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The Plight of the Mentally Ill – The Challenges Mental Health Service Users Have Found in Using Psychiatry and Related Activism

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This essay will attempt to outline some of the challenges psychiatry and reliance on the biomedical model to treat mental health poses to mental health patients. I will also attempt to outline some activists who opposed the psychiatric paradigm and the different types of activism available to people who wish to change how mental health is treated and managed. Finally, I will look at a way forward and what could be achieved through activism and healing and empowerment of the patient or those who experience mental health difficulties.

Firstly, psychiatry relies on the Biomedical model when treating mental ill health, it believes that mental ill health is caused by “faulty brains” and chemical imbalances which must be treated and managed with medication. It believes these illness’s have a biological basis much like epilepsy or any other disease and it must be treated by a psychiatrist who is a doctor who has done additional training in order to be able to diagnose the illness’s and prescribe medications to manage it. Psychiatry is the primary method of treating mental ill health in the UK. This means many people who feel their health issues are caused by social and psychological or even spiritual reasons don’t necessarily get treatment and healing for those issues.

Overall is their evidence for a purely biomedical perspective? Certainly, in the past about 60 years ago the chemical basis for mental ill health was considered factual and evidence based. In the 1950’s “there were two revolutionary new drug treatments. The introduction of chlorpromazine in Paris in 1952 “… the synthesis of haloperidol in 1958 swiftly followed. In 1952, Max Lurie in Cincinnati first coined the term antidepressant after a trial that investigated isoniazid for tuberculosis. The first tricyclic antidepressant, imipramine, was launched in 1958, with amitriptyline hard on its heels in 1961.” (Burns, 2020) These drug treatments took the world by storm and in 1959 the Mental Health Act tightened up measures for compulsory treatment of mental health patients. The public was generally under the impression that mental health disorders were biological and based on chemical imbalances. Then, following this in the 60’s came the first of the anti-psychiatrists. They were known as R D (Ronnie) Laing, Michel Foucault, Erving Goffman and Thomas Szasz. These men dared to see mental health troubles from a very different lens that actively challenged the chemical imbalance theory looking at the very real social and psychological reasons certain individuals get diagnosed, they published popular books about their findings and were active speakers on the topic.

In addition, 50 years of intense scientific study into the chemical basis of disorders such as depression failed to prove that it was in fact caused by a chemical imbalance and was not due to an imbalance of serotonin as previously thought, leaving psychiatry in a position where it was not actually scientifically proven and/or evidence based (Moncrieff, 2014 cited by Vicary and Mallon 2024)

There is no biological test for these disorders, diagnosis being made purely by the observation of different behaviours, signs and symptoms. So, it cannot be measured in the same way as any other disease which has a biological basis and indeed there is no real evidence a diagnosis exists on a biological and chemical basis as psychiatry claims.

So why then in the UK, is psychiatry still classed as the main and most reputable treatment for mental health issues? Why is it so many people accept their diagnosis and think that to become well is to take and be compliant to a prescription of psychiatric drugs? While it is true many people have found the medications helpful, and that is why they continue to take their medications, a large portion of the mental health population has never recovered enough so they can return to work and live fully functioning lives again despite their medications. Many service users are simply excluded from mainstream society and are instead maintained while still unwell and experiencing side effects and secondary health issues from their medications, on health-related benefits, often isolated in their homes or put into specialist shared houses as supported living.

Compliance with their diagnosis and psychiatric drugs may also be considered the only option and service users may feel they have no other choice or that the professionals must know best.  In the UK, psychiatry is actively forced on patients with compulsory treatment in hospitals, with being detained under the Mental Health Act.  It is considered by the powerful authorities that medication and forced treatment is the best and most vital option to help these patients despite lack of evidence and other forms of treatment may not be employed. Another challenge people with mental health conditions face are they may be traumatised by the compulsory, forced and often heavy-handed hospitalisations and administration of psychiatric drugs. I have lived experience of this in the UK and it is experienced in psychiatric hospitals across the world (Kennedy, 2021 cited by Samra,2024) There’s a serious power imbalance between the patient and the psychiatric system which deems individuals unwell and must be treated with methods that are not backed up by serious science and it must be very difficult to form a helping or therapeutic relationship with someone and build trust while forcing them to comply.  Service users often have no choice on how they are treated and if they refuse treatment can lose their liberties and come under the complete legal control of mental health services.

