There is no doubt that for last fifty years or so the medical world has been revolutionizing expeditiously with numerous achievements. The morbid body parts were replaced, ailments and bodily disorders and countless sicknesses were controlled. Lives were prolonged through various interventions than any other epochs in the human history. Pharmaceutical companies and their research helped to fight many deceases and we should be grateful. However, there are some areas drugs for cure worked less that need more attention. The mental process is tricky to analyse altogether and the knowledge of social psychiatry, however, can be integrated into the field of psychology in order to brighten up some grey areas. Dr Nilani L. De Silva provides a series of valuable intricacies through her ethnographic research conducted in mental facilities in China, Philippines, Cambodia, Sri Lanka and Sweden. The book also provides a vibrant insight into humanistic psychology that value human agency and intra psychic power. If one is dedicated to bring forth new knowledge, then it is important to critically analyse existing models. I think one then ought to pay more attention to areas that are not working well. I believe Nilani conscientiously accomplished this task with striking consistency in a powerful way.
Professor Daniel M. Wegner
The scope of this book is to provide a clear account of clinical psychology and in doing so to critically analyse how our mind is being subjected to external forces by illuminating examples from fieldwork in Sweden, China, Sri Lanka, Cambodia and the Philippines. The book also provides a vibrant insight into humanistic psychology and this disposition is more in tune with postmodern philosophical disposition that is calling for deconstructing some of the existing knowledge to bring forth a new awareness that is conducive to present day realities.
It also suggests alternative ways in which clinical psychology can improve when treating people with psychological setbacks. The writing can work as a handbook for: students, researchers and teachers as well as doctors who treat mental illnesses. Not the least this book also gives school psychologists, and educators who work in a plural and multicultural milieu a valuable insight. Not only can this book also serve special teachers who work with children with different needs with valuable psychological hints to develop a better cognitive-social-emotional teacher-pupil relationship.
To expand psychology by bringing knowledge from various disciplines such as pedagogy, sociology, culture, political economy, human geography and the field of neuroscience will certainly be a valuable project worth pursuing and that explains the rationale of writing a scholarship of this kind. This interdisciplinary academic background that I gained throughout my academic years was the stepping-stone towards that direction; that is to analyse the present day clinical practices using a multidisciplinary approach.
I must say, psychology as a discipline came to occupy me a little less than a decade, since then I was preoccupied with the subject and actively played a part in research and various national and international platforms addressing many issues that were problematic but have got normalised and contained in the system. I was mostly concerned with the way in which children with special needs were handled within educational institutes, by school psychologists as well as within the clinical psychology. I was concerned the way in which psychiatrists’ and ordinary medical doctors’ medicalisation the human mind based on flimsy assessments. I was concerned about passivizing of the human mind by those who have power and money. Finally, I was concerned when our psychological derailing has become a business for gigantic pharmaceutical companies.
The conceptualisation and writing of this book spanned field research conducted in several locations and experiences gathered working with related issues and therefore are valuable contributions to the academia as well as for those who are working in the field. The answers to some of the questions raised in this book required detailed ethnographic study based on careful participatory observations and analysis. My task was to explore the discursive practice and mosaic of interrelated issues, actions and interventions within the field. I touch upon these essential areas, not in the hope of rendering ultimate knowledge, but for readers to make their own judgements, analysis, and also to make things clearer than they already are within the clinical practice of psychology.
As a researcher, pedagogue, a public speaker, published scholar, coach and mentor for several doctoral and postgraduate students, I can say I belonged to the academic tribe. As a life coach and therapist, my role is somewhat different, giving an ear to someone in need elevated my spiritual sanity and social virtues. As a working single mum of three growing up kids, I must say the entire process strengthened my different personas. This is to say, culminated lived experiences in different countries and different roles that I played have no doubt helped me throughout the writing of this book. I must emphasise, the contents here are intended to be a valuable, non-patronising and aim to provide some answers and solutions that psychology discipline needs but failed to deal in depth.
I joined hands with many valuable authors when writing this book and I want to thank them for their inspiration. Also, some parts of the work here built upon direct interaction with many individuals who have in some way inspired—either by challenging me or by encouraging—me and my gratitude to them. My special thanks to Professor Daniel M. Wegner and Helen Thorington, my copy editor and typesetter also time to time furnished me with valuable insights. I also want to thank many who read some chapters and gave comments so I could reassess my writing. As always, I want to thank my children, especially my two sons who had to put up with when mum is too concentrated on her writing. I must always indebted to my students and friends for all your support. Kids, Nat, Jonathan and Mark again, I am indebted to you.
Key concepts: Deconstruction psychology, Medicalization of human mind, postmodern approach, Humanistic Psychology, clinical psychology.
Chapter 1Introduction: An Opening Up of Major Arguments
A recent meta-analytic study estimated that about 27 percent, which is equal to 82.7 million of the adult EU population, 18-65 years of age, is or has been affected by at least one mental disorder in the past 12 months and about one third of them had more than one mental disorder. Similar statistics bear a resemblance to many countries in the West. None western countries are following in the same trajectory. Our society is suffering from all kinds of neurotic behaviour and today's average society in most developed world, spending on mental health care much more than any other sicknesses. How come we have not analysed this upsurge in order to find answers to reduce such?
Answers to emotional setbacks and most minor mental illness are sought through—psychopharmaceuticals, rather Medicalisation the mind. Drugs are chemicals to alter brain environment, and they give quick answers, but least care that rightly deserves and meanwhile pharmaceutical companies are making huge profits. The sad scenario is, it does not look like we will climb to a new state of consensus or an elevated state of treatment in the near future, although changes towards that direction can keep the escalating psychological problems in human societies and human personalities at bay.
Humans are indeed different from all other species; while animals are satisfied with a modicum of necessity and mostly live in the present, we, humans, seem to have never been satisfied until we reached some higher good. We are also the only creature that drags along the past, and struggle through the present hoping for a better future. In doing so, we mostly live in the past or in the future and/or juggling in between and the feelings of pressure of limitations that are wearing us down. Conversely, societies’ go through far-reaching changes and at times it is hard to keep it up with constant vicissitudes that are taking place around us. The above background briefly explains some of the reasons, perhaps, why we are prone to a more discontented, disoriented and dissatisfied. We are more susceptible to cognitive dissonance today than never before.
To make matters worse, we are also members of a world society full of paradoxes. We have built magnificent and most secure urban centres full with skyscrapers, highways, runaways, 3-D, 4-D high-tech urban cyber nuclei and also have made mass destruction weapons capable of destroying them totally in matter of few seconds. We have produced great wealth, yet excruciating poverty in the world makes societies paralysed; our emotional morals are in some ways affected, as we human by nature are naturally chained with others, and fear and pain in one region affect the people collectively, albeit involuntarily and unconsciously.
The digital communities such as social media, twenty-four hour news, effectively keep us on alert on the destitute, calamities and cruelties’ around the world. When those pains of others portray virtually we cannot help becoming psychologically part of them. That means whether it be poverty, cruelty, tyranny and hypocrisy at home or elsewhere, they psychologically affect us in various ways in our days than any other epochs in the past.
