Social Construction and Medicalization

Psychiatry and the DSM

psychiatry and the biomedical model of mental illness. When the DSM was evolving, so too was the field of psychoactive drug. at first, DSM was not used to treat medical disorder. Enhancing the status of psychiatry as a series of deliberate and strategic steps.

DSM 1

published in 1952, First official manual and glossary of mental disorder with the focus on clinical use.

Contained 106 disorders called "reactions" conceptualized under -> psychosis, anxiety, depression.

IT was influenced by Freuds Psychoanalytical model

DSM 2

published in 1968, slightly different. Increased disorders from 106 to 182. Removed the term 'reaction' but continued to be based off Freuds model of psychoanalysis

DSM 3

published in 1980. Utilized by psychiatrists, insurance companies, hospitals, courts, prisons, schools, researchers, government agencies.

Goal was to ==bring consistency to diagnosis== (in which need to meet threshold to be diagnosed) and ==Justified the use of psychoactive drugs.==

Ushered in the biological psychiatry era by standardizing diagnostic reliability.

Marked the key change of psychiatric diagnoses from theoretically-infused to seemingly scientific and precisely defined mental disorders. 494 pages with 265 diagnostic categories

DSM 4

published in 1994, not many changes, increased number of disorders to 300+.

in order for disorders to be included, More empirical research to substantiate the diagnosis.

Mental disorders were more dimensional and overlapping than discrete and specific

DSM 5

published in 2013 with around 300 conditions.

Mental disorders exist along a continuum (mild, moderate, severe).

Most people opposed to the changes on DSM 5. Process of determining a specific diagnosis, selecting diagnostic criteria, and evaluating the information is performed by a committee as opposed to using actual medical evidence or tests

controversy and the DSM

lack of transparency on the committee that defined mental disorders and if their work was critical evaluated or how feedback from public review.

Another concern was that the committee could be funding their own work

changes with DSM 5

Generally criticized for expanding diagnostic criteria and labels (ex - why do they define how long you grieve for).

Negative -> Reliability and Validity, Lowering the threshold for diagnosis, Can result in inconsistent diagnosing, misdiagnosing, or over-diagnosing and Lack of transparency.

Positive -> Acknowledging impact of discrimination and racism and Changes in inclusive language.

problem of over diagnosis

we are over diagnoses with things like bipolar and less of those that dont get diagnosed so its more inconsistent.

ex - Bipolar disorder should be accurately diagnosed (criteria are clear and tend to not overlap with many other disorders). less than half who reported being diagnosed, met the criteria. 30% who have not been diagnosed, did meet the criteria. Demonstrates the flawed nature of our diagnostic system based on categories

How the wrong diagnosis can be harmful

1. health problems as a result from taking wrong medication. Up to 20 percent of people with bipolar disorder may be mistakenly diagnosed with depression. because they tend to be younger and have more symptoms but more coping mechanisms

2. Delay in diagnosis – approximately 9 years

DSM & Canada

majority of Canadian mental health care professionals reply on DSM to inform their diagnosis. Taught in undergraduate, graduate programs medical school and residency. Started being used after DSM-III

Alternatives to DSM

has reflected opinion of its writers, some form of behavioural observation. ex -

1. international classification of Disease (ICD) (most popular, includes all disease related diagnoses),

2. Psychodynamic diagnostic manual (PDM, bc the others dont consider personality),

3. (HiTOP, says that DSMs over lap, aims to simplify diagnosis), (RDoc) (trying to use biological makers to diagnosis), (PTMF, doesn't consider itself a diagnostic system, more that they are side effect of socially oppressive powers),

4. Chinese classification -> includes cultural specific diagnoses, more comprehensive but more reliance of biomedical model

social construction of mental disorder

Mental illness to some extent has always been, in part, a social construct. studies how cultural conceptions and historical eras differently affect how mental illness is defined, understood, and treated.

how those with the social power to do so define specific symptoms and behaviors as being indicators of “mental illness', rather than a biological trait of a person.

There are a lot of mental illness diagnoses that we no longer recognize as legitimate (ex - BSDM, defined as one to attempt to control people)

creating an age of depression - horowitz

Diagnoses as resulting from political struggles, powerful economic interests, and compelling moral narrative.

Prior to DSM-III, Major Depressive Disorder was thought to be serious and rare, viewed as a psychotic disorder, delusions, hallucinations and vegetative states.

in 1976 – there were 12 different diagnostic symptoms for depression. Feighner criteria address diagnosis for many disorders – evidence for their classification system for MDD was limited, noted there was primary and a secondary form.