There is also challenges to mental health service users around the labelling and diagnosing of themselves with a disorder. These diagnosis or labels often carry significant stigma and may leave people feeling unhappy about themselves or may lead them to being excluded or treated differently in society. As previously mentioned, there is no biological test for a mental health disorder and it is instead a judgement based on the opinion of society, family members and mental health professionals. Who decides who is acting abnormally or not? Normality can also vary from culture to culture – in a secular society someone who is hearing voices or experiencing visions of hell or the voice of God may be labelled with schizophrenia whereas in a religious or shamanic culture they may be labelled as a prophet or shaman and trained for their gifts. There have also been those activists influenced by Foucalt who concluded “mental illness is simply a convenient label to remove uncomfortable and supposedly deviant individuals unable to contribute economically” (Burns, 2020)

To address this power imbalance and aid those individuals diagnosed with a mental health condition and have come under the care and control of the psychiatric team often against their wishes, there has been the need for activism. Activism is where groups of people work together to effect change. In the case of the mental health system changes could include changes on who gets diagnosed as mentally unwell and why, changes to the narratives people have around their experiences and struggles, what is classed as a mental health problem or not, how mental health patients are handled and their power status and role in society, changes in who gets detained, for how long and why and changes in how mental ill health is managed and treated. Activism can also include trying to change public opinion and attitudes both in terms of stigma and prejudice and exclusion of those deemed mentally unwell, and also on what sort of treatments the public should expect from their health service should they or a relative become unwell or diagnosed with a mental health condition.

Activism can be done in a variety of different ways but can be broadly put into two different types conventional actions and radical actions (Johnston and Gulliver, 2022 cited by Jones 2024) Conventional actions are those which are legal and use standard processes and institutions in society such as writing to an MP or attending a peaceful protest or making a You Tube video whereas radical actions tend to be illegal such as occupying a building or blocking a road.

Successful activism can include Franco Basaglia’s reforms of Italy’s psychiatry where he rejected the medical basis of diagnoses and the exclusion they fostered. In 1978 Italy passed Basaglia’s law banning admission to mental hospitals and required them all to close. (Burns, 2020)

Another successful form of activism was the removal of homosexuality from the Psychiatrists DSM, Diagnostic and Statistical Manual of Mental Disorders, the bible for diagnosing mental disorders. To achieve this activist employed both conventional and radical activism lobbying the APA to declassify homosexuality, in 1973 homosexuality was finally no longer considered a mental disorder. (Jones, 2024b)

Current forms of conventional activism could include the popular You Tube Channel by Lauren Kennedy which until recently was called “Living Well with Schizophrenia” – in this channel Lauren has put herself and her story into the public domain where she has been managing a diagnosis of schizoaffective disorder. On her channel she has highlighted many concerns such as her experience with forced medication (Kennedy 2021 cited by Samra 2024 to reducing stigma of the disorder by talking about the issues and being a popular You Tube celebrity while also having a mental health diagnosis. She has also recently started highlighting other potential avenues of treatment instead of relying on psychiatric drugs, with her exploration of medical keto, to the end where she has been able to come off all her psychiatric medications and now manages her symptoms with this diet and the help of her keto coach. Her activism has helped shift public opinion on what someone with a mental health disorder looks acts like, fostered dialogue on the issue in her comments section, influenced professionals and has inspired many people living with mental health disorders to live better lives.

Activism can be paid or unpaid – activism that is paid may be undertaken by mental health organisations such as Mind or Rethink Mental Illness lobbying the government on behalf of their members or undertaken by Experts by Experience’s employed by Health Boards to implement change from within the health service using their lived experience and use of the services as a guide. Employed peer mentors and therapists with the dual role of having lived experience while also working within the health system can also utilise change from within the system.  Unpaid or voluntary activism may be done by service users or by concerned friends or relatives and carers either individually or by forming grass roots organisations and movements such as the psychiatric survivor’s movement. The skills and talents of people with mental health conditions may be employed in activism such as using the arts and creativity to conduct craftivism, the art of gentle protest by creating beauty and a better world through engaging with others, inspiring thought and fostering dialogue with crafts and creativity, (Corbett, 2016)  

