The drugs don’t work: an analysis of mental health and the modes of social control. Mental health inthe UK has faced a large amount of disparity in regards to the way that peopleare treated in relation to their human rights. This is an issue that is stilldifficult to understand as 1 in 4 people will suffer from a mental illness inthe UK today[1]. Theexperience of suffering with a mental illness can be interlinked withinequality and the question of an individual’s freedom and autonomy being takenaway from them. It appears that the question of having one’s freedom isdirectly under attack when suffering from a mental health illness which leadsto the question of whether they are ever free. Efforts directed towardsachieving autonomy and freedom should not become separate from achievingsubstantive equality for people with mental health illnesses. Structuralfactors such as inequality, gender, family living conditions, socio-economicconditions, and discrimination contribute to the ways in which a mental illnesscan increase and have a negative impact on an individual’s ability to recoverfrom an episode. A human rights approach to mental health is determined onacknowledging the individual who is suffering with a mental health illness byrespecting their dignity as an individual, their autonomy and independence, andtheir freedom to make their own choices. Operating through a rights-basedapproach instructs us to examine and scrutinise the language, implications, andmodels of mental health that have been adopted previously, especially whentaking health discourse into account. Such an approach also requires us to lookat the ways in which human rights have been characterised as being based on a particularmental state and how discrimination characterises the lives of people withmental health illnesses especially when matters of treatment are brought intothe question. In this essay, I will look at Michel Foucault’s approach to humanrights being based on a particular mental state and the implications oftreating people solely through the approach of medication. I will use thisapproach in the form a timeline dating from the 19th century to thepresent day, specifically looking at two case studies: the first titled, A Mind That Found Itself[2]by Clifford Whittingham Beers written in 1908 and David’s Box: The Journals and Letters of a young man diagnosed as aSchizophrenic 1960-1971[3]by Richard Hallam and Michael Bender in order to provide an analysis of howaccess to the right type of mental health treatment appears to be a case ofprivilege which can still be seen in mental health treatment today. I will alsolook at the approach of healthcare within the UK still being centred onexcluding those with mental health illness rather than integrating them withintheir communities as both case studies show. Finally, while acknowledging thathealthcare professionals are under a duty of care to provide people withmedication as a form of treatment, I would argue that it should be down to theperson suffering with a mental illness to exercise the right and agency intheir own lives and who, consequently, should be supported in such a way thatthe barrier between their freedom and autonomy should not work against them inrelation to their mental state. The nature of mental health practices in the UK can be dated back to 1247 when a monastic priory was founded in the city of London on the site where Liverpool Street station now stands[4]. The priory operated in such a way that it was able to provide food and shelter for those who were deemed as being ‘’sick’’. However, from 1330 onwards it was renamed as Bethlem Hospital[5] and was reported as having evidence of providing the earliest treatments of madness. In 1676, Bethlem was granted permission to be built at Moorfields in London making it the first hospital for the insane in the UK[6]. As a result, Bethlem became a unique setting on the basis of it becoming somewhat of an attraction to members of the public and confirming its place as a receptacle for the madness of the nation[7]. I would argue that Bethlem became a way of exposing those in a particularly vulnerable state as being dangerous to the livelihood of a ‘’sane’’ society, and in order to offer protection to those people it appeared that secular confinement was the best way to implement that safety. Throughout the earlier periods of the 16th-19th century, madness was described as a ‘’beastly’’ condition, and for the most part that those deemed as mad ‘’deserved it.’’ The nature of the asylum and its positioning within society then was a daily reminder of what to keep away from – to distance yourself from a particular ‘’mental state’’ that would ultimately separate you from the rest of the world. This isolating treatment of patients with mental health illnesses is still indicative in regards to how mental health services operate today. There is a clear comparison to be made between the geographical positioning of Bethlem in the heart of London throughout the 16th century as a haunting reminder of exclusion to its position now being situated on the outskirts of London in Kent as a people who have been forgotten and failed by the system. Many have questioned the care and support that is offered within hospitals, and whether the balance of power[8] operated under the Mental Health Act is one that seeks to criminalise those with illnesses or in fact empower them to have agency over their own lives. It appears that even today mental health professionals operate on a basis of ‘’knowing what’s best’’ which makes psychiatry on a whole much harder to challenge. However, this essay will go on to explore the impact of lived experiences and how those experiences are able to offer a strong account of being free as an individual when suffering from a mental illness.Foucault hasdescribed the principles of madness as being rooted in many varying aspectswith the main two branches being divided between melancholia and mania. In thisinstance, ‘’the aspects of madness’’ are directly linked between what mentalstate becomes violent and what remains contained. Melancholy, has beendescribed as being a state that ‘’never reaches violence[9]’’and proceeds on the basis of a concentration of nervous power and of its fluidin a certain region causing the mind to be in a state of sleep[10].Applying Foucault’s theory of melancholy to Clifford Whittingham Beers’ A Mind That Found Itself illustrates howthe instances of varying mental states described in Madness and Civilization do not take into account the livedexperience of an individual who has encountered melancholy and differing statesof mania. It also highlights the clear battle between freedom and mental healthrights on the basis of an individual such as Clifford Beers not being‘’violent’’, but him as an individual, being deemed so on the basis of histhoughts. Throughout the course of his personal accounts there are manyinstances where he is struck with the battle of whether or not to commitsuicide. The passage below illustrates how he is aware of his actions in such away that proceeding with suicide on the basis of his intellectual mental stateis something he is not able to do. ‘’Considering the state of my mind and my inability at that time to appreciate the enormity of such an end as I half contemplated, my suicidal purpose was not entirely selfish. That I had never seriously contemplated suicide is proved by the fact that I had not provided myself with the means of accomplishing it, despite my habit, has long been remarked by my friends, of preparing even for unlikely contingencies. So far as I had the control of my faculties, it must be admitted that I deliberated; but, strictly speaking, the rash act which followed cannot correctly be called an attempt at suicide—for how can a man who is not himself kill himself?[11]’’If we are toanalyse this passage in direct link to the acts of 1842[12]and 1845[13]whereby the erection of county borough asylums was mandatory[14] andActs of Parliament gradually transferred the organisation of these institutionsinto the hands of the medical profession[15]it does present a detrimental flaw in acknowledging thoughts of suicide asbeing enough for an individual to be placed in an asylum. Beers wonders ‘’how can a man who is not himself killhimself[16]’’demonstrating a sense of awareness which confirms his state of melancholy not‘’reaching a state of violence’’ yet he is still deemed as not being within therealms of sanity. Similarly, in This isMadness [17]there are first person accounts from individuals who have been treated withrestrain within the hospital environment on the basis of them being considereda threat to the natural order. However, if as noted by Foucault these thoughtsrarely ‘’reach violence’’ then the basis of institutionalisation solely relieson the power of those operating under the ‘’psychiatric empire[18]’’being granted the ability to take away the rights of those individuals based ona mental state that only appears to be a threat to themselves. Foucault alsoexplains mania and melancholia being rooted in individuals being focused on theidea of a particular mental such as death or fear, and in accordance with  those tendencies, perhaps seeing themselves‘’to be beasts, whose voice and actions they imitate.[19]’’However, I would argue that this is just one of the ways that those sufferingwith a mental health illness are conditioned by their surrounding socialfactors rather than it being a reflection of themselves. For example, if we areto consider Beer’s moment of suicide thought: ‘’ I really wished to die, but so uncertain and ghastly a method did not appeal to me. Nevertheless, had I felt sure that in my tremulous frenzy I could accomplish the act with skilful dispatch, I should at once have ended my troubles[20].’’It appears thathis contemplated suicide is depicted as a moment of frenzy as mentioned aboveto be a signifier of melancholy, and in understanding that it reveals therelationship between freedom of thought and mental health. As it states inArticle 9 of