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The epoch of coercive psychiatry in young people

A mental health crisis amongst the young has been the discourse for many years and with the pandemic, this discourse becomes even more acute.

Michel Foucault defined these types of discourse as regimes of truth - mechanisms that are stated and tacit of an epoch. These assumptions start to be so basic that they appear as knowledge. But what do we need to be careful of? Whilst I am not discrediting this piece of research, we have to look at it based on what is actually happening in many western health care systems.

Mental health disorders - clinical diagnoses, are given by a psychiatrist. It used to be the case that medication was always prescribed by a psychiatrist, indicating that the patient had a clinical, i.e chemical imbalance which needed medication intervention to resolve it. With the proliferation of the use of anti-depressant medication by GP's, without a thorough diagnosis, for a whole range of problems, and not just anxiety and depression, the bio medical model is now becoming a regime. The DSM-5 and ISDN-11 which categorise mental disorders seems to widen out, including more and more aspects that affect normal life every time they are revised. Adjustment disorder is a good example of this; someone may be struggling to cope with external events such as divorce or loss of a job or changing school for a while, and could be labelled with a pejorative definition that they are disordered and mentally ill. How is this ok?

Not only that, many countries are following on from the American system of health insurers demanding a mental disorder label from a psychotherapist coupled with a psychological formulation before the person can receive payment for therapy. This puts intense pressure on the therapist to diagnose a disorder so the client can receive support, that they can be paid, and throws up a whole host or moral and more importantly ethical dilemmas. As Binswanger stated, we now live in a society that has modified mental illness as being a structure of being in the world. This is coercive psychiatry that is not even being delivered by psychiatrists.

So when we use the clinical labels of depression and anxiety, we cannot be sure who provided that label and why. I wonder about the discourse that is being constantly fed to us about young people. Whilst I agree wholeheartedly that their emotional well being is more at risk and they may feel more occasions of low mood, anger, discontent or much more on edge than they usually do, this does not mean that it will turn into a disorder. What it means is that their overall well being is being affected. Well being is the state of being happy and contented, and if someone is discontented and unhappy it does not mean that they should become pathologised. Young people are living their formative years through the most extreme pressure, unknowns and grief. They may struggle, they may feel more down than up but isn't this to be expected? The language of discourse both by young people and the general population means that the clinical words of anxiety and depression are used all the time to describe phenomena that may not actually fit the definition. Let's not attempt to perpetuate this. Instead of labelling lets, provide support, love and kindness.


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