Author Archive

Dworkin: The Rise of the Caring Industry

Ronald W. Dworkin – Frank Henry Sommer Professor of Law and Philosophy at New York University and Jeremy Bentham Professor of Law and Philosophy at University College London – has a piece entitled “The Rise of the Caring Industry” in the June 2010 issue of Policy Review.  The essay can be accessed online here.  The author of the 2006 book Artificial Happiness: The Dark Side of the New Happy Class considers how the growth of the helping professions (particularly those concerned with mental health) represents not simply an institutional change, but a shift in ethos.  As he puts it:

In this way the caring industry exercises a double fascination — on the one hand as a sounding board for lonely, unhappy individuals, and on the other as emblematic of a new ethos of civilization. The age of caring is a more skeptical age, but also a more tolerant one, expressing a distrust of authority and an antipathy to old enthusiasms that wavers between laughter and disgust. It would be wrong to say that people today deny the world; they simply prefer to ignore it, presenting a blank wall of indifference to how people live and what they believe. They prefer meeting their psychological needs through a therapy session rather than through a community of blood brothers.

The topic has been of particular interest to observers in the United States, and, over the past fifteen years, a number of scholars and writers have written on the subject, including Ellen Herman (The Romance of American Psychology: Political Culture in the Age of Experts, 1995), Eva Moskowitz (In Therapy We Trust: America’s Obsession with Self-Fulfillment, 2001) and Barbara Ehrenreich (Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America, 2009).

BMA on Conversion Therapy and Homosexuality

The British Medical Association has approved a motion that supports calls from a number of other professional organizations and gay and lesbian rights activists in rejecting so-called “conversion therapy” of homosexuals.  The organization calls on the NHS to “not fund ‘discredited’ conversion therapy for homosexual people,” according to the BMJ website.  The American Psychological Association has also taken a stand on these kinds of interventions, citing some of the prominent research on sexual orientation, pastoral counseling, and ethics.

Laqueur, “We Are All Victims Now”

The recent issue of The London Review of Books has a fascinating review by historian Thomas Laqueur (“We Are All Victims Now”) of The Empire of Trauma: An Inquiry into the Condition of Victimhood by Didier Fassin and Richard Rechtman (translated by Rachel Gomme).  Cutting a bit against the grain of accepted wisdom on the subject among historians of the human sciences, Laqueur concludes:

I take trauma as it is wielded even in these [various professional] communities to be largely epiphenomenal and strategic, and part of a larger story. The empire of trauma, the elevation or degradation of the term into a floating signifier, is the result of processes that we see at work elsewhere. Like so many others (‘tragedy’, ‘agony’), it is a word that has been translated from another realm and retains only wisps of its original meaning. Many more people are ‘passive aggressive’ than ever before; Bernard Madoff is a ‘sociopath’ not a ‘scoundrel’. This doesn’t matter very much; I don’t think that the drift of any of these words away from their narrower technical meanings into common usage makes much difference; I don’t think, and I am not sure Fassin and Rechtman do either, that the ubiquity of a word speaks to its efficacy, though they do seem to think that it testifies to the power of the newly constructed category.

More important, I don’t think they make the case that the category of trauma as it has been constructed in particular professional communities has in fact transformed reality, offered a language for victims to speak about historical wrongs and so on. I would suggest that the empire of trauma, in the sense of a universal acceptance that the suffering of others matters, that psychic wounds demand our attention, is part of a revolution that began in the 18th century, and whose moral dilemmas are still with us. ‘I do believe that in the end humanity will win,’ Goethe wrote in 1782. ‘I am only afraid that at the same time the world will have turned into one huge hospital where everyone is everyone else’s humane nurse.’

The review is available here to subscribers.

Diagnostic Ambivalence and Psychiatric “Workarounds”

The Science, Knowledge and Technology section of the American Sociological Association has awarded this year’s Hacker Mullins Student Paper Award to Owen Whooley (NYU) for his paper “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders” (Sociology of Health & Illness, vol. 32, 2010: 452–469).

