MENTAL HEALTH Treatment and control

Killing with kindness
If social scientists are to be believed, the northern hemisphere is reeling from the impact of an army of ‘hyperactive’ children - tyrannising parents and running amok in classrooms. But methods used to control this new menace, warns David Ingleby, have sinister implications for the freedom of the whole of society.

ORWELL’s 1984, a nightmare of a totally managed society, doesn’t seem to have materialised. But did Orwell teach us to look for the managers in the right places? I want to suggest that it is the people we most trust - those responsible for our welfare - who constitute the biggest potential threat to our freedom. And that the people who are least able to look out for themselves - our children - are the ones most at risk.

Question marks began appearing above mental health services when disillusioned psychiatrists like Szasz, Laing and Cooper - founders of the ‘anti-psychiatry’ movement - began arguing that mental health really meant nothing but conformity. If you didn’t think, feel or act ‘appropriately’ you ran the risk of being labelled ‘mentally ill’ and having the undesirable bits of your personality removed - surgically, if necessary.

But focusing on these bully-boy tactics has diverted attention from the real threat. We listen aghast to horror stories about the forcible treatment of political dissidents in Russia and sigh with relief that little of that sort goes on this side of the Iron Curtain. And it’s true. In the West patients tend to seek

treatment of their own accord, with only a minority having anything done to them against their wishes. Indeed, since the 1 950s most governments have begun closing their inhumane, costly and ineffective mental hospitals.

But criticising just the ‘hard’ psychiatric methods - compulsory detention, isolation, electroconvulsive therapy - allows the ‘soft’ ones to flourish unchecked. With an up-to-date psychiatrist it is much harder to see how

help shades into control; Valium and psychotherapy seem such friendly treatments that one can understand the indignation of psychiatrists who are accused of being agents of social control.

Yet the basic drive to force people to conform has not changed. The difference is that this goal, and the methods used to achieve it, have become accepted - even embraced - by the population itself. The professional has become a kind of parent-figure in whom enormous trust is invested: he knows best and he has your best interests at heart. He is not trying to eliminate problem behaviour, but is helping you realise your true human potential.

And, true to their parent-figure image, today’s mental welfare activities have focused increasingly on our children. Many of these activities have been good for children: the clamp-down on infanticide, neglect and blatant exploitation. But at the same time they have turned the raising of children into a technical problem that needs the constant monitoring of experts. Mere parents can only try to carry out their tasks skilfully. And when the parents fail to fulfil their role in the manner deemed appropriate, then the experts are standing by to ‘intervene’ as surrogate parents.

Occasionally this intervention is blatantly repressive: the UK-based organisation MIND, for example, has discovered many cases of children ‘in care’ being massively drugged to quell their protests (a routine practice, of course, in prisons). But even more worrying are those interventions that masquerade as treatment.

Take the case of hyperactivity. Suppose a child is restless, fidgety, boisterous and lacking in concentration. Such children have irritated parents and teachers through the ages. But suddenly, in the 1960s, it was suggested that this behaviour stems from otherwise undetectable ‘minimal brain damage’, and that drugs can put it right. Within a few years, about a million American children were living under permanent sedation to control their ‘hyperactivity’.

The explanation is simple. In the past such children were simply beaten into submission. That method of control is no longer socially acceptable. But the kids still need to be controlled. Labelling them ‘mentally ill’, gives their controllers an excuse to use drugs to keep them quiet.

And now the experts’ concern has broadened to encompass new-born babies. The Holy Grail of an ‘optimal childbirth’ has been created in the wake of women’s dissatisfaction with hospital production-line births. Only effective ‘bonding’ can ensure a baby’s healthy development, they say. So now this most personal and intimate event has also become a task which - like the rest of parenthood - you perform either well or badly, according to the latest whim of the experts. And at last year’s World Congress of Infant Psychiatry it was even proposed that the unborn foetus may be next in line for psychological help!

Having a treatment to administer, of course, is only half the battle. You also have to decide who needs it. To this end new systems of child ‘screening’ are being set up to detect deviations ‘at an early stage’, which then alert the experts to a need for ‘preventive intervention’. In one such programme (in California), results are stored on a regional computer and parents are notified automatically when they should start to worry.

It seems to me that we are in the middle of a concerted effort by the experts to take over childhood. And, if you see it from their point of view, that makes perfect sense: since all problems are supposed to originate in childhood, child-rearing is much too important a matter to leave to parents.

Of course they don’t want to do away with parents altogether. After all, parents can apply the newest techniques of child-rearing much more efficiently than professionals. But they need guidance. Hence the steady flow of books, magazines, TV programmes and training courses to provide the requisite know-how to inept mums and dads.

Has ‘Big Brother’ arrived after all? Not really. Because there is no spider at the centre of this web of tender concern. Individual psychiatrists, psychologists, social workers are more concerned about their own job security than about creating a society of conforming androids.

The aims of intervention, however, are very much an ideological matter. We have come to treat the professionals as benevolent parent figures who know what’s best for us. As a result, instead of an open moral and political debate about how people should live and what should be done about their problems, we have an ostensibly neutral technology of mental health, in which the norms are chosen by professionals whose books we can’t understand and who won’t even let us see our case-notes.

We don’t trust our own insights and capabilities and we feel less and less in control of our own lives: as, of course, we are. Many of us have learned a healthy distrust for the medical profession which claims to know about our bodies. Shouldn’t we be even more cautious about to whom we entrust our minds?

David Ingleby, currently lecturing at the University of Utrecht, has worked for many
years with the Medical Research Council in the UK Amongst other publications is his book
Critical Psychiatry: The Politics of Mental Health, Penguin 1981.