I have now had time to digest your thoughtful and thought provoking post.
You express feelings that I am sure are shared by many on the mail list.
Re: the specifics of the schizophrenia dialogue that has been going one the
past month or so, I have little to say; after paying some initial attention
to it when it began, I have only been loosely monitoring it recently due to
lack of time. As a result, I cannot really comment on its preemptive
nature. However, I take your experience of the conversation quite
seriously, and was saddened to discover that you have been upset by the way
the conversation has proceedded.
I hope that, as constructivists, we are especially respectful of diversity
of viewpoint. I wholeheartedly believe that all those involved in the
schizophrenia discussion, both pro and con, want the best for their
clients. Perhaps the pitfalls of e-mail communication made discussion of
this heated topic difficult. While we may not all agree re: schizophrenia
and constructivism, I hope we can avoid arguments that imply that persons
on this or that side of the debate are not engaged in the debate with a
good faith respect for one another. One of the reasons I value the mail
list is the mutual respect with which its members typically conduct
themselves. I, echoing other sentiments posted in recent days, would urge
you not to drop your NAPCN membership. Your voice is indeed valued, even
when others may disagree with you.
As editor of the NAPCN newsletter and as organizer of the NAPCN 2000
conference (to be held in New Paltz, NY) I just wanted to clarify several
things. First of all, I initiated inviting Thomas Szasz to be the keynote
speaker at NAPCN 2000. This invite predates and is independent of the
schizophrenia discussion on this list, which--as I mentioned--I have not
really had opportunity to attend to. I invited Szasz not because all
constructivists agree with him or because I wish him to be the latest
"poster-boy" for PCP, but because 1) I believe he is an influential voice
in psychiatry and psychology whose ideas resonate with a large number of
constructivists; 2) he is a "draw"--perhaps getting more people to attend
the conference than in the past; 3) he lives only 3 hours from New Paltz
and was willing to commit to coming to the conference (he is an unusually
popular speaker, and tough to book!); 4) the NAPCN Steering Committee
agreed with me that Szasz was a worthy keynote speaker; I checked with them
because I knew Szasz was controversial even among constructivists, and
wanted the diverse steering committee to give me feedback on having Szasz
as speaker. As Stephanie Harter pointed out, NAPCN has a long history of
inviting "non-PCP'ers" to speak at its conferences. Szasz continues this
tradition. As I pointed out in the newsletter, a sub-theme of the 2000
conference will be "constructivist perspectives on disorder." This means
we hope to develop a program that includes perspectives both consonant and
dissonant with Szasz's approach. I would encourage you to consider
submitting a paper to the conference--perhaps one elaborating your ideas
about how constructivism and physiological models of schizophrenia can
co-exist within clinical practice. I can't imagine that this wouldn't be
of interest to many conference attendees.
In closing, thank you for expressing your concerns; I see this as an
opportunity to take this dialogue (and its many sub-issues) further.
Having said that, I again urge you to stick with us. We may occassionally
blow off steam in a preemptive manner, but--then again--don't we all do so
once in a while? Continuing the pursuit of dialogue is the best way to
remedy the periodic preemption that occurs in most all human discussions.
It can be frustrating at times, but--in my experience with NAPCN and
mailbase members--is usually worth it.
Regards,
JON
At 11:04 PM 2/21/99 EST, you wrote:
>Dear List Subscribers,
> It is with some reluctance that I write this lengthy posting. Unfortunately,
>I am concerned about this issue and its effect on Kelly's work ever being
read
>as we further divide an already small group of people familiar with the work
>off George Kelly.
> At present, I am bothered by recent postings regarding schizophrenia for
>which I have responded more than others in support for the continued use of
>the construct of schizophrenia for medical treatment. I was responding to an
>argument previously that the construct of schizophrenia should be eliminated
>or replaced with a new label. I considered it useful as a construct
>imperfectly identifying a group of people whom hear and see things and who
>respond to medication. After medication, the group I see no longer hears and
>sees things and report that they feel they now feel "normal." I work only
>with severely chronic psychotic individuals and try to help them to be
able to
>live in the community. I wanted to discuss their construction of the world
>pre and post medication as well as floridly psychotic and lucid. I was met
>with discussions that were simply pre-emptively anti-psychiatric. Use of
>medication was broadly categorized for all patients to be a bad thing and
>there was no point in discussing it as schizophrenia did not exist. Because
>of money spent by drug companies, research was invalid. Individuals for whom
>it had an effect apparently were exceptions and my own individual findings
(as
>a personal scientist) were not valid. Apparently, those that agreed with an
>anti-psychiatry standpoint had more valid opinions than those doctors
>(apparently money grubbing uncaring people) that were not anti-psychiatry.
