A response to Professor Willem Buiter’s blog Sunday 6th January, 2008 ‘Is Britain going mad?’

First paragraph: A binary is set up: those who suffer from mental illness – a terrible affliction – and the rest of the population who do not and conform to the government’s definition of acceptable citizens. The government in their NICE clinical guidelines elaborates this distinction. The government separates mental illness into component parts: depression, anxiety, OCD, AHD, and so on. The government uses its clinical expertise to 1) define the component symptoms (inability to sleep, etc) and 2) parcel these symptoms up and give them a label – Anxiety and so on. GPs, instead of using their clinical judgment and listening skills, now use the government-approved tests for conditions such as depression. The results from these naff tests then inform the GP of what treatment should be offered.

This link between government-defined symptoms of psychic suffering and government-recommended treatment is based on ‘scientific’ evidence of evidence-based practice. A risk-analysis (in the Donaldson Report the ‘Health Industry’ is defined, many times, as high risk and compared with Chernobyl, Alpha-Piper and aircraft pilots crashing aircraft. In all these scenarios, there is a loss of life) and a cost-benefit analysis gets included in the evidence-based practice. It is little wonder that evidence-based practice recommends a ‘quick, cheap and easy fix as the only permitted and standard treatment.

Second paragraph: ‘Mental illness can be hidden or faked.’ I agree with this paragraph. In addition, I note that the government is driving this definition of mental illness – a term I do not use. Many of the symptoms vilified as mental illness by the government, occur, in my practice, in what the government would define as acceptable citizens. When did you last feel very anxious or depressed? In my case, last weekend. These symptoms have to be heard in each individual’s context not added up into a machine for eliminating ‘mental illness’.

Third paragraph: ‘Many people tell lies easily and effortlessly’. I agree with this paragraph. There is anecdotal evidence that victims of government-controlled counselling and therapies do fill in feedback forms positively at the end of sessions so they can escape. Jacques Lacan has commented on the use of lies by subjects. A psychoanalyst is interested in the meaning of the lie.

Fourth Section: I agree with much of this economic analysis. Indeed, given my rudimentary understanding of economics, I am impressed by it. This does not stop me from commenting:

I agree a serious statistical study of the relationship between IB claims based on mental and behavioural disorders and possible non-medical drivers of such claims would be useful.

However, I fear that qualified psychiatric experts, using the government-approved NICE clinical guidelines, will not provide the conclusive test outlined. The reason? The logic of NICE guidelines has been purloined from industry or elsewhere. It is a logic which produces certainty that is very far from the uncertain processes involving relationships used by most talking therapists. Qualified psychiatric specialists have been reduced to collaborators who implement the government’s orders. There are always exceptions who work against the standard being forced on them.

‘The creation of a high-quality process to verify a person’s inability to work’. The only reason the doctor to patient coupling works is because of the relationship of trust. Read Dame Janet Smith on Shipman. A human-being is not an object to be judged as in an industry-based quality control process. Of course, the claimant will know what is the objective of the interview and will distrust the relationship. If you were under suspicion in Stalinist Russia, would you trust a member of the secret police who has been sent to interview you? I agree that the government is wrapped up in cloud cuckoo land.

I agree with the dismissal of the Tories position and Lotd Layard’s position.

I agree with the comments on hastily trained cognitive-behavioural therapists. Two points: cbt is effective with some people in some situations. My argument is that it must not be the only approved statutory mode of treatment. 2) The government’s clinical judgment is being exercised in many more areas of mental distress than anxiety and depression.

Last paragraph: I agree with this. If I had written it, I would substitute psychic distress for mental illness.

In talking about his latest book ‘Violence’, the philospher Slavoj Zizek states governments use a cycle to justify implementing their control systems. The cycle is: definition of a threat: with mental illness this varies from fear of all Health workers becoming murderously deluded as Dr Shipman to the mentally ill being as Jews in the Third Reich: deceitful, undesirable and not one of us. The government comes to our rescue by protecting us (safeguarding in the Health Professions Order 2001) and curing all the undesirables through the provision of Lord Layard’s Happiness Centres (Improved Access to Psychological Therapies.)

And in Education, Social Work, the provision of Identity cards, the registration and regulation of all therapists, counsellors and therapists, etc., so far apathy or collaboration seems to be winning.

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