'Bad Care'
READING 1. Exract from 'Stress, Oppression & Women’s Mental Health: A Discussion of the Health Consequences of Injustice'- Elizabeth McGibbon & Charmaine McPherson
https://tspace.library.utoronto.ca/bitstream/1807/42150/1/12.2.McGibbon-McPherson.pdf
The intersections of the social determinants of women’s mental health (SDH) [...] have a profound impact on the body’s stress managing systems— the sympathetic adrenal medulla (SAM) and the hypothalamus-pituitary-adrenal cortex (HYPAC), both located near the brain. The SAM-HYPAC system is structured to deal with everyday stresses in addition to more acute stresses. The system regulates our bodies through short-term stressful times and helps us maintain overall wellness. The problem arises when long-term, chronic stresses, such as those described above, eventually overtax the SAM-HYPAC system. The adrenal system becomes overwhelmed and is unable to maintain physiological balance. The result is adrenal fatigue. Chronic adrenal fatigue causes depression, obesity, hypertension, diabetes, cancer, ulcers, chronic stomach problems, allergies and eczema, autoimmune diseases, headaches, kidney and liver disease, and overall reduced immunity (Varcarolis, 2013). These physical and mental health outcomes of adrenal fatigue are embodied in oppressed peoples. They combine with social and material deprivation and discrimination to create consistently unjust health outcomes and an everyday kind of physical and spiritual suffering that has gone unacknowledged for far too long.
--
READING 2. Extracts from "Unraveling the Biopsychiatric Knot"- Sascha Altman Du Brul
https://www.mapstotheotherside.net/unraveling-the-biopsychiatric-knot/
There are few things as powerful as identifying the manufacturer’s mark on what we have perceived as our personal demons.
–Aurora Levins Morales
The biomedical model of psychiatry, or “biopsychiatry,” rests on the belief that mental health issues are the result of chemical imbalances in the brain. This is actually a very new idea, but in a short period of time it has come to be regarded as common sense by a whole lot of people all over the world. More and more, the belief that our dissatisfaction and disease is a result of our individual “brain chemistry” has been desensitizing many of us to the idea that our feelings and experiences often have their roots in social and political issues. We find ourselves with all this medicalized language in our mouths about neurotransmitters and serotonin that doesn’t actually get to the heart of so many of the problems we see around us.
[...]
1980 Was the Year
1980 is a useful date for understanding the recent transitions in our conceptions of mental health and illness. In 1980, the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual (DSM-III). The DSM, although it was intentionally written in a style that makes it sound scientifically objective, was a creation of one particular school of psychiatrists at a particular point in history with a particular world-view slanted towards the biomedical model.[i] The 1970s were a socially volatile time: the discipline of psychiatry was under attack on all sides for both being oppressive and “unscientific.” Its makers packaged the DSM as scientific and neutral, reframing the concept of diagnosis from a loose and vague set of descriptions based on Freudian psychoanalysis to a detailed symptom checklist. Today, with the massive support of the pharmaceutical industry, it is accepted as the “Bible” of psychiatry and used as a diagnostic tool all over the world.[ii]
1980 was also the year that Ronald Reagan was elected to office in the USA, ushering in what is known as the “neoliberal revolution.” The older “liberalism” has its roots in the 19th century philosophy that emphasized minimal state intervention and free trade. The horrors of the Depression, the specter of Fascism in Europe, and a strong labor movement made the idea of unrestrained free market capitalism less attractive in the 1930’s. The period in history from the 1930s to the 1970s saw the rise of welfare states the US and UK, a philosophy that prioritized social security, public education, and welfare. The 1980s saw the liberalization of trade, business, and industry, massive transfer of wealth from public to private, enormous growth in power of multinational corporations, and the triumph of consumer culture.[iii]
Obviously these are huge topics that require much time and space to truly unravel. Right now I’m just going to focus on one example of the way biopsychiatry and neoliberalism united to affect our lives: the shifting understanding of “depression.” As I intend to show, Western cultures and increasingly the rest of the world, are coming to relate human sadness and distress to an individual’s brain chemistry. While there is absolutely no scientific proof that this is the case[iv], the biopsychiatric world view helps enable big business to maintain power and fuels the needs of the market based economy.
