Smoke and Mirrors (3) Denormalising ‘Normal’

“De-normalising Normal”

Well, since this is my blog, I thought I’d take it somewhere different this week. In the tweet world that I have recently joined – and am I glad I joined it – there appear to have been a lot of conferences? Conferences big and not so big, and with what appears to be a common theme (that may just be my understanding) running through them.

What is that theme? Well, it appears to be the theme that people living with ‘lived experience’ of mental health, are, still, not being listened to. There is still an almighty power vacuum between SUs and those who hold sway over how the clients ‘distress’ is both viewed and acknowledged, and then treated.

The power imbalance is enormous, unhelpful, frightening and above all, wholly unnecessary, it seems to me. If people listened to each other, a lot of people could be spared a lot of grief and trauma and retraumatisation. Possibly a lot of professionals would also need to come down off their high horses, take a bucket and shovel and clean up after themselves…

So, as someone who isn’t an SU; who isn’t struggling with distress or the lived experience of distress, rather, who is a counsellor and therapist, I thought I might stick my oar in and test the water.

You might want to know that I’m a social scientist (courtesy of my teaching degree) who happens to also be a solution focused brief therapist, a clinical hypnotherapist- Ericksonian – (UK registered), all learned later in life,  and I was a special needs teacher specialist (social, emotional and behavioural issues, as it was called then, for 30+ years). Although I started out teaching humanities (history and geography) and that almost killed me.

My MA is in Inclusive Educational Practice and Curricula, and I spent a number of years working in young people’s secure settings. I’m also trained as a Restorative Justice and Practice practitioner and trainer and have worked across many schools as an RJP facilitator and trainer. I am also registered as ‘differently abled’ and have been, all my 65 years.

I am sorry (irony alert), that I don’t have a psychology background; mine is fully grounded in the sociology of ‘deviance’ (sic) and how we can learn to learn to include those who have this label applied, that is, anyone who isn’t ‘normal'(sic) … to me, I guess, by definition, if you’re not regarded as normal, then you must be deviant, somehow. And sadly that seems to be the milieu in which so many people who struggle with mental health distress, are stuck; being ‘not normal.’

I wonder, therefore, given my background, whether it would be ok to refer to myself as a ‘social psychologist’? Enough of that for now…

I guess it will probably be helpful to have an idea as to how the world views the labels ‘normal’ and ‘abnormal’ (or not normal, or deviant, or some other, value-laden label), so that we’re all on the same page. Remember, please, that labels are socially defined, by those with the power to get labels to stick. We call these labels, ‘ascribed’ – someone telling someone else ‘you are x, y or z’.

NORMAL:

(c) Arthur Edelman

Okay, the picture above is a representation of what people (I say that advisedly) might think ‘normal’ looks like. However, in a short while we will have a closer look at what the difficulties of defining ‘normal’ might have to say about the concept. And, before we go any further, it is a concept, not a ‘truth’. One person’s normal is definitely another person’s not normal.

I’m going to start by giving rein to my social science background. As I said earlier, I would like us to agree a definition of  what ‘normal’ might be, and what its opposite, ‘not normal’, might be thought of as?

Throughout time, it seems to me, different people have labelled different actions as normal or otherwise than normal. And, if we accept that premise as a statement of ‘fact’, we might ask ourselves a further two questions; who is doing the labelling, and why?

One  of the great writers on ‘deviance’, a sociologist called Howard S. Becker, who was said to have founded a theory called ‘labelling theory’ will explain his thinking shortly; in his thinking he uses the same medical analogy that modern psychiatrists had started using in the early 2oth century – the suggestion that ‘deviance’ or ‘abnormality’ was pathological, within the body; an ‘illness’. So, Becker puts thus:-

“…A less simple but much more common view of deviance identifies it as something essentially pathological, revealing the presence of a “disease.” This view rests, obviously, on a medical analogy. The human organism, when it is working efficiently and experiencing no discomfort, is said to be “healthy.” When it does not work efficiently, a disease is present. The organ or function that has become deranged (abnormal – my choice) is said to be pathological…” (Becker, H, 1963, 1966, 1973, 1991).

You should note that he is not on the side of pathologising deviant behaviour at all, as the next bit will clarify.

