Modern psychiatry has turned suffering into a health problem.
It gives disease-sounding names to distressing feelings and behaviours (‘generalized anxiety disorder’, ‘eating disorder’, ‘attention deficit hyperactivity disorder’), to legitimise the idea that they are illnesses. There is no scientific evidence to support this hypothesis, despite several decades and billions of dollars of research. The brain of a person who feels depressed is no different to the brain of someone who does not.
This approach, known as the medical model, has several consequences.
First, it presents itself as a justification for the prescription of drugs, which psychiatry calls ‘medication’, to nullify the symptoms of distress.
Second, it creates a power imbalance, whereby the sufferer is told that doctors, psychiatrists and therapists have expert knowledge about their suffering, and authority over its treatment.
Third, it leads people suffering to believe that they have a disorder, that their pain is the sign of a dysfunction within them, and that to be ‘healthy’ is to be without distress. The medical model’s end goal for the sufferer (the ‘patient’, in psychiatric terms) is ‘mental health’, a standard which is presented as a natural order of being, but is in fact a normative concept.
For the twelve years during which I received outpatient psychodynamic therapy for an ‘eating disorder’, alongside a daily dose of Prozac, I understood that being healthy was my North Star. I had to organize my life so that it appeared, to my therapist, that I understood what mental health was.
Altering my behaviour was essential to overcoming the ‘eating disorder’; it was only by eating certain combinations of food, at certain times, in certain conditions, that I could recover. Since the ‘eating disorder’ distorted my thoughts, I was told, it was important to monitor them, too. Rumination – dwelling on a subject – was discouraged; if I allowed my thoughts to roam freely, how could I complain about being depressed?
In my late twenties, I had a series of crises. I realised I was far unhappier than I had been at seventeen, when I had first sought treatment. The pursuit of mental health had made me mad. Through good fortune, someone I knew explained the medical model to me. He told me that it was an unproven theory, driven largely by profit motive. The system that I had trusted in as the one and only way to receive help, was in fact a scientifically corrupt, ethically problematic construct, that had convinced me and countless millions of others that our suffering was an illness – an illness that didn’t actually exist.
Events around me were causing enormous emotional pain, and I wanted relief. But psychiatry had been revealed as the emperor’s new clothes. I saw through it; it had nothing for me. I quit the Prozac and the psychodynamic therapy. I found the Site for Contemporary Psychoanalysis and began seeing a psychoanalyst three days a week. He had trained at the Philadelphia Association, set up by R.D. Laing in 1965, which approaches distress in all its forms as an intelligible response to relationships, circumstances and social norms.
Life changed, almost overnight. Before, therapy had involved sitting in front of an ‘expert’ and discussing the latest evidence of my illness – the lunch I hadn’t wanted or the tears that wouldn’t stop. Now, it was a conversation, with someone who refused to entertain the notion that I was disordered.
In one of our first sessions, I told my new psychoanalyst that it was my fault I was so depressed, because I was having the wrong thoughts. I was sitting facing him; it would be a year before I lay on the couch. He threw his head back and roared with laughter. He kept laughing and laughing and laughing. No therapist had ever laughed in my presence. I wasn’t sure what to do. Eventually, I couldn’t help smiling.
What’s so funny? I asked, hesitantly.
That! he exclaimed. What you just said!
That I have the wrong thoughts?
Charlotte, he said, struggling to keep a straight face. There is nothing wrong with your thoughts.
The most ridiculous of the medical model’s lies toppled fast – that I had the wrong thoughts; that feeling depressed was a biological flaw; that I was a danger to myself without ‘antidepressants’.
But other egregious implications persisted – that my suffering was a sign I was not normal; that while in emotional pain, I must do something to eliminate it; and that how I liked to spend my time was wrong. These have taken years to dislodge. Here are several things that happened during that process.
I read more than ever before
My psychoanalyst helped lift my hangover from psychiatry. But I only saw him three or four hours a week. The rest of the time, books were critical. I read every writer I could find who challenged the pseudoscientific edifice on which the medical model teeters. An inexhaustive list includes Michel Foucault, R.D.Laing, David Cooper, Thomas Szasz, Sigmund Freud, Jacques Lacan, Donald Winnicott, Slavoj Zizek, Marion Milner, John Heaton, Robert Whitaker, Richard Bentall, James Davies, Jacqueline Rose, Adam Phillips, Darian Leader, Jessica Taylor, Lucy Johnstone, Joanna Moncrieff and dozens more.
