There are people who question the
legitimacy of psychiatric disorders. In the video shown during a lecture in
week 3, Dr. Thomas Szasz is “exposing psychiatry as a pseudo-science.” His
critiques of psychiatry are based around the premise that the diagnoses of
mental disorders are too subjective in nature, and unless a disorder has
definitive and universal criteria
that can be used objectively by various medical professionals, it cannot be
legitimate. One of his charges was against the ambiguities regarding attention deficit hyperactivity disorder (ADHD). He explicitly
states that, “ADHD is not a disease,” reasoning that, “no behavior or
misbehavior is a disease or can be a disease.” Dr. Szasz’s main basis of
disapproval is because ADHD lacks objective scientific figures.
Dr. Szasz is a very passionate
speaker and frankly, after watching his speech, I was partially convinced of
his views, at the very least his charges towards ADHD. The diagnosis of ADHD
does seem very unreliable because the nature of its diagnosis is determined by the
professional opinion of each person’s specific psychiatrist. Diagnosis figures
vary between individual doctors, as well as between countries. The significantly
large variance in global statistics of the disease, specifically the high
prevalence in western countries like the United States versus a fraction of
that statistic in other parts of the globe, make ADHD an area of close
scrutiny. Some have proposed a social construct theory of ADHD, which questions
the medical validity of the disorder, stating that it is used by western
societies as means explain abnormal behavior. This theory is aligned with Dr.
Szasz’s philosophy.
Despite the evidence, I do realize
that there are people living with mental disorders whose daily function and
productiveness depend on the their medical treatment. For example, many people
with ADHD state that the intake of medication has improved their quality of
life drastically. People suffering from the disorder may feel offended and even
marginalized by the criticisms since the disorder is something that is very
real to them. There are also many other disorders beyond ADHD that need to be
considered in the context of Dr. Szasz’s argument.
This is just one case where the
definitions of disease, illness, suffering all seem very unclear. Even within
the same western culture, we have different opinions on what distinguishes a
person from having a disorder or not. If we were to extend the boundaries to an
international level, it is simply inevitable that there are going to be
cultural clashes and societal differences in terms of what is acceptable medical
treatment and diagnosis.
As shown in this picture, there are different ways to view the same
subject. Depending on our contextual upbringing, our “glasses” will be
different. We are beings that make decisions and judgments by using the
combination of our specific societal norms, religion, moral values, and
personal opinions. Therefore, what makes sense in one “glasses” may be
irrelevant or unsupported in the lenses of another. Within psychiatry there is
clear opposition surrounding the legitimacy of disorders. The views Dr. Szasz,
and his supporters, are drastically different from those of western
psychiatrists and the sufferers of such disorders. It is difficult to discredit
any of the claims since logical reasoning exists for both notions.
Schizophrenia, for example, is an
area that is recognized as being treated and medically interpreted differently
across cultures. “Progress in understanding cross-cultural variations in the
course of schizophrenia requires that research methodology be anchored in a
deeper set of reflections about the processes whereby culture might shape the
evolution of schizophrenia.” (Corin et al. page 111) Corin et al identifies
culture as a key factor in the psychotic experience. Just as culture affects
medical diagnosis/treatment, it also carries contextual significance how people
from different cultures perceive and live with mental disorders. Simply put,
culture affects the medical practices of not only doctors, but also the medical
experience of patients. The article, Living through a staggering world, provides
a transcript of interviews from several individuals from South India living
with schizophrenia. The authors compared and analyzed the personal accounts and
identified similar characteristics of the disease presented by each individual,
which included feelings of fear, confusion, paranoia, hallucinations, etc. After
reading the personal accounts in this article, I was convinced yet again, but
in favor of the opposing viewpoint that mental illnesses are in fact
legitimate. One disturbing quote reads:
“…I was always thinking of who
would shout at me at college…. Voices would tease me, scold me, that I could
not bear. But I was afraid of shouting back. So I imagined that I was shouting
back at times in my mind…” (Page 132)
These individuals indicated signs of severe psychological
distress and gradual “alteration of self” shown by the loss of previously
capable abilities.
If we
were to apply Dr. Szasz’s theory to this illness, he would discredit its
legitimacy completely. In one of his interviews he makes an analogy stating, “If you talk
to God, you are praying; If God talks to you, you have schizophrenia.”