Alternative forms of treatment also need to be promoted and discovered which may better address the human needs of those with mental health struggles, looking at the very real social and psychological and spiritual reasons for their difficulties. Support networks could be better built up and communities fostered so people are less isolated in dealing with their issues with experienced peer mentors guiding and facilitating growth and healing processes which empower the patient rather than subduing them. The Recovery College Model which is peer lead and service user developed and run could be a definite way forward as could looking at alternative ways of viewing mental health difficulties such as the Power Threat Meaning Network which addresses power imbalances and encourages people to form more hopeful narratives where they create different stories of their lives with a more hopeful future on why they experienced difficulties rather than purely see themselves as “mentally ill” or through the lens of a diagnosis or disorder.

Service users face real challenges with how mental health conditions are currently treated in the UK. While many people do find medications helpful, they are often not “cured” from their disorders and there is very little real evidence for the chemical imbalance theory of mental health. Mental health diagnosis’s do not have a biological test and are based purely on the opinion of professionals and the norms of a particular culture. There is a huge power imbalance in how mental health patients are managed which can be open to abuse and can be perceived of as oppressive rather than helpful.  Mental health patients can lose their liberties if they refuse to comply with psychiatric treatment. In the past groups of people who you wouldn’t class as mentally ill today were considered mentally ill such as homosexuals and the same could also apply today for other marginalised groups and those classed as deviant or economically unproductive.  

Activism is needed to change the challenges service users face, there have been many successes in challenging psychiatry and changing public opinion from the advent of the ant psychiatrists with their books and public speaking, to Basaglia’s reform of Italy’s psychiatry to popular you tube channel activism by Lauren Kennedy to the work of organisations such as Mind, Recovery Colleges and the Psychiatric survivors Movement. In fact, we can all be changemakers and demand real evidence based and compassionate care for mental health difficulties instead of over relying on an often-oppressive psychiatric system and forced compliance to psychiatric drugs.  Current narratives around peoples struggles and what causes them can be challenged.  

Mental health patients can be included in the dialogue of what comes next and service users and their carers with their lived experience both in their knowledge of how to manage a crisis and come through to the other side and their knowledge of what it’s like to be on the recovering end of psychiatric care could lead the way in helping to shape the future of mental health services

References

Ambord, N., Burr, C. and Gianfranco Zuaboni (2024) ‘A Glimmer of Hope: The Impact of the Recovery College Bern on Personal Recovery, Well‐Being and Self‐Stigmatisation—A Mixed Methods Study’, International Journal of Mental Health Nursing [Preprint]. Available at: https://doi.org/10.1111/inm.13482.

Burns, T. (2020) ‘A history of antipsychiatry in four books’, The Lancet Psychiatry, 7(4), pp. 312–314. Available at: https://doi.org/10.1016/s2215-0366(20)30106-1.

Cardiff and Vale Recovery & Wellbeing College (2024) Cardiff and Vale University Health Board. Available at: https://cavuhb.nhs.wales/our-services/welcome-to-the-cardiff-and-vale-recovery-wellbeing-college/ (Accessed: 13 March 2025).

Jones (2024a) “Different types of activism”, K243 Mental Health in Society. Available at:Learning Guide 12 Doing: advocacy, activism, mental health and wellbeing: 2.2 Different types of activism | OU online  [Accessed 12/03/25]

Jones (2024b) “Removing Homosexuality from the DSM, K243 Mental Health in Society. Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?id=2279892&section=3.1 [Accessed 12/03/25]

How To Be A Craftivist: The Art of Gentle Protest by Sarah Corbett – YouTube (no date) http://www.youtube.com. Available at: https://www.youtube.com/watch?v=PtHaM7j3Hvg (Accessed: 3 February 2021).

MIND (2024) Mind, the mental health charity – help for mental health problems, Mind. Mind. Available at: https://www.mind.org.uk/.

