On the Friday 12th July 2019 I was listening to Radio 4 in the morning, whilst making coffee at my friend’s apartment, about to leave and cycle to my boat in the boatyard in Brighton Marina to work on her.
And then the program ‘D for Diagnosis’ came on the air, and I had to stay and listen to it. Presenter Claudia Hammond investigates the constantly shifting nature of diagnostic labels in mental health, exactly what Eyes On Trauma is campaigning around.
You can listen back to this ‘D for Diagnosis’ Radio 4 program via BBC Sounds here.
Diagnoses Are Of Their Time
What becomes clear is that mental health diagnoses are often based around assumptions about how people should be expected to behave.
Diagnoses are products of their time, either expressing society’s intolerance of indifference, or using them as overt tools of oppression.
Looking at the History of Psychiatry
At the Wellcome Library in London, historian of psychiatry Dr Jen Wallis illustrates this with a few examples from the deep depths of psychiatry’s past.
In the days of slave trading, Dr Wallis explains that it was believed that “black slaves are pre-ordained and naturally should be submissive, and so for them to decide to run away clearly meant that they were mad.”
This is a view we would now find abhorrent within today’s society, as we have instead moved towards greater human rights, multiculturalism and freedom of speech & movement.
Women Particularly Oppressed
As another example, Dr Wallis goes on to say that a lot of text books written by psychiatrists, especially in relation to female behaviour, illustrate the expectations of the ways different groups of people were expected to behave. (Listen back at 09:46.)
These expectations and assumptions around women’s behaviour continue today, and still remain a big part of the problem with having our trauma recognised, validated and healed compassionately.
Maudsley & Hysterical Women
Dr Wallis goes on to introduce Henry Maudsley, whom the NHS named their top UK psychiatry training hospital after. But what kind of views did Maudsley inform his psychiatry with?
Well, Maudsley happened to be a proponent of degeneration & de-evolution theory. He believed in evolution, but also believed there must be a counterbalance, a de-evolution. In his 1870 book ‘Body and Mind’, Maudsley talks about hysterical insanity – again, referring to women in particular. The diagnosis of hysteria isn’t just about physical signs, e.g. convulsions, but it also talks about moral issues, conversation that tends to be erotic or the obscene. Maudsley believed that these hysterical women would fall foul to moral perversion if they are not put under the control of a psychiatrist.
So this is a top psychiatrist, who believes in de-evolution, and is obviously using hysterical women as his target here. His description of what we would now see as traumatised women would today be abhorrent. (And by the way, those convulsions and moral issues are probably emotional flashbacks.)
Dr Wallis explains that a lot of diagnoses aren’t around today, with social and cultural factors continuing to have an influence on diagnosis now.
Shellshock
Shellshock was also mentioned as an example of this – now known as PTSD, and the symptoms having changed as well.
This shows us how trauma presentations can differ hugely with time, given society’s assumptions and expectations towards it.
Time To Move On
Whilst we’re taking steps in the right direction and have already moved away from the label of hysteria, the modern equivalent of borderline personality disorder (or even emotionally unstable personality disorder… or explosive anger disorder… or any of these other horrific labels) treats patients – mostly women – in exactly the same individual-blaming trauma-invalidating ways.
And no wonder, with Maudsley’s name still hanging above the NHS’s top psychiatry training hospital’s door. It’s time we challenged these un-trauma informed, abusive stalwarts of psychiatry and psychology.
Summing up her views on diagnosis, Dr Wallis thinks we’ll look back on some of our current diagnoses in 100 years and be appalled by them. (Listen back at 12:14.) Yes! Bingo! But come on – we don’t need to wait 100 years. It’s called complex trauma and it’s all around us and we can do something about it now.
Time To Validate Trauma
It’s brilliant that these topics are getting so much attention in the media at the moment, and we are finally able to have these much-needed discussions.
But it’s really disappointing that people still aren’t validating the bigger picture of trauma, abolishing modern-day hysteria ‘personality disorder’ labels, talking about complex trauma & emotional flashbacks, and calling for wider trauma-informed practice and care.