Do you know the swiftest way to cure an american schizophrenic? Why, simples: we just stick him on a plane to the UK and chances are, he should be cured.
Huh? I know. It didn’t impress my tutor at the time, though i felt i had a point. Even at University – before, too, i guess – i had this irritating habit of using quite funny stories (in my viuw) to illustrate deadly serious points.
In this case, the finding, well documented at the time (in the 70’s), was that for a given cohort of patients, US psychiatrists were something like 30% more likely to diagnose them as suffering with this condition than UK ones.
The point i was making was that this particular “condition” was no such thing – at least not at the edges – and that its diagnosis and definition were actually quite subjective. My tutor doubled clinical psychology at the Maudsley Psychiatric hospital. He also did not like my…approach (?)…attitude (?).
Interesting, in the light of my later run-ins with clinicians that of all my tutors, this was the one that i could not stand and with whom i broke after just four weeks of increasingly bitter exchanges (he attempted to substitute diagnosis for assessment of my work: i pretty much accused him of being abusive).
Otherwise, i loved my subject, adored most of my tutors…from cuddly Prof. Michael Argyle – later heading off to “study happiness” (academically!) to the sharp but slightly up-himself Richard Dawkins.
Right? Wrong? i don’t care
I digress. But not too much. Another relevant fact is personality type. I have been, with one slight adjustment since transition INFP/ENFP for most of my life. In pen picture, that makes me either a “Dreamer” or an “Idealist”.
(Who’d have thunk it!).
One characteristic frequently attributed to the -NFP bit of that type is an indifference to absolute right or wrong: i am motivated by people, how they feel, and by achieving calm and consensus within relationships. NOT by whether something ticks a box to say its correct or not.
So: am i “an ENFP”? Sort of. But here’s the crux. Do i possess certain personality characteristics because i’m ENFP…or am i ENFP because i possess those characteristics. Chicken: meet egg.
And what does it mean to say i “AM” an ENFP.
In my own universe, actually, next to nothing. I enjoy doing these psych tests because…i see them as springboards for insight. Sometimes they pin down something i couldn’t quite see by myself and wrap it up in neater words and language. They’re a start point…just as knowing the “norm” or the “average” for a particular behaviour interests me because it gives me something to measure myself against.
You are what you do (doo-be-doo-be-doo!)
All of the above…all these category thingumajigs are just tools, to help me expand understanding. They are NOT definitions or boxes to limit me!
In fact, i am also a tad queasy with focus on how i “am”: when i study people, behaviour (whatever) i am interested in function. The way individuals will act and things they will DO when they experience situations and stimuli. Not some abstract classification of how they ARE.
Because, personally, fundamentally, i doubt the possibility of getting to grips with “essence” in this way. If it looks like a duck and it walks like a duck, i’ll count it as such – however much it quacks “chicken” back at me.
Two more category things. The first falls pretty obviously out of the above. I don’t just think that psychiatrists, therapists and the like wrongly categorise folk: i think they are wrong to use categories as definitional/deterministic tools.
I could delve deeper: explain how i have spent a fair period of my life constructing statistical models that create categories. Of the sheer frustration that I and the head researcher at one ad agency had with a client when, producing two different categorisation systems based on two sets of data, the client demanded that we sort out which was “right”. Head: meet table!
I could wiffle about “fuzzy set theory”.
And i know, because i have the ability to go behind the numbers, that many, many supposedly fixed categorisations are as much artefacts of the statistical method used to generate them….whether you went CHAID or cluster or step-wise or…I know: this is where the mathematical geeks start to salivate and the rest of you part company.
So let’s drop it there with an observation that categories equal constructs: they rarely ever match real world “things”.
That’s a good point to introduce another word i’ll get back to later – “reification”: the idea that it is possible to treat abstracts as things.
Coughs and sneezes spread diseases: so do psychiatrists
And last up in this canter through, in my opinion, a major category error underlying a great deal of psychiatry is a model – the medical model – that depends absolutely on categorisation and the issue i began this article with.
Because if you are ill, you quite possibly suffer from an illness. No, honestly! And those writing about medicine have tended, over time, to state that a medical illness has three components: a cause (aetiology), which may be injury or virus or lack of vitamins, or whatever; a set of core symptoms (from sneezing to pustules); and definite treatments (this drug kills that nasty).
And psychology, to some extent – and its illegitimate big brother, psychiatry has bent over backward to create the same sort of medical model for mental illness. That, in essence, is the entirety of the Diagnostic Standards Manual: an attempt to create neat boxed-up categories of mental illness, which will enable practitioners to continue to pose as the equivalent of medical doctors (and impress the non-professionals along the way).
Yet its simply not true. If the simplest way to cure someone of “an illness” is to swap therapists, questions need to be asked. The individual is not suffering from “an illness”: they simply exhibit behaviours which may be uncomfortable, invconvenient or even anti-social.
It is in the interests of some professionals to claim that such behaviours can be diagnosed. They can’t.