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.
Dennis the menace?
Dennis, an attractive but very thin ten year old sits quietly in an examining room of a Learning Disabilities Clinic in Oakland, California while the doctor checks his school record. Next he checks the boy’s eye movements. Dennis has a slight reading problem, a bit below standard. But the main problem, according to his mother and teachers, is that he has ‘trouble concentrating’. ‘He’s not one to sit still’, his mother says. At home he’s ‘kind of lazy’, she adds, and can sit and watch television forever.
Dennis explains that he doesn’t like school and that’s why he won’t sit still there. ‘It’s not that you won’t sit still. You can‘t sit still’, the doctor tells him. ‘No’, Dennis insists, ‘I won’t.’
Dennis has been on an amphetamine drug called Ritalin since first grade. He doesn’t take it in summer because he doesn’t need it when he’s not at school. ‘Do you know what Ritalin does to him?’ asks the doctor. Dennis’s mother says no, except it stops him eating. That’s why he’s so thin. And the school says he’s a little better on it. The doctor explains about hyperactivity, low arousal, sleep-deprivation and lethargy while Dennis’s mother nods as his words pass over her.
‘Let’s keep him on Ritalin’, the doctor concludes. ‘He seems to need it.’
CIBA-Geigy, manufacturers of Ritalin, have done well out of the epidemic of hyperactivity that seems to be sweeping the Western world. Though nearly twice as expensive as Dexedrine - another amphetamine commonly prescribed for hyperactivity - its share of the kid-quelling medication market rose from 50 per cent in 1970 to 80 per cent and $30 million a year in 1974. Much of its popularity comes from aggressive marketing campaigns in the late 1960s where it was promoted even to Parent Teachers Associations for any child with ‘functional behaviour problems' - i.e. to any child at all.
Having discovered that heroin addicts were grinding up the drug and injecting it to lengthen their heroin ‘high’, however, the US Food and Drug Administration have now classified it, along with Dexedrine - or ‘speed’ - as the dangerous drug it really is. Nevertheless, well over one million children are still being routinely dosed up with it to control what many would judge to be simple, boisterous naughtiness.
But not all parents are as passive as Dennis s mother. In Cranston, Rhode Island, Danny’s parents receive a note from his teacher warning them that if Danny is not given medication for his hyperactivity, he will be expelled from school. They reply that their doctor has put Danny on Ritalin (though in fact he has done nothing of the sort). A week later a note comes back from his teacher thanking them for their cooperation and explaining that Danny’s behaviour is much improved.
Information from ‘The Myth of the Hyperactive Child’ by Peter Schrag and Diane Divoley; Penguin Books.
...in the US
1971 3% of US schoolkids are ‘hyperactive’ according to the US Department of Health, Education and Welfare.
1974 Official estimates put the number at 15%.
1978 1.7% - 18% of US schoolkids are receiving drugs to control ‘hyperactivity’.
...in the UK
1950 600 ‘maladjusted’ children in the UK*.
1966 8,000 ‘maladjusted’ children in the UK.
1976 20,000 ‘maladjusted’ children in the UK.
1978 16,000-18,000 schoolkids in the UK are receiving drugs to control ‘hyperactivity’.
* 'Maladjustment' in the UK is defined in the same terms as ‘hyperactivity’ in the US: unmanageable, defiant, disobedient, aggressive, lying, truant, unable to concentrate, violent, overactive, etc.