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Psychiatric Abuse and the Concept of Mental Illness _________________________________________________________________________Swansea University E-Theses Psychiatric abuse and the concept of mental illness. Al-Mutawa, Marwan S How to cite: _________________________________________________________________________ Al-Mutawa, Marwan S (1989) Psychiatric abuse and the concept of mental illness.. thesis, Swansea University. http://cronfa.swan.ac.uk/Record/cronfa42877 Use policy: _________________________________________________________________________ This item is brought to you by Swansea University. Any person downloading material is agreeing to abide by the terms of the repository licence: copies of full text items may be used or reproduced in any format or medium, without prior permission for personal research or study, educational or non-commercial purposes only. The copyright for any work remains with the original author unless otherwise specified. The full-text must not be sold in any format or medium without the formal permission of the copyright holder. Permission for multiple reproductions should be obtained from the original author. Authors are personally responsible for adhering to copyright and publisher restrictions when uploading content to the repository. Please link to the metadata record in the Swansea University repository, Cronfa (link given in the citation reference above.) http://www.swansea.ac.uk/library/researchsupport/ris-support/ A THESIS ENTITLED PSYCHIATRIC ABUSE AND THE COMCEPT OF MENTAL ILLNESS Submitted to The University of Wales in candidature for the degree of Philosophiae Doctor by MARWAN S. AL-MUTAWA April 1989 ProQuest Number: 10821267 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 10821267 Published by ProQuest LLC(2018). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 ABSTRACT This thesis presents a critical analysis of the limitation and weakness of the concept of mental illness and proposes the Reactive Functional Disorder (RFD) approach as an alternative moral perspective on mental illness. Chapter one highlights, through an analysis of the problems of psychiatric treatment in Kuwait, the vulnerability of the concept of mental illness to abuse. In Chapter two, it is argued that the current definitional systems used in psychiatry have contributed to the vulnerability of the concept of mental illness to abuse by employing definitions which are terminologically, clinically, and morally weak. In Chapter three, the RFD approach is presented in the hope that this account might provide a deeper understanding of the moral and conceptual implications of the concept of mental illness. Chapter four provides an analysis of some of the writings of Thomas Szasz, the controversial American psychiatrist, who argues consistently that mental illness is a myth and psychiatry is unlike other well-established medical disciplines. It is argued that Dr. Szasz, in reality, is less against psychiatry than against psychiatric coercion and involuntary hospitalisation. In Chapter five, the current limitations of the concept of mental illness are discussed with special reference to political abuse of psychiatry in the Soviet Union. The RFD approach is applied theoretically to cases in the Soviet context in order to see whether this model might provide some way towards alleviating the problem of psychiatric abuse in the Soviet Union. The final chapter argues that it is very difficult to establish a value-free model of mental illness due to the uniqueness and complexity of human personal suffering. It is concluded that what should be generalized is a definition of personal suffering that is based on a mutual patient-psychiatrist agreement on the content and frame of psychiatric interpretation. The fundamental argument in this thesis is directed towards placing the patient’s values and his personal definition of his suffering above the values of society or ’significant’ others. DECLARATION All the work submitted in this thesis is the result of the candidate's own investigation except where I have indicated my indebtedness to other sources. Candidate:............................ Date : : ft. \ JS.S.% Sup e rv r s or . \ . a-y y *»- • .