The idea of mental illness predates any discovery of mental illnesses. It’s a hypothesis—a proposed way of understanding mental suffering.
‘Nothing wrong with posing that hypothesis.
But how does a hypothesis become a belief? Ideally, by being confirmed. In reality, much more often, by serving our interests, fitting nicely with our wishes, jibing with our hopes, relieving uncertainty, or otherwise making us feel better.
The success and cultural authority of the mental health industries reflects both hope and need: we hope to escape suffering, and we need professions dedicated to understanding suffering and its relief.
Neither of those is a bad thing.
The idea that suffering—some sorts of suffering, at least—consists of mental illness fits both the hope and the need.
If suffering is not our natural state—if healthy people aren’t prey to certain sorts of suffering—but results from something having gone awry, we can hope to set things right. We can relieve pain by restoring health, or even avoid it altogether by good health practices. Health is, by definition, natural, so health should come easy, if we just understand what gets in the way. Ipso facto, happiness should be easy—natural—if we can just understand the impediments to good mental health.
The idea of mental illness, then, made for a nice hypothesis.
As readers of Mad in America know, it has been less-than-robustly confirmed.
But the idea just won’t die. One reason is that so many people hope it’s true. We really, really want to believe that suffering isn’t our natural lot, that just doing the right things for good mental hygiene will make for a happy life.
Another reason the idea won’t go away is the very reason it became widely accepted in the first place: When the idea arose, professions devoted to studying health and illness already existed—namely, the medical professions.
The importance of an institutional home cannot be overstated. With institutional support, a profession gains legitimacy, resources, and access to markets. And institutions, unlike scientific hypotheses, do not die from being wrong. The values and worldviews, livelihoods, and life’s meaning for countless tens of thousands of its adherents depend upon any established institution, and those people will do whatever it takes to keep their way of life alive.
When the mental health industries were aborning in the late nineteenth and early twentieth centuries, exactly two social institutions dedicated themselves to the relief of psychic pain: medicine and religion.
Whatever else was involved in medicine’s usurping the role of religion in care for the mentally anguished—and a great deal else was involved, much of it ugly and dishonest—medicine offered the possibility of new insights. Religion had pretty much said what it has to say, and anguish hadn’t vanished. While the loving kindness some religious institutions offered to the mentally tortured and despairing may have helped—and may still help as well as anything—the cold fact was that religion had nothing new to offer. Religion simply wasn’t a good source for new professions of care.
Medicine, though, could pursue a new idea: mental illness. Maybe that would shed new light.
Medicine had the advantage, as well, of quite possibly making use of the benefits of science. The idea of mental illness arose around the same time—the latter half of the nineteenth century—as medicine began to turn toward science as a foundation for practice.
Medicine, then, could provide an institutional home for professions studying suffering from a scientific perspective, in pursuit of the hope that a normal life is a happy life.
Psychology and social work, and literally hundreds of other movements—from the “New Thought” of the late nineteenth century to many different schools of psychotherapy in the mid-twentieth century to the “New Age” of the late twentieth century—tried to offer alternate ways of understanding mental suffering. None had medicine’s big advantage: an existing profession, with the attendant institutional support, cultural status, and financial resources.
Psychology had the best opportunity to provide an alternate, with its growing institutional basis in schools, and with government imprimatur and protection—by 1977, psychologists had gained licensure in all states. But as I’ve explained before, the lure of money was too great, and psychology made itself subservient to the medical model.
(Social work never had a chance, realistically, of establishing itself as a rival profession. Identified as “women’s work” from its inception, it always suffered the lack of power and prestige that women’s work suffers in our culture. Such advances as feminism made for women came too late, in the course of the competition between mental health professions, for clinical social work to become anything other than what it now is—a devoted handmaiden to psychiatry.)
The hypothesis that mental suffering is due to illness was never a bad hypothesis—and I believe, unlike a fair number of Mad in America writers and readers, that in some instances, it is true. But the idea that suffering consists in the effects of mental illness remains an idea more believed than evidenced. The scope of its application, the devotion and even vehemence with which it is held, and the billions of dollars its economy circulates far outdistance its scientific support.
We believe it because it suits us, and it has found an institutional home.
The medical model has become the faith of a secular age.
More on that next time.
“The hypothesis that mental suffering is due to illness was never a bad hypothesis—and I believe, unlike a fair number of Mad in America writers and readers, that in some instances, it is true.”
This sentence is the weakest link in an otherwise good article. Please elaborate on what you meant by this.
Which part is not clear?
What “instances” is it “true” that “mental suffering” is due to “illness”?
Instances you believe are to be this, “unlike a fair number of Mad in America writers and readers”…
You didn’t list any.
I do, in fact, think that the medical model is sometimes applicable, for axiomatic and empirical reasons.
It’s simply axiomatic that things break, and complex systems have more breaking points than simple systems. Minds are certainly complex systems, with many breaking points. Ergo, they break.
Empirically, it certainly seems to be the case that sometimes the “machinery” is awry. In my personal and professional experience, I have certainly known many occasions when this was the most plausible and parsimonious explanation.
The problem with the medical model is not that it is always wrong, but that it is made to do work, and used as the basis of authority and life-guidance, that it lacks the epistemic credentials to do–and that it often does that work for which it is unqualified very badly.
‘Hope that makes my meaning clear.
Thanks–
Bob
No. That’s not clear at all. Tell me an example of a LITERALLY broken, or ill, thought or feeling. And explain to me the ‘broken system’ which generated it.
If you’re saying a brain is broken, prove it. If you’re saying a mind is broken, tell me how it broke, and tell me what you think a mind is.
I’m very unconvinced of your answers.
Have a look at the movie “A Beautiful Mind”–which, in fact, underplays the severity of Nash’s illness and overstates his recovery. If you don’t agree his mind was “broken,” there will be no convincing you, and there’s no point discussing it further.
“Have a look at the movie “A Beautiful Mind”–which, in fact, underplays the severity of Nash’s illness and overstates his recovery. If you don’t agree his mind was “broken,” there will be no convincing you, and there’s no point discussing it further.”
Well there we have it. You believe Nash has an “illness”, and by extension, anyone who has the same label Nash got, has an “illness”.
You’re absolutely right. There is no point discussing it further if you believe people in distress have “illnesses”.
Maybe I should have just let this ‘argument from Hollywood movie’ stand on its own.
This is a comment on Bob Fancher’s suggestion to watch the movie “A Beautiful Mind” as convincing evidence of a brain “illness.” John Nash’s story was distorted by the screen writer, whose mother was a psychiatrist. However, Sylvia Nasar’s book, “A Beautiful Mind” give a very different picture of what was going on with Nash. In the book, Nash says that what changed his life and his condition was a decision. He said, “I finally decided that my delusional thinking was a waste of time.” (I don’t have the book in front of me at the moment, but I think that’s pretty close to his exact words.) Can one simply decide not to have an illness anymore? I don’t think so.
The mind isn’t an object, locatable in space, but an abstract concept. It isn’t a thing that literally can be broken. There is no thing called the ‘mind’, contrary to the delusions of the supposed cartographers of the mind, like Freud and Jung (who were really colonizers of human nature and experience). If there was, its form and functioning would be observable.
This may seem like pedantic, but it is necessitated by the furor-diagnosticus of psychiatry, who believe in metaphysical illnesses and hold it against people.
You confuse description with ascription; you can’t describe something that isn’t susceptible to empirical observation as broken or ill, you can only ascribe those things to a concept whose referent isn’t a physical thing.
Yes, I have seen that execrable waste of celluloid ‘A Beautiful Mind’, and I hardly see how that proves the existence of a broken mind. You don’t prove the existence of cancer by showing people Hollywood movies.
Actually, the “form and function” of mind are quite observable. Countless thousands of carefully-conducted psychology experiements have done exactly that.
Cledwyn,
I hope you and Bob keep this discussion going. I think it’s important. If mind is metaphor, can metaphors be observed in terms of form and function? Is that ascription? Description? I’m curious to read how this develops.
I left the first comment in this thread, and I should have trusted my initial gut feeling. I knew something was off about this article, and it is true, something is off about it. It’s a half-critcism of the medical model, and the author believes it is completely legitimate to medicalize some human thoughts and not others. The evidence provided that in some people “the machinery is broken”? well Bob Flancher has given us a guy who cuts up dead rat brains, and a Hollywood film. That’s about it.
I think the main reason it won’t go away is that the medical profession and a significant portion of sufferers like the idea of “no-fault” disease. The Doctors think it is good for patients to believe this, because it will encourage them to comply.
Many patients out there (and their families) desperately want to cling to this belief because they think that without it:
– their family/upbringing screwed them up; or
– there’s something wrong with/weak about the sufferer.
