![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Estella on September 11, 2006, at 1:06:07
I found this today:
'A Madness for Identity: Psychiatric Labels, Consumer Autonomy, and the Perils of the Internet'
Sorry but I can only find access via muse (which needs individual / institutional subscription)
http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/v011/11.4charland01.html
Abstract
Psychiatric labeling has been the subject of considerable ethical debate. Much of it has centered on issues associated with the application of psychiatric labels. In comparison, far less attention has been paid to issues associated with the removal of psychiatric labels. Ethical problems of this last sort tend to revolve around identity. Many sufferers are reticent to relinquish their iatrogenic identity in the face of official label change; some actively resist it. New forms of this resistance are taking place in the private chat rooms and virtual communities of the Internet, a domain where consumer autonomy reigns supreme. Medical sociology, psychiatry, and bioethics have paid little attention to these developments. Yet these new consumer-driven initiatives actually pose considerable risks to consumers. They also present complex ethical challenges for researchers. Clinically, there is even sufficient evidence to wonder whether the Internet may be the nesting ground for a new kind of identity disturbance. The purpose of the present discussion is to survey these developments and identify potential issues and problems for future research. Taken as a whole, the entire episode suggests that we may have reached a turning point in the history of psychiatry where consumer autonomy and the Internet are now powerful new forces in the manufacture of madnessThere are three commentaries (responses) available from here:
http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/toc/ppp11.4.html
Posted by Declan on September 11, 2006, at 1:17:36
In reply to internet and the manufacture of madness..., posted by Estella on September 11, 2006, at 1:06:07
Identity disturbance keeps on changing its face. No more hysteria or dissociative disorders. SI seems new to me, apart from drugs of course. I'd never thought of that as a possibility.
Posted by Estella on September 11, 2006, at 2:55:39
In reply to internet and the manufacture of madness..., posted by Estella on September 11, 2006, at 1:06:07
It raises some interesting issues... But...
> Clinically, there is even sufficient evidence to wonder whether the Internet may be the nesting ground for a new kind of identity disturbance.
Doubtful...
> we may have reached a turning point in the history of psychiatry where consumer autonomy and the Internet are now powerful new forces in the manufacture of madness
He sounds a little social constructionist. I guess... he is. Actually... The social constructionists aren't really that bad. Szats, (or however you spell that) for example isn't so bad. He just takes a very narrow reading of the concept of 'disease' where a disease is a bodily matter. If psychiatric categories don't map onto brain disturbances then Szats would say they aren't real diseases. We could grant him that but say he is wrong because some (or all) psychiatric categories do map on to brain disturbances. Or we could say that disease is a broader category and thus there can be diseases that aren't disorders of the body.
What he does do... Is draw our attention to the abuses of psychiatry. Good on him for doing that. He also draws our attention to the medication bandwagon (driven by the drug companies). Good on him for that. Another thing he does... Is draw our attention to the social and psychological factors that are implicated. So... Good on him for that.
The article that I linked to... I'm not sure that it is so good really. But it is kinda interesting, I guess. Mostly about consumer moderated 'pro' disorder sites. Where people encourage each other along in their sickness. We don't do that - do we? Where you need to have your sickness to remain part of the in group. We don't do that - do we?
There does seem to be some paranoia about increased autonomy among psych patients, however.
And so what is the mistake we are making if we refuse to give up our dx? It isn't comperable to the mistake the f*cking diagnostician made - is it? It isn't a statement about how people with that dx actually CAN and DO improve - is it?
Sheesh...
And the commentaries... Aren't much better IMO. (Where do they find these people?????)
Posted by finelinebob on September 11, 2006, at 2:58:36
In reply to internet and the manufacture of madness..., posted by Estella on September 11, 2006, at 1:06:07
> 'A Madness for Identity: Psychiatric Labels, Consumer Autonomy, and the Perils of the Internet'
Oh Noessss!!!!11!11!11one!1!!
The iPatients have taken control of the eSylum!!
If those researchers want to investigate the "manufacture of madness", then they need to look to pharmaceutical advertising and HMO's preference for pills -- the HMOs win because the don't have to pay whiny therapists who expect to be respected (HMOs: "LOL! As if there are enough of you for us to care!"), Pharmas win because they get paid anyway and HMOs again because the HMOs have consumers over a barrel when it comes to co-pays (HMOs: "ROFL!! 'The customer is always right'?! Our execs need new Audis, gotta keep up with the GlaxoSmithKlines!!").