“You can prove —
objectively, not by making a "clinical diagnosis" — that X has
neurosyphilis or does not have it; but you cannot prove, objectively, that X
has or does not have schizophrenia or "clinical depression" or post
traumatic stress disorder.” (Szasz)
His
argument is that there is no such thing as “mental illness”, only behaviors
that are disapproved of by clinicians, family, etc. In the context of
schizophrenia rather than ADHD, I find this harder to agree with, however. It
doesn’t seem right to me to categorize the severe psychological distress
exhibited by people with schizophrenia as simply abnormal behavior. The
severity of the disease and its widespread affects of virtually all aspects of
life for afflicted individuals give reason to support its legitimacy.
Perhaps it
is due to my different perceptions of health and disease that gives me an
opposing point of view. Many others may have other differing stances on the
legitimacy of mental illnesses, which would be due to their specific
perceptions. Regardless, people should all try to understand others views and
be sensitive to each topic of discussion because mental illnesses are a highly
personal issue.
Sources:
Living Through a Staggering World: The Play of Signifiers in Early Psychosis in South India by Corin et al.
http://www.psychotherapy.net/interview/thomas-szasz
https://www.cchrint.org/about-us/co-founder-dr-thomas-szasz/quotes-on-schizophrenia-as-a-disease/
Using Dr. Szasz’s lecture on ADHD that we watched in class, we’ve discussed the controversy of diagnosis ADHD being unreliable. As mentioned in Ann’s blog post, I also think that ADHD is a medical condition that is hard to diagnose because different doctors may have different opinions of diagnosis. Unlike cancer or some other diseases that can be diagnosed using medical technology, diagnosing psychological disorders or diseases are based on psychiatric assessments and observing behaviors. Like many other psychological disorders, ADHD is determined through psychiatric assessments determined and observed by their doctors. In the post, Ann also uses the story of schizophrenics in India to claim that culture also shapes the medical treatments of doctors, and psychotic experiences of patients. I also agree with how culture shapes the treatment of the disease, and how it shapes the experiences of the disease itself, such as in the case of ADHD.
ReplyDeleteAfter watching Dr. Szasz’s speech about how he claims ADHD is not a disease, it made me reconsider whether ADHD was actually a medical condition or just a cultural hype. I think to a certain extent ADHD is culturally diagnosed, and the disorder itself is a reflection of what our society considers normal or abnormal at the time. In United States, hyperactive kids who lack attention, and have impulsive behavior are considered ADHD, regardless of whether or not they actually do have these disorders. In other hand, other cultures they might view these behaviors as a part of a character of a child, and believe they will grow out of it. By labeling these kids or adults as ADHD, it seems that we are creating excuses for our behavior, and fixing these differences with drugs and treatments. Hyperactivity, short attention span, and impulsive behavior all represent symptoms of ADHD, and it’s these are behaviors that American society considers taboo, or problematic. Even though American society seems well developed compared to other parts of the world, it seems we are still falling behind in accepting a wide range of behaviors or characteristics that are far from “normal”. There’s a recent increase in number of ADHD diagnosed people in United States. The increase in numbers may not all be from the increase in people actually having the disorder, but actually the number of people becoming more aware of the disease, and fitting the behavior into a disorder.
Although in some extreme cases, where the behavior is so out of control that a patient is having trouble with daily activities, diagnosing the disease, and treating the patient for ADHD would be helpful in such a case. In Ann’s blog post, she also mentioned about how culture shapes the experience of the disease for the patient. In many ways our society enforces certain types of behaviors and expectations on people. However, not everyone can meet these standards, because we are all different. In a way I think the society is also creating a disorder called ADHD to define what is not considered good or efficient. For people who are diagnosed with these it might lead them to think they have a problem, and depend on drugs to make them “normal” instead of fixing their behaviors, or accepting who they are.
Ann Lee writes about the legitimacy of psychiatric disorders by analyzing the different opposing viewpoints of ADHD as a real disease. The greatest critique of ADHD is that it is diagnosed subjectively; therefore, there is no scientific data that validates that an individual truly has a disorder/abnormality instead of a child-like behavioral trait or laziness. The tendency of identifying a condition with objectivity is heavily directed toward proving the biomedical physiological abnormality in an individual. Therefore, diagnosing a condition objectively is determined through the lenses of the western, biomedical culture. Our western culture tends to associate unreliability with subjectivity, for obvious reasons because subjectivity does not align with our culture’s definition of objective science. However, Attention Deficit Disorder (ADHD) has become a common subjective disease that has been medicalized and treated with pharmaceutical drugs. What has become prevalent is that ADHD is known to be a western disease, nonexistent in other regions in the world. This poses the question as to why ADHD is not globally recognized: is it a culture-bound syndrome?