Beckers style of sociology is called ‘interactionist’, that is (using Wikipedia) to help us be on the same page, since it is universally accessible:

“…In sociology, interactionism is a theoretical perspective that derives social processes (such as conflict, cooperation, identity formation) from human interaction. It is the study of how individuals shape society and are shaped by society through meaning that arises in interactions…” (Wikipedia, accessed 07/10/2018 on-line.)

Which is also helpful to us since interactionism tells us that ‘normal’ is amorphous, WHICH, however, comes to mean behaviour which the majority of people regard as acceptable behaviour;  that which is NOT an infraction of the rules in some way. So, normal behaviour is socially acceptable, in other words?

And interactionism works because we need to understand things in a common-sense way and have the same views. Think about it, for a moment.

So, if you drink alcohol and get drunk, how different is that from smoking a spliff, snorting cocaine or doing other drugs and getting high? Well, we ‘know’ that getting drunk is something that lots of people do, they pay their taxes (duty) on the alcohol and some perceive it as a rite of passage. It only becomes a problem when someone becomes addicted to alcohol and ceases to function as a ‘normal’ colleague, husband, wife, father, mother etc.. other than that, what’s wrong with letting your hair down at the weekend?

Smoking weed, or crack, or using other drugs, on the other hand is regarded as de facto deviance; absolutely ‘not normal’ and something usually done as an outcome of criminal behaviour; that is, of illegal dealing, obtaining and end user using. No duty is paid, suppliers are usually gang members and the whole chain is seen as highly criminalised, never mind that it might be an individual using a couple of joints to relax after a busy week at work (or perhaps a line of cocaine, etc. for the same reason)

Either way, and some might regard these as simplistic examples, both things are defined differently, by different people and in different societies. The use of marijuana in some countries is legal and in some ‘decriminalised’. Alcohol is largely freely available and not at all illegal (other than in most Muslim states). So, we begin to see how interactionism helps trickle down ideas of normal, not normal, which is so defined by those with the power to do so; the phenomenon becomes understood in a ‘common-sense’ way and is viewed as such by the majority of people within particular societies across the globe.

(c) John Baker

(used with permission from unsplash)

Righto, Allen Frances, who was chair-person of the group who came up with DSM-IV, has written a great book, challenging those who have it that mental health is only ever biological; that it can be diagnosed  and can then then be cured with pills, as with other pathalogical illnesses.

He says this, right at the start of the book: ‘Normal is losing all purchase— if only we look hard enough perhaps everyone will eventually turn out to be more or less sick…’ (Frances, A. 2013 p:3). Perhaps, we can but hope, not that everyone turns out to be sick, rather that we understand that everyone else isn’t, necessarily, ‘normal’ (sic).

You might well ask is this a good thing, or a very bad thing? And I suppose my answer would be, ‘it depends’ … As I understand it, the hopes around the DSM manuals (and DSM is shorthand for ‘Diagnostic and Statistical Manual), were that it could provide assistance to anyone who felt distressed, by allowing the psychiatry business to say what could be done to address that distress; make it better in other words.

It was with DSM-III (according to Frances) a ‘…very fat book that quickly became a cultural icon … and the object of undue worship as the “bible” of psychiatry. … (which) sets the crucial boundary between normality and mental illness …’ (ibid p:xii).

Problem is, as Frances says, ‘…The lesson is clear— we have far too much faith in pills, far too little trust in resilience, time, and homeostasis… (ibid p:33). Thus we create deviance where there was none, and we create ‘normal’ where it might not be warranted. As with everything in social and cultural life, it ALL depends on who is doing the labelling, and why. Which, questions are important because, the ‘power to label is the power to destroy …’ (ibid p:109.

Why would he say that? Generally, he holds that we, as human beings are hard-wired into being able to show compassion only for those who are like the majority (so called). This has a knock on effect of those who are labelled – that is, the not ‘normals’ amongst us, feel not only that we don’t fit, but that we are ‘damaged goods'(ibid p:109) with all that that implies..

And this damaged thinking, that often comes from being not only misdiagnosed, but also from being diagnosed at all, can lead to what are known as ‘self-fulfilling prophecies’. If you are …’told you’re sick, you feel and act sick, and others treat you as if you are sick … (and whilst) the role of being sick can be enormously useful when someone is truly sick … but the sick role can be enormously destructive when it reduces expectations, truncates ambitions, and results in a loss of personal responsibility…’ (ibid p:109).