If people think the above are the only alternative explanations then I understand why they turn to the biological view. For me, I don’t think making some people better by telling fairy stories is a good enough reason to lie to everyone.
The medical model is not the same as the biological model. Both of the alternatives you mentioned were, in fact, developed within the medical model. Personality disorders, for instance–which were for decades the main diagnoses–are presumed to involve one or both of those ideas. The medical model is simply the idea that one’s problems reflect “malfunctioning” psychological faculties, so that the remedy for one’s problems is to be found in healing, restoring, or compensating for this malfunction.
If the question is ever of something NOT biological, medicine has nothing to say, and the word ‘medical’ should never even be used. It’s anything BUT parsimonious. It’s a wrench of confusion thrown into the gears of understanding the problem, despite whatever easily misunderstood version of ‘it’ the ‘medical model’ you have in mind.
Biological psychiatrists would surely agree with you, which is why they have tried so assiduously to root everyone else out of the seats of power within psychiatry for the last thirty years or so. The chair of the DSM-5 committee, who seems intent on turning psychiatry into clinical neuroscience, would also agree with you. Historically, though, you’re simply incorrect. The great majority of developers and practitioners of the medical model have not reduced suffering to biology, and the medical model does not presuppose or imply reductive biological explanations.
I guess I don’t buy the “medical” model either.
The idea of “personality disorder” just sounds like a more scientific way of saying “we don’t like your personality” or “we think you’re weird”.
It’s all rubbish.
In science there are no good hypotheses or bad hypotheses, only true and false.
Well, now, that’s just not true, as any working scientist–or
any graduate student in the sciences who is designing a thesis project–knows. Hypotheses can be plausible or not, ripe for study or not, coherent with known principles or not, etc.
And at the hypothesis stage, one simply cannot know whether an idea is true or false. That’s what makes it a hypothesis.
I agree, a hypothesis is either true or false, we just don’t know yet which. Speculating about whether a hypothesis is true isn’t science, it’s speculation. As any worthy scientist will tell you, science provides proof for a thesis that is widely accepted and that acceptance must endure indefinitely. Pithagoras’ theorem is as true today as it was thousands of years ago, under the same conditions and for the same reasons. In contrast, using an example which is popular on this website, the scientific validity of the benefits of lobotomy, enshrined early on by the Nobel Prize in Physiology, quickly lost its scientific status. The arguments sustaining the therapeutic value were not science to begin with. A substantial part of accepted medical knowledge changes with the times; that is the one reason those parts do not qualify as science. In the case of psychiatry, virtually the entire body of knowledge is mere speculation. The world has not seen such an impressive speculative edifice since alchemy.
Judging a hypothesis as good or bad is not an act of science, proving one way or the other is. Unfortunately, far too many don’t distinguish between the two.
Sorry for a typo: “that is the one reason…” should be “that is one reason”
Well, judging a hypothesis is not only part of science, but a central part of science. Every grant-making committee, every investigator deciding whether to undertake an inquiry, judges the quality of the hypothesis to be studied.
No one in science suggests “speculating” on the truth or falsity of hypotheses. What makes science science is studying whether or not a hypothesis is true. What makes a hypothesis good or bad is its likelihood to lead to significant findings.
If, for instance, someone proposed to study the hypothesis, “Hearing voices is a function of microscopic green onions growing in the inner ear,” that would be a bad hypothesis, because it is implausible and would be a waste of time and money and other resources to study. If, though, someone proposed to study, “Hearing voices is due to malformations in neurological connections between certain parts of the brain,” that would be a good hypothesis, because it is plausible, within the range of currently conceivable methods, and would lead to significant findings, whether or not it turned out to be true.
You can find the characteristics of a good hypothesis here:
http://www.chsbs.cmich.edu/fattah/courses/empirical/10.htm
As for how science works–which is not quite as you say–this is a nice recent piece:
http://radar.oreilly.com/2012/07/discovering-science.html
And BTW, Moniz won the Nobel Prize “for Physiology or Medicine.” I don’t think anyone considered him a physiologist. And since the development of non-Euclidean geometries in the nineteenth century, the status of the Pythagorean Therorem has, in fact, changed.
This comment actually belongs after Bob’s last comment in this thread. As he does not give me the opportunity to answer afterwards, I’ll just answer before.
Bob, you are correct; I did truncate the title of the Nobel Prize. The 1949 prize for Medicine is probably the most egregious example of delusional science. In fact most of what has gone for research in relation to psychiatry is delusional science. The reason I call it delusional is because the academics in the field believe and portray themselves as scientists. When you refer to the paucity of “scientific support” for the current practice of psychiatry, if you mean that minimal part of the alleged scientific support that is actually deserves the label, we agree. The fact that their claims have constantly shifted is evidence enough that it wasn’t science all along. And, as you state about the Medical Model, the delusional belief they are contributing to science won’t go away anytime soon.
The purpose of my original comment was to emphasize what you yourself claim:
“The hypothesis … was never a bad hypothesis—and I believe,…, that in some instances, it is true.”
Your reason for qualifying the hypothesis as good or not bad is because you believe it to be true. In other words it is a matter of faith. Your judgment is “an idea more believed than evidenced”.
I frankly disagree with most of your subsequent comments, however.
“Well, judging a hypothesis is not only part of science, but a central part of science.”
Equating the decisions of a funding committee or, in some instance, those of a Nobel Prize committee or the hopes of an aspiring scientist to science is like equating the Church to God. They are very different things.
“What makes science science is studying whether or not a hypothesis is true.”
No. Keeping busy studying does not make science. What makes science is the creation of models based on deductive logic and generally accepted facts that provide explanatory and predictive power in a certain domain of phenomena. It is fair to say, though, that science can be considered one method of determining truth.
If you decide not to pursue the theory of “green onions growing in the inner ear”, there’s nothing wrong with that; science does not legislate how ideas are generated. However, many of the most revolutionary ideas in science were for a time considered as preposterous as “green onions” before their power was understood and accepted.
“No one in science suggests ‘speculating’ on the truth or falsity of hypotheses.”
True. No one in science suggests “speculation”, but it is the only thing that many so called scientists actually do.
The so called consumers and the media are as much to blame as doctors and the pharmaceutical companies.They keep running to their doctors to solve their emotional problems. Doctors are only human and it is so easy and quick to dish out a pill. The medical model won’t go away because it is so convenient: so many people want to believe in it. Also, people will always have emotional problems and will look for easy answers and someone will want to make a profit out of it: it is all part of life!
The question that keeps bothering me is why so many people want so badly to embrace the idea that they are “mentally ill? What is the payoff in embracing such an idea? You go to parties and everyone there is talking about how they are “depressed” and they got antidepressants from their doctor! It’s like they are proud of this. It reminds me of older people who have to show everyone their “railroad tracks” scars from heart bypass surgery. I think that you are right; the drug companies and the psychiatrists couldn’t push these damned drugs on us so easily unless we want to see ourselves as having a problem. I sometimes think that people don’t want to experience any kind of suffering at all for any reason and are willing to drug themselves to the gills to keep from having to experience it. I am not talking about survivors or people in the system here; I’m talking about the average American in our society.
“I am not talking about survivors or people in the system here; I’m talking about the average American in our society.”
You see, this is deeply considerate and thoughtful and nice. More people should learn from you including that line.
I’ll be talking about that next time, Stephen. Thanks for your note.
This clearly written article is thought provoking. I have a few questions.
Does the idea of “mental illness” beg the question? Like someone having a hunger illness because they are starving? (Psy prescribers have a treatment handy for dampening the symptoms of any imagined illness: tranquilizers.)
Has there been at least a third response to madness or mental suffering in addition to religion and medicine? A socipolitical one? Someone may go crazy for a biological reason such as a thyroid problem, which may be effectively addressed by medication; for an emotional or spiritual reason such as great loss, which may be addressed helpfully through one’s spiritual or religious community; but also for sociopolitical reasons such as racism, lack of housing & education, environmental degradation… which may and must be addressed by societal change and supports.
This may be another reason we let our individual minds take the blame and the drugs: societal change is tough and can seem impossible and feel overwhelming.
There have been many alternative explanations offered, as I said. Certainly a variety of schools of thought have developed sociopolitical explanations–Marxist, feminist, postmodern, etc.. However, none of those have been able to find an institutional home, hence have fallen to the wayside.
I would add that sociopolitical explanations are unlikely ever to find a dominant place within mainstream mental health care. More or less by definition, these approaches call for reforming society. Also almost by definition, the mainstream–to be economically viable and to achieve legal protections (licensure)–supports and serves, rather than threatens, the status quo. Society is not likely to institutionalize care that demands that society change.
There have been some state paid workers and units who have worked with socio-political explanations. Some psychologists training courses have this embedded in them. I believe some of the courses at the university of East London, where Professor Mary Boyle worked, had this bias.
