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Failing to live up to the agreed definition

January 20, 2008

I start with three items of news: Steve Wright who is accused of murdering five prostitutes, the inquest into Princess Diana’s death and Britney Spears.

Descriptions of the late Princess Diana’s behaviour include the adjective: paranoid and the symptom bulimia. Both are considered non-U behaviour for a fairy-tale princess. Britney Spears’ non-conforming behaviour around hairstyle and motherhood does not match what we, the viewing public, expects from one who has been nominated an icon. From Metro, Thursday January 17 2008. ‘The star’s well-documented meltdown is worth £60million a year to the US economy. Winners include record companies, perfume makers and the paparazzi. Record label Jive - £200million, seven tours - £300,000 a show, Las Vegas’s Pure nightclub sells table space near her for £25,000, Snaps of bald Spears £250,000. And so on.’ Britney Spears fall from what is expected or expected standard, is of international interest. Princess Diana’s failure to live up to our standard in which we imprison her also sells newspapers and has not financially done Paul Burrell any harm. Both women fail to live up to the agreed definition of normal behaviour. This failure is of interest to us. I refuse to use the term mentally ill in reference to these two. Why? Because it is us, through the media, who are defining these symptoms/behaviours as abnormal. As a psychoanalyst, each subject is different. I do not apply a common standard or meaning to an individual’s symptoms. These symptoms or behaviours do not automatically categorise human beings into mad or normal. The government, in enforcing its clinical judgment through NICE clinical guidelines, is able to distinguish mad or mentally ill from normal or up to standard. Further, with the economist, Lord Layard’s help, the government takes their definition of mental ill-health, such as anxiety or depression, and turns it, via the government-approved application of cbt, into normal measurable well-being and happiness. So non-conformist behaviour excluded as not normal and those not up to the standard are placed outside society, usually homeless in London. Behaviour defined as abnormal or not up to standard has three economic consequences: 1) In the famous, it earns others a lot of money 2) for those with jobs, absence from work is a cost to their employers and the NHS and 3) those on sickness-benefit and unemployment benefit are a drain on the government and the NHS.

Steve Wright is attracting much attention. This takes up three pages of the Metro’s coverage. There must be something about this crime which attracts the reader or the coverage would be more modest. There is something abnormal about this crime. Everyone is capable of killing – fortunately most people do not but this crime goes beyond our expectations. The ‘abnormality’ maybe, that having killed a stranger, the body is then laid out in crucifix form, and in a short period of time there is a repetition. The repetitions are to a pre-ordained or certain pattern. The context for this repetition, usually called a delusion, has been commented on by both Sigmund Freud and Jacques Lacan. Uncertainty and relationships are denied in the delusion. There is something beyond this on a political level. It is possible to use these extraordinary events to create fear in the population. Take Dr Shipman. He was certain that he was doing his victims a favour. They would no longer suffer. A question: How does a prostitute tell a murderously delusional punter from their normal clientele? How do patients, colleagues and probably family members tell a good doctor from a good but murderous doctor? The government’s answer is to build up the fear (the medical professions are now a ‘high-risk industry’ – see Donaldson Report) and pass legislation (for example, the Health Professions Order 2001) the objective of which is to ‘safeguard the health and well-being’ of the population. Thus, the government creates a safe space from which uncertainty and relationships are excluded by legally enforced registration and regulation.

My contention is that this is impossible both for prostitutes and users of practitioners within the area called ‘health services’. I suspect that the risk undertaken by prostitutes is much greater than that of health service users. The legislation HPO2001 and NICE clinical guidelines produce certainty and exclude or vilify uncertainty. These are on the statute books now. This is not an example from Stalinist Russia or Animal Farm but put in place to protect you from me.

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