Can we trust the Mental Institute?

Abstract
Throughout this project, I have outlined the basic understandings of mental health
in order to lay out the fundamentals in what we can actual label as a disorder, and
whether our view on a diagnosable disorder is still viable. Another key aspect of the
essay is the social stigma around therapy, why people seem to have such an
aversion to asking for support from a therapist and whether it is actually a better
course of action, compared to the use of medication. I also discuss a little about the
over monetisation of the system, predominantly in America, where there is a clear
monopoly over the pharmaceutical industry, and what the effects of this are. To
finalise, I reflect on the possibility of a change being needed to our diagnosis of
some mental health disorders, such as anxiety, the need to lift the stigma around
therapy due to its superior use when dealing with many disorders and how I believe
that the system in America is a clear indicator in where we want to try and avoided
ending up.

Introduction
With the advancement of medical technology and research in all fields, one would expect
there to be breakthroughs in all areas of medicine, including psychological. This is not shown
however in the recent figures that report a 20 fold rise in the number of people reported to
having a mental illness within the last 30 years, a notable increase being in anxiety
stemming from fears and depression.
Does this rise actually show that more people are developing these mental disorders, or is it
just us not having ever known how to classify them, so now labelling more people than ever
as people with disorders? If this is true, and there is a rise, then why is nothing extra being
done about it? We live in a western society where incredible sums of money are being
pumped into the healthcare system, and into psychiatric help, yet nobody has reported any
great advancements or any significant improvements.

The sole fact that anxieties and disorders are so common would raise a number of questions
in the minds of medical practitioners and normal people who may be worried about their
own health. A few of those questions have been outlined in the co-written book, All We Have
to Fear, by Allan Horwitz and Jerome Wakefield and include:

How does psychiatry distinguish normal fears from disordered anxieties, and has it
got the distinction right?

If anxiety makes no rational sense, does that mean it is a psychiatric disorder?

Is the seeming rise in anxiety disorders a real epidemic of medical disorder, a

normal response to our increasingly stressful lifestyles, or perhaps an artefact of the
way psychiatrys understanding of anxiety has been evolving?

When my anxieties keep me from doing socially or personally desirable activities

such as performing in a theatre club, going to a party alone, or making presentations
at work or if Im afraid of heights and wont go hiking on cliffs or wont travel by air
is there something wrong with me? (All We Have To Fear, 2012)

Also, why are we so fixated on drugs? Why is it that when we go to the GP, so many of us
expect to be prescribed something, and many of us will actively ask to be given something if
we were otherwise not given anything? A lot has to do with the media, and corporations
pedalling their new drug to make the most profit, whilst really not caring about the patient at
all.
For me, the debate over whether we can trust the mental institution comes from many
angles; social stigma, an over monetised system based on drugs rather than other forms of
therapy, and whether our diagnosis of what is a mental disorder is flawed.

Literary Review

The first place I decided to go looking to get research around this topic was the actual
legislation regarding who is admitted and whether there is an appeal system put in place to
help those who feel as though they have been wrongly admitted. The 1983 act was mostly
put in place to give the medical professionals the right to detain someone who was thought
to have a mental disorder without their own consent, by the rule that they arent sound of
mind to make the decision for themselves.
I decided to get a general overview of who is illegible to be detained and sent to a
mental institute, and the definition as given within the Mental health act of 1993 and of the
reformed act from 2007, for a mental disability was a very loose, any disorder or disability
of mind.(Notes, 2007) Psychiatrists have taken this to cover: schizophrenia, anorexia
nervosa, major depression, bipolar disorder and other similar illnesses, learning
disability and personality disorders.
Upon further reading, as I suspected, most of the time a learning disability cannot cause
someone to be sent to a mental hospital, but rather those who have a learning disability in
combination with another illness, or are prone to outbreaks that could be cause for concern
with regards to himself, or those around him.
Another source that I will use, and one of the main reasons that I became interested in this
topic, ultimately settling on this question for my EPQ is a study by David L. Rosenhan: On
being sane in insane places. He begins by talking about how in differing societies, some