>The quest for invalidating information of any other belief comes complete
with
>conspiracy theories of suppressed information. Those who blindly followed
>tenets of psychiatry were fools. Those who championed anti-psychiatry were
>geniuses and noble (all profits from anti-psychiatry books are probably sent
>to a non-profit organization). I also am sure that none of these anti-
>psychiatrists received tenure on the basis of this research and are probably
>penniless.
> I guess I had always believed and questioned both poles of this argument
>but I was wrong. I also subsumed both the works of the psychiatrists and the
>anti-psychiatrists under a larger construct called the medical field and read
>both. Perhaps I was wrong.
> I also received my most recent NAPCN newsletter in which I would learn
>that Thomas Szasz will be a keynote speaker at a NAPCN conference.
Apparently
>this is an acknowledgenment that this is the correct point of view. Recently
>posted was also an APA resignation letter from a doctor putting down the
work
>of Dr. Torrey who has empowered parents groups (NAMI) in the United States
>over the years to battle psychiatrists and get people out of hospitals and
>into quality mental health centers rather than the streets. He publishes a
>now prestigious report evaluating the quality of mental health systems for
>each of the 50 states and a smaller section evaluating programs
>internationally. I am surprised to see this letter call him part of the
>establishment. He, Dr. Lamb, Fountain House, Dr. Beard, Bill Anthony, and
>others in the field of psychiatric rehabilitation and psychosocial
>rehabilitation would be amazed at this current promotion after years of being
>impugned.
> I respect the work of Thomas Szasz. His work pushes an envelope asking
>questions about categorization in the field of psychiatry. Unfortunately it
>is not a new set of questions or groundbreaking work (the myth of Mental
>Illness was written in 1961 (6 years after Kelly). His work builds on
this by
>collecting comments on research of those currently disenchanted with the
>classification theory research. He is a lightning rod. Dr. Szasz's work is
>preemptive. It is also impermeable to the usefulness of the psychiatric
>approach where it can be useful. It is work that has suffered badly from
>"hardening of the constructs." I believed it wholly until I started working
>with those with schizophrenia.
> Dr. Szasz's work has always been subsumed under my own personal construct
>system. I go back and read it periodically. I use it as I do the Catholic
>Church and Planned Parenthood regarding abortion and birth control. Neither
>forms my opinion, but I still go back to them to check the poles.
> Now apparently, this list and the conference suggest that this is
accepted as
>Kellian and consistent with Personal Construct Psychology? I think not.
> I went back to Kelly's original work (1955- Volume 2) and looked what he had
>to say about medication (pgs 612-614, .756-766). I list all the pages in the
>index linked to medication. In his 2 volume set, Kelly lampooned the
medical
>model of classification, behaviourists, mechanists, psychodynamics, and just
>about everyone else in the quest to push people to examine the individual and
>not blindly applying some single template to all man. It seems he wanted to
>keep open to the idea of applying any and all theories non-pre-emptively
to be
>used by the personal scientist. He did not discard any theory that might
have
>use in some range of convenience. He also made clear that he was a
pragmatist
>in practice….
> In volume 2 of his work he addresses medication and the physician. He says:
>
> 'A psychological construction of the apparent facts may fit ever so neatly;
>but so may a physiological construction. Now the question is: is this a case
>for the psychologist or for the physician, or is it a case which neither
>should attempt to treat alone? The really important question to ask is: what
>can each of these two types of practitioners do for the client and what is
>likely to happen to the client if either or both of them fails to do
anything?
>The answer to that question should make clear the answer to the practical
>question of when each discipline should seek the professional
collaboration of
>the other.' (pg 614)
>
>In 1966, Kelly himself talked of the problems of diagnostic classification
>(Clinical Psychology and Personality- Brendan Maher- 1969- The Role of
>Classification in Personality Theory- pgs 289-300). His arguments were
>occurring prior to DSM-II, which would be published in 1968. DSM I was a
>terrible document published in 1952. This was a speech in which Kelly spoke
>to the American Psychiatric Association. This was probably as DSM II was in
>draft form or getting ready. He was a part of the debate and not on the
>fringes. Kelly was working to make a difference to the field. He had
stature
>from the quality and usefulness of his work which was ahead of its time.
