Given the problems with diagnosis covered in the previous post, we might ask why practitioners continue to employ these, often without critical consideration, and to maintain a split between the ill and the well.
In her book, Users and Abusers of Psychiatry, Lucy Johnstone suggests that it is very tempting for mental health practitioners to treat clients or patients in an 'us and them' way because of how invested they are in the current system. There is the danger that, without such clear splits, their job security would be in danger. Also they would lose the sense of expertise and professional power that they have if, for example, there was a de-medicalising of distress or a de-professionalisation of support for people who were struggling. There is a danger, more widely, that those who have an investment in being seen as sane, in control, and professional require a comparison group of those who aren't (and this may play out in mental health systems, in families and other groups, and in society at large).
Christina Richards presents a further reason why it may be difficult for practitioners to shift away from an 'us and them' approach to distress. She argues that underlying a resistance to change might be a sense of: '“I have been doing things this way for years and will continue to do so as this way must be right (because if I have been doing it wrong for all these years look at all the pain I’ve caused/ time I’ve wasted/ good I could have done)”. It boils down to: “I can’t act in the future, because that proves I could have done so in the past”.'
This way of thinking can keep people very stuck on both sides of the 'us and them'. For practitioners it prevents critical exploration of their current ways of understanding and practising, and substantial revision of diagnostic manuals, etc. which have been used for so long. For clients or patients it makes it difficult to change in ways that might alleviate suffering because changing is seen as acknowledging that one could have changed previously (this is especially difficult because taking personal agency is seen as putting a person on the 'not ill' and 'all my fault' side of the dichotomy explored in my second post). The more time passes, the harder it can be to step away from the way you have been doing and seeing things. There is a kind of tyranny of consistency which would be helpfully addressed by a model which embraced the fact that people change over time and that it is okay to revise and adapt the way we used to see things or admit that we were wrong in the past.
Richards quotes the great sage, Esme Weatherwax, who said that 'Sin ... is when you treat people as things. Including yourself. That's what sin is.' Whilst, of course, we require some kind of language to describe, and make sense of, our experiences of distress, we need to be cautious of ways of understanding that function to trap people and to concretise things rather than enabling them to move. We also need to be alert to understandings which assume that the biopsycho can be disconnected from the social such that it is only the individual who is seen as disordered or malfunctioning, rather than wider systems, and only target treatment at the individual (rather than the family, the school, the organisation, the media, or wider culture, for example). The social aspect is something that I will explore further in the next post.