There was a London based psychologist, in White City, who used individual work with people with mental health problems, followed by group work followed by community work that sounded as though it was based on the work of Paolo Freire, where the group were asked about the problems they experienced where they lived and then thought out how to change the situation, sometimes by lobbying the council for things like better lighting for where they lived.
But yes, this is not mainstream thinking in the NHS in the UK.
So my guess is that occasionally funding for seeing mental distress in a social-political way is found for some small project and then it goes.
To my mind this raises the question of prevention, which services are beginning to look at more and more. To me this means tackling child sexual assault, family violence, poverty, racism, homophobia, sexism etc etc. To some user groups it means teaching, “Self esteem,” in schools and to some professionals it might mean putting people on drugs at a young age.
However a socio-political analysis of both mental distress and the success of the medical model and more specifically the influence of the drug companies in promoting various strands of this to enable more product to be sold may help develop strategy in challenging this by illuminating possible allies.
“We really, really want to believe that suffering isn’t our natural lot…”
This is the key piece for me Bob. I don’t bring up religion in my blogs or comments because it’s just too divisive and I don’t think it will move the conversations forward, but I’m tempted!
I think suffering is a natural part of life. Of course we try to minimize suffering and maximize pleasure, we are all a little Epicurean at heart no? But to imagine we’re entitled to a life “free from suffering” Not in this life. So I guess I’m one of those who doesn’t want to conceptualize normal human suffering as illness but as part of man’s condition.
I agree completely, David, that suffering is part of the human condition–and that analyzing most of it through the medical lens distorts.
Stay tuned for the next installment. In saying that the medical model is the faith of the secular age, I hope to saying something more interesting, and helpful, than simply analogizing the mental health industries to religion. We’ll see if I can pull that off!
I will definitely stay tuned! I’m very curious with “the medical model is the faith of the secular age” line.
I enjoy your blogs more and more and feel bad about being so critical of your first one. Mea culpa!
Thanks for the good words.
Don’t worry about that early criticism. ‘Twas a shock at the time–but we just had to get to know each other better!
If the medical model is the faith of the secular age, why have conservative churches bought into it so readily? Have they become secularized without realizing it? At least as regards “medicine”?
This is easy enough to explain, and also very easy to fix on the part of most advocates. The trouble is the word “medical model.” Because the recovery model IS a medical model – it’s evidence and science based.
To clarify, say “disease model” for people who believe extreme emotional states come out of the blue with no previous abnormal life situations. “Disease model” says the underlying cause is permanent. It’s says mental health issues are biological, chemical or structural in origin. It says the treatment should be chemical or surgical or electrical, and we know how well those work.
“Distress model” says that strong emotional experiences are a normal response to abnormal events, that all people can equally experience these states given enough emotional distress and not enough supports or resilience.
Please, please people, STOP saying “medical” model. The distress model IS a Medical Model – it’s more science based and evidence based than the Disease model. Saying “disease model” points the blame squarely on those selling the disease and selling false storytelling with diseases that have no evidence base. Saying “distress model” says clearly that our problems are universal but completely resolvable.
http://wellnesswordworks.com/category/distress-vs-disease/
I don’t know of advocates of the medical model who believe what you claim about the “disease model.” For instance, diseases, disorders, illnesses have causes, and no one I know would deny that life events can be among the causes. It is also not true that the medical model presupposes or asserts permanence, or that treatment must be of the sorts you mention.
As for what you’re calling the “distress model”–well, I’m talking about the history and cultural influence of an idea, and the idea I’m talking about is historically and culturally pervasive. Your distress model is not.
I would point out that “normal response to abnormal events” does not establish what you seem to want. For instance, the normal response to being hit in the head with a baseball bat is a concussion, which is surely a disorder. The normal response to abnormal events may, indeed, be a disorder, disease or illness.
I’m sorry you don’t like my language, but I’m reasonably sure it is historically and culturally accurate.
“I would point out that “normal response to abnormal events” does not establish what you seem to want. For instance, the normal response to being hit in the head with a baseball bat is a concussion, which is surely a disorder.”
Wrong. What happens after someone got hit with a baseball bat in the head is not a disease, disorder, or illness, it’s the body trying to heal the damage done, i.e. the concussion. If you want to use medical allegories, you’ll have to distinguish between a) the harm done by a disease process, or accident, or assault, and b) the body’s own immune system at work, trying to heal whatever harm was done. Now, what we (psychiatry, society, you) call “mental illness” isn’t the disease, the accident, or the assault itself, but the attempt to heal the harm done.
And, “A Beautiful Mind”… Really, that was lame. How does the idea that the mind is something that can be broken make you feel better?
Just to make that clear, since the comments around here tend to be (mis-)taken as personal attacks: my question is not meant as a such. I think it is extremely important that we all ask ourselves this question, before we judge others. Especially those of us who have the power to rule over (and potentially ruin) others’ lives with our judgements.
i don’t think that is quite what Corrina is getting at, although I could be wrong.
It is certainly true that the normal response to being hit on the head with a baseball bat is concussion. So:
concussion is a disorder.
and
concussion causes a dysfunction in biological processes in the brain.
It does not follow, however, that concussion is a dysfunctional response to being hit over the head with a baseball hat. Or that concussion itself is a dysfunction
This is an important distinction. At the beginning of WWII, for instance, it was believed that war neurosis, battle fatigue etc. resulted from an inherent vulnerability in the soldiers that experienced it. As a result, the U.S. Army used a screening process to exclude those deemed neurotic – from memory I think it was about 7% of draftees. After some time, however, it became clear that a large proportion of ‘fit’ soldiers continued to suffer from War neurosis and battle fatigue, when exposed to extreme battle conditions for extended periods of time. As a result, war psychiatrists hypothesized in 1942 that battle fatigue (while remaining a dysfunction) was a normal reaction to abnormal conditions, and focussed efforts instead on maintain regular periods of rotation, R&R etc. At this point psychological screening was almost totally abandoned.
Moving back to the present topic, it should be clear that any sort of disorder, be it biological, psychological or behavioural can be judged to be either disordered or dysfunctional in itself – yet still be considered a normal response to abnormal events. Erectile dysfunction is a normal response to abnormal event such as advanced prostate cancer. Hypervigilance, reactivity and insomnia can be normal responses to abnormal events such as exposure to war and sexual abuse. Prolonged periods of sadness and depression can normal responses to abnormal events such as bereavement and loss of livelihood.
It goes without saying (for me at least) that all judgements about disorder or dysfunction have to be made against an implicit judgement of what constitutes normal or proper function. Such a judgement is easier in some cases than others, but it is particularly hard to make in psychiatry. It’s difficult because when it comes to human behaviour we have no concept of normal or proper function that is independent of social and cultural value judgements.
Sorry to have come the long way round to make my point, but this is why I think it is important to acknowledge that every disorder and dysfunction is a normal and natural consequence of some sort of insult, whether it is biological, psychological, social or emotional.
When we fail to make this distinction, we implicitly place the ‘blame’ squarely on the individual experiencing psychlogical distress (i.e. genetic vulnerability, psychological pre-disposition, neurotransmitter dysregulation etc.) and fail to acknowledge the external causes of psychological suffering. It is no coincidence that a psychiatric classification system (the DSM) that is based on symptoms and not aetiology has led to medical establishment that pathologizes the person and largely ignores their circumstances and history.
thanks for you post by the way, Bob. Totally awesome, and I look forward to part 2.
Thanks for the thoughtful reply.
But when you write, “It does not follow, however, that concussion is a dysfunctional response to being hit over the head with a baseball bat. Or that concussion itself is a dysfunction,” surely you are not serious. No one could plausibly deny that a concussion is dysfunctional.
You’ve raised a host of issues, some of which inhere in the medical model and some of which don’t. On the issue of blame, for instance: Social psychologists have long-since shown that we all tend to explain our own behavior in terms of our circumstances and the behavior of others in terms of their personalities, traits, or character. This is not a function of psychiatry or the medical model, but a basic fact of how our minds work.
I certainly agree that the causes of suffering must be understood in order to assess it, and to relieve or come to terms with it. Which sorts of suffering are due to what circumstances, and whether that suffering is likely to be permanent or passing, and whether we have some responsibility for it, and whether it disqualifies us for fit company, and how to deal with it–these are empirical questions, and the answers will differ for different sorts and occasions of suffering. To try to resolve them at the conceptual level is a mistake, no matter which set of concepts we use.
Attribution bias is a nice way of looking at it and, of course, it’s a very human trait – so we shouldn’t single out psychiatrists for it (that would be meta-attribution bias!) .
