On psychiatry, privilege, and parlor games.

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The concern has been growing in my mind lately that a lot of autistic people see psychiatric classifications of people as a value-neutral system that is essentially benevolent, scientific, accurate, and probably useful in understanding the way that human beings operate. A few of them have actually experienced psychiatry, but mostly in a cursory way that has avoided the nastier features. A few have experienced the nastier features of psychiatry and believe that if they just put themselves into the right classifications and frenetically avoid the wrong ones (while promoting stereotypes about those they do see as belonging to the wrong ones) then they’ll be okay. Most haven’t experienced much if anything of psychiatry at all and are speaking from a position of immense privilege.

Which is what I thought when some responses to the Autobiography of Anonymous were brought to my attention.

People were actually sitting around trying to figure out whether this woman is autistic or not.

Because apparently when writing about the wrongs that have been done to her, she should’ve been really careful to make sure to include all the stereotypical traits and DSM or ICD criteria she possibly could.

This is someone who has been chewed up and spat out by the psychiatric system where she lives, which is by all accounts (not just hers) nasty.

This is someone whose life is incredibly representative of what happens to chronic psych patients in general, and also of what happens to people who are both unidentified as autistic and not managing to “function in society” in various ways.

This is someone who’s been living alternately homeless, filthy, starving, and in jail because she can’t get the assistance she needs (and who has nonetheless kept looking for it trying to survive).

And people actually seem to care more what diagnostic grouping they can fit her in than what is happening to her.

Do you think this would be okay if she really were a “psychopath” or “attention-seeking”?

Do you think that whether she appears to you over the Internet to be “more autistic” or “more OCD” or “more other things” has a shred of relevance to the fact that she’s in trouble and needs assistance to get out of trouble?

Do you think it’s a good idea to classify someone’s attempts to get help to survive as “attention-seeking”? What about survival-seeking, hello???

Do you really think that psychiatry’s treatment and labeling of her over the years was benevolent, objective, and helping her in some way?

Do you really think that the idea that professionals automatically know what is going on in someone’s head more than that person does — and implicitly reinforcing that idea by automatically siding with professionals and doubting the person damaged by them — is not going to harm people?

I just get this picture in my head of all these people sitting around in relative comfort, playing a mildly amusing parlor game of “What category does this person fit in according to psychiatry, based on one piece of her writing?” and “Can I see autism in someone’s writing?” and so forth. And passing judgment on a woman they have never even met. While said woman might well be starving or homeless or on her way to jail again because she can’t get the assistance she needs in order to survive, and therefore has to put herself in positions where she knows she’ll get in trouble but it’s the only way she’ll be able to eat. The disparity and the callousness here is sickening to watch.

People need to wake up and realize that these classifications aren’t a parlor game, aren’t a neutral classification system, aren’t enforced by people with any more insight into human nature than the average layperson, and aren’t a mildly interesting way to pass the time while watching people at a distance and neatly sorting them into categories the way I used to enjoy sorting buttons as a young child.

They are a life and death matter to a lot of people who don’t have the privilege of sitting around discussing them in a calm and detached manner. The power of that system to essentially blacklist a woman from getting any help to survive, to heap derision and nastiness upon her everywhere she goes, to tell her who she is and deny her the right to define herself in any way, to ensure that no doctor will even see her, to ensure that she will forever be stuck between a rock and a hard place when it comes to survival, to ensure that Internet people will automatically doubt her because of the labels some in the system have bestowed on her… that needs to stop being lost on those who don’t have to live the sort of life she lives. And if people don’t think that it’s mostly privilege (whether ability, class, race, whatever) keeping them out of the same position she’s in, they’ve got another think coming. Her life greatly resembles the lives of a lot of people I know. And her life could be any one of ours. No amount of invocation of psychobabble (which usually translates into “take her, not me”) will change that.

People like her are in danger of dying and all some people can think about is what false medicalized category she belongs in and how “pure” she is or isn’t. That’s the bottom line here, everything else is details.

About Mel Baggs

Hufflepuff. Came from the redwoods. Crochet or otherwise create constantly and compulsively. Write poetry and paint when I can. Physically and cognitively disabled. Anything you hear in the media or gossip is likely to be oversimplified at best and wildly inaccurate at worst, the only way to get to know me is to actually know me. I'm not really part of any online faction or another, even ones that claim me as a member. The thing in the world most important to me is having love and compassion for other people, although I don't always measure up to my own standards there by a longshot. And individual specific actions and situations and contexts matter a lot more to me than broadly-spoken abstract words and ideas about a topic. My father died a couple years ago and that has changed my life a lot in ways that are still evolving, but I wear a lot of his clothes and hats every day since he died and have shown no sign of stopping soon.

69 responses »

  1. Thanks for the link to the anonymous essay. I’ve seen something similar happen to a friend of mine (not autistic–so feel free not to post this if it is too OT). She has experienced bouts of major depression at numerous points throughout her life, and has frustrated medical personnel for years because she doesn’t respond to the usual antidepressants. So they have decided that she is not really depressed–just pretending to be–and that she really just has a personality disorder. End of story. They don’t have to treat her.

    For that reason, and other reasons, I’m pretty cynical about the DSM-IV and its classifications of mental disorders. In my line of work, I’ve read literally hundreds of psychological and psychiatric reports over the years, and I truly believe that the “personality disorders” are used as a dumping group for difficult patients. “Borderline personality disorder” is psych-speak for “you’re irritating the hell out of me.” “Antisocial personality disorder” is psych-speak for “get away from me you criminal.”

