The idea of ‘self’ is difficult to define but represents a set of ideas, representations and beliefs that are held about what it is to be a person. As psychiatry is a subject concerned with thoughts, feelings, behaviours and relationships, how people view themselves and the accompanying attitudes of psychiatrists to this (our ‘gaze’) are central to its execution. In Western cultures, we overwhelmingly choose to define ourselves in terms of our individual direction and achievements. This orientation is often portrayed as an objective truth, but is in fact simply an extremely powerful cultural construction.
Construction or not, individualistic ideology has had a substantial influence on thinking about mental distress. Psychiatrists have based much of their work on individualistic notions which as a consequence assume that emotional problems can be studied and understood separately from any other context. When seeking to diagnose an individual as having a mental health disorder, current classification systems, when rigidly interpreted, require no consideration to be given to circumstances beyond a patient’s psychopathology. Forms of emotional distress are then defined in terms of disordered individual experience and social and cultural factors are seen as secondary and may or may not be taken into account.
This approach sits ill at ease alongside patient experience. The lives of people with mental health problems have often been very eventful, and normally not in a good way. The message that life stories are largely irrelevant is then not always popular. Gail A. Hornstein writes in OpenMind on this subject (link no longer available):
Many patients feel deeply wounded by the assumption that madness has no link to life experience. As Jacqui Dillon, Chair of the National Hearing Voices Network, England, said at a recent conference, “Pathologising the experience of people like me, who have suffered terrible trauma, only adds insult to injury and protects those who have abused us. Instead of asking, what’s wrong with you? people should ask, what’s happened to you?”
Our individualistic beliefs are understandable. They are welcomed by some patients as they allow entry to the sick role and it can be comforting to regard suffering as something separable from the self and which for amelioration can be passed over to an expert. It would also be strange if psychiatry had been immune to this central tenet of capitalist societies and the approach also proves expedient to research, where individual phenomena can be captured by way of surveys and rating scales.
However as a profession with regards to this, I would hope that we could, collectively, be more ‘self aware’. This is not to suggest that mental health professionals are deliberately ignoring patients’ stories, that they are bad people, or even that mental health systems have been purposely set up in order to ignore the needs of vulnerable groups but it is interesting how dominant and rarely questioned ideas and discourses can work to render us blind to systemic inconsistencies and inadequacies.
The current paradigm allows the social and ideological origins of distress to be ignored and its implications side-stepped. Our helpful – but not too helpful – approach makes possible the propagation of mental health services, who are actually supported by a fragmented and individualistic society.
In order to be truly transformative, mental health services would then need to be honest about the social, political and ideological conditions that often lead to mental distress. Alas even if this were to magically happen, our message would be lost unless there was a corresponding move in greater society toward a value system where people seek satisfaction more from helping others rather than pursuing private advantage.
Proper leadership, that’s what we need.
Individualism – Wikipedia
Addendum 10 September 2009
Here’s an interesting paragraph from Richard Bentall’s Madness Explained
When constructing the self, the child internalizes historically and culturally determined values. It is therefore possible that the self as known to people of the past may have been quite different from the self as known to people living in the modern world. Roy Baumeister has argued that for medieval Europeans, the self was relatively transparent, and was equated with visible manifestations and actions. As life on earth was, at that time, believed to be a preamble to eternal bliss, there was no need to search for self fulfilment. In modern Western societies, in contrast, the self is often viewed as a hidden territory that can only be known with difficulty, but which must be explored (perhaps with the technical assistance of a psychotherapist) if its special talents are to be fostered and self-actualization achieved.
Also from Psychiatric imperialism: The medicalisation of modern living by Joanna Moncrieff (link no longer available)
The medical model of mental illness has facilitated the move towards greater restriction by cloaking it under the mantle of treatment. This process of medicalisation of deviant behaviour conceals complex political issues about the tolerance of diversity, the control of disruptive behaviour and the management of dependency. It enables a society that professes liberal values and individualism to impose and reinforce conformity. It disguises the economics of a system in which human labour is valued only for the profit it can generate, marginalising all those who are not fit or not willing to be so exploited.
(this one makes more sense if you read the entire article…)
The person in the patient BMJ personal view Alastair Santhouse 1 November 2008 (restricted access)