In 1851 Dr Samuel Cartwright announced in a New Orleans medical journal a psychiatric condition he labelled “dreapetomania”, which he described as an uncontrollable urge to run away as observed in black slaves.
He argued that giving slaves too much kindness triggered the illness, creating confusion in a species God intended to be “submissive knee benders”.
Cartwright indicated that a slave’s improper respect for the master’s property was due to another medical condition he named “dysaesthesia aethiopis”, to be treated by light beatings and hard labour.
What is obvious to us now – slaves tried to run away because of their cruel treatment – was seen as a medical condition by Cartwright and his contemporaries.
Yet psychiatry acting as an agent of social and political control can’t be quietly relegated to the shadows of a shameful history. Last month the Lords at least stalled government plans to detain and enforce treatment on people with mental health problems, considered as a potential danger to themselves or others but who have committed no offence. The group of people concerned are those with a so-called diagnosis of personality disorder.
The medicalisation of human behaviour is a fundamental part of the problem. All the while we see complex psychosocial problems in terms of illness and disease we will continue to demean and control the people we claim to be helping to reclaim their lives. The illness model robs people of taking responsibility for their own behaviour. And to do so is to take away their humanity. On the one hand we encourage independence on the other we take it away by provoking passivity through illness.
Illness disempowers people. Prefix “illness” with “chronic” and you also remove all vestiges of hope. The social function of psychiatry is to manage people, which is achieved through the concept of illness. In an exhaustive study Sarbin and Mancuso failed to legitimise the value of the disease model as an explanatory theory and a practical tool for conditions such as “schizophrenia”. Shunned by professionals the book is now out of print. And although the emperor has been shown to have no clothes the system still bows to him.
Nigel Leaney manages a mental health residential service