The Birth of the DSM: How Sadness Became a “Brain Disease”
Modern psychiatry has its roots at the beginning of the industrial revolution and it can be useful to see it as response to the massive reorganization of an entire society along market principles which undermined traditional ways of caring for the sick and older support networks and healing modalities[v], but to tell this part of the story we are actually going to begin in the 1940s. At the end of World War II psychoanalysis completely dominated the field of mental health, providing the leading explanations of mental illness and their treatments.[vi] The 1960s were a time of great social and political upheaval that reshaped the landscape of ideas of the self and what health and wellness looked like in society.[vii] By the 1970s, psychoanalytic theoretical schools, and different clinicians, had many different ideas about the fundamental nature, causes, and treatment of mental disorders. There was a growing anti-psychiatry movement that accused psychiatry of using medical treatment mainly in the interests of social control.[viii] There were highly publicized experiments showing the complete lack of reliability of diagnosis made in mental hospitals.[ix] Psychiatry’s legitimacy as a medical field was seen to be in jeopardy. It was at this point in history that the DSM-III was developed.
The DSM-III was an attempt to create a universal guidebook for psychiatric diagnosis. It was written by a school of psychiatrists who saw their mission to rid psychiatry of prejudice and superstition, by turning it into an “objective science.”[x] Their intention was to be scientifically rigorous and “theory neutral,” meaning that it claimed not to presuppose a particular theory or cause of why a patient was mentally ill. The idea was to define disorders on the basis of symptoms and not causes. “It shifted psychiatric diagnosis from vaguely defined and loosely based psychoanalytic descriptions to detailed symptom checklists—each with precise inclusion and exclusion criteria.”[xi] But in its attempt to be scientifically neutral, the DSM-III left no room for any ideas of mental distress that were not viewed as “illness” and “disease.” Furthermore, the idea of “scientific objectivity” put the power for determining well being and sanity in the hands of the psychiatrists, using a vocabulary that while sounding “objective,” was in fact culturally based in Western scientific practice. The new “objective” diagnostic criteria worked better if there were defined treatments for the “disorders.” As it turned out, this was very beneficial for the bottom lines of the pharmaceutical companies, as well as opening the door for a drastic shift in the psychiatric paradigm.[xii]
Rise of the Neoliberals
During this same period, an equally complicated paradigm shift was happening in the world of economics and politics. The 1980s saw the rise of neo-liberal economic ideology: the privatization of public enterprises, the reduction of wages by de-unionizing workers and eliminating workers’ rights that had been won over many years of struggle, the elimination of many health and environmental regulations, and the dismantling of social services such as health and education and welfare.[xviii] The consequence of these policies: massive unemployment, underfunded schools, overcrowded prisons and the shrinkage of our social and economic safety nets. Along with all of these political and economic changes, has been the transformation of poverty from a social problem to an individual failure.[xix]
Similar to the ideology of biopsychiatry, neoliberalism uses scientific sounding language that talks about “free trade” and “self-regulation of markets” that on the surface appears to be neutral, but masks an ideology which benefits the powerful and already wealthy; and the two systems work seamlessly together. The notion of a chemical imbalance in our brains easily plants the seeds of doubt in our minds about our own happiness and wellbeing. One of the driving forces of the market economy is dissatisfaction – the market place would not function without a consumer culture that operates on feelings of inadequacy and lack of personal fulfillment. But what if it is actually the society itself, and the toxic world-views we have inherited, that are driving us mad and making us depressed?
“A society that is increasingly socially fragmented and divided, where the gulf between success and failure seems so large, where the only option open to many is highly demanding and low paid work, where the only cheap and simple route to carelessness is through drugs, is likely to make people particularly vulnerable to mental disintegration in its many forms. It has long been known that urban life and social deprivation are associated with high levels of mental disorder. Neoliberal economic policies are likely to further increase their pathogenic effects. By medicalizing these effects, psychiatry helps to obscure their political origin…The social catastrophe produced by neoliberal policies has been washed away and forgotten in the language of individual distress.”[xx]. (Joanna Moncrieff 251-3)
Meanwhile, both the biopsychiatric model and neoliberal economics are global. There is a lot of evidence that, with the help of the DSM and the pharmaceutical industry, the biopsychiatric paradigm is rapidly spreading throughout the world. From Hong Kong to Tanzania to Sri Lanka, Western ideas of mental illnesses — depression, schizophrenia, anorexia, and PTSD are growing, with the resulting, loss of traditional forms of knowledge and understanding of health and wellness.[xxi]
--
[i] Lewis
[ii] Watters
[iii] Giroux
[iv] Fabrega
[v] Foucault
[vi] Curtis2
[vii] Curtis3
[viii] Howwitz 101
[ix] Horwitz 98
[x] Lewis 5
[xi] Lewis 97
[xii] Thomas 23
[xiii] Horwitz 210
[xiv] Lewis 122
[xv] Horwitz 185
[xvi] Horwitz 215
[xvii] Horwitz 187
[xviii] Martinez
[xix] Brown
[xx] Moncrieff 251-3
[xxi] Watters