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       Chapter Five How Society Responds to Mental Distress

      Plus ça change, plus c’ est la même chose. The more things change, the more they remain the same. Survivors of the psychiatric system, both the patients who suffered at the hands of the system and those members of staff who were appalled by the cruelty of the system and struggled against it, can only agree that the more things change the more they remain the same. Some aspects of the psychiatric system are much better than they were twelve years ago, but much of the system, and the ideas on which it was based, remain. Administrators of a health service became managers of a health business, and psychiatry, which had rejected Freud and Jung and all that followed them, discovered psychotherapy. Such changes brought a vast increase in the psychiatric and managerial jargon that may try to sound thoughtful and efficient but of which Craig Newnes, one of the founders of the critical psychology movement, said, ‘The new National Health Service has embraced a culture of militarism, business jargon, and meaningless soundbites. The militarism is typified by a new language of targets or objectives and sometimes more pointedly; in a recent NHS marketing seminar group leaders discussed “Principles of Marketing Warfare”, “Attack Strategies (including guerrilla attacks)” and “Principles of Guerrilla Marketing Warfare”. And all of this presented to nurses and other staff quite explicitly pacifist in their politics or nature. The business agenda is reflected in a preoccupation with business plans and similar documents concerned with tendering, purchaser risk and efficiency improvements.’¹ Miller Mair, a psychologist who has seen the changes in the psychiatric system over the last thirty years at close quarters, commented, ‘The language of marketed care degrades people and contributes to a cruder understanding of ourselves.’²

      Many psychiatrists use the jargon of therapy, but this jargon, as well as military and marketing jargon, is naught but a smokescreen to hide the fact that the system remains the same, and for the same reasons that the system in France remained the same - namely that the people who hold the wealth, prestige and power in the system do not want to relinquish what they hold, and are prepared to sacrifice those who have no power, prestige or money in order to keep what they hold.

      ’Twas ever thus. Throughout history no privileged group has ever voluntarily given up its privileges. The privileged always manipulate their society in order to keep their privileges, and much of this manipulation is aimed at keeping the society stable, for only in a stable society are their privileges safe. For a society to be stable it must be made up of people who conform to its rules and customs. Anyone who does not conform is a threat to society and to those who hold power.

      Those who do not conform in terms of race, nationality or religion are easily dealt with. They become strangers, enemies, and are easily persecuted.³ Such persecution can be carried out in many different ways, but always the persecutors try to justify their cruelty. It is not unknown for psychiatry to supply such justifications. During the Second World War German troops were stationed in Norway, and a number of these soldiers had liaisons with Norwegian women. Children from these liaisons were classed by Hitler as Aryans, the highest possible classification in the Third Reich. As such they had to be taken from their Norwegian mothers and placed in special homes reserved for such privileged children. At the end of the war the Norwegians transferred their hatred of the Germans to these children. They were put in orphanages and asylums where they were sexually and physically abused and not educated. As justification for this a leading Norwegian psychiatrist explained that these children were mentally subnormal and insane because their mothers must have been insane to have consorted with German men. Only recently have a few of these children, now quite elderly, been able to speak publicly about their cruel treatment.⁴

      Those who do not conform to the laws and customs of society, but who cannot be expelled as strangers and enemies, are deemed to be bad or mad, if not both, but in any event they are punished because they are feared. For their hundredth issue the journal Open-mind ran a survey to find the heroes and villains of mental health. (A most distinguished group, Freud, R. D. Laing, Peter Breggin and myself, appeared in the survey as both heroes and villains, thus supporting my contention that different people see things differently.) The nominations for the villains category were submitted by a reader, Terry Simpson. His first nomination was ‘fear’. He explained: ‘Fear of “madness” is second only to fear of death in our society. Distressed people have been abused, isolated, assaulted and killed in a systematic way since the term “mad” was invented.’⁵

      Our fear of madness stems from our fear of annihilation as a person. If we do not understand our own fear, then when we find ourselves falling apart, crumbling, shattering, disappearing, we fear that we are going mad, and indeed our reaction to the threat of annihilation as a person is what society calls madness. Madness is our fear of annihilation and our defences against that fear. If we understand what our fear is - that is, that events have shown us that there is a serious discrepancy between what we thought our life was and what it actually is - we can, despite our sadness and distress, act sensibly and effectively. If we do not understand what the fear of annihilation is, we become frightened of it. We then deny this fear in ourselves and we reject those whose behaviour may remind us of the fear we want to deny. This is why people suffering mental distress are rejected.