> In 1980, DSM III began to eliminate many of the fuzzy unreliability of
>theoretical concepts and replaced the concept of neurosis and others with
only
>observable behaviors. DSM IV continues this. Lots of people were involved in
>this writing.
> I am not sure Kelly would still continue to advance these arguments today as
>if they are new. DSM IV is here to stay. Perhaps ICM will come. Whining or
>wishing change is not going to help. Kellian concepts of classification are
>not likely to catch on and move to widespread use displacing DSM. So..
how do
>PCP'ers make use of the DSM?
> Increasingly, the current work is becoming less relevant to me. This is
>particularly true as less and less is done to adapt and expand research to
the
>real world of practice. I work in the field of non-traditional mental
health.
>I have worked with adolescents and adults. I have integrated Kelly's work
and
>find it helpful. I have followed Kelly's students. I especially like the
>work of Don Bannister, Larry Leitner, Alvin Landfield, Dennis Hinkle, James
>Mancuso, Jack Addams Weber, and others. They have influenced me.
> I also use the work of RET, cognitive-behaviourists, dialetical theory, and
>others. I fear I am beginning to see less utility in the proponents of the
>field adapting and influencing the field.
> I have subscribed to the Journal of PCP (who knows what the title is now)
>since the beginning in order to support current research. I thought it was
>great to expose others to Kelly's ideas. I thought it was important for
>Kellians to look outside for new ideas although I was concerned about
watering
>the ideas down. Integrated theories could be subsumed.
> On the other hand, I am not sure that the anti-psychiatry movement is
>necessarily consistent and equal with Kelly's ideas. Psychiatry, by Kelly's
>own admission, was outside the range of conveniance of the theory. Anti-
>psychiatry is one possible construct system of the health field. While I
>support PCP, I will not support the statements I have seen on this list. I
>also really am embarrassed and disappointed at the thought that someone could
>actually believe that medication research, brain research, and schizophrenia
>have not advanced the plight of this group. The research and the
>effectiveness of new medications (I do not get this from journals) on real
>people is amazing and is a long way from the mid-1970's. I fight
ignorance of
>schizophrenia daily as I watch my clients afraid to reveal their illness and
>communities battle against housing of the mentally ill. Many ignorant
>community people also believe schizophrenia does not exist and that these
>crazy people are dangerous. They believe schizophrenics are faking it or are
>coddled. This is not an academic argument. I know the needed housing our
>program and others create to get people out of the hospital. I did not
expect
>to see these statements on a list of learned people.
> I am also bothered at the elitist confirmatory bias of those on the list
of a
>theory of "scientists."
> Szasz as keynote speaker and these comments have bothered me enough to
refuse
>to renew my NAPCN membership along with the Journal Subscription, which I
have
>had since issue one. It may mean nothing to anyone but… I am hoping that PCP
>will continue to evolve but at present I will return to the original
works. I
>want to read about what can do the most for my clients. I have not recently
>read anything in the field of PCP that makes a difference to the
schizophrenic
>in the community. This includes works that benefit the person with
>schzophrenia or the treatment provider. Please let me know what I have
missed
>in practical treatment or the person with schizophrenia. In fact, the field
>of psychology has given me little to improve the chances of keeping housing
>for the mentally ill (cognitive behaviourists and RET excepted). On the
other
>hand, I have found much more useful applications and developments from the
>field of psychiatry for those they call the "schizophrenic" in the last
two or
>three years. Saying otherwise, flies in the face of the data I have seen in
>the field with actual people. I use these developments along with
>psychological interventions and conceptualizations to assist my clients to
fit
>in.
> I do not think that equating Kelly with anti-psychiatry is a good thing.
>It is this juxtaposition by NAPCN and not the work of Szasz that bothers me.
>I think this is dangerous. If it is not biased, is there a counterpoint to
>the keynote?
> Please enlighten me as to why I am I am incorrect.
>
>Most Sincerely
>
>John Fallon
>
>
>
-----
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
e-mail: raskinj@matrix.newpaltz.edu
personal web page: http://www.newpaltz.edu/~raskinj/index.html
Constructivist Chronicle web page:
http://www.newpaltz.edu/~raskinj/CCIndex.htm
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