For decades, professional psychiatrists and medical scholars were trying to persuade the general public that mental illness was something an individual could not control. In other words, because mentally ill patients are not capable of controlling their behavioural reactions, coercion and involuntary hospitalisation and treatment are the best ways to protect the society from the public dangers of mental illness. The interests of the mentally ill patients were historically interpreted from the standpoint of the potential damage they could cause to the healthier members of their community. Coercion for the benefit of the patient and the public was the dominant perspective adopted by psychiatrists. Unfortunately, the interests and life quality of those, who are considered to be mentally ill, were persistently overlooked. Even today, thousands of people enter the mental health system under the pressure of external social forces, without clearly realising what is awaiting them after the diagnosis. Schizophrenia is, probably, one of the most controversial mental health diagnoses currently given to individuals. Those, who receive the diagnosis of schizophrenia against their will, are fated to experience stigma and isolation, reduced quality of life, and continuous confusion due to the lack of meaning and power to change the situation.
Schizophrenia: A Brief Insight
In order to understand what difficulties are facing those, who are given diagnosis against their will, it is imperative to understand what schizophrenia is and how it works. Jones and Buckley (2006) start their book with the phrase, “Schizophrenia is a debilitating and serious medical illness that has a profound effect on the patient’s life, as well as the lives of their immediate family, friends and carers” (p.v). In this way, most psychiatrists and mental health scholars establish a common belief in the debilitating nature of schizophrenia and its obvious danger to the healthier public. Despite the rapid evolution of the psychiatric science, researchers and practitioners do not have a single universal understanding of schizophrenia. More often than not, this diagnosis is understood as a collection of behavioural and mental phenomena, which range from hallucinations and other abnormal perceptions to language disorders and cognitive problems (Jones & Buckley 2006). Consequently, psychiatrists have freedom to interpret a wide range of symptoms as schizophrenia. Unfortunately, and as mentioned earlier, few psychiatrists ever think of the consequences of involuntary diagnosis for the diagnosed individual. The roots of this problem and its concurrent difficulties grow from the fundamental features of the modern public health philosophies dealing with mental health.
Schizophrenia as Mental Illness: Where the Roots Grow
Today’s public health philosophy rests on the three essential assumptions, whenever it comes to diagnosing and dealing mental illnesses. First, individuals who are diagnosed with mental disorders are claimed to lack competency and capability to make autonomous decisions (Pescosolido et al. 1999). Second, individuals who have received a mental disorder diagnosis are generally believed to be at higher risk of self-harm and present increased danger to others (Pescosolido et al. 1999). Third, and based on the two abovementioned assumptions, coercion is necessary to reduce and prevent the damaging consequences of individual incompetence and minimise the risks of danger (Pescosolido et al. 1999). In light of these philosophies, it comes as no surprise that many individuals enter the mental health system against their will, being pressured by their relatives, friends, and co-workers (Pescosolido, Gardner & Lubell 1998). Police and similar institutional agents also contribute to the growing number of involuntary schizophrenia diagnoses. In all these situations, individuals have little control over their future; they also have no control over what happens to them within the mental health system (Pescosolido, Gardner & Lubell 1998). These involuntary diagnoses have far-reaching negative consequences for individuals and result in considerable social and emotional difficulties.
