Early identification

  These problems already confront some families with schizophrenia. An Australian service for treating young people with schizophrenia as early as possible has begun successfully to identify individuals who are at very high risk of developing the illness. These are usually adolescents in families with schizophrenic members and who themselves are ‘odd’ or ‘withdrawn’ and report unusual, but not clearly psychotic, experiences. Should the team, being fairly certain that the young person is likely to become ill, offer treatment with antipsychotic drugs? They have conducted a trial where they gave one half drugs and the other half placebo. Those given drugs developed fewer psychoses. However, not all of those without drugs did become ill (i.e. if it had not been a trial they could have been given the drugs unnecessarily). The implications for young people at such a sensitive stage of their development are clearly enormous. This is just one example of the sort of decisions we will increasingly face as technologies improve.

  Specificity of gene identification in mental illness is still a long way off. Any large-scale genetic screening to avoid psychiatric disorders would inevitably mean a steady reduction in the rich variety of human behaviour. How happy would we be with that – a world without Van Gogh or without Schumann?

Brainwashing and thought control

  Most of the scarier fantasies about psychiatry have usually been about its ‘awesome powers’. Ever since the term ‘brainwashing’ was first used during the Korean War in the 1950s these fears have condensed around it. In truth psychiatrists have little extra knowledge about such procedures beyond those well known in cognitive and group psychology. Psychiatrists and psychologists do advise governments and the military about how to persuade people but their techniques are hardly more advanced (if as advanced) as those of successful advertising agencies.

  Millgram’s famous experiment is mistakenly quoted as an example of this power. He used actors to demonstrate that normal people were prepared to deliver severe, even life-threatening, electrical shocks to other people if told it was part of a psychology experiment. This study did not demonstrate the awesome power of psychology, but rather the scarier, but commonplace, propensity we all have to surrender our judgement to ‘authorities’.

  Where some of the earlier ‘science fiction’ fantasies have proved right is in the pervasive use of mood-altering drugs. ‘Soma’ in Aldous Huxley’s novel Brave New World was a drug to keep the masses contented and submissive in a totalitarian state. How far are we from that when 30 per cent of the adult population of France were taking psychiatric drugs in the late 1990s and when 10 per cent (and rising) of US schoolboys are taking ritalin? There is an increasing availability of such drugs which both treat mental illness and also enhance how healthy people feel. ‘Better than well’ is how many describe the effects of these ‘designer’ drugs. People have always self-medicated with recreational drugs but now prescribed drugs are widely used to deal with normal life stresses.

  This risk that psychiatry may invade all aspects of our life and ‘medicalize’ the human condition is increased by the emphasis on the simpler, more reliable but democratically negotiated approach to diagnosis discussed in Chapter 6. The size of the psychiatric population used to be restricted by psychiatrists only giving a diagnosis when the patient’s experience and behaviour was felt to be fundamentally ‘different’. If a diagnosis follows automatically from a series of complaints (without being filtered through such a judgement) then there is little restriction on expansion. We increasingly encourage self-disclosure and attention to our feelings, hence perhaps the rapidly rising number of people who consider themselves depressed or anxious. Most of us welcome this more accepting, open approach to human experience. Equally, most of us support a more balanced relationship embodied in a psychiatric consultation which takes the patient’s symptoms more seriously than the psychiatrist’s preoccupations. But are we happy with the consequences as ever-increasing segments of our lives become labelled as psychiatric disorder?