrate the usual denial.

"If detained for spurious reasons I find it hard to see how they would stop the women from applying to the Mental Health Review Tribunal (MHRT) for discharge, and how the Mental Health Act Commission (MHAC) wouldn't find out either through visits or from folk shouting about it when they're out and safer. ... if detained in hospital you have an automatic right to appeal to the MHRT for discharge; in hospital or out, if you feel the Mental Health Act is being used wrongly, the MHAC want to know!"

"I can see how it could happen, too [but] I'd have thought someone in authority (I hadn't heard of MHAC) would hear. After all patients talk to other patients (and so on) and yes, former patients would talk."

"I also don't see how, *even if it were true* it could happen. Yes the psychiatrists may be muslim but hardly any of the nurses are - so surely they would raise the alarm and encourage patients to apply to a tribunal."

"the UK ... has all kinds of safeguards to stop precisely this sort of thing from ever happening"

"I'm telling you as a [registered mental nurse] that this sort of thing could NEVER happen. Simply because (a) the nurses would start asking all sorts of awkward questions about why this woman is detained despite not displaying any psychotic symptoms and (b) even if they didn't, the patient's solicitor would take the doctor to the complete and utter cleaners at the MHRT."
Comments such as these are typical in such cases, but seem to exaggerate the likelihood that other concerned professionals would object, and underestimate the difficulties of arguing with people labelled as 'experts' who have the power to refuse you. Especially when you are in a position of weakness, and feeling thoroughly cowed by the experience of being at the mercy of people who are not in any way answerable to you.

The incident reported by Gledhill links the abuse to dubious private motives (e.g. disapproval of errant wives), which is the principal context in which most people find the idea of medical abuse comprehensible, if they allow for it at all. However, other cases suggest that no such obvious motive may be required. The enjoyment of power, impatience or simple indifference may be sufficient to create abusive situations, once you have a set-up in which one person is able to have power over another.

My colleague Celia Green points out — and I agree — that simply being forced into contact with the psychiatric profession constitutes abuse in itself, whether or not the particular psychiatrist behaves in a way that other psychiatrists would regard as acceptable. If psychiatry has any benefits at all, these can only be provided in a morally acceptable way by individuals choosing them to use them non-coercively. 'Coercion' here ought to include tacit coercion, i.e. where a person is forced to interact with professionals on their terms in order to obtain medication (e.g. lithium) which cannot be obtained via the free market. (A criticism which obviously applies, mutatis mutandis, to the medical profession in general.) Incidentally, I do not go along with the idea of some psychiatry critics that mental illness is necessarily a myth, although there are obviously dangers in allowing 'illness' to be defined by professionals who are too intimately involved with the state apparatus.