Lecture 25

Question 1

______ previously described “abnormal” patterns of behaviour that were recognized only within specific cultural contexts

Answer 1

Culture-bound syndromes

Question 2

Numerous different critiques of Western psychiatry (based on biomedical model) exist
* These include critiques by people who have experienced the mental healthcare system
* These contributors self-identify in many different ways using different terms, including:

Answer 2

◦ Psychiatric survivors
◦ Ex-patients
◦ Psychiatric prisoners, psychiatrically incarcerated
◦ Consumer–survivors
◦ Service users
◦ Mad people; those experiencing madness

• These represent a rejection of system-imposed diagnostic labels (i.e. “schizophrenic”), which are often homogenous and “essentializing”

Question 3

People within the mental healthcare system have experienced a range of harmful treatments and rights/freedoms restrictions which are seemingly “justified” by the classification of people into diagnostic categories (which can be seen as labelling and pathologizing)
* These include:

Answer 3

coercion, restraint, forced confinement, criminalization, forced medication, and other inhuman treatments

Question 4

define trepanning

Answer 4

• boring small holes in the skull to permit demons or spirits to escape

Question 5

What is Ontology

Answer 5

• study of belonging

Question 6

What is epistemology

Answer 6

study of knowledge

Question 7

Diverse explanations for madness included…?

Answer 7

• religious, spiritual, and social explanations
• It was thought that all people had the potential for madness
• In some instances, madness was thought to be a means to truth or insight (or some form of “genius”)

Question 8

What did the Hippocrates argue?

Answer 8

• Argued that madness had a natural (biological) cause - previously it was thought that bodily conditions were biological and madness was spiritually caused (gods)
• He thought that an imbalance in the four humours (black bile, yellow bile, blood, and phlegm) could cause madness
• This theory influenced treatment of madness into the 19th century (1800s)

Question 9

What were the scientific advances which supported improved medical diagnosis during the 19th century (1800s)

Answer 9

• Pathology emerged as a science and allowed physicians to connect physical changes with illness (autopsies identifying diseased organs in ill individuals)
• However, madness or mental illness is rarely associated with visible structural abnormalities (unlike most physical conditions)
• While it is assumed that madness is a disease of the brain, there are many uncertainties- but the biological model remains dominant: assumption is that advances in science will allow us to observe the causal mechanisms in time (i.e. chemical imbalances)

Question 10

The biomedical model can be considered a model of what?

Answer 10

“reality” and for “reality” (Clifford Geertz, an anthropologist)

• Provides an “aura of factuality” to our understanding of mental health and illness
• It is a worldview used to explain phenomena and to justify treatments
  (medications, involuntary hospitalization) – but it is not proven
• We can view psychiatry as a cultural system, like religion, which expresses a view of the world, and provides guidance about how to act or function

Question 11

The biomedical model has been critiqued in a number of ways:

Answer 11

◦ Some argue that it is best seen as “a myth”
◦ Others point to the diagnostic process as a means of social control and surveillance
◦ Some argue that inequities in power and control are mediators of mental illness
◦ Colonialism has been identified as causing mental distress and illness

Question 12

explain anti-psychiatry

Answer 12

• Emerged as a challenge to mainstream psychiatry
• Since 1960s onward, critiques from scholars like R.D. Laing, Thomas Szasz (who said biomedical models are a myth) and Michel Foucault have been important
• Viewed diagnostic process and labelling with disorders as a form of social and political control
• Mental illness is a fundamentally political issue, deeply connected to broader contexts and systems of power
• Social, political and philosophical context and dynamics shape our understandings and responses to mental health and illness
• Considered by mainstream psychiatry as a “fad”, but a rather dangerous one

— essentially a challenge to mainstream (orthodox) psychiatry

Question 13

explain critical psychiatry movement

Answer 13

• Seeks to analyze the social role and ideas of the profession (social perspective)
• Aims to avoid the polarization that anti-psychiatry produced
• Contests the notion that mental illness is reducible to a disease of the brain – argues that the mind is a more holistic construct than just the brain

Question 14

What does the critical psychiatry movement critique?

Answer 14

• Critiques the “technological paradigm” applied to understanding mental illness (e.g., mechanistic), and suggests that this is an insufficient rationale for treatment
• Critiques “mechanistic understandings”: mental illness is due to faulty cognitive or emotional processing

Question 15

What does conventional psychiatry assume?

Answer 15

that causes of brain pathology or faulty psychological processes will eventually be discovered, but in the interim this provides a justification for psychiatric treatment
◦ Objectifies people by reducing problems to brain disease/psychological mechanisms
◦ In the view of Critical Psychiatry, conventional psychiatry is part of the problem rather than the cure

Question 16

explain Richard’s book

Answer 16

• Richard Bentall’s book “Doctoring the mind” (2009) was deemed incendiary and divisive by mainstream psychiatry
• Book sought to emphasize that biomedicine’s technical approach creates care that may be coercive and dehumanizing for patients
• Bentall advocates for “warmth, kindness, and empathy” (always a good idea)

Question 17

what was a historically problematic rise to dominance?

Answer 17

• It is argued that Western psychiatry is inherently racist, relying on culturally-based norms of behaviour which excludes other systems of knowledge
• The Mental Health Act (England and Wales) was reviewed in light of findings that people of colour are more likely to be involuntarily admitted to psychiatric care
• Black people being 4 times more likely than white people to be involuntarily hospitalized for psychiatric issues
• People who are black are disproportionately diagnosed with schizophrenia, in the UK and in the USA
• In the USA, black men are more likely to be deemed “violent” clinically and receive higher doses of medication for psychotic symptoms

Question 18

What was the Blofeld report?

Answer 18

in response to the death of a black man named David “Rocky” Bennett in custody (was restrained in a medium-security psychiatric unit)- focused on institutional racism but also dangers of restraining individuals face down

Question 19

What is the premise of mad studies?

Answer 19

The premise of mad studies is that people who have experienced or been diagnosed with a mental illness has “counter-expertise” from a perspective that is generally absent (lived and living experience)

• This places them in a position to challenge assumptions within the field - highlights the value of their experience/perspective
• The field of “mad sciences” insists that the experiences of people who have been in the system of care must be foregrounded, so that challenges to our assumptions about mental health care can be considered