We also have developed a better moral consensus along human rights, equal opportunities, embracing of differences, equity and building awareness to stop the demarcations of human along race, class, gender, and other social attributes. Yet our ego turns tyrant to others who look different to us and have different beliefs and lifestyles. We have become more judgmental of others, and also victims of stereotypes. In the sense, we are more divided, biased and our minds are tearing apart.
The divorce rate is rising in the West and in the rest of the world divorces take in many shapes and shades without having to officially register divorce. All has altered the family concept. The family virtues no longer fostered or fostered differently and social capital and affection-orientation once work as a psychological filter within communities are challenged. The world, particularly urban dwellers, which is increasing in number, the idea of extended family, social capital, social cohesion that were once worked as an emotional blanket do not exist today.
According to some, States that have taken some kind of a big brother role, particularly in welfare societies where I come from—that has the world highest divorce rate—pinpointed that State interference is one of the reasons family system is breaking. The state interference was a humanitarian sentiment towards children, also women and seen as a necessity; however, increasing State interference has disempowered parents, particularly the father. The biological purpose of the father is to protect children during their years of dependence, and when the biological function is taken over by the State, the father diminution in the functions of father losses his raison d’ etre. The gloomy stories from foster homes, lack of involvement of fathers in upbringing of children, single moms juggling between work and home, all have an effect on children’s psychology and medication of minds of young adults are on the increase and all such have a toxic effect.
The communities have become less cooperative, less contentment and suspicious. Social virtues and emotional bonds, compassion and care once chained us humans together in all walks of life in the early evolutionary history is taking many deviations. In some areas we are becoming super sophisticated, manufacturing even robots responding emotionally to us, with all these technologies we are forgetting the significance of emotional acumen that needs to keep the human species going forward. Our collective emotions are becoming fragmented and affective disorders in societies are buttressing.
Today our elders and young children are under the care of the State, while we work hard and subsidise the welfare process through a tax system, we also wrongfully expect State to take more responsibilities of our elders and young children. Then again education institutes today are mainly function to prepare youngsters for the labour market. In such context, character building: ethics, compassion, rights and obligations, which were part and parcel of these institutions once, today, have pushed to the periphery and social and emotional acumens that one need for successful life were neglected.
Those who are not fortunate with welfare, grapple around with alternative arrangements. To support these arrangements they have to work extra hours, stress level is on the increase. The stress chemicals change the texture of the body anatomy, brain is in this case remain most vulnerable and affecting our emotional resilient. Meanwhile, our children get less time with us parents and the quality of time invariably affected by level of stress.
What I have mentioned above is a tip of the iceberg of growing paradoxes of today’s societies. As a result, our collective lives are haunted by ‘ontological’ insecurities, albeit, without us being consciously aware of it. Insecurities and fears stir our minds and manifest in different ways, affecting our state of mind (psychology) and state of being (philosophy). We are becoming emotionally vulnerable, prone to psychological ups and downs and in some case susceptible to psychosomatic sicknesses. A stress related mental disorders are on the increase in almost all societies, in Sweden where I live situation is becoming unbearable and ‘pills’ have become the escape. We are losing our psychological pliability and our mental immunity and what more! The capacity to deal with upheavals in life is approaching a tipping point. To make matters even worst the answers are increasingly sought by medicalization of the human mind.
Against these backgrounds, a well-deserved journey into present day psychology of practice will be able to light up some of the glowing coal hidden under grey ashes and I am glad for making it a my business. The writing of this volume, I believe is a good start to debunk plethora of areas that need attention and caution. This in fact, will help particularly; those who work in the area to navigate better out of crowding problems. As mentioned, deconstruction of existing knowledge to deal with complexities of today’s reality starts from looking at the psychology of practice today.
Challenges to the Current System
In this section I would like to outline specifically some of the arguments that will be dealt with throughout the book. To begin with, the environment and social context in which mental pathologies stir play a significant role and need to bring from its peripheral disposition to the centre when trying to understand and treating people with emotional setbacks. The social reality and immediate environmental factors in which individuals mould, their personalities develop were largely ignored in the present clinical models in which people are treated in psychiatry and mental health services. This is a matter need to problematise when seeking deconstruction of psychology.
In clinical psychology, diagnosis methods, medicalizations of mind and drug treatments to control the symptoms have become the norm. In a way, it is not wrong to say that mental problems have seen and increasingly becoming a brain problem and in that context, manipulation of brain chemical through drug treatments have become the common answer to emotional setbacks.
A longitudinal study that was conducted for the past 11 years by Professor Mathias Uhlen and his multinational team at Royal Technical College, Microbiology lab in Sweden published their ground breaking result 06th November 2014 in the Human Protein Atlas. It was found that the human proteins that is ‘working-horses’ in our organism, and is more unique than previously thought. We know all pharmaceutical medicines have to deal with body proteins when fighting deceases. The problem is the medicine that was intended to affect certain protein types; say in kidneys can have an effect on the same protein type in the heart, brain and liver causing unexpected bi-effects. Before it was thought medicine meant to control protein in the kidney affect only that particular protein in the kidney. But then according to this new finding protein of the similar kind find in all other organs can have an effect on other anatomies.
The medicine we take, which includes even the psychopharmaceuticals have an effect on other vital organs. For instance, psychopharmacology that is given to alter chemical milieu in the brain can affect the same protein in the heart, liver and kidney. This result, of course, will have greater pressure on pharmaceutical giants to deal with the matter; meanwhile ordinary people expect to act more intelligently and cautiously when it comes to the medicalisation of their mind.
When it comes to people already suffering from different kind of illness that are in a fragile status, and are vulnerable to available treatment modes. I am not saying here that people suffer from severe emotional setbacks avoid visiting psychiatrists or learn to cultivate a positive attitude and other available methods to fight their emotional challenges. What I am trying to say is there are other methods, such as therapy, and approach of cure and care model that give reassuring information, comfort and solace to patients who are suffering from mundane emotional setbacks.
I also problematise the term disorder or disease. The doctors’ mission is to cure the decease, or control the disorder. In doing so, they are overlooking the illness—the patient’s experience of disease; how their patients reacting emotionally, to diagnose. According to the humanitarian argument, physicians need to work on a care and cure model and give attention to the psychological and social reality of patients under their care. Unfortunately the existing instrumental approach which offered today do not provide care and cure model a chance and there is no room or condition for such interventions.
The human body is an energy field and bio, social, cultural and psychological field and each of these systems are intimately entwined and influence our thinking, behaving and total wellbeing. Medicines that give to alter chemicals in the brain and nervous system alone cannot give answers to psychological derailing and psychosomatic illness. Especially when it comes to psychosomatic sicknesses one need to take into consideration the psychoneuroimmunology (PNI) system, which includes the mind (psycho), nervous and hormonal system (neuroendocrine system) and immune system. A French neuroscientist Francisco Varela called the immune system as the body’s brain.’ Research confirms that the chemical messengers that operate most extensively in both brain and immune system are those that are most dense in neural areas that regulate emotions.
There is a strong association between nerve cells and immune system. The hormones release under stress have a profound effect on the immune system that releases immune cells in the blood stream to fight all kinds of viruses, bacteria, and even cancer. These important connections and associations and a holistic picture were not taken into consideration in the medical model that tailored for psychiatry. This is problematic.
