![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 49. Go back in thread:
Posted by alexandra_k on September 28, 2006, at 0:36:39
In reply to LOL Alex! (nm) » alexandra_k, posted by muffled on September 27, 2006, at 22:24:57
Posted by Jost on September 28, 2006, at 1:19:32
In reply to my t is going away :-), posted by alexandra_k on September 27, 2006, at 20:45:30
Posted by alexandra_k on September 28, 2006, at 22:23:01
In reply to Re: now that's an interesting coincidence (nm) » alexandra_k, posted by Jost on September 28, 2006, at 1:19:32
groan.
now i feel terrible.
i just...
don't know what to say.
i feel ungrateful :-(
but it was a coincidence, yeah.
i hope she hasn't been reading here :-(
:-(
:-(
Posted by alexandra_k on September 29, 2006, at 1:14:28
In reply to Re: now that's an interesting coincidence, posted by alexandra_k on September 28, 2006, at 22:23:01
Maybe it is about... Her wanting to terminate me. Not in the sense of referring me on, in the sense of terminating me. Because she does try and say 'do you want to make another appoitment?' (hoping I'll say 'no'). She does try to move to fortnightly sessions. I don't think they are typically a long term service. More a very short term / once off kind of service.
Maybe she thinks that there is nothing wrong with me and I don't need therapy.
Maybe...
She is right.
Maybe I don't need therapy. If I want therapy then that is another matter and one day when I'm earning I guess I'll have that option.
I think...
It might just... Be time to move on from this. Time to move on.
Because... Sure... I'm sure I could benefit from seeing someone. But how much money would I be prepared to pay to do that? I don't want to become a therapy junkie. Maybe it is time for me to move on.
I don't know what is up with me today...
Not seeing her for two weeks.
Then she is going away in October.
So I'll see that other lady and we shall see...
Maybe it is about... Her wanting her supervisor to assess me to see whether they should continue to see me or not. I'm thinking the answer is going to be 'no'. Part of me wants to say that I haven't been able to express my vulnerability because it isn't safe. But another part of me knows that if I can keep my vulnerability hidden... How much help do I really need.F*ck I piss myself off sometimes.
'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. 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. (Rakusin and Feiner, 1963, p.140). Both Laing... And Szasz, who sees hysterical behaviour as a game played by a person to get help, subscribe to such a paradigm. It explains the disturbed behaviour with the following assumptions: 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). And second, 'symptoms' occur as a result of situations where such strategies are intelligible... The intentional paradigm denies that the disturbed patient is entitled to the sick role. 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. According to the intentional paradigm, people will play at being mad in order to avail themselves of the benefits of the sick role:
The patient emerges as an individual who, for reasons we shall specify, very often chooses, though not necessarily consciously, institutionalisation as either an intermittent or enduring way of life. Once in the institution, the ...[person] exploits his environment in a wholly effective and rational manner in order to extract from it personally satisfying outcomes (Braginsky, Braginsky and Ring, 1969, p. 162)
Posted by Racer on September 30, 2006, at 13:16:22
In reply to Re: now that's an interesting coincidence, posted by alexandra_k on September 29, 2006, at 1:14:28
>
> 'The *Intentional paradigm* also assumes there are no mental illnesses. Instead, abnormal behaviour is seen as the volountary adoption of strategies to cope with difficult circumstances. 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. And Szasz, who sees hysterical behaviour as a game played by a person to get help, subscribe to such a paradigm. The intentional paradigm denies that the disturbed patient is entitled to the sick role. SInce he is volountarily bringing about his disturbing behaviour, he is responsible for it.Do you believe this stuff, Alex? If so, I hope it's not as painful for you as it is for me just reading it.
Seriously, it's painful for me to read that sort of thing -- very painful. Even though I don't believe it, and even though I think that sort of theory is damaging to people with psychiatric problems (whether you consider those primarily biological or psychological), and even though I know that I don't believe in them -- it's still painful for me to read them. I get hit with a wave of intense shame, that it's MY FAULT that I feel like this, that it's MY FAULT and I should just fix it. (Fix it, that is, or die. Guess which one seems easier to me when I get to feeling that way?)