    Anybody who finds themselves taking the DSM too seriously might want to take a quick look at a book (written in the 1600s) called Anatomy of Melancholy, by (I think) Robert Burton. It is clearly the predecessor to the DSMs, with lovely diagnostic trees similar to the DSMs, but contains diagnoses such as “lycanthropy.” If anything shows that psychiatry and psychology are not sciences but social constructs, the history of diagnosis of “mental” problems does…

  2. You have essentially defined the fallaciousness of the medical model of disability or Linnaeus’ disorder which is the pathological desire to categorise and pigeonhole then reject that which does not fit.

    Medical people should never be the gatekeepers of any system of welfare.

    And for a little bit of anecdotal evidence, in my little experience of the phenomenon psychiatrists find it easier to see OCD than Autism when looking at a particular set of traits.

    The reality is that there are no strict bounds between any conditions be they mental or physical, the world does not have smooth edges and there are strong social and psychological reasons for any system to want to cover up it’s mistakes.

    Too many Dr’s bury theres.

  3. I have to admit, my first reaction was “this poor unfortunate woman is obsessed with psychiatric labels.” But of course, the larger tragedy is how obsessed our society is with them. There are no magic labels or pills to fix everyone’s problems. “Anonymous” is finally learning that after a lifetime of misery. Many people (and far too many in positions of power) never know any better.

    You’re quite right that those of us who haven’t been in such a situation are speaking from privilege. Not necessarily class or race or other forms of socially recognized privilege, but the good fortune to encounter ideas that foster independent thought and a strong sense of self.

    Along those lines… I consider myself very fortunate that, just by chance, you were the first person I happened to come across when I first started reading about autism on the Internet four years ago. Many thanks for your insightful writing…

  4. I read her story a little while ago and my heart (metaphorically) broke for her. It never occurred to me to question what “category” she fitted into, but she is in a better position to judge than somebody reading her words. Words on a screen can only give one a limited idea of what a person is like and it is impossible to categorise and list absolutely everything about how a person is.

  5. I am so sorry this is happening to this woman. It is something that could easily happen to anyone in the mental health system. Prior records take precedent no matter what is in them or how dubious the “facts” are compared to what is happening with the person in front of them right in the moment.

    I have no idea what can be done about it. I think the whole thing is just criminal.

  6. Eleanor:

    While I’m autistic, and often discuss autism, I don’t view my blog as confined to that topic and it’s not off-topic to discuss things that aren’t about being autistic. (I wrote a bit about that in this post, which actually touches on a lot of the same themes as this one in a lot of ways.)

  7. Amanda, I have a vivid and instinctual distrust of psychiatry in general. But to me, the story in question (absolutely regardless of the category into which the person fits – I couldn’t agree with you more) points out a fundamental problem ripping people apart in this country. Involuntary commitment laws were changed to protect innocent, difficult people from being committed by their families or others who could gain control of their fate. This reform was critically necessary, as the horrible — I would say crimes — of the past couple centuries of psychiatry attest.

    The problem is that the law goes somewhat too far. It is now extraordinarily difficult – well nigh impossible – to get somebody committed who desperately, desperately needs it. There are “categories” of people who are simply not good at taking their medication, for example. I think we all know several, but paranoid schizophrenics come particularly to mind. There are categories of people who represent a danger to themselves or others, but in a way that is either not “imminent” or is difficult to prove beyond a gut horror. Why must a family wait in terror until their loved one’s life is destroyed (and possibly somebody else’s) before the state will act?

    There has got to be a better solution. Somewhere, there has to be a happy medium that is more humane about the suffering going on inside a person, regardless of whether it is likely to manifest in violence. Human suffering is human suffering, and if it can be alleviated by a more structured, restricted environment, there MUST be a way to get somebody into one.

    With that said, there is still a long way to go in making mental hospitals (what remains of them) humane, as well. There is a long way to go in seeing the mentally ill as humans with dignity and potential rather than wastes of time and energy, or playthings for somebody with a degree.

    I’ve had friends who voluntarily committed. They really needed it. They were out as soon as their insurance stopped paying, whether they were cured or not. If one of them wouldn’t go in, and got (say, in her case) down to 82 pounds, I couldn’t help her by getting her committed. I’m not a fan of psychiatry, and my interactions with the “profession” have served to reinforce my beliefs. But there have to be good ones out there, and there is a desperate need for help for those who need it, like anonymous.

    I am reminded of the dangerous power of projection: the ascribing to others motivations that would make the OBSERVER act that way rather than the search for motivations of the actor. I see a tremendous amount of that in the discourse you describe, and in psychiatry itself (done badly). Caring for other people is a sacred responsibility, and it would be a better world indeed if more people who purport to practice caring took to heart the other-centeredness that is required.

  8. I… really don’t think the answer is commitment laws. Any help that happens in psych wards is essentially by accident, and the harm greatly outweighs the help.

    There needs to be something completely different, not an overhaul of psychiatry and painting a new face on it, but something closer to what Judi Chamberlin describes in On Our Own and Irit Shimrat describes in Call Me Crazy. As in, not even modeled on psychiatry at all, but on the idea that people can help other people, including people who are extremely confused about reality or extremely distressed.

    I’d really recommend reading Irit Shimrat’s book in particular if you can get your hands on it.

    I know the image of “schizophrenics off their medications”, but I don’t agree with the image that provokes in people’s minds, even when it is images from real life, it removes the context, and it removes the person.

    I know what it’s like to be told I’m a paranoid schizophrenic and will need to be on meds the rest of my life. I don’t take meds. Yeah it can be said it was a misdiagnosis, I did not really hallucinate or have delusions (other than the standard ones most people have), I just appeared to or was judged to for a complicated set of reasons that’d take way too much explanation for this comment (see other posts if you’re curious).

