Chapter 3
Treatment Issues
If you're a journalist making your first foray into mental health territory, you might want to pack a guide book.
Definitions and Distinctions
TREATMENTS
If you're a journalist making your first foray into mental health territory, you might want to pack a guidebook. Innocently assuming that everyone here approaches mental illness from the same point of view could result in confusion or even capture by partisans. The political economy of the land you're entering is complex.
If you had a fixer, she would probably start by explaining in a rather simplified way how different groups here feel about the "bio-medical model" of mental illness - which is to say, the view that mental disorders stem from physical ones and so require medical solutions. Not everyone agrees - at least completely.
Psychiatrists - who are medical doctors - do. But they also usually accept that other factors are involved, and some go further than others in embracing alternative treatments. They also vary in their degree of devotion to the DSM-5, the psychiatric 'bible' sometimes criticized for sweeping too many common aspects of life into the diagnostic net.
Psychologists and social workers may approach things from psychological, social or environmental perspectives, or all three. The degree to which they also attach importance to the bio-medical model may vary widely. Many studies have pointed to "upstream" social problems, such as poverty and poor availability of housing, as having a significant influence on some mental health outcomes. Whether this is a matter of causation or exacerbation, results can be harmful and even deadly.
Then there are various formal and informal organizations representing the views of people with lived experience of disorders, some of which emphatically reject the bio-medical model. The 'consumer/survivor' movement also has its own internal divisions, but broadly speaking, people within it may not accept the mainstream concept of mental illness. In extreme cases, people with schizophrenia may be encouraged to let their voices guide them. But psychiatrists, psychologists and social workers accept certain self-help techniques practised elsewhere along the consumer/survivor spectrum.
Treatment and Consent
Neuroscience, meanwhile, increasingly uncovers physical differences in the brains of people with mental disorders, though doubt still exists about what starts these processes.
In many physical illnesses, there’s relatively little room left for disagreement about causes and treatments. Mental disorders provide much more scope for alternative theories. All this can make life difficult for journalists trained to boil things down into easily-digested packages or to respect mainstream positions.
Reporters and editors may be right to be wary of assertions that stress any one cause or contributory factor at the expense of the others.
Aside from the pro-and anti-psychiatry debate, there is another broad issue of which journalists should be aware. It concerns consent to treatment.
The historical legacy here is strong and bitter. At one time, patients with perceived mental disorders were considered virtually outside the human race as far as rights were concerned. Today we no longer condone experimenting on people who are mentally ill, but the debate over forced treatment is far from settled. It centres on disorders such as schizophrenia – in which one symptom can be that the patient has no awareness that he or she is ill. Schizophrenia, like most disorders, encompasses a broad range of conditions from mild to severe, and some patients do have insight into their state. Others – including a tiny minority who have made bloody headlines – may periodically have so little contact with reality that the Criminal Code says they may not be held responsible for their actions.
Provincial mental health acts govern and restrict the conditions under which doctors can require patients to be treated against their wishes. Some doctors chafe against some of the restrictions. Human rights activists in the mental health sphere often push in the opposite direction. And, as we shall see later, mental health courts base much of their undoubted success on effectively coercing those before them into accepting treatment instead of prison.
Health writer and publisher Marvin Ross, Chris Summerville and Dr. Anthony Feinstein discuss the problem.
Treatment and Recovery
The matter of recovery in cases of mental illness is one that often conflicts with public perception. The vast majority of patients, across the broad spectrum of mental illness, do recover in the clinical sense of returning to the state they were in before they became ill – if they have received correct diagnosis and treatment. Some recover in the different sense that, with treatment, they regain workable control of their lives, hold down jobs and become once again productive members of society, with their illness held in check. This may be the case even when illness is severe.
Chris Summerville, long-serving CEO of the Schizophrenia Society of Canada, elaborates.
Reactions to rare cases involving violence, however, demonstrate that much of society doesn’t yet really believe it. We will deal at length with issues around Not Criminally Responsible verdicts in the legal section that follows. For now, we are concerned simply with the doubt many people display that such persons can ever be rehabilitated to the point where society’s need for protection is met. This often appears to be rooted in the belief that treatment is simply a matter of ‘taking the pills,’ with the corollary that if someone stops taking his or her medication, all bets are off. But treatment for severe illnesses such as schizophrenia is a great deal more complex, leading to a much higher degree of certainty that patients can be released into the community, in time, without adverse consequences.