How clever of Juliette Jowit to pinpoint the error in the thinking of all us NHS and social care professionals beavering away in the psychosocial approaches to “mental illness” all these decades (The NHS can no longer act as if minds don’t matter, 10 November). Stone me, mental illness isn’t a “mental” thing at all – it’s simply a physical illness, “the physical basis” of which “is clear”. So our current epidemic of depression has nothing to do with loneliness, unrealistic competitive expectations, huge differences in wealth, obsessive focus on material gain, racism, sexism, homophobia, bullying, xenophobia, childhood abuse or other trauma – no, none of that stuff. As Dr Cantopher apparently assures us, it’s simply “a deficiency of two chemicals”. The answer: drugs. Simples. So however screwed up, spiritually barren and mean our society, those without the deficiency, drug-corrected or otherwise, would bounce out of bed every morning, blissfully unconcerned about all the social crap, and eager to get on with creating more wealth.
Well, if Cantopher were to draw fluid from the spinal cords of depressed people, and eve (again, pretty logical)n if he were to find such a deficiency, it wouldn’t prove a thing. The whole chicken-and-egg thing about “mental illness” is very far from clear. Recent – neurobiological – findings suggest that what we do and what we think influence brain chemistry (not much of a surprise there, I think) but also the structures of our brains. This line of approach wouldn’t have surprised Freud in the least, and Jowit is right in thinking he might feel somewhat vindicated. And that great bete noire of biological psychiatry Thomas Szasz made exactly the point she makes: “the concept of mental illness is unnecessary and misleading”, and if you believe that a person is suffering from a disease of the brain “it would be better … to say that and not something else”. Of course, he had hold of the opposite end of the stick from Jowit.
No, mental illness isn’t like diabetes. (Why is the comparison always diabetes?) There are moral, political, economic, social, spiritual aspects to it. Those things are beyond the scope of any National Health Service.
Mike Kaye
Huddersfield
• In reading Jon Ronson’s interesting article (Why didn’t we see it coming?, 8 November), I was disappointed by the unnecessary inclusion of a simplistic and somewhat misleading summary of principles of the Mental Health Act 1983 alongside it (Psychopaths and the law around the world). I was particularly concerned that comments about personality disorders being deemed untreatable perpetuate a damaging and inaccurate view held historically within the field of mental health, increasingly considered by professionals to be a myth. Such comments especially neglect the developing evidence base demonstrating the effectiveness of psychological therapies in ameliorating the emotional suffering of, and difficulties presented by, many individuals who receive such diagnoses. Let us hope that, through ongoing research and clinical innovation, these unhelpful perspectives on recovery are put to bed for good.
Nathan Kitchenham
Clinical psychologist working in forensic services, London
• Your guide to the legal status of psychopathy in the UK is wildly out of date. The 1983 Mental Health Act that you cite did require those suffering from “personality disorder” to be deemed “treatable” to be detained against their will. There was no such requirement for “mental illness”. However, this act was amended in 2007 specifically to remove the “treatability” clause. The act no longer has the terms personality disorder or mental illness in it. There is only one broad category of “mental disorder”, and the requirement is for “appropriate treatment to be available”. These weasel words were introduced primarily to allow for the detention and treatment of individuals with “dangerous severe personality disorder”.
Compulsory treatment of personality disorder (then called “psychopathic disorder”) was only introduced into the 1959 Mental Health Act against vigorous resistance. Psychiatrists at the time did not want the power and responsibility of detaining individuals for whom they believed they had no effective treatments. The “treatability” clause was added to sugar the pill. Other, wiser jurisdictions have recognised this mistake. Rather than widen the net as we did in 2007, they have excluded personality disorders from detention under their mental health acts.
Tom Burns
Emeritus professor of social psychiatry, University of Oxford
• In the last few days there have been reports of three tragedies involving people who lost their lives because mental health and other services failed to adequately treat severely ill patients. The cases of Deyan Deyanov (Care failings betrayed us, say murder victim’s family, 12 November), Matthew Williams (Review into oversight of cannibal killer after jail, 10 November) and Peter Holboll (Son with paranoid schizophrenia admits killing Tamara Holboll, bbc.co.uk, 3 November) inevitably hit the headlines and wrongly link mental illness to violence, which can only fuel stigma.
They also reveal the failure to take psychotic illness seriously and to respond to the concerns and requests for help from families. What is even more unforgivable, and does not require resources or inquiries, is the failure to extend fundamental courtesy to the families of victims in their quest for the truth.
If mental health services continue to be unable to treat safely those very few cases of patients with severe illness and a history of violence, how can they provide for the majority of mentally ill people who pose no risk to anyone but themselves? Surely services have a duty of care to protect the lives of their patients and the public.
Marjorie Wallace
Chief executive, Sane