So, are you posting this because you believe it? Or is it a way to "punish" yourself? You OK?
Posted by frida on September 30, 2006, at 16:25:15
In reply to Do you believe this? » alexandra_k, posted by Racer on September 30, 2006, at 13:16:22
Racer, I must say I agree with you, how painful to read...it does bring guilt and shame and pain.
it makes one feel that you have no rights to ask for help..I Hope that's not how you are feeling, Alex...
sending you support,
Frida
> >
> > 'The *Intentional paradigm* also assumes there are no mental illnesses. Instead, abnormal behaviour is seen as the volountary adoption of strategies to cope with difficult circumstances. 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. And Szasz, who sees hysterical behaviour as a game played by a person to get help, subscribe to such a paradigm. The intentional paradigm denies that the disturbed patient is entitled to the sick role. SInce he is volountarily bringing about his disturbing behaviour, he is responsible for it.
>
> Do you believe this stuff, Alex? If so, I hope it's not as painful for you as it is for me just reading it.
>
> Seriously, it's painful for me to read that sort of thing -- very painful. Even though I don't believe it, and even though I think that sort of theory is damaging to people with psychiatric problems (whether you consider those primarily biological or psychological), and even though I know that I don't believe in them -- it's still painful for me to read them. I get hit with a wave of intense shame, that it's MY FAULT that I feel like this, that it's MY FAULT and I should just fix it. (Fix it, that is, or die. Guess which one seems easier to me when I get to feeling that way?)
>
> So, are you posting this because you believe it? Or is it a way to "punish" yourself? You OK?
Posted by muffled on September 30, 2006, at 16:57:12
In reply to Re: Do you believe this? » Racer, posted by frida on September 30, 2006, at 16:25:15
Yeah, I guess thats why I haven't posted to this thread.
Its rather awful to think such a thing.
Like we WANT to feel like this?
God, if I WANT to feel like this then I REALLY AM SICK.
And I got no excuses.
Just my own sick and distorted and twisted and f*cked up mind.
I can't rip my barain out.
I can't die on purpose.
What the f*ck do we do then.
The people who wrote that are the ones that are SERIOUSLY f*cked up.
They are the ones that should die.
I TRULY hope you don't beleive thatSH[*]T. Alex. You nice. They are screwed, not you.
I LIKE you.
Better to go. Muffled
Posted by ElaineM on September 30, 2006, at 18:29:27
In reply to Re: Do you believe this?, posted by muffled on September 30, 2006, at 16:57:12
I'm really hesitant to post this cause if I'm messed up I don't want to offend others but this isn't how I've come to interpret the Intentional Paradigm. I'm a bit surprised to see it reacted to like this. Unless I'm confusing it with something else. Am I? I remember reaction to it at school not being negative at all, it actually seemed PRO-patient. If I'm confused, what am I actually thinking of then?
Does anyone know what the Intentional Paradigm's view of the role of medication in recovery is? Is it essential........or is there only a small role possible...........or is it 100% never part of that view.....somebody help my brain...
....cause then I'll know if I'm thinking of a totally different concept altogether, or confusing fields, or something.
Posted by Jost on October 1, 2006, at 1:33:14
In reply to Re: now that's an interesting coincidence, posted by alexandra_k on September 29, 2006, at 1:14:28
Not in my book.
There was an interesting series of articles way way way back in the New Yorker by Susan Sheehan about a woman who was psychotic and the story of her life and comings and goings in mental hospitals and group homes, breakdowns, and reassemblies. It was pretty gripping.
I came across a reference to it in recent searches online.
It pretty well destroyed the mystique built up around mental illness by Lang and Robert Lifton and others in the era when it was seen as a type of freedom from convention and the constraints of "normality."
A choice? Who would choose to live with that sort of pain?