    But I knew people who really did hallucinate, really did have delusions, and if the meds were so great for them they’d stay on them. It’s like Irit Shimrat said, she went into the hospital crazy but not sick, when she got put on meds she was both crazy and sick. I know people who voluntarily take psych drugs and it’s because they believe they work for them. With others… if they were working so well in the first place people wouldn’t mind being on them.

    So… I don’t believe in forced psychiatry, because I don’t think that psychiatry is actual medicine. If people voluntarily go in, and really think it helps them, that’s their choice. But I’m with Mindfreedom as far as my stance on forced psychiatry goes.

    If things went the way I thought they should go, psychiatry would be replaced by a combination of people helping each other out in a very non-medicalized way (this could be both paid or unpaid, but certainly shouldn’t be an entire psychiatric-profession sort of thing), and actual neuroscience/neurology/cognitive science/etc. when it comes to things that really are generated by the brain. And people who’d been there would be helping each other out with stuff instead of talking to people who’ve never experienced these things but have sure read a lot of theories.

  9. I’m against forced meds and forced commitments.

    I’m also pretty disgusted with mindfreedom, as a recent newsletter referred to the “mushroom cloud of autism”. If they want to be as ‘crazy’ as can be without meds and just live with social supports, good for them, but then they owe it to me to not use hysteriaspeak about MY neurocooties when I want the same thing.

    Hypocrites piss me off.

  10. Recently, out of interest, I’ve been looking at the DSM personality disorders, and how they’ve changed between DSM-III-R and DSM-IV (I may make a webpage about it sometime). And it’s really clear, looking at those, that these categories are not well defined. I sometimes think we should throw descriptions of a variety of people with a variety of different diagnoses into a big heap, and then start sorting them into ‘who seems alike’ without reference to any of the current diagnostic categories. And then figure out new names for the categories, maybe borrowing the old ones if they seem a good description but with totally different groups. (In fact, maybe I could try to do that with what case studies I can find, and write a book on it. Not saying anyone has to accept my classification, of course.) And I think there should be more focus on quantifiable things like scores on actual tests (maybe not even behavior questionaires like ‘are you anxious around unfamiliar people’ but things like testing galvanic skin response to various stimuli, or asking them to arrange blocks in designs, if they have sufficient motor ability). And on what the people say about what it’s like for them.
    On a side note, Dependant Personality Disorder sounds a lot like battered woman syndrome, and to a lesser extent the effects of institutionalization. Another side note is that Schizoid PD sounds similar to autism, and Avoidant, Obsessive Compulsive and Paranoid PD sound like they could be caused by discrimination/abuse.

  11. I forgot to mention this, but in my book about School Trauma that I’m working on, I wrote a thing about misdiagnosis in which I said I doubted my school experience would’ve been better if I really had ADHD like they insisted I did. For one thing, the psychiatrists would have given me Ritalin rather than refusing to medicate me. And I would’ve probably either spent a bunch of effort vigorously denying myself (as I did to a certain extent because of the overlap between ADHD and autism) or thought to myself ‘they’re right, I am defective’. Had they accurately diagnosed me as autistic, it would’ve been worse as well. Partly for the second reason, also because they would’ve had horribly abusive interpretations of suggested treatments. I might even have gotten Risperdal – the school certainly considered me aggressive, which is what that med is recommended for in autistics.

  12. Kassi: Oh good grief. I haven’t been keeping up with Mindfreedom stuff. Last I knew they were pro-choice on meds and such but often (but not always) annoyingly Bregginean on autism and the whole idea of neurovariance existing in the first place. I definitely don’t share their stance on autism.

  13. I have to say during my recent interview with a psych, she was quite astute when it came to an assessment of whether the usual array of antidepressants and ssri’s in her armoury would do me any good. She was happy to prescribe my drug of choice, propranolol so at least I have a fighting chance against autistic induced excited delirium syndrome http://www.autismvox.com/autism-induced-excited-delirium-syndrome/

    As for Breggin, he has an axe to grind, which is why I don’t trust his objectivity.

    As for delusions the biggest one I have is that the rest of the world exists or that there ever really was a Bishop Berkeley :)

    As for ‘as for'(‘)s, (gotta get the hyphenation right eh?) I have repeated myself inadvertently there, tis not good grammar, but what frits me is the neurolgical substrate for my having done that, or was it just a quirk in the quantum mechanics or a quark in the quagmire. I dunno I was just predestined to be of that generation that not only knew python ab origino but aurally fixated on HHGTTG :(

    Getting off the point, I very much appreciate what you are saying in this blog, it the whole empowerment equation and the seeming inability of anyone to not read stereotypes into any situation.

  14. From a stance of privilege I sometimes wonder if, compared to other professions, the fields of social work and psychiatry have a higher incidence of people with mental illness. I don’t know the science on that, but it’s a topic that should be given a full study, if that hasn’t been done already.

    No profession is perfectly sane, of course. But, for example, most seminaries screen for mental illness. I wonder how often the fields of health science do the same? Is this a policy that should be federally mandated? Is certification (i.e. a bachelor’s degree) good enough? In a field so murky, how does one create definition?

    Best–

  15. andreashettle:

    Peter Breggin is a psychiatrist who finds that biological psychiatry threatens his own (more psychoanalytic) views, and he’s hailed as a hero by some psych survivors for opposing forced drugging… but the guy believes the refrigerator mother theory of autism and all sorts of other crap, and only seems to be taking the position he’s in for professional reasons, like Laurentius says. You can look him up various places I’m sure. I don’t trust him any more than Laurentius does.

