Published on November 20, 2008
Contemporary Adult Mental Health and Social Policy: Contemporary Adult Mental Health and Social Policy Psychiatry as social control The medical model as metaphor: The medical model as metaphor The medical model is the dominant paradigm of psychiatry. The medical model is not a scientific concept or theory. It cannot be confirmed or falsified by facts. A model is a conceptual-linguistic construction, a metaphor. The medical model is a metaphor which portrays psychiatry, psychiatrists, and psychiatric patients in the language of medicine. The medical model projects the metaphors of illness on to the patient and the metaphors of medicine on to the psychiatrist. The medical model & mental illness: some consequence: The medical model & mental illness: some consequence Anyone who becomes the object of psychiatric attention, is viewed through the medical model and is subject to being labelled as mentally ill. The medical model in psychiatry disguises and obscures crucial differences between psychiatry and medicine The general and superficial similarity between medicine and psychiatry is that both are concerned with people who suffer and/or deviate from criteria of normality. The difference is that medicine deals with conditions of the body which it classifies as medical illness. Psychiatry deals with certain kinds of thinking, feeling, and acting which it classifies as mental illness. Another crucial difference is that all adult medical patients are voluntary. Their consent is required before treatment can occur. Adult psychiatric patients, by contrast, can be defined as mentally ill, involuntarily committed to a psychiatric institution, and forced to submit to drugging and electroshock. The critique of the medical model: The critique of the medical model Begins in 1960s Predicated upon the view that psychiatry is based on certain basic philosophical errors These errors have a political dimension which skews the approach of psychiatric professionals in significant ways Key Critical Theorists: Key Critical Theorists Szasz (1960) The ‘myth’ of mental illness Foucault (1961) Madness & civilization Goffman (1961) Asylums Laing (1960s) Sanity madness & the family Rosenhan (1973) On being sane in insane places Scheff (1970s) Labelling theory Thomas Szasz: Thomas Szasz If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If God talks to you, you are a schizophrenic. Thomas S. Szasz The Myth of Mental Illness (1960): The Myth of Mental Illness (1960) ‘At the core of virtually all contemporary psychiatric theories lies the concept of mental illness. A critical examination of this concept is therefore indispensible for understanding the ideas, institutions and interventions of psychiatrists.’ Szasz (1960: 113) Epistemological Error: Epistemological Error Implied dualism (mind/body) is a ‘habit of speech’ or culture It is an error to interpret communications about ourselves or the world as symptoms of neurological functioning (e.g. colour systems) The notion of mental symptom is therefore inextricably tied to the social and particularly ethical, context in which it is made, just as the notion of bodily symptom is tied to an anatomical and genetic context Szasz (1960: 113) Psychiatry and Mental ‘illness’: Psychiatry and Mental ‘illness’ Psychiatry implicitly attributes problems in living to underlying physical processes by using the term ‘mental illness’ when it has no scientific justification for doing so The illness model obviates the need for psychiatrists to examine carefully their own social and ethical position vis-à-vis the treatments they offer and the people they treat Problems in Living: Problems in Living ‘When I assert that mental illness is a myth, I am not saying that personal unhappiness and socially deviant behaviour do not exist; what I am saying is that we categorize them as illnesses at our own peril. The expression ‘mental illness’ is a metaphor we have come to mistake for a fact.’ Szasz (1960: 118) Thomas Scheff ‘On being mentally ill’: Thomas Scheff ‘On being mentally ill’ Particular reference should be made to the question of whether they [mental health practitioners –LG] are unknowingly aligning themselves with the social status quo; for example by accepting unexamined the diagnosis of schizophrenia, they may be inadvertently providing the legitimacy of science to what is basically a social value judgement Scheff 1970 Rules of conduct: Rules of conduct Explicit rules of conduct and labels for transgressive behaviour (e.g. theft, adultery, perversion) Implicit, culture bound assumptions regarding appropriate conduct (‘residual rules) Mental illness as ‘residual rule violation’ Residual rule breaking: Residual rule breaking Offences against residual rules lumped together as ‘mental illness’ No scientific verification of cause, course, site, invariant signs and symptoms and treatment for major mental illnesses Mental health industry ‘ a spirited defense of the social order’ (Scheff, 1970) The politics of mental illness: The politics of mental illness The mental health researcher may protest that he is interested not in the preservation of the status quo but in a scientific question: “What are the causes of mental illness?”