the Human Rights Act: ‘’Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief and freedom, either alone or in community with others and in public or private, to manifest his religion or belief, in worship, teaching practice and observance[21].’’If we are to consider the freedom of thought as a rights bearing entity in relation to one’s mental state then surely, as an individual, the act of thinking, whether good or bad, cannot be enough to consider whether one is in fact a functioning member of society. Beers is able to acknowledge himself from a place of intelligence when he states: ‘’after refusing for a long time I finally weakened and signed the slip; but I did not place it on the book. To have done that would, in my mind, have been tantamount to giving consent to extradition[22]’’ which ultimately demonstrates the constraints of not being able to exercise his freedom or autonomy as a result of it being taken away from him. Thus, the notion of ‘’disciplinary power[23]’’ is brought into focus as melancholy is dependent on a particular type of intelligence which could also equate to a positive form of mental state. Intelligence is considered as a desirable trait when understanding personality formation which suggests that the ‘’power of the state’’ comes into governing what perception of intelligence the nation understands. Surely then, the notion of freedom and autonomy as rights bearing entities become blurred as it is a ‘’madness at the limits of its powerlessness[24]’’ providing the ultimate paradox to how someone who is clinically insane would operate. Foucault specifies that ‘’melancholia, finally is always accompanied by sadness and fear; on the contrary, in the maniac we find audacity and fury[25]’’ highlighting the history of psychiatry being based on its ability to socially exclude individuals. His approach to psychiatry illustrates the complexity of power and sensitises us to the destructive impact of ordering the human world in terms of simple binary distinctions such as good/bad, right/wrong, truth/ideology, illness/non-illness[26]. Critiquing individuals on this basis then highlights the position of psychiatry as depriving individual mental rights on the basis of conforming to a constructed order of power rather than understanding its place as a process. Whilst in hospital, Beers described experiences of his physical health also being affected by his undergoing treatment for his mental health. For example, ‘’my brain was in a ferment. It felt as if pricked by a million needles at white heat. My whole body felt as though it would be torn apart by the terrific nervous strain under which I labored[27]’’ illustrates his lack of mobility as a result of being under such severe mental distress. The force of this indifferent power demonstrates how immobilisation also acts as a form of discipline as it operates in the form of an asymmetrical relationship with the person in control and the individual. In this instance, Beer’s is able to understand that position by being under ‘’terrific nervous strain,’’ but he also identifies this when going home from the hospital and speaks of his brother as ‘’acting as a detective’’ and ‘’finding himself still under surveillance.’’ It is governance in this form that acts as control in the form of surveillance which on a whole the creation of the mental health act feels constituted on.[28]  I propose, therefore, that immobilising an individual of their mental and physical rights acts as a form of surveillance whereby taking agency over the minds and bodies of individuals leads to the deprivation of freedom and autonomy.  By representingBeer’s as both the ‘’maniac’’ and the ‘’melancholic’’ suggests that betweenmania and melancholia, the affinity is evident: not the affinity of symptomslinked in experience, but the affinity – more powerful and so much more evidentin the landscapes of the imagination[29]However, I would argue, that again, displays a flaw in psychiatry as it isconditioned on individuals adhering to a set mode of behaviours in order to bedeemed as ‘’free’’.  It alludes to mystarting statement on psychiatrists or mental health professionals not beingchallenged on their perception of ‘’knowing what’s best’’ when the likelihoodis that it will lead to a failed analysis, and ultimately prescribinglimitations on freedom that are considered legitimate. Throughout thecourse of the second half of this essay I will look at the accounts of a youngman named David and how his diary sheds considerable light on the nature ofmadness and on the services available to people diagnosed with schizophrenia inthe 1960s.[30] The1960s appeared to be a time that saw the ‘’anti-psychiatry movement[31]’’become dominant with the key message being: madness is a product of a madfamily or a mad society[32]. Anumber of psychiatrists such as R.D.Laing[33]and Thomas Szasz[34]have been seen as the most important representatives of the anti-psychiatrymovement in highlighting the damaging effects of psychiatric diagnosis, drugs,ECT treatment, and involuntary hospitalisation on individuals.  