A recent study published in Global Studies of Childhood explores the ways that young people understand and interact with psychiatric diagnoses. The analysis is grounded in philosopher Ian Hacking’s notion of the “looping effect,” which argues that people change in reaction to receiving diagnostic classifications. The authors analyzed fifty-one interviews with Swedish 15-year-olds and found that these young people gave different meanings to their diagnoses than the institutional, psychiatric understandings.
The researchers, Sofia Kvist Lindholm and Anette Wickström from Sweden’s Linköping University, explain:
“Hacking suggested that ‘scientific knowledge about ourselves – the mere belief system – changes how we think about ourselves, the possibilities that are open to us, the kinds of people that we take ourselves and our fellows to be.’ However, when people interact with classifications, they may cause systems of classification to be modified in turn. Hacking referred to these feedback effects as ‘looping effects.’”
Some critical approaches to psychiatry focus on “dominant discourses” or ideologies in the field, and how these understandings can be resisted. Much of this work stems from the French philosopher Michel Foucault’s ideas about how people are socially constructed in relation to dominant ideologies within a particular cultural history.
The philosopher Ian Hacking, influenced by Foucault, came up with the idea of “looping effects” while studying the history of seemingly viral but historically limited ‘mental illnesses’ such as Multiple Personality Disorder (now called Dissociative Identity Disorder). Hacking focuses on how diagnostic categories give people a new framework to understand themselves through, which ultimately changes how people see themselves, other people, and the world.
The current study seeks to understand the “looping effects” or feedback effects involved when young people understand themselves in relation to diagnostic categories. The authors aim to show the nuance of how these diagnostic categories are actually taken up in everyday life while critiquing dominant discourses or narratives about what it means to be diagnosed with a ‘mental illness.’ Fifty-one semi-structured interviews (41 individual and 10 group interviews) with Swedish 15-year-olds from two different areas (urban and one rural) were analyzed. The sample consisted of thirty-two females and nine males.
“The interviews focused on what makes them feel well and what their health problems measured with the international survey Health Behaviour in School-aged Children (HBSC) represent in their daily lives. We also asked them what meaning they would give to concepts commonly applied in summarizing reports on young people’s wellbeing,” the authors explain.
Performing a discourse analysis of the interview data, the authors found several prominent themes. “Anxiety” and “depression” were the most referenced diagnostic categories, which were used to refer to daily struggles. Anxiety was often referred to in a non-pathological way as “having too much to do, being uncertain or aware that one might not succeed, or having to do things they did not really feel like doing.” Depression was more often associated with a form of actual mental illness, but still used a way to talk about “feeling low.”
The authors discovered a pattern of young people describing anxiety about succeeding or failing at life tasks, such as performing well academically, which they viewed as their “personal responsibility,” echoing individualistic cultural discourses:
“The pressure they describe reproduces individualistic ideals and discourses characterizing our contemporary western society to create a life of one’s own and discourses of ‘responsibilization’ that direct individuals to become ‘enterprising selves’ who govern themselves in accordance with a ‘hollow individualism.’”
Rather than merely an internal psychological symptom, anxiety was understood as a symptom of challenging external demands and the resulting internal pressures.
Anxiety was also used by young people to point to challenges associated with family life and peer relationships. The authors state that “the 15-year-olds relocate the focus of anxiety to external factors such as their school situation, their social relations with peers and family, and ideals and norms of contemporary society and local peer groups. In this way, they de-pathologize the state of anxiety.”
The concept of depression was shown to receive a de-pathologizing treatment by young people as well, with many of those interviewed equating being “a little depressed” with feeling “a bit low.” The authors argue that these rhetorical moves show how young people pick up and redefine psychiatric language for their own purposes, adding nuance as well as devaluing and de-pathologizing these categories in the process.
The young people, in their construction, delineated a difference between “real anxiety” or “a real depression” and their non-pathological use of these concepts. According to the authors, this shows how young people transform psychiatric categories into “dynamic cultural categories,” making their own meaning of psychiatric language.
The authors believe that these findings suggest caution for epidemiological studies on mental illness. Researchers may interpret these young peoples’ use of psychiatric language in a less critical fashion and falsely assign pathological categories to them, or assume that psychiatric intervention is necessary, without understanding that these concepts have been “transformed […] into cultural categories rather than diagnostic categories.”
The authors conclude:
“The way that young people change the meaning of the psychiatric labels involves appropriating the psychiatric label, without adopting the psychocentric-problem definition involved in the clinical definitions of anxiety and depression,” the authors conclude.
“Rather than reproducing a sense that the battleground is inside young people’s heads, they locate the battleground in their social and structural context of managing school, their social relations, and norms and ideals of society and their peer groups.”
Lindholm, S. K., & Wickström, A. (2020). ‘Looping effects’ related to young people’s mental health: How young people transform the meaning of psychiatric concepts. Global Studies of Childhood, 10(1), 26-38. (Link)