Essay question

“According to Thomas Szasz, mental illness is a myth used by psychiatrists as a device for social control of antisocial and difficult people.” Discuss.

Outline answer

You might wish to start by considering what is meant by the concept “mental illness.”  You could start by identifying its statutory definition (section 1(2) of MHA 1983) of being “any disorder or disability of the mind”. To what extent might this definition be considered too wide? Bear in mind that it does not normally include learning disabilities or dependence on alcohol or drugs, and you will need to consider the statutory definitions and comment on the exceptions to these categories. Note that the American Diagnostic and Statistical Manual of Mental Disorder as well as the World Health Organisation’s International Classification of Diseases also provide definitions of specific mental health conditions.  Consider whether there are sufficient safeguards to ensure that a diagnosis of “mental disorder” is not applied too widely and indiscriminately to persons who may have antisocial behaviour or appear “difficult” or different from societal and cultural norms. You might want to look at this tension in the context of personality disorders. Remember also that the Mental Health Act 1983 previously stated that no-one should be treated as having a mental disorder only because of “promiscuity or other immoral conduct” or “sexual deviancy”. This provision was removed by the Mental Health Act 2007 as well as the term “psychopathic disorder” as a category to describe disabilities of the mind that resulted in abnormally aggressive and irresponsible conduct. Have these changes made it less difficult to currently categorise someone with a mental disorder and if so, how is this balanced against any potential societal benefit?

The question asks for comment regarding control of persons who are labelled as having a mental disorder. Remember to look at the statutory provisions for compulsory admission and treatment of persons under the legislation.  You might wish to analyse these statutory provisions as they are framed in the MHA 1983. Section 131(1) applies to voluntary patients and you may wish to compare the safeguards when the Act was brought into force compared with the impact of the subsequent Bournewood litigation.  Sections 2 and 3 of the Act apply to compulsory admissions. The requirements of section 2 are less stringent than those of section 3, but are they stringent enough? You might wish to comment on this with reference to relevant case law (e.g. R(MH) [2005] and Savage [2008]).

Look at the statutory provisions that permit treatment to be given. Section 58 technically requires consent of the person but if the person is unable to provide consent, or is capable of doing so but does not provide consent, then treatment can still be provided on the basis of a second opinion (SOAD). Section 63 arguably goes even further and enables treatment to be given to competent adults without consent and against their wishes, and without the need for a second opinion. Consider some of the cases in which section 63 has been applied, for example Re KB (adult) (mental patient: medical treatment) [1994]; Re E (medical treatment, anorexia) [2012]; Thameside & Glossop v. CH [1996] and R v. Ashworth Hospital Authority [2005]. What were the issues and outcomes in these cases, and what do they imply in the context of the question?

Finally, in your conclusion, you might like to refer to the thesis of Szasz. Since there are no special laws for patients with physical illness, is there really a need for special laws for patients with mental illnesses?