But isn’t it the case that attribution bias arises because of the different heuristics (rules of thumb) that we use to determine the causal factors of behaviour? That is, we tend to ignore the external factors that contribute to other people’s actions and at the same time ignore the internal factors that lead to our own behaviour. As a result, we tend to hold others more responsible for their failings, while diminishing our own responsibility by blaming external factors instead.
What I am suggesting is that there is a structural attribution bias built into the medical model. The DSM codifies this bias by classifying disorders according to symptoms (the domain of the individual) while ignoring aetiology (the domain of the environment). I’m not suggesting that this form of classification was the result of an attribution error (psychiatrists didn’t suddenly choose to blame the patient) as I don’t believe that is the case. What I am suggesting is that this classification system is the cause of the attribution error that exists today, in that it underlies the prevalence of the biological model, which elevates biological dysfunction over environmental stress.
And one last thing. Concussion is not itself a dysfunction, because it is not dysfunctional to suffer a haemorrhage when hit on the head by a baseball bat!
thanks for your great reply!
I wouldn’t disagree that psychiatric diagnosis codifies and reifies attribution errors. I believe most psychiatric diagnosis “legitimizes” a host of errors, including attribution errors.
But Adam–sweet Jesus, when you claim that a concussion isn’t dysfunction, I believe you’ve been run over by your train of thought!
Perhaps we have a different understanding of what dysfunction means. I know it probably sounds overly pedantic, semantic, and philosophical, but I think it’s important to be precise about the meaning of the words we use. If we are not, we will tend around each other in elegant circles forever without really achieving a meaningful dialogue. So, here’s the nub of my argument:
only things with a function can be dysfunctional
concussion does not have a function
_________
concussion is not a dysfunction
I think this is a really important distinction, and here’s why: imagine that I hit ten people over the head equally hard with a baseball bat, and five of them developed a concussion. You could then say either: a) the five people with concussion were dysfunctional, or b) the five had a concussion, which is a dysfunction or c) five people had concussion (which is a normal response) and that this concussion led to a dysfunction (e.g. diziness, cognitive deficits, consciousness etc.).
In my opinion, the former two are nonsensical for this reason: some of the symptoms of concussion result from the body’s natural response to trauma – and may aid recovery (i.e. concussion can be caused by astrocytes mopping up damaged brain cells). In this case not having a concussion may lead to worse outcomes than having concussion.
So where does the dysfunction lie? Does it lie in having concussion? No, I don’t think it does. Does dysfunction lie in the concussion itself, no it does not. Can the concussion lead to other dysfunctions (i.e. cognitive impairment)? Yes, I think it can.
So concussion itself is not a dysfunction (although you might argue that it is a disorder
I have lots more to say about dysfunction, if you’re interested. I think it’s the veil behind which psychiatry hides much of its pseudoscientific claptrap.
regards
Adam
This strikes me as hopelessly sophistic reasoning.
Concussions are set of brain dysfunctions caused by a blow.
Brains have functions. A trauma causes a set of dysfunctions, malfunctions–whatever way you want to name it: the brain simply is not working correctly. We call that set of brain-gone-wrong events a concussion.
By your argument, one might as well say that cancer is not dysfunctional, since cancer doesn’t have a function.
(This comment is in reply to the comment below, which does not have a reply button.)
Thanks for taking the time to reply. This is obviously something we aren’t going to agree on. While that may be a frustrating outcome, it is no no reason to accuse your interlocutor of sophistry.
I’m not suggesting that there is no such thing as dysfunction. I make two points
1) that the term dysfunction be applied to its proper subject: the mechanism which fails to work as it is designed.
2) that the term is both practically useless and misleading unless we know how that mechanism operates, and what function it is designed to fulfil.
I believe that the misuse of this term is highly problematic in psychiatry. Sorry if my analysis got under your skin – I was just trying to make the discussion clearer.
All the best
Adam
Sorry, that comment was in reply to the comment above, I just don’t know how to use a message board!
It is what it IS. Concussion itself is NOT a dysfunction, but can cause the conditions for dysfunctional sequelae.
What bugs me most about Bob’s argument against the validity of Adam’s explanations is that it bears such a close resemblance to what I find most repugnant about many psychiatrists. While reaping the benefits of status as MDs, psychiatrists have ventured out into a realm of what can only be viewed as “making it up as they go along”. This is not OK. This is unacceptable. It violates the very premise and foundation of medicine as a scientific practice that is grounded in humanistic ethics.
No, you can’t call yourself whatever you’d like to be, if in fact, you are not performing according to the standards of the identity you have chosen for yourself. This is fraud.
Medical terms have concrete meanings, because they refer to concrete, consistent operations. Medical terms are not the whimsical musings of self proclaimed prophet, or a wanna-be doctor of medicine.
Respect for the language and adherence to meaning that gives meaning to the terms requires both study and discipline. If ever there were a litmus test for a charlatan it would be something that demonstrated a strong determination to use language as a tool for communication that increases mutual understanding… as opposed to… making it up as you go along…
Adam,
Is your point about the concussion that the hemorrhage is a functional response to a dysfunctional event? If so, would a person experiencing a hemorrhage be functioning optimally or less than optimally, but not necessarily dysfunctionally? Is that kinda what you’re getting at?
My point is that it is really important to ascribe dysfunction to the thing that is not functioning, because that is what dysfunction means. To do so, we need to define scientifically what a function is.
Otherwise, if we’re not careful, we start to call people dysfunctional – and that is a dangerous thing to do. What, after all, is the function of a person?
Dysfunction is a very complex notion. As a word, it often inserts a lot of implicit meaning into a statement that is hard to spot. If something is functional, then it fulfils the role for which it was designed. For human artefacts, this role is often explicit – we know what pencil sharpeners are designed for, so we know what a functional pencil sharpener is supposed to do, so we know how to judge when a pencil sharpener becomes dysfunctional – it fails to sharpen our pencils.
Functionality in biology is much more complicated. Take the following statements
the heart circulates blood
the brain processes information and initiates behaviour
Such functions are usually ascribed to natural selection. The function of a biological system are defined by the role that system has previously played in increasing selective fitness, therefore this system was preserved (i.e. designed) because of its functional role. We judge such biological systems to be dysfunctional when they fail to function in this way.
More complicated still are functional ascriptions of human behaviour, for example:
The function of the brain is to process stimuli and control behaviour
The function if the limbic system is to regulate emotion
The function of a janitor is to sweep the floor
The function of a psychiatrist is to reduce the incidence of mental illness
These are functional ascriptions judged against our cultural values and norms, and they are implicit in just about every psychiatric diagnosis there is. At first glance, the first two may seem like scientific statements, but they are actually mixed up with our normative statements to such an extent that they are not really scientific at all.
Bob,
Isn’t Adam’s point above that “the term dysfunction be applied to its proper subject: the mechanism which fails to work as it is designed” consistent with what you’re saying? That human beings weren’t designed to be free of distress, worry or struggle? So when we experience these, they can’t rightly be called “dysfunction” but functional?
My point is much simpler: “normal response to abnormal circumstances” does not imply “not a disease or disorder.”
All diseases and disorders have causes; these disorders or diseases are not only the normal but in many cases the necessary “responses” to prevailing conditions. I used concussion as an obvious example.
And if we can’t agree that a concussion is a disorder, then, to my mind, the language has lost its meaning.
YES!! EXACTLY….
Showing how psychiatry and religion have been competing to own the same problem seems a useful line of inquiry. On one hand psychiatry dismissed ~10000 years of attempts to try to understand suffering, without showing or making a scientific breakthrough that would justify that rejection, on the other hand most religions tied their own hands by claiming that the final and definitive answer was contained in a given book, or revealed by a given man.
You are saying that a lot of people are equating most suffering with pathology. That seems quite convincing now that you said it (it never personally occurred to me that people would think that way). Your assumption is that this dubious belief (most suffering is caused by individual-dysfunction) is the main propaganda tool of the medical model, right?
On this specific subject, is there a fundamental difference (other than vocabulary) between you and those that suggest that we distinguish the “worried-well” from the “severely mentally ill”, and redirect “medical resources” (including insurance coverage of talk-therapy) to the latter?
http://articles.latimes.com/1993-12-13/local/me-1329_1_mental-illness
If so, where do we draw the line? Do you believe there is a convenient empty space between mental function and dysfunction, or is there a continuum, and some (preferably independent) institution has to draw the line somewhere?
The difference between me and the people who talk of “worried well” is mainly that those people tend to be dismissive of the suffering of those who are not severely mentally ill. There’s something condescending, to my ear, about the “worried well” language.
For most suffering, I think the question of “well or ill” is unilluminating. Knowing that someone does not suffer a major mental illness doesn’t tell us much about what’s the problem for him or her, and parsing his or her problems in medical terms isn’t going to shed light on anything. That’s part of the point of my series of posts on “The Idea of Depression”–medicalizing most suffering makes us less smart about it, not more able to help with it.