So, are examples of ‘damaged thinking’ (cf:above) that is, ‘self fulfilling prophecies’, simply down to language games; or something more pernicious and scary?

Personally, I think  the language games that some people are given to playing ARE pernicious and scary, especially when they are used to maintain a status quo, or rather, the status quo of the  holders. As Harré has it, “…’people are what they believe they are’ … and what they believe they are is what the best authorities tell them they are …”(Harré, 1989, in Shotter, J & Gergen K, J, Eds, 1989 p:22). Now, he then goes on to explain that he is also aware that other natural belief systems also give rise to people believing they are what they think they are. And to my mind this is true. The media, in all its  forms, is one way through which this happens.

However, it is also my contention that we also have to look at “… The concept (that, my addition) the person as a relatively autonomous self-contained and distinctive universe is said to reflect the sham and illusion that is the bourgeois individual, not its reality … for the … bourgeois individual (and others, my addition), whose integrated wholeness, unique individuality, and status as a subject with actual powers to shape events has become null and void…” (Sampson, E.E 1989, in Shotter, J & Gergen K, J, Eds, 1989, p:3).

Because, neither the individual nor society exist separately one from from the other: “…Rather, society constitutes and inhabits the very core of what passes for personhood: each is interpenetrated by its other…” (Sampson, ibid p:4). Society is a primary agent for social development, learning the rules etc., (I will talk about the role of education in a later blog).  And is the stronger of the two phenomena, personhood and society, despite the apparent freedom we have to believe that we can, somehow, shape our own future.

We believe that we have agency, can choose x.y or z . However, Mead explained, almost 100 hundred years ago that this is fallacious, but good news if we can get a complicit and compliant society to follow on, just for now. As Mead says “… We are continually interpreting what we see by the something that is represented by possible future conduct. So, to understand what is appearing in experience, we must take into account not only the immediate stimulus as such, but also the response…(Mead, G H, 1936, in Strauss, A. Ed, 1956 p:68).

Now, some of you may happen to read Mead and may well read on in the tome cited from above; and be surprised to read that he talks about behaviourist psychology, about conditioned responses, such as Pavlov’s dogs did.

And, I guess you might think I’m peeing up the wrong tree (no pun intended). Except I don’t think I am, it’s just that it’s not fashionable to regard people as being conditioned into behaving in certain ways. Yet the evidence is all round us – see the rise of the anti-immigration movement, white supremacy etc.  Ad agencies thrive on getting us to change and or at least, modify our behaviour; as do politicians and others of all stripes.

Anyway, I digress. Chomsky (2002) suggests that this has to do with who is allowed to identify a particular social, or political need, and about how that need is disseminated, in the appropriate way, to the masses (us).

One way of doing this is for those with power, (them), to convince those without power (us) that it is democratically useful if the masses are “…barred from managing of their own affairs…”(Chomsky, 2002 p:9) whilst the management and ownership of information must be tightly controlled (ibid, p:9).

And to do this we need to have a “…’specialised class’ of ‘responsible men’ who are smart enough to figure things out” (Lippmann, 1922 in Chomsky, 2002). Especially as he regarded the masses as a ‘bewildered herd’ (Lippmann, ibid p:9) whose role was to support the specialised class by voting them in, and then just becoming spectators. And so, I believe, it is with the modern take on psychiatric diagnoses, and things like DSM-V.

The doctors know best and we don’t; except we are now suffering from the greatest exposure to iatrogenesis we have ever been exposed to. Illich explains: “… physicians insist on the obvious: namely, that medicine cannot be practised without (my emphasis) the iatrogenic creation of disease. Medicine always creates illness as a social state…” (Illich, 1977, p:44).

Thus, if the psychiatrist diagnoses you with an ‘illness’ there must be an illness to diagnose, and one will be created – this is called iatrogenesis. This then legitimises the behaviour of the physician in treating that illness, so called. So, the physician decides what normal is or isn’t and what must, should, ought to be done about. From incarceration to ECT to tablets for whatever the iatrogenic illness you have is.

