Thanks for the reference David. Not sure what I'll make of it from your
description but will give it a try. I was particularly struck by your
noting that:
"A key insight is that psy-disciplines do not come to know
about an independently existing world of psychological phenomena but
construct them".
You bet we do! All the time. And we will continue to do it. Did I say
reality? Actually I said reality for me, by which I meant my own shabby,
subjective reality where I am apparently disabled by "acritical" modes
of thinking. You may be different but I'm afraid my constructions are
all I've got.
Just going Going back to David's examples. I'm not really disputing that
many aspect of psychiatry and medical thinking have, at times and in
varying ways, been damaging. And that they sometimes continue to be
damaging! Of course these examples are shocking and painful even to
read. I realise that David's veiws are very deeply held. However, for
all the emotive content and Foucaultian flash I would suggest that
comptele equating of labelling with slavery and "big Pharma" (which
seems to be seen as an unreserved evil) is actually completely
erroneous.
Maybe I can also work in a philosphical reference. Karl Popper this
time. I expect he too was hamstrung by "learning and conventional
understandings of 'knowledge'", but I can't help feeling he had his
moments. One such was the widely cited example of asserting that all
swans are white then going off and finding a load of white swans to
prove it. These examples seem to me to be white swans. However, seeing
them as proof does seem to disregard the presence (in my own brainwashed
consciousness at any rate) of other swans which are a variety of
colours. In the case of labelling children I wholeheartedly oppose of
much labelling which occurs (ADHD seems a particularly frequent dustbin
and ritalin an overused waste manager). However in other cases labelling
often seems a useful component. I can't help feeling that getting a
diagnosis of dyslexia is rather more useful than being disregarded as a
dunce with no prospects. Similarly, I've found a number of diagnosis
relating to autistic type presentations have helped difficult
situations. Are "a range of externalinfluences from the societal to the
parental" the whole story. There are some small matters of neurology and
biology which I think impinge too. It may be that we gradually move
beyond the current construction of labels and into something quite
different but I can't help feeling that they will always be there and
that this may not be entirely bad. Just to be absolutely clear here: I'm
not saying that all diagnosis is helpful nor that all labels are useful
nor that all those who apply labels do it well nor that a system which
stresses labelling is a particularly good one. I spend a good deal of my
professional life and a vast portion of my energy (I think at any rate)
trying to move beyond labelling in thinking about how to help people.
However I do not oppose it principle because sometimes it is helpful and
useful. All the emotive examples in the world won't change that. I have
plenty of my own.
One other little point concerns (some) people actually liking diagnosis
I remember going to a Sane conference a few years ago (my first and
last) and encountering quite a few self-identified "patient" who found
being given their diagnosic labels among the best thing that had every
happened to them. I found this pretty hard to swallow for all sort of
reasons but actually, no matter how much I thought they had been
brainwashed by the medical establishment, this was what some people
found helpful.
I have very similar feelings about detention as I've said. Several weeks
ago David (I think) sent something to this list deploring the number of
forcible detentions. The thing is that I'm not clear how David (or
anyone else) can actually know if that number is high. Or if its low. Or
how many of those detentions may have been necessary or helpful. Well I
guess that for some people who have expressed opinions on this any
number of detentions is unacceptable. However, I'm afraid I can't really
buy this in my own experience as I do encounter cases where is seems 9in
my limited subjective world) to be the most humane and compasionate
thing (I can hear you howling). Again, I'm not saying that the mental
health act is a great document, or that it is always used well. I'm
pretty clear though that, if it was abolished tomorrow for reason of
both social control and comapssionate decency we'd have a similar
document involding involuntary detention before parliament by the end of
the month. And hey, guess what, I spend a good portion of the time I
have left over from arguing about labelling, challenging detentions and
arguing for rights and liberties.
I think you can probably infer my positions on matters such as ECT and
"big Pharma" from this.
The reason I suggested that the original posting made an unsophisticated
argument (I stand by this) was that it seems to me only to focus on the
white Swans and to reject the swans of other colours which complicate
the argument. A bit like looking a a small part of a picture and making
a decision about what is depicted. It seems to me to involve easy
generalisations which do no engage with the complexities of a difficult
issue.
"The question arises for me, if we are indeed to take
the stance and fight against the diagnosis and labelling of children,
then
how do we do so without denying support to the children and families
who,
with or without the label, desire it?"
I recognise the dilemma outlined by Elaine Douglas (and for me if can be
a very sharp one) however I'd go further as I'm not sure I would "fight
against" in a blanket fashion as, as I've said, sometimes it appears the
best course and sometimes it is reductionist, authoritatian and
damaging. That is can be both is where the dilemma really sharpens and
where the argument requires an approprite recognition of complexity.
