Eight Producing radical change in mental health: implications of the trauma paradigm
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Sarah Nelson
Abstract
Our psychiatric hospitals, secure hospitals and outpatient psychiatric clinics are packed with the victims of crime – especially with victims of child sexual abuse (CSA). This fact continues to be heavily obscured due to dominant medical model paradigms in mental health. As a result, such hospitals and clinics remain major parties to the concealment of the extent and impact of such crimes.
This chapter considers the persistence of biomedical models of mental ill health despite repeated and continuing evidence for trauma aetiologies, and discusses some reasons why this evidence has been consistently ignored. It argues that it is very important, but not sufficient, to challenge biomedical models of mental illness, to challenge current diagnostic labelling, and to oppose coercive techniques of restraint: as many committed critics within and beyond the mental health professions have already done. It is also very important, but not sufficient, to provide – for survivors of abuse and indeed survivors of other serious life adversities – adequate, humanistic, caring, appropriate therapeutic and support services, and genuinely to involve service users in shaping those services.
But the major implications for prevention of the crimes which continue to make so many people mentally ill must also, at last, be fully acknowledged and acted upon. Given the major roleaccorded to prevention in many other areas of public health, it is after all extraordinary and unusual that they have not been. Thus our mental health systems, with forceful prompting from governments and health authorities, need actively to contribute to multidisciplinary efforts to prevent and reduce CSA.
Abstract
Our psychiatric hospitals, secure hospitals and outpatient psychiatric clinics are packed with the victims of crime – especially with victims of child sexual abuse (CSA). This fact continues to be heavily obscured due to dominant medical model paradigms in mental health. As a result, such hospitals and clinics remain major parties to the concealment of the extent and impact of such crimes.
This chapter considers the persistence of biomedical models of mental ill health despite repeated and continuing evidence for trauma aetiologies, and discusses some reasons why this evidence has been consistently ignored. It argues that it is very important, but not sufficient, to challenge biomedical models of mental illness, to challenge current diagnostic labelling, and to oppose coercive techniques of restraint: as many committed critics within and beyond the mental health professions have already done. It is also very important, but not sufficient, to provide – for survivors of abuse and indeed survivors of other serious life adversities – adequate, humanistic, caring, appropriate therapeutic and support services, and genuinely to involve service users in shaping those services.
But the major implications for prevention of the crimes which continue to make so many people mentally ill must also, at last, be fully acknowledged and acted upon. Given the major roleaccorded to prevention in many other areas of public health, it is after all extraordinary and unusual that they have not been. Thus our mental health systems, with forceful prompting from governments and health authorities, need actively to contribute to multidisciplinary efforts to prevent and reduce CSA.
Kapitel in diesem Buch
- Front Matter i
- Contents iii
- Acknowledgements v
- Introduction 1
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Setting the scene: some barriers to progress
- From rediscovery to suppression? Challenges to reducing CSA 21
- Lies and deception in the backlash 59
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Children and young people
- Fact, myth and legacy in notorious child abuse cases: Orkney in context 103
- Stigmatised young people: from ‘abuse fodder’ to key allies against abuse and exploitation 133
- Models for ethical, effective child protection 175
- Community prevention of CSA: a model for practice 213
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Working with adult survivors of sexual abuse
- Physical ill health: addressing the serious impacts of sexual violence 251
- Producing radical change in mental health: implications of the trauma paradigm 287
- Pathways into crime after sexual abuse: the voices of male offenders 319
- Rethinking sex offender programmes for survivor-perpetrators 349
- Conclusion 373
- References 381
- Index 425
- About the authors 441
Kapitel in diesem Buch
- Front Matter i
- Contents iii
- Acknowledgements v
- Introduction 1
-
Setting the scene: some barriers to progress
- From rediscovery to suppression? Challenges to reducing CSA 21
- Lies and deception in the backlash 59
-
Children and young people
- Fact, myth and legacy in notorious child abuse cases: Orkney in context 103
- Stigmatised young people: from ‘abuse fodder’ to key allies against abuse and exploitation 133
- Models for ethical, effective child protection 175
- Community prevention of CSA: a model for practice 213
-
Working with adult survivors of sexual abuse
- Physical ill health: addressing the serious impacts of sexual violence 251
- Producing radical change in mental health: implications of the trauma paradigm 287
- Pathways into crime after sexual abuse: the voices of male offenders 319
- Rethinking sex offender programmes for survivor-perpetrators 349
- Conclusion 373
- References 381
- Index 425
- About the authors 441