As for “drawing the line”–no, at present I don’t think we can, in any fine-grained way. Some things are pretty obvious, but that’s on the far side of the lines that need to be drawn.
Not knowing where, most of the time, to draw the line is one big reason that I think it wise to refrain from assimilating suffering into the medical model wherever possible. I believe, and practice, that one should always assume that a person’s basic mental equipment is working correctly unless forced to another conclusion.
Eventually I think we’ll know how to draw the line, or some lines in some cases. But that will require a great deal more science than we currently possess.
As an example of the kind of science that will probably eventually help with this, you mght have a look at Kevin Mitchell’s blog, “Wiring the Brain.” I don’t agree with his aversion to psychological explanations, but I greatly admire his work. The URL:
http://wiringthebrain.blogspot.ie/
Thanks, as always, for your thoughtful comments.
Stanley, you mght find interesting a series of posts I wrote for a different site a couple of years back, on “secular pastoral care,” how mental health care might appropriate some of the realities of experience over which religion has traditionally exercised stewardship, that mental health types tend to pretend aren’t real. It starts with “Someone to Talk To” http://www.mentalhelp.net/poc/view_index.php?idx=119&d=1&w=436&e=39056
and goes through “‘Boundaries’ as Moral Ideals.” http://www.mentalhelp.net/poc/view_index.php?idx=119&d=1&w=436&e=41187
I do find those posts extremely valuable, and very well-founded in all possible meanings of the term. I’d like to recommend them to anyone.
If I may suggest, a link to that mentalhelp.net blog in your MIA bio could benefit readers.
Thanks, Stanley.
“We really, really want to believe that suffering isn’t our natural lot, that just doing the right things for good mental hygiene will make for a happy life.”
Very true. All the philosophers and poets who ever lived are laughing at this folly of modern Western thought.
Sometimes I wonder if this isn’t what I’m supposed to be. I am often asked to give readings at some odd literary function or another, and lately, I’ve been writing my own story out of the random memories I regained over the last several years. They marvel at the emotion, in my works of “fiction”, because they can’t imagine my life as a reality. I catch myself wanting to tell them that it’s okay, and I will keep silent, which for the last 14 years I have done amazingly well. Of course, having no memory helped. Living in my head, is like I think Nietzsche said, “Battle not with monsters, lest ye become a monster, and if you gaze into the abyss, the abyss gazes also into you.” A normal person wouldn’t last an hour in there. I think about how normal must be easier. The thing is, I’ve also seen Van Gogh’s paintings, read Wolfe, Poe, heard Mozart, mused with Plath, and I don’t attest to be anything so iconic, but their suffering gave life to something so beautiful and innately human. I don’t know if I could see them “cured” if it meant never having experienced their gifts.
Bob, your faith in science is touching, but I have to disagree with you that there is meaningful evidence that even severe “mental illnesses” are physiological in origin. You are right in saying that “The idea of mental illness predates any discovery of mental illnesses.” But the medical model proponents have assumed that this hypothesis is true and taken us on a completely unscientific pathway, leading to definitions of “mental illness” that have no relationship whatsoever to anything physiological. Once we’ve defined these unscientific categories based on social myth and prejudice, of course, no amount of research will ever prove any of them to be physiological diseases, because we defined them without bothering to check if they are diseases at all. There is no fixing that without wiping the slate clean and starting over, and genuinely asking the question, “Could SOME of these phenomena that we observe be caused by physiological events, and if so, which ones, and how do we objectively tell them apart?” and then actually test out this hypothesis against real physical evidence.
The “medical model” as used by the mental health system today is not science, it’s closer to a religion. I always find it fascinating that the DSM is called the “psychiatric Bible.” It definitely has more in common with religious scripture than it does with science. But at least in a religious setting, they acknowledge they are dealing with the spiritual, where as in the DSM religion, there is no spirit to be found.
—- Steve
I’m not quite sure what point you’re making about my post, Steve. I’m sure I didn’t say anything about physiology, or make the claims you’re attributing to me. I also don’t know exactly what you’re referring to as my “faith in science.” My claim is that the medical model isn’t going away, and my argument consists in explaining why. My argument is sociological and historical. I’m reluctant to set out on a different discussion–how physiological explanations factor into the medical model, for instance, or whether psychiatry has irretrievably contaminated the scientific study of mental distress.
However, there is reason to believe you’re wrong when you write, “There is no fixing that without wiping the slate clean and starting over, and genuinely asking the question, ‘Could SOME of these phenomena that we observe be caused by physiological events, and if so, which ones, and how do we objectively tell them apart?’ and then actually test out this hypothesis against real physical evidence.” There are, in fact, very serious scientists doing serious work on precisely that question. I cited one example, Kevin Mitchell, in a reply to an earlier comment.
This is what I meant about faith in science (see quote below from your comment). On reading some of your other comments, I can see that we’re in substantial agreement. The point I was making was that as long as science is studying “entities” like “Bipolar Disorder” and “ADHD” which are purely social constructs with no objective verifiability whatsoever, there is no chance of science developing any answers. In effect, science has already been thrown by the wayside in even using these terms for research. We need to admit that these categories are not scientifically meaningful, DISCARD this crappy terminology, and start over with a method of “drawing the line” (as you put it) that allows a sufficient measure of scientific verifiability. Otherwise, I don’t think any science can really happen.
— Steve
“Not knowing where, most of the time, to draw the line is one big reason that I think it wise to refrain from assimilating suffering into the medical model wherever possible. I believe, and practice, that one should always assume that a person’s basic mental equipment is working correctly unless forced to another conclusion.
Eventually I think we’ll know how to draw the line, or some lines in some cases. But that will require a great deal more science than we currently possess.
As an example of the kind of science that will probably eventually help with this, you mght have a look at Kevin Mitchell’s blog, “Wiring the Brain.” I don’t agree with his aversion to psychological explanations, but I greatly admire his work. The URL:
http://wiringthebrain.blogspot.ie/“
You wrote: “We need to admit that these categories are not scientifically meaningful, DISCARD this crappy terminology, and start over with a method of “drawing the line” (as you put it) that allows a sufficient measure of scientific verifiability. Otherwise, I don’t think any science can really happen.”
Ah–got it. I would agree with that. Thanks for clarifying.
I am removing several comments from this thread which cross the line from sharing personal opinion to a personal attack on the author’s character and reputation. Please remember to keep comments civil and review the posting guidelines if necessary.
Thanks, Matthew.
Bob Fancher,
I have been reading your article, and the ‘brain wiring’ biological and genetic researcher whose blog you linked to and recommended at least twice in your comments here.
I’ve read all your comments. I have come to think you may believe something is genetic and biologically wrong with the “wiring” of people’s brains who’ve been labeled schizophrenic or otherwise ‘seriously mentally ill’?
Is this the case? Do you believe the medical model you criticize in your article, should be applied to so called ‘serious mental illness’ or not?
What in particular about genetic ‘brain wiring’ researcher Mr. Mitchell, applies to this debate about the medical model?
In your career as a psychotherapist did you often work with people with serious mental illness labels?
Do you yourself have a history of first hand personal experiences with your own problems that got called ‘serious mental illness’?
I am trying to figure out why it is you seem to place so much stock in a brain wiring researcher and the film ‘A beautiful mind’? Is this the closest you’ve ever got to such experiences?
(This comment does not breach the guidelines).
I am intimately, and tragically, familiar with serious mental illness. I welcome all intellectually serious attempts to understand and deal with it, including attempts to understand how brains work.
I’ll try asking again…
“Do you believe the medical model you criticize in your article, should be applied to so called ‘serious mental illness’ or not?
What in particular about genetic ‘brain wiring’ researcher Mr. Mitchell, applies to this debate about the medical model? ”
I note you say ‘tragically’. What I think is tragic is the prejudice to judge people’s crises as brain diseases.
My final comment. A comment carefully drafted to conform to the guidelines. Guidelines that rightfully demand civility.
It’s hard to respond within the guidelines to an article by a blogger who talks a good game about humanistic interpretations and responses to the problem of human distress (aka ‘mental illness’), yet seems to reserve an exception to these humanistic responses for those labeled “seriously mentally ill”.
Bob Fancher states above in his piece that:
“The hypothesis that mental suffering is due to illness was never a bad hypothesis—and I believe, unlike a fair number of Mad in America writers and readers, that in some instances, it is true. ”
I tried asking Bob Fancher what these ‘instances’ were, because I suspected my own problems may have been one of these ‘instances’ where as he says “it is true” that my mental suffering was “due to illness”.
