Re: Who controls explanations of unwanted behaviors.

Jonathan D. Raskin (
Fri, 13 Feb 1998 10:47:13 -0500

At 02:52 AM 2/13/98 -0500, you wrote:
>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

All well said. However, I am struck by the amount of time we are devoting
to defending DSM and the medical model. It is as if we are saying, "Ok,
those criticisms of DSM and the medical model have some legitimacy, but
don't say them too loud, and be sure to emphasize the good in DSM, too."
This strikes me funny, because I don' believe DSM or the medical model need
a lot of defending to prop them up; they are doing quite well on their own,
thank-you-very-much. Constructivist and narrative approaches, on the other
hand, seem to me to need a good deal of delineation and defending as
viable, perhaps even preferable, constructions of disorder. How is it that
even those of us who call ourselves constructivists seem anxious at efforts
to place alternative conceptions of disorder on (at least) equal footing
with DSM and medical model approaches?

Jonathan D. Raskin, Ph.D.
Department of Psychology-Jacobson Faculty Tower
State University of New York at New Paltz
75 South Manheim Boulevard
New Paltz, NY 12561-2499
office phone: (914) 257-3471; fax: (914) 257-3606