Involuntary Schizophrenia Diagnosis: Difficulties and Problems
Schizophrenia: is diagnosis valid? In 2011, the psychiatric world celebrated the first hundred years after the schizophrenia diagnosis had been introduced. In 1911, Eugen Bleuler, the Swiss psychiatrist, was the first to use the schizophrenia diagnosis in practice. Still, after so many years, the scientific diagnosis of schizophrenia lacks any scientific basis. Therefore, to those who are given this diagnosis against their will, schizophrenia can become a major life obstacle and the beginning of the road, which leads into nowhere. Szasz (2000) is right: as long as psychiatric professionals have no objective, empirically proven, physico-chemical observations that are directly related to schizophrenia diagnosis, the claim that it is a serious mental disorder will remain unsubstantiated. The main purpose of any medical diagnosis is to predict the outcome of the disease and develop a treatment regimen that will enable the diagnosed individual to achieve the best possible results. At present, most schizophrenia diagnoses made by clinicians are entirely subjective. Simultaneously, in most cases, schizophrenia diagnoses are associated with poor health outcomes whilst, in reality, between 50 and 70 percent of people with the diagnosis showed considerable health improvements or totally recovered (Ciompi 1980; Kua et al. 2003). The biggest part of this evidence comes from those, who have survived the trauma of coercion, isolation, and imposed medical treatment after the schizophrenia diagnosis (Breeding 2008).
The validity of schizophrenia diagnosis raises many questions. For individuals, who enter the mental health system against their will and receive the diagnosis involuntarily, schizophrenia looks as unsuitable and much unexpected way to pathologise their experiences (Breeding 2008). The process of establishing and confirming diagnosis necessarily involves the identification of certain pathological features that are believed to correlate and associated with any independent feature of a mental disorder (Breeding 2008). This process is inherently pointless, as long as the range of behaviours, experiences, and clusters is too wide and unpredictable to translate it into the schizophrenia diagnosis. To a large extent, the only thing psychiatrists can accomplish when giving a schizophrenia diagnosis against individuals’ will is telling them that certain behaviours and reactions are improper and unwanted. As a result, they demand medical treatment and even isolation from the rest of the community. Meanwhile, such claims lack any genetic or biological evidence, while also breaking the individual’s dignity, stability, respectability, and self-control (Szasz 2000).
Schizophrenia diagnosis and stigma. One of the most pertinent difficulties facing those, who are diagnosed with schizophrenia, is that of stigma. Despite the dramatic speed of mental and cultural evolution, the postmodern society has not yet learned how to deal with the people, who were given a schizophrenia diagnosis, especially when it happened against their will. According to McDaid (2011), the public perceptions of mental health diagnoses are dominated by negative impressions and stereotypes. Even in the absence of explicit symptoms, a person who is known to be diagnosed with schizophrenia (even if it happened involuntarily) can be thought to look and behave in a bizarre way (McDaid 2011). Mentally ill people, especially when it comes to schizophrenia, are conceptualised by the public in four different ways: (1) they are believed to be dangerous; (2) they are claimed to be responsible for their health state; (3) they are considered as chronically ill and untreatable; and (4) they are regarded as unpredictable and unable to comply with the prescribed social rules (Angermeyer & Matschinger 2004). The difficulties experienced by these people due to stigma and negative stereotypes are pervasive and extremely problematic to reverse.
First and foremost, individuals who are diagnosed with schizophrenia experience problems finding decent employment. McDaid (2011) suggests that 90% of individuals who either use psychiatric services in the UK or have a history of schizophrenia diagnoses want to enter and operate in regular workplace settings. Yet, due to highly negative responses of the existing and potential coworkers, such individuals have few chances to realise their social strivings. It is not difficult to imagine that individuals who are given the schizophrenia diagnosis against their will and do not experience any explicit symptoms will find it particularly discouraging to remain constantly unemployed. For instance, in Germany alone, only 14% of individuals with schizophrenia are officially employed (McDaid 2011). The word combination “individuals with schizophrenia” means the presence of a medical diagnosis, which does not necessarily imply the presence of any factual mental disorder.
Those, who are given schizophrenia diagnosis against their will, will also experience problems accessing and utilising health care services. On the one hand, any attempt of involuntary schizophrenia diagnosis makes the individual strongly reluctant to come in touch with mental health professionals (McDaid 2011). On the other hand, individuals who are labeled to have a severe mental health problem are much more likely to face barriers to adequate care, even if the need for such care has nothing to do with mental health. Such individuals enter the health care system, being labeled as different from the rest of the community. They are not simply diagnosed with schizophrenia – they are “schizophrenics” (Angermeyer & Schulze 2001).