things may be read differently, and What is viewed as normal in one culture may be seen
as quite aberrant in another (The Rosenhan Study: On Being Sane in Insane Places,
n.d.). This in itself challenges the loose definition of what is a disorder or disability, and what
is only perceived as one. Despite this overarching statement, there is one question that he
asks, and goes on to study, which is, Do the salient characteristics that lead to diagnoses
reside in the patients themselves or in the environments and contexts in which observers
find them?(The Rosenhan Study: On Being Sane in Insane Places, n.d.). Though this
study took place before the latest copy of the mental health act was in place, the fact that
there are still people who are wrongly admitted and held, whilst other mistrust the institution
from insider views or headlines, such as Mental hospitals 'treat patients like prisoners'
from The Independent, shows that there is maybe a need to restore the faith in the system,
by carrying out a similar experiment, but in the modern day.
There are current debates ongoing over the reformation of the current system from
one that predominantly uses medication as a form of treatment, into a system that, like the
Finnish, is based on a method called Open Dialogue. As reported in the guardian, when
talking about the alternative Finnish method, About 80% of participants are back at work or
training within 2 years.(Mainstream psychiatry is failing but there is another way |
Society | theguardian.com, n.d.), which is an incredible figure, and shows the effectiveness
of their method over our own. There are a lot of other studies that have shown similar
results, and within the study of psychiatry, you learn about the Talking Cure, which has now
evolved into the Writing Cure, or Writing Therapy. The source (Writing about emotional
experiences as a therapeutic process, 1997), explains that within its study, the patient is
asked to write, at specific times, about superficial matters, such as how they spend their
time. There is also an experimental group to which the patients are assigned in which the
patient is asked to, Write about [their] very deepest thoughts and feeling about an
extremely important emotional issue that has affected [them] and [their] life, and they are
also asked to, Explore [their] very deepest emotions and thoughts. This is writing
paradigm which has been reported to be extremely powerful. Within the study they have
also written that there was an overwhelming majority that said the writing experience, in
which they explained a certain trauma, was valuable and meaningful. Though the use of this
method may seem, in itself, not helpful to the inner biochemistry that makes up some of the
problems that cause such anxieties within the patients, it has been reported that writing or
talking about emotional topics also has beneficial influences on immune function, including

t-helper cell growth (the cells that make up part of the immune system to ward off and fight
infections), and that whilst at the time, the writing of the experiences was traumatic, overall
there was a significant increase in the patients moods and long term well-being, emotionally
and psychologically.
Another aspect that I will be looking into with regards to my question is based on the
current social stigma around going to therapy or being a therapist. As said in an article
written by a therapist on the web page psychology today, where she talks about all the
different encounters she has had with this strange stigma surrounding therapy. She
mentions a selection of names that she has heard referencing psychiatry and therapy, some
of her favourites being hocus pocus, mental brainwashing, and headshrinking. This link to
it being a sort of magic trick puts it almost on par with mentalism, contacting the dead, or
even hypnotists, which in todays society are not trusted as real sciences, of course. But this
comparison lowers the bar for how much trust each new generation has in this form of
medical help when in actuality it can be the only thing that is needed to help someone
improve their situation and get over a possibly life altering set of mental changes that can
lead to a greatly diminished form of living. Alongside tackling the stigma around therapy and
therapists, we must also tackle the stigma around mental illness itself. This will complete the
chain of why our system is seemingly flawed and not as effective as in and other countries
with a higher rate of discharging patients to integrate back into society.
Questioning the rise in the number of people who are being diagnosed, specifically focussed
on anxiety, I have read and will be taking information from the book, All We Have to Fear,
written by Allan Horwitz and Jerome Wakefield. They predominantly focus on whether the
irrational fears and anxieties that people have nowadays that we label as mental disorders,
actually stem from past human influences and events, giving them good reason to exist.
This is actually quite interesting and ties in as they state within the first chapter that they
mean to, place the understanding of psychiatric study of anxiety disorders, and learn
something about how correctly or incorrectly or ambiguously- the definitions of normality
and pathology are applied in such a classificatory process (All We Have to Fear, 2012).
Whilst it does not directly reference my topic, it does go into a lot of detail around the
classification and diagnoses for mental disorders, and at which point someone is actually
mentally ill as opposed to having a natural reaction that does not need any medical
attention whatsoever.

Discussion

Previously I highlighted that the definition within the legislation over what a mental disorder
is, was incredibly vague and in itself opens up a debate over what can and cant be
classified, giving no real base structure to the system as a whole. After some more rooting
around I did find a website called NAMI, which stands for the National Alliance on Mental

