Sunday, July 25, 2021

Comments by christinaemanuel

Showing 4 of 4 comments.

  • This is exactly right.

    I am a psychoanalyst and psychotherapist. Making a diagnosis I am a political act: I, the person in “authority,” declare something about a “subordinate” person. We confuse applying metaphors for human experience (i.e., diagnoses) with knowing something definitely true about a person.

    I work with many people with so-called autism. Making that diagnosis is the ultimate gesture of an authority declaring something about society, determining what is “normal” and what is deviant.

    I don’t know about you, but I don’t think I should have that power.

    Christina Emanuel, MFT, PsyD
    Pasadena, CA

  • Well done, Sera. Thanks for this.

    When a person is reduced to a diagnosis her humanity is lost, even though I think SOMETIMES labels are useful ways of describing something that happens sometimes to some people. They might be a helpful starting point in some cases but never an end point. And no label COMPLETELY explains the subjective experience of an individual.

    I’m a mental health clinicians and I hate the new DSM coming out, in which the APA has invented more ways than ever to pathologize human experience. And I bet Big Pharma can’t wait for the new DSM to be released. I can already envision the commercials for meds to “treat” *normal* grief, for example.

    Your piece reminds of the words of Harry Stack Sullivan: “We are all more simply human than otherwise.”

    Christina Emanuel, MFT, PsyD
    Pasadena, CA

  • Faith, thank you for this post and for your letter to the NY Times. You get it exactly right when you state, “the medical model of mental illness offers little more than a brutally reductionist framing of our humanity, one in which disease severely and persistently supersedes one’s rights and undermines one’s potential.” And you write very well too.

    I am a psychoanalyst ( and psychotherapist; I encounter a lot of human suffering in my work. I think a great deal about the themes you lay out.

    You ask, “Why is it that the loudest voice in the room is the voice of biomedical psychiatry?” I think this is because Big Pharma, et al., are extraordinarily skilled at their messaging, invoking cognitive frames that are persuasive, repetitive, and attractive (see George Lakoff’s writing for more on this:

    Biomedical psychiatry fails to realize that making a diagnosis is a political act—someone in authority declares something about a subordinate person—based on three fallacies.

    First, they assume that empiricism is the only way we can know things about a person, reflecting a bias toward scientism. This excludes learning about people phenomenologically and anecdotally, an equally valid way of knowing things, as you point out.

    Second, biomedical psychiatry is informed by statistics that they assume tell us something useful about what is “normal” and “deviant.” I was both surprised and not to discover that the leading statisticians of the 19th century—those who laid down concepts of “normative data, ” the bell curve, etc.—were eugenicists. (For more on this see L. Davis’ book Enforcing Normalcy,

    Third, they assume that psychiatric diagnoses are literal things rather than metaphors we use to try to account for human experience as best we can. Diagnostic labels describe behaviors and roughly line up with some experiences people have, but a set of behaviors is not the same thing as an individual’s experience in the world. Sometimes diagnoses are useful starting points. For example, I work a great deal with people with autism and most are relieved to learn that there is a way of describing their experience in the world in a way that makes sense, opening up possibilities and choices. But diagnostic labels are never good endpoints, as that is reductive to the point of absurdity, ignores the contextuality and complexity of an individual’s experience, may lead to harmful over-medication, marginalizes a person politically, and gives the incorrect impression that a person is only and always so labeled.

    Because Big Pharma and biomedical psychiatry are so good at conveying their message most people don’t realize how wrong and dangerous it is.

    Christina Emanuel, MFT, PsyD
    Pasadena, CA