    Kevathens:

    I don’t really know how to respond to that idea. It seems to be possibly built off the stereotype that the sorts of people who are normally considered mentally ill, are somehow dangerous and destructive, and that their/our presence as psychiatrists and social workers could be what’s wrong with the profession. That seems sort of… doubly wrong to me. The problem in those fields is not that the people who work in them are individually problematic, it’s more about who holds power and what kind of power is available to these people. I didn’t know seminaries screen for ‘mental illness’ but that sounds incredibly discriminatory and not something to emulate, replicate, or hold in high regard.

  16. Kevathens:

    I do know that at least the social work field does attract people who have encountered their own share of tough life challenges in general (poverty, homophobia, alcoholism and drug abuse either their own or in the family, witnessing domestic violence, etc.) and enter social work because they know exactly what it is like to need help from the social work field and want to give something back to other people whose life situation today is similar to what theirs was in the past. When this happens — just as long as the person concerned is now coping well, and is able to emotionally and mentally separate themselves from the people they work with — then I think it can be a real strength. The people who are striving to overcome poverty, domestic violence, or whatever get to have the benefit of experience of someone who has actually been through the same thing. And the co-workers who have not had similar life experiences can benefit from their insights as well, and use what they learn in their own work.

    I’m not actively working as a social worker, but I did pursue a masters degree in social work so I’ve had a number of classmates who have shared generously of their life experiences and I know I’ve learned from them. One student who was both deaf and learning disabled I believe was planning to work as a school social worker with deaf students with learning disabilities. I know she was very knowledgeable on the topic. (Okay, not a mental illness — but I think it fits in with the general theme that overcoming past challenge can be a STRENGTH, not a liability as you seem to imply.) Another was a few years sober and working with alcoholics. She once led an excellent class activity that helped us learn about how alcoholism can affect the whole family, and talked about how many people recovering from substance abuse strongly feel that only someone else who has actually “been there” is really in a position to understand them and help them overcome their addiction.

    I will probably not return to the social work field — my stronger interest is in international development. But if I were to find myself in a social work agency, and if I were to find that some of my co-workers had successfully dealt with the challenge of mental illness and were drawing upon what they had learned from that experience in their own day to day work, then I would be honored to call them my colleagues. In fact, I would view them as an asset. In those circumstances, I would hope that I could turn to them for advice in my own work.

    I’m not saying that people with mental illnesses (or people labeled as such) are necessarily universally good any more than they would necessarily be universally bad. I’m not even saying that mental illness would never cause a problem. Certainly it would have to be dealt with in some responsible manner (psychiatry and medication if the social worker feels those approaches are appropriate in his/her case; or through other approaches if other approaches seem to work better.)

    But I utterly fail to see why people with mental illnesses should automatically be screened out of the so-called “helping professions” simply because they carry a certain DSM label. I think a blanket rule of this sort would cause far more harm than good.

  17. You’re right. Anonymous’s diagnoses is, on a fundamental level, not relevant. What’s relevant is that whenever she asked for help with stuff she couldn’t cope with herself, she was either rejected, blamed, and punished, or forcibly locked up, blamed, and punished. You’d think that basic logic would kick in, and someone would catch on that as they kept punishing her for not being what they wanted, she kept getting worse and worse.

    I think the big gap is not the lack of involuntary commitment, but something fundamental to a lot of medical systems; the patient is not supposed to decide they want something, ask for it, and get it. Especially if they’re getting public benefits. Especially in psychiatry (or treating pain). From her autobiography, it looks like one of the reasons anonymous got such a hostile and cruel reaction was that she kept saying what SHE thought she had, and asking for specific things SHE thought would help her. That seemed to set off a much worse reaction.

    So a good starting place would be having the psychiatrists give patients what they wanted and thought would help unless there was a strong and specific reason to do otherwise. There are some cases where a psychiatrist should legitimately refuse a request, but that knee-jerk reaction of “she wants this kind of help, so she shouldn’t get it” or “he thinks he has this condition, so it can’t be true” needs to stop. And the efforts to identify and weed out scammers and manipulators needs to be adjusted and toned down so that first and foremost, people who need help can get it. A label that one doctor stuck you with at one point (whether “bad behavior”, “manipulative”, or “borderline personality disorder”) shouldn’t be irrevocable.

  18. I’m currently writing a book on psycho-educational diagnosis in special education, because so far clinical diagnosis has been a hypothesis-confirmation issue, rather than a process of finding out about the client’s experience.

    Psychiatry has little to offer anyone.

  19. I started looking up Breggin and he does seem to be a bit of a quack, at least when it comes to medications for people with ADHD

    http://www.quackwatch.org/11Ind/breggin.html

    (I *don’t* think that anyone with ADHD should be coerced into taking medication against their will, nor do I think parents should be coerced into medicating their children. Even though ADHD medications are generally far safer than some of the other medications that have been discussed in other threads on this blog site — Prednisone, neuroleptics, etc. — ANY medication still carries a certain set of risks with it. But although it isn’t for everyone, I’ve run across a lot of people on the Internet for whom it really helps a great deal and wouldn’t want to have to do without it. I’d be on them at least occassionally if I could, but so far none of the ADD meds have been effective for me. So I tend to mislike anyone who makes sweeping statements about meds necessarily being always and universally bad, at least in the case of the more common ADD/ADHD meds.)

  20. J, I think you hit the nail on the head.

    I’ve been experiencing the same thing with asthma treatment. I know how my body feels and what I need, but I’m not necessarily supposed to say it.