In response I was directed by Bob to go watch the film ‘A beautiful mind’. I can only think back to the most confused and harrowing states of mind depicted in that film, and report back that I’ve had similar experiences, extreme experiences, that fit in one way or another with what is depicted in that film, not that this proves anything about alleged “illness”.
Other commenters pressed further for Bob Fancher to give an example of where the ‘line should be drawn’, between ‘illness’ and ‘broken minds’ and the ‘machinery not working’. In response, Bob offered a link to the blog of the researcher behind the Mitchell Laboratory.
The Mitchell Laboratory conducts animal model research with a very mainstream and standard biological determinist approach, encapsulating the presuppositions of the alleged objectivity of psychiatric labeling, behavioral genetics, and ‘brain wiring’ neuroscience. On their site they say they research “altered brain wiring in conditions such as schizophrenia”. I don’t know how many of you have had your brain wiring examined and found to be “altered”, but apparently this is what they research.
http://www.gen.tcd.ie/mitchell/
Now I’m sorry to say I made some hot-headed remarks in this comment thread. I don’t like to feel misled, by clicking on an article, taking the time to read it, and trusting the editors of madinamerica.com to select bloggers who are sensitive to the audience that reads this site, when I see an article titled “why the medical model won’t go away”, and the blogger recommending as ‘evidence’ for the distinction he clearly makes between those who deserve the medical model, and those who don’t, I felt offended.
I felt degraded, objectified, and shocked, that here, in this community, this site, whose stated aim is to ‘rethink psychiatric care’, that I would be in the same environment here as a blogger who seems to believe my problems and my experiences are to be solved and explained, by cutting up rat brains in a laboratory.
I could go and get psychotherapy from the author of this piece. But in the back of my mind, I don’t feel I could ever shake the dismay I feel, that my psychotherapist would believe rat brains being dissected, are the key to solving the problems I had in my life.
What I find more life affirming, and more respectful of human dignity, is when people believe that the problems I experienced can be understood in human terms. When someone writes a piece apparently criticizing the medical model, yet seems to, appears to, believe that there are exclusions to the humans whose problems he is willing to understand in human terms, I feel objectified, degraded, and othered.
I prefer to spend time in an online community where I am an equal. Not someone who “science is going to explain one day”, if only the Mitchell Laboratory gets more grant money to slice up rat brains.
I feel I should have been more moderate in my comments. I also feel if there are any bloggers writing for madinamerica.com who believe that if someone walks into their office with a “serious mental illness” label, that they are prejudged to be biologically diseased, genetically inferior, and the rightful target of rat brain research, that they are a blogger who doesn’t understand the sensitivities of this audience here, and what we’ve been through, and how degraded and dehumanized we have felt, to be defined not as human beings with understandable problems and crises, but as biologically inferior beings, so much so that science needs to produce a genetically engineered mouse brain to slice up, to understand.
I don’t believe Mr. Fancher’s brain is diseased, nor do I believe Mr. Fancher has bad genes that explain his behavior and thoughts. Nor do I believe a researcher purporting to have created a rat/mouse model of Mr. Fancher’s brain is a “serious scientist doing serious research”. I wish he would extend the audience of this site the same benefit of the doubt. Until that day, I will be boycotting his articles.
Thanks for this response. I think something significant is occurring every time these feelings and views are stated in an honest and peaceful way. I really liked your statement to me that, for you, “[linking to a biological research lab targeting schizophrenia] is like someone going into an LGBT forum linking approvingly to a reparative therapy website.” I hope I’m not crossing any lines by quoting a private communication. If so, I will remove this post.
These tender issues of how we understand and define ourselves – and how eagerly some adherents of the medical model presume others are brain-damaged – are at the heart of the conversation on Mad in America. I often think of this environment as a place to practice refining and clarifying the personal, moral, and political ramifications of the medical model, so that we can best communicate with the mainstream world. It is not possible accurately hone our minds and language in an echo chamber where everyone generally agrees with each other. So one important facet of this community is to create space for civil dialogue between parties who disagree. As you note, Bob Fancher does state clear that his views may run contrary to the majority wisdom on this site. Therefore he is taking a risk. He could possibly feel very much in a defensive position by posting here at all. The degree to which we can all civilly and articulately communicate is precisely the degree to which we can learn from each other.
I’m reluctant to engage in any further discussion of the issues raised in this most unpleasant and uncalled for exchange. Things have been imputed to me that I did not say, that are not implied by anything I did say, and that I do not believe—some of them very ugly. I do not care to engage in further conversation of that sort—and won’t.
For the sake of clarity, however, and so that this particular exchange is more likely to be remembered correctly in the future, I’d like to state a few things plainly:
1. I believe there are such things as mental illnesses. It would be very strange if, in fact, there were no such illnesses: things break, systems go awry. But I do not believe, in most cases, we know how to identify them with any precision, and in no case do we understand fully their etiology.
2. I do not believe that mental illness equals brain disease. I do not know how to be any clearer about this than I have been. Some mental illnesses are likely to be best understood in neurological terms; some are likely to be better understood in psychological terms.
3. Brain science is, and will remain, central to understanding human life, including how minds work—as cognitive neuroscience is already establishing.
4. Whether an illness turns out to be best understood in neurological or psychological (or other) terms has nothing to do with its severity or duration. Presumably a fair number of mental illnesses will be analogous to sunburns, flu, or food poisoning.
5. Whether or not one has an illness has nothing whatsoever to do with one’s value as a person. To be ill is not to be inferior.
6. Whether one’s illness is incapacitating is an empirical issue, not a conceptual one, and must be determined by what capacities a person shows or fails to show. Certainly some of the greatest contributors to all cultures have been persons who, every reasonable consideration would suggest, most likely suffered mental illness. It is only reasonable to assume that countless millions of people who suffer similar challenges contribute brilliantly and ably, if less visibly, than these culturally prominent people.
7. But as I have said many times, I do not think most suffering should be understood in terms of the medical model. One should always assume that the person’s basic human capacities are functioning correctly unless driven to a different conclusion.
Please note that, in fact, I never said anything about any individual’s problems.
That should cover the relevant concerns, so I won’t have anything else to say on these issues in this thread. Thanks.
These recent exchanges raise some serious questions about how we wage the struggle for human rights for those people labelled mentally ill. If some people (including myself) have a goal of defeating the ideology and practice of Biological Psychiatry as one step toward creating a better world, then we better be clear and united on our strategy.
Know who your potential friends and enemies are and UNITE ALL WHO CAN BE UNITED.
Not everyone currently on our side of the barricades will be in perfect agreement. It can be both lazy and divisive to just verbally slam someone against the wall by trying to prove that they may be holding on to some last vestage of the disease model. Use persuasion and be more scientific; personal experience should provide living examples that only deepens our understanding of real life phenomona.
We want more people to feel welcome on this blog even if they say something unpopular. Yes challenge them, but do it with the strategy of patiently winning them over and uniting all who can be united to a more correct point of view as well as encouraging everyone to take decisive action in our movement.
We cannot be TOO SCIENTIFIC in our struggle. We should always be trying to understand how the “real” world functions. This is why I have a problem with the concept of “consensus reality.” There is a real world out there independent of any one person’s perceptions. We need to be ruthless in our efforts to understand how that real world operates so we are better able to transform it in the best interests for all of humanity.
Science is not partial to any one particular ideology. Biological Psychiatry with all it misplaced funding of bogus science may occasionally stumble on some truths. They will use this to serve their own agenda. We should not be afraid of any scientific discovery. We can use these truths to serve a more humane agenda.
Science pursued only for one particular agenda (even a well intentioned agenda) is called “Instrumentalism.” Instrumentalism will not advance our movement. I vehemently disagree with Dr. Healy’s position on ECT, but I also believe I can learn from him because he has uncovered some of the truth about psychiatric meds.
Anonymous, I deeply appreciate your involvement in this blog. You are relentless in your criticisms of Biological Psychiatry. You are both passionate and articulate about your own experience and the overall oppression of people labeled as meantally ill. You have very unique and important point of view. When I soon make a contribution to this blog I will be most interested (and perhaps even a little nervous) about about your comments, but I do very much welcome them. Please consider the above suggestions about better “rules of engagement” in or common struggle.
Bob, Your contributions to this blog are very much appreciated. We have had a few disagreements but you challenge us and make us all think more deeply about these issues.
