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Why I Won’t Diagnose

A madhouse in Vienna. It's not a prison at all, oh no. For their own good!

A madhouse in Vienna. It’s not a prison at all, oh no. For their own good!

We have a terrible history of using diagnoses of mental illnesses to oppress minorities and silence people with little political power. Everything that was considered undesirable or threatening could be called ‘crazy’, and once you’re considered crazy you lose it all. Your credibility, your voice, your rights. Obviously some people are so disturbed that they need intervention, people who become a threat to others or need to be protected from themselves. But as psychologists and psychiatrists we have this huge power, the power to label someone unwell, to hold them in psychiatric hospitals against their will and without a trial. Historically, this power has been abused greatly. And when I say greatly I mean terribly and on such a huge scale it will take your breath away. Psychiatry has often been a tool of social control, medicalising unwanted behaviours like going against the existing establishment. Label a political prisoner a mental patient and you can keep them against their will in a psychiatric hospital indefinitely.

I’m not against psychiatry at all. I believe mental disorders are a real thing and that therapy can provide real help. But I recognise the dangerous position we’ve placed psychiatry in, with too much power and too little restrictions. And I recognise the complicated and unfair position of people suffering from a mental illness.

One of the big problems is that psychological disorders are not treated the same as a¬†physical disorder. Saying someone has a broken leg is non-judgemental, but calling a person crazy invalidates them. If a person is crazy it means what they say is of no importance at all, that we don’t have to listen to them, that their experiences can be ignored. We see this with sex workers a lot, anti-prostitution activists will accuse prostitutes of being victims of violence. They will accuse sex workers of being psychologically unwell, of suffering from PTSD, accuse them of needing help. They use this accusation to argue that sex workers do not need to be listened to. They might say they want rights, but they’re crazy, what do they know. They might say they chose this work, but they’re traumatised, so what they think they know about themselves is irrelevant.

Sex workers often counter this by stating (correctly) that sex work does not necessarily correlate with psychological problems, but that is beside the point. People who have experienced trauma, who are suffering from PTSD or are battling some mental illness should simply not be reduced to objects that can be done to. The fact that someone is traumatised does not mean it is okay to rob them of their agency, rob them of their voice, rob them of their power and do with them as you wish. We should not use psychiatric diagnoses as a form of violence.

In some situations, criminals have more rights and credibility than psychiatric patients do. I mean, let that sink in.

A nice long soak, that should calm him down! Yay psychiatry!

A nice long soak, that should calm him down! Yay psychiatry!

Accusing someone of being crazy is the ultimate way of silencing them. Obviously this is harmful to sex workers and other groups with little political power, as they’re on the receiving end of the insult. But it’s harmful to people suffering from a mental disorder as well. The underlying argument of prohibitionists (people with a mental disorder do not need to be listened to) is prevalent still, and it’s exclusively harmful. It does no good at all.

I understand the desire to lash out, to use their own nasty tricks against them, so I understand when sex workers and their allies accuse prohibitionists of being crazy. More than once I’ve been asked to confirm that prohibitionists are often traumatised, that they have a sexual disorder or something wrong with their personality, as if that would be of any relevance at all. I’ve always declined because I believe people who have suffered trauma are not automatically wrong. Even if you were raped by half the world does not mean you’re not right. Doesn’t mean you’re not wrong either, it’s just not relevant. Perhaps some prohibitionists do suffer from some mental illness, some probably do, and some might suffer from diabetes as well. It changes nothing.

The wonderful Maggie McNeill argued that some beliefs are so obviously untrue, it’s easy to conclude that person is either lying or mentally ill. She mentioned someone who believed penis-in-vagina penetrative sex is unnatural, so obviously that person must have lost contact with reality somehow. But I disagree. The thing is, the healthy human mind is very capable of making an ass of itself. Our healthy brains can hold contradictory beliefs, ignore obvious facts, believe in things that logically cannot be true. A healthy mind can be a nasty, mean-spirited mind. A horrible person with crappy ideas might be genuinely unwell, as can a lovely and logical person. It changes nothing about their arguments.

So I will not diagnose your opposition. As immoral and disgusting I believe some people are, that does not mean I will label them with a mental illness. And just because someone is suffering from a mental illness, does not mean we get to ignore them, silence them or speak for them. A mental illness is not an insult. And being wrong or mean is not an illness.