    I used to think that just learning to understand and communicate what was happening to me was enough, that this was the main barrier I was dealing with. But I learned that, and the barrier barely budged.

  21. I had fantasies for many years that I was not human, imaginary world, etc. I remember reading “I Never Promised You A Rose Garden” and
    thinking I was schizophrenic just because I too had a rich fantasy life.
    So I decided that I would get rid of my fantasy life. ( That was actually a good decision as the imaginary world backfired on me. )
    That is one of the proudest decisions in my life to become human again. But it did not happen with the psychiatrist’s help. And I was
    not happy to hear many years later that I was autistic, not
    schizophrenic. I had been lied to by omission. They told the teachers I was learning disabled. Which gave me a very bad
    education. I was tought academic subjects when I had not been tought
    how to relate socially. And I had no idea how relate school to
    the non-school world.
    I am still trying to undo harm caused by believing a simple
    defense mechanism I used for a number of years was wrong.
    I am still trying to undo harm caused by thinking
    some years later; fantasies=attachment=wrong-truth=non attachment
    =equals right so in a way I tought myself not to have attachments
    when that is what I needed.

  22. About Breggin, I’ve actually run into autistic people who support him, ostensibly because of his anti-psychiatry stance, which I find really inexplicable in light of the fact that he buys into the refrigerator mother thing.

    There’s a certain strand of thinking that seems to go “psychiatry = cold and impersonal; psychotherapy = warm, loving and compassionate.” I can certainly agree with the first assessment in the case of a majority of psychiatrists I’ve met. I will never agree that all psychotherapy is good, loving, warm, and helpful. Sometimes it can amount to mental torture, brainwashing and mindfuckery in its purest form– Irvin Yalom has a story about how he “cured” a plural patient, in his book “Love’s Executioner,” that makes me sick to read. (The title of the book alone should reveal something about what he really thinks he’s doing.) Sometimes I’d prefer impersonality and a bottle of pills.

    And no, obligatory disclaimer, I am not saying that all therapists are horrible, evil people. I’ve run into some who were well-intentioned if clueless; I’ve known other people who said they were, genuinely, helped by therapists, as I’ve met others who said that psych drugs really were helpful to them.

    In some of the specifically anti-drug-writings, also, I’ve noticed a distinct veneer of view-from-aboveness towards people who were actually damaged (neurologically, etc) by psych drugs– portraying them as horror-movie creatures or as pathetic damaged goods, dehumanizing freak-show language when describing the effects of tardive dyskinesia and similar movement disorders, perpetuating the idea that disabled people live horrific lives with no potential for happiness and might be better off dead, etc. I can’t see how that can be construed as either supportive or compassionate to people who are actually dealing with the effects of brain damage due to overdrugging.

  23. It is clearly the predecessor to the DSMs, with lovely diagnostic trees similar to the DSMs, but contains diagnoses such as “lycanthropy.” If anything shows that psychiatry and psychology are not sciences but social constructs, the history of diagnosis of “mental” problems does…

    Oh, some people still insist that “clinical lycanthropy” (which apparently encompasses a whole bunch of things, from acting ‘animal-like’ to believing you were a nonhuman animal in a previous incarnation) is a valid disorder/classification. I’ve hung out a bit in places where people talk about identification with nonhuman animals, believing you’re the reincarnation of one, etc, and a lot of the time it is really just a personal belief system that some people find works for them, but people certainly do get off on tears about “these people are mentally ill, they have clinical lycanthropy, these poor unfortunates must be treated and helped!”

    I also believe that people who think they are in a sufficiently powerful/privileged/etc position to never, ever run into a horror story with The System, should consider whether they are actually as safe as they believe they are. Sometimes all it takes is to say the wrong thing to the wrong doctor– sometimes the things that people would normally think of as power and privilege (i.e. coming from a very rich family) can end up working against you, because you will be the one whose family has good insurance, and the ability to keep coughing up money for more and more “treatments”; you’ll be the one they’ll try to recruit for supposedly superior private institutions, “teen boot camps,” etc. We’ve known people who were able to evade the system only because their family didn’t have the insurance to pay for them to be “treated.”

  24. Psychiatric classifications of people are not a value-neutral system in the same way that plant or animal classification are, but they are necessary because otherwise psychiatric patients would be labelled as just mad or crazy. I don’t know what could replace them. They can be benevolent and of some use in understanding different psychiatric conditions. But they must never dehumanise psychiatric patients.

    I thought that readers of the Autobiography of Anonymous would would accept her as being autistic, except for those people who believe that because she can write she cannot possibly be autistic.

  25. Ballastexistenz, I identified quite strongly with the issues you raise here. What is your opinion on tests designed by Aspies for Aspies? I am afraid that they are just as bad as the official tests and used in just the same way to exclude people. For example:

    http://www.rdos.net/eng/quizs1.php

  26. Believing in diagnostic categories seems somewhat like believing that a line drawn in the sand is actually a brick wall. As noted above, the lines in the sand actually shift–quite often–so I would like to propose a new one: “Diagnosis identity disorder,” for people whose diagnosis has become obsolete, or who have been dumped from their diagnosis due to changed criteria. Okay, I’m being facetious, but I’ve certainly heard people suggest that aspies can’t “speak” for other autistics due to the fact that they can “speak” in the first place. And kids being yanked out of one educational setting and away from their friends and put into a different one on the basis that their latest IQ test is a few points over or under some arbitrary cut-off line, etc.