Richard,
David Ross (on August 11, 2012 at 6:09 am) commented: “I encourage folks to read Bob’s series related to this topic on mentalhelp.net.” Following his suggestion, I happened upon a transcript of, “An Interview with Robert Fancher, Ph.D., on Cultures of Healing,” which includes these following lines (presumably written by interviewer, David Van Nuys, Ph.D.) in its introduction:
“Therapists’ embeddedness and lack of ability to criticise their own understandings blinds them to the fact that they have a worldview (one among many), and that these worldviews both have ethical ramifications that need to be explored, and also bias their interpretations. Many therapists do not attend to their role as moral agents with values and agendas that necessarily influence their clients.”
http: //www.mentalhelp.net/poc/view_doc.php?type=doc&id=36039
Indeed, at one point, in that interview, Robert Fancher’s own words run as follows: “…psychologists tend not to be very self aware about their assumptions. They tend not to be sufficiently methodologically self critical, so that there are profound assumptions shaping how they look at their data of which they tend not to be aware.”
Certainly, he’s right about that; and, from that point of view, I believe it would be best, were he to continue dialoguing; but, even if he refuses to do so, I believe he is asking to be seriously questioned.
And, certainly, there are grounds here for seriously questioning Mr Fancher’s beliefs.
After all, this current post, by Mr. Fancher explains, “The idea of mental illness, then, made for a nice hypothesis,” and, “As readers of Mad in America know, it has been less-than-robustly confirmed,” and, “The medical model has become the faith of a secular age”; meanwhile, in ways he seems professing that faith himself.
E.g., in the last point, of his ultimate, parting comment (directly above), he emphasizes: “I do not think most suffering should be understood in terms of the medical model. One should always assume that the person’s basic human capacities are functioning correctly unless driven to a different conclusion.”
Of course, no one thinks most suffering should be understood in terms of the medical model, but what does he mean to imply, when saying, “One should always assume that the person’s basic human capacities are functioning correctly unless driven to a different conclusion”?
Does he imply that, if we perceive, what he calls, “a person’s basic human capacities” are functioning ‘incorrectly,’ then we should presume that person needs medical attention???
If so, then, *what* exactly are, “a person’s basic human capacities,” and *how* do we know if they are functioning “correctly”?
*Who* shall be the ultimate judge?
Also, *who* determines if and when such vaguely defined criteria even exist, in reality?
Or, more precisely: *which* sufferings should be understood in terms of the medical model???
Should suffering – even when unattributable to verifiable, physical disease – be understood in terms of the *medical* model???
In his comments, Mr. Fancher seems implying a ‘yes’ answer to that question – especially, when he’s applying the term, “serious mental illness.”
But, what, in his view, is, “serious mental illness”??? …well, he refers to the movie, “A Beautiful Mind”.
Cledwyn Bulbs (on August 8, 2012 at 2:02 pm) commented, in reply: “…You don’t prove the existence of cancer by showing people Hollywood movies.”
I’m inclined to agree, with Cledwyn Bulbs, on that point – particularly in this case, as the movie cited by Mr. Fancher was, in fact, a film *deliberately* produced in a way, to *falsely* suggest, that *medicalization* was a ‘help’ to Mr. Nash, in his recovery; but, by Mr. Nash’s own accounts, he was not helped by medicalization.
In fact, Mr. Nash explains: the movie was *deliberately* inaccurate, in that way; the screenwriter altered the story to appease the sensibilities of his own mother, a mainstream psychiatrist.
I have blogged briefly about that movie, here (with reference, at the end, to a pointed article, by Robert Whitaker):
http://beyondlabeling.posterous.com/a-beautiful-mind-a-misleading-movie-on-so-cal
In any case, I feel Anonymous has done the right thing in this thread, and I think Mr. Fancher may know that, in his heart; for, in his above-mentioned interview, with mentalhelp.net, Mr. Fancher makes clear, that he well understands: the basis of all therapists’ primary assumptions should be questioned, for their “worldviews” do “have ethical ramifications” which are far-reaching.
Finally, and emphatically, about your strategy of, “patiently winning them over and uniting all who can be united to a more correct point of view”:
To you, it may feel right to be patient, in that way; for me, and for others who have been similarly tagged by psychiatry, it would be simply foolish; and, I, personally, would not care to be a part of any movement, which wittingly sacrifices anyone’s basic human rights; but, that is what your ‘patient’ strategy inevitably entails.
I suggest reading Dr. Martin Luther King Jr’s famous book: “Why We Can’t Wait”
‘‘The old order ends, no matter what Bastilles remain, when the enslaved, within themselves, bury the psychology of servitude.’’ (MLK, p 121)
I deleted a few comments here that were in reply to another deleted comment because they were breaking the tables and making it hard to read the thread. Apologies to those commenters. I’m working on instigating a more robust comment system.
I want to thank Bob Fancher for writing one of the most interesting blogs on Mad in America, and for his extremely patient responses to commenters.
Thanks, Altostrata. Very much.
Thanks also
I encourage folks to read Bob’s series related to this topic on mentalhelp.net.
There were some good exchanges of comments prompted by this blog.
Thanks.
I watched a video today titled, “there’s something wrong with the sun and moon”. The video went on to show pictures of distinct, observable anomalies.
Why do changes, and processes within changes, have to indicate a disease or disorder or something “wrong”? Because of human error in thinking, right?
If we think there is an ideal, anything that isn’t that ideal is automatically wrong or somehow not okay. And that wrong thing would need to be corrected, to restore back to that perfect model.
Maybe the real “problem” is in human ability to think perfectly, instead of it’s mistakes.
It appears my comment was deleted, although it didn’t attack anyone, and in fact began by saying that I thought the article in general was pretty good. I thought the author had touched on a lot of important points, most of which I agreed with.
But I DON’T agree that the way to make any kind of change in the abusive enterprise that is modern psychiatry is to talk about it as if it is some kind of interesting intellectual problem, rather than an institution that destroys the lives of literally millions of people.
Those who can afford to live their lives as one constant graduate seminar at Harvard are welcome to continue. After all, Cloudcuckooland was set up 2500 years ago (or was it 400 years ago?)to be a wonderful place for the better class of people. I sincerely hope you stay there and never leave.
But I am not as privileged as you and have to live in the real world. That real world for me included many years of psychiatric abuse that have left me with scars and pain that will never go away.
So my question, at least one of them, is, what is the purpose of this website? Is it to try to change psychiatry and ultimately protect its victims? Or is it to provide a forum for narcissistic intellectuals who have plenty of opportunities to bloviate elsewhere? It certainly doesn’t seem to be for people like me.
Go ahead and delete my comment again, but you will soon find out that I won’t be silenced.
Hi Ted,
The nature of psychological suffering is a lot more than an intellectual problem, it’s a human problem, which results in the pain of countless individuals, each with their own particular experience and story.
For this situation to improve, we have to challenge the current paradigm, battering away a it until it finally falls to pieces. To do so, we need to attack it on several levels.
If biological psychiatry is inhuman and uncaring, then we ned to fight for a more human and empathetic understanding of other people’s subjective experience.
If biological psychiatry is conceptually flawed and full of contradiction, then we need to point out those flaws, and try to search for a better understanding.
If biological psychiatry is based on flawed empirical evidence, then we need to challenge the interpretation of that evidence, and undertake studies that give a better account of the experiences of people treated with psychiatric medication.
Because Biological Psychiatry is firmly established as the scientific, political and economic and conceptual paradigm of mental ‘disorder’ it has to be challenged at all levels at once. We have to use every weapon we have to break it into pieces.
Mentally, I’ve had my own troubles, and my experiences don’t correspond to the way psychology or psychiatry have explain them. That’s why I decided to become a psychologist – so that I could do my part in trying to fix what I believe is broken.
So I’m not writing my comments as some sort of intellectual dick-swinging exercise (and if you read Bob’s writing carefully you’ll the same is true for him). I’m trying to improve my own understanding through discussion, so that I can play my part in trying undermine Biological psychiatry.
Everyone here is pulling in the same direction, we just have different ways of doing it.
.
Hey Ted,
Please see my comment above. Your previous comment was deleted because there was a problem with the whole comment thread caused by the deletion of the comment you were replying to. There was nothing wrong with your post. Apologies for the confusion.
-Matthew
Jonah, thanks for your challenging response. You raise many legitimate questions and critcisms of Fancher’s blog on the medical model. I was more focused on the method in which we carry out sharp struggle on this blog. In no way was I suggesting that we should be patient in the struggle for revolutionary change, including in the treatment of people labeled mentally ill. I will fight for reforms but I believe this system is beyond repair. In other contributions on this blog I too have challenged “go slow” partial type criticisms of Biological Psychiatry.
What I am questioning is an “inquisition” type approach to ferreting out people still holding on to pieces of the disease model. I support the efforts that Anonymous and others have made exposing professional arrogance and those blog contributors making light of the power and control they have as doctors in the psychiatric field. But there have been some times when the line has been crossed where certain methods of struggle seem to push potential allies away from our movement. If someone defends one small aspect of the medical model they should not suddenly become no better then Dr Bierderman or Max Frank. Yes they need to be vigorously challenged, so let’s do the hard work and become more scientific and prove them wrong.
