Wednesday, February 25, 2009

There is reason to believe that a society which sees people as 'mentally ill', call's them 'mentally ill', and treats them as 'mentally ill' aggravates by those acts the condition which it calls 'mental illness'.(Sheff,1966).

When considering how factors beyond the individual influence those deemed to have mental illness it is first necessary to determine what mental illness is and this has long been the subject of debate amongst the medical /psychiatric, scientific, religious, legal and political hierarchy. It is therefore important that popular moral, ethical and cultural influences of those in power at the time be taken into account.

The original definition of madness which dates back to the 17th century, as the condition which justifies confinement in the asylum, is accurately demonstrated by Szasz,
“To be considered mad, it was enough to be abandoned, destitute, poor, unwanted by parents or society” and continues by reflecting how such incarceration were not necessarily in the best interest of those being diagnosed and incarcerated,
“this action was to be taken on the complaint of parents, or, if these were dead, of near relatives, or the parish priest. The wayward children were kept as long as the directors deemed wise and were to be released only on written order by four directors. (The manufacture of madness, 1971).
This would therefore suggest that “madness” was in fact a societal issue rather than a purely medical one.
In British society today the medical/scientific model remains the dominant prospective. This model however has its roots firmly planted in the past regarding mental illness generally as a biological, genetic or chemical mal-function in the individual and continues to follow in the traditions of the pioneers of psychiatric medicine such as Charcot (1825-1893) and keaepelen (1856-1926). Whose primary focus was neurology.
Charcot often regarded as the grandfather of modern psychiatry believed .that hysteria (madness) was a neurological disorder caused by hereditary problems in the nervous system, however it could be argued that his most important contribution to psychiatry was that he defined hysteria (madness) as an illness rather than a mode of malingering which at the time was a popular label attached to suffers of mental health issues. Charcot used hypnosis to induce a state of hysteria and studied the results, and was accredited with changing the medical community's opinion about the validity of hypnosis.
The medical model the term, (cited by Ronald D. Laing in his The Politics of the Family and Other Essays) as the "set of procedures in which all doctors are trained." aims to find medical treatments for diagnosed symptoms and syndromes of mental ill health which are based on assumption that date back to Kraepelen.
Kraepelin identified three major severe psychiatric disorders; dementia praecox, later renamed schizophrenia, by Bleuler (1857-1939). Manic depression, which covers all mood disorders, and paranoia, which basis the diagnosis of patients under the label of delusional.
Kraepelin’s theories dominated psychiatry at the beginning of the 20th century and he opposed the approach of Sigmund Freud, who regarded and treated psychiatric disorders as caused by psychological factors.
The problem with the medical model as Laing argues is that because the diagnosis of mental illness is based on the conduct or behavior of the patient, and not pathology, the "diagnosis" contravenes standard medical procedure and hence the medical model’s examinations and tests which are usually conducted after the diagnosis unlike with physical diseases and ailments which are diagnosed by evident pathology found during examinations and tests, mental illness is diagnosed by patient's conduct with only a hint of a pathology not cited at the time of diagnosis.
As the medical model approaches mental health issues from a traditionally historical, scientific and biological medical prospective it has limitations which include a failure to appreciate the significance of internal experiences, lack of recognition of individuality and diversity, and lack of appreciation of the role of culture in mental health. It has also been suggested that by so doing the medical model actually contributes to, rather than elevates the problem by continuing to treat patients with mind altering drugs such as chlorpromazine, Librium, diazepam and other members of the tranquilizer and Benzedrine varieties all of which are often encompassed under the umbrella of anti-psychotic drug therapies over long periods which cause side effects which in fact reflect symptoms commonly cited in the diagnosis of mental health issues such as memory loss, anxiety, insomnia, irritability, mood swings, paranoia and lethargy. Furthermore in the treatment of what is regarded as severe long term mental ill health, it is still the practice of many psychiatric practitioners to inflict barbaric treatments such as electric shock treatment on mental health patients.
It is widely regarded that former charcot student Freud (1856-1939), founder of the psychoanalytic school of psychology, revolutionized the approach to psychiatric medicine with his theories of the unconscious mind, involving the mechanism of repression; and his theory of transference in the therapeutic relationship and also his ideas on dreams as sources of insight into unconscious desires. Hailed as "the father of psychoanalysis”, Freud influenced not just psychiatric medicine but feminist theories, philosophy, and psychology. However, his theories remain controversial.
Like his mentor Charcot, Freud experimented with hypnosis on his neurotic patients, but abandoned this form of treatment, in favor of treatment where patients talked through their problems. This became known as the "talking cure" which is widely recognized as the basis of psychoanalysis. This view it could be suggested saw the beginning of a more holistic approach to mental health and widened the modes of practice used to diagnose mental ill health by incorporating physiological and sociological influences.
Freud developed a theory of how the human mind is organized and operates, and how human behavior both conditions and results from this particular theoretical understanding. Freud’s biggest contribution to psychiatry was his argument for the existence of an unconscious mind. This suggested that people could discover repressed thoughts about themselves and their environment and controls them; Freud believed that we are not completely aware of all our thoughts and sometimes react in ways unrelated to conscious thoughts. Freudian psychoanalysis was to bring repressed thoughts and feelings from the unconscious mind to the conscious realm, by encouraging patients to talk in free association. His early work can be linked to Joseph Breuer Who he credited with the discovery of the psychoanalytical method. Freud used a form of treatment based on that developed by Breuer which he modified and called "pressure technique". His findings from this suggested that many of his patients were victims of childhood sexual abuse. .
In Freud's opinion, reasoning occurs in the conscious mind the ego, the mind also contains the hidden, irrational elements of id and superego, which lie outside conscious control driving behavior and motivating conscious activities, resulting in these structures bringing into question human ability to act purely on the basis of reason. Since hidden motives are also always at play. This model of the mind makes rationality suspect, motivated by hidden urges or societal forces e.g. defense mechanisms, where reasoning becomes "rationalizing" reflecting some of the theories encompassed under physiological and sociological mental health models.
Freud was criticized throughout his career for his theories of the unconscious mind and dream analysis since unlike with the medical model his conclusions where not based on matter or the physical aspects of health and his theories were at times seen to be delving into what has come to be regarded as suedo- psychiatry and mysticism, he was also accused of being obsessed with theories related to sexual deviance however given the strict moral structure of western culture of the time most mental health diagnoses deemed mental health patients to be guilty of some form of sexual deviance as Thomas Szasz illustrates (the myth of mental health(1962) the manufacture of maddness1971)
The deviant label has historically been synonymous with mental health diagnosis as the behavior of the mental health patient deviates from the accepted norm of the cultural and societal rules laid down by the hierarchy of those making the diagnosis. However it has long been recognized within the sociology camp that certain groups of people are more likely to be labeled thus e.g. woman, black people (men in particular), homosexuals. Social class will also be a contributing factor. Historically British societies rule makers and hierarchies have traditionally belonged to the upper and middle classes and are notably predominantly white Christian males.
It is also notable that often the deviant/ mentally ill label may be applied to someone without them ever having committed an act of deviance by there association with those labeled under the vast umbrella of deviant behaviors, as is explained by Becker in his (the outsiders (1963)).

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. (Sheff, 1966).
(The manufacture of madness, 1971).
Ronald D. Laing in his The Politics of the Family and Other Essays
(the myth of mental health, )
http://en.wikipedia.org/wiki/Medical_model`
(the outsiders(1963)).

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