Tuesday, January 25, 2011

(Re)Constructions of Mental Illness

The DSM as symbolizing the dominance of discourse in the creation of mental illness, definitions of mental disorders as prior to and separate from culture and personal experience, and American imperialism in regards to the construction of mental disorders

“…We’ve been changing not only treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders – depression, post-traumatic stress disorder and anorexia among them – now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness” (2).

“Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world’s psyche, and applying it around the world represents simply the brave march of scientific knowledge” (4).

“This current view (intersection without ideology), like the earlier one (ideology without intersection), is premised on the positivist idea, shared by the patients and nearly all of the staff, that science uncovers its objects and does not construct them” (Young, 119).

“Critics have been concerned that with the rapid increase in brain imaging techniques, the traditional basis of psychiatric diagnosis will be overtaken by crude biological reductionism” (Cohn, 81).

Both the Young and Cohn articles demonstrate how mental illnesses are constructed in certain contexts. In conjunction with the medical definition of the disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), both seem to focus on the importance of scientific knowledge in the construction of the illness. However, the examples of posttraumatic stress disorder (PTSD) and the mental disorders indicated by brain scans complicate a simplistic scientific construction of illness by introducing the role of ideology and technology in the patient’s construction of the disorder.

Young claims scientific knowledge to be the result of scholarly discourse and institutional ideologies (118). He uses the example of how PTSD is constructed and treated at an Institute that was created by the Veterans Administration (VA) to provide “specialized treatment” for PTSD (110). He discusses the interplay of discourse (scholarly work that provides a rubric for diagnosis) and ideology (local systems of knowledge that provide an arena for the materiality of PTSD) in creating scientific knowledge. Though historically the perceptions of the relationship between discourse and ideology have varied at the Institute, currently the notion of ideology has been abandoned for a sole focus on discourse, confirming “that science uncovers its objects and does not construct them” (119).

However, ideology continues to dominate the construction of PTSD at the Institute because of its authority and efficacy (126). The power of the Institute’s ideology persists because it is “sanctioned by the administrative authority” and because therapists must not only adhere, but also believe the legitimacy of the ideology (126). Meanwhile, patients use ideology as a means of “throw(ing) meaning around the unbounded and incoherent misfortunes of (their) postwar lives” (127). The patients are also able to avoid moral responsibility for their present state by medicalizing the past. This “sickness without psychosis” provides the men with comfort and a sense of self-efficacy (127).

Cohn address the claim that brain imaging technology will succeed at locating diseases –such as depression and schizophrenia – fully within the brain (68). In evaluating this possibility, he discusses the virtual impossibility of creating a stable and distinctive object of illness because of its contingency on the establishment of a “normal” brain (71). However, the use of brain imaging technology in the form of brain scans seems to provide patients with the illusions of objectivity and fact. Though many professionals are uncertain of the ability of the scans to define illness, an air of certainty still surrounds these images. “This imbued sense of certainty emanates from the illusion, largely colluded with by the researchers themselves who are anxious to demonstrate their expertise to the volunteers, that somehow the images are divorced from the many people and technical decisions involved in their construction” (76).

Though this new technology seeks to locate disease within the brain to further scientific knowledge of mental illness, patients attempt to use the scans not only to make their illness external, but also to provide an explanation of their condition for their social relationships (74, 79). Technology masks the uncertainty surrounding the meaning of the scan, so patients appropriate the images as extensions of themselves in their social lives, assigning personal (and perhaps scientifically unjustifiable) meaning to the images (67, 78). This, however, reveals a paradox: while patients “wanted to use the images to find ways of divorcing themselves from the illness, the illness itself refuses to be redefined because in the end it emerges not from the internal body but the nature of the person’s social relationships” (80).

Therefore, in these examples, both ideology and technology serve as a means of providing patients with a false sense of security regarding the stability or meaning of their disorder. Mental illnesses defy concrete definition, as they are a reflection of social relationships and culture. Ethan Watter’s article entitled “The Americanization of Mental Illness” addresses this issue in confronting the problems surrounding the globalization of American definitions of mental disorders (the DSM). Though “scientific leaps in understanding the brain haven’t yet created the sorts of cultural stories from which humans take comfort and meaning,” these definitions and technologies are presented as fact not only in the United States, but also globally (8).

Without the existence of a “stable, distinctive object of illness,” how could we possibly expect to apply the DSM in other countries (Cohn, 71)? Though the DSM blatantly ignores culture (until the “culture-bound syndromes” section on pages 845-849 of the DSM-IV), the role of culture cannot be ignored in the construction of a mental disorder (Watters, 4). Since “mental illnesses are not discrete entities,” nor will they ever be, we should use caution while introducing our ideas of mental disorders into other cultures (1).



Cohn, Simon. 2010. “Picturing the Brain Inside, Revealing the Illness Outside: A Comparison of the Different Meaning Attributed to Brain Scans by Scientists and Patients.” Pp. 65-84. IN Technologized Images Technologized Bodies. Edited by Jeanette Edwards, Penny Harvey and Peter Wade. New York: Berghahn Books.

Watters, Ethan. 10 January, 2010. “The Americanization of Mental Illness.” The New York Times. http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?_r=1

Young, Allan. 1993. “A Description of How Ideology Shapes Knowledge of a Mental Disorder (Posttraumatic Stress Disorder).” Pp. 108-128. IN Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life. Edited by Shirley Lindenbaum and Margaret Lock. Berkeley: University of California Press.


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