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Are psychological diseases discovered or invented?
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08-12-2011 9:19pm#1
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I think your question misses the point. New psychological (I'll use the term) 'disorders' are often more reflective of new qualitative judgements around what's normal or not. Your example of homosexuality being a good case in point. (Though you probably know as well as I that there are still many who subscribe to the disorder hypothesis when it comes to homosexuality).
You should check out the book 'Selling Sickness' by Ray Moynihan and Alan Cassels. I think it's a Canadian publication (I picked it up in Canada a few years back). While it's basically it's a pop a big pharmaceutical companies and an exposition on how many behaviours are pathologised in the name of selling more drugs, it does prompt thinking along the very lines you question. The chapter on ADHD appealed to my cynical side about the diagnosis I must say.
Puts me in mind of a nice little book 'Opening Skinner's Box' by a Lauren Slater - somewhere in that book she mentions an early 19th century preparation for children, a 'Mrs. Winslow's Soothing Syrup'. Based on opium as I recall. It seems that certain kids have needed sedation for at least the last 200 years. The Moynihan and Cassels book has the cheek
to suggest that the notion of a behaviourally disordered, and therefore diagnosable and treatable-by-medication child has its roots in, and has been pushed by, WASPish North America where little brats really do upset the decorum. (Now that I think of it, maybe this book was a Canadian did at the US! Hmmmm). Anyhow, Mrs.Winslow would have been proud of Rialin.
Interesting question. Looking forward to other replies.0 -
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I guess what I'm getting at here is why should we "medicalise" behaviour in the first place? Is there a legitimate argument for helping an individual with a severe tendency towards melancholy by telling them they have a "disease" and need to visit a doctor? Help yes, if a person wants to helped; but why provide that help in a medical format?
I would think the main reason is to alleviate suffering; their behaviour or way of being in the world is causing them distress. I'd imagine the reason it is approached in a medical way is down to a default reaction, in particular nowadays where if someone is in distress they go to the doctor, whose natural approach is within the medical model. But there are types of therapy that acknowledges the same distress in a less medical way.
But just to note, there are some disorders that are so pervasive, in my opinion, the medical approach is the only one that is efficient at helping; like schizophrenia or severe depression. I was watching some afternoon program yesterday and there was an Irish actor on it (I should know her but I'm embarrassed to say I dont!!
) she spoke about her depression and how she tried to kill herself 30 something times. I'm sure that lady would have taken any approach going to alleviate her pain.
But I think you have a good point about their being something almost therapeutic in the diagnosis itself. I think there is something to that; I work with the families of people with dementia, in their case its the other who is diagnosed, but when they explore the illness and realise that others are experiencing the same there is a huge wave of relief. They aren't the only ones going through this; that knowledge can be freeing, nothing has changed, their loves one is still ill but now it seems more manageable.
Anyway I'm rambling now. There are good and bad points to the medical/psychiatric model but behind the science I think it is motivated by a genuine attempt to alleviate the suffering of people who are presenting with these behaviours.0 -
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That's not a valid analogy; sleep isn't classed as a mental illness. The behavioural patterns that we have classed as illnesses are still relatively mysterious in terms of their aetiology and we should be asking why is this the case?
I was just making the point that there're many processes which occur which we cannot explain. In other words... it would be great to know what leads to a particular behavioural pattern but we are still relatively far off determining the neural processes behind ANY process on a behavioural level - we might know some of the areas involved or some of the genes responsible but I don't think there's a systematic explanation for any single behaviour.I didn't say it was a feasible experimental protocol. I was trying to point out that, just like depressed people, happy people probably have physiological processes going on in their brains that would distinguish them from non-happy people; so this isn't a valid reason by itself to class a behaviour pattern as an illness because arguably all behaviour patterns have exclusive neurological correlates--whether it's something that has been classed as an 'illness' or not.
I see your point (I think
). Yes, every behavioural pattern has an underlying process, but a process that leads to behaviour typical of a mental illness may be disordered compared to that which leads to what is considered "normal" behaviour. For example, immune cells in the brain typically carry out neuroprotective functions in terms of fighting infection etc etc... however these cells can also become chronically active (dysfunctioning so to speak), leading to neurotoxicity and possibly contributing to neuroinflammatory diseases such as parkinsons disease / alzheimers disease which produce atypical behaviour. So just because a process is happening in the brain doesn't mean it's happening "in the right way"...
So it's not a problem if people have a different neurological process occurring, leading to different behaviour UNTIL that behaviour becomes harmful to the person. E.g. A different process might underly being attracted to red heads vs. blondes, not a problem until one's neurology leads to them being attracted to childern.Or that the evidence doesn't give the doctors much to go on except what essentially boils down to a value judgement?
I suppose it can be partly a value judgement on the doctors part, in conjunction with the patient fulfilling certain criteria. Hopefully they are qualified to make that judgement.
I see your point about medicalising certain behaviours - or calling them disordered. I'm gay, and all over the world that's seen as something that's wrong, or needs treatment etc... but I feel that if one suffers from symptoms which are affecting their lives negatively and leading to the possibility of them harming themselves / others, then they should be given whatever treatment has been validated to be most effective. This may be psychotherapy and/or medication.
I don't mean this in a sarky way, but what would you propose as an alternative to the medical model, which incorporates the possibility of pharmacological treatment?0 -
what would you propose as an alternative to the medical model, which incorporates the possibility of pharmacological treatment?
The biopsychosocial model?
LinkyThe biopsychosocial model (abbreviated "BPS") is a general model or approach that posits that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness. Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms.
I saw Kinderman at a conference a few years ago and was very impressed. Many Clinical Psychology training course have taken his ideas on board in the way they are organised.
There are also a few psychological models of emotion - SPAARS, ICS etc.
As for anti-depressants work for people, so lets prescribe them - well there is evidence that they work no better than placebo, and often have worse side-effects
and then there's the rather disturbing studies that show that anti-psychotics can worsen psychoses etc etc.
It seems paradoxical that drugs that ameliorate acute psychotic symptoms over the short term will increase the likelihood that a person so treated will fare poorly over the long term.
Lots of studies quoted here.0 -
JuliusCaesar wrote: »The biopsychosocial model?
Linky
I saw Kinderman at a conference a few years ago and was very impressed. Many Clinical Psychology training course have taken his ideas on board in the way they are organised.
There are also a few psychological models of emotion - SPAARS, ICS etc.
As for anti-depressants work for people, so lets prescribe them - well there is evidence that they work no better than placebo, and often have worse side-effects and then there's the rather disturbing studies that show that anti-psychotics can worsen psychoses etc etc.
Lots of studies quoted here.
Following the BPS (which health psychologists use when looking at a health issue, either mental, physical or both) the drugs would only affect the biological side of things. The psychological side of psychosis, depression and many other illness or disorders. To fully treat the person at the center of the diagnosis you have to look at their own psychological and social health. Otherwise, the interactions between these can make things worse (eg. treat with drugs but nothing is done psychologically. the side effects on the body can cause psychological stress making things worse for the person as a whole).
Im not saying medications should be written off nor should they be fully depended on. All these things have to be 'married up' to suit the needs of an individual.0 -
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