Illness. They defined, in a much more in depth manner, a mental illness to be a medical
condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily
functioning. Even giving an analogy to clarify, Just as diabetes is a disorder of the
pancreas, mental illnesses are medical conditions that often result in a diminished capacity
for coping with the ordinary demands of life. (What is Mental Illness, n.d) Though this
definition seems to make a lot more sense, there is a lot that can be argued against it, as it
would encompass irrational fears of public speaking, or fears which disrupt a persons
feeling and mood as mental disorders. The mere fact that Horwitz and Wakefield have
managed to fill a whole book debating only the origins of anxiety show that it cannot
possibly be that simple. If something has been dangerous to us as humans in the past, yet
now ceases to be an issue. Is it irrational to have an innate fear of those same dangers now?
This is an extremely important topic for research as, if it is found out that a certain number
of fears and anxieties are actually biologically hardwired into us and have no need to be
cured then why are people who suffer from them made to feel as though there is
something wrong. In what way are people going to be more likely to trust an institution that
cannot even perfect the most common problem. In order to find evidence to show that fears
and anxieties are biologically programmed would be to ask the question, if it was going to
solve something, then what would it be trying to solve? To make it simple, if an organism is
put into a situation where it could take harm or have its life threatened then it should be its
highest priority to become safe and protect itself from predators, or an environmental
danger. If were looking at what seems an irrational fear, we have to look at fear as a
response mechanism. As a reaction that stems from animals as well as humans, we can look
into the basic reasons and biological responses from animals as most living creatures,
noted by psychophysiologist Arne Ohman, risk ending up on a predators menu. (Face the
best and fear the face: animal and social fears as prototypes for evolutionary analyses of
emotion. Psychophysiology, 1986) By this clear logic, all organisms must have some way to
protect themselves or withdraw from danger if they want to have any chance of surviving,
which we can assume would be engineered into them without them having to consciously
think about what they were doing, otherwise it wouldnt work as much of a rapid response.
Even research as old as Darwins shows the study of fear within animals and how there is a
link in their response with the response of humans. Not only is the link between species
interesting, but also within humans, our reaction to fear show similar traits regardless of our
community. Darwin found great exertions to escape from danger will have caused, the

heart to beat rapidly, the breathing to be hurried, the chest to heave, and the nostrils to be
dilated, and further explains, affirming his believe in the trait being passed through
inheritance, and now, whenever the emotion of fear is strongly felt, though it may not lead
to any exertion, the same results tend to reappear, through the force of inheritance and
association. (The expression of emotions in man and animals, 1872/1998) Clearly this kick
of adrenaline, mixed with the raising of the forehead and brows, widening the eyes allow
animals to respond better to danger with heightened senses of sight and hearing, in
combination with a rush of energy in case of an escape. The conclusion that I share with
both Horwitz and Wakefield, is that this genetically biological base produces a universal
grammar that constrains (but does not determine) the surface expressions of fear.
A fascinating piece of evidence to back the statement that some irrational fears and
anxieties are actually ingrained within us from before we can even think, and links us
biologically to animals was a test carried out by Gibson and Walk in 1960 with the use of a
Visual Cliff. The visual cliff was a box with a drop half way along the floor, however the drop
was covered with glass and was actually safe to stand upon. The experiment was carried out
by placing 36 infants ranging from six to fourteen months of age upon the safe floor. The
childs mother would stand on the other side of the visual cliff and call the child to her. What
was startling to me was not that only 3 crawled onto the deep cliff, but that despite being
shown by tapping it themselves, or have someone prove that the glass was there and they
would not fall, the baby refused to cross to her mother. This shows an innate sense of
danger in situations that could prove fatal, and some could even pin down as a fear of
heights in a child of only 6 months. Not only was this shown in humans, but when testing
with chicks, lambs and kids, none stepped onto the visual cliff, and when suspended above
it, they all showed a similar reaction freezing up and jumping off as soon as they hit the
glass. Despite this, when tested with ducks and water-dwelling turtles, they showed no such
fear of the drop, as they wouldnt in their own habitat, so they crossed readily onto the glass
side.
Alongside this study when trying to prove the biological stem of fears was another study to
see if there was a link between past experiences of falling from heights and a later adopted
fear. Surprisingly, falls resulting in serious injury between 5 and 9 years occurred with a
greater frequency in those without a fear at age 18, and more incredibly, no individual
who had a height phobia at age 18 had a history of a serious fall before the age on nine.