"They also present complex ethical challenges for researchers"? Yep, we can't be objectified, dehumanized, enumerated and turned into statistics so easily now, can we?
"the Internet may be the nesting ground for a new kind of identity disturbance"? Yep. Sounds like a little democratization of their "subject pool" is causing some psychiatrict professionals to develop severe cases of autonophobia.
What does it say about these authors when they refer to us as "consumers"?
So, "Many sufferers are reticent to relinquish their iatrogenic identity in the face of official label change; some actively resist it." We don't know what's happening to us, a doctor gives us a label, we do some research and perhaps find others like us because of that label. And these researchers find it surprising we don't want to discard this identity when the labels may have seemed arbitrary in the first place but the people we find are real? Sure, some of these new labels may make more sense, but then again how long were we told the SSRIs weren't responsible for any sort of sexual dysfunction?
These problems exist within the research community, not our community. If they can't figure out how to "hit a moving target", then they'd better learn their jobs better.
Posted by Estella on September 11, 2006, at 5:38:30
In reply to Re: internet and the manufacture of madness..., posted by finelinebob on September 11, 2006, at 2:58:36
> These problems exist within the research community, not our community. If they can't figure out how to "hit a moving target", then they'd better learn their jobs better.
:-)
Ian Hacking has a surprisingly good theory of "hitting moving targets". I'll try to reconstruct (though I might get it a bit wrong).
He talks about... I think it is called the "looping effect". The notion is...
An ecological niche arises. For example, in France (in some century or other) people had to carry around identity cards and the authorities frequently asked to see them. Then people started travelling.
Then psychiatrists started discovering that some people would go travelling without their identity cards and when the authorities questioned them they denied knowledge of who they were. They wrote down the symptoms and called it a disorder.
Then people hear about the disorder and that in conjunction with the ecological niche resulted in many many many more people travelling without their identity card (dissociative fugue). Dissociative fuge became a legitimate way to express / escape distress. So... More and more people start doing it.
So there is a new ecological niche that leads to some symptoms.
The symptoms are recorded and a concept is invented to categorise the symptoms (dissociative fugue).
The existence of the concept has a 'looping effect' on the symptoms. The notion is that the existence of the concept means that people get to hear about the concept and it becomes a 'socially acceptable way of expressing distress'. Hence... The existence of the concept results in more symptoms and / or slightly different ones.
Then psychiatrists observe slightly different symptoms than they did before.
Then the concept is modified to better capture the symptoms.
Then the concept filters back down to the general public.Etc etc.
He tells the story with Multiple Personality Disorder. The notion there is that there are multiple personalities in one body. Then the concept changed and clinician's don't believe in multiple personalities anymore. Instead they believe in dissociated identities (fragments of selves). There is a significant difference between having more than one self and not even having one!
Consumers tend to underappreciate the difference in conceptual revision between MPD and DID. That was talked about in that paper.
He said that there can be trouble when consumer groups insist on MPD terminology / theory when their clinicians are attempting to show them they don't even have a single self (even less more than one). I have some sympathy... Seems to me he picked some very dodgey support groups though ;-)
He said that Borderline Personality Disorder might go the same way in future.
He said that anorexia support groups tend to be counter-productive (I think I've heard similar things for in person group therapy for anorexia, however so I'm not sure the problems are the result of the internet forum).
And as for a new disorder...
Bollocks. He thought he had discovered a new variety of 'fictitious disorder'. For those people who think they are multiple.I don't know what it is...
How people become so detached...Sure there is a lot of crap out there...
But there is a lot of crap psychiatry out there too...Szasz is surprisingly good. I'd heard a lot of bad things about him (as part of the anti-psychiatry movement).
His main beef is:
1) Social control. Mostly around involountary hospitalisations.
2) Drugging people against their will.I think it is good that he is doing that. Someone needs to. Sometimes you need a person to push hard and be a bit 'out there' in order to really get the topic on the agenda too. He emphasises how mental illnesses are different from physical illnesses.
- mental illnesses are typically disturbances of behaviour (that can't be found on autopsy.
- physical illnesses are typically disturbances of parts of the body (that can be found on autopsy).
- mental illnesses means that people may be locked up against their will.
