Book review: Drop the Disorder! by Adie Hulm

Drop the Disorder! by Jo Watson questions the entire concept of pathologized diagnosis by examining the consequences and social construction of distress. It examines the question of who decides what is normal and why do we perhaps judge and reduce people who are so often going through an authentic, understandable, emotional struggle with trauma? It then goes further by challenging the political and institutional process by asking how psychiatric diagnosis holds so much power and how can it be positively challenged before discussing the alternatives to diagnosis.

Personal review 

After many years of working within the mental health sector of various NHS
establishments I can see now how much of my initial confusion and dislocation to the medical process was simply based on a gut feeling and disconnection that has often been hard to quantify or articulate. So therefore, in many ways, this book started to become somewhat revolutionary for me the more I read. It was a little bit like reading where cartography had not been before! It started out by offering me empathy and understanding in its language, like a form of paraphrasing of my own thoughts and feelings before doubling down and empowering me with cogent, researched academic arguments and narrated real-life experiences that all set out to challenge the morality and legitimacy of the medical model as I have always known it.

By the end, I was engrossed by the narrative, and a confirmed disciple of
the Drop the Disorder! movement despite being left with an unexpected sense of deflation. This deflation was not because of the book itself. It was because I couldn’t get away from the reality of how difficult the message it communicates so brilliantly still remains such a challenge. Specifically, the challenge of attempting to penetrate power structures that hold such strength of rubric to which we all inevitably become shackled to. And of course, these structures inevitably start to become dogmatic and therefore leave very little room for nuance.

But despite this, it’s that nuance of change I remain hopeful of because Drop the Disorder! narrates stories that cannot be unheard. And I have confidence that the idea of an alternative language to the medical process can start to filter through. My hope would be that any reader will be able to feel the necessary call for recognition of this to be realised the further they read on as I did, even if I was not personally in any great need of complete conversion myself. But equally, from a more political or sociological position I’ve often found when systemic change is mentioned, I become instinctively interested in the movements that challenge or seek to empower what might be described as “disadvantaged groups”.

And this is how the book describes those at the mercy of the system, diagnosed, labelled, and condemned to a process that disadvantages their recovery, and ultimately their right to be a person. And the more I read the more curious I became about the resistance to change and the difficulties that are faced when trying to bring about change. So, I was particularly educated by the way the book encouraged the reader to explore who would be negatively impacted, and were that change to be brought about. It offers endless examples that include “Of the 170 people constructing DSM -IV, 56% had one or more financial associations with the pharmaceutical industry; of those on the committees that decided the ‘disorders’ for which drugs are the first line treatment, 88% had financial ties to drug companies” (chapter 6. P71)

But here might be the consequentially embedded brick wall that fuels my
sense of deflation… Because labels have power. And “A further barrier to language change may derive from the privileges granted to those who have been given a psychiatric diagnosis. A label such as ‘clinical depression’ or ‘schizophrenia’ written on a health record can often be an essential requirement for accessing state benefits and a necessary passport into specialist mental health services” (chapter 10, p127). I would also suggest from a psychological perspective, in the current sociological context, a label can also represent a recognition of the pain an individual is experiencing and give meaning to their cry for help. “Therefore, until we witness a paradigm shift in the way the developed world makes sense of human suffering and overwhelm, a reliance on biomedical language will, to some extent, be necessary.” (Chapter 10, p127).

And this book continues to highlight this as one of the most complicated parts of challenging the system. We’ve come so far in a process of categorising and labelling that without this recognition the book’s underlying message might easily start to sound too farfetched or too fantastically revolutionary for some. But if I’m to find flickers of hope in response to my deflation It comes in every new story told from sheep analogies to octopus tentacle terminology. And for every new personal story, there becomes a greater strength in number, and that increased collective weight encourages a belief that the ideology can start to penetrate. And with that in mind, I feel it might be worthy to continue this review aligned to the personal storytelling theme from the book within my own story. And how Drop the Disorder! has enabled me to understand and communicate the reasons for the incongruence I once felt in being part of the system.

I was a 26-year-old support worker sat face to face with a recently sectioned, police-escorted patient on a mental health ICU ward. As this patient looked me in the eye with what took considerable effort to fight the level of sedation they were under, they asked me… “What can you actually do for me, how can you help me, you look like a teenager, how can you help someone of my age, how can you understand what I’ve been through?”

This moment has stayed with me for all of my working life because it provoked personal feelings of incompetence, inadequacy, and rejection. But it was the power of this interaction and the difficult feelings I experienced that encouraged me to start asking myself for the first time… “Exactly how am I helping these people I’m supposed to be caring for?” The language of counselling has started to provide me with answers to these questions. Or perhaps more pertinently the language of person-centred theory. And if this needed further reinforcement then it comes in waves throughout this book. Within the language of Drop the Disorder! I am now able to describe that version of myself to have been a tiny compliant cog within the system. I didn’t have an answer for this patient because, like them, I was doing what the system told me to do.

At that moment the patient was just initials to me on an ICU whiteboard, a label of what was wrong with them, with a long script of negative ‘warnings’ attached which made me fearful of sitting too close, let alone leaning in to truly hear who they were or what had happened to them. Those scary, dehumanising labels and instructions therefore just reinforced and justified my need to be compliant in the denial and irrelevance of the unique social and cultural experience of that individual. I became complicit through the naivety of an institutional process that absolved my lack of human connection and moral responsibility because I wasn’t caring for this patient, I was prison guarding them.

And as I reflect on my personal experience and the language of Drop the Disorder! it also helps me understand where some of my frustrations in the more recent awareness of mental health manifest. It’s not that I don’t think it’s important to encourage greater acceptance and understanding of what another might be going through or even to raise awareness of specific disorders. But the current promotional pitch of raising awareness often feels like it just reinforces a greater attachment to the label for me. And I again find myself worrying that the nuance of this book’s message is consequentially being lost even within an admirable effort to create positive action. Because for me it feels like if we are not careful we might end up moving further away from encompassing a more holistic idea such as recognition of the variety of psychological diversity within all of us.

Drop the Disorder! should be essential reading for anyone working within mental health and that of course includes student counsellors. Because at its heart this is ultimately an intended call to arms, a message for us all, particularly those within the professions that have an even greater influence to create change by always reflecting on what we do, who we are, and what we believe in. And that’s the attitude every counsellor should be working with from day one. Because when a counsellor is attempting to understand a client and empathise with their personal story they are trained to be aware of difference and diversity and resist categorisation and the generalisation that is found within a diagnosis or label.

So when a counsellor is trying to discover a client’s authentic character they will be doing all they can to avoid linguistic laziness in order to hear an individual’s experience in full paragraphs to understand who they truly are. And that’s because as Drop the Disorder! explicitly communicates, there is not a single person that can be fully understood or uniquely experienced within a single word, diagnosis, or label.

Drop the Disorder! Challenging the Culture of Psychiatric Diagnosis is available now from PCCS books.