The Wellcome Collection in Euston, London, home to all things combining medicine with art, recently held a talk entitled 'Disordered?' The premise of the discussion was quite simple: We currently have a number of personality disorder categories used by psychiatrists today, such as antisocial, borderline, avoidant and dependent. What is the impact of receiving this diagnosis? Is it helpful to categorise these disorders in the first place? And do they really have any meaning?

The panel was a good mixed bunch: Historian Lisa Appignanesi who wrote 'Mad, Bad and Sad', Honorary Consultant Psychiatrist Paul Moran from the Institute of Psychiatry and Sociology Lecturer Susie Scott from the University of Sussex. Science writer and Radio 4 presenter Claudia Hammond moderated the discussion and the audience was even treated to a few words from the artist Bobby Baker, whose exhibition at the space was what led to the talk in the first place.

Lisa Appignanesi asked some interesting questions about whether we are trying to create a world where everyone is the same, nobody deviates from the norm, everyone feels happy - almost a 1984 type of dystopia. She suggested that this has led to an increase in medicating mental illnesses instead of letting the people affected embrace them. She was not suggesting that medication is wrong or that people shouldn't seek treatment if they need it, just that maybe it's ok to be different. (This viewpoint echoed a message that came across in Stephen Fry's documentary on bipolar, where many felt that the medication destroyed their ability to be creative.)

Appignanesi also drew attention to the fact that sometimes disorders are created by the pharmaceutical companies. She referred to Ritalin - a drug initially designed for sufferers of Mohr's Syndrome - leading to the birth of ADHD (attention-deficit hyperactivity disorder). Surely the problem should come first and then the cure?

Paul Moran drew from the American Psychiatric Association's definition of personality disorders as being "an enduring pattern of inner experience and behaviour that deviates markedly from the individual's culture, is pervasive and inflexible." He said that all of these points needed to be observed simultaneously in order to make the diagnosis, because key symptoms, such as unhappiness with life, isolation, emotional distress and relationships problems are things that unfortunately we all experience.

Susie Scott particularly focused on the issue of labelling. She quoted the definition for avoidant personality disorder in the DSM IV (the American bible also known as the Diagnostic and Statistical Manual of Mental Disorders). It stated that it was "a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation." Scott pointed out that this definition also applied to shyness and questioned that if we label something as an illness, do people then conform to its expectations?

Another issue that was raised was the stigma surrounding people who self-harm. Moran said he had heard of instances where self-harmers had gone to A&E to be stitched up, only to be treated without anaesthetic as a "punishment" for damaging themselves.

No firm conclusions were raised, but the talk did provide a lot of food for thought on the issues of labelling people with mental illness and how it can affect them as a result, and also society's attitude to them.
 

Photo: Courtesy of www.notmytribe.com