I have through conversation with a couple of other bloggers entered into the discussion about how psychiatry can be relative. I am using specific examples but it is not my intention to make light of or be dismissive of any disorders or the people who struggle with them.
Part of the discussion on my part surrounded a friend I have who deals with Obsessive Compulsive Disorder (OCD). He has no formal diagnosis (admitted to me at least) but is clearly so. He seems not to view himself or his “impairment” as psychiatric in nature. Does the fact that I view him as having OCD make him so? Does his denial make him not obsessive/compulsive? If he was in a room with a psychiatrist would he be considered as having OCD? If he was in the same room with a mechanic would he have OCD? I brought up the fact that in the past he may have simply been considered eccentric. Should we be alarmed that there are no more eccentric individuals? Eccentricity seems to have been diagnosed out of the vernacular. In our age of “there’s an app for that” have we arrived at “there’s a diagnosis for that” and subsequently “there’s a pill for that.” How have pharmaceutical companies influenced psychiatry and mental health? In pushing pills do we push diagnoses?
It appears to me that to a degree psychiatry can be specific to time and place. A behaviour exhibited on a psychiatric ward will certainly be checked off a list of symptoms in the Diagnostic and Statistical Manual of Mental Disorders, (DSM). At the shopping mall it may not even be noticed.
Part of what drew me into conversation was the fact that not long ago homosexuality could be found in the DSM. It would appear certain disorders can be cured by a shift in popular opinion. I’m not sure what I would think of myself or psychiatry if I was one day discharged from a psychiatric hospital because a new edition of the DSM came out. I guess it would depend on how many rounds of electro-shock I was exposed to.
I was also wondering about anorexia nervosa. My knowledge is limited but my understanding is that it was rare 60 years ago. Once society and psychiatry caught wind of this condition it became almost epidemic by comparison. Interestingly, it continued to be rare on other continents but seems to have spread with the adoption of western psychiatry and the DSM. Early cases of anorexia nervosa appeared without the typical aversion to becoming fat, confounding the argument of the changing societal ideal of beauty. The best example of what I am trying to arrive at is Lady Dianna’s disclosure of her struggle with bulimia. I don’t know the statistics but there was an increase in cases of bulimia which followed. It is often explained that others are more comfortable with self-disclosure when a celebrity comes forward. We might ask whether people find an avenue for their discontent paved by popularity. Where does one get the idea to take laxatives?
If a diagnosis is unheard of does it thus remain?
As the hysterics of the 1800’s disappeared other conditions took their place. Could it be that the pain is universal but the pandemic is always shifting? Will the disorders that plague society today become oddities in another 150 years? Is mental illness unaffected by popular thought and psychiatry itself ? Are we susceptible to taking something that disturbs us deeply and attaching the symptom of the day? If I was from another part of the world with a culture specific condition would I be disregarded by western psychiatry and the DSM-IV?
I’m glad psychiatry changes. In the past I may have been a good candidate for a lobotomy. It can send a strange feeling through your body to know how your symptoms were dealt with even 50 years ago. We look back and shake our heads but never consider that another generation will do exactly the same at what we consider to be science. I may not be around for it but I will not turn in my grave as disorders continue to wax and wane.
I’ve thought about this as well. I’ve arrived at the conclusion that it’s probably a problem only if it’s having a significantly undesirable effect on your life. I think overdiagnosis contributes to the idea that these issues don’t really exist.
Possibly psychiatrists and patients are too eager to find a name for difficulties. On the other hand it is often difficult to find a diagnosis. I swam for many years in the psychiatric pool not quite knowing which end I was in, unfortunately it was the deep end 🙂 As tough as I am being on psychiatry it has also helped me to swim.
I’m inclined to say you’re quite right (it won’t happen too often!) that diagnoses happen according to some psychiatry fashion (for want of a better word) but I will never claim psychiatric illnesses to be fashionable while the stigma that exists today continues, and while people need to hide their illnesses from those close to them. How could that be called fashionable?
You also make a good point about eating disorders and I recently read that ED’s really don’t exist in third world countries. I’m sure the media has a role to play on this, and I’m inclined to put the blame on the media for the increase in bulimia you referred to. Did my own ED come from media influence? I don’t think so although about 15 years ago I was badly addicted to using laxatives, so your question about how that happens makes me think. I’m inclined to think the media has some role there too. I certainly never got advice from anyone to use them, I just ‘knew’ that it was worth a try. Actually it’s about the last thing one would ever call fashionable because it’s pretty hellish life.
One more thought is that I had a great aunt (my father’s aunt) who was always described as “difficult and a little odd”. Now I suspect she would have had the BPD label thanks to the DSM, so yes I think you’re right.