- you have the right to refuse treatment for physical illness as your constitutional right.
- a psychiatrist (maybe with a judge) decided whether you will be locked up and medicated.
- a family member decided whether you will be hospitalised and treated if you are judged incompetent to decide for yourself.
- lots of controversy over physical illness being objective and mental illness being essentially value laden. lots of controversy...Sasz would be willing to grant that what we call mental illnesses with a bio basis are real bodily diseases. He wouldn't call them mental illnesses anymore however. And he wouldn't think that you should be involountarily locked up and medicated etc. You should be treated with the same respect as someone with a physical illness. If you are incompetent then family members should decide and not psychiatrists.
He is fairly interesting...
Posted by Phillipa on September 11, 2006, at 11:49:15
In reply to Re: internet and the manufacture of madness..., posted by Estella on September 11, 2006, at 5:38:30
Where did you find this article? I am interested in other comments. Love Phillipa
Posted by alexandra_k on September 12, 2006, at 22:59:19
In reply to internet and the manufacture of madness..., posted by Estella on September 11, 2006, at 1:06:07
found this in the ICD-10
F62.1
Enduring personality change after psychiatric illness
Personality change, persisting for at least two years, attributable to the traumatic experience of suffering from a severe psychiatric illness. The change cannot be explained by a previous personality disorder and should be differentiated from residual schizophrenia and other states of incomplete recovery from an antecedent mental disorder. This disorder is characterized by an excessive dependence on and a demanding attitude towards others; conviction of being changed or stigmatized by the illness, leading to an inability to form and maintain close and confiding personal relationships and to social iso-lation; passivity, reduced interests, and diminished involvement in leisure activities; persistent complaints of being ill, which may be associated with hypochondriacal claims and illness behaviour; dysphoric or labile mood, not due to the presence of a current mental disorder or antecedent mental disorder with residual affective symptoms; and longstanding problems in social and occupational functioning.
Posted by Phillipa on September 12, 2006, at 23:09:44
In reply to Re: internet and the manufacture of madness..., posted by alexandra_k on September 12, 2006, at 22:59:19
Alex that's me!!!!!!So what do I do? Love Phillipa
Posted by Dinah on September 13, 2006, at 6:31:39
In reply to Re: internet and the manufacture of madness..., posted by alexandra_k on September 12, 2006, at 22:59:19
Wow. I'm wondering if that could be rewritten in more neutral terms. If I saw that on my receipt, I would never be able to drag myself back to that clinician and show my face. I think it might make me withdraw from people altogether, feel stigmatized by my illness, and feel dysphoric.
They're blaming the internet for that? I wonder how much of it is iatrogenic.
I guess that's one of the secondary diagnoses they don't put on your receipt for insurance purposes. And I suppose my reaction would be why...
Posted by alexandra_k on September 13, 2006, at 8:44:21
In reply to Re: internet and the manufacture of madness... » alexandra_k, posted by Dinah on September 13, 2006, at 6:31:39
> Wow. I'm wondering if that could be rewritten in more neutral terms. If I saw that on my receipt, I would never be able to drag myself back to that clinician and show my face.
Thats nothing, you should see some of their other ones!
;-)
> I think it might make me withdraw from people altogether, feel stigmatized by my illness, and feel dysphoric.
Its OTHER dx's that are supposed to make you do that... But wait... Maybe that particular dx confirms itself ;-)
> They're blaming the internet for that?
No. Sorry... I should have made that clearer. The first guys were saying they found 'good evidence' for a new kind of disorder. One that is (to be fair) induced by the taking away of dx label. The stress and identity confusion that people go through when they get a dx of a severe disorder taken away. So clinicians pronounce you cured (or alternatively dx'd i guess) and because your dx had become part of your identity (because of persistent posting to a site in support of people with that dx, lets say) you... increase problematic behaviours (as one example) in order to get the dx back again... That was their thought.
I just found this in hunting through the ICD. Thought it was interesting. Kinda semi sorta related, but not what they were talking about at all. This one seems to have more to do with the stigma around getting a dx in the first place.
> I wonder how much of it is iatrogenic.
You mean therapist / clinician / diagnostician induced? Well... They were the ones who handed out the dx so in a sense they are the proximal cause...
