Najwa Nosology* Decoded

AS the bizarre technical assessment of Najwa Peterson demonstrates, South African society is increasingly finding itself constructed within psychiatric terminologies. Aside from the travesty of intellect and the abuse of the English language as it stands, the volley of psychobabble from physicians associated with the case has implicated Najwa in an abstract thought crime, for which there is no cure except, perhaps to demand better terms.

Surely being labeled with a “chronic severe major depressive disorder with psychotic features and recurrent lapses” has rendered Najwa’s trial meaningless and the understanding of legal process by the public near impossible? How are we as South Africans expected to react, to a biological decree – if Najwa has an illness which is both chronic and severe, as well as potentially a major disability, then surely she is clinically depressed, and as a result is not responsible for her deeds, and must be excused of the crime? Or does the suggestion of pathology here mean Najwa is guilty? Has she confessed to her doctor then?

As if to make the point and bring home the complexity of the situation, the panel of psychiatrists and psychologists tasked with making this assessment have literally drawn up a diagnostic check-list that boggles the imagination.

In addition to the alarming and suggestive “depressive disorder with psychotic features and recurrent lapses”, there are at least seven disorders and related features which include  “dysthemia, chronic severe panic disorder with agoraphobia with recurrent lapses; chronic severe generalised anxiety disorder with recurrent relapses; post traumatic stress disorder, and chronic primary insomnia.

To make any sense of our legal system, a person accused of a crime must be considered innocent until proven guilty, and furthermore, to make our system work, it is also necessary that we presume that the defendant is psychiatrically fit to stand trial until proven otherwise.

The biologists who see Najwa as the victim of her genes may well be right but the “its all in our genes’ school of thought invariably ends up excusing murder while condemning any deviation from the norm as pathology. People considered “different” or “maladjusted” continue to be labeled bipolar or schizophrenic in a society in which any expression of emotion is mania, and the ordinary exhibition of grief is pathologised.

Surely it beggars the brain to believe that a single person can suffer from so diverse a set of disorders, that some of the terms advance the study of the afterlife, since dysthemia is a depression in the spirit according to one dictionary, and so one is forced out of respect for Taliep and his family to question the diagnosis.

The answers to why such highly technical terms have been introduced to literally perplex and confound the public, and which now invade our tabloid ridden discourse, and societal conversation in general, may be found in the highly controversial, Diagnostic Statistical Manual for Mental Disorders or (DSM) published by the American Psychiatric Association and its companion, the International Classifications of Diseases (ICD).

As the DSM increasingly pervades our psychiatric drug obsessed society, its value as a diagnostic tool is increasingly under attack for its lack of scientific veracity. Studies by Professors Herb Kutchins and Stuart A. Kirk for instance have found, “there is ample reason to conclude that the latest versions of DSM as a clinical tool are unreliable and therefore of questionable validity as a classification system.

The DSM is essentially an attempt to supplant notions of good and bad, with technical terms and values derived from a psychiatric construction of reality, one which posits an essentially archaic notion of discrete mental illnesses, first developed by Emil Kraepelin in 1887. Such a diagnostic system creates a series of mental labels which are said to exist within negative or positive values, but which at the end of the day, are really just convenient linguistic compartments into which we put our subjective experiences – experiences whose determination or underlying cause are either unknown, or derived from a subjective analysis of any given situation.

The illusion of scientific discourse, created by the fantastic technical constructions offered us by Najwa’s psychiatric assessment panel, is compounded by the fact none of the so-called disorders in the DSM have ever been conclusively proven – unlike diseases which are discovered, mental illness is invented – and disorders such as Attention Deficit Disorder (ADD) are voted into the manual every couple of years, and used by the profession to avoid issues such as strict liability, and quibbles over medical insurance billing.

As Kirk and Kutchins write: “Twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliablity by regular mental health clinicians. Nor is there any credible evidence that any version of the manual has greatly increased its reliability beyond the previous version.

Again, “To some observers, [cases such as these] suggest that psychiatrists are merely hired guns, paid to say whatever will help their clients. In this view, psychiatrists’ testimony is predictably divergent; their professional status as experts serves merely to cloak their paid performances in respectability. Any detailed analysis of the scientific basis for their testimony would [therefore] be irrelevant. To others, psychiatrists are objective, scientific practitioners trying to bring their best professional judgment as competent mental health experts to bear on difficult cases. Their sharply divergent opinions, therefore, must be due to the uncertain state of psychiatric knowledge or the uncertain art of psychiatric diagnosis.

A well-known example of the general unreliability of the DSM is the controversial debate surrounding homosexuality, which was once considered a mental illness and eventually jettisoned (in its final form as egodystonic homosexuality) in 1987.

The DSM panel has also been accused on more than one occasion of discriminating against women. According to Paula Caplan Phd, of the US-based Coalition for Informed Patients and Doctors, psychiatric diagnosis shows bias against African-Americans and black people in general. “Few laypeople or even therapists realize that psychiatric diagnosis is not a scientific endeavor, although some of the most powerful people and organizations in the mental health field assert that it is. As a result, millions of people who seek help because they are suffering have no idea that they are not being diagnosed in scientific ways and thus that their treatment largely lacks a scientific basis” A textbook published by the American Psychiatric Association as recently as 1993, distinguished between white and non-white eating disorder.

The philosopher Herbert Marcuse once remarked: “what is at stake is the redefinition of human values in technical terms, as elements in technological progress.” But the new ends, which are technical ends, essentially represent the advancement of the profession of psychiatry, which is dependent upon sustaining a complex discourse of quasi-scientific communication, and thereby creating an aura of expert testimony to achieve its goal.

It is not the intervention of medicine in the law per se, which is the problem, and which one should be objecting to, but rather, the insinuation that our law is not capable of determining legal competancy, since such knowledge of the defendant – as can be addressed in a written column such as this one – has been cordoned off behind a veil of mystery or a simple medical technique.

The disturbing influence of psychiatric assessment on society has been noted, as too the resurgence in mental health screenings at school level, and the associated epidemic of ADD and Attention Deficit Hyperactivity Disorder (ADHD). Psychiatric drugging of children progresses into adulthood, and the move away from notions of the common good, to relativistic or normative value judgments made by teachers, scholars, academics and scientists, is a growing trend world-wide.

Who determines what the common good is? Are we able to decide for ourselves or do we all have to get expert testimony to tell us how to think, act, and behave? The psychiatric watchdog, Citizens Commission on Human Rights (CCHR) has already raised the issue of the link between psychiatric drugs and violence. The use of anti-depressant medication may well be a link in the Najwa Peterson trial, if one believes CCHR spokesperson, Erica Chesler since, “a total of 11 international drug regulatory agencies have warned of side-effects associated with psychiatric drugs,” since “the US Food and Drug Administration as well as drug regulators in the UK, Australia, Canada, Japan and Germany have issued warnings that antidepressants and other psychiatric drugs can cause suicide, homicidal ideation, hostility, psychosis, psychotic depression, severe restlessness, hypermania (abnormal excitement) agitation, anxiety, irritability, impulsivity, mania and hallucinations.

The public have a right to know, and one can only hope that the court will hear argument, for and against these controversial theories, since without sufficient debate, we are all the poorer, as our world becomes increasingly globalised and South African’s fall victim to the modern techniques of psychiatry and the technologies of the pharmaceutical industry.

* nosology – medical term for the classification of disease

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