No, I can't accept that.
By the way, why does the person play that "game" to "get help" Szasz? Why does the person "need" help-- or do they not need and only want it? If they need it, how is it a choice? Need and choice don't go together.
Anyway, while Szasz gives a critique that shows some assumptions, and forces them to be deepened, I don't think he's right that mental illness is not a disease, even if it's a very special type of disease, and even if some of the symptoms partake in areas of life that we also consider to invoke spiritual or philosophical questions.
Jost
Posted by alexandra_k on October 1, 2006, at 4:43:10
In reply to Do you believe this? » alexandra_k, posted by Racer on September 30, 2006, at 13:16:22
I'm not sure what to think...
I guess they say it is volountary. But then they say that it can be unconscious. They then conclude that one isn't entitled to the sick role because it is volountary. But if it isn't conscious...I'm not sure what to think...
Posted by alexandra_k on October 1, 2006, at 4:44:03
In reply to Re: Do you believe this? » Racer, posted by frida on September 30, 2006, at 16:25:15
Yeah... Thats what I'm thinking.
I'm not sure if I believe it or not...
Posted by alexandra_k on October 1, 2006, at 4:45:04
In reply to Re: Do you believe this?, posted by muffled on September 30, 2006, at 16:57:12
Hey Muffled. I know its not true in general. I'm just wondering if it is true for me. I've... Been told it is often enough to get me thinking on it...
Posted by alexandra_k on October 1, 2006, at 4:47:23
In reply to Re: Do you believe this?, posted by ElaineM on September 30, 2006, at 18:29:27
> this isn't how I've come to interpret the Intentional Paradigm.
I've never heard of the 'Intentional Paradigm' before reading that book...
> it actually seemed PRO-patient.
If it is PRO-patient then I guess it is pro patient rights (ie anti involountary commitment and enforced medicating). But I'm not sure on this guys analysis of the intentional paradigm...
What are you thinking about it?
Posted by alexandra_k on October 1, 2006, at 4:51:33
In reply to Re: psychosis as a choice?, posted by Jost on October 1, 2006, at 1:33:14
> Not in my book.
Thats why I'm sticking to the case of me.
> A choice? Who would choose to live with that sort of pain?I'm not sure it is meant to be about choosing to live with pain. I think that it is more the 'volountary' symptoms that people adopt in order to get help for their pain.
> By the way, why does the person play that "game" to "get help" Szasz? Why does the person "need" help-- or do they not need and only want it?I think it goes (though I could be wrong). That while pain is hard and all it counts as a 'problem in living' and well... Everyone has got those. But some people volountarily adopt certain symptoms in order to be institutionalised or to get a therapist or to get a psychiatrist or whatever. Thus they don't need help for their specific symptoms (which are volountarily adopted). If they need help at all it is for their pain. And while pain is hard and all it is a 'problem in living' that isn't categorically different from... Every other human being in the world...
Just worried about me here...
Posted by Dinah on October 1, 2006, at 10:12:04
In reply to Re: psychosis as a choice? » Jost, posted by alexandra_k on October 1, 2006, at 4:51:33
That was written a long time before MRI's etc. Back when autism was considered to be caused by refrigerator moms.
Now they've got proof that the brains of schizophrenics are different than the brains of non-schizophrenics, that chronic depression alters the physical brain, etc.
They were probably doing the best with the information they had. But we've got more information now.
BTW, as someone with a long time involvement with multiple generations of dogs, I'd pretty much have to reject the hypothesis anyway. Dogs are capable of being anxious, depressed, euthymic, dysthmic, and any range of things that fall into mental illness. And it's utterly amazing how many of those things are genetic, down to small behavior anomalies. And it's not nurture either, because sometimes it goes father to puppy, and the puppy has never seen the father in its life.