The excessive use of various drugs that are freely released by highly competitive pharmaceutical giants from the most powerful countries in the meanwhile have hit the jackpot, especially when emotional setbacks of you have become the business for them. The irony of the matter is not only these ‘modern avatars’ controlled the mental sicknesses; they also controlled the medical staff. Psychiatry is most vulnerable and thus exploited by market and the failure to recognise this is tragic.
As it was argued by some scholars’ diagnosis has become prevalent as practitioners are under the impression and convinced that they can see exactly what is going in people’s head by listening to what their patients narrate to them. Elaborating further, the present day’s psychology treatments are based on neither deductive nor inductive approach or one can say the latter to be the most probable scenario but often doctors are rushing from one patient to the other and it is difficult to know whether they have enough time with any of these methods. Some psychologists in the field argue that one should treat patients for their symptoms rather than looking for diagnose categories and medicating them according to universal handbook—Diagnostic Statistical Manual (DSM). But this is rarely taking place in real world; at least there is no right condition of doing so.
The arguments that are raised above have taken into consideration a list of factors such as bi-effects, the individual dynamics, and phenomenological aspects of the brain, DSM, categorisation of mental sickness, excessive power hold by pharmaceutical giants as well as the absence of sociocultural considerations within existing clinical models. All such are vital when assessing a patient for mental disorders. My research conducted in, in-patient and out-patient units in different hospitals, namely Sweden, China, Philippines, Cambodia and Sri Lanka give a gloomy picture; and consequences for not seen the aforementioned areas as an important part of the psychiatric assessment and evaluations is a matter of concern. The above are in brief some challenges that we face and rest of the book deal in detail of these challenges and future direction.
The Scope of the Book
The writing is meant for academia: teachers, students as well as apprentices and practioners of the mental healthcare sector throughout the globe that are interested in the reconstructive approach to psychology. I shaped narratives in this book so that readers can better grasp the events and scientific explanations behind them without having to slow down when confronting academic and technical jargons. Valuable information is given to those who work in the mental health care sector. There are also helpful hints when treating clients/patients with different sociocultural reality, which is so far remaining as an unaccounted problem within these services. No doubt reading will help nuanced and sophisticated knowledge in these respective fields that previously culture played a minimal and superficial role and hence the possibility to overcome a few barriers and bottlenecks they may have faced. The suggestions are also made on how to deal with different culture in a cultural sensitive manner other than the one that one is familiar with.
I also devoted a few chapters for those who advice or who would like to find the correct way when consulting mental health care services such as psychologist, psychiatrists and also different kind of therapeutic treatments. The field is confusing and most clients that had been consulted mental health care sector were not aware of the different between psychologists, psychotherapists and psychiatrists. It is important to understand the competencies entailed in these professions and my research in the field shows that not many people are aware of the parallel involvement of these professions within the clinical psychology and different treatments entailed by visiting a psychologist and psychiatrist. This book filled this gap.
The book in a way deconstruct psychology to promote largely appreciated humanistic psychology that is now gaining influence and largely influenced by the post structural philosophical stance. In a way this stance is subsumed well in the postmodernist view. Postmodernity, is in nutshell, seen as realisms after modernity that encourage deconstruct old ways of thinking. This disposition also cautious of external powers such as power of the market, and power of grand theories, methodologies and scientific truth. I must say that the unscrupulous residuals of modernity projects are still plaguing us and need attention and postmodern view that inspired my writing aim to focus on some of these areas.
I must add a line here, the postmodern, is a misunderstood and misused concept, it is terribly wrong to think that one upgrade from modernity to postmodernity, it is not, and linear thinking is a bygone notion. Postmodern demands deconstructing of modernity project and reconstruct something more suitable to present day realities. I give a detail description in a later chapter how I use the concept, postmodernity, deconstruction process and humanistic approach to psychology, which I think is decisive to the call.
Chapter 2Challenges to the Current System of Categorising the Human Mind
The humanistic perspective that is endorsed in the writing here seeks that practioners in the field should look at individual as a whole, not in the prisms of classification, diagnostic categories. In that case contextual knowledge of the individual that is being treated need to take into consideration when assessing symptoms. We also know that classifications and labels give certain guidelines for treating patients with similar symptoms. However, within therapeutic and psychiatric diagnosis the labels remain relatively unreliable and weak thus the concern. Moreover, the classifications and label commonly used in the field are growing each year and at times practitioners use them bluntly and have caused more damage than good.
A telling example is Attention Deficit Disorder (ADD), ADHD. It was recently found that ADHD and PTSD, Post Traumatic Syndrome, show similar symptoms. This fact was not known before and there are one too many confusions in diagnosis and classification model. Up until the seventies homosexuality was in the DSM, the bible of psychiatry. American Psychology Association (APA) keeps adding all kinds of classification every year and overly pathalogising individual's ordinary problems.
When we talk about different mental classifications, say for an example, doctors find an individual suffering from some kind of mood disorder or impulsive control disorder, or apathy, although these terms can be arbitrary concepts and are liable to alter or discard as circumstances around the person change or life style is organised to damp the stress but diagnostic label stays hard on people’s mind. Considering these, giving a stamp profoundly has an impact on the person and those around them, and therefore ought to take place prudently. Damage can be permanent, especially if they have been presented to clients by doctors as they are some kind of biological or and inherited factors. Later in this book I will take inherited and environment argument related to mental illness using latest studies in the field.
In my opinion the effect of labels undervalues and withhold the resilient nature of each individual and also inborn capacity that we have to self-regulate. Not only that there is another negative aspect to medical labelling of individuals. They give an impression that there is something wrong with the person, and those who influenced by these categories fail to see the person other than the framework of these categories or labels. Moreover, it is not wrong of me to say the job of psychiatrists in this case is to find one or two symptoms fitting with the label, although I cannot claim that all psychiatric pursue such methods, but there is a formidable condition for doing so and my research on the topic confirmed this in all five countries that I have conducted my research.
One may ask what is wrong with the categories. The categorical thinking is difficult to avoid. Let me elaborate a few downsides with categories. Categories once established takes a while to weed off and people tend to hold on to them. As a result prejudices is formed and people who got a diagnose classification have to fight more with these prejudices than their own illness. Categories also tend to put people into small boxes and administered the medication specified to each label by the DSM; the risk factors were not scrutinised enough.
Telling example is children who were categorised as ADHD and are subscribed to ADHD medicine, in reality, what their suffering was may be some kind of post-traumatic condition which need different treatment. The worst scenario was teachers and those around them treat classified children specific way in schools. They are grazed by ‘normal eyes’ as ‘abnormal persons’. It is not common to hear that judgements were passed in school corridors with children show different behaviour. My daughter who always had full of energy was seen by some as an ‘ADHD kid’ and I had to test her to prove that to her that she was not suffering from such condition.
The system passivized people and children are included in the making. Moreover, all kinds of emotional distresses subject to prescription, starting from highly addictive sleeping pills—with prolonged use often caused rebound insomnia—to happy pills. More often than not people tend to over consume them depending on their level of anxiety. The medications may control the patients’ symptoms, as drugs of such kind are mostly substitutes to controlling psychological symptoms to be just manageable level but never a remedy.
