Is historical and present-day psychology a force of good?

Historical and present-day psychology

Psychiatry has a significant influence on society, but whether this influence is a force for good or not is still actively questionable, depending on the individual questions asked.

Historical and present-day psychology viewing the works of William Shakespeare’s Macbeth with Lady Macbeth going through a mental breakdown, followed by the sixteenth century with the government’s agenda to push for legislation and punishment for people who do not fit into social norms or adapt to what the government considers being normal society, creates an expansion in asylum centres to modern-day community outreach programs, leading to psychiatry working much better to be such a force of good.

In The Birth of Psychiatry, David W. Jones shows that grief and despair are common themes in Shakespeare’s plays. This shows awareness of mental health issues in sixteenth-century Britain. The seventeenth century saw further exploration of the causes of happiness and unhappiness, revealing a growing interest in understanding the human condition.

A scene from Macbeth, with Lady Macbeth showing clear signs of mental health-related issues and the doctor taking notes for memory recollection as Lady Macbeth is suffering from ongoing fear and worries of anxiety from what seems to express guilt followed by shamefulness regarding past events with signs of hallucination on seeing non-existing things such as blood pouring from the tap and onto the hands followed by the attempt to wash the hands clean from the blood that does not exist and smelling nonexistence blood from her hands the sound from the servant in shock when lady Macbeth uses harsh chemicals to wash the hands clean along with the feedback that the lady does not get much rest showing an indicating factor to a more serious mental health requirement as the doctor does express that this is beyond his capabilities to treat.

Lady Macbeth’s inability to care for herself or become a potential risk to herself or others shows creative thinking in Shakespeare's writing. The doctor’s note-taking and ability to communicate at an understandable level with the servant whilst screening Lady Macbeth’s care illustrate that the audience acknowledged mental health detailed scribing during that era. The servant’s role seemed to evolve during these events, shifting from a servant to a carer.

Mind UK’s 2020 report, “How to Cope with Sleep Problems,” states that mental health issues like anxiety, depression, paranoia, and psychosis can lead to disrupted sleep patterns because individuals may find themselves stuck in a vicious cycle.

The sixteenth-century push by the government and religious leaders with the agenda to discourage vagrancy and begging through acts of legislative initiatives referring to ‘poor law’ often resulted in cruel punishments for those who did not choose to reform, quoted by Brundage (2002), resulting in an aggressive act from enforcers to change the social norms and how people think and feel, including identifying differently with people who do not commit to change, identified as antisocial. Eventually, the nation changed with scientific endeavours that led to the Industrial Revolution (David W. Jones, The Birth of Psychiatry, p. 25), favouring more rational thinking and behaviour from people as previous thinking became less favourable to irrational and no longer accepted.

According to Foucault, a psychiatrist, this is an essential mechanism for enforcing such norms (Foucault’s Madness and Civilisation, 1967). Associates in psychiatry enforce particular standards of behaviour, including thinking and feelings, thus resulting in power, which is ever-present in our lives. A visible example of the direct use of power to confine people whose behaviour doesn’t align with social norms to control is that involved in moral treatment and the subsequent talking cures.

The expansion of private asylum centres operated by entrepreneurs who offered a paid service to take in and care for the insane had increased through the eighteenth century (David W. Jones, The Birth of Psychiatry, p. 27), progressing toward the invention of new language and terminologies such as insanity for those judged to be insane, eventually banished from normality with efforts to confine and treat them. 

Private asylum centres flourished during the nineteenth century with the government actively interested in controlling those who were thought to have behaved or threatened the social norms, with the controlling factors involving treating everyone identically that could do more harm than good, including rigid structures such as when to sleep, what to eat, wash or bathe, and what dress code to wear, stripping personal identity away from the people who were confined in such systems. Similar to the structure of the schooling and military services that require the individual, in most cases, to have no alternative options on how to dress, sit, stand, and when to speak by senior’s approval.

The 1980s saw a decline in the asylum population, with the ongoing cost pressure to maintain these expensive centres now becoming a drain on resources. The government eventually accelerated the closure of asylums by introducing a Community Care Policy, Audit Commission, 1986. This policy shifted across various national health and social care services, taking away long-term institutional care to support people in their homes and communities. The post-war period witnessed an expansion of diagnostic categories of mental disorders, which meant that mental illnesses became viewed as something prevalent across a wider group of people having the good intention to make the service more accessible and available with the purpose of monitoring people with low incomes, including children for the overall wellness for society and to monitor individual services users more closely.

The owner’s intentions for the asylum centres will always be unclear; however, it has always been better to service the community on a much broader scale by housing people in a controlled, confined environment long-term as the establishment became more business income-generating with overcrowding and understaffing. Asylums largely came to deserve their characterisation as dismissive prisons that their families and communities rejected. Scull (1996) quotes David W. Jones, The Birth of Psychiatry, Ch. 1, p. 27.

Bentall emphasises that 16 distinct symptom combinations can lead to a diagnosis of schizophrenia, questioning whether they are meaningfully discussing the same experience in different cases. None of the authors who critique the diagnosis question whether the experience is real or distressing, whether the diagnostic describes the knowledge of the person’s problem, or whether the diagnostic is helpful.

Empathised Peter Campbell, a service-user activist, historian, and writer, stated that challenges to the scientific concept of schizophrenia have never significantly involved mental health service users, who are more concerned with the consequences of diagnosis than the validity of the diagnostic process. 

The importance of considering a diagnosis is the overall impact on those who receive it, especially the service users, rather than the technical questions of validity and reliability. Some people may find comfort in knowing a diagnosis, as it meaningfully improves what could have been a very confusing situation. Furthermore, diagnosing what is happening can enhance communication between treatment programs and medication that might not have been available otherwise. 

A labelled condition can also impact how others interact, such as students with dyslexia requesting additional time and support in their work or understanding attention deficit hyperactivity disorder (ADHD) and where the person sits within the spectrum. However, there is an attachment issue with these labels: The individual becomes more attached to the label than to the associated condition.

The downside associated with this is a societal stigma attached to receiving a mental health diagnosis, which can lead to discrimination from others, including how loved ones attribute certain tendencies to be associated with the condition rather than the understanding of the distress the person is experiencing, or the lack of specific job opportunities, including relationships.

Whether agreeing that on balance psychiatry has been a reasonable force or not will always depend on the person receiving the care; however, some aspects have been beneficial, such as the closure of asylum centres and the right to patient-centred care, obviously within limits, as there are some cases of mental health in which the individual is not of sound minds, such as the conditions under the umbrella of dementia.

Historically, psychiatry has been an evil tool pushed for political motives to change society to a new direction for thoughts, feelings, and behaviour, causing a stigma on those that do not conform, such as the homeless, gipsies, and traveller communities, being viewed as outcasts. There is no denying that psychiatry has contributed to being the gateway change to mental health throughout history; whether it’s a positive change or not is still debatable. The stigmas associated with mental health conditions have lowered within the younger generation.

Akhtar, (SAC Dip), Lead Counselling Psychologist.