One Man's Schizotypal Disorder is...

An interesting article appeared today in The New York Times about the American exportation of psychiatric diagnoses. It's long, but worth reading. Here's a link. And here's an excerpt:
Mental illnesses, it was suggested, should be treated like “brain diseases” over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma. This idea has been promoted by mental-health providers, drug companies and patient-advocacy groups like the National Alliance for the Mentally Ill in the United States and SANE in Britain. In a sometimes fractious field, everyone seemed to agree that this modern way of thinking about mental illness would reduce the social isolation and stigma often experienced by those with mental illness. Trampling on indigenous prescientific superstitions about the cause of mental illness seemed a small price to pay to relieve some of the social suffering of the mentally ill.

But does the “brain disease” belief actually reduce stigma?
Anyway, this is some provocative stuff in my judgment. Having discovered that Muslims in Zanzibar with little or no advanced medicine are better at preventing relapses of schizophrenic behavior, and other stuff like this, I'm glad to see The New York Times (long a devotee of modern psychiatry) giving so much space to this report. The article says, "The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her." Including, obviously, the psychiatrist himself.


Insignificant Wrangler said...

Very smart article! I like how the "cure" for schizophrenia seems to be small acts of kindness. It is interesting to ponder whether techno-industrialization isn't in someways an agitator of schizophrenia--if the natural biological ancestry isn't rejecting the ideological-cultural context created for it.

I've been thinking a lot lately about how our contemporary technology re-tribalizes [Ong] our global village [McLuhan], arguing that technologies like Facebook essentially recreate the common table that our nuclear family life obliterated. In that sense, the end of the article fell close to where I've been dwelling.

And, of course, as a rhetorician I find it fascinating that discourse can have such powerful effects on the human mind and body. If you word it, it will come?

Casey said...

If you word it, it will come!!! I love that.

But wait, have we just rediscovered what we've supposed to have known all along?: "In the beginning was the Word..."


Casey said...

Wishydig: lotta issues with that article.

"Western…practitioners often prefer to believe that the 844 pages of the DSM-IV…illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs."

not a fair representation of a norm.

“The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.”

this jumps to motivation where the study as described offers none. just correlation.

in fact the whole article puts a lot of weight on analogy and correlation. it's pretty cheap logic.

there are some interesting claims in there, but i'd like to see the WHO studies about schizophrenia and cultural comparison. newspaper pieces about science rarely hold up under a tiny bit of investigation. just look at all the news outlets that believe myths about male/female differences in language. we're not even talking about fine points here. it's basic facts, the big numbers, that get thrown away.

Casey: I hear you, M.C. In fact I really didn't get all pit-bully on this article because you had prepared me to read it critically.

I still maintain, though, that both Western clinical psychiatry AND more traditional forms of religious narrative could benefit by putting them on the same cutting board and trying to make a synergistic collage.

The stuff in the Bible about demons and spirits may very well be wiser than we think, revealing more about how different our methodologies are than about how "advanced" we are in our understanding. It's probably impossible to know the frequency of what we call schizophrenia as it occurred in the ancient world, but it does sometimes seem that it is exacerbated by modernity as a whole... and Psychiatry (including therapy, not just the drugs) must see itself as a part of--indeed, as a high representative of--the modern project.

Take depression. What is depression? Well, almost all of the phraseology in the DSM-IV is descriptive... but has become associated with negatives: "limited range of feelings," "feelings of emptiness," etc.

But the "feeling of emptiness" is a neutral datum of psychology, not *necessarily* the sign of a disorder... a Buddhist teacher might very well recognize that as a state immediately preceding awakening. If, upon presenting, a patient were told that she was very close to the kingdom of heaven, rather than showing symptoms of clinical depression, might she react differently? So the interpretation influences subsequent patient-behavior.

And I know you'll argue that a good psychiatrist will be aware of those kinds of possibilities -- and doesn't read the DSM-IV that way. But at SOME point (maybe not yet) that would be like me arguing that a good televangelist actually can heal people by knocking on their foreheads and yelling "devil come out."