The British Psychological Society (2018) Power Threat Meaning Framework – The British Psychological Society, http://www.bps.org.uk. Available at: https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework. [Accessed 12/03/25}

Samara (2024)” Psychiatric services across cultures” K243 Mental Health in Society. Available at: Learning Guide 8 Critiques of psychiatry: 2.1 Psychiatric services across cultures | OU online [Accessed 12/03/25]

Vicary and Mallon (2024) “The medical model of depression” K243 Mental Health in Society. Available at: Learning Guide 2 Introducing mental health and mental ill-health: 4.1 The medical model of depression | OU online [Accessed 12/03/25]

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UK LOCKDOWN – Planting seeds of Light

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seedsWell its day 4 of the lockdown in the UK for the Coronovirus Crisis

I am living in a shared building with our own rooms and shared kitchens and thankfully so far nobody here has got the virus

I have been busy keeping my gratitude journal during this time noting three things every day that Im grateful for to counteract the often anxiety making news

Today I am grateful for the financial security not just for myself but for most people I know with the government paying sick pay and 80% of the wages for both the employed and the self employed. I am so grateful for having somewhere safe to live during this time with plenty to do, courses internet and art and even gardening. I live within walking distance of the sea so when I go for my permitted walk per day i can walk on the sea front within safe social distance of everyone else.

thankyou

 

I am hoping that others are finding the crisis equally as comfortable and if your only issue is anxiety and fearing for the future I can help with that

A lot of this battle is not physical but is literally in our hearts and minds . Mindfulness helps with this to be fully present during this time is not putting anyone in danger but is ensuring that we can have the best life and best response to danger and adversity

There are also little tricks and activities which can be done not to pretend that there is no concern but to remain positive during even a lockdown.

One of which is try and nurture life – so much of our world is about buying and consuming which is essentially eating and taking constantly in a hungry basis – but some of what we do should also be about nurturing and giving life and joy to someone else, difficult when your on a social distance – you may do this in your work if your service based but it can be good to cultivate this life in your own sphere and environment as well.

One simple way to do this can be to plant some seeds – so while there is a focus on illness fear death dying and calamity in the media and on the news you can have a plant or two growing on your windowsill that you grew and cultivated and brought to life yourself

This plant or even tree can be symbolic of the light life and joy that you bring forth into your own life and into the world as opposed to just consuming and taking. The seeds you plant of harmony in the world as opposed to the turmoil.

In the UK M and S are even giving away free seeds with plenty of ideas on how to plant them and repot the plants and herbs https://www.marksandspencer.com/c/food-to-order/little-garden

There is also a wonderful meditation of hebrew chanting which is perfect to plant more love and joy into the world by Rabbi Shefa Gold

Or zarua laTzadik, u’l’yishray lev simcha
Planting Seeds of Joy and Light Hebrew text
Plant the seeds of Joy and Light; Tend them carefully day and night,
In this soil so dark and deep, I plant the dreams that Love will reap

Planting Seeds of Joy and Light: Or zarua

The singing or chanting is a beautiful intention to sooth any worries and fears and to begin planting a good fruit to harvest later in the year both physically and spiritually once this lockdown and crisis is over.

Also beyond, simple things you can do is notice the beauty of the sky or the trees or the sunshine – share your bread with the birds, bake or cook something delicious and cultivate light joy beauty into present awareness to grow like seeds.

 

 

Ephemeral Art, Impermanence and the meaning of Life

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There is a lot of art”out there” and most leave the tracks and traces of the artist who made them but what happens when the artist deliberately sets out to leave no trace of their art? When it is an ephemeral piece swept up and destroyed by its creator or by the ravages of time itself – the only trace that may remain perhaps in the form of photographs capturing a temporal fleeting moment of beauty and wonder. Perhaps they exist only in the memories of those who saw it for its brief existence and perhaps it’s there as a history of the landscape in which it was formed. It existed for a time, it was here and then it was gone. There is a unique philosophy to the artists who choose to create such fleeting ephemeral works of art and in this essay we will look at the works of three artists in particular who choose to express their art in this short lived way and that is Andy Goldsworthy, Tibetan monks and Ryan Moule.

What story does the art tell from the artist who deliberately chooses to leave no trace except for photographs and memories. There are actually many forms of art by artists who do this everything from simple sand sculptures and beach art to environmental land art to light painting and the ancient intricate colourful sand mandalas of the Tibetan monks.