(Non-associative fear acquisition: behaviour research and therapy, 2002) To me, getting rid
of the possibility that the fear of heights is a learned condition, and that all land-dwelling
species in Gibson and Walks Visual Cliff study showed the same traits, opposing the aquatic
species who showed no fear at all, proves beyond any doubt I kept prior that humans, not
unlike many other species have been intrinsically designed to fear high places.
So I have established a fundamental flaw in the way that we categorise mental disorders,
and the need for further research into a more detailed classification system. Despite this,
and whether or not too many people are being admitted, is there something wrong with the
actual system put in place at the moment to treat those who are experiencing problems? In
a way, there is actually a problem on both ends of the line. People have a skewed idea over
what therapy is for, and what happens when you attend a session so they dont go when
they need to, and medical professionals are prescribing drugs too easily. The figures alone
show the problem, the American Psychological Association wrote an article in 2012
explaining that since the introduction of Prozac, a revolutionary drug of its time that showed
few side effects the numbers of people taking antidepressants shot up by a factor of four
and a study at the time recorded that, more than one in ten Americans now take
antidepressants, becoming the most commonly prescribed drugs. If there is a better
method to treat these problems then why arent medical professionals using them? Therapy
is a more effective method for anxiety and depression especially when they have been
brought about by problems within the patients life. The problem lies with who treats the
patients, In the United States, almost four out of five prescriptions for psychotropic drugs
are written by physicians who aren't psychiatrists. (Psychiatric Services, 2009) It shows that
those physicians who have not had extensive training in recognising and treating mental
disorders find it a lot easier to prescribe a drug than analyse a situation to see if a person
would be better off with therapy. In fact, this method of prescribing drugs may be ineffective
to the point that it is actually not even helping the patient. Recent studies have shown that
antidepressants when put up against a placebo actually had extremely similar results. This
was shown more closely in those with mild or moderate depression but the difference was
still "relatively small even for severely depressed patients." (PLoS Medicine, 2008) I have
been focussing on the actual professional here, when I did mention that the fault lies in both
parties. People have an idea in their heads over who goes to therapy, the first thing that
jumps to mind is crazy people, when if you actually talk to any therapist at all, they will
almost all tell you that the majority of their patients are actually those struggling with life

problems, are going through a tough time, have suffered a loss or has an addiction of sorts
and is embarrassed to speak to others about it. The problem is, therapy is seen as only for
people who have serious mental conditions, or even that you need a mental condition to
even consider using therapy, and if given the chance, many patients will still opt for the drug
option over consultation. Its much more time effective, and a lot of people would be too
embarrassed to share with their friends and family that they are having therapy. A perfect
example, showing a lot of what I stated is shown in an anecdotal story written by Dana
Gionta with an encounter she had with social stigma and misconceptions of therapy, Upon
seeing my checks made out to Dr. Gionta, I was asked by the bank teller "What kind of
doctor are you?" I'm a psychologist, I said. He then asked, "A clinical psychologist?" I said
yes, then, "You must deal with a lot of crazy people." This both amused and somewhat
surprised me. I then paused and carefully thought about how I was going to answer this,
without adding to his already unfortunate stereotypical view of the profession. I said "well,
actually, I work most often with people dealing with difficult life transitions,
like divorce,health challenges, relocation, work stress, and family/parenting issues." "So,
where is your practice located?" he asked. "Branford, CT, I said." At this point, he appeared
to lower his voice and half whisper something to me. I believe he was trying to find out how
much I charged? I couldn't make it out, and out of the corner of my eye noticed the other
bank teller starting to look curiously at him and our exchange. I found this quite
amusing...like something out of a sitcom. He finally asked, as the banking transaction was
nearing the end, "Do you have a business card?" I gave him my card, thanked him for his
help, and walked away. (Psychology today: The stigma of therapy, 2008)
Trying to alleviate the stigma surrounding therapy, and scolding those for prescribing drugs
would be completely irrational in itself if there isnt proof for therapeutic treatments. There
have been tests done to try and find out whether there is an advantage in using Cognative
Therapy (CT) over Anti-depressant medication (ADM) in general treatments for depression.
Preliminary studies from the 1960s showed that the ADM in general prevented symptoms
rather than providing a long lasting cure from the depression itself. This said, again in those
studies they showed that CT was a less efficacious method and overall was not that much
more effective than the placebo. After further detailed analysis by a paper studying this
topic from the US National Library of Medicine and National Institutes of Health, it found
that, there were suggestions in these data that the outcome of CT varied across research
sites as a function of therapist experience, which might account for the apparent