Gemma Dexter asked if there are better ways to help without the use of
labels. I spend quite a bit of my professional life asking this
question. Often the answer is yes and sometimes the answer is no.
John
-----Original Message-----
From: The UK Community Psychology Discussion List
[mailto:[log in to unmask]] On Behalf Of Dexter Gemma
Sent: 10 January 2008 13:26
To: [log in to unmask]
Subject: Re: Screening of children
I also work in a child & family service and am aware of several of my
colleagues struggling with the same dilemma as Elaine raised,
However, my particular issue is how does a child reach a position in
life where this kind of way of relating to the world becomes his only /
best / most accessible solution?
My guess would be that this has been largely via a range of external
influences from the societal to the parental
Then to say that the child themselves has a "disorder" because the way
of relating that they have developed in order to survive does not prove
"adaptive" seems false, unfair, even immoral to me
I know this is an old point now, that has been much discussed, but
surely we can find ways of providing help without having to use the
labels?
Gemma
-----Original Message-----
From: The UK Community Psychology Discussion List
[mailto:[log in to unmask]] On Behalf Of Elaine Douglas
Sent: 10 January 2008 13:11
To: [log in to unmask]
Subject: Re: Screening of children
David and John,
I find David's viewpoint regarding the creation and application of
medical
labels as a means of controlling individuals persuasive and provides an
alternative view of the issue from the mainstream and traditional.
However, the complexities and difficulties for me to fully adopt this
stance come from my interactions with some children who have been
"labelled" ODD. I suppose, a difficulty in applying the concept to the
child and family who are dealing with this on an everyday basis.
Yes, I can see that there is a genuine case that the children are
rebellious and defiant against the confines that, for example, school
places upon them. However, many of the children that I have seen with
this diagnosis are rebellious and defiant to a level that pervades
almost
every aspect of their lives and severely impacts their ability to have
relationships, access to education and cuts them off from the kind of
opportunities that are fought for under probably any kind of
discrimination act that we can think of, whether it be disability,
gender,
race or age. Often the family are at a loss as to what to do and how to
help their child - which, as you know, is where psychology comes in by
providing access to 'help and support'. I do see that whilst psychology
as a profession continues to provide this well-intentioned labelling
service it maintains the status quo, but to remove this access to help
and
support without other changes in society, for example, alternative
methods
of accessing education etc, then the child and their family are left
high
and dry by everyone. The question arises for me, if we are indeed to
take
the stance and fight against the diagnosis and labelling of children,
then
how do we do so without denying support to the children and families
who,
with or without the label, desire it?
Elaine
> Dear John,
>
> Re "Well I actually might be interested in the reference if you have
it
> handy."
>
> The reference is: Nikolas Rose (1996) Inventing Our Selves:
Psychology,
> Power and Personhood. Cambridge University Press.
>
> The whole book is brilliant in my view but there will not be much new
to
> those familiar with Rose's important contributions to critical
thinking
> about psy, because versions of many of the chapter were previously
> published as papers. Chapter 5 (Psychology as an Individualising
> Technology) is especially relevant to the point in hand. Rose
summarises
> its contents thus: "In Chapter 5 I develop Michel Foucault's
hypothesis
> that all the disciplines bearing the prefix psy or psycho have their
> origin in what he terms a reversal of the political axis of
> individualisation. I examine the role of the psychological sciences as
> techniques for the disciplining of human difference: individualising
> humans through classifying them, calibrating their capacities and
> conducts, inscribing and recording their attributes and deficiencies,
> managing and utilising their individuality and variability" (page 19).
> Rose's work and critical scholarship more broadly is hugely important
to
> community psychology, in my view, but usually difficult to access for
> those who have been thoroughly disabled by acritical ways of thinking,
> mainstream ways of learning and conventional understandings of
> 'knowledge'. A key insight is that psy-disciplines do not come to know
> about an independently existing world of psychological phenomena but
> construct them and are best understand as part of the technology
through
> which people are governed.
>
> I note that you object to "the kind of certainties in this kind of
> argument" on the basis of "the reality" (for you) (apparently without
> irony) and that the 'reality' is that people's 'lives may be
improved' by
> labelling with disability, detaining them against their will in locked
> wards and their generating profits for the pharmaceutical companies.