> I guess that's one of the secondary diagnoses they don't put on your receipt for insurance purposes. And I suppose my reaction would be why...Is it ICD code or DSM code that goes down for insurance purposes? I could be wrong... But I thought that DSM code was used in the US. That that was... A huge motivation for the DSM. The ICD provides general medical codes (it is used primarily to figure prevalence rates for diseases and such especially that figure on discharge forms and death certificates - i think).
But I guess it is kinda semi sorta related to fictitious disorder (which is a DSM disorder)... And of course there is always the good old NOS. Don't know how much medication / therapy / social intervention your average health insurance policy gives you for the treatment of that one anyways ;-)
Posted by Dinah on September 13, 2006, at 9:44:00
In reply to Re: internet and the manufacture of madness..., posted by alexandra_k on September 13, 2006, at 8:44:21
My pdocs put down both codes. My therapist puts down none at all.
I was going to say that this must be the only subspecialty where such judgemental terms are used in descriptions.
But then it occurred to me that that might not be true.
It would seem that there could be judgement neutral revisions.
Posted by Jost on September 13, 2006, at 22:00:07
In reply to Re: internet and the manufacture of madness..., posted by Estella on September 11, 2006, at 2:55:39
Did you mean Szasz?
as in Dr. Thomas Szasz?
also-- did you read the comments?
Is the original article there?
I read the first comment-- wow that guy needs an editor-- real bad.
He makes the original article sound pretty awful-- although I don't see how the internet plays into what he talked about.
I'll have to read more later-- but sounds fairly pernicious to me, at first glance. Not the internet part, but the part about there being "facts" about autonomy that are similar to facts about doing a high jump-- if you think the facts are calculable concrete details like "strength of one's legs" and "height of the jump"--
and also their analogy between the kind of automony that they're talking about and some type of moral or philsophical concept of autonomy. Iie according to the comment)
But I'll have to see if I have time to look at it.
Jost
Posted by alexandra_k on September 13, 2006, at 23:21:48
In reply to Re: internet and the manufacture of madness... » Estella, posted by Jost on September 13, 2006, at 22:00:07
> Did you mean Szasz?
> as in Dr. Thomas Szasz?yes indeedie do. he has been given an unnecessarily hard time imho. if you can access the above articles (which i guess you can) then i'll hunt down an article by Szasz which is fairly short so you can see what i'm saying if you like. i mean i disagree with some of his assumptions, but he isn't a raving loonie. he makes some very good points.
> also-- did you read the comments?yes i did.
> Is the original article there?first link is the original article.
second link takes you to the table of contents for that edition of the journal.
there are three responses / commentaries. well... two responses and one response to the response.> I read the first comment-- wow that guy needs an editor-- real bad.
lol. yeah i agree. thats why i said 'where do they find these people'? generally it is quite a good journal (imo) so that article surprised me greatly.
> He makes the original article sound pretty awful-- although I don't see how the internet plays into what he talked about.
yeah. though... i think in many respects the original article was pretty awful...
> I'll have to read more later-- but sounds fairly pernicious to me, at first glance. Not the internet part, but the part about there being "facts" about autonomy that are similar to facts about doing a high jump-- if you think the facts are calculable concrete details like "strength of one's legs" and "height of the jump"--i guess i'll have to read it again... i don't remember that part. i was browsing looking for something else but hit upon that. i'm more interested in the taxonomy debate and whether the notion of dysfunction / disability / illness is objective or essentially involves a value judgement.
> and also their analogy between the kind of automony that they're talking about and some type of moral or philsophical concept of autonomy. Iie according to the comment)i don't remember that either...
did sound a little like they thought that patient autonomy was a bad thing, however. see what happens? the loonies get ahold of the internet and congregate making themselves worse...
Posted by alexandra_k on September 13, 2006, at 23:27:18
In reply to Re: internet and the manufacture of madness... » Estella, posted by Jost on September 13, 2006, at 22:00:07
> I read the first comment-- wow that guy needs an editor-- real bad.
That would be this guy:
Harold Merskey, MA, DM, FRCP, FRCP(C), FRCPsych is Professor Emeritus of Psychiatry at the University of Western Ontario. He is widely published on neuropsychiatry, hysteria, pain, psychopharmacology, medical classification, and occasionally on psychiatric history and bioethics. Recent articles include "Pain Disorder, Hysteria or Somatization?" which was published in Pain Research & Management (2004) "The Persistence of Folly. A Critical Examination of Multiple Personality Disorder. Part I. The Excesses of an Improbable Concept. Part II. The Defence and Decline of Multiple Personality Disorder (by August Piper & Harold Merskey)," in the Canadian Journal of Psychiatry (2004). He can be contacted at 71 Logan Avenue, London, Ontario, Canada N5Y 2P9, or via e-mail at: harold.merskey@sympatico.ca.
