Re: Who controls explanations of unwanted behaviors.

Esteban Laso (
Fri, 13 Feb 1998 02:52:21 -0500


Bob Large wrote:

-----Original Message-----
From: Bob Large <>
Cc: pcp list <>
Date: Thursday, February 12, 1998 2:26 PM
Subject: Re: Who controls explanations of unwanted behaviors.

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 the
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 boon
to trauma therapists who have used the diagnostic labels to legitimise the
suffering of their clients/patients. DSM III has also won in the world of
health funders - insurance companies and the rest. It seems society likes
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-medicine
- 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 us
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

Right! The "disease entity" has proven a good frame of reference for lots of
problems between and within people. Medical narratives, also, are very
popular nowadays -maybe because they serve to replace guilt and shame with
pity and tolerance, like the "satanic possession" metaphor. Sometimes you
need to know that your faults will not be held against you -that you can
always say you were sick or just too tired or absorbed, etc, and go on being
pretty much the same fellow to your friends.
And, like you say, this shouldn't be an ad hominem argument. Rather, I'd
like to point out the main errors I find in the common misuse of
psychiatry -and of every theory, like psychoanalisis:
-Preemptiveness: the "nothing but..." and the "only this kind of..." "This
is nothing but a X sindrome and only this kind of treatment will do".
-Lack of accountability: when the "this is caused by the X factor" becomes
the "it's not your fault, you know...", and then the "you can't help it, so
leave it all to me".
This is to say: whenever a _construct_ is seen like _the-thing-out-there_,
problems are to be expected.

Best luck,

Esteban Laso