On the issue of neurology and brain science, we should all try to become as educated as possible; we can even learn by negative example from bad science. We should not turn people away from reading contending view points on other websites. Real science is our friend, learn to wield it as valuable weopon in our struggle. I think we have enough science and experience to blow away Biological Psychiatry but right now they control all the major insitutions of power.
Correction: My reference at the end of the second paragraph is to Dr. Max Fink (the infamous ECT doctor) not Max Frank.
I agree, bloggers and posters are often attacked here for failure to adhere to an absolutely politically correct point of view or theoretical orthodoxy, the rules of which are known only to the attacker.
I find this very unpleasant: People who are allies being trashed for a choice of words or prejudices arbitrarily attributed to them.
It’s a sad reality that people who have been abused sometimes go on the lookout for opportunities to abuse others and go at it enthusiastically when they find the least opening.
That’s what I perceive as the basis for the excesses that appear in comments on this site, and it weakens the dialog.
I agree, certainly, that people should not be personally attacked, nor should they be held to some standard of political correctness that doesn’t make any sense. I don’t agree with myself 100 percent either.
And I certainly see the value of developing ideas and analyzing facts so that we have more resources in our fight to create a system that really helps people.
But I do think that intellectualizing about things has its limits. And while I would not name anyone, I also think there is a certain air of superiority among some people who write on this website that I find very offensive.
While as I say, refining ideas and analyzing facts can be very important, in the last analysis change will be won mostly by the people who have been abused by this system we are all talking about.
And that is because for us these issues are not intellectual abstractions, but part of our lives that we have to live with every day.
I appreciate the connections I have forged with people who have experienced the full gamut of psychiatric abuse. In retrospect, I had been told the truth of this paradigm of *harm*… out of the mouths of babes locked up on a psych ward years before Bob Whitaker got intensely curious about the rise in mental illness and disability from it in America.
You won’t find a description or definition for the *radar* psychiatric survivors have for locating a threat! I like to use the analogy “canaries in a coal mine” to describe the vital function psychiatric survivors fulfill on this site and for anyone who is determined to wipe the slate clean and start over…
When I read the lengthy philosophical and intellectual discussions here, that Ted refers to as one long Harvard seminar, I have to overcome my response, or rather, struggle through the queasiness I feel to READ and process the arguments, debates. This happens to me because on an inpatient unit, the treatment team meanings are a forum for the multi-disciplinary approach to treatment. In this setting, I found that I was the least important to the lead clinician who was formulating treatment. My input was based on connection with the patient, and it messed up the intellectualizing and philosophizing that was given the most attention. So… multiply years of witnessing the complete disregard of a patient as a human being, and observing the damages done to patients by intellectual philosophers… and well, queasy is the radar I have developed as a psychiatric survivor— in a different category, to be sure.
I do read and process the discussions and debates here, and find that my initial response was spot on! I mean to convey my full agreement with Ted, Anonymous and others who feel that HERE we should boldly confront reality. Because HERE we don’t have to worry about how much worse it will be for the patient or whether we will have a job at the end of the day.
I absolutely believe that the time has come to challenge the deep thinkers in exactly the same ways that their brand of thinking has challenged both patients and committed, compassionate mental health professionals. They buckle, whine and slip way—- and have a glimpse of what it feels like to suffer a personal attack from someone who knows next to nothing about you—personally.
It’s all about sharing the experience… learning as we grow!
I agree, Ted. That’s one of the criticisms I have of the UK’s Critical Psychiatry Network — a lot of philosophizing but where are the doctors are offering enlightened treatment to real people?
Same with a lot of relatively progressive groups looking at psychiatric reform. A lot of talk, no action.
That’s the problem with the ivory tower and its inhabitants.
But — Thinking does have to take place before acting, and wouldn’t you want to discuss those currents of thoughts before you have to deal with the results?
Forgot to offer my comments on Bob’s actual post.
I have been unable to confirm that “Medical Model” has ever been utilized in the mental health field. My education and training in medicine before psychiatric experience, led me to question psychiatry’s claim to a medical speciality long before issues regarding drugs and diagnoses were exposed. It’s simple really. there is a selective, via the judgment of the clinician, view of the credibility of the patient as historian and story teller of their own experience. In other words the primary “Subjective” information that is key to forming a therapeutic relationship with a patient is overlooked, selectively in psychiatry.
This is a very subtle divergence at first glance, but it has proven to be THE divergence that separates psychiatry from medicine. Consider the terminally ill, unconscious patient in an ICU who is presenting serious end of life challenges for doctors. Do the doctors assume that the patient has no quality of life and simply wean him off of life support? NO! Hell, NO! It is vital to make every effort to determine what the patient’s wishes are, in the absence of advance directives, legal guardians and/or close family members and friends to speak for the patient. EVEN when all objective signs point to a reasonably expected outcome, the doctor cannot act without regard for the individual attributes, beliefs and wishes of the non communicating human being in his care. Even when the science is totally biology driven— there is reverence for that which makes us human and defies both science and biology.
Clearly the medical profession does not fully adhere to it’s own model, and often times there is little effort employed to illicit or ponder the subjective input of the patient, BUT the model itself contains this vital component. Psychiatry NEVER did. Once a person has become problematic for others, the model of care employed is finding the right fit between what has been objectively obtained from encountering the person and the theories of conjecture that pass for a body of *scientific knowledge*.
This is why we should STOP saying that currently psychiatry utilizes a medical model, albeit flawed in many ways. The TRUTH is that psychiatry NEVER even pretended to use this model. And this fact is extremely important going forward in our movement. It explains why Adverse Drug Reactions have been dismissed. It explains why Adverse Drug Reactions have led to the discovery of new disorders and theories on worsening presentations of serious “mental illness”. IT explains why so many people are still being harmed.
The really big gorilla in the room is wearing a sign. the sign says:”I am a fraud.” The letters MD after my name stand for: “Major Delusion” and I have grown big and fat exploiting the trust people place in the medical profession.” This gorilla should not be asked to address intention as at this point it is irrelevant. Let the intellectuals and philosophers spin their analysis at their leisure and we can all read their brilliant ideas at our leisure … WHEN this outrageous criminal behavior is exposed and STOPPED.
Some of the bloggers on this site display a rather peculiar propensity that looks like ADD… they can’t seem to devote full attention to the well known fact that people are still being harmed in what they are calling a “medical model” that needs fixing.
How does one get their attention??? Politely, we may suggest attention to semantics, but if we don’t assert that MEDICAL does not belong in any description of our current paradigm of psychiatric care, then we are just spinning our wheels and wasting precious time.
SOME of us struggle with impulse control when the issues pertain to life and death. I can say from first hand experience that it was precisely the emotional battles that were waged from humanistic care givers in ICUs that forced doctors to revisit the medical model as it was conceived and designed. When waging a battle for justice and human rights, one need not employ (verbal) restraint. In fact, to do so is a sign of human weakness. IMO. of course.
Well said! Most psychiatrists don’t even think about what “model” they are using. People have “symptoms” and they prescribe drugs to dampen or eliminate the undesirable thoughts/feelings/behaviors. Of course, what is undesirable is usually filtered through their own biases or the biases of those who have determined that another person’s behavior constitutes a problem. The whole diagnostic thing is just a way to get reimbursement.
There’s nothing “medical” about this model!
— Steve
One more thing.
I missed the thread that was deleted from this bog. I am working again on an inpatient unit where the premise is “Recovery Model” real education… maybe even wiping the slate clean. There is potential and if it continues to blossom I am going to offer my experience on this site. My work schedule and related work-related ventures limit the time I have to visit this site.
I do not advocate for deleting anything… but for sustaining engagement— even when it becomes painful, or especially when it becomes painful to do so. Even when commenters call each other on violations of the guidelines—- or side line discussions derail the thread from the topic of the blog itself. I don’t like censorship. Period. Here’s why:
“The agony of breaking through personal limitations is the agony of spiritual growth.” –Joseph Campbell, “The Hero With A Thousand Faces”
I owe a tremendous debt of gratitude to one particular commenter, Anonymous. The degree to which Anonymous has pushed me past my personal limitations is is one of the major reasons I got back into the ring… working in the trenches. I have only scratched the surface of recognizing my personal barriers to effecting change and upholding human rights and justice. But I know that without the voice of courageous people like Anonymous, I can’t even see my own barriers.
To Altostrata, I don’t want you or anyone to think I am opposed to any intellectual analysis. And if you saw my comments outside this website, I am very consistent in saying that we should think about and analyze our situation before we take action.
But I think intellectual analysis should be a tool one uses in their practical work, not an end in itself.
By the way, are you in the UK? I am from California, though visiting Alaska at the moment.
I’m in California.