State of Psychology Practice Today
The dimensional features of emotional setbacks and psychological disorders augmented at the same vigour amongst all levels of age groups and this is a documented fact. The mental illness and deaths, which even includes suicides started to escalate even in many parts of the developing world that once thought consist of having a supporting emotional and social capital that work as a psychological buffer. In the West, the young teenagers under antidepressants were on the increase and so was the sickness such as obesity, anorexia and bulimia, also apathy and melancholy. In order to control mental ill health pandemic the mental clinics and professionals were forced to develop methods to control symptoms of patience with the help of pharmaceutical companies.
Psychopharmacology has overtaken patients, doctors and medical system and the respective governments, health ministries were quite contented with such measures, because drugs keep the user tranquillised, less harm is done (of course, as long as the patient swallows pills), and such methodologies are cost effective than giving therapeutic treatments and easy to administrate but they have their own demons. Apart from that, we also must take into consideration why with all medical interventions people are becoming sicker; especially, the mental sicknesses and physical ailments related to life style are pulsating and psychosomatic sicknesses are eating up the health budget. While they increase in vigour, not only in one particular region, but simultaneously many parts of the world, social problems are becoming an individual psychic problem and psychiatry is developing in one direction—medicalization the mind. This is problematic.
The clinical psychology today is in aggressively developing towards a singular direction and most mundane emotional setbacks were dealt predominantly through drug treatments. Such treatments kept symptoms under control but cure, or addressing the root cause of the problem seem to have slipped, or not seen as a matter of urgency or even important. Here Diagnostic and Statistical Manual of Mental Disorders (DSM), an American invent have become the bible in the trade that doctors cannot be without. As it was argued by Ian Parker those who carry out the diagnoses and those who are subject to it, are subjected to the power of the DSM—the manual transforming normal people, who are for some or another reason going through some kind of emotional upheaval. The treatments were sorting to put patients into the taxonomy presented in the manual then write a prescription. Call in a month to ask how the client is feeling. What is the problem with that?
The human organism is complex, and mental process is unlike body process, complicated and anatomy of the brain and nerves and chemical traffic itself do not give us a conclusive picture of how the mind works and how the rest of the body such as immune system—the ‘brain of the body’ works. In this context, medicalization the mind obviously a problem faces that need to be addressed in right proportion. There are ample studies show that even mild emotional distress suppresses by anti-depressant drugs in many developing countries in the West. The worst-case scenario was when my own research revealed that in some developing countries such drugs available to purchase over the counter without any prescription. The most expensive drugs were either legally or illegally produced and sell in most pharmacies in Asia, Africa, South American and Middle East countries either under the same name or name with similar rhymes.
Much of psychiatric methods to treat people with psychosis even neuroses is based on contemporary medicine remain on shaky scientific foundation. As it is impossible to count the stars in the sky so it is impossible to explain all of the intricacies of the brain using neuroscience and new technologies; the deeper the science goes the more there to discover. We can understand so much, but no more, at least as is seen today. Therefore, we do not know how altering brain chemicals affect people in the long run. It is not seen as profitable for finding long-term effects of medication, there were no longitudinal studies, at least as it is seen today.
The research, based on lab studies and qualitative research—mixed methods—and longitudinal studies aim to deliver a better understanding of the mental health perhaps help practioners to make earlier detection and symptom control but not the root cause. Concluding this section, I must say a science like psychology needs to develop with having in mind the need of justifying a practice that is not always the best interest of people. Then individual need to be able to question, and demand changes of methodologies and practices (medicalization) that are less effective. That can be done by reasoning with the public and building consensus to bring about changes. I think it is imperative to the journey forward, and the balanced and harmonised links between different dimensions, no doubt will help practioners to take a right stand when practicing psychology.
Chapter 3Postmodern Humanistic Philosophical Disposition and Deconstruction of Clinical Psychology
The postmodern deconstruction approaches that will be explored in this book influenced by the post modernity’s more philosophical posture and aim to explain matters pertaining to mind, brain, body, society and psychology. Deconstruction of psychology means a critical analysis of everyday practice of psychology, which means practices that we have taken for granted despite flaws, and many malpractices and gaps in clinical psychology in order to bring necessary changes. It is suggested new ways of thinking by clearing some of the residuals where psychology is witnessing problems.
The virtue of the deconstruction can be developed with varying context. Before moving further, it is instructive to define the concept of postmodernism, but then again this has proved to be challenging for the reason that the concept outlaws precise definitions. The concept can be used in different context. In short postmodernism is—‘real ism after modern ism —and throughout this book I explain how this perspective can be espoused to give meanings to a holistic view of mental process and human existence.
Describing the development of the concept, we can say that postmodernism is a notion which emerged in the latter quarter of the 20th century. The philosophical disposition of the term is in fact closely connected to post-structuralism and just like the latter; it is not a theoretical package rather an approach. One of the virtues of its philosophical disposition is, the approach avoids many pitfalls sobered through the modernity project. The practices within this approach encourage practioners to deconstruct knowledge to incorporate humanistic, care and cure base approach and non-universal means to the treatment process, and give more time to understand the complex nature of the human mind. Give necessary attention to social and cultural rudiments and inborn mental capabilities as well as the agency and structure.
Realism after Modernism
Let me start first explaining what the modernity project is before explaining the post modernity. Modernity is a package that was introduced by Europeans who at the time held an astounding position economically, culturally and militarily as well as technically, in the world. The powerful position was partly owing to the great wealth some European countries accumulated through invasions, pillage and prowling of other nations that were flourishing with natural resources outside Europe. The birth of the modernity project was developed and underdeveloped countries, thus begun to emerge in the world order. European countries played a prominent role from arts to science and economy and knowledge making. So in nutshell modernity is a concept that started in Europe and embraced by the rest and has its good and evil hence the need of deconstruction. Realism after this gave a birth to postmodern thinking.
To elaborate more, the modernity period that started in Europe changed the world ecologies, way of life, science, philosophy, psychology and even language. The language of – isms, binaries, categories, classifications that usually tend to be furtive are still with us. They confused minds and there are many diffused areas still are needing attention. Ian Parker comments on the distribution of representations of the world like this: ‘we are used to living in a world conceptualise and operate ideologically in order to open up and close down certain forms of action’. Ideologies invariably govern our mentalities.’
Returning to my previous discussion, the term postmodernity became popular in academia with the Jean Francois Lyotard’s book ‘The Postmodern Condition.’ However, earlier, various individuals within the critics of the arts society used the term; nonetheless, it was Lyotard who gave a nuanced meaning to the term. One of the main arguments of Lyotard, which is also relevant to discussions of this book, is his critical disposition of Meta narratives and grand theories and for their totalizing effects. Grand theories were seen by Lyotard as far from reality and not qualified enough to explain problems in the contemporaneous.
Further, some of the post structural scholars such as Foucault and Deluze argued that the narratives that were produced and attempted to sum up and handed over as the story of entire human beings has only one sided truth and hence frightfully misleading. The lack of plurality in the construction of knowledge was seen as problematic as it destructs the development of mind and transforms thoughts and also tends to disconnect people from the truth.