I read about the Power Threat Meaning Framework; about the efforts of the United Nations Special Rapporteur to challenge the medicalization of distress; and about the experiences of people such as Laura Delano, who, like me, had trusted psychiatry to help, only to find it caused serious harm.
Previously, the eating disorder therapist had made me understand that my pain was a medical problem, and therefore philosophical questions were not relevant. The therapy room was not a space for intellectual discussion. Indeed, when at eighteen, I read that a common symptom of ‘eating disorders’ was over-intellectualization, I told myself that to intellectualize was unhealthy, and would perpetuate my illness.
On the very rare occasions I mentioned to the eating disorder therapist what I was reading on my English degree, I was apologetic. Literature was not as serious as psychiatry; what was important in the therapy room was my illness, not my interests. In hindsight, I think I felt apologetic because I had taken the conversation into a field in which she was not confident; I had challenged her authority and the extent of her knowledge, and that, in psychiatry, is something the patient should never do.
In psychoanalysis however, I discussed everything. My analyst told me to stop apologising for quoting from whomever I was reading. He let me talk. I began to understand that I didn’t have to bring him evidence of my problems every time we met. I could speak to him about what I enjoyed. In analysis, the question was not how to be healthy, but whom and what to love, how to live, and, in fact, how to suffer.
While I read more books, I stopped reading most media articles about mental health, unless to laugh at them. With the exception of a very recent spate of articles that challenge the dominance of biomedical psychiatry, most reporting by the main media outlets restates uncritically the claims and assumptions of the medical model. Concepts such as ‘mental disorder’ are presented as medical fact, and the false merits of ‘antidepressants’, even for children, are repeated.
Meanwhile the media fails to report studies like this one, which showed that children told they had ADHD (psychiatry calls this ‘diagnosis’) were 2.5 times more likely to harm themselves than those with exactly the same symptoms but who were not told they were disordered.
I walked a lot
When I stopped believing in the notion of mental health, I began to walk – everywhere. I couldn’t stop. I roamed around London, the city I had lived in for ten years, yet which I had never really claimed on foot. I walked two hours from my flat into Soho. One Sunday, I walked three hours to meet a friend in South London for lunch.
In eating disorder therapy, I had denied myself the pleasure of walking. To exercise in excess was, I learnt, yet more evidence of an ‘eating disorder’. To recover, I should limit my exercise. I did as I was told. I tried to imagine what a normal person would consider a normal distance to walk. I decided upon half an hour. Any distance longer than that, and I should do the non-eating-disordered thing – the ‘healthy’ thing – and get the bus or tube. For years, even when I wanted to stretch my legs, I forced myself onto public transport. Writing this now, I am aware this sounds quite mad. It was. But I was simply confining myself to the parameters of ‘healthy behaviour’ that I had been given. The psychiatric gaze ushered me off the pavement and onto the bus.
After I left the medical model behind, the desire to walk everywhere was, I think, a reclamation of many things: my legs, my body, my city, and the power to spend my time and energy however I chose.
I stopped living under the ‘psychiatric gaze’
I had spent my entire young adulthood living under the ‘psychiatric gaze’. Everything I did, said and thought was judged and evaluated through the prism of the medical model’s value system. Worse, I had adopted that gaze myself. I had learnt to monitor and alter my thoughts and actions according to what psychiatry deemed to be appropriate and correct – or, to use its own language, ‘healthy’.
To give an example, my eating disorder therapist pressed onto me the idea of relaxation. I didn’t relax enough, apparently. This was a common symptom of ‘eating disorders’. Therefore if I learnt to unwind, I would lessen the disorder. I had never really thought about relaxation. But I took what she said seriously. I forced myself to watch television in the evenings, because that was apparently how many people liked to unwind. Most TV bored me, but I thought that was the point. To want to be stimulated was to refuse to switch off, and it was this refusal to switch off that was part of my illness.
When I read interviews in the newspaper with people – writers, artists, experts – who said there was no boundary between life and work, that they were always working in one way or another, I judged these people through my therapist’s lens, and frowned on their ignorance of healthy behaviour. They were clearly obsessed by their work, and obsession is a dirty word in psychiatry.
It has taken me several years to realise that I don’t find the kind of relaxation that the eating disorder therapist espoused to be relaxing at all. I, too, am now happily obsessed by whatever I am working on at any given time. I don’t want to switch off from it, for the sake of ‘health’. Other ends than psychiatry’s notion of ‘health’ have become far more interesting to me, anyway; I prefer to be obsessed.