Coercion and involuntary imposition of schizophrenia diagnosis undermines the very purpose of the mental health system. The chief goal of all mental health and rehabilitative services is to assist individuals in making autonomous decisions, living a self-fulfilling life, and being socially accepted, full members of the community (Corrigan 2007). Mental health professionals should help individuals minimise the barriers to happy living, which emerge as a result of serious mental illnesses (Corrigan 2007). Schizophrenia diagnoses, provided involuntarily and in the absence of a strong empirical basis, lead to an entirely opposite result. They result in stigma and labeling, which further exacerbate individuals’ uncertain mental health status.
Schizophrenia diagnosis and the lack of meaning.Schizophrenia diagnosis given to individuals against their will is inherently damaging and never benefits the to-be-patient. These individuals are neither happy to receive the diagnosis, nor can they make use of it or find it helpful. On the contrary, the diagnosis makes them powerless and deprives them of voice (Coleman 1999). It imposes a despair narrative on individuals, which translates into a huge barrier to recovery and reintegration into the community. As mentioned before, any schizophrenia diagnosis is inevitably associated with the process of pathologising individuals’ experiences (Breeding 2008). Under the influence of such diagnoses, individual experiences are narrowed down to disease frameworks. Society and mental health professionals fail to grasp the deeper meaning of individual decisions and perceptions. Not surprisingly, for such individuals, schizophrenia diagnoses represent a source of considerable confusion. Still, under the influence of the existing media stereotypes, most society members will readily view such diagnoses as beneficial to the patient and the rest of community.
Schizophrenia, Diagnosis, and Coercion: The Other Side
Given that the majority of community members hold negative views on schizophrenia and those, who have received the diagnosis, they will also support coercion in entering and using the mental health system by such individuals. In other words, they will assume the so-called “coercion to beneficial treatment” perspective, which exemplifies one of the most powerful and direct articulations of coercion support (Link, Castille & Stuber 2008). The supporters of this perspective claim that mental health is impossible without coercion. Since individuals with severe mental illnesses usually lack awareness of their problem, they may try to avoid treatment and “create a circumstance that may have many unfortunate consequences for those with severe psychiatric disorders, including homelessness, incarceration, violence, and suicide” (Link, Castille & Stuber 2008, p.411). This perspective also suggests that schizophrenia diagnoses provided against individuals’ will respond to the circumstances of mental health and treatment. Supporters of the Coercion to Beneficial Treatment perspective will also regard stigma as secondary to the positive impacts of coercive diagnosis and treatment (Link, Castille & Stuber 2008). Most likely, they will treat stigma as a product of psychiatric symptoms and reduced quality of life, not the diagnosis itself.
Unfortunately, these society members forget about the lack of scientific basis in schizophrenia diagnosis. As a result, they cannot be confident that the individuals given such diagnosis against their will actually experience the discussed mental health problems and need any treatment. The body of evidence supporting coercion in mental health is quite scarce, whereas the body of proof showing the deleterious impacts of disclosing a schizophrenia diagnosis continues to expand (Pandya et al. 2011). Individuals who enter the health care system for reasons other than mental health problems and leave this system with a schizophrenia diagnosis will hardly find their way in life. Even the best psychiatric services will be largely ineffective managing the difficulties facing those, who have been given schizophrenia diagnoses against their will (Thornicroft et al. 2004).
Thousands of people around the globe receive a schizophrenia diagnosis against their will. The scope of difficulties facing such individuals can hardly be ignored. From stigma and reduced life quality to continuous confusion and the lack of meaning – any schizophrenia diagnosis has a variety of damaging impacts on those, who enter the mental health system. At the same time, the society is mostly supportive of coercion in mental health care, being governed by the negative perceptions of those, who have received such diagnosis. Until there is an empirical basis to support schizophrenia diagnoses, they will remain an entirely subjective and extremely dangerous way towards social exclusion and discrimination.