Stigma, madness and mindfulness
1 Stigma, the madness of psychiatry and a redefinition of health
Dr Jenny Willis
The WHO‘s definition of health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" is understandable in its context of post-war, 1948, idealism. But is it fit for the vastly different 21st century world of globalisation yet division?
In the UK, the rapid movement of care of the mentally ill from health/social institutions into the community has been controversial. It was based on well-meaning but ill-thought through ideologies and has resulted in a significant reduction of health service generic hospital beds, and an exponential increase in ‘forensic’ beds in the public and private sectors, as well as in penal institutions: over the last 25 years, the prison population has doubled, disproportionate to demographic growth. This is the madness of psychiatry and has added further to stigmatisation of the mentally ill.
This presentation explores the definition and process of stigmatisation. It shows how pejorative language add to stigmatisation, then returns to the WHO definition of health.
2 Madness and mindfulness
Dr N Yoganathan
In the past, medicine (including psychiatry) was practised in a paternalistic way: from a perceived imbalance in the brain’s humidity (Hippocrates) or of the humours (Galen); through religious or evil possession; to the socio-dynamics of the asylums; psycho-dynamics (structure of the mind); neuro-psycho-pharmacological and cognitive/behavioural science (function of the mind).
21st century Western psychiatry has seen the incorporation of complex Eastern philosophical ideas, which are inherently incongruent, resulting in DBT and mindfulness practices. These may meet the demands of short-term, quasi-measurable outcomes but are likely to be mindless in the long term. Components of the body can be defined, measured and normatively compared, but the ‘mind’ of an individual is not confined to the brain alone: broader contexts of ‘family’ and ‘community’ are involved. Hence, despite scientific advances, and centuries of philosophical/religious debate, ‘the mind’ remains elusive.
This second presentation compares psychiatry from didactic and dialectic perspectives. An alternative model of the mind is proposed before addressing stigmatisation and mental illness. Various methods of dealing with mental illness are considered, including mindfulness training.
3 Zen, madness and mindfulness
Dr N Yoganathan
In the 21st century, the bio-psycho-social model and less paternalistic approaches to psychiatry were meant to provide a more integrated, egalitarian service and reduce stigma, but have largely failed in the UK. This is because evidence-based practice is appropriate for aspects of medicine that can be unambiguously measured. Its blind application in the field of psychiatry though, has resulted in robotic processes such as short-term targets and guidelines, splitting, dehumanised and increasingly mindlessness practice. Ironically, this is nothing less than another form of paternalism. In the UK, many patients with complex mental health needs find themselves confined to penal and forensic institutions.
It is not surprising that CBT (an effective though robotic treatment for less complex conditions), is now being adulterated through the superficial incorporation of very complex Eastern philosophical concepts such as Zen and mindfulness so as to become more humane. Is this ‘old wine in new bottles’ or Kentucky-fried Buddhism?
In order to address these contexts and controversies, we must revisit some of the principles of the past, e.g. Socrates’ questioning, Plato’s pursuit of supreme knowledge through dialogue, the antinomies of Kant, to the Hegelian triad of thesis/ antithesis/ synthesis.
Darwin’s model of adaptation is achieved over several generations, but for a healthy mind, adaptation must be achieved within a single lifetime.
The final part of this symposium presents some examples of Eastern philosophy and art. In conclusion, we propose that the WHO’s definition of health as "a state of optimal physical, mental, and social well-being." Only then, can we be truly mindful of long-term, more humane outcomes.