    Ettina Says:
    May 30th, 2007 at 17:12
    Recently, out of interest, I’ve been looking at the DSM personality disorders, and how they’ve changed between DSM-III-R and DSM-IV (I may make a webpage about it sometime). And it’s really clear, looking at those, that these categories are not well defined.

    Lilac^Amorpha Says:
    May 31st, 2007 at 5:27

    * * *

    Oh, some people still insist that “clinical lycanthropy” (which apparently encompasses a whole bunch of things, from acting ‘animal-like’ to believing you were a nonhuman animal in a previous incarnation) is a valid disorder/classification.

    Oh, I’m not suggesting that lycanthrophy’s exclusion from the current DSM is necessarily good or bad, valid or invalid…just that the DSM reflects popular notions. For example, I think it was as recently as the 1980s that being gay was still a “mental disorder” in the DSM. And at some point, I remember there was a “shyness disorder.” Wonder how they treated THAT one??? On one of the hyperlexia lists I belong to, someone was bemoaning recently that hyperlexia isn’t an “official” diagnosis, and hoping for its inclusion in the next DSM. I’ve got to say that I don’t share that hope–because if they put it in there, they will feel obliged to start trying to cure it.

  27. Kevathens,

    In clinical psychology, the prevailing attitude is that if you have a mental disorder, that’s part of your medical history. Thus it’s nobody else’ business. Unless it interferes with your ability to do your job, no employer or educator has the right to ask you about it.
    I imagine that by a rigid, application of the somewhat arbitrary criteria in the DSM, many mental health professionals would be diagnosable with something. But then again, probably much of the population would be.

    As many people here have pointed out, it is a fallacy to take the categories in the DSM too seriously. First, human behavior isn’t categorical. Second, the categories are only estimates based on statistical data that applies to MOST people, so obviously the criteria won’t be appropriate for all people. Finally, there is such a dizzying variety of different kinds of human psychological problems that it would be silly to think they can all fit into neat categories.

    I think diagnostic categories should be used with a grain of salt, as guidelines as to what MIGHT be going on with someone, or not at all.

    On the other hand, if you take as a given that we use a medical model for psychological problems (which is by no means perfect, but may be the only way in today’s climate to get insurance to pay for treatment,) we may need these categories to some extent. It’s hard to see a problem as an “illness” unless there is a clear set of criteria for whether the illness is present or absent.

    My preferred approach to mental health would be to allow the medical model as one of a variety of ways of looking at people’s problems, and empower people to choose the lens through with they view their lives. For example, I have problems with anxiety, but it best suits my needs to see that as a part of my personality that has benefits and negatives, rather than as an illness. I have luckily been able to seek “treatment” (or, in other parlance, “assistance”) for this without having it unneccesarily medicalized.

    Hopefully within my generation, or within a few generations, we may develop a less rigid way of looking at human behavior. Step one would be to acknowledge that most problems range on a continuum from the degree of difficulty that most people experience, to a degree of difficulty that warrants treatment or intervention.

  28. Side note:

    My understanding is that counseling psychology, which produces Master’s and Doctorate level professionals who call themselves counselors, is far less accepting of the medical model. They tend to be more interested in empowering clients to work together with the counselor to find solutions to life problems.

    The down side of this is that many counselors are uninterested in working with people whose mental illness is severe or disabling, or to put another way, whose life problems are more difficult than is normal for the population.

  29. In what way has empowerment struck you as a strange idea? We may be working off different definitions of it.

    Your post on therapy culture is interesting. I don’t have much experience with therapists, or people involved in mental health who have the attitudes you describe. There may be people out there who do, but I don’t and while I see a lot of dysfunctional attitudes in the places I work and study, I haven’t noticed those.

    I see the personal and the political as two related, but independent, spheres. When somebody is affected by an issue that is political, there are two problems. One is how to change the political climate and be activist and make the world a better place, both for that person and for everyone affected by the same problem. The other is how that individual person is going to deal with the problem on an emotional level. I think both issues need to be dealt with, but the second issue is more appropriate for therapy.

    For example, say that a woman is facing gender discrimination at work. There are obviously political ramifications and issues for this. And activism and political assertiveness (i.e. filing a lawsuit, seeing a supervisor, etc) on the part of the discriminated person is appropriate as a political solution. This activity may also help the person personally, in that it helps her feel better (more “empowered” :) )about what’s going on. But there are other ways to address her personal problem, such as seeking support outside the workplace, and developing strategies to help her anger at the situation not be so consuming. These could be the subject of therapy. Not that there is anything pathological about the woman, she may be reacting in a perfectly “normal” way to a horrible situation. But nevertheless, a thearpist can help her with these things if she needs it and wants therapy.

    I should also note that in this example, there is probably nothing pathological about her being angry at the situation. She is having her rights violated. But she may choose to find ways to not be so angry (and remain politically active) because she may find that she likes her life better that way.

  30. I’m going to state right now, I have no idea what empowerment actually means. I’ve heard it tossed around, and I’ve had one friend (an extremely liberal social worker who’d spent a lot of time in academia) try to explain it. But I never got any real idea of what it means, or what’s involved (except it’s supposed to have to do with power, and it’s supposed to be generally good, and fix everything without requiring anything terribly concrete and measurable.)

    So I’d like to hear a real explanation/translation for the buzzword impaired.

  31. I think my being buzzword-impaired myself both makes it hard for me to describe what’s wrong with that word in this context, and hard for me to describe what it’s referring to. :-/ (I can’t come up with a good response to Rachel and it’s not for lack of trying.)

