I want to draw attention to an article written by Joanna Moncrieff and published by the Journal of Social Theory and Health in 2010. One of the issues that is very important to me is the ways in which the subject of mental health is a subject of political, economic, and cultural issues. Underrepresented in discussion about "mental health" are issues of poverty and class prejudice, issues of cultural bigotry toward persons labeled as "mentally ill, and issues of political power that impact policy and practices within the public mental health system. Below is the introduction of Moncrieff's article:
I would encourage you to read the full text HERE.
Modern diagnostic systems in psychiatry, like the Diagnostic and Statistical Manual (DSM), now in its fourth version and soon to be updated, have been enormously influential. Many formal concepts like ‘clinical depression’, attention deficit hyperactivity disorder (ADHD) and more recently bipolar disorder have been incorporated into lay language and understandings, helping to shape the way ordinary people view themselves and their situations (Healy, 2004; Rose, 2004). These systems also form the basis of a vast research effort aimed at mapping the prevalence, aetiology, outcome and treatment response of the entities defined. They are also used in pharmaceutical marketing, which often starts with raising awareness of a particular diagnostic category, before going on to promote a drug for its treatment (Koerner, 2002).
The basis of modern diagnostic systems, the idea that psychiatric disorders can be conceptualized in the same terms as medical diseases, has been challenged for decades now. Antipsychiatrists such as Laing and Szasz, and sociologists such as Conrad, stressed the differences between medical diseases and psychiatric conditions and pointed out the social control function served by dressing up normative judgements about behaviour as medical facts. Although their work provided an important conceptual analysis, it often relied on extreme and exceptional examples of the use of psychiatric diagnosis, such as the incarceration of dissidents in the old Soviet Union. Less attention has been paid to the nature of routine psychiatric practice. More recent analyses have highlighted the tautological and redundant nature of psychiatric diagnoses (Bentall, 1990). A diagnosis is applied on the basis of observations of an individual's behaviour, but diagnostic categories are defined by collections of typical behaviours.
Champions of the idea that psychiatric disorders are like other medical diseases have continued to assert their position (Craddock et al, 2008), but have not answered the basic arguments posed by their challengers. David Pilgrim recently argued that the debate had been rehearsed so many times that the question that remained was not about the validity of psychiatric diagnosis, but why it has survived, and what interests it serves (Pilgrim, 2007).
In this paper I examine the gulf between what psychiatric diagnosis purports to be and how it functions in everyday practice. I have returned to the analyses of Jeff Coulter, a sociologist with an ethnomethodological orientation, and David Ingelby, a psychologist and philosopher, whose work examines the differences between psychiatric diagnosis and diagnosis in the rest of medicine. In particular, it suggests that contrary to other areas of medicine, where diagnosis determines the appropriate treatment to be given, in psychiatry diagnosis is merely a ‘signal’ for the application of pre-existing institutional arrangements. I shall present the stories of two real psychiatric patients, who are reasonably typical of people with severe and long-standing psychiatric problems. These stories illustrate how psychiatric diagnosis can be understood as functioning as a political device, in the sense that it legitimates a particular social response to aberrant behaviour of various sorts, but protects that response from any democratic challenge.
I would encourage you to read the full text HERE.
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