Can Psychiatry Be Misused? The Fine Line Between Mental Health and Accountability

Think about a university student cheating on an exam. They get caught and, upon being discovered, claim they experienced great anxiety and/or were having a breakdown to escape any sort of penalty. Or consider a celebrity accused of having behaved violently and who states to the public that they were “not in the right frame of mind” at the time. In both circumstances, mental health is being discussed about its true nature as a mental concern and in the potential for use as an excuse. Can people use psychiatry as an improper excuse?

The field of psychiatry contributes significantly to the study of mental health; the diagnosis and treatment of mental disorders (i.e. depression, schizophrenia, and bipolar disorder) affect the day-to-day routines of patients. Many people view mental health issues negatively, and this stigma has affected people with mental illness by limiting access to care and causing millions more to become mentally ill.

The American Psychiatric Association (2022) estimates that there is a vast number of persons who have benefited from improved mental health care services due to modern psychiatry and all of the changes that have occurred. While some individuals do use their mental illness as an excuse for their actions, and there is a growing body of evidence to support this theory, most individuals are not the ones who are abusing that to, say, justify a behaviour that could have otherwise been unjustified.

The Fine Line Between Understanding and Misuse

Misapplying psychiatric information has legal implications, social issues, and personal situations (whether they are individual or those who will be affected by this). For example, people could exaggerate their symptoms in hopes of not getting in trouble or gaining sympathy from family and friends. People can also use psychiatric terminology to stereotype a person, sometimes treating them unfairly based on that label. However, we cannot view mentally ill persons as having a violent or irresponsible nature just because they have an illness. The real issue at hand is how improperly these terms and concepts are used, rather than the problem of having a mental illness. Research has shown that people with mental illnesses experience victimisation more frequently than they commit crimes (Stuart, 2003 and Fazel et al., 2009).

Mental Illness as a Shield to Escape Responsibility

The use of mental illness as a legal defence is one area in which psychiatry has become controversial. The insanity defence is meant to exempt an individual from having to take on full legal responsibility for their actions when they were unable to understand their actions because of a severe mental illness. A true benefit is to protect mentally ill people from the consequences of their actions. Critics maintain, however, that people sometimes use this defence inappropriately.

Malingering is the act of feigning or exaggerating symptoms to avoid consequences. Consequently, forensic patients who may try to have their sentences reduced report it more often (Resnick, 1997; Rogers, 2008). Ways individuals can misuse psychiatry:

• Feigning hallucinations or having no memories of an event
• Using a mental health diagnosis as an excuse for abusive behaviour
• Ascribing all negative behaviours to a mental illness
• Seeking sympathy rather than accepting responsibility.

Research indicates that an insanity plea is only successful approximately one per cent of the time in court. As a result, courts tend to scrutinise these types of pleas closely (Callahan et al., 1991).

Labelling, Control, and the Misuse of Psychiatric Power

Social or institutional pressures can misuse psychiatry. As a result, psychiatric diagnoses sometimes reflect social or cultural biases rather than true mental illness. This can lead to concerns regarding how psychiatry’s power can limit people’s freedom, identity, and acceptance in society (Bloch & Reddaway, 1984; Bayer, 1987).

The use of psychiatric diagnostic labels can still cause stigma and prejudice today. People have certain perceptions based on those labels when they hear someone has been diagnosed with one of these types of mental disorders, and can form conclusions about their character based solely on the diagnosis that will affect how they relate to the person diagnosed, whether they will get the job they want or any job (Corrigan & Watson, 2002). Research indicates that people may not seek help from a physician because of this stigma (Corrigan & Watson, 2002).

Responsibility, Identity, and “Who Am I Beyond My Diagnosis?”

A psychiatric diagnosis can sometimes limit or entirely define someone’s identity through their illness. Mental illness can affect how someone feels and behaves. However, individuals should not use mental illness as an excuse for all of their actions. Mental health professionals believe that when someone has a mental health difficulty, we should respond to them with compassion; however, they should still be held accountable for their behaviour and encouraged to work towards improving themselves (Beck, 2011).

There are some significant differences between:

• Explanation vs. excuse 
• A mental health diagnosis is a factor in behaviour, but not a definition of the person’s character. 
• Support and accountability should coexist. 
• Recovery requires some type of treatment, self-awareness and taking responsibility.

According to research, also, having the power to make choices beyond their diagnosis helps people recover and increases their self-esteem (Slade, 2009).

Conclusion

In today’s healthcare system, there are few other areas as valuable as the Psychiatry field; this is because Psychiatric services provide people a way to comprehend the effects of and deal with the pain associated with mental illness. Therefore, psychiatric care has been responsible for saving lives, reducing stigma concerning mental illness, and increasing public understanding of mental health conditions that were either previously not understood or ignored.

In addition to the aforementioned, however, the Psychiatry field also can be misused when/if a person utilises their mental illness as an excuse for not facing consequences for his/her actions, when a Psychiatric label is used inappropriately to manage or stereotype a person, or when a diagnosis replaces personal responsibility altogether.

Keeping equilibrium is where the challenge lies! On one hand, society must continue treating mental illness with respect and compassion; on the other hand, society must understand that a psychiatric explanation cannot always, and should not always, relieve individuals of responsibility for their actions. Just because someone has misused mental health services does not take away from those individuals who are genuinely struggling with a mental illness; similarly, some individuals have a genuine illness and will use it to manipulate or escape being accountable. Psychiatry should provide tools for individuals to heal and grow, not be a means of avoidance, control, or judgment.

References +

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing. 
• Bayer, R. (1987). Homosexuality and American psychiatry: The politics of diagnosis. Princeton University Press. 
• Beck, J. S. (2011). Cognitive behaviour therapy: Basics and beyond (2nd ed.). Guilford Press. 
• Bloch, S., & Reddaway, P. (1984). Psychiatric terror: How Soviet psychiatry is used to suppress dissent. Basic Books. 
• Callahan, L. A., Steadman, H. J., McGreevy, M. A., & Robbins, P. C. (1991). The volume and characteristics of insanity defence pleas: An eight-state study. Bulletin of the American Academy of Psychiatry and the Law, 19(4), 331–338. 
• Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16–20. 
• Fazel, S., Gulati, G., Linsell, L., Geddes, J. R., & Grann, M. (2009). Schizophrenia and violence: Systematic review and meta-analysis. PLoS Medicine, 6(8), e1000120. 
• Resnick, P. J. (1997). Malingered psychosis. In R. Rogers (Ed.), Clinical assessment of malingering and deception (2nd ed., pp. 47–67). Guilford Press. 
• Rogers, R. (2008). Clinical assessment of malingering and deception (3rd ed.). Guilford Press. 
• Slade, M. (2009). Personal recovery and mental illness: A guide for mental health professionals. Cambridge University Press. 
• Spinelli, M. G. (2004). Maternal infanticide associated with mental illness: Prevention and the promise of saved lives. American Journal of Psychiatry, 161(9), 1548–1557. 
• Stuart, H. (2003). Violence and mental illness: An overview. World Psychiatry, 2(2), 121–124.