Inclusion without cure will liberate us all
| DOI | https://doi.org/10.1108/17465729200400002 |
| Pages | 7-12 |
| Date | 01 March 2004 |
| Published date | 01 March 2004 |
| Author | Adrian Faiers |
| Subject Matter | Health & social care |
journal of mental health promotion •volume 3•issue 1 •march 2004 © Pavilion Publishing (Brighton) Ltd
Inclusion without cure will liberate us all
Adrian Faiers
Senior manager
InterAct
Guest
editorial
Social inclusion is the motherhood and apple pie of the
caring professions. But when does social inclusion
become social control? And where do mental health
promotion and cure fit in the murky continuum
between the two?
Professor Richard Bentall, author of Madness
Explained (Bentall, 2003), ended his MACA 2003
Henry Hawkins lecture with a compelling anecdote.
His book finishes with the same story. Bentall, who
holds the Chair in Experimental Clinical Psychology at
the University of Manchester, described an encounter
with the Dutch psychiatrist Marius Romme. It was
Romme who discovered that large numbers of people
in Holland hear voices without needing psychiatric
treatment. In the middle of a conversation between the
two of them, the psychiatrist said something that had a
great impact on the UK psychologist. ‘I really like your
research on hallucinations, Richard,’ he said, ‘but the
trouble is you want to cure hallucinators, whereas I
want to liberate them.’
This may appear to raise old issues of medical versus
social models of mental ill health. But perhaps it does
more. Perhaps it raises issues of social inclusion versus
social control. We may regard cure, whether by medical
or psychotherapeutic means, as an early step on the
road to inclusion, but it may also be part of bringing
people into line with the rest of society.
In his book Bentall himself argues that ‘people can
sometimes live healthy productive lives while
experiencing some degree of psychosis’. He further
argues that ‘the boundaries between madness and
normality are open to negotiation’ and that ‘psychiatric
services are imperfect and sometimes damaging to
patients’. On this basis he asks: ‘Why not help some
psychotic people just to accept that they are different
from the rest of us?’
This would also, of course, require society to
change: society would need to accept that psychotic
people are just different. The argument could also be
extended to what society currently regards as other
mental disorders.
Bentall makes two important qualifying points:
first, this ‘does not imply that people in distress should
not be offered the most effective treatment that is
available (drug or therapeutic)’; second, it does not
mean that society should not be protected from ‘the
very small number of patients who behave dangerously
towards others’. Presumably he would also accept the
need to protect patients who are a danger to
themselves. Bentall’s final assertion is that (what others
might call) inclusion without cure ‘would almost
certainly make the world a better place for mad and
ordinary people alike’.
It may not be an entirely new idea, and it would
require considerable changes in modern western
attitudes, but I believe it is worth re-considering some
of the arguments in favour of such an approach:
•modern western society appears to be failing to
promote positive mental health
•such an approach might help us all to better
understand, accept and express (rather than repress)
more aspects of our own personalities and mental
make-ups – it may, adapting Romme’s phrase,
‘liberate us all’
•it could contribute to creating a more accepting and
less controlling society, with benefits for everyone,
not solely for people currently regarded as having
mental health problems.
Modern western society is failing
There is an emerging consensus that the UK is
experiencing an epidemic of neurotic disorders: notably
anxiety and depression, as well as drug and alcohol-
related mental health problems. World Health
Organisation data suggest that mental disorders will
exceed coronary heart disease in the global burden of
disease in the developed world by 2020. Oliver James,
in his book Britain on the Couch (James, 1997), argues
that there is, compared with the 1950s, an epidemic of
depression, irritability, aggression, paranoia, obsessions,
panics and addictions. He sees these problems as the
outcome of disappointed aspirations, encouraged by
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