…however his (sic) question is loaded- like “When did you stop beating your wife” or, more to the point, “what are the causes of witchcraft?” Scheff 1970 Schizophrenia as ‘residue of residues’: Schizophrenia as ‘residue of residues’ Broadly defined symptoms (e.g. inappropriateness of affect, bizarre behaviour etc) are offences against social understandings Mental health procedure and medical model posit internal states based on external events Residual Rule Breaking: Residual Rule Breaking Residual rule breaking (RRB) arises from diverse sources RRB is high relative to treated mental illness Most RRB is denied and transitory Stereotyped imagery of mental illness learned early in life Stereotyping madness: Stereotyping madness Stereotypes are continually reaffirmed inadvertently in everyday social life Labelled deviants are ‘rewarded’ for playing deviant roles Labelled deviants are punished when they attempt to return to conventional roles (e.g. Laing, 1970) Denial & Labelling: Denial & Labelling Societal reaction is the key process determining outcome in instances of RRB Denial ‘normalises’ RRB (‘boys will be boys’) and deals with transient instances If labelling occurs ‘deviance is stabilised’ leading to a ‘career of chronic mental illness’ Ideological critique: Ideological critique A parallel critique of psychiatry focuses on the social uses, functions, and consequences of the medical model. It maintains that the medical model of psychiatry is an ideology which justifies covert social control. "Diagnosing" persons as mentally ill who complain of or display certain forms of undesired and undesirable thought, mood, and behaviour renders them vulnerable to being managed by a ubiquitous mental health system. Involuntary confinement and forced drugging can be seen as means of social control. Ethico-legal critique: Ethico-legal critique Critics argue that mental illness is an ideology used to protect the public against persons who are judged to be dangerous or disturbing but who have not necessarily violated any law. As a covert form of social control, psychiatry violates the principle of rule of law which prohibits depriving a person of freedom without an accusatory indictment and a trial by jury governed by rules of evidence which gives a verdict of guilt for violating a specific law. This critique of psychiatry is based on the ethical and political respect for individual freedom under law which is the political foundations of most democracies. Medical-coercive psychiatry violates these fundamental values. These issues invite debate in competent forums, yet they are ignored. Psychiatric and psycho-pharmacological research : Psychiatric and psycho-pharmacological research The premise of the medical model is that "mental illnesses" are caused by "pathological" changes in the chemistry, structure, or organization of the brain. Critics of the medical model maintain that the scientific evidence at hand does not adequately support the claim that neurochemical factors cause the behaviours which are labelled "mental illness.“ Much psychiatric research is flawed and methodologically inadequate insofar as it presupposes the truth that it is supposed to be testing The medical model as an ideology : The medical model as an ideology The social interest served by the medical model ideology is the public mandate for a greater degree of social control than can be provided under rule of law. By labelling certain behaviours as medical illness, the medical model serves, enables and justifies an extra-legal, covert form of social control. Unlike persons who are diagnosed with physical illness,, persons who are "diagnosed" with serious mental illness may be defined as not responsible, be deprived of freedom without indictment or trial, and be forced to take drugs and other "treatments" against their will. Viewed through the medical model, these violations of human rights appear and are justified as medical treatment. Viewed through the moral paradigm they are seen as a covert means of social control. The medical model developed as an ideology in a historical and political context. It was "selected" by powerful social and political forces for its utility as a paradigm to describe and control certain forms of deviant behaviour. Ideology & psychiatric ‘identity’: Ideology & psychiatric ‘identity’ Ideologies support and perpetuate social interests and, in turn, are supported and perpetuated by those interests. The medical model serves society as an ideology which justifies covert social control. It also serves the interests of psychiatrists by supporting their identity as a physicians. The personal, professional, and economic interests of psychiatrists are promoted by the medical model. No medical model, no medical psychiatry. If mental illnesses do not "exist," if the term is a metaphor which uses the language of medicine to judge and describe thoughts, feelings, and behaviour, then psychiatrists cannot not be viewed as "real doctors." The medical model supports the self-interest of psychiatrists and psychiatrists promote the medical model. Medicalization & Social Control: Medicalization & Social Control Women and madness Political madness in the Soviet Union Ritalin and Attention Deficit Disorder Race & Mental Illness The addiction industry User accounts of psychiatric coercion A final word….: A final word…. DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document. To its credit it says so -- although its brief apologia is rarely noted. DSM IV has become a bible and a money making best seller -- its major failings notwithstanding. It confines and defines practice, some take it seriously, others more realistically. It is the way to get paid…. The issue is what do the categories tell us? Do they in fact accurately represent the person with a problem? They don't, and can't, because there are no external validating criteria for psychiatric diagnoses…. APA as an organization has implicitly (sometimes explicitly as well) bought into a theoretical hoax. Is psychiatry a hoax -- as practiced today? Unfortunately, the answer is mostly yes. Letter of Resignation from the American Psychiatric Association Loren R. Mosher, 1998
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