Feighner criteria became virtually the sole basis for DSM-II diagnosis and claimed that this was the first step

Feighner Criteria for depression

1. Must have a dysphoric mood marked by symptoms such as being depressed, sad, or hopeless.

2. 2. Five additional symptoms from a list including loss of appetite, sleep difficulty, loss of energy and agitation, loss of interest in usual activities, guilt feelings, slow thinking, and recurrent suicidal thoughts.

3. 3. Must have lasted at least one month and not be due to another psychiatric or mental disorder

major changes in DSM 3 of diagnosing depression

Exempt from diagnosis anyone who meets the symptoms of depression due to bereavement after the
death of a loved one that lasts no more than 2 months and are not of extreme severity .

• Lowering the necessary duration of symptoms from one month to two weeks.

Medicalization

many aspects of life are transformed into medical issues requiring biomedical health care. A process whereby ‘nonmedical problems’ become defined and treated as medical problems, usually in terms of illness and disorders.

It shapes how society responds to certain issues, like social norms.

creeping medicalization - Normal aspects of life become an issue that we need to treat. There is also the verse - ex de-medicalization of homosexuality

medicalization Can also be understood as social control

1. behaviour that departs from what is regarded as normal or socially acceptable is understood as having biophysical causes.

2. ex - the medicalization of deviance like alcoholism or child abuse into a medical problem.

3. ex - ADHD, which individualizes the causes and consequences of disruptive behaviour, response would include some form of medication

advantages of medicalization

1. reduces stigma of problem as a sign of moral decay

2. 2. loosens up funds for research and treatment.
   

3. 3. Comfort and solution for those who are diagnosed

disadvantages of medicalization

1. labelling issues places pressure on individuals to take on a sick role identity that brings support and acceptance

2. 2. focuses 'illness' at the individual level, and away from societal level

3. 3. gives more authority to the medical model (everything may become a 'condition')

explanations for medicalization

1. Biomedical ideas, images, language, and practices offer answers to basic questions of human existence posed by issues of embodiment, such as abnormality, illness, suffering, and disability.

2. 2. two general approaches to the study of medicalization - conflict approaches (iatrogenesis) and a foucauldian approach (surveillance medicine)

iatrogenesis

sickness and injury caused by the health-care system. Early studies of medicalization focus on the social-control aspects of organized medicine within capitalist society.

characterized professional medicine as a system of social regulation and expanding boundaries of medical expertise. Three types - clinical, social, cultural

Clinical Iatrogenesis

illness or injury caused directly y the health-care system . Medical mistakes

Social Iatrogenesis

indirect harm medicalization causes to society by defining aspects of life as medical issues. Stigma associated with mental disorder

Cultural Iatrogenesis

harm relating to increasing medicalization of life that compromises our own ability to look over our own health without medical intervention

Surveillance medicine

The sources of medicalization are decentralizing beyond the scope of the medical profession, like social media algorithm.

Foucault's approach -> medicalization is a process that proceeds through a complex set of social relation, it is something that we ourselves are doing.

Parsons (1951) showed that social benefits come with accepting medical interpretations of reality. Social relations of healing are defined in the general population through widespread medical screening as an aspect of population health promotion.

Risk factors are factors believed to lead to diseases that often are treated as diseases in their own right.

Surveillance medicine blurs the lines between ill and healthy as everyone becomes a “pre-patient

Stress in the 21st Century

9/11 shifted towards more macro forms and more severe forms of stress experiences. research has focuses on natural and man made disasters and mass violence .

9/11 likely added to the attention given to traumatic events in particular, as this was a sudden and unprecedented event that was traumatizing in part because it challenged fundamental beliefs and assumptions.

mental health issues are worse for people exposed to secondary incidents (car crash, a person dies a bit after the crash).

increased provision of treatment

Prevalence of mood and anxiety disorders and symptoms have not decreased despite increases in the provision of treatment.

hypothesis -> changes in risk factors, awareness or reporting of symptoms, treatment quality and targeting and need for prevention

mental health crisis

Around 450 million people currently struggle with mental illness. Mental illness is a leading cause of disability in this country, preventing nearly 500,000 employed Canadians from attending work.

The inter-relationship between addictions and other forms of mental illness, and their connection to physical health.

Access to services is a major barrier -> 75% of children with mental disorders do not have access to specialized treatment services. Indigenous youth are about five to six times more likely to die by suicide than non-Indigenous youth.

what is leading to increased prevalence

1. Classifying some medical disorders as mental disorders.

2. . Lowering the threshold of what it takes to be diagnosed with a given disorder

3. 3. Less people on the outside, less people deemed normal.

4. 4. Normal trials and tribulations of life have been pathologized.

contributing factors

1. payment for treatment

2. 2. capitalism - power of pharmaceutical companies

3. 3. increased work expectations (capitalism/neoliberalism)

4. 4. need for a ' quick fix' or ' easy answers' (instant gratification)

5. 5. diagnosis can provide access to services