I figure it’s appropriate to finish out the year with another barely cohernnt rambling complaint#2016
Why are individuals privileged by mental illness?
The mainstream understanding of psychological disorders is the biopsychosocial model; this model sees disorders as originating from a combination of factors: genetics and biology, cognitive patterns, and social milieu. Each of these locates the disorder inside of the patient in a non-trivial sense – the difference between being substrate and source. The first two, biology and cognition, do so obviously, but the social aspect seems to transcend the patient so, to avoid looking like an idiot, I’ll suffer elaborating. The short version is that the social is reduced to interactions with people, and abandons any structural analysis; the patient is an independent unit bumping up against other units rather than a being inseparably coupled with its lifeworld. Understand this and the rest is obvious, so may as well jump right in there. I’m sooooo excited.
There is no moment of birth, only a process of becoming; long before delivery, medical experts sex and gender us by ultrasound, instantly attaching a host of social norms, opportunities, and expectations, but there are also more subtle factors – such as being conceived in a caste system, or possessing a royal bloodline, or being the child of a celebrity. We exit the womb inseparably coupled to a preexisting environment. We act and are acted upon, and we create our world while simultaneously being created by it — we freely act, but options seen and options available are both restricted by how we are situated in the world. For example, the invention of camera phones has fundamentally transformed experience – unlike cavemen, when modern man comes across a beautiful waterfall in the wilderness he comes across a photo-op. Hell, even that ‘wilderness’ was created, demarcated by off-limits signs, gates, and trails.
Look at how we would approach the 420-for-lyfe question of who am I? The ability to ask this question already comes with an understanding of what an ‘I’ is. Contextualized by setting and social norms, only certain types of answers are allowed. One is a male, an accountant, a father; the response, if it does not directly name a role, will immediately attach itself to one. When an identity is asked of us by another, our answering is an engagement in mutual self-affirmation – our relationship to a role is endorsed in utterance and legitimized in its acceptance; our understanding of ourselves is always pointed outward. Contrary to being separate human units interacting with our sociocultural milieu, we are to some degree constituted by it.
Mainstream psychology is necessarily unable to accomodate this conception of a human being. Its model of psychological disorder requires the human being’s abstraction from his lived circumstances – this process is unavoidable; after all, the entire goal of the DSM is standardization. In standardization disorder must be causally internal to the patient, as there is something, euphemistically, ‘abnormal’ about his mind; this replaces the actual human being with an imaginary one, swapping a uniquely situated social organism for an instrumental fabrication. We can see how this plays out in practice: the patient always presents himself to the psychologist as an individual – there is nobody else in the room – and there can be no ‘scientific’ treatment if the professional does not take this appearance as the actual; likewise, there can be no treatment if the necessarily subjective symptoms of the patient are not quantified – the medical file becomes a collection of surveys (3/3/2014: patient’s mood was neutral (5.5)) and efficacy is reflected in the peaks and valleys of charts. One can imagine – unchanged – the same technique applied to robots.
This difficulty seems insurmountable for the overloaded psychiatric professional who does nothing more than prescribe drugs based on photocopied questionnaires – regardless of their desire to have an in-depth, psychotherapeutic relationship with the patient. In the United States, at least, the psychiatrists privileged enough to have that sort of practice are very, very rare. But what about psychotherapy generally? Therapy involves a deeper, more personal understanding of the client, and the practitioner learns in detail – for better or for worse – about the patient’s friends, family, workplace, dreams, failures, etc. Unfortunately, in the mainstream, this individualized understanding will not translate into practice – at least not in the sense required. Evidence-based treatment, highly desired, will run this relationship through psychology’s interpretive framework – the patient’s situation is then understood in and reduced to the context of standardized research, diagnostic manuals, and conferences. The popular cognitive behavioral therapy is an excellent example: treatment becomes repairing irrational thought/behavior patterns of the patient (on top of this, it’s intended to be a short term, fix-this-please treatment!).
People will say that depression is just a ‘chemical imbalance,’ and that medication is designed to correct this imbalance. To be forgiving, this likely stems from a desire to reduce stigma (it’s not being weak), and I’m sure/hopeful no practitioners actually believe this, but it is mistaken as hell. We know about neuroplasticity, and we know that in normal situations the chemicals produced by the body happen to be related to the outside world (pure magic, obviously). Your ‘chemical balances’ might change when your cat dies, but they are not the problem. I can’t even right now. Fast illustration: if someone tells you love is just chemicals, they are being dumb. It’s the same concept.
Thoughts are private. But remember above, when the waterfall was intrinsically a photo-op? Thought patterns shouldn’t be thought of as belonging to an independent individual; as language is a social activity, so is thought. In those olden days people would dress in black to represent being in mourning – an understanding of their feelings and themselves in social symbols/[better word choice here]. The principle is the same today – when a depressed person puts on sad music, what are they doing other than participating in a cultural ritual, understanding themselves as depressed by consuming certain content? Same issue as everything else: how can you justify privileging your thoughts as a personal disorder when they are so interdependent? OK I am bored with thiscarp. It’s all the same problem.
The Role of Medication
Pharmaceuticals have effects, and sometimes they are required. A lot of the above mentioned issues aren’t reformable, and what mental health treatment looks like is contingent upon various social systems, structures, and institutions. Nothing’s going to change. It will get worse though. The ideal situation is drugs for acute crises in order to prevent injury to self and others, but they are not any sort of treatment for the disorder. There are always exceptions, but most people are not suffering from depression because of biological constraints; however, it’s often the case that the non-biological constraints are just as deterministic. 😦 (You try being happy working 3 Taco Bell quality jobs simply to avoid starving)
Apologies to all the science and fields I shamelessly misrepresented. But come on, look how short this is – what do you expect? Ilove you all, promise.
 If you assume (standard) that cognition takes place wholly within the body.