It is my intention to use the word ‘distress’ to refer to mental ill-health throughout. This seems safer as the use of mental ill-health seems such a loaded descriptor and somehow suggests an equation with ‘sickness’. Distress, on the other hand, implies a range a sensations – from mild – to – severe.
(c) Unsplash, Morgan Basham
I also have no wish to be seen as someone who denies that biology may play a part in distress, and it is beyond the scope of this blog to say much more just now, except that, Cromby, Harper and Reavy (2013) have explained my thinking in such a way that it will be helpful to cite some of their thoughts here, thus:
“… (it is) not that biology is irrelevant to distress, but that, in most cases biology does not seems to be the primary cause of distress … overall patterns of biological features (are not) .. present in every person given a particular diagnosis, and none… is confined exclusively to persons given that diagnosis. Indeed, some are observed in people with NO (my emphasis) psychiatric diagnosis whatsoever … (and)… Whenever it seems as though a primary biological cause of distress might have been identified, alternative explanations are always available, contradictory evidence is always present and methodological errors … are relatively common…” (Cromby, J. Harper, D. & Reavey, P. 2013, p:78)
This post will show how it is that we are told that distress is a pathological phenomenon and how and why it is that this idea was promulgated by the medical profession initially AND thereafter by the pharmaceutical companies. We will be coming on to look, in Part 3 at Big Pharma and how these ideas have gained prominence over social context and social constructs.
The ‘smoke and mirrors’ of the 21st Century will be becoming clearer; I hope, especially in regard to issues of mental distress. And, in time, you may never look at things the same way again. I fervently, and hopefully believe you will begin to understand, once armed with the truth, that you DON’T have to experience distress in the way you do, and the best way out of the struggle is to talk to someone, not to take expensive and unnecessary medication.
So, let’s start from the beginning. Jacqui Dillon, who has lived experience of distress puts the notion of being unwell into its real context when she explains “… the experiences, feelings and possibilities of our personal lives are not just a private matter of personal preferences and choices but are limited, moulded, defined and delimited by the broader political and social context…”(Dillon, 2011 in Rapley, et al, 2011 p:141).
Jacqui here, is actually referencing her belief that the ‘personal cannot be, ever, other than politically developed’ (ibid, p:141), and she links this awareness to her recognition of the efforts of women’s liberation during the 1960s. Those of you who are aware of Jacqui’s back story will know that she was abused, sexually, physically and emotionally and that her experience of distress arose from this, and the chapter referenced in the previous paragraph tells her story.
There are a number of sub-plots to the ‘smoke and mirrors’ story, which is just as well since this blog is episodic, rather than book length.
In due course, I will be releasing the blogs already written as podcasts, and from that point on offering both blog and / or a podcast will allow subscribers to choose which format suits them best. I hope you like what I am trying to do, by the way.
(c) Unsplash, thanks Morgan Basham
We can all be forgiven for thinking that knowledge is objective, true and out-there; stuff for us to learn; be told about, to read about, to grab on to and to ‘KNOW’ and so on. However, the rub is that like most other aspects of social-life, knowledge is a social construct.
As Bruner suggests, the reductionist thinking behind, for instance, the science of psychology, leads us to view issues of the mind as simple; merely a matter of “…causal explanation and prediction..” (Bruner, 1990 p:xiii), leading us to know why they might happen, once, and then again, and again some more, relentlessly.
In the first part of ‘smoke and mirrors’ I cited work by Mary Boyle about the psychiatric and psychological refusal that exists to include context as important when thinking about distress. In this blog, Bruner adds to our thinking, I believe, showing that context is important, when he explains that if all we seek to do is ‘insist upon explanation in terms of “causes”, (this) bars us from trying to understand how human beings interpret their worlds, and how we interpret their acts of interpretation … if … the object (is) the achievement of understanding, why is it necessary … for us to understand in advance of the phenomena … especially when … a … causal explanation forces us to artificialise … to a point almost beyond recognition …?'(ibid p”xiii).
As Scheler has it, there is “… some sort of relationship between thought and an ‘underlying’ reality other than thought …”(Scheler, in Berger & Luckman, 1966, p:18). So, to my way of thinking, ‘thought’ as referred to above, is the (putative) ’cause’ of the distress, and the ‘reality other than thought’ is the reality of the context in which the thought is had, and that is the reality of the distress; not in its manifestation, rather some other factor (context) that facilitates the distress.
Reality, says Anselm Strauss of George Herbert Mead’s thinking, ‘…is always in the present, that the past refers to “that conditioning phase of the passing present which enables us to determine conduct with reference to the future which is also arising in the present” (Mead, In Strauss (Ed), 1977, p:xxix). So reality is now; it (reality) has been shaped by the past, just as the future will be shaped by what happens in the futures current present. Context cannot be ignored, and the present is the only place that we can assess whatever it is that ails us. And without acknowledging context we cannot hope to begin to make sense of whatever is happening – and neither can the psychiatrist.
And this has been the fundamental problem that has dogged science for ever, as far as I can see: science’s Procrustean mission to make things fit some strange theory held by someone about something. In the case of those for whom this blog is intended, that is those people who have received a medicalised diagnosis which tells them that the answer to their distress lies in some mythical pathology, that the fault lies with them and some quirk of psychological ‘fate’. An internalised quirk at that: innate and determined by our genes or some other, ‘natural’, predisposition.