:-)
Posted by alexandra_k on September 14, 2006, at 9:19:37
In reply to Re: internet and the manufacture of madness... » alexandra_k, posted by Dinah on September 13, 2006, at 6:31:39
> Wow. I'm wondering if that could be rewritten in more neutral terms.
what do you find to be not neutral about it?
(i'm serious. there is dispute about whether illnesses are objective or essentially value laden / judgemental so i'd be interested to know what you find value laden / judgemental about it)
Posted by Dinah on September 14, 2006, at 9:52:10
In reply to Re: internet and the manufacture of madness... » Dinah, posted by alexandra_k on September 14, 2006, at 9:19:37
I suppose this would be the sentence
"an excessive dependence on and a demanding attitude towards others"
It seems that there could be a more neutral way to put that. I had one yesterday, but I can't bring it to mind right now.
I think that the issue about rather pscyh diagnoses are value laden is a most important one. Clearly the mental health community itself has decided they *can* be, since they have removed various "illnesses" from the DSM. But I also get the feeling that the Axis II disorders especially are culturally based, and do have a values judgement built into them. An ideal of "healthy" that is tied into what the community values. Isn't it generally agreed that some disorders listed in the DSM (esp. Axis II) would not be considered disorders in some parts of the world? And that in other parts of the world, there might be diagnoses of people who weren't sufficiently affiliative? Clearly if someone could go to a different society with the same set of "symptoms" and be judged fine there, and ill here, then the judgement of illness is based on a lack of adherence to customary cultural norms rather than a true illness?
Posted by Phillipa on September 14, 2006, at 17:54:53
In reply to Re: internet and the manufacture of madness... » alexandra_k, posted by Dinah on September 14, 2006, at 9:52:10
Very true. The only example I have is not a country one but a region one. Up North if you walked around with a Bible in your hands in a psych hospital they would deem that you were religiously preoccupied. Which could lead to many AXIS ll dx. Now here in the South it's so common most patients carry them around read from them all the time. Love Phillipa
Posted by Jost on September 14, 2006, at 19:59:42
In reply to Re: internet and the manufacture of madness... » Jost, posted by alexandra_k on September 13, 2006, at 23:21:48
From the comment (which might not be about everything in the initial article), the article discussed severe neurological disabilities, and their relevance to patient autonomy. Not mental illness type disabilities--although perhaps they draw conclusions about that, too-- but it seemed more concrete types of neurological deficits.
He gave the case of John-- I wasn't sure what neurological deficits John had, but they were described as severe. More importantly, it seemed, John not only lacked the ability to recognize through his self- observation that he had a deficit, but also the ability to integrate information from others to that effect.
The authors seemed to use this to draw a conlcusion that a person with neurological deficits needed to be able either to observe the deficit and/or to take in information from others about the deficit to be able to have autonomy. Or that inability to do these things would impair or exclude autonomy.
Since I found myself disagreeing, on a basic level, with this premise--although it might have some truth too-- I didn't read that carefully. The commenter's view is probably closer to mine--
even more so, if the ideas that I mentioned before (about the high jump, eg) were applied to socalled "mental illness."
I'll look at the initial article, though--
Jost
Posted by Jost on September 14, 2006, at 20:04:02
In reply to internet and the manufacture of madness..., posted by Estella on September 11, 2006, at 1:06:07
yeah, the comment I read was:
Agich, George J., 1947- Seeking the Everyday Meaning of Autonomy in Neurologic Disorders
It was about a paper by Anderson, Joel, and Lux, Warren: "Knowing Your Own Strength: Accurate Self-Assessment as a Requirement for Personal Autonomy"
The article you cited did talk about the internet, so I'll read that.
I guess there were several articles and comments on them.
Jost
Posted by alexandra_k on September 14, 2006, at 20:30:00
In reply to Re: internet and the manufacture of madness..., posted by Jost on September 14, 2006, at 20:04:02
Ahhhhhhhhhhh.