Abstract

In 1980 the American Psychiatric Association (APA), faced with increased professional competition, revised the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychiatric expertise was redefined along a biomedical model via a standardised nosology. While they were an integral part of capturing professional authority, the revisions demystified psychiatric expertise, leaving psychiatrists vulnerable to infringements upon their autonomy by institutions adopting the DSM literally. This research explores the tensions surrounding standardisation in psychiatry. Drawing on in-depth interviews with psychiatrists, I explore the ‘sociological ambivalence’ psychiatrists feel towards the DSM, which arises from the tension between the desire for autonomy in practice and the professional goal of legitimacy within the system of mental health professions. To carve a space for autonomy for their practice, psychiatrists develop ‘workarounds’ that undermine the DSM in practice. These workarounds include employing alternative diagnostic typologies, fudging the numbers (or codes) on official paperwork and negotiating diagnoses with patients. In creating opportunities for patient input and resistance to fixed diagnoses, the varied use of the DSM raises fundamental questions for psychiatrists about the role of the biomedical model of mental illness, especially its particular manifestation in the DSM.

New Collaboration with Psychiatric Times

The scholarly blog Psychiatric Times has invited H-Madness to share a monthly guest blog with their readers.  You can follow the monthly contribution here. (Note: You must first register with Psychiatric Times before you can have access to the series.  Registration, however, is free).  This month, Greg Eghigian discusses some of his thoughts on learning lessons from history.

Colloquium on the History of Psychiatry and Medicine (Harvard)

The Colloquium on the History of Psychiatry and Medicine offers an opportunity to clinicians, researchers, and historians interested in a historical perspective on their fields to discuss informally historical studies in progress.  Below you will find an announcement of this year’s unusually rich Colloquium (note meeting rooms for specific dates).  Please join us.

David G. Satin, M.D.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Department of Postgraduate and Continuing Education, McLean Hospital

And

Center for the History of Medicine, Francis A. Countway Library of Medicine

present

COLLOQUIUM ON THE HISTORY OF PSYCHIATRY AND MEDICINE

David G. Satin, M.D., DLFAPA Director

Open to students of history and those valuing a historical perspective on their professions.

———-Fall, 2010———-

September 16

“Anomalous Sensations and Astounding Disclosures’: Nineteenth-Century American Narratives of Asylum Experience”

Kathleen M. Brian:  Ph.D. Candidate in American Studies, The George Washington University

October 21

“Reforming Mental Health Via Hollywood:  ‘The Snake Pit’ (1948) and Its Audiences”

Benjamin Harris, Ph.D.: Professor of Psychology and Affiliate Professor of History, University of New Hampshire

November 18

“German-speaking Psychiatrist and Neurologist Émigrés to the U.S. After WWII”

Frank W. Stahnisch:  Associate Professor, AMF/Hannah Professorship in the History of Medicine & Health Care, Department of Community Health

Sciences and Department of History, University of Calgary, Member of the Hotchkiss Brain Institute

December 16

“Asylum:  Inside the Closed World of State Mental Hospitals”

Chris Payne

4:00 P.M.—5:30 P.M.

Minot Room, fifth floor, Countway Library of Medicine

Harvard Medical Area

For further information contact David G. Satin, M.D., Colloquium Director, phone/fax 617-332-0032, e-mail david_satin@hms.harvard.edu

On the Lighter Side: Darth Vader’s Diagnosis

Both the British Psychological Society’s Research Digest Blog and The Guardian feature a story on Eric Bui and his colleagues at Toulouse University Hospital in France.  They have written an article arguing that the Star Wars character Darth Vader most likely meets the diagnostic criteria for borderline personality disorder.  Bui and his colleagues see such arm-chair diagnosis as a way of teaching young people about the disorder and, in turn, helping to undermine the stigma associated with it.

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