  32. Buzzwords in general weird me out. I don’t even know exactly how to delineate buzzwords from subject-specfic jargon, and there is probably some overlap there, but there’s definitely an icky, fake feel to a lot of what would probably fall into the category of “buzzwords”. They always remind me of a guy at a prior job who decided, for some reason, that he wanted to “mentor” me, and ever since then (due to what he did) I’ve been very very hostile to the whole notion of “mentoring”.

    Basically, what happened was that he lied to me about wanting to have a meeting about some work project we were both on — what he really wanted was to shut me inside an office alone with him for several hours and try to get me to accept him as a “master”. He was obsessed with “Neurolinguistic Programming” and (I guess) wanted to “program” me. And part of his deal was that I had to learn his Special New Vocabulary so that he and I could have conversations in which all the words meant all kinds of things that they don’t ordinarily, with the goal being that this would enable him to instruct me along the way to “self-actualization” (or something similarly buzzword-y).

    One of the words that he wanted to re-define and turn into a buzzword was “promise”. He insisted that from then on, I was not allowed to say I would do something unless I could “promise”. I wasn’t allowed to try anything, and real-world contingency factors were not allowed to enter the picture — basically, I had to just say I would do whatever he told me to, and I had to “promise” it, and that the promise would become a “contract”. Breaking the “contract” was grounds for accusations of being a “liar” and lacking integrity. And I had to accept this set of conditions before I was allowed to leave the room that day.

    Every time I suggested that his plan didn’t sound like it would work to make me a better engineer, he would say things like, “So you’re just happy to go through life without reaching your potential?” or “You’re just putting up those psychological defenses again — we need to work on breaking those down!” He also told me that what he was going to do to me might “feel like torture” but that it was okay because he’d gone through something similar at the “leadership seminars” he’d supposedly attended. I really really should have gotten up and left the room, but I didn’t have the confidence at the time.

    Eventually I agreed to his “conditions” just so I could leave the room. And he proceeded to basically treat me like an unruly child from then onward. He would sit behind me as I attempted to do my work (I was writing assembly code at the time) and make comments the whole time. He also made me “promise” to get a certain coding task done within a certain amount of time, and when it turned out to take longer than that, he yelled at me for breaking the “contract” and told me to go off and do something else (a manual task) if I was “even capable of doing that”. I became extremely timid and started feeling incredibly stupid all the time — it wasn’t until two co-workers told me that I was being psychologically abused that it really hit me that that was what was going on.

    For years (up until fairly recently) I wondered why I hadn’t been strong enough to simply get up and walk away when he had me cornered in the office. But now I can see that he was using a lot of really nasty intimidation techniques, and that he was capitalizing on my insecurity, vulnerability, and speech difficulties (e.g., making me repeat stuff he said as a “condition” of leaving the room — which didn’t strike me as as weird as it should have, since that was how I saw a lot of conversations anyway while growing up because I didn’t entirely understand their purpose).

    In retrospect I can see that the buzzwords and redefinitions of common words were all part of a kind of mystique that this guy was attempting to create — one that presented him as a sort of archetypical Wise Man who could “save” me from my ignorant and incompetent state. If my other co-workers hadn’t stepped in when they did I might very well have ended up losing a lot of skills. And I actually did end up losing a few cognitive skills as it was (though I think I’ve gotten most of them back at this point) — basically, this guy bullied me into thinking in a way that forced me to bypass all the ways in which I thought *well* in favor of ways that made me more obedient. So when I finally broke away from the intimidation it took a long time to even figure out where most of my brain was. It was very creepy.

    I know this is a rather long comment but it’s the first thing that came to mind when you mentioned being “buzzword-impaired”. I’m pretty buzzword-averse at this point and I now see the use of such words (or the attempts to twist vocabulary into having meanings that carry all kinds of weird connotations with them) as a major red flag.

  33. Hmm. Labels are just shortcuts to me. From a pscyhiatric pov, it *is* scary. I agree with you there. The way “other people” are classifying to me is not as big a deal. When I read that, my first thought was “PTSD” and I related a lot on that level regarding abuses. Those abuses happen at a social layer, to me, high above whatever underlying neurological pattern would be described. The main point was a life story and not a defense of diagnosis or any such to me. Because I thought of the label “PTSD”, it was a summarization of what I felt. I use diagnostic labels more as shortcuts and not as “rigid” tools because I, like you, deny the whole psych establishment’s competence overall. The big issue to me appears to be something along the lines of a “bred and groomed successful doctor” simply isn’t going to understand those who are down on their luck easily and simply haven’t “walked in their shoes” kind of issue.

    When people use a diagnostic sound label, they could be trying to classify or just come up with a simple reference to summarize the experience. The latter I have less of a problem with. The former is a futile “mental masturbatory” exercise that ignores the person’s needs as you say.

    Not sure I’m hitting all the points or even the main point but I felt an urge to comment. Not sure if it’s the best kind of urge to do so or not. I’m always about letting people explain themselves without interference more and more lately….it annoys me too when someone’s humored or their pains are written off. It’s happened to me too many times, I won’t dismiss people’s claims and try to take them at face value. Sure, I may be a bit naive in doing so but I’m setting an example of what I want others to do and that is to trust more. It’s also a part of “respecting another’s basic wishes” and not obstructing people over petty things like so many control freakish doctors out there can do out of a feeling of wanting power and absolute authority and being “in control” and “driving” another person who they see as having lost that control (despite the wishes of that person to maintain their own freedom).

    Thanks for writing about this in any case. It was much needed mention as a reminder about our psychiatry system and the whole trap of debating petty labels. All my labels come with disclaimer (adjective only, not diagnostic) and the caveat “based on what they have identified themselves as/what they are relating to”.