I started writing
The year I left the medical model behind was the year I began to write, seriously. Since I was a child, I had wanted to write a book. But during the years of eating disorder therapy, every time I sat down to write, what came out were furious, sad and lonely words. Editing them through the psychiatric gaze, I made myself stop after a few paragraphs, because what I had written was clear evidence that my thoughts were wrong. These words presented a problem; I was supposed to be in recovery – indeed I believed myself to be striving towards a life of health – yet when I gave my pen free reign for just a few minutes, what emerged were cries and despair.
Under the combined pressure of both the psychiatric gaze, on behalf of which I tried to filter out bad thoughts, and my depression at seeing the most strident of those bad thoughts make it into ink, writing was not possible to sustain. I refused to expand what I had to say, which is that I was suffering. I saw what I wrote only as disordered, negative. To declare on paper I was suffering was, in the logic of psychiatry, self-fulfilling; that is, to speak of suffering is to ensure its continuation. The pursuit of mental health was making me mad. Expression was impossible.
In a beautiful essay on the 1964 book Sanity, Madness and the Family by R.D.Laing and Aaron Esterson, Hilary Mantel recounts how refusing psychiatry’s description of herself led her to write:
The question of whether I was or was not physically ill was still open, but the question of whether I was mentally ill was closed. It was a non-question. It was not up for debate. This may sound arrogant. But I believe it was necessary for me to draw a big black line between my past and my future. I had to save my life, I felt. I did not have a solution to my problems, but the solutions offered by others had led me deeper into trouble. I had taken on other people’s view of me as not just a sufferer, but a patient. I had taken the drugs they handed to me and they had produced in me symptoms which looked and felt like madness. Once I had experienced akithesia, I knew what madness felt like. So it was not a question of minimising, disguising, covering up my distress; it was a question of redefining it.
At the same time I began to write. This was my way of redefining me. I felt the insights I had from the book in many ways empowered me to do so; I had more faith in my own judgment and powers of observation and indeed, you might say that for a while they were the only things I trusted.
I stopped feeling less sane than everyone else
In eating disorder therapy, the world is divided into two sorts of people: those with disorders and those without. The latter group manage to live a mentally healthy life, one learns, by themselves. The former group can only do so with the tools and drugs of psychiatry. For years, I longed to be in the latter group. I longed to be normal. I felt lesser, because I wasn’t.
Outside the construct of ‘mental health’, I feel far more at home in the world. The foundation of the medical model is stigmatization: classifying certain behaviours as normal, and deviations from them as abnormal. These deviations, as explained earlier, are given disease-sounding names such as ‘eating disorder’. The notion of ‘destigmatizing mental illness’, which is bandied about in psychiatric circles, is laughably incoherent. It is not logically possible to ‘destigmatize’ a status which is born out of stigmatization.
I became furious
A pseudoscientific model of thought, bankrupt ethically, intellectually and philosophically, stole twelve years of my life. By some measures, I am lucky to have escaped it when I did, at twenty-nine. Others have had far more time robbed. But I envy someone like Hilary Mantel, who reached ‘a moment of inner decision, dawning knowledge’ at twenty-one, on the cusp of adulthood. It is impossible to know what nine years of Prozac has done to my brain, and to the brains of millions of others. These drugs are neurotoxins, not ‘medication’.
Satire helps. I find myself laughing out loud at interactions like this, which show how flimsy the foundations of biomedical psychiatry really are:
When I open the ‘eating disorder’ self-help manuals I used to pore over, I realise they are better read as dystopian fiction. Ridicule, directed at oppressive, coercive systems, is powerful. Subversion works. Every system contains the seeds of its own destruction, and few more transparently so than the medical model of distress.
enjoyed this and happy to see someone escape – however the resources required to make escape more likely to happen are simply beyond most people. This means ‘living under the ‘psychiatric gaze’ is unavoidable and inevitable as people try and eek out the toxic crumbs of reasonable adjustments and benefits the gaze offers – like some oozing teat of doom – resources are the be all and end all of any chance of escape. Without them you are left with a spoon to dig 500 hundred miles of tunnel under and away from the psychosis we call normal culture.
This is beautifully written Charlotte. Thank you 🙏
This is a great article! Thank you Charlotte!
Thank you for reading!