I haven't read that article :-)
The first link I provided gave you a link to the article about the internet (I posted the abstract in my post).
The second link I provided gave you a link to the table of contents for the whole journal. The first article in the journal was indeed about patient autonomy. It is an interdisciplinary journal between philosophy, psychology, and psychiatry and sometimes the philosophers and psychologists worry about neurological conditions rather than more paradigmatic examples of mental illness, yeah. Some people think that neurological disorders should count as mental illnesses (being disorders of the mind after all).
If you scroll down through the table of contents...
You should find the article about the internet (the one I posted the abstract for). Just below that article there are two responses (sounds like you read the first of those) then the authors of the main article respond to the two respondants.
I did think I'd missed something...
:-)
Posted by alexandra_k on September 14, 2006, at 21:25:41
In reply to Re: internet and the manufacture of madness... » alexandra_k, posted by Dinah on September 14, 2006, at 9:52:10
> "an excessive dependence on and a demanding attitude towards others"
Okay :-)> I think that the issue about rather pscyh diagnoses are value laden is a most important one.
Yeah, there is a lot of debate...
> Clearly the mental health community itself has decided they *can* be, since they have removed various "illnesses" from the DSM.
Yeah, that is true. I guess the debate is fairly much around the issue of whether mental illnesses are *essentially* value laden or whether psychiatric classification can approximate the objectivity of... classification of clades in biology (for example).
According to the folk theory of biology whales are fish. Then the biologists come along and tell us that whales aren't fish they are mammals. According to folk theory of biology trees are a natural kind. Then the biologists come along and tell us that trees aren't a natural kind. There aren't any interesting generalisations that you can make about trees in general and whether something is a tree or a shrub can depend on climate and other environmental conditions.
The DSM has been critiqued for being something like a systematisation of folk theory of mental illness. A lot of the categories in the DSM haven't been validated and it is very unclear that you can make interesting generalisations on the basis of the current dx categories. Psychiatry isn't as well developed as a science as biology is. One of the hopes is that pscyhiatric nosology should improve so that it captures real kinds of mental illness.
There would be a problem with this approach if psychiatry was essentially value laden in a way that biology (as an example) is not.
Wakefield has been influential for his 'harmful dysfunction' analysis of mental disorder. He thinks that there are two components to mental disorder.
1) An (objective) dysfunction / disorder / disease within the individual.
2) A value judgement that that dysfunction / disorder / disease is bad.
He thinks that both conditions are necessary and that they are together jointly sufficient for mental illness.He has been critiqued on a number of grounds. With respect to his first condition, some have argued that the notion of disorder / dysfunction / disease is essentially value laden and hence the notion is not objective.
Medicine and some aspects of biology also make use of the notion of disorder / dysfunction / disease, however. If those notions are essentially value laden then psychiatry, medicine, and those aspects of biology would be in trouble with respect to being a proper (objective) science. Perhaps...
> An ideal of "healthy" that is tied into what the community values.
Perhaps... Though... If I break my leg then there wouldn't seem to be any problem in saying that my leg is objectively malfunctioning, disordered, or diseased. How I feel about my leg being broken, whether I think it is a 'good' or a 'bad' thing, however, would seem to be a seperate matter.
> Clearly if someone could go to a different society with the same set of "symptoms" and be judged fine there, and ill here, then the judgement of illness is based on a lack of adherence to customary cultural norms rather than a true illness?
The judgement is. But is there a fact of the matter about whether the person is ill or not? If you think dysfunction / disorder / disease is objective then it follows that people can be wrong with their judgements.
If mental illness is a neurological dysfunction / disorder in the sense that there are neural mechanisms that are malfunctioning then psychiatry (once we have hit upon the true natural kinds of nature) would seem to be similarly objective.
Some people argue that psychiatry, medicine, and biology more generally requires value judgement because you can't cash out function / malfunction (dysfunction or disorder) in a way that doesn't require value.
Ruth Millikan has done a lot of work (in philosophy) on how function / dysfunction can be cashed out in a way that doesn't require values (it is determined by physical facts and a historical notion of 'proper function').
e.g., the proper function of the heart is to pump blood. the heart does a lot of things besides pumping blood, however, it makes thumpity thump noises, for example. If the heart made thumpity thump noises rather than pumping blood then the organism would die, however. If the heart pumped blood but didn't make thumpity thump noises then the organism could be just as well off as a heart that pumped blood and did make thumpity thump noises. The heart was selected (by natural selection) in virtue of its pumping blood. Hence, the proper function of the heart is to pump blood.