It is nearly all smoke and mirrors and the snake-oil salesmen continue in business and we still have to take ‘normality’ back; this is why we must ‘de-normalise’ normal.

You may be pleased to know, there is more to come.

 

References:

Becker, H, S.  (1963, 1966, 1973, 1991) Outsiders: Studies In The Sociology Of Deviance   The Free Press Simon & Schuster New York

Chomsky, N (2002) Media Control: The Spectacular Achievements Of Propaganda (2nd Edition) Open Media  Seven Stories Press   New York

Frances, A. (2013) Saving Normal   Harper Collins New York

Harré, R. (1989), Language Games and Texts of Identity, in Shotter, J & Gergen K, J, Eds, 1989  Texts of Identity   Sage  London

Illich, I, (1977) Limits to Medicine, Medical Nemesis: the Expropriation  of Health  Marion Boyars  London

Lippmann, W (1922) Public Opinion in Chomsky, N (2002Media Control: The Spectacular Achievements Of Propaganda (2nd Edition) Open Media  Seven Stories Press   New York

Mead, G H, (1936), in Strauss, A. Ed,  George Herbert Mead On Social Psychology  1956   University of Chicago Press   Chicago

Sampson, E.E (1989) Deconstruction of The Self, in Shotter, J & Gergen K, J, Eds,(11989)  Texts of Identity  Sage   London

 

‘Smoke and Mirrors’ (2)

Part 2:

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.

Paul

References:

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

 

 

 

Mental Health – If You’re Struggling, Do You Have Any Idea Why? Are you Medically Ill?

Are Mental Health Issues The Same as Everyday, Medical Illnesses? If not, why the hell do we treat them as if they are?

Are issues to do with mental health treatable in the same way as regular, physical illnesses are?

Evidence suggests that treating mental health as you would physical health is the last thing you want to do.  Why?

Well, (long and drawn out) Meds to treat mental ‘ill-health’ (sic) have, as a side effect, the fact that they cause, err,  depression and anxiety, amongst other issues. Oh, and have and do lead to suicidal tendencies and thoughts… in some people …

And I certainly am a long way from being alone in believing that we should NOT ‘… use the language and logic of pathology to frame psychological problems …’ (Thomas & Bracken, in Rapley, Moncrieff & Dillon Eds. 2011 p 13). Especially where pathology is to do with ‘disease’ and the Royal College of Pathologists, who describe pathology as a ‘bridge between science and medicine’, appear to be giving pathology some kind of reified, determinist qualities it doesn’t deserve. We need therefore a different idiom (if that’s what is felt is needed here).  In other words, we should NOT BE USING a medical model to describe or diagnose mental illness (the word ‘illness’ is not attributable to, nor should it have a place within, the psychological lexicon).

However, the use of the medical model, is the one favoured by psycho-therapies currently in use in the NHS, especially where such therapies are ‘evidence based’ (Dallos, in Rapley et al, Eds. 2011). Especially where ‘evidence based’ is taken to mean research and therefore science based and thus forming the bridge between etc., etc., (see above).

In the medical model, in the NHS, my understanding is that such as DSM V (see earlier blog) and the WHO handbook of mental health and disease (earlier blog) are used to provide diagnoses. Which, given that it is our belief that psychological unwell-ness is not biologically determined (of an interior origin) but is rather the result of socio-economic and other environmental factors acting externally, would seem fairly counter-intuitive. If the causes of such unwell-ness, as I’m thinking of it, is external, how is a pill, administered internally and acting upon goodness knows what (the brain) going to help?

Thankfully, there is evidence that it is possible, in “…helping to reveal and resist madness-making (sic) paradoxes and practices of the mental health professions, and … to show how these (paradoxes and practices – my addition) are shaped and maintained by wider regimes of societally based inequality and oppression…’ (Dallos, in Rapley, et al (Eds.) 2011 preface).

As Dallos concludes his preface, he asks a rhetorical question; a question I have been asking asking myself for a good while – as a teacher, as a counsellor and latterly as a certificated clinical hypnotherapist; and I thank Rudi for asking it: “…If professionals like me can so easily be ignored by the medical professions what hope for the many who are less privileged?” (Dallos, R in Rapley et al, Eds., 2011 preface)

Don’t go away – there is more to follow …

Paul