Of
> course, during slavery some argued that the 'reality' was that some
human
> beings' lives were improved by being labelled as 'slaves', detained
> against their will and generating profits for plantation owners and
> pointed out that some slaves were 'well kept', 'well dressed', 'well
fed'
> etc. Psy-technicians also colluded then of course as now. Samuel
> Cartwright presented a paper to the Medical Association of Louisiana
on
> the 'disorder' drapetomania which had the "diagnostic symptom, the
> absconding from service." Cartwright also 'discovered' a psychiatric
> disease called dysaesthesia aethiopica which was responsible for
laziness
> amongst slaves. (http://en.wikipedia.org/wiki/Drapetomania; Thank
goodness
> we don't live in such benighted times any more . . . oh what's that
psy
> technicians have come up with? Oppositional Defiant Conduct Disorder?
>
> "ODD is one of two potentially serious psychiatric disorders that may
be
> seen in up to 30 to 50 per cent of children with ADD (although both
are
> separate problems - they aren't caused by ADD). The other condition is
> conduct disorder (CD). Both occur mostly in boys, but ODD is more
common
> than CD, appears at an earlier age and is generally less severe. The
first
> signs usually become apparent at about the age the child starts
school,
> about four or five. In the early stages it can be difficult to
diagnose -
> many children of this age have periods when they're negative, hostile
or
> defiant. However, when this behaviour persists while playmates leave
it
> behind them, the problem may become clearer. The American DSM criteria
for
> diagnosing ODD are:
>
> 1. A pattern of negative, hostile and defiant behaviour lasting at
least
> six months during which four or more of the following are present:
often
> loses temper, argues with adults, actively defies adults' requests,
> deliberately annoys people, blames others, touchy or easily annoyed,
angry
> or resentful or spiteful or vindictive.
> 2. This behaviour causes clinically significant impairment in
social,
> academic or occupational functioning.
> 3. The behaviour doesn't exclusively occur during a psychotic or
mood
> disorder.
> 4. The behaviour doesn't meet the criteria for conduct disorder or
> antisocial personality disorder."
>
> http://www.bbc.co.uk/health/ask_the_doctor/odd.shtml
>
> BB Lahey, B Applegate, RA Barkley, B Garfinkel, K McBurnett, L Kerdyk,
L
> Greenhill, GW Hynd, PJ Frick and J Newcorn Am J Psychiatry 1994;
> 151:1163-1171
> DSM-IV field trials for oppositional defiant disorder and conduct
disorder
> in children and adolescents
>
> http://ajp.psychiatryonline.org/cgi/content/abstract/151/8/1163
>
> David
>
> The reality for me is that I find the kind of certainties in this kind
> of argument unconvincing as my own experiences is that the "procedure
> through which psy-technicians create and reinforce ideologies of
> Normality" sometimes actually works out quite well for all its faults.
A
> pros and cons argument if you like. People may be helped, their lives
> may be improved, resources may become available (such as for some
> children labelled with a something like Aspergers). Incidentally I
feel
> the same way about compulsory detention and treatment and even about
> "big Pharma".
>
> My point is that these issues seem to me to often be ambigious and
there
> are useful aspects in all of the things which you have dismissed. I am
> aware of many of the problems you suggest and of the way in which
> individuals use and misuse labels, treratments without regard to the
> complexities. The's just it really. It is a complex reality My
problem
> with the argument initially put forward is that that It seems to me
that
> the desirability/morality/utility of any such processes seems (and
> correct me if I'm wrong) deemed worthless for ideological reasons.
>
> John
>
>
> -----Original Message-----
> From: David Fryer [mailto:[log in to unmask]]
> Sent: 09 January 2008 15:28
> To: [log in to unmask]; McGowan John (Sussex Partnership
> Trust)
> Subject: Re: Screening of children
>
> Re "I can help feeling that banning screening (or diagnostic
labelling)
> is
> a rather unsophisticated response to a complex issue."
>
> One objection to such screening (and its associated rag bag of normal
> distributions of psychological variables, norms etc) is that it is a
> procedure through which psy-technicians create and reinforce
ideologies
> of
> normality which then open the way for the 'ab'-normal to be
constructed
> as
> disability (and via dominant medical models) positioned as in need
> of 'treatment' through medication which creates bigger and bigger and
> more
> lucrative markets of consumers for big pharma. Banning screening could
> be
> argued to be a sophisticated response to the psy-complex issue. Nik
Rose
> argues the important part of this more fully and coherently if you are
> interested (and also if you are not interested).
>
> Help us to be the best we can be ...
>
> Become a member of Sussex Partnership and help us to fight stigma and
> raise the profile of mental wellbeing.
>
> Visit our Foundation Trust membership web page for more information
and a
> membership application form.
>
>
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Help us to be the best we can be ...
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