I agree with your point that it can not be fashionable to have a mental illness when one is confronted with stigma. I wasn’t using the word fashion in that sense. No one looks for a diagnosis to fit in or be glamorous to my knowledge but there may be a few. I was more referring to the fact that fashions shift and change and move about the world. Look at Kate Middleton, do you notice more hats lately? There at least seem to be trends in psychiatry. I think another good example is the Emo lifestyle which is associated with depression, self injury and suicide. When I was a teenager there was no such thing as Emo. I’m going out on a limb but I wouldn’t be surprised to find that self harm has increased since I was younger. Again, where does one get the idea to cut themselves. I’m sure it can be an original thought but outside of tribal scarring I’m not sure it existed as it does today. Did Freud see young women who self-harmed?
I think you’re quite right and I guess what I meant was an extreme. Times change and as you say, so do diagnoses. Recently there was a news report in NZ about a huge increase in the number of teenagers self harming in NZ now, There were no reason given as they were starting a study to look into it. Actually if the figures were correct it is quite alarming. When i was at school there certainly wasn’t much evidence of it around. An NZ blog I follow suggested that actually it was a spiritual coming of age thing. I tried to get my head around that but haven’t been able to, although if yu consider the Emo thing then perhaps that is somewhat of a spiritual process for some. I’m not sure.
It may be exposure that results in an increase in a particular behaviour. Men did not shave their heads 25 years ago but as more did so, more did so. It seems as though there is a pool of symptoms and behaviours available related to time and place. If you look at PTSD and soldiers each war resulted in different symptoms. Some cultures have entirely different illnesses. Mental illness is not a virus that manifests through exposure but it would appear exposure does play a role.
Very interesting and balanced post.
Thanks for taking the time to read my post and comment, both are appreciated. I hope all is well with you.
I’m sorry I don’t get enough time to comment, but I always enjoy reading your posts, as they are invariably thought-provoking. Further to our previous conversation, I’ve started reading Ian Hacking’s “Mad Travellers: Reflections on the Reality of Transient Mental Illnesses”. It’s a fascinating and very readable account of a condition apparently common in the late 1800s, of “ambulatory automatism” or fugue, in which people would have a compulsion to leave everything and travel for hundreds of miles without really knowing why. Then the condition mysteriously disappeared. This is not to say that these people were intentionally copying each other, or that they did not suffer real distress and altered states of consciousness (many of them lost their families, their work, their friends – even their identities – through their compulsive walking). Hacking simply asks why did this particular response to – what? stress? pain? confusion? – occur at this particular time.
I think you make an interesting suggestion that certain forms of pain may be universal, but our responses to them are not. I’m actually writing my PhD thesis on “self-mutilation” (as psychiatrists then called it) in the nineteenth century, and accounts of self-cutting are extremely rare. However “dermatitis artefacta” (scratching or applying caustic substances to the skin) is a huge topic of concern. Something else that has always intrigued me is research historians have done on mental distress in the 16th and 17th centuries, where accounts almost never include information about hallucinations, because these could be incorporated into everyday life for many people (as part of religious experience, for example, it was not unusual to see things that other people could not). Perhaps some experiences are made more painful in some contexts than others. Of course, all this cultural relativity sometimes only makes it harder for us to actually understand our own (and others’) experiences!
No worries about not having time to respond. I am happy to hear from you when you are able. I have a friend working on his PhD and in his case finding time for sleep is even a challenge. I wish you well and am quite interested in your thesis. I have experience with self-harm. I don’t completely understand my motivations but it seemed a way to give voice to the psychic pain I was experiencing at the time. I used to use the term self-mutilation myself. I wonder at times if tattoos, piercings and branding are not more socially acceptable forms of self-harm. All involve pain and alter an individual physically. They are also each expressions of something; often deeply personal to the individual.
I have always been fascinated by the effect of culture on psychiatric experiences and symptoms. I am reading a book presently called “Crazy Like Us – The Globalization of the American Psyche” It speaks well to our conversation. I am curious as to why people in developing countries have better outcomes when dealing with schizophrenia. From what I can tease from the book so far it may be due to the fact that belief in spirits allows the sick person to remain in the social group. Similar to your findings on historic hallucinations, these hallucinations can be incorporated into everyday life as well. These individuals are not in need of exorcism but rather spirits which affect the entire community may need to be placated. In our society the schizophrenic person and their delusions are entirely foreign and separate and so we keep these individuals at a distance which may affect outcomes.
I have never heard of ambulatory automatism. I agree that although conditions seem to come and go they are very real to those of us who experience them. Possibly my condition will shift or disappear in time but my experiences were significant to myself and those connected to me.
Very good questions… like the laws of physics can and do change with new discoveries and revelations, so too with psychology. You raise a very good point with the issue of prescription drug companies, and the madical industry as a whole, having a huge monetary incentive to diagnose people as ill and prescribe them medication and treatment… not a good thing! The trend is definitely towards more illnesses, more drugs, and a more doped up population.
Great post! Peace,
Thanks Ben, it is my belief that in a hundred years people will look back at what we did and thought and wonder at us. It is unimaginable to think they thought the world was flat at one point and I believe following generations will be dumbfounded by our actions and beliefs. Thanks for taking the time to read my blog.
Take Care, Brett