Re: Who controls explanations of unwanted behaviors.

Bob Large (
Thu, 12 Feb 1998 14:11:29 -0500

Re: Jim Mancuso has certainly struck a chord!
This discussion is in danger of becoming polarised into yet another
tiresome debate about the profession of psychology counterposed against t=
profession of psychiatry.
As I see it the ascendance of the "diagnostic narrative" is not purely
attributable to the machinations of psychiatry but to the facility with
which notions of "disease" and "disorder" enter into social negotiations.=

Alcoholics Anonymous have used the disease model very successfully to
provide a blame-free escape from alcoholism at a time/place in the world
when alcoholism was something to be ashamed of. DSM III has proved a boo=
to trauma therapists who have used the diagnostic labels to legitimise th=
suffering of their clients/patients. DSM III has also won in the world o=
health funders - insurance companies and the rest. It seems society like=
a neat pigeon hole for complex problems.
What I find fascinating is how quickly American psychiatry moved from its=

roots in the Meyerian approach - which was a psychobiological,
activity-oriented approach which framed "disease" as "reactions" - the
defunct DSM II used the term "reaction" I think - or was that DSM I? So
what we have seen in America is the rapid discarding by psychiatry of its=

holistic heritage, as well as psychoanalysis, in favour of a
disease/disorder model - maybe in order to stay in league with bio-medici=
- but it is also a victim of its own success. DSM III has proven a great=

bandwagon......and gravy train for psychiatrists and psychologists alike!=

So what is to be done? Whinging about psychiatrists is not going to get =
very far. The thing to do is to get out there and articulate some
alternative constructions of the world of psychological suffering and to
present those constructions in general psychological, psychiatric and
medical fora - we might be surprised to find that a lot of people are
sceptical of simplistic diagnostic narratives!

Anyway thats my view from the bottom end of the world!

Cheers, Bob Large

Robert G Large
Associate Professor of Psychiatry
Department of Psychiatry & Behavioural Science
University of Auckland
Private Bag 92019
Ph: #64-9-8118608/ Fax: #64-9-8118698
email: <>

7:58 Friday, February 13, 1998