Thursday, October 6, 2011

Does Mental Health System Perpetuate Abuse?

Yesterday, as we endure the second Mental Health Week of the year, I again put my concerns about such PR events on the record - the main concerns being that they are superficial, and generally don't bother to mention one of the most significant of all mental health issues - trauma.

I suggested that psychiatrists and other mental health professionals in fact help to perpetuate stigma through their reluctance, if not outright refusal, to deal with trauma issues. That's ironic because more than ever mental health advocacy organizations are working to overcome stigma - and that's good, but they need to go deeper.

Today, I will take it one step further, by suggesting that this not dealing with trauma in fact perpetuates the abuses of trauma, especially for those who have endured childhood sexual abuse. It perpetuates abuse because:
  • the objective facts of the trauma remain hidden (the secret persists), and so whatever shame or stigma is associated with the trauma is allowed to persist
  • the abuse of body, mind and spirit caused by the trauma - whether it is from childhood sexual abuse, a motor vehicle accident, torture, or combat - remains untreated if left unexplored, and so the patient doesn't get the treatment and relief she/he deserves, and may in fact suffer a great deal more
Statistics on the prevalence of trauma are such that clinicians are justified, if not outright obligated, to find out if new patients in mental health practices may have a trauma history. Instead, as I pointed out in yesterday's blog post, many psychiatrists and others would rather not, finding it easier (on themselves primarily) to make a diagnosis based on the more obvious symptoms and signs.

Frankly, given what is known today about the epidemiology of trauma, I find this approach disgusting. Perhaps, one day, lawyers will pick up on this negligence, and incorporate it in malpractice suits.

Barbara Everett and Ruth Gallop wrote a book which should be must reading for anyone having anything at all to do with mental health practice: The Link Between Childhood Trauma and Mental Illness. The authors make it clear that there are links, though not necessarily causal. Nonetheless, it's in the understanding of the relationships between childhood sexual abuse (and other traumas), and such things as early childhood attachment patterns, and mental illness onset later in life, which suggest so strongly the need to determine if patients have a previous trauma history.

I'm on the record for saying failure to do so is both negligent and perpetuates the abuse. But I am not alone. Read what Everett and Gallop have to say, in their book:
For the mental health system not to acknowledge and use this information in treatment and care plans is yet another form of abuse.
This lack of acknowledgement and use of the valuable histories which patients bring into the consulting room - histories of their own lived experience which contain so much the discerning clinician needs in order to work well with them - is unacceptable. Yet it goes on everyday throughout the world.

What it means for many patients is that they cope less well with their mental illness. They often have a more difficult time getting along with others; their relationships suffer. Whatever shame and stigma may have been experienced from the original traumas is now compounded.

So, to the Canadian Alliance on Mental Illness and Mental Health, the Canadian Mental Health Association, and their counterparts in the US and elsewhere: if you must have Mental Health Weeks, stop being so superficial. 

The real life mental health narrative is a messy one - it is not the sanitized picture you folks, with your public relations professionals, put forward in annual mental health weeks. The people with mental illness who depend on you deserve better, just as they do very often from their psychiatrists and other mental health professionals.

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