The writing of Derrida, Foucault and also the psychoanalyst Jacques Lacan’s clinical practice influence the proposed deconstruction approaches. Lacan started with bringing Freud’s radical unravelling of human experience to deconstruct and reverse the priority given to certain concepts by Freud, whose psychology was the motor in the Western Enlightenment tradition during the height of modernity.
Lacan also urged to deconstruct the binary language in which societies, individuals, minds and emotions were constructed. Lacan questions the theoretical absolutism, cultural essentialism and over-confident loyalties to what Jean Lyotard (1984) called ‘meta narratives’ that were often constructed in the west based on western realities. Lacan’s works were later used by a number of scholars within and beyond the discipline to criticise mainstream psychology. I am not going to get involved in a theoretical argument here, and if anyone is interested in further reading, please refer to his work on The Other Side of Psychoanalysis.  A great work of the author .
Come back to the topic, post modernists’ problematise the individualism, rationalism, autonomy, one-fits-all methods, and other imperatives that were seen as the protagonist. Instead, the postmodern disposition seeks holism, communalism, spiritualism, inclusiveness and embracing differences. They saw the categories and classifications and categorical thinking and ultimate truths of scientific findings, which are neither true nor false but presented as truth as problematic. In fact they were seen as some of the pathologies suffered under modernity.
In postmodernist thinking, the right or wrong is not a cut and dry issue, what is right to the other, another can perceive wrong. The shoe that fits one may pinch another, there is no blueprint for living that suits all, and in fact, no universal language exits without undermining the other. The power of stereotypes that buttress prejudices according to this view comes from the need of self-confirming.
What is more, it argues against the universal answers to diverse problems. It also problematises the ignorance of folk philosophies, undermining traditional know-how and traditional ways of life. Some postmodern thinkers want to promote an alternative way of thinking, which is in the sense closer to being inclusive than accuracy, and conceptualize the world in diverse aspects, naturalist, humanitarians, tradition and transcended and atheism, religion and all included in the thinking. This disposition question the profligate focus on psychic insufficiency, not only that the western biased knowledge production, commercialisation of the field of psychology and last but not least medicalisation of human mind.
Plural Epistemology in Psychology
Illustrating further above arguments, for an instance, this disposition challenges the one sided construction of knowledge. It was no longer seen as evocative because the world is neither Europe nor America. Furthermore, the west today consists of plural voices and, not just one race but multiple races and ethnicities. Plurality is there to stay, in that context, no one race should have a power or voice over the other. Together, all should be contributed to develop the nations that cater their needs and wants. Follow the law that laid upon by each nation and learn to respect and expect cultural differences, religious faith, life styles. In the sense, the postmodernists argue that it is wrong to claim legitimacy of one and demand mixture of knowledge, knowledge combines all colours of the rainbow.
They also contend the objectification and subjectification of citizens through all kinds of disciplinary mechanisms in a tacit way, in some cases appealing directly to people’s subliminal mind to a point that no longer individual autonomy, personal integrity, agency are taken as a matter of importance and in some cases tacitly they were stolen. In a way the deconstructionists question the way we are still influenced by social and psychological factors subscribed during the modernity project while pinpointing some of the hegemonic conceptual cornerstones. They seek to close the door upon some of this sociopsychological constructs. Instead, it urges investment in epistemological pluralism, open systems, and bottom up approach.
A Lyotard argument that brings examples from digital communication world, for him, development of digital technology can alter the way in which knowledge is produced. He said knowledge is no longer a powerful means of communication that was produced to bring forth necessary changes, development, positive transformation, when the main objective of its production is controlled by market forces. The multinational corporations who controlled the market decide on what to communicate and what not to communicate to the public. There is also a fair share of myth making when knowledge is unregulated. For Lyotard, this development was a mercantailation of knowledge and in that context, he questioned the credibility of knowledge itself.
Although, Lyotard was talking about knowledge construction and dissemination, we can make parallels to understand how similar scenarios have influenced other areas in our life and are continuing to do so. The unregulated power enjoyed by free markets and the role of the democratically elected governments and their passive disposition not to react when markets are deceiving people is very much in vogue in every part of the world today. The medicalization of emotional setbacks within the clinical practice using Diagnostic and Statistical Manuals of Mental Disorder (DSM) and treating diagnose not the individuals and sorting to keep symptoms of pathologies under control through medicalization the mind are some of the telling examples.
The psychological setbacks do not have to be a permanent condition. The childhood trauma is not always stirred emotional derailing. In fact, the postmodern approach to psychology challenges the analytical methodologies that are being used to understand complex nature of human psyche. They argue that childhood traumas and unfulfilled desires are seen as the root cause and have a tendency to oversimplify something complex. The deconstruction disposition seeks to have a conceptual hold on the self and one’s own mental capacity to deal with life issues and demands that practitioners use diverse methodology to empower people. It is within a diverse intellectual milieu that normative framework for postmodern humanistic psychology developed; embracing differences and promote epistemological pluralism and incorporate alternative methods.
The way forward is to explore the factors that have prevented the discipline moving towards to incorporate a more humanistic approach to psychology of practice. The psychological culture also operates outside the boundaries of clinical practice, for example, schools, workplace, religious organisations, recreation centres, military and media as well as in business and marketing. In each field, there should be a process of deconstruction in order to provide a useful and new ways to understand, assess, reassess, build and strengthen human involvements. The arguments raised in this book intended to encourage reflection in order to bring forth these needed changes.
Chapter 4Psychological Paradigms Good and Evil
During the Renaissance with flourishing advancement made discovering more about human anatomy, the discussions of mind and body connection lose in the Descartes century old mind-body argument. New medical discoveries have been made in genetic science, body tissues, DNA engineering and the way brain storing up instructions, transfer information from cell to cell and from organ to organ. All these were no doubt valuable discoveries, an enthusiastic revolution within the field.
Also with all these developments and resistances to the culmination of the enlightenment logics, thinking, and reasoning, scientific truth to find answers to psychological problems are dominating psychology today. The imbalances of brain chemistry emphasized in psychological diagnosis are some of these residuals. In a way it is not wrong to say the remnants of western philosophical disposition where mind and body was separated, despite criticisms, continuing when it comes to treating psychological setbacks. What is the problem in doing so?
Thorny issue dividing mind and body, mainly focused on the sickness: deceased body, the problem accompanied was when deceases were not understood as part of ontological entities and failed to see the inner working of the body and mind. Let me illustrate further. To critically analyse why an individual develops in paradoxical directions, it is important to establish the root cause of the behaviour and this is the first step. The mechanism of our cognitions, conscious, and how the sensory system works can give intelligent answers to why we do what we do and what keeps us hold on to some habits even though we know they can harm us. Some of these crucial factors cannot unfold by separating the mind and body, or merely looking at brain anatomy, the contextual as well as situational factors need to bring appropriately to the picture. This is the other step that needs to involve when using reconstruction approach and paradigm changes in psychology.
A system that built on to study how people work under different emotional conditions no doubt give practitioners clues as to how emotionally resilient their clients are, so doctors can advise their patients accordingly. By investigating habits and thoughts, perhaps can be the sources of some of the problems; and that way practitioners have more data pertaining to the clients. By discussing client’s doubts, fears and worries psychiatrists can enhance the necessary knowledge that is needed of the patients under their care. Providing knowledge, power and courage to deal with some issues bothering them, clients may be able to deal with emotional problems with self-efficacy or in a therapeutic environment. Such needs assessment, evaluations and depth consultancies. They are lacking in the public mental health services. Psychiatry neither has time nor have such assessment criteria. The problem lies not with the professions, but the established practices and cost cutting actions.
