Posted by ElaineM on October 1, 2006, at 17:15:49
In reply to I have a different take on this., posted by madeline on October 1, 2006, at 16:24:47
This was what I was thinking of though I wasn't (still not) sure that what I was writing about was the "Intentional Paradigm". I'll throw it out here anyways and someone is free to name it something else, if I'm wrong.
================>>>>>>The *Intentional paradigm* also assumes there are no mental illnesses. [never mind the *in general* notion. worrying about me here] Instead, abnormal behaviour is seen as the volountary adoption of strategies to cope with difficult circumstances. 'Our view of psychosis [never mind *psychosis* worrying about me] constitutes more a 'way of life' hypothesis than a 'disease' hypothesis.
I don't know, I interpret the "Intentional Paradigm" differently, though I usually refer to it as the Socio-Cultural explanation for mental illness. I haven't read the specific book quoted from, so I'm only gonna refer to the quotes given. Most of my work on Mental Illness was sociologically based, reading alot of Goffman's work on Total Institutions, and the Stimga of MI. This is all just my own impression, and I likely won't be able to expand on it anymore than I do in this post cause my head is foggy and the words don't come. But, when I read "way of life", I don't find it insulting or feel that it negates psychological pain or suggests I chose the circumstances I grew up in or the events that happened to me.
>>>>We assume the patient to have what he regards as good reasons for behaving the way he does - that he has in mind some purpose from which his behaviour logically follows.
I think here the patient can sound either sinister or not depending on how you look at it. "Good reasons" and "purpose" make it sound overtly contrived, but to me the sentence just says that people engage in behaviours that they believe will benefit them within the circumstances they live. Isn't that what coping is? Developing anorexia I evidently once thought (and still am often trapped there) that at that point in my life, during the f*cked up stuff that was going on at that particular time, within the dynamics of how I had been living and grown up in, that losing weight would make living not only more tolerable, but *possible*. I think if I hadn't (unconsciously) chosen anorexia I would have committed suicide -- I would not have been alive today. I'm not saying that in the long run anorexia is not as bad, but just that it was a coping strategy to survive an unbareable condition. It doesn't mean it (or any other MI, or like SI) is healthy -- It's not. And ideally, the person (who deserve's such) would get help to function in a *healthy way* in a *healthy circumstance*.
>>>>>And Szasz, who sees hysterical behaviour as a game played by a person to get help,
Again, I'm not so well read, this wasn't the focus of my degree, but (and this is a literal question) is it possible that "game played" was only being used synonimously with "strategy enacted" or "technique implimented", or something like that.
>>>>>>first, that 'symptoms' are really volountary actions performed as a result of desires (to cope) and beliefs (that this strategy is the best way to cope)
Yes, this makes sense to me.
>>>>>>And second, 'symptoms' occur as a result of situations where such strategies are intelligible...
To me this second part eliminates the possibility of the socio-cultural model of MI placing blame. Actions are unconsciously (or also sometimes consciously) chosen because in the context in which they occur they seem to make perfect sense. When actions are placed in a different context, that's when the word "disordered" would be unfairly used to describe the action. Family systems theory (I think) is based upon this idea. It makes sense to me. I'm not saying that there aren't medical brain illnessess, but I don't think that that's what's being proposed by the "intentional" model. I just see it as another way to explain the occurence of "MI" where there is no biological or physiological root cause. I guess aruging can occur because I kinda remember reading somewhere that behaviours (ie. CBT) can alter reactions in the brain, for some things. I don't know, perhaps academic posts are over my head.
>>>>SInce he is volountarily bringing about his disturbing behaviour, he is responsible for it. In fact, on this paradigm, it is often the very existence of the sick role that makes such disturbed behaviour possible
For me, I only interpret "voluntary" to mean that the symptoms are not biologically caused. I don't necessarily interpret "voluntary" as having a negative connotation. Although it does also happen the other way, if patients "choose" their behaviour it's because it *doesn't* seem (or at least not completely, or even orginally) disordered to them. They are acting "logically" according to the environment/circumstance they are in, so they cannot be "blamed". Like in studying family systems for example, when Dad and Mom are fighting at home, a child may "act out" to pull focus -- providing the parents with a source of common focus as a distraction from the anger between the two, keeping the family together. Often it is the child that is brought in for treatment and labelled mentally ill for their "dysfunctional" behaviours, when really they are filling a necessary role in their family. The child is behaving "logically" according to what is needed for the family system to balence out -- their "MI" is really the symptom of the dysfunctional marriage.
I don't know maybe I'm naive but it makes sense to me. Is my anorexia my fault? Technically, I *did* starve myself. Nobody forced me to do that. Yes, I chose that. But I did NOT choose the events that prompted me to "choose" the starvation as the only "logical" option to me. And to me, that erases the idea of placing moral blame on the patient, on me.
Yet, I also agree that the "playing at madness" can occur. Though I think it would be to "perpetuate" the sick-role, and not "originate" it. That's where most of my reading of Goffman came in - how total institutions further MI. I can see the "benefits of the sick-role" as being an attempt to escape the stigma of what it means to carry the MI label in certain societies. I see a patient choosing institutionalization as choosing the only environment they feel they can function in, or at least the one that feels safer. I can personally say that the longer I was in the hospital, the more afraid I was to leave -- you learn all the "inside rules", the staff and how to relate, secondary MI, group cohesion and acceptance instead of stigma. It is hard to explain but easy to experience. But often when I was out of the hospital, I longed to be back in, and often did end up back there -- Though I know that doesn't occur with every person who ends up in total institution.
I guess, just in general, I don't feel the intentional paradigm is a blaming one -- at least not in a "I choose the pain that I've suffered" way, or in an "I deserve all the sh*t that happened to me" way. I don't think that the Int.Paradigm suggests that the patient doesn't deserve help. To me it doesn't have anything to do with *wanting to be sick* -- it actually has to do with a patient's first attempt at *wanting to feel better*. Goffman's study of total institutions suggested that the patient didn't deserve the sick label, because it forces a sick identity. The patient derserves *better* than that label affords them.
Okay, I'm kinda scared cause this is the first "something other than emotional support" post I've made. I've probably asked more questions in my post than argued anything but oh well. Sorry if I'm confusing, the thinking part of my brain is rusty. If I'm crossing theories here let me know because I focused on Sociology during my studies. But I'm trying to argue that I agree with the beliefs of everyone who've posted, but am saying that I'm not sure that the Int.P. exists to contradict those beliefs.
So, am I confusing this with something else?
poster:ElaineM
thread:689710
URL: http://www.dr-bob.org/babble/psycho/20060926/msgs/690884.html