On December 30th my friend Caoilte Ó Broin was reported missing.
On January 2nd Caoilte’s body was found in the River Liffey.
In previous years Caoilte spoke more frequently and with greater despair about his mental suffering. His anguish inevitably led to his stay at one of our country’s psychiatric units just before his death. Plenty of family, friends and commentators have been vocal in their outcry towards legislative and administrative oversights that facilitated the discharge of an acutely unwell young man – and without notifying his family to boot. While they are right to criticise this protocol I can’t help but feel that there is so much more at stake than poor protocol.
Our Approach to Psychological Diagnosis is Fundamentally Flawed
Through his suffering Caoilte had been aligned with the term ‘dual diagnosis.’ Dual diagnosis refers to a situation whereby a person is said to suffer from a ‘mental illness’ and some form of substance abuse concurrently.
Most services in our country refuse to work with dual diagnosis patients. Often people with a ‘dual diagnosis’ are told by service providers to sort out their addiction then come back when they’re ready to work on the other problem. Their view is one that compartmentalises and separates mental life in to neat boxes.
The approach here is equivalent to assuming that when we consume drugs we do so in a little microcosm with high walls. An arms-folded Neanderthal guards the breaches by a large sign that reads: “No other thoughts in or out!” You might expect this little skit as the production of some surrealist comedian like Noel Fielding but the gravity of the situation is much more likened to a black comedy or Theban tragedy.
Geraldine Strathdee, National Clinical Director of Mental Health for England, recently tweeted: “Dual diagnosis. What does that mean?” She seems flabbergasted and I wholeheartedly sympathise with her. As a practising psychoanalyst I have to admit I haven’t the foggiest what a dual diagnosis is supposed to mean. It’s nonsensical and irrelevant.
Aware of the impotency of dual diagnosis she continues her tweet by calling for a rebrand in favour of a neater, less ‘ambiguous’ term. She’s not alone in this.
Unfortunately calls like this are the embodiment of the perpetuating problem. Cries that our diagnostic manual is failing has traditionally led to appeals to reinvent the (punctured) wheel. Many psychologists are caught up in their efforts to refine and redefine their diagnostic system until they’re blue in the face. It’s a word play with no end in sight. Inevitably, the focus is on creating more elaborate diagnostic terms and not on treatment.
Where is the Clinic of Psychology?
For three years I studied, alongside Caoilte, in Maynooth University. We studied psychology. In this time we learned, exclusively, how to categorise, measure, and test human experience. There was never any discussion on how to implement treatment. Not once. The clinic of psychology vanished behind a plume of psychometric testing.
Our psychology department’s approach is not exceptional or extraordinary here. It epitomises the fundamental approach to psychology in our country. It is a discourse that is hell bent on standardising human experience. Rather than focus on Caoilte’s treatment, involving the vast expansive valley of his psychical experience, his cause was lost beneath the veil of diagnosis. The eyes of this discourse fixated firmly on the term ‘diagnosis.’ Scarcely moving beyond that for fear that they would be exposed to a great unknown. It has been said many times within psychoanalytic circles that the function of this obsession with diagnosis serves to allay the psychologist’s anxiety much more so than the patient.
Can we Stop Speaking of Mental Health and Illness?
Our obsession with mental health and illness is killing us. Both of these terms are extremely unhelpful in battling the severity of suffering Caoilte faced.
The relationship between both terms supposes that a healthy mentality exists somewhere, if we can just find it. Much like a pro-athlete we too can fine-tune our minds and have a healthy one, right? The notion is one of nirvana. A mirage oasis in the desert that’s led our thirsty camels astray. Show me a ‘healthy mind’ and I’ll show you a two-dimensional Hollywood prop waiting to topple. It’s a hoax.
To speak of mental illness harks to a disease. Something that is broken or wrong within the body, and possibly something that is fleeting. How often have we heard someone say “I knew someone who had a mental illness once,” as if the illness just popped up like a bout of tonsillitis or a dodgy knee. In this light mental illnesses are champions of the one of the longest games of hide-and-seek ever. They can not, and will never be found in the body.
(Mis)Hitting the Point
Neither will mental suffering be located in sweeping statements like depression, generalised anxiety disorder, OCD, addiction, the list goes on. These terms operate at the same level of a cheap stereotype – their neat image appealing from afar. Yet, the moment we move close enough to hear of someone’s story, their own intricate labyrinth of thoughts, we can see clearly that these diagnoses are also mirages. They tell us nothing of the singularity of the individual. Of the epic of their life with its desperate lows and soaring highs. Of the myths of distant relatives and past loves succumbing to time and memory. Of their hopes for the future and paradoxically the crushing expectation that can bring. These elements interweaving and wrangling to produce the intricate tapestry of their mind. No, the approximations that these diagnoses are based on, the quantification that they aim at – utterly useless. Caoilte’s death marks this impotency in the strongest possible way. How can the void that his death has left be quantified? What equation or survey can depict this?
What can be said is that once we are borne in to language we suffer. Every single one of us. As soon as we learn to speak and operate within the community of others we are at a loss. This is inevitable and inescapable. The moment psychology begins to divert its gaze away from the seduction of diagnosis and instead back to the clinic is the moment we begin to stem the tide of untimely deaths drowning our nation. A clinic whose discourse moves past platitudes and dead ends like ‘depression.’ A clinic that encourages speaking of the profound and radically singular experience of each individual.
Caoilte’s only diagnosis was named ‘Caoilte.’ Tragically, that is something he never articulated.
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