Also, it so happens that if we visit an ordinary doctor, the doctor finds it hard to send us home without writing a prescription. Some doctors can write an entire pharmacy, more the tablets merrier it is, and a bad habit that we have gotten accustomed to. We never suspect that it could be so that doctors cannot make an exact diagnosis as to what caused the pain in the stomach. Nowadays of course doctors can administer lab tests and get answers quite quickly and efficiently, but not all countries have lab facilities, then the latter methods prevailed. Moreover, when it comes to mental ill health, they cannot be diagnosed by taking blood from a finger. What is lacking in present-day is any attempt to establish how the various approaches and related strengths can work together to improve the practice of psychology not only at clinical level but also terrain of different fields within psychology in general. The gaps need to close by gradually deconstructing the psychology that had been influenced by the conventions and methods as well as methods that are influenced by neo liberal market models where few powerful actors dominate the field.
Deconstruction of One-Fits All Models
The mental sicknesses of all kinds are rising and, according to World Health Organization around 450 million people in the world suffer from some kind of mental illness and out of which majority of them find in their prime stage of life. Practitioners need to open for various approaches to deal with the problem other than working on the decease model that do half the work. No doubt decease model is good and classification I assume useful for research purposes and to observe certain patterns and isolate variables and genetic and environmental associations as well as sociocultural variations as they play an important role.
The exclusive uses of one-fit-all treatment methods do more harm to the patient than good. I am not saying therefore one should throw the baby away with the bath water, but to deconstruct existing knowledge to make something original, multifaceted and more appropriate to the contemporary values and realities. Certainly refining existing ones, we can reduce some of the harm.
Moreover, it is simply not possible to produce one size fits all knowledge base or treatment method as there significant differences the way psychology is being interpreted and associated treatments have different meanings to different people. For some people traditional methods are important to incorporate and these methods have a placebo effect. In fact, this knowledge is now becoming an important aspect within the humanistic psychological orientation. Science is slowly opening their lab doors to measure the effect of traditional methods.
When it comes to mental illness as mentioned earlier, one need to have more focus on patients’ behaviour patterns and also thinking patterns and this is done by listening to patients' narratives. Psychiatrists predominantly work in, in-patient and outpatient units within the health care do not always have the time to analyse people’s behaviour by listening to their narratives in detail. Normally the focus is on controlling emotional hubs. Pharmacology has a way of taking over the natural ability that we are born with to process mental distress, and our inner strength to cope with mental issues. As an example, patients are on anti-depressant or happy pills for a period of time, will find out soon that they are not able to feel either happiness or sadness. Patients’ feelings were neutralised by medication. They are not even able to cry when they want to cry and release some of the toxic hormones. The downside of this will explain latter part of this book.
In addition, patients are constantly being put in a position where they have become victimized by powerful forces, mostly in a tacit way. The victimization has become so grave that they have become adapted to the ideas promoted by these forces and have normalized such without even realizing to what extent they have become passive receivers. Rarely did they question these powers and knowledge that they postulate, and doctors of all kinds who are prescribing anti-depressant pills are becoming a common factor. Not all of them profess therapeutic tools to seek explanations to practical psychological problems, which are acerbating the situation. This is to say that treatments, which yield, that is, justified by the outcome for the patient is near to the ground.
The above are some gaps exist in clinical practice today. The part of the problem originated and is situated in the modernity project where science was thought to have answers to all problems. I am a scientist, and no way have I undervalued science, neither I try to present the probable truth found in science as final truth. There are problems. To minimize gaps between those who possess knowledge and power, and credentials, degrees have the freedom to give drugs treatment and those who can counterbalance that power with appropriate knowledge is not without challenges. Considering the above it is time to give a deeper understanding of how our body, brain and emotional structure function in related to social reality in which we live when we involved in a reconstruction process.
The humanistic disposition, which is becoming popular within psychotherapy, is a trend one needs to uphold. The paradigm change thinking elucidates reconstruction of knowledge influenced by grand narratives that had the tendency to oversimplifying the complex reality of human mind and need to deconstruct not entirely throwing what all these intellectuals told us but reconstruct to see things in a different light and different perspectives. This is I guess is often the struggle within the discipline of psychology. The way forward is to understand the psychology that is still under the influence of the gigantic modernity project. Although modernity projects residual perhaps will never leave us completely, yet when one involve in a discussion on paradigm changes one needs to be inspired by new period, new thinking.
Consequently, one can say we need to wear a different set of glasses to critically analyse areas that need attention. This is the way forward and saying and doing is still a problem. In psychology, there will be benefit in looking at the mental process in multiple ways. The extrangualation always give rich and holistic knowledge. The scientific knowledge integrated with other kind of knowledge which is included even the traditional knowledge is a worthwhile effort. Once this is achieved dichotomies in the world can be tamed and categorical thinking becomes irrelevant or rather less relevant to use as a working model. In concluding this section I must say, the paradigm changes are in vogue and are being instigated in many other fields to include epistemological pluralism, but psychology still talks a universal language to address a diverse problem. The interdisciplinary approach to the construction of new knowledge whereby several disciplinary communities’ dialogue with each other to combine knowledge should be fortified in the production of knowledge, particularly psychological methodologies.
Chapter 5Medicalization of the Mind
Medicalization is a term used to define when nonmedical problems are treated with medications. One of the arguments made by this book is that most of the time nonmedical emotional issues are being increasingly subjected to medication and this is turning to be a pathology by itself. The foregoing chapter explained how the deconstruction approach to psychology, both as an applied and academic field, also a field that studies the human mind and behaviour can be reconstructed not only to bring a new knowledge but also promote diverse ways to access and treat mental setbacks. This chapter critically analyses the clinical psychology’s understanding of normality and abnormality and discusses the problems therein.
Psychology as a young scientific field has been operating to treat mental disorders from the time discipline was established. When it comes to clinical psychology, treatment procedures of today remain the same as yesterday, the difference is before we had only a few kinds of prescription drugs for treatments for broken love affairs, failing exams, laid out from jobs, personal bankruptcy, divorce, unfaithful wives and husbands, problematic teenagers. Now there is a multitude of them and pharmaceutical companies are thriving and rivalling to medicalise our mind.
Also, compared to the wicked old days, we have moved away from storing people that show visible disturbances in their behaviour in locked facilities in remote suburbs. This is not to say that we have completely moved away from such, the psychiatric wards still have iron gates or electric doors. But the stigma of having a family member with a mental condition is not as painful and shameful today than a few decades ago. Psychiatric wards are not brutal as was sometimes ago. Melancholy, anxiety and panic attacks and compulsive disorders were more heard and tolerated but kept agonisers at a distance level by public. That is one side of the story. The other side of the story is the pharmacology and medicalization of emotional setbacks and loopholes in the entire system along with the culture of caring persons with mental illness.
