Issue 233 of SOCIALIST REVIEW Published September 1999 Copyright Socialist Review

Mental health

The label doesn't fit

Hysteria from the press

The issue of personality disorder has frequently dominated the headlines over the past few months. In the wake of the Michael Stone case, the first week in August saw the Scottish papers obsessed with news of the release of Noel Ruddle from the state hospital at Carstairs.

Ruddle was sent to Carstairs in 1991 after being found guilty of shooting down a neighbour (hence the media's exotic description of hint as 'the Kalashnikov killer'). At that time he was diagnosed as suffering from paranoid schizophrenia, a condition that appeared to respond to treatment at Carstairs, following which it was claimed he was suffering from an 'underlying personality disorder'. The 1984 Mental Health (Scotland) Act states that individuals with a personality disorder can only be compulsorily detained in a psychiatric hospital if their condition is 'treatable'. Since a majority of psychiatrists who examined Ruddle in 1999 decided his condition was not treatable at Carstairs, Sheriff John Allan not unreasonably felt that there were no legal grounds for his continued detention and released him on 2 August.

The result has been hysteria from the press, Tory Party and the SNP. In response, justice minister Jim Wallace has now announced that one of the first pieces of legislation to be passed by the Scottish Parliament when it meets in the autumn will be an act to ensure that in future people with this diagnosis can continue to be detained, regardless of 'treatability'. The likelihood is that Jack Straw's proposals for 'preventive detention' of people with a personality disorder will also now be implemented in Scotland, despite the protests of two committees of lawyers and mental health professionals who are currently reviewing Scottish mental health law.

There are problems with the way the Ruddle case has been handled, but a blanket restriction of the rights of people with a diagnosis of personality disorder amounts to scapegoating and is a diversion from the real issues. Not the least of these is the debate over what constitutes a personality disorder. The label tends to be associated in the public mind with coldblooded killers like Fred West or Dennis Neilsen, people whose intellectual faculties are unimpaired but who appear to lack any moral sense. In the title of a recent Hollywood movie, they wear a 'mask of sanity' but suffer from what in the 19th century was known as 'moral insanity'.

In fact, individuals like West and Neilsen with so called anti-social or psychopathic personality disorders constitute only a small fraction of people given the label 'personality disorder'. The overwhelming majority are people who are no more dangerous than the rest of the population but who experience such severe difficulties in their behaviour or personal relationships that they eventually come into contact with the psychiatric services.

Since, however, they cannot easily be slotted into a particular psychiatric classification (which in practice often means they fail to respond to psychiatric medication), they are often given the label personality disorder, described in one influential textbook as 'a psychiatric wastebasket'.

Nor is the diagnosis an exact one. As the National Schizophrenia Fellowship pointed out in response to Straw's proposals, a large percentage of those who are initially given the label are subsequently diagnosed as having a quite different condition--rather worrying, since those given the label could be detained indefinitely without having committed any offence.

Finally, despite the horrific crimes that some very disturbed individuals may commit, we should reject the media portrayal of them as inhuman monsters. As with the child killer Mary Bell, they are often people who have suffered horrendous abuse and violence in their own lives. In many cases, that will lead them to self harm, or to make repeated suicide attempts, while in a very small number it will lead them to behave violently towards others.

In practice, being given the diagnosis of personality disorder has the dual effect of giving individuals a stigmatising label on the one hand and, since personality disorders are usually seen as 'untreatable', cutting them off from the possibility of help on the other.

The assumption of both government and also many psychiatrists is that, if psychiatric drugs don't work, then nothing can be done. In fact, on a daily basis many other mental health professionals are providing a range of non-drug therapies such as cognitive therapy, psychotherapy, anger and aggression management, and other 'talking treatment'. These treatments can play a valuable role in helping people pick up the pieces of their lives.

The fear of many professionals, however, is that the present media and government demonising of people with a personality disorder will further marginalise them from society and make them less likely to seek out help, especially if they believe they may be labelled as 'psychos' and detained indefinitely at Jack Straw's pleasure.

That's assuming, of course, that services are available--the inquiry into the Michael Stone case showed that he had in fact sought help on several occasions but was turned away due to lack of resources. Too often the term 'untreatable' is a smokescreen for a lack of will to invest in easily accessible quality services.

Far from being an aberration, Straw's scapegoating of people with a personality disorder is consistent with New Labour's authoritarian approach to other stigmatised groups such as lone parents and asylum seekers. As Nick Cohen recently observed, 'If you want to know what Jack Straw is thinking of doing on any issue, ask yourself, 'What would Michael Howard have done?"'
Keir McKechnie and Iain Ferguson
Personality Disorder: A Dangerous Label? is the title of a one day conference being organised by Glasgow Association for Mental Health on Thursday 30 September. For details, phone Laura Jarvie on 0141204 2270.

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