Firstly looking at Andy Goldsworthy, he is a British sculptor, photographer and environmentalist. He produces site specific sculpture and land art in a natural and urban setting. His work is made from leaves sticks stones ice and all sorts of natural material and is often completely transient in nature.

“Anthony Goldsworthy’s work”

He likes to create something from the energy of the landscape, something with rhythm, like a dance “a lot of my work is like picking potatoes you have to get into the rhythm of it” (Goldsworthy 2009). The philosophy behind his work is all about the dance of life which is fleeting and temporary in nature. Time plays a significant role in his work he creates a piece takes a photograph of it in its prime and then leaves it to the elements to decay destroy and “kill” the artwork leaving nothing permanent behind. To Goldsworthy this is important to understand the reality of birth, life and death.

His artwork also emphasises the connectedness of all things and the connectedness of the art and us to nature and the landscape. It and we are part of the natural world. Time is something that connects us all and the environment in which we live which is temporary and not eternal. His ephemeral artwork leaves no legacy except for photographs and memories but this is living the honesty of life on earth and how eventually even the most indelible mark fades to nothing in the end. Its also about treading lightly on the earth as an environmental measure and leaving only a gentle footprint on a delicate planet.

This concept is also found elsewhere in the world with the Tibetan Buddhist monks and their beautiful temporary sand mandalas

In Tibetan Buddhism they have a teaching on impermanence and how everything on earth in this life is temporary. The idea in Buddhism is to become conscious of this fact and live life well and in accordance with what are the known laws of nature. The teaching can be summed up in the phrase “this too shall pass” which is a jewish folktale where a king commissioned a ring to be made that would make him happy when he was sad and sad when he was happy. He was a wealthy man and money was no object to him, the ring that came back was a simple gold ring with the words “this too shall pass” engraved on it. (see story at the end) Which is the essence of impermanence, nothing lasts forever when you have all the riches and wealth in the world, this will pass when you are having the worst experience in your life this too shall pass and so it is with life itself, this too shall pass and whatever life you have carefully crafted for yourself all your achievements and reached goals will one day pass into old age and death. The Tibetan sand mandala reflects this – it is beautifully made and may even incorporate beautiful images of the inner world deities and archetypes but once it is carefully and beautifully created by an expert monk – it is immediately swept up into grey sand and distributed as a blessing to the local people or put into a stream to distribute the blessings to the whole world. This teaches the Buddhists monks and those who see it the lesson of how to live with impermanence in mind – like a beautiful sand mandala life should be a blessing and carefully constructed a beautiful thing for the world to behold, then it is swept away by death and decay. It teaches that although life is temporary it is ideally still worth striving for and a good life is to create a beautiful piece of art from it to bless the world leaving only photographs and memories behind.

These sentiments are also found and echoed in the ephemeral artworks of photographer Ryan Moule in his talk in November 2016 he mentioned how he realised that one day his photographs could end up in a charity shop somewhere after he had died and how he didn’t really want to see this happen so he decided to create a temporary set of photographs in an exhibition called deviated light showing the decay of buildings as a visual and conceptual analogy for the impermanence of photography. It also raises the question of collective memory and whether things are better remembered after they have been photographed. In his talk Moule was quite philosophical about life and he played an ipad air advert which showed his views about how like the Tibetan sand mandala life is an artwork or poem of a greater collective poem of the whole of life in the universe and we have this moment of life short as it is in the scheme of things is to contribute a verse, so he asks the question what would your verse be? His photography will fade to black eventually but that was his contribution to the great story or poem of life as it rolls ever on. The ipad advert was based on a poem found from the dead poets society

O Me! O Life!

BY WALT WHITMAN

Oh me! Oh life! of the questions of these recurring,

Of the endless trains of the faithless, of cities fill’d with the foolish,

Of myself forever reproaching myself, (for who more foolish than I, and who more faithless?)

Of eyes that vainly crave the light, of the objects mean, of the struggle ever renew’d,

Of the poor results of all, of the plodding and sordid crowds I see around me,

Of the empty and useless years of the rest, with the rest me intertwined,

The question, O me! so sad, recurring—What good amid these, O me, O life?

 

  Answer.

That you are here—that life exists and identity,

That the powerful play goes on, and you may contribute a verse.