Into the argument, I mentioned that the language of psychiatry changed from mind to brain. Brain science that largely neglected the social neuroscience adds water to the burning oil. The psychiatrists have become biochemical and people’s mental states were seen as dysfunction of the brain and answers were found by bio medicalization the individual and damages they bring are far worse than one can ponder. There are alternative routes to the medical model. The existing instrumental approach and assessment of clients need to replace with cure and care model. It is important to note here that alternative routes do not necessarily have to rule out drug treatment, as seventy percent of people who suffer from condition such as schizophrenics respond well to drug treatments and so medical model is something we cannot thrust aside. Nevertheless the medical model needs comprehensive deconstructions, as biological methods have become the only tool in psychiatry. Moreover, as mentioned, such interventions reduce mind’s natural capacity.
This is to say stimulation to drug treatments, as the only method, passivizes the natural process that organism is programmed to. Self-regulating process, particularly when emotional setbacks hit a person is withheld by present treatment process. Additionally, in biological methods there is no room to find out social and other significant factors related to mental disorders. What we have forgotten is that drug itself cannot solve the matter if the social factors that cause the problem are not properly dealt with. Such were not taken in the treatment process. This I see as a reductionist view of seeing individuals’ emotional setbacks. Moreover, it classifies individual behaviour disorders as some kind of mental condition without detailed contextual information.
When it comes to thinking about it in the good old days, pharmaceuticals meant both remedy and poison. Today they are part of our stressed life and most of us may have some kind of tranquillizer in their bathroom cabinet and pain killers and sleeping pills are as important as packing tooth paste in the travel bag to cope with mundane stress. More and more there are people who take ordinary painkillers to calm their nerves and such are becoming the Praxis. After effects of administration of psychopharmaceuticals are not well communicated, one finds it only through experience and then it will be too late to give up the pain killers or happy pills because your brain has already become habituated and it is difficult to reverse the process.
The depression related to socioeconomic problems and unemployment is increasing in one hand and on the other hand anxiety disorder related to stress for overworking making people mentally and physically sick. Another factor complicating stress is the prescription writing of drug treatments by physicians. A few years ago anti depressive drugs were only prescribed by psychiatrists. They have an additional education within psychiatry to do so. Nowadays a family doctor or for that matter any person who has a M.D. can prescribe anti depressive tablets. I wanted to find out whether this is really the case in Sweden and asked my GP (family doctor) to prescribe me sleeping tablets. I am an anti-drug person and quite hesitant to administer even an aspirin on my body unnecessary. I have learnt how powerful my body’s brain that is my natural immune system and carefully kept antibiotics at bay. I was surprised to find when my doctor prescribed me ‘antidepressive’ tablets, so that I will be able to sleep better. When asked I was told drugs relax and put me to sleep. My doctor also mentioned list of other drugs, which I was guessing come under the same anti depression family. My conclusion of this experiment was doctors prescribe drugs without knowing so much of their real intention.
Drug overdose is becoming a new epidemic and Western countries are pioneering. Compared to a few years ago, today’s market is saturated with various drugs just like disorder categories. These constructed categories administered prescriptions in a similar way as a prescription of antibiotic for bacterial infection. At least, when it comes to bacterial infections, the body can be subjected to numerous lab tests for verifications. Mind and brain cannot be tested similar way. When it comes to biological model and interventions, they are normally used to remedy dyfunctioning body parts. The replacing of infected body parts is a medical achievement, but as mentioned, it cannot be applied to the brain and mind. Allow me to elaborate further on what I mentioned earlier. If you suffer from some kind of physical ailment, medical doctors have to put you through a series of lab tests; for instance, taking your urine, blood, saliva or tissues to diagnose your medical condition before administering drugs. Doctors’ use deductive principle, ruling out hypothesis against various tests before making any concrete diagnosis. But psychiatrists do not have those possibilities and there is a considerable level of risk factor involved when making a diagnosis.
What about the revolutionary brain image technologies? The new brain scans machines do not tell much. The biology of the brain does not give enough data to make deeper analysis. The only way doctors can treat patients is by listening to your emotions and behaviour and then treat you with some kind of anti-depressants and how scientific is this? The entire act is nothing but reducing a unique individual to mere ‘disorder’ and treated with medicalization. This is also another way of saying that applies psychology do not have a treatment process that include root cause analysis, performance enhancement, self-help, and ergonomics.
When a doctor prescribes some kind of drug, they almost always give the assertion that the condition that you have is due to a chemical imbalance in the brain. Most patients do think doctors and tablets they prescribed have sure shot answers and cure you from all emotional turmoil. The answer always lies in you, if you trust the doctor and tablets; they can have a placebo effect, no doubt. As I said earlier, if doctors tell you otherwise, it does not sound right either, we have gotten accustomed to the idea, and doctors have gotten the same idea that sending a patient away without a prescription is a job half done.
The above is not the case for all, but there is an established culture one cannot deny. Say, if a doctor writes an antibiotic prescription every time you visit a doctor, after some time your body becomes resistant to that antibiotic or your natural immune system slow down. Likewise, temporary life crisis, stress related conditions do not always have to be psychiatric conditions that need to medicalize and doing so weakens our natural inborn ability to deal with psychological issues which give a character or personality its strength.
There is little evidence to support the drugs affect basic motivations, perceptual process and sometimes even underline factors behind anxiety and pathological disorder. Not only that but also this position has called us to perceive our mind and body differently. Can a simple tablet cure our personality structure and hormonal malfunctioning and bring us to feel better almost instantly? How can this be so simple? What are the long-term effects when the brain gets accustomed to adjusting chemicals imposed by drugs?
We are born with capabilities such as cultural influences, interpersonal influences, self-improvement and forward thinking. Can this process be encapsulated to a tiny pill? A tablet to keep our symptoms controlled, fix our personality structure and hormonal malfunctioning and bring us to a state of feeling good. Usually we opt to listen to our doctors, we hold on to those tablets prescribed by them as if our life depended on them. But we leave the doctor’s room not knowing the reason what is causing that hopeless feeling. Why should you; tablets have the answer—short, sweet and extremely cost effective method for health care sector. Why intervene with such a model?
Concluding this section, I must say that our brain anatomy is designed to function a certain way under different emotional conditions and every individual has a proportionate amount of stamina to do so unless a person suffering from personality structure disorder. Our way of accumulating experiences, interpreting them, level of vulnerability therein has an individual character so does the condition of our mind. The condition of one’s mind cannot be generalized to classify a person who has a distressed mind or shows apathy or hopelessness using a universal yardstick as our personality structure is organised differently. Doctors need to study a wide range of complex behavioural activities in a patient by looking into multifaceted levels. The mind is contextual, so do our brains—is phenomenological. Moreover, according to good old Freud, bad moods cannot be called true depression in psychiatric sense. Mild depression, anxiety, panic attacks, feeling low and worthlessness are feelings we all feel time-to-time, just like flue or cold. Healthy doses of them help us to reconstruct our life and build our mental immunity. Nonetheless, the world in which we live today seems to be looking for an easy way out and following a different direction, of course, with the help of those who have power and knowledge. In that context, it is important for us to ask why increasingly medicalizing of human minds was not subjected to deeper analysis and whose responsibility to do so?
