Posted by Cam W. on June 3, 2001, at 13:41:41
In reply to Re: thanks everyone, posted by Noa on June 3, 2001, at 9:36:06
As some of you know, I have done some research on stigma. I'd like to add some to this talk of stigma (which has most recently cost me a job and, for a while, I thought a career).
The use of scientific principles has uncovered universal laws in the physical and biological sciences; in which experiments done in identical conditions yield the same results, again and again. However, in the social sciences the outcome is based usually less on science and more on social aspects. Then normative cultural values (what is normal or abnormal) are thrown into the mix. Thus, nondiscrete behaviors are pigeon-holed by science into discrete categories, most often flavored by Western cultural norms.
When taking the world as a whole, what Western cultural norms consider right, moral, rational, healthy, and legal, may be wrong, immoral, irrational, sick, and illegal in another (more often vice versa). Much of DSM-IV appears to be moral and political judgements of the U.S. psychiatric community (thus, opinions of Western science) rather than part of any diagnostic nosology. For example, a bacterial infection can be cultured and an appropriate antibiotic can be prescribed; but in psychiatry, we attempt to take a set of symptoms and try to fit them to the symptoms of a disorder. When a psychiatrist thinks that he/she has the closest fit, a diagnosis is made. This method of classification is much more subjective than the objectiveness of, say, microbiology.
The history of psychiatry has many, many instances where clinical observations of deviations in prevailing social, cultural, political, and ethical standards of Eurocentric conduct have received inappropriate labels of disorders or disease. These include things as mundane as the vitamin B deficiency pellagra and syphillis being deemed psychiatric disorders to categorizing "deviant acts" such as homosexuality, child abuse, masterbation, polygamy, prostitution, lying, and lacking a mainstream religion, as illnesses. It is in this way that psychiatry can, itself, be lumped into a category with religion and politics. Thus, psychiatric categorization, is no more than a measure of the political success of the dominant ideology.
The classification of many psychiatric disorders are influenced by the ability of special interest groups to effectively organize and lobby decision makers. For example, DSM-I (1952) and DSM-II (1968) classified homosexuality as a "sexual orientation disturbance", but a campaign by the Sexual Preference Rights Movement, including disruptions of APA meetings, had homosexuality removed as a disorder. The APA trustees voted unanimously for this change. In 1974 nearly 60% of 10,000 votes cast in an APA member referendum to formally approve the change, were in agreement, but in a separate survey of about 2500 responding psychiatrists nearly 70% opposed the change (ref. Greenberg DF. The Construction of Homosexuality. University of Chicago Press, 1988). Thankfully our social fabric has been, more or less, reweaved in 25 years.
Furthermore, what is the difference between a cult and a religion? Answer: about a hundred years. Seriously, the difference between a cult and acceptable religious beliefs is often based on the number of members and reflects the milieu or social environment of the evaluator, including current cultural norms. J.Gutman noted that when certain practices appear strange or unpopular: "A religion becomes a cult; proselytization becomes brainwashing; persuasion becomes propaganda; missionaries become subversive agents; retreats, monasteries, and convents become prisons; holy ritual becomes bizarre conduct; religious observance becomes aberrant behavior; devotion and meditation become psychopathic trances." Waco anyone?
This sort of thing can also be shown in a nonreligious bent, where the collective deviance exhibited by a particular group has been called hysterical or sick, based soley on the assessment of these acts by scientists (or lay public or media) as being at variance with Western standards. For example, many social scientists claim that the Nazi movement was a form of mass psychopathology among the German people, ignoring the literature on conformity and cultural context in shaping Nazi beliefs.
I guess what I am trying to say is that when it comes to determining what is acceptable and what is not, the remains a fine and ever-changing boundary that more often reflects the social world of the interpreter than the mental state of those being interpreted. The difference between which side of the line one stands on often depends on who is holding the chalk.
Yes, stigma starts even before one is pigeon-holed. This is why many people do not seek help for mental illnesses. How do battle stigma? I really don't know. Perhaps the medicalization of mental disorders as biochemical disorders may help some, but ideologies and stereotypes are deeply entrenched in our cultural fiber. Perhaps the first step is for the sufferer to realize that they are not alone and that 1 in 4 people will at some point in there life suffer from a mental illness that will require professional help. Also, the "coming out of the closet" by such people a Kay Redfield Jameson and Ted Turner does help, but it is not a painless emergence. Until such time as the cultural mores drift in a positive direction for us, all we can do is to hold our head up high and say, "This disorder will not run my life, I will!"
Just some meanderings - Cam
poster:Cam W.
thread:6255
URL: http://www.dr-bob.org/babble/social/20010526/msgs/6280.html