^. ^ ^ Date : ____£?. ^ I hereby declare that this work has not already been accepted in substance for any degree nor is it being concurrently submitted in candidature for any degree. Candidate: .x^.......... Date: .....j 1 IV CONTENTS Page ABSTRACT DECLARATION 111 CONTENT IV ACKNOWLEDGEMENTS INTRODUCTION VI CHAPTER 1: THE PROBLEM OF PSYCHIATRIC TREATMENTS IN KUWAIT CHAPTER 2: THE CONCEPT OF MENTAL ILLNESS: WEAKNESSES AND LIMITATIONS 51 CHAPTER 3: THE REACTIVE FUNCTIONAL APPROACH (RFD) AND THE CONCEPT OF MENTAL ILLNESS 122 CHAPTER 4: THOMAS SZASZ AND THE CONCEPT OF MENTAL ILLNESS 198 CHAPTER 5: PSYCHIATRIC PRACTICE IN THE SOVIET UNION: AN ANALYTICAL STUDY OF SOVIET PSYCHIATRIC INVALIDATION OF CITIZENS AND THE ROLE OF THE RFD MODEL IN VALIDATING SUCH INDIVIDUALS 235 CHAPTER 6: THE CONCEPT OF MENTAL ILLNESS: VALUE-FREE OR VALUE-LADEN 307 CONCLUSIONS 381 BIBLIOGRAPHY 388 ACKNOWLEDGEMENTS I warmly thank my supervisor, Dr. Martyn Evans, for his encouragement and guidance. Without his support this work would not have reached completion. I also owe a considerable debt of gratitude to Dr. Donald Evans, the Director of the Centre for the Study of Philosophy and Health Care for his consistent enthusiasm and for providing support at all stages. I extend my gratitude to Dr. Geoffrey Hunt who kindly showed his interest and concern in my work. I would also like to thank Mr. Daniel Rashid and all the staff in the Center. Finally, I would like to extend my thanks to Mrs. M.E.Coles, who efficiently typed this work. INTRODUCTION The concept of mental illness is the focus of a deeply controversial debate concerning the validity and reliability of studying or specifying mental phenomena and the clinical reality of psychiatric labels. Philosophers, psychiatrists, clinical psychologists social workers, sociologists, and other related professions such as lawyers, etc., have reacted differently to the concept of mental illness and psychiatry in general. Some argue for a radical departure from the current definitions of mental illness. Others raise doubts as to the applicability and usefulness of the study of mental phenomena and doubts as to psychiatry as a medical discipline. Such writers usually end with the conclusion that mental illness is no more than a myth or that mental illness is the expected result of being labelled as mentally ill. Such concern is centred on the moral and ethical outcome of psychiatric diagnosis and the need to promote and understand the mental patient’s right to autonomy and self-government. Others, however (mainly traditional and organic psychiatrists), would take the opposite view that diagnosis and treatment in psychiatry have proved to be highly effective and reliable in many countries in the world. They claim that recent advances in genetic and neurological research will lead to a demonstration, in due course, that human suffering is predetermined by genetic factors. Such writers argue that the effectiveness of psychiatric treatment in severe psychotic conditions is a clear evidence of the chemical or organic basis of mental phenomena. This thesis is an attempt at a moral and conceptual analysis of the moral limitations of the concept of mental illness. Moreover, the present writer hopes that such analysis is relevant to the problem of psychiatric abuse by showing how, in practice, the concept of mental illness is vulnerable to abuse. The vulnerability to abuse of the concept of mental illness will be analysed in Chapter One, MThe problem of psychiatric treatments in Kuwait". This chapter will show that the concept of mental illness has contributed significantly to the problem of psychiatric abuse in Kuwait. Different forms of abuse are discussed with the support of case illustrations such as: involuntary hospitalisation, the use of ECT and other forms of medication, informed consent, and justice in the allocation of psychiatric resources. Chapter two attempts to highlight the conceptual, clinical, and moral weakness of the concept of mental illness. It is argued that although many definition systems in psychiatry (such as DSM-III and ICD-9, etc.) provide us with a single definition of mental illness, clinicians in different countries are affected by their cultural norms of adjustment in the diagnosis of mental illness. Thus, a subjective rather than a clinical or observational set of symptoms is the central determining criterion in the diagnosis of mental illness. It is further argued that the morally negative outcome of psychiatric labelling is so significant and long-lasting that it will lead to an invalidation and dehumanization of those who are so labelled. Case illustrations and a review of clinical research will be discussed in order to show how the concept of mental illness can be vulnerable to abuse in psychiatric practice. Chapter three argues that the RFD model (Reactive Functional Disorder) represents
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