What I've found is that many to most traits (illnesses if they're traits that prevent effective functioning) are genetic. But their expression (how they manifest themselves in actual behavior) in many cases has to do with environment. So in humans, I would imagine that some illnesses are congenital (genetic or otherwise), and that others are a result of an interplay of genetic or congenital factors and environment (per the research on attachment and neurobiology or per Linehan's model of the invalidating environment coupled with emotional lability).
Chosen? I don't believe so, and I can see how the assumption on the part of mental health professionals who may have never seen an MRI or SPECT scan could be hurtful. Thank heavens we've come a long way since then, although I'm not a huge fan of the mainstream biological reductionism of today either.
Is my experience anecdotal? Sure. But I think you'd be hard pressed to find an observant person who is familiar with multiple generations of dogs on both sides who would disagree.
A different species? Sure. And of course there are differences between dogs and humans. But they aren't completely different, and this is one area where I'd say they weren't.
Posted by muffled on October 1, 2006, at 11:13:39
In reply to Re: Do you believe this? » muffled, posted by alexandra_k on October 1, 2006, at 4:45:04
> Hey Muffled. I know its not true in general. I'm just wondering if it is true for me. I've... Been told it is often enough to get me thinking on it...
***Alex, you got some issues....
No question.
Its just you sound so knowledgable, mebbe you throw T's off?
But cerebrally knowing stuff, is alot diff. than having fears and emotions and stuff inside, messing with your life....
mebbe you need to get down to real basics, insteada all the dx and science stuff. Just get down and dig in the actual basic shitpile of stuff that messes up your life.
You could say the same for me, but what of all my weird sh*t in me? I want to be more stable. I'm trying. I don't WANT to be this way.
But I AM improving.
I can't understand alot of the brainy stuff you say...
Then sometimes you go with real gut stuff...
And you say stuff....
But I still feel i know so little bout the real inside Alex...
I dunno why?
Curious really.
Hmmmmm.
Take care Alex,
Muffled
Posted by madeline on October 1, 2006, at 16:24:47
In reply to Do you believe this? » alexandra_k, posted by Racer on September 30, 2006, at 13:16:22
I hope that these theories are correct. That somehow I have the power to choose whether or not I want to be depressed, manic, psychotic, schizophrenic etc....
Imagine how wonderful that would be. We could choose to be free from all this that binds us.
Instead of just being helpless victims of illness, we could bring ourselves out of it.
I hope more research is done on this theory. Because, boy, if I knew how to choose differently, you'd better believe I would.
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?
Posted by madeline on October 1, 2006, at 17:49:23
In reply to This was what I thought of, posted by ElaineM on October 1, 2006, at 17:15:49
i thought that was very intelligent, rational post.
Thank you for your insight.
Posted by alexandra_k on October 1, 2006, at 19:44:27
In reply to Re: psychosis as a choice?, posted by Dinah on October 1, 2006, at 10:12:04
> That was written a long time before MRI's etc.
Yes. Before the success of pharmacology, in particular.
> Now they've got proof that the brains of schizophrenics are different than the brains of non-schizophrenics...
Well...
http://www.dr-bob.org/babble/social/20060922/msgs/688958.html
One trouble is that the theorists involved have become known as part of the 'anti-psychiatry' movement. Another trouble is that the anti-psychiatry movement tends to get muddled up with the scientologists. When people are simplifying a theorists position (to summarise it to make it manageable) sometimes they don't give the fairest summary. It can be hard to grasp what theorists are thinking when they have a huge body of work too. And here, the *intentional paradigm* isn't just a simplistic summary of one person, it is a simplistic summary of a whole bunch of people. You end up with a fairly short statement of a theory but you may well have your work cut out for you if you wanted to establish that anyones considered opinion was that that was a fair statement of their views.
> What I've found is that many to most traits (illnesses if they're traits that prevent effective functioning) are genetic. But their expression (how they manifest themselves in actual behavior) in many cases has to do with environment.Yeah. The genes determine (or fix the probablility of) unfolding / maturation / development from within, and the environment (incl social env. and nutrition and cognition and stuff) fix unfolding / maturation / development from without...