ReplyDeleteSomething that I completely agreed with was Ann lee’s analysis of why ADHD is such a controversial topic. “Even within the same western culture, we have different opinions on what distinguishes a person from having a disorder or not. If we were to extend the boundaries to an international level, it is simply inevitable that there are going to be cultural clashes and societal differences in terms of what is acceptable medical treatment and diagnosis.” Because of ADHD’s subjective diagnosis, this indicates variability in the diagnosis. A culture bound syndrome is prevalent disease in a specific community, but ADHD, even within the boundaries of its own community in the US encounters a lot of opposition. Therefore, like Ann stated, it is inevitable for discrepancy to exist beyond the community.
This blog entry, made me think about the discussion in lecture about classifying ADHD, along with other conditions like anorexia nervosa and evil eye, as a culture bound syndrome or a global health issue. What all these conditions have in common are that they are not universally acknowledged as legitimate disease. And it made me come to the conclusion that a reason why some condition may not be perceived as legitimate may be due to the fact that the condition is so dependent on the culture. This would indicate that the reason why other societies do not acknowledge a disease might be because the culture has never been exposed to an environment that reveals the specific disorder. For example, a reason why ADHD has become medicalized and is prevalent in the US society is because our culture demands that children grow up in the education system. The western culture emphasizes education, children sitting in classrooms for long hours, in which their behavior is closely monitored by based upon a “normal” standard. This cultural upbringing of children widely contrasts with different cultures; therefore, a disorder like ADHD is not identified in other societies. ADHD has been medicalized in the United States because the culture deems complete, still focus as a necessity to success.
Something else that I agreed upon was about the necessity to be sensitive on the topic of mental health. Regardless of our own health beliefs that have been constructed through our own experiences and culture, we cannot impose our beliefs as an absolute, nor are we ever in a position to state that an individual’s illness is not valid when it is apparent that the individual’s own perception is a very real thing.
Dr. Szasz poses a very interesting argument in that video regarding the legitimacy of mental disorders. His comparison to disorders and diseases associated with organs such as the heart, liver, lungs and so on being the ones deemed legitimate seems to be fairly sound. However, at what level do the disorders associated with those organs be determined as a disease? In terms of a mental illness like schizophrenia there is a certain extent of physical occurrences that cause the effect of the illness. This is a prime example of conflicting perceptions of health and illness as well as the different opinions associated with them.
ReplyDeleteI have to agree with you on your issue with Dr. Szasz’s idea of schizophrenia not being considered a legitimate illness simply because it has to do with disapproved social behavior. When it comes to issuing a diagnosis for a mental disorder I think we can all agree that it is much more difficult that being able to draw blood for an indicative sign of a disease that manifests itself in a much more physical way. Not to mention the actual diagnosis of a mental disease can be a great challenge in itself. I feel that that may be a factor in the opinion of Dr. Szasz. However the difficulty of a diagnosis should in no way affect the legitimacy of an illness. I can somewhat relate to his idea of objectively proving that there is the presence of a disease in someone being the only legitimate form of diagnosis. Although, if there was an objective way to test the balance of chemicals in an individuals brain to see if there are abnormalities would that then fall under Dr. Szasz’s category of legitimate disease? Although there is not currently a way to test that I do not think that it should be brushed aside without acknowledgement. In addition to considering the way mental illness to be tested I think an important factor in legitimizing a mental condition is taking its etiology into consideration. If there were past events in an individuals life that may have had an effect on the state of their mentality could that be considered an event of causality? In the case of a disease that Dr. Szasz would deem legitimate if there were a person who somehow got alcohol poisoning several times throughout their life and it led to a liver condition I would imagine that would be considered a legitimate disease. If there were a sequence of traumatic events that a person experiences during their time at war and they come back with PTSD and their condition is not considered legitimate because it is not objectively testable I simply can’t agree that that is right. No matter how difficult the aspects of diagnosis may be and what the etiology and symptoms of a disease may be I don’t feel that different levels of severity of measurability should determine an illnesses legitimacy.