You could say that treating survival as the organisms 'good' is to introduce values. But... seems to be a pan-cultural 'good' so thats okay. Maybe psychiatry can similarly cash out the notion of disorder, dysfunction or whatever in a naturalistic way that isn't interestingly value laden... Or maybe not. Even the biology case is controversial. Still, if psychiatry only requires values in the way that biology requires values then that isn't terribly interesting... Most people agree that biology is a proper objective science so there isn't such a problem.
Just some ravings (sorry I didn't have time to edit...)
I'm not sure what I think...
Whether it is possible for psychiatric taxonomy to be objective (similarly to biological classification of clades) or whether that will never work because classification essentially requires value judgements where the value judgements that are required vary across cultures...
I'm not sure what I think...
Is the term 'excessive' something that can be cashed out objectively or is it essentially value laden? (going back to the terminology you thought required value judgement). Is the term 'demanding attitude' something that can be objectively assessed or is that essentially a value judgement too? Hard to say... I agree such language should be curbed / eliminated if possible.
Posted by alexandra_k on September 14, 2006, at 21:26:43
In reply to Re: internet and the manufacture of madness... » Dinah, posted by Phillipa on September 14, 2006, at 17:54:53
> Very true. The only example I have is not a country one but a region one. Up North if you walked around with a Bible in your hands in a psych hospital they would deem that you were religiously preoccupied. Which could lead to many AXIS ll dx. Now here in the South it's so common most patients carry them around read from them all the time. Love Phillipa
Yes, that is an interesting example.
That just... Don't seem scientific...
Posted by Phillipa on September 14, 2006, at 21:51:41
In reply to Re: internet and the manufacture of madness... » Phillipa, posted by alexandra_k on September 14, 2006, at 21:26:43
Why does it have to be scientific as docs diagnose by the behaviors they see and they can't be measured. No blood tests, no Ct Scans. Just objective and subjective observations of patienst.s love Phillipa ps or what the patient tells the doc for instance hallucinations, delusions, suicidality
Posted by Jost on September 14, 2006, at 22:17:27
In reply to Re: internet and the manufacture of madness..., posted by alexandra_k on September 12, 2006, at 22:59:19
The article actually is about how the internet is a medium for patients to self- (or group-) reinforce an identity that takes as its basis an illness that doesn't "exist." He's concerned about ethic dilemmas and also the harm that may be done to patients who have come to identify themselves as a person with that disorder, and to feel that without the disorder, they have no self.
Such people (according to the article) insist on using the label or resist removal of the label even when psychiatrists come to believe (scientifically so to speak) that the syndrome doesn't exist. Presumably, however, they don't have the particular problem that they believe, and therefore various harms may result, when that disorder's non-existence is denied by/in the internet chat groups.
The person(s) in question may be suffering from some psychiatric condition, but not the one that they believe they are.
The example the writer is about to use is multiple personality disorder. He suggests that in the future, borderline personality disorder may also come to be discredited, and that this might have a similar identity-creating value for certain people. His concern is with groups on the internet, which are elusive to professionals, either because they don't last long, or are scattered around (many small groups exist, and they form and reform elsewhere unpredictably).
The groups are started, maintained and led by "consumers" as opposed to professionals. Presumably his further concern is that the consumers (or potential or ex-patients) whose identities are dependent on recognition of the disorder could make it harder for others in the group to disidentify, or will pressure newcomers to adopt the group identity-lablel. [That last sentence, I admit, is conjecture about what he's about to say-- but if I'm wrong, I'll note it later, but I don't think I am --seems pretty inherent in what he says so far.]
So you can pretty easily see where he's going with that. He does mention "factitious: illnesses, which apparently are a new category in DSM-- and sees some possible connection with that. Ugh. Anyway, I do wish articles could be short--
I'll have to check Mersky-- but I can't believe his writing is as bad as Aitch's (or whatever the guy's name was).
Jost
Posted by Phillipa on September 14, 2006, at 22:47:03
In reply to Re: internet and the manufacture of madness... » alexandra_k, posted by Phillipa on September 14, 2006, at 21:51:41
Jost I really understood that amazing. Love Phillipa
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