> Chosen? I don't believe so
Though they allow the 'choice' can be unconscious. This idea fits well with how some symptoms were prevalent at certain times while some other symptoms are prevalent at certain other times. Hysterical paralysis (for example) was a frequent complain around the time of Freud and Bruer whereas it is very rarely encountered today. That suggests that there are different 'choices' as to how one expresses ones distress... Biology can't explain that one (symptom 'choice' in those cases). Maybe symptom 'selection' sounds better than symptom 'choice'?
> although I'm not a huge fan of the mainstream biological reductionism of today either.
Yeah.
Posted by alexandra_k on October 1, 2006, at 19:49:31
In reply to Re: Do you believe this? » alexandra_k, posted by muffled on October 1, 2006, at 11:13:39
> ...mebbe you throw T's off?
> But cerebrally knowing stuff, is alot diff. than having fears and emotions and stuff inside, messing with your life....
> mebbe you need to get down to real basics, insteada all the dx and science stuff. Just get down and dig in the actual basic shitpile of stuff that messes up your life.Yeah Muffled. I'm reading this because it is thesis related. I've decided not to go there in my thesis, anyway, but I think it is important to understand some of the views. Even if it is just historical interest. But then I do have a bit of a side interest in how it all relates to me...
Yeah, I think you are right that I throw my t's off. I don't mean to. But I guess I do. Sometimes I don't know what to say... And sometimes t's find silence hard. So I try and think of something to say and the only thing that seems manageable is to talk about my week for a bit... And to talk about what I've been reading and stuff. I guess... It is a defence, yeah.
The sh*tpile of stuff...
I'm not sure how to get to that. I'm not sure how to talk about that. I'm really not sure...
I forgot to ask my t for her email address last week. So... You know what I'm going to do? I'm going to try and write something for her. And I'll read it to her. I'll try and make it fairly short and managable. But I need to figure out how to connect with her.
Posted by alexandra_k on October 1, 2006, at 19:56:25
In reply to I have a different take on this., posted by madeline on October 1, 2006, at 16:24:47
> Imagine how wonderful that would be. We could choose to be free from all this that binds us.
> I hope more research is done on this theory. Because, boy, if I knew how to choose differently, you'd better believe I would.
I hear you. The word 'choice' is something that I find particularly hard... The notion of 'choice' is all tied up in the notion of blame and responsibility. It is also a point that theory doesn't exist in isolation... Usually something like a treatment plan follows from the theory. And... What is the treatment plan that follows from this theory?
Sounds like no treatment to me.
And yeah, that is a bit hard to take. I don't think that follows... May have followed in practice. May be that the people (if there are any) who believe symptoms are a 'choice' thought that the best treatment was to discharge the person and that was all. There are behaviourist views (I'm thinking of Spanos in particular, who wrote about treatment) where they called it 'strategic enactment'. They thought that the people who strategically enacted mental illness symptoms were indeed mentally ill. They were cautioning against a clinician overfocusing on the symptoms, however. The notion was that the symptoms are a strategic enactment, but the point that the person did strategically enact meant that they were indeed mentally ill. So they had a treatment plan. Though the treatment plan sounds rather... Worrying too... The notion is to punish (ignore) the symptoms and reward (praise with attention and the like) non symptom behaviour. Thus the patients behaviour would be shaped towards successive approximations of mental health, one can only suppose.
I have trouble with that view too...
Posted by alexandra_k on October 1, 2006, at 21:27:35
In reply to This was what I thought of, posted by ElaineM on October 1, 2006, at 17:15:49
Sometimes different fields lable the same things differently, and label distinct things with the same term. I have been struggling with the notion of 'dualism' as it is used in psychiatry / psychology. It might well be that sociologists use the term 'intentional paradigm' differently from how this guy (psychiatrist) is using it. In philosophy the closest I've come to the term 'intentional paradigm' is Dennett's notion of the 'intentional stance' which is a very different notion...