 

Source:  Poetry Foundation https://www.poetryfoundation.org/poems-and-poets/poems/detail/51568

 

The common thread of all these artists are they are approaching and expressing what can be an ugly and uncomfortable truth for us all about the temporary nature of life old age and death, in a beautiful and profound way. It makes us think and reflect on this reality and how to best live our lives without shocking us too much. It also makes us think of those who have passed and the contributions they made before they died.  No matter what we do how wise or rich or skilled we become nobody escapes death and when it comes, our body will return to dust leaving only memories to those we leave behind. It helps us appreciate the transient and beautiful nature of life and perhaps makes us value our loved ones or even our enemies that much more because we know they have their time and they too shall be gone like the colourful artworks which leave no real trace behind them.

The King and His ring – jewish folktale

During the festive Passover meal with his ministers, King Solomon teased Benaiah son of Jehoiada, his arrogant Chief of Army.

– “Benaiah, I was told that there is a special ring that has special power. It can change the mood of a person. A sad person becomes happy when watching it and a happy person becomes sad. I know that you of all people in the kingdom can find the ring. Would you be able to find this ring and bring it to me until the eve of Sukkot eve, that is 6 months from now?”

– “If it exists anywhere on earth, your majesty,I will find it and bring it to you”replied Benaiah.

King Solomon smiled as he knew that no such ring existed, but he wanted to give his minister a taste of humility.

Time passed and Benaiah sent soldiers and messengers throughout the kingdom, examined records, consult with elders yet he could not find even a hint of the existence of the magic ring. Spring passed so did summer. The last harvest of the year, and with it the Succoth festival, was approaching. Then came eve of Sukkot day. With only a few hours to go before the deadline, Benaiah was wandering in the streets of Jerusalem. The sun was setting casting a golden light on the city which until today all its buildings are made of stone. All the merchants were busy with the last sale and prepared to close their stalls. In desperation he turned to an old silversmith.

– “Have you by any chance heard of a magic ring that makes the happy person forget his joy and the broken-hearted person forget his sorrows?” asked Benaiah. The silversmith listened carefully and smiled. He took a plain silver ring from his old and dusty box and engrave something on it. When Benaiah read the words on the ring, his face lighted up as he knew he had found the right ring.“This is the ring!” he cried, and gave the poor jeweler all the money in his purse.“Come to the palace and you shall have more,” he added, “for I cannot thank you enough.”

The sun set. The time for the holiday dinner arrived. That night the palace was full of guests ready to celebrate with the king.

– “Well, my friend,” said Solomon, “Have you found a ring that can make a happy man sad and a sad man happy?” Everyone who knew about the search for the impossible ring laughed and Solomon himself smiled.

But to everyone’s surprise, Benaiah held up a ring and declared, “Here it is, your majesty! I found a ring. It has three Hebrew letters engraved on it: Gimel, Zayin, Yud. Then he whispered the meaning of these initials in the king’s ear.

As soon as Solomon heard the meaning of the inscription, the smile vanished from his face. He looked at the guests filling the banquet hall, the tables covered with shining serving pieces, silver goblets, and the finest food one can find. Tears rolled down his eyes. He felt sad. The entire hall was in total silence. A ring that makes the king cry?

Then King Solomon looked at the ring again and started to smile again then laughed so hard infecting the entire palace with giggles and laughter. Everyone wanted to know the meaning of the initials.

The King revealed to his guests what was written on the ring: “The three letters are ג,ז,י represented three words: Gam Zeh Ya’avor”. It means in English: “This too shall pass.”


In life everything is temporary. In fact, life itself is temporary. In between birth to death we all experience the roller-coaster of life.

King Solomon had everything – power, women and wealth then he realized at the end of his life the illusion to hold on to things as they are not the source of happiness. So he turned to a spiritual search and wrote in Ecclesiastes :

” The words of the Teacher,son of David, king in Jerusalem: “Meaningless! Meaningless!” says the Teacher. “Utterly meaningless! Everything is meaningless.” … “What has been will be again,what has been done will be done again; there is nothing new under the sun.”

 

Source: https://www.linkedin.com/pulse/20141021084324-7280985-the-king-and-the-ring-this-too-shall-pass