The Trouble with Modernisation: We Need Better Relationships, Not Policies and Procedures
| Pages | 3-7 |
| Date | 01 September 2005 |
| Published date | 01 September 2005 |
| DOI | https://doi.org/10.1108/13619322200500022 |
| Author | Rex Haigh |
| Subject Matter | Health & social care |
The Trouble with
Modernisation: We Need
Better Relationships,
Not Policies and Procedures
Rex Haigh
Consultant Psychiatrist
Berkshire Healthcare Trust
Personal Perspective
ersonality disorder (PD) is a problem
of relationships: with friends and family,with partners
and children, with professionals – and ultimately with
oneself. Of course, nobody’s personality is perfect – but
the number of those formally diagnosable with PD, to
whom it causes longstanding and enduring distress, is
probably between five and 13% of the population.
In the National Institute for Mental Health in
England (NIMHE) policy guide, No Longer a Diagnosis
of Exclusion (2003), service users explain how
unsuitable care from the statutory services can easily
make them worse. This has been called the ‘cycle of
rejection’. Here, I am going to argue that this
dehumanising effect is inevitable in a system that
strives to define what is acceptable in solely
behavioural terms, institutionalises coercion through
mechanisms like CPA, aims to predict and control
human action with increasing accuracy, pays attention
to only one type of evidence, prizes the technological
over the human, and pays little regardto trust,
continuity and relationship. The implications arewider
than for personality disorder alone; they are about ways
of conducting professional relationships that are
ethical, compassionate and human.
Power and control
It is frightening to be confronted with impossible
dilemmas in clinical practice: realising that there is
much we cannot understand or control. The
Pcommonest in working with people diagnosable with
personality disorder is probably ‘ignore me and I’ll hurt
myself’. Clinical protocols require us to ‘assess risk’
and ‘exclude depressive disorder or psychosis’.
However, neither are helpful as they attempt to predict
and control, and so move away from understanding the
underlying problem; hence objectifying the person and
making a therapeutic relationship less likely.
Somebody with a personality disorder admitted under
coercion or discharged as an ‘attention seeker’may
well be made to feel worse. The underlying issue is
commonly the consequences of physical, sexual or
emotional abuse – abuse of power – in ways that have
disrupted normal emotional development. Further
experience of abuse or rejection is likely to resonate
with powerful primitive feelings, and cause escalation
of disturbed thinking and behaviour. This is a situation
where rational and logical discussion will cut no ice: a
relationship needs to be established at this stage, not a
procedure undertaken.
As Illich wrote in Medical Nemesis 30 years ago,
expropriation of one’shealth is a consequence of the
medicalisation of life:
‘An advanced industrial society is sick-making because it
disables people from coping with their environment and,
when they break down, it substitutes a clinical prosthesis
for the broken relationships.’
We might now be better at collaborating with GPs in
deciding what to do about our risk of heartdisease, but
Ithink responsibility for normal things like feeling
distress, despair and desperation has more than ever
been medicalised and expropriated. It is the
The Mental Health Review Volume 10 Issue 3 September 2005 ©Pavilion Publishing (Brighton) 2005 3
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