Posted by Jost on September 15, 2006, at 8:08:22
In reply to Re: internet and the manufacture of madness... » Jost, posted by alexandra_k on September 15, 2006, at 0:13:36
Alex_k,
Thanks for linking to the article. I enjoyed reading it and found it interesting, although maybe not totally news. It did sum up and integrate a certain point of view. I'm not up on the literature at all, but at least it uses a more contemporary approach to analysis of social interactions, such as internet support groups and chat rooms.
Below are the main points. He seems to have a fairly nuanced view of psychiatric disorders as having a value judgment of some kind-- at least potentially-- including a positive value to those who adopt them as a form of identity-- he addresses the instablity of the disease entities themselves, as categories--although not deeply. Summarizes some implications of the change in categories for patients. Not sure how much you'd get out of it for your work, but is easy reading.
Main points: (and I quote a few parts here)."..As a result [of finding groups of people who identify themselves as having an illness that someone themself has, esp. on the internet], people probably become more attached to their diagnosis and iatrogenic identity. In effect, their identity becomes increasingly defined by, and inextricably intertwined with, their diagnosis. Philosopher Ian Hacking calls this process the "looping effect of kinds".
The looping effect of kinds occurs when "people classified in a certain way tend to conform to or grow into the ways they are described" (Hacking 1995, 21; see also Elliott 2003, 227–234). Classification of this sort is an interactive phenomenon. ..
...This is because the classifications that do the classifying "interact with the people classified by them" (Hacking 1999, 123). ...In this spiraling dialectical process, each element—the classification and the classified—mutually reinforce and sustain each other as they evolve jointly. There is considerable evidence that the Hacking looping effect is a genuine sociological phenomenon. In his work on psychiatric labeling, Thomas Scheff refers to [End Page 341] something very similar, which he calls "feedback in deviance amplifying systems" (1966, 97–101). Edwin Lemert describes a related phenomenon called "secondary deviance" (1972, 63). In all of these cases, the focus is on how labels become integral organizing factors in the lives of the individuals who are labeled, as they search for validation and acceptance by bonding with others of their own kind....
...Elliott and Hacking fail to mention one central aspect of the manufacture of iatrogenic identity, namely the role of autonomy...
.....Patient autonomy now includes the ability of patients to contest and defy the nosological edicts of medical authority.....[discusses Multiple Personality Disorder in a la Hacking, and the deep epistemic divide between that and what replaced it, Dissociative Identity Disorder... although internet groups resisted change, and even when accepted it, often simply used the new name as if its meaning were identical to the old one].
...Another more speculative but timely example is Borderline Personality Disorder. In this case, there are good grounds to believe that label change may happen. This could cause serious harm to patients currently diagnosed with that disorder who have finally found an identity—an iatrogenic identity—through their disorder. Again, these are patients who already have problems with identity. This compounds the possible harms of label removal....
[Discusses dimensional vs categorial model in DSM--ie currently DSM uses a categorical model-- ie a group of symptoms from various sources, often anecdotal, is put together, and given a name, suggesting that the cluster of symptoms is a "disease" demarcated from normal behavior. The dimensional model suggests that these "symptoms" occur within all individuals, and are perhaps more prominent in some troubled people, but that they are by no means radically different from characteristic spresent in everyone.]
...The adoption of a dimensional model would represent a drastic change, a significant paradigm shift (Kuhn 1962). It is not clear whether or how much of the original classifications and their labels would be retained. In some dimensional proposals, probably most current terms for these disorders would be abandoned. What if this happened?...
...The search for identity can also take a dark turn in the unregulated virtual communities of the Internet. Some identity seekers attempt to reinforce their sense of iatrogenic identity by indulging in their disease. This is a telling illustration of Lemert's "self-defeating deviance" (Lemert 1972, 85). Certainly, these individuals would surely resist label removal of the official sort. But they even appear to resist label removal of a therapeutic kind. They do no want to get well and instead indulge in how to be sick—more effectively. In this third example, the search for identity has degenerated into a full-fledged madness for identity....
...Consider the fact that there are "pro-anorexia," "pro-bulimia," and even "pro-cutting" sites and chat rooms on the Internet....
...The examples we have examined show that where there exists sufficient consumer interest and solidarity, psychiatric labels and their virtual communities can be kept alive online through the technologies of the Internet. These both validate and reinforce psychiatric diagnoses that may no longer be considered scientifically valid. Thus psychiatric labels may survive among consumers although they have been abolished by professionals....
...First, because persons often identify with their label, to remove a label is to threaten a person's identity. Saying the label is no longer legitimate, or was a mistake in the first place, can therefore cause serious harm, particularly to persons already suffering from disorders that implicate identity. Second, the retention of psychiatric labels by consumer forces that operate independently of the psychiatric establishment can possibly cause further harm to patients if the labels are truly empirically invalid. New, more scientifically appropriate labels may not be adopted and more effective treatments may not be sought....
...web sites that offer consumer label survival after official label death may prevent sufferers from getting better help and treatment. There is also the worrisome possibility that sufferers in search of solidarity and a validated identity may be lured by "pro" disease sites quite contrary to the ideals of health and recovery. In both cases, the potential harms are considerable..."
Louis C. Charland, Ph.D. (Philosophy, University of Western Ontario, 1989) is currently Associate Professor in the Departments of Philosophy and Psychiatry at the University of Western Ontario, where he also holds a joint appointment with the Faculty of Health Sciences. He worked as a program consultant and research analyst in the area of health for several successive branches of the provincial government of Ontario, Canada. Following this, he held several bioethics-related positions at McGill University in Montreal and the University of Toronto. Charland has published widely in the philosophy of psychiatry and the philosophy of emotion. In 2003 he was awarded a Visiting Member Fellowship at the Institute for Advanced Study in Princeton, New Jersey. He can be contacted at the Department of Philosophy and Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6A 3K7, or via e-mail at: charland@ uwo.ca. His web site can be found at: http://publish.uwo.ca/~charland.
~~~
My comment:
His concerns are first, that professionals do not sufficiently recognize the role of the internet, esp. support groups and chat rooms, where people with various shared characteristics, Including a psychiatric diagnosis, meet to support one another . This is a powerful tool for establishing and reinforcing identity, esp. for those whose identities are unstable, or unrealized. Professionals also have not taken care to think through the effects of de-labeling these disorders, on individuals previously labeled with them-- ie whose identity is iatrogenic (ie caused by the medical profession).
He regrets the power of these groups to resist reconceptualizations of mental diseases, which may provide better treatment to those who suffer them.
At the same time, there are ethical problems in taking away the identity that supports individuals' coping and ability to connect to others ( ie the disease they've identified with).
Plus he is further concerned about the effect of consumer "choice" of disease, or recruitment of individuals to their "illness"-- for example, the pro-anorexia sites, or pro-amputee sites. In his view, these sites are so strongly committed to the value of the originally-problematic disorder, that they may pressure those with uncertain identities or with great needs for social approval into adoption of harmful or at best mistaken definitions of their identity.
Yet (again, in his view) it may be ethically dubious, as well, as technically difficult, to locate these individuals and to try to deprive them of their present identities, under the guise of educating them about the current state of psychiatric knowledge or belief.
Jost
poster:Jost
thread:684913
URL: http://www.dr-bob.org/babble/social/20060911/msgs/686144.html