As a result ofthe movement, there were a number of things that did change in terms ofbringing to light the policy of incarcerating people in large mental institutions.Many people became politically active throughout this period in order toprevent people from having to face such treatment from the NHS. The charity,MIND[35]which was originally known as the National Association for Mental Healthcampaigned for the closure of large mental hospitals and also for the humanrights of current hospital patients as well as ex hospital patients. However,the process of hospital closures didn’t take place until the 1980s and 1990s.Mental hospital patients were then described as ‘’service users’’ yet, the actof integrating them in the community with the support of health professionalsbecame scarce as larger efforts were being administered to help those sufferingfrom family breakdowns and child abuse rather than mental illness[36].  The link between ‘’mental disorder’’ and‘’psychiatric illness’’ is one that is blurred now as the definition of mentaldisorder has always been legal rather than medical[37].However, the recent change in the law since the 2007 Act[38]makes it possible for a person will a mental disorder to be closely monitoredin the community and to be detained against their will if it is expected thatthey could pose a serious risk to others in the future[39].This shows that the possibility of integration within the community still isn’tviewed as a social and human right of those suffering with a mental healthillness. The issues that have prevailed for many years between the medical andsocial model[40] arestill apparent with the main concern being over the word ‘’treatment’’ and howit is implemented. Detaining an individual is only permissible for the purposesof ‘’psychiatric treatment’’ which sheds light on the fact that detaining themfor having certain beliefs isn’t possible, but deciding that they need to be treatedon behalf of their mental state is deemed as acceptable. The act of‘’treatment’’ typically implies medication and it is seen that people adheringto medication is a way of minimising the risk of disturbing behaviour[41],however, it shows how it acts as a form of control[42].In the case ofDavid, there are many factors that I will explore in relation to medicationbeing a form of control depriving him of his freedom and liberty as anindividual suffering from Schizophrenia. Taking into account his early teenageyears, David was described as a highly intelligent young man with an IQ of 123however, as a result of taking Largactil[43],now known as Chlorpromazine there was a sudden shift in his ability to processinformation, and as a result he became much slower in regards to academiceducation. It was noted by his school teachers that he was often ‘’unhappy’’and in July 1957, the school became concerned about David’s ‘’state of mind[44].’’The head teacher of his school wrote to his to his father to inform him thatenquiries were being made about David’s mental health  illustrating that looking at effective waysin which they could help David within a local environment were cast away.Erving Goffman[45]spoke of stigma as a social identity that becomes ‘’discredited’’ by possessingan attribute that makes an individual different from others in the category ofpersons available for them to be, and of a less desirable kind – in the extremea person who is quite throughouly  bad,or dangerous, or weak.[46] Ifeel that this is true of David’s ability to form relationships with peoplewithout being judged as an individual who is inferior or one that cannot betrusted on the basis of his ‘’mental state.’’ For example, when he speaks ofthe horrible effects of medication robbing him of his memory he states: The horrible possibility that my memory, visual imagery, and whole state of mind have been horribly mutilated and permanently disfigured by treatment makes me wish for a good fairy to rescue me from the ghastly realities of the situation. I only have to look around me, read the papers, watch the television, to realise that ‘’to all intents and purposes’’ the human body is a machine, complex but vulnerable, so vulnerable. I fear being marred by such things as rheumatism. I fear physical exhaustion. I fear the utter collapse of my mind. I predict ultimate disaster.[47]The treatmentthat he encounters when in hospital becomes the basis of David understandingthe process of what is making him ”mad.’’ With this in mind, he exercises hisright as a patient to write to the Chairman of Managers[48]to make an appeal in relation to Section 26[49]of the Mental Health Act 1959. David explains in his letter: ‘’Since a person can only be detained from outside a hospital if his condition is sufficiently retarded to warrant detention, why does this not apply inside a hospital, and why is such an order not rescinded immediately the patient regains his faculties? And how can (one assume in one way) a person under Section 26 be allowed to wander at will outside the hospital grounds, unless he is legally sane, and certainly in a medically fit enough condition to warrant this. And if he is legally sane, how can he be under Section 26, the Section used (I think) for the utterly incapable.’’