> I don't know, I interpret the "Intentional Paradigm" differently, though I usually refer to it as the Socio-Cultural explanation for mental illness.
Okay. So I have gotten interested in philosophy of psychiatry. I do analytic philosophy rather than continental and there really isn't much analytic philosophy of psychiatry out there... I found one very recent, very good book on the topic and he said that to the best of his knowledge his was the only book written on the topic. I was a little surprised so I had a hunt in the library and I found this "The Philosophical Defence of Psychiatry". He talks about the following paradigms in psychiatry:
- The medical paradigm
- The psychodynamic paradigm
- The behavioural paradigm (though he lumps cognitive in there too on occasion)
- The intentional paradigm
- The sociological paradigm
He says that one might be concerned that these paradigms all compete and thus psychiatry is in a hopelessly fragmented state. What he aims to do, however, is to show how they are all different theories (that can compliment or conflict) within the over-arching medical paradigm. For the most part he tries to show the different theories are consistent. He also acknowledges conflict, however, (in case falsification is important).This is what he says about the sociological paradigm:
'The sociological paradigm also contradicts the medical paradigm by assuming that there are no mental illnesses. Instead, disturbed behaviour is seen as the consequence of social forces.
> The social model maintains that mental illness is related clearly to social factors and there is no difficulty in predicting that one will follow from the other. For example, it has been shown in many studies that people who live in poor deprived geographical areas, who are unemployed and in unsatisfactory housing and have no special occupational skills, are likely to suffer higher rates of mental illness than the rest of the population (Tyrer and Steinberg, 1987, p. 77)
> Abnormal behaviour is seen as a symptom of a disturbed society, and for this reason the individual is not consideed ill - if anything is ill, it is society. This paradigm makes a number of assumptions. First, that abnormal behaviour can be the result of labelling. And second, that abnormal behaviour can be the result of averse social circumstances. In this way, the sociological paradigm seeks an explanation for the patient's behaviour outside that individual in a sick social group' p. 142
___________________________________
> is it possible that "game played" was only being used synonimously with "strategy enacted" or "technique implimented", or something like that.Yes, I think so. But I could be wrong... I think the notion of playing a game isn't meant to convey glee or anything. More a strategic enactment, yeah.
> Okay, I'm kinda scared cause this is the first "something other than emotional support" post I've made.((((Elaine))))
I know some people don't like these kinds of discussions... But I guess there are enough threads and posts for people to pick and choose what interests them. I get a lot out of them. Thanks for putting yourself 'out there' to talk to me :-) I appreciate it a whole heap.> I've probably asked more questions in my post than argued anything but oh well.
Thats cool :-) I wasn't arguing anything either. Just presenting a theory as this guy wrote about it. I'm not sure if his is the most perspicuous statement of it. He has a chapter on it, but I don't think I'm going to read it... I started doing a lot of work on the book, but he makes some fairly dodgey philosophical claims. I think that is why... Other analytic philosophers have fairly much ignored him... But I wanted to write about different 'paradigms' and different levels of explanation and how they relate to one another. I don't think I'll write on the particular paradigms he has chosen, however. They don't seem to be a part of mainstream theorising anymore, best I can figure. I think I should focus on genetic / environmental. Genetic / neurobiological. Cognitive / neuropsychological. I don't know because I don't know enough about this as yet... But I think I need to find the current productive scientific research programs and worry about how they relate to one another. There is a whole heap of decent philosophy on the nature / nurture controversy too. And a whole heap of stuff on how the biologists and social constructionists views can be synthesised for a more complete picture. I think I need to worry about them.
> Sorry if I'm confusing, the thinking part of my brain is rusty.
I don't think you are confusing, I think you are very clear. If I haven't engaged more with what you have said its because... I think you are speaking a lot of good sense.
> If I'm crossing theories here let me know because I focused on Sociology during my studies.
Thats hard for anyone looking at stuff that has been done within another discipline. I struggle with that too...
> 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.
Yeah. Thats what Reznek is trying to argue. I'm not sure his arguments succeed but... I agree with the general spirit.
