There are so many articles out there on changing the mental health system and the great crisis in mental health today. Well, I haven’t been practising forever, and I am fairly young, but it seems as if the crisis in mental health has been upon us since I first understood mental health as an entity, thing, or discourse.
The crisis is now decades long, and I am beginning to see the crisis as something very different. Perhaps there is no crisis, I would hazard to say, with some pause and disclaimers that this is not say things are going the way they should for many people needing help with their condition. Thus, the crisis is not rooted in available treatment, access, best practice, or quality of care.
Sure, these aspects of mental health are vital, and integral parts of the entire picture. But, are these the realms that are truly suffering? Are these the layers and intersections of mental health which need a radical course correction?
I am going to go out on a limb here. I am going to suggest that the crisis is how we as a culture understand madness, illness, and disorder. This is going to sound rather sociological or Foucault in theory. Let’s really think about this for a minute. For centuries, prior to institutionalisation, mental illness or madness wasn’t talked about in mainstream culture. Madness was hidden away, concealed, and very taboo.
Now, in comes the age of pre-institutionalisation, and early forms of treatment, right through the very heights of great psychiatric warehouses. Still, madness was tucked away, with the slight adaption and shift in language.
From madness, to illness, and now, post-institutionalisation we have birthed the modern mental health disorder and are coming to understand these disorders, as aberrances in health and wellness.
These trends, shifts, and ways of talking about mental health can be located in more than just the language of the day. These shifts are visible throughout the discourse, and every intersection that society crosses path with the psychiatric patient. Especially, the treatment of disorder. From an illness of the soul, to the mind, and all ways medicalisation has creeped into mental health.
My point with all this change talk is that when it comes to the great crisis. There is no crisis! Well, the crisis is really how society shapes the discourse. The crisis is embedded within our ever-moving social apparatuses that hail each of us as healthy, contributing, members of society.
These apparatuses, conversely, identify, mark, and point to parts of our population that aren’t congruent, that just don’t fit. The crisis in no one thing and will not be solved by changing one or even multiple aspects of the mental health system. Maybe this can be best proven by talking about the evolution and beginnings of the crisis. When did it start?
So, while for centuries the way society understood mental health went through radical course corrections, the crisis only began a few decades ago. Why? Because now mentally ill people are out among us, with us, they are everywhere. This is the first time (with the exception of indigenous cultures in South America and Eastern stretches of the globe) in Western culture that people with a mental health disorder are allowed to roam the streets with people without a mental health disorder, mix, converse, and interlink within and around the mainstream or general population.
The crisis must therefore be fear. The crisis is the unknown and the dangers lurking just ahead when someone with a mental health disorder creates a ripple in the norm. When someone labeled as different, does something dangerous that gets enough attention from the media and apparatus structures in culture, creating a panic, and need to continue to label, mark, and treat this population differently given the danger just underneath the surface of society.
In doing so, the crisis is really man made. We created it. Who is we? Society, and the apparatus forces governing the expression of culture. This force is the semiotic locus of the crisis. From this locus, extends out to the radius, and periphery: fear. This fear is thus preemptively manufactured.
I am also theorising that this fear is caged in regard for the health of people with a condition to ‘help them’ but in reality, it is to hurt them, mark them, and label them as potentially dangerous. We do this with regard for how it impacts the diagnosed only to map these changes as shifts in the law and how treatment is regulated through the law.
This fear allows society to supersede and transcend the law at times, such as forced treatment laws. The fear, the so-called crisis, is just another ploy to create new law and order around disorder until dysfunctions, functions throughout culture.
Image credit: Freepik
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.