[50]It appears thatDavid is questioning whether being ‘’insane’’ is the basis for being‘’detained.’’ Especially in regards to their being different warrants on whatappears to be acceptable on hospital grounds and outside them that question therequirements of being ‘’legally sane.’’ It highlights the same process ofprivate and public modes of complying to sections of the Mental Health Act inregards to medication too. For example, it is noted that David wrote ‘’largeparts of his diary under the influence of choral’’ and ‘’became addicted tochloral, and also to Mandrax, originally introduced as a supposedly safealternative to barbiturates.[51]’’This demonstrates that the act of receiving medication was presented to Davidin the form of a ‘’favour’’ as though the drugs he became addicted to werebetter than any other way he would have been able to relieve himself oftension. As mentioned above, an individual should be in receipt of being ableto comply with their right to freedom of speech, but David isn’t able toexercise this right on the basis of being ‘’mentally ill’’? He also isn’t ableto view his ‘’human body’’ as his own, but one that is specifically being usedfor the basis of social control through medication. Therefore, Goffman’sanalysis on ‘’stigma’’ being based on an individual’s behaviours andcharacteristics making them ‘’different’’ becomes linked to Foucault’s accountof discipline as it is on the basis of an individual being different that controllingthem is considered acceptable. In order to keep the ‘’crazy’’ away you mustmedicate them regardless of it being against their will (punishment), controlthem through their social environments (hospitals), and monitor their abilityto reconnect with their own lives (discipline). As David goes on to say ‘’mymemory is growing worse with the passing of each. On occasions, my happinesscoefficient’ is at a lower level than on the 13th June. But my mainproblem is my memory – destroyed (partially) by that fiendish concoctionoriginated in North India – chlorpromazine – trade name Largactil… Saw in the‘book’ that night, Largactil 50 or 100 mg as necessary!!! This shows theextraordinary natures of these idiot psychiatrists[52].’’Mental healthrepresents an area of one’s lived experiences that are challenged andconflicted with the state. As explored within this essay, the factors on whichthat becomes applicable are on the basis of limited access to support, thetrust of health professionals, and the right kinds of treatment. Although,there have been further changes to the Mental Health Act in regards ‘’towardsupholding the rights of the individual to choose what’s best for them.’’ Iwould argue that the notion of ‘’consent’’ is one that still fails to beaddressed in mental health discourse. In accordance to the current MentalHealth Act of today, there appears to be little improvement on the basis ofworking with individuals on the right kinds of treatment for them. The modes ofmedication such as the ones that David was in receipt of throughout the 1960ssuch as ECT and Chlorpromazine still operate today which leads to thequestion:  how likely is it that thesemodes of ‘’treatment’’ are worthwhile if there are no signs of improvement over40 years later? Thus, there remains a need to introduce other forms oftreatment such as talking therapies and allow individuals the right to suchtreatments at the most earliest signs of struggles with their mental health.The therapeutic space would be one where problems, although experiencedindividually, could be contextualized; internalised oppression from parents,school, work, peers or wider society could be spoken about, witnessed, thoughtabout and put into context.[53]Such an approach would work with individuals and reinforce the nature of themhaving the right to make their own decisions and not being dictated by healthprofessionals or psychiatrists. Therefore, the future of mental health servicesshould aim to understand the perspective of the individual suffering as it nolonger remains the case of prescribing drugs that have been categorisedinto  groups such as ‘’anti-depressant’’and ‘’anti-psychotic’’ as it is not possible to control what side effects theywill have in the future.  A positivepresence is needed in reasserting the principle that the characteristics ofwhat someone can be deemed ‘’mentally ill’’ for such as low self-esteem,paranoia, confusion, despair, and loneliness are experiences that us as humanswill experience in our lifetime. The Foucauldian theories explored within this essay such assurveillance, discipline, and control illustrate the similarities between thatof the hospital and the prison. These spaces are created deliberately in orderto protect the ‘’non criminals’’ or in this context the ‘’sane,’’ andsimultaneously limit the rights of the ‘’criminals’’ and the ‘’insane.’’ Ithighlights that as long as these systems are in place the freedom of thosesuffering with mental health illnesses will always be in jeopardy. Consequently,the first step towards ensuring those suffering with mental health illnessesare no longer incriminated is by ‘’representing the rights of people psychiatryis monitoring[54],’’and creating a system that is based on experience such as from ex-patients andservice users who have lived through the same process. Bibliography Andrews, Jonathan. (1991). Bedlamrevisited: A history of Bethlem hospital 1634-1770. Queen MaryUniversity of London, p.10.Bartlett, Peter (1999). ThePoor Law of Lunacy: The Administration of Pauper Lunatics in Mid-nineteenthCentury England. London: Leicester University Press.Beers, Clifford (1908). AMind That Found Itself. 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(1963). Stigmaand Social Identity. Available:https://campus.fsu.edu/bbcswebdav/institution/academic/social_sciences/sociology/Reading%20Lists/Social%20Psych%20Prelim%20Readings/III.%20Self%20and%20Identity/1963%20Goffman%20-%20Stigma%20and%20Soc.Last accessed 21/04/2018.Hallam, Richard and Bender, Michael(2011). David’s Box: The Journals and Letters of a Young Man Diagnosedas Schizophrenic, 1960-1971. London: Polpresa Press. p.17, 23, 50, 51, 56,132, 134, 231, 232. Historic England. (2018). FromBethlehem to Bedlam – England’s First Mental Institution. Available:https://historicengland.org.uk/research/inclusive-heritage/disability-history/1050-1485/from-bethlehem-to-bedlam/.Last accessed 21/04/2018. Killaspy,Helen. (2006). From the asylum to community care: learning fromexperience. British Medical Bulletin. 79-80 (1), p.245.Laing,Ronald (2010). The Divided Self: An Existential Study in Sanity andMadness. 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The certificationof insanity in nineteenth-century England and Wales. History ofPsychiatry. 9 (35), p.267-290.[1]NHS: Mental health. Available: https://www.england.nhs.uk/mental-health/.[2] Beers,Clifford, A Mind That Found Itself.[3] Hallam,Richard and Bender, Michael, David’s Box:The Journals and Letters of a Young Man Diagnosed as Schizophrenic, 1960 – 1971.[4]Killaspy, Helen, From the asylum tocommunity care: learning from experience p.245.[5]Historic England: From Bethlehem to Bedlam – England’s First MentalInstitution. Available:https://historicengland.org.uk/research/inclusive-heritage/disability-history/1050-1485/from-bethlehem-to-bedlam/.[6]Same as 4.[7]Andrews, Jonathan, Bedlam revisited: Ahistory of Bethlem hospital 1634-1770 p.10.[8] Newnes, Craig and Dunn, Cailzie, This isMadness: A Critical Look at Psychiatryand the Future of Mental Health Services p.144. [9] Foucault,Michel, Madness and Civilization: AHistory of Insanity in the Age of Reason p.127.[10]Same as above.  [11] Beers,Clifford, A Mind That Found Itself p.14.[12]Bartlett, Peter, The Poor Law of Lunacy.[13]Wright, David, The certification of insanity in nineteenth-century England and Wales.[14]Newnes, Craig and Dunn, Cailzie, This isMadness: A Critical Look at Psychiatryand the Future of Mental Health Services p.18.[15]Same as above. [16] Beers,Clifford, A Mind That Found Itselfp.14.[17] Newnes,Craig and Dunn, Cailzie, This is Madness:A Critical Look at Psychiatry and theFuture of Mental Health Services. [18] Newnes, Craig and Dunn, Cailzie, This isMadness: A Critical Look at Psychiatryand the Future of Mental Health Services p.144.[19] Foucault,Michel, Madness and Civilization: AHistory of Insanity in the Age of Reason p.111. [20] Beers,Clifford, A Mind That Found Itselfp.15.[21]Equality and Human Rights Commission: Article 9: Freedom of thought, beliefand religion. Available:https://www.equalityhumanrights.com/en/human-rights-act/article-9-freedom-thought-belief-and-religion.[22] Beers,Clifford, A Mind That Found Itself p.31.[23]Foucault, Michel, Discipline and Punish.[24]Foucault, Michel, Madness andCivilization: A History of Insanity in the Age of Reason p.119.[25]Same as above.[26]Bracken, Pat and Thomas, Philip, FromSzasz to Foucault: On the Role of Critical Psychiatry p.226.[27] Beers,Clifford, A Mind That Found Itself p.7.[28] Newnes, Craig and Dunn, Cailzie, This isMadness: A Critical Look at Psychiatryand the Future of Mental Health Services p.146.[29] Foucault,Michel, Madness and Civilization: AHistory of Insanity in the Age of Reason p.125.[30]Living with Schizophrenia: Schizophrenia: A Brief History. Available:https://www.livingwithschizophreniauk.org/advice-sheets/schizophrenia-a-brief-history/.[31]Double, Duncan “The limits of psychiatry.” BMJ: BritishMedical Journal.[32] Hallam,Richard and Bender, Michael, David’s Box:The Journals and Letters of a Young Man Diagnosed as Schizophrenic, 1960 – 1971p.17. [33]Laing, Ronald, The Divided Self: An Existential Study in Sanity and Madness.[34]Szasz, Thomas, The Myth of Mental Illness.[35]Mind: A History of Mind. Available:https://www.mind.org.uk/about-us/what-we-do/our-mission/a-