Wilhelm Greisinger, the German known as the founder of biological psychiatry decided, in 1867, that ‘…patients with mental illness were individuals with brain or nerve diseases. In Vienna, Theodore Maynert, who taught Freud, was more interested in the frontal lobes of cadavers, than his living patients…’ (Appignanesi, 2008 p:107).
In the same year (1867), Henry Maudsley published ‘Physiology and Pathology of Mind’. Maudsley was a ‘…proponent of the physical basis of all mental illness …’ (ibid p:108) as well as someone who believed that ‘insanity’ (sic) was to do with heredity; and was, thus, genetic in nature.
Steven Rose (1999) explained that the ‘…history of biology, as a discipline, has given excessive authority to reductionism, which collapses higher level accounts, such as social or behavioural ones, into molecular ones. Such reductionism becomes crudely ideological (my emphasis) when applied to the human condition…'(Rose, 1999. accessed 23.09.2018).
Distress doesn’t become more ‘determined’, by internal factors, than these two men, Greisinger and Maudsley, could make it. You are your genes, and if these predispose you to ‘distress’, then so be it.
Except that both behavioural genetics and molecular genetics have been shown to be flawed in the assertions they appear to allow researchers and proponents in both camps to make.
Behavioural genetics is that science that attempts to study correlations between diagnoses and their relations to genetics. The best known studies of which are, according to Cromby, Harper and Reavey (2013, p:78) studies of twins. However, and I urge you to read their conclusions, evidence shows that the majority of twin studies are ‘flawed’ and significantly fail to show any supposed correlates between genetics and distress, that would allow anyone to use, with absolute confidence, the binary expression, x is present therefore y is the likely outcome. See also (Joseph, J. 2003, ‘The Gene Illusion: Genetic Research in Psychiatry and Psychology under the Microscope’ PCCS Books).
Additionally, we have Molecular genetics, the study of genes using biological tissues, carried out through chemical processes and computerised analyses, which allows for samples to be magnified and then their DNA to be ‘explored’ (Cromby et al, 2013, p:81) citing (Joseph, J. 2006, ‘The Missing Gene: Psychiatry, Heredity and the Fruitless Search for Genes’, NY, Algora). Except that, whilst this move was hailed as the one that would unlock the role of genes in the development of distress, per se, we have, as Cromby et al, say, ‘… No breakthroughs … and if anything the goal of identifying ‘genes for’ distress seems to receded even further…’ (Cromby et al, ibid p:81).
However, having said all this, and doubtless having real people shouting at me and telling me that you “know how I feel, so why don’t you go away” or some such. Can I just add that there is undoubtedly something of the biological in the whole question of distress and it is to be found in what has come to be called ’embodiment’.
Rom Harré (2002) has it that, in looking at the role of biology in distress, if indeed one agrees it has a role, we should, in all likelihood, look at biology not as the ‘cause’ of distress, rather as the ‘enabler‘ of distress. As he suggests, and as is noted by Cromby et al, (2013)…’As humans we are embodied creatures, so there is a clear sense in which the biological systems of our bodies are necessary to enable our experience – all our experience …’ (ibid p:89).
This seems to me to be a reasonable role for biology to take, especially when we all seem to be calling for those who ‘experience’ distress in some form or other to come forward and talk about the ‘meaning’ their distress has for them.
And, if they expect their experiences of distress to be taken seriously, it is not up to me to suggest that the causes of their distress are only to be found somewhere ‘out there’.
However, context is crucial in the causation of distress and embodiment is crucial in the manifestation of that distress. And I say this because our understanding of the meaning of ‘how we feel’ is a social construct. Which will be the theme of my next blog in the ‘smoke and mirrors’ series.
Appignanesi, L. (2008) ‘Mad, Bad & Sad: A History of Women and the Mind Doctors from 1800 to the Present’ Hachette Digital Kindle Edition
Bruner, J.(1990) ‘Acts of Meaning’ Cambridge, Mass Harvard University Press
Cromby, J. Harper, D. & Reavey, P. (Eds. 2013) ‘Psychology, Mental Health and Distress’ London Palgrave
Dillon, J. in Rapley, M. Moncrieff, J & Dillon, J. (Eds, 2011) ‘De-Medicalizing Misery: Psychiatry, Psychology and the Human Condition’ London Palgrave
Harré, R. (2002) ‘Cognitive Science: A philosophical Introduction’ London Sage
Joseph, J. (2003), ‘The Gene Illusion: Genetic Research in Psychiatry and Psychology under the Microscope’ PCCS Books), in Cromby, J. Harper, D. & Reavey, P. (Eds. 2013) ‘Psychology, Mental Health and Distress’ London Palgrave
Joseph, J. (2006), ‘The Missing Gene: Psychiatry, Heredity and the Fruitless Search for Genes’, NY, Algora, in Cromby, J. Harper, D. & Reavey, P. (Eds. 2013) ‘Psychology, Mental Health and Distress’ London Palgrave
Rose, S. (1997). “Lifelines: biology, freedom, determinism”. Behavioural and Brain Sciences (1999) 22, 871 – 921 Accessed on-line 23.09.2018 at www.researchgate.net/publication/12031918
Scheler, M. ‘Die Wissensformen und die Gesellschaft'(1960): in Berger, P. and Luckman, T. (1966) ‘The Social Construction of Reality: A Treatise on the Sociology of Knowledge’ London Penguin
Strauss, A. (1977) Ed, in Mead, G. H. (1977) ‘On Social Psychology’ Chicago Chicago University Press