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Can the mental health
system
cause paranoia? By Tamasin Knight |
Since I have been
actively involved in mental health I have noticed that a number of
people
labelled paranoid have had some additional previous psychiatric
diagnosis.
This set me wondering that perhaps the emergence of this paranoia
rather
than being caused by biochemical imbalances or even psychological
vulnerabilities, may be more likely to have its roots in peoples
involvement with the mental health system and as a result of the
prejudice
and discrimination received from the public. Once you are
diagnosed you
have to live knowing that you have less rights than a criminal,
knowing
that you can be forcibly drugged and knowing that 46% of consultant
psychiatrists want to erode your rights further by introducing
Compulsory
Treatment Orders. Is it really that difficult given this situation to
start generalising especially as all of this is likely to put you in
a
suspicious state of mind? The diagnosed person may start speaking
metaphorically - the fear that the mental health system is out to get
them
is transferred to another powerful authority such as the FBI or the
Mafia.
Feelings that people are conspiring against you or are spying on you
could
also be explained in this way. The woman who complains that there are
video cameras in her flat recording her may be displaying a reaction
to
experiences of being watched on a ward or after having her parents
instructed to monitor her eating patterns. It may also be that a
lot of
what users say that sounds like paranoia is really a reflection of
reality
that the mental health professions would rather not acknowledge. The
man
who claims that secret meetings are being held about him may well be
accurately describing the many meetings in which various mental
health
workers will discuss him. The person who says that people are
stealing
their thoughts, while being compulsorily administered neuroleptics is
about as close to the truth as one can get. In addition, due to
the
nature of the mental health system it seems perfectly understandable
that
people may find themselves in a suspicious state or ‘paranoid’ in a
more
general sense because of it, but I feel this is more a natural
response to
the system that anything else - ‘just because you’re paranoid doesn’t
mean
they’re not out to get you!’ Indeed, I feel such suspicion is
necessary
sometimes if the oppressive and unhelpful practices are to be
changed.
Being given endless excuses as to why you cannot see your notes and
if you
eventually do get to see them observing that various chunks have been
blanked out can start people off wondering, what are they trying to
hide?
When mental health workers insist on turning every positive about you
into
a negative - high achievement becomes a symptom of obsession, having
ambition turns into grandiosity -surely it is not hard to come to the
conclusion that they are against you. And when you know that you can
be
sectioned surely at least sometimes, it is difficult not to feel
persecuted and that they are out to get you. It has been shown that
people
living under the oppression of racism become more paranoid than those
who
do not. This seems to be because the genuine and understandable
suspiciousness in response to the racism generalises to other
matters.
Similarly is it not possible that because people are in a suspicious
state
caused by the mental health system they may start to make ‘paranoid’
inferences about other situations - neutral comments become criticism
and
mockery, the noise downstairs a burglar. The discrimination those
with
psychiatric diagnoses receive from the public may also have a part to
play
in the development of paranoia. Is it really that difficult for
someone
repeatedly turned down for jobs because they use the mental health
services, someone who lives among prejudiced neighbours, someone who
has
to endure the almost daily dose of negative media coverage, to become
suspicious in other situations or of their friends? When they join a
new
group they may become convinced that other members are talking and
laughing about them. If you come to see that your whole community is
against you, when new people enter, what evidence do you have to
convince
yourself that they will be any different? Similarly if people are
used to
being treated unfairly by others, when they receive a silent phone
call in
the middle of the night, what evidence is there to suggest that this
is
not workmates trying to make them tired so they perform badly in an
assessment the next day? Again people being discriminated because
of
their diagnosis may speak metaphorically or, their worries about
prejudice
may become exaggerated. Maybe they are listening to me through the
walls.
Maybe they are watching me each time I leave my house. Maybe they are
reading my mind so they can find out how to distress me further.
However,
after listening to others who have been harassed and truly persecuted
because of their diagnosis, these exaggerations do seem
understandable if
not factually correct. Indeed, considering the conditions under which
many
users have to live, it seems that the person who says that others
‘have
got it in for me’ may be showing exceptional insight into the
prejudice
and discrimination often directed towards those with psychiatric
diagnoses. In cases where it seems that prejudice/discrimination
played a
major part in causing someone’s distress perhaps it might be better
to
help them cope with prejudice rather than to try and convince them
via
drugs or Cognitive-Behaviour Therapy that they live among loving
neighbours and it is them with the problem. These two suggested
causes,
the mental health system and prejudice/discrimination, need not
always be
two separate factors. The most obvious combination would seem to be
in the
cases of prejudiced mental health workers, but I also find that the
issue
of diagnosis can bring about a union. I have often found that
prejudice
seems to be caused by the diagnosis itself, rather that the actual
experiences. If you tell someone that you have a ‘mental illness’ or
say
what your diagnosis is, the result can be prejudice and
misunderstanding.
However, if you describe exactly the same experiences, saying for
example
how you felt, instead of using diagnosis, the person you are talking
to
often seems to be more sympathetic and show less prejudiced
behaviour. So
it may be that the prejudice caused by the labelling process can
assist in
causing paranoia. It would seem that there are several ways to
prevent
or reduce this ‘secondary’ paranoia, yet I feel that the first and
perhaps
most important one is simply the recognition that some of the
practices
used in the mental health services can be paranoia
inducing.
'Tamasin
Knight is
an undergraduate at the University of Exeter, and in addition is
developing alternative ways of helping people who are experiencing
distressing beliefs with a grant from the Mental Health
Foundation. She
can be contacted at: T.M.Knight@exeter.ac.uk'
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