10

discrepancy between these findings and those that have been obtained in other randomized
trials of CT and ADM. Reading deeper into this research I found that the conclusion given
was that it would take a combination of both CT and ADM to find a lasting cure, but that CT
was the only one that gave prevention in later life, as opposed to simple suppressing
emotion for a period of time.
This is a very specific matter, and not in any way a representation of the wide variety of
mental disorders that can arise, however there are places that use next to medication in
drug form to treat their mental patients and have garnered staggering results. In Finland
they are trying out a new form of treatment for patients with schizophrenia and psychosis,
which they have named Open Dialogue which boasts that at the end of their treatment
80% of those treated with the approach return to work and over 75% show no residual
signs of psychosis. (Finland Open Dialogue, n.d) Is this treatment all that it boasts to be? It
almost sounds too good to be true, to the extent where it makes no sense not to use it
everywhere in the place of prescription medication. After more research I found out some
more details of the study and found that it was a little bit less reliable than it would seem. A
quote from Kristian Wahlbeck who is a Research Professor at the National Institute for Health
and Welfare, Mental Health and Substance Abuse Services in Helsinki said that he was,
familiar with the Open Dialogue programme. It is an attractive approach, but regrettably
there has been virtually no high-quality evaluation of the programme. Figures like "80 per
cent do well without antipsychotics" are derived from studies which lack control group,
blinding and independent assessment of outcomes." It would seem as though despite having
promising results, their needs to be a lot more research before it can be labelled a
breakthrough in research, and Wahlbeck himself, though expressing a need for a treatment
like this also states, before it has been established to be effective, it should be seen as an
experimental treatment that should not be clinical practise."

Corruption, Drugs and Fraud

Basing my research on the American system, its clear that the top pharmaceutical
companies hold a monopoly over the whole country, with a staggering figure from
psychology today which shows that, the top ten of these companies in the fortune 500

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make more money than the other 490 combined. If we look at this and compare it to other,
similar corporations, it is no surprise that such a wealthy system has become so corrupt and
unethical in its development. Cigarette makers gave no link to lung cancer for many years,
energy companies and political allies have denied links between fossil fuels and global
warming, despite the clear science, yet drug companies have been more cunning, more
systematic and more successful in infiltrating the knowledge base concerning their products.

More and more companies are funding drug testing to shine a positive light on their own
manufactured drug, which in some cases can not only be completely ineffective but also
cause side-effects with no gain at all to taking it. The problem lies not only much farther up
the chain, but also with the doctors themselves. An example of this is the now ceased Pfizer
production of the drug Neurontin as a treatment for bipolar disorder, pain, migraine
headaches and drug or alcohol withdrawal. Warner-Lambert; psychiatrist, promoted the use
and effectiveness of the drug by paying doctors to listen to pitches for unapproved uses, and
treating them to trips abroad that have been known to total over a quarter of a million
pounds. The Food and Drug Administration (FDA) forbids drug companies from promoting
the drugs for off-label uses, which means in a manner not approved by the FDA, but instead
of registering to get an FDA label for the drug, which can be an expensive process which
requires a lot of proof from clinical trials, the company tried to bump up the sales through
aggressive promotional strategies despite scientific studies showing its lack of effectivity. All
of this was written in the report from the Justice Department. More tactics that they used, as
quoted from prosecutors in the article on sfgate.com, included, planting company
operatives in the audience at medical education events to contradict unfavourable
comments about Neurontin, and paying doctors to allow sales representatives to sit in on
patient visits. Its not this having happened that is the most worrying part of the situation,
its that there could be drugs on the market now that are being unknowingly given to
patients having no effect to help their condition, if anything worsening it with no knowledge
from the doctor prescribing or, of course, the patient. The difficulty in the situation lies in the
drug companies funding up to 80% of the drug trials, leading to an unknowing bias and
drugs being put on the market with a seemingly legitimate study showing their
effectiveness. This imbalance in drug trials is both terrible and great news. Terrible for all the
previously stated reasons but drug trials cost an incredible amount of money, getting an FDA
takes a long time and also costs a lot of money. Where does all the money lie in the system?

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With the big drug companies which naturally leads to them being the main donors of money
for up and coming drugs. The problem is that without this funding, even real breakthrough
drugs with the power to change some treatments forever wouldnt be able to get out of the
first phase of clinical trials.
Another problem that rises from this style of pharmaceutical company domination is that
due to their control over what gets developed, they can keep pumping out different named
pills that essentially all do the same thing. Statins, different variations on Viagra, medication
to stop hair loss, all of these are the big sellers in the eyes of the companies and these are
what make it through the production line. There may be drugs waiting to be funded that can
cure, or at least be more effective than current malaria medication, for example. These
drugs will get stuck with no funding whilst more cosmetic drugs that appeal to the consumer
who want to live longer, or at least look better doing so. America has a bad habit of
creating an atmosphere where it is normal to be on some kind of medication, and that there
is a pill to solve any problem you may have, with an alarming number of adults and their
children demanding some kind of medication after every visit to the hospital or GP.

Conclusion
13

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