Posted by muffled on October 1, 2006, at 21:44:36
In reply to Re: Do you believe this? » muffled, posted by alexandra_k on October 1, 2006, at 19:49:31
> Yeah, I think you are right that I throw my t's off. I don't mean to. But I guess I do. Sometimes I don't know what to say... And sometimes t's find silence hard. So I try and think of something to say and the only thing that seems manageable is to talk about my week for a bit... And to talk about what I've been reading and stuff. I guess... It is a defence, yeah.
***Yeah. Proly you got good defenses to stay safe...
>
> The sh*tpile of stuff...
>
> I'm not sure how to get to that. I'm not sure how to talk about that. I'm really not sure...*** mebbe you could just start by talking bout stuff that triggers you. like people talking behind, and gossip, and exclusivity,and people saying you smart, things like that. Stuff that upsets you, and meebe that'll be a start in a corner of the pile, a place to begin and talk. Rather than talk bout inane type stuff. And its ok if you get upset, cuz THATS when you can process and learn stuff with your T. If you don't feel like talking bout something, then do it, lay it on the table and see what happens.
I find the best sessions usu. are a result of my behaving like an idiot sometime before......
>
> I forgot to ask my t for her email address last week. So... You know what I'm going to do? I'm going to try and write something for her. And I'll read it to her. I'll try and make it fairly short and managable. But I need to figure out how to connect with her.
>
***Mebbe don't worry so much her. mebbe just put some of the iside Alex on the paper, and see what she does with it.
Let Alex out, all her anger or pain or insecurities or confusion etc, whatever, let it come out.
See what happens.
Mebbe she a good T, mebbe not.
Good luck in it, whatever you manage.
Writing works well for me.
I write for myself, then mebbe edit slightly to give to my T. Often I don't edit at all.
Take care Alex, you a feisty little sweetie you are!!! :-)
Muffled
Posted by alexandra_k on October 1, 2006, at 23:53:27
In reply to Re: Do you believe this? » alexandra_k, posted by muffled on October 1, 2006, at 21:44:36
> *** mebbe you could just start by talking bout stuff that triggers you. like people talking behind, and gossip, and exclusivity,and people saying you smart, things like that.
Hmm...
<pout>
How did you get to know me so well...
<cross look>
Well... I guess I can't argue with that...
;-)> And its ok if you get upset, cuz THATS when you can process and learn stuff with your T. If you don't feel like talking bout something, then do it, lay it on the table and see what happens.
I'm a bit scared of showing her my emotions. Because sometimes... They are very strong. And people find that aversive. Hell... *I* find that aversive. I guess I shouldn't assume that she will find it aversive... But it is part of people generally and our culture in particular to find intense emotions to be aversive - isn't it? I'm not sure how she copes with the bits of emotions I've shown her. I remember one time she looked really very surprised... I was fine... Then I started raving about something for maybe 20 seconds and was kinda wound up with tears streaming... And then I freaked a bit and pulled myself together and was back to calm. All in the space of about 30 seconds.
I remember one of my t's... I was reading my file and she had wrote (on the basis of a single meeting) INTENSE and she underlined it about 4 times so strongly she almost ripped a whole in the page.
:-(
> ***Mebbe don't worry so much her. mebbe just put some of the iside Alex on the paper, and see what she does with it.
> Let Alex out, all her anger or pain or insecurities or confusion etc, whatever, let it come out.I... I don't know what to say...
Sometimes... I find it hard to talk. I wouldn't say anything at all... T's don't like that :-( So I've learned to talk. But I talk about... Stuff that doesn't matter. What matters? I don't know. How to get to what matters? I don't know. Sometimes I think something matters and then I say it and it doesn't seem to matter. I don't know. Confused...
> Take care Alex, you a feisty little sweetie you are!!! :-)
> MuffledThanks muffled.
((((muffled))))
I wish I wasn't feisty :-(
I'd rather be... Kind.
Take care.
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