In January 2012, I asked psychiatrist, Dr Hugh Middleton for his views on ‘undiagnosis‘. This led to this question:
Once identified as one with a mental health difficulty (or even worse in some ways, a specific diagnosis) how does one clear one’s name?
Starting with Hugh Middleton’s thoughts on this subject I hope you will agree the following is realistic, useful and worth passing on as it points a way forward in reducing stigma and suffering:
It involves being able to walk away from all the fuss others make about it.
A truly “recovered” position is when the causes of the distress do not matter any more. Unfortunate or traumatic things happen to us all. These can cause a change of direction or other lasting consequences, such a failed relationship being painful and necessitating changes to allow new possibilities.
The idea that an episode of disturbed behaviour somehow marks the person as inevitably and eternally flawed is a primitive one based upon archaic notions of mental stability. Long after a diagnosis, if one is no longer distressed, anxious or a source of concern to others, then it is only a problem if people relevant to you still believe there to be one.
Bereavement is a form of emotional distress but few would say it is a ‘mental illness’. Most people eventually move on in some way, even after a period of great emotional distress through bereavement. Having got ourselves together again, there is no question of ongoing abnormality for having been through this experience. Occasionally someone may not fully recover from a particular bereavement: I know a woman whose daughter was killed and naturally she suffered extreme emotional distress. Then her physical health rapidly deteriorated and 30 years later she is still very unwell. Even such a sad outcome did not result in a mental health diagnosis and she able to get by with support from understanding family and friends without any the stigma commonly felt for life by those who have been given a diagnosis.
When emotional distress is labelled as ‘severe mental illness’, the public (to some extent that is all of us) can associate the label with manifestations of extremely disturbing behaviour. It is difficult to shrug off terms such as ‘psychotic illness’ and move on from it.
Rituals that help people to move on after bereavement are well-known, such as the funeral, disposing of effects and making new friends/relationships. People who have suffered all forms of emotional distress have always had ways of coping and moving on if they are allowed to do so. Since the 1980’s it has become increasingly popular for those who make good recoveries to document and share these through books and training courses. How recovery happens is certainly not a mystery, as simple concepts and methods lie at the heart of these accounts of recovery. Unfortunately alongside this increased focus on recovery is a modern belief that ‘in-recovery’ is the only state worth aiming for and healthcare staff now often shy away from talk of ‘full recovery’.
Involvement with anti-stigma work has led me to doubt that this can have much effect until healthcare staff can get over the ‘in-recovery-forever’ idea. The public can be influenced by celebrities who appear to be in-recovery, but the people most of us look to for guidance about what is possible are the health professionals. It is they who need to return to the roles of the pre-drug era where belief in full recovery was widespread.
Ultimately, recovery from emotional distress will return to normal when we can all stop calling it ‘mental illness’. Hardly any of the people being diagnosed either have a definable mental problem or a diagnosable illness. Emotional distress is to do with emotions and when people can be helped to understand their emotions and what has caused their distress then full recovery becomes the norm. It is time those who have recovered start to work more closely with the medical professionals who are ready to abolish psychiatric diagnosis.
Roger Smith – based on my conversation with Dr Hugh Middleton in January 2012
Rethinking Bipolar