The Diagnostic and Statistical Manual-Psychiatrists Bible
I think it is pivotal to the call to provide a brief overview here of the DSM the Diagnostic and Statistical manual of Mental Disorders. The DSM includes 16 chapters and 947 pages that address various kinds of disorders. To name few: cognitive disorders, substances related disorders, psychotic disorders, mood disorders, anxiety disorders, sexual disorders, dependent personality disorders, voyeuristic disorders and adjustment disorders to name a few.
The latest version DSM-5 were released in 2014 with an update findings from genetics and neuroscience. There are 297 disorders in the DSM-IV manual. According to many scientists in the field some of listing of disorders in the Manual is highly misleading. According to this author many of the disorders are behavioural manifestations as well as has a sociopsychological character and not only that certain behaviours are mistaken for symptoms and often lead to erroneous diagnoses. This is to say that there is a great deal of controversy surrounding DSM. The Manual itself can be categorised as pathology. Although the lack of scientific vigour and validity of DSM disorder categories is on the rise, but there is no paradigm shift in the latest psychiatric bible, which is the DSM -5.
The DSM is a registered trademark belonging to the American Psychiatric Association (APA) and its universal classification methods helps medical persons to administer available pharmaceutical that was thought to have some kind of positive reaction of various mental conditions. Many countries adopted the APA Hand Book to treat their clients and never question the problem of universal disposition of the manual. How it is possible one classification in general can be used to single patients’ in particular? Such questions were never probed. The amount of various kinds of chemical subsistence released to the market is normally meant to adjust most important anatomy in our brain and mind, is directly corresponding to the Manual.
When I was doing my research on children with special education needs in a few schools in Stockholm, I noticed teachers and schools work hard to make diagnosis of children. Parents usually give their consent. With the diagnosis I noticed that students capabilities have tended to get lost. Special teacher that was supposed to give attention to the student finding it hard to get some kind of cooperation from students. There were incidents of aggressions towards the special teacher as students do not want to feel pointed out or different from others.
For instance, in the case of school children, diagnosis is a must for schools to apply funds for supporting staff. Schools are tacitly looking for answers for children whose behaviour seem odd, in my opinion, through a malpractice system. Pathalogising children prepare them for a different kind of life and adversaries of such system go quiet, there is always an economic factor behind such established malpractices. In addition, school psychologists, and doctors are too quick to judge something as dynamic as the human personality. As mentioned, diagnostic categories may give the person some kind of relief, but far reaching consequences were not accounted, as it should be.
Ironically, diagnoses based on such manuals soothe our minds, especially when we are being confronted with uncertainties. Our mind simply does not like uncertainties, and craves explanations, and when doctors and patients have no way to account for symptoms, they can feel out of control. As patients, and parents of children who had been sorted out within the school system share the similar feelings. The uncertainty also tends to make all kinds of inbuilt diagnoses and we feel some kind of reassurance when doctors or school psychologists make a diagnosis. Which is often using the DSM manual, and in this context the DSM is a handy tool for these professions and its many flaws were not taken into consideration. Parents or teachers are not conversant with what kind of methodology doctors use to make such diagnose. There were many questions not asked or answered, but both parties are happy having an answer—make a diagnosis.
I mentioned earlier that mental strength that we have so well proportionate to satisfy most of the hurdles we face in life, but labels under estimate this inborn strength in us. According to my own experience and my observations and depth studies in the field, and listening to my own clients as a therapist, I noticed that by understanding this inborn strength one could minimise the medicalization of the mind. First of all, it goes without saying that a person suffering from mental pressure, emotional set back, the feeling of hopelessness owing to many reasons requires a schematic investigation before classifying. This goes with children that were quickly identified as suffering from ADHD. But such schematic investigations are costly, and time consuming. As said, psychiatrists are doctors who treat sick bodies with medications. There are little therapeutical healings, one can expect from them. This is however not the case for all.
The recent influences from neuroscience, particularly after the technological development of brain scanning machines that helps to profile images of the brain, although such technology helped in many areas, but it also leads practitioners to become more apt to look at the brain to find mind problems. Psychology revolves around Natural science and that also means the phenomenology that is meant to understand human behaviours that are predominantly based upon the methodology that has an experimental nature (laboratory conditions). When it comes to experimental data to test hypothesis in a controlled laboratory setting, usually such begins with a specific problem, construct a hypothesis, and controls the conditions for the verifications of the hypothesis which is in a way typical for positivism (natural science methods). Obviously the positivist approach per se in psychological investigations can have a number of problems and some of them I have already discussed earlier. Unfortunately the psychology of knowledge is largely influenced by such laboratory studies, but there are other ways these lab studies can be strengthened.
The humanistic perspective, which is the conceptual framework of this book focuses on these ‘other ways that lab results can be reinforced, that is a holistic approach, which combines external and internal factors, associated with the mental process of a ‘whole person.’ Unfortunately there are tensions between positivist perspective and humanistic perspectives within psychology. Although positivist and humanistic approach both may share commitments to the ideals of psychological well-being but they represent fundamentally different approaches and methodologies to understand and treat psychological setbacks of individuals. Concluding this section, psychology needs to wake up and move away from claiming that discipline belongs to the natural science and move forward to embrace the opening up to such probes that postmodernity and humanistic psychology demands. The predicament that lays out in the rest of the book provides several avenues to address these problems using ethnographic work done in different mental health facilities.
DSM and Absence of Root-cause Analysis
Continuing further on the DSM, according to Burr is socially constructed. What does he mean by that? People are nothing but diagnosis of some kind of pathology and pathology is in the focus when try to find answers not the individual. The mental health care practioners have become victim of these powerful apparatus and various psychopharmaceuticals recommended by these manuals against different pathologies. Such prepare them to an instrumental approach to treatment. Admittedly, many diagnosis codes based on the DSM coding system which provides a wealth of information for medical personal, this way of working, as mentioned, is cost effective and durable but it lacks the care and cure.
According to the information at hand, the majority of data used in the manual was compiled from discharged in-patients who were admitted to hospital for several mental conditions. Such data are least appropriate for patients who seek services for outpatients in clinics. Moreover, the out-patients units’ doctors work under a certain time pressure, as such, they do not have enough time to collect contextual data that is necessary to encapsulate and assess what is really the matter with the patient—a root cause.
The neo liberal models of economisation of doctors' time invariably affecting the practice. Absence of root-cause analysis not only increases the chances for misdiagnose. It also increases the population that can be addicted to psychopharmacology as well as recurrence visitations to doctors. Such were not always accounted. In this context, I am not wrong to say that since assessing problems, framing problem, critical reflection and analysis therein that need to be included in the treatment process is largely omitted and it costs more money for taxpayers.
Going back to the system of classifications, putting mental setbacks into different categories according to my view is damaging like any other human sorting. Modern classification of mental illness grew out of the work of the German psychiatrist Emil Kraepelin (1856-1926), who divided mental illness into categories for the sake of research. In fact, we have always been a classifying animal. The appetite for arranging the world into patterns was a contributing factor in the development of the natural sciences. With amidst of complexities and confusions, the order and categories give some kind of exactness, perhaps satisfying. The category mistakes occur when one tries to apply a conceptual category to a given problem, when in fact, that conceptual category simply does not belong to the problem at hand yet trying hard to fit into it.
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