  34. Some legislation passed about education here that meant that help should be provided not on the basis of labels, but on how children’s needs present in school. And loads of people in the education system just cannot deal with that concept (lots of people can, this is not meant to diss everyone). It seems that they need to cling to the labels and the pigeonholes for kids. Richard Dawkins has an essay in ‘Devil’s Chaplain’ on evolution, that people can’t get their heads round it because it’s a continuum, rather than a set of clearly defined categories/species. It seems general that there’s a ‘must box’ impulse that overrides care, rationality or anything else.

    “…not even modeled on psychiatry at all, but on the idea that people can help other people, including people who are extremely confused about reality or extremely distressed.”
    Some of the best help I got with my (relatively mild) depression was from other people who’d been there and done that. On the other hand, I think I screwed up a friend with similar problems even more when I tried to do the same for her. I ended up angry and resentful at her for taking up all my energy with her problems when I was barely coping with my own. This isn’t meant to criticise the ideas, because I think that part of my problem was being there alone – there was no network to ‘spread the work around’, so it was just the two of us, and because she was a close friend I took her problems on as my own.

    Kevathens: I’m going to start studying to be a doctor, and as mentioned above I’ve had some mental health problems. I hope this will make me a better doctor, not a worse one. I hope that I will be able look at patients who come to me at their lowest ebb and think ‘there but for the grace of god go I’ rather than dismissing them. I am considering psychiatry, but a lot of forced medication in psychiatry is because of lack of money, rather than lack of care. In general practice in the UK doctors say they’d love to give patients talking therapies rather than anti-depressants, but those therapies aren’t there – and they’re rather give the depressed patient an SSRI that *might* help than send them away with nothing, or a letter that puts them on a two year waiting list. There are doctors who are bastards, and doctors who are misguided by the prevailing medicalised models, but there are others who end up doing these things out of despair at finding anything else for a patient aside from prison.
    A major problem with recruiting good psychiatrists is that it’s one of the lowest status jobs in medicine. Some people choose to be psychiatrists, but a good many end up there because they’re too crap to do anything else (low status profession = not enough people to fill posts). I think they’d account for many more of the problems with psychiatry than those who’ve had mental health problems. Amanda’s written a lot about power relationships as well – even if the person in power is being ‘good’ there is still that coercive power relationship in psychiatry which can worm into the soul.

  35. David N. Andrews M. Ed. (Distinction) Says:

    Psychiatry has little to offer anyone.

    You know guy, I usually have no problem with your comments. But this one is Wrong, in my opinion. I have Sleep Apnea, Asperger’s and Major Depressive Disorder. Without my antidepressants things are much worse.

  36. Some history. In the 19th century annual reports by state asylums in the USA included such idiosyncratic and moralistic diagnoses as vagabond, volitional old maid, noisy, and idle; and more universal diagnoses such as religious melancholy, idiocy, dementia, epilepsy, and insanity. Insanity was usually qualified by descriptors such as indolent, boisterous, industrious. During and after the Civil War nostalgia became a popular diagnosis.

    The term neurasthenia introduced and popularized in the mid 19th century was adopted around the world.

    To enable state hospitals to communicate diagnostically with one another, and to obtain meaningful national statistics, more accurate and supposedly scientific diagnoses emerged in the late 19th century, such as dementia praecox, mania, depression and manic-depression.

    In the first decade of the 20th century, possibly because of eugenic concerns sparked off by mass immigration, the United States Census sought better data on the ethnic and diagnostic status of patients in mental hospitals.

    The Statistical Manual for the Use of Institutions for the Insane, published in 1918, consisted of categories of psychoses: organic, toxic, infectious, nutritional, dementia praecox; and manic-depressive insanity, psychoneurosis and neurosis. The Statistical Manual had undergone ten editions by 1942.

    However there were significant objections by leading American psychiatrists to this system of classification, who developed their own systems. One was developed by Adolf Meyer, and another by the US army under the influence of Brigadier General William Menninger came into force in 1945.

    By 1946 American psychiatry had three competing official classification systems, none of them in line with the International Statistical Classification (later the International Classification of Diseases or ICD). In 1944 the American Pyschiatric Association (APA) Special Committee on Reorganization was set up. The DSM-1 was completed in 1950 and published by the APA in 1952.

    In December 1973 the Board of Trustees of the APA voted to remove homosexuality as a mental disorder from the DSM-II. Because of a campaign of opposition to this decision a referendum was held. In April 1974 the votes were counted – 58% of American psychiatrists who voted supported the decision. Which means that as much as 42% voted to keep homosexuality as a mental disorder.

    The whole episode raised the question of how could psychiatry be scientific if the classification of something as a disorder could be settled by a vote.

  37. Labels helped me last year. I was going through a bout of (still am going through it) becoming “more autistic.” I did not even know what autism was. I always say now, “Thank God I found out I was autistic, because otherwise I’d think there was something wrong with me!” (Please attribute to me if you use that quote!) For me, having the DSM criteria was a starting place, but the DSM criteria fall WAAAAY short of who I really am and the “conditions” I have an my life experience. My labels came from Internet sources. Thankfully, I first looked at the Wikipedia article on autism, and not something like Autism Speaks. When I scrolled to the bottom, me being me, and politically minded, I first linked to anything that looked like it had to do with “autistic community” and “autistic rights” so was immediately steered to autistics.org and similar sites within less than 24 hours of reading about autism. I’ve learned much more by writing to and talking with and meeting other autistic people than I ever learned by reading the DSM criteria but if the criteria were not there I don’t know how I would have ever figured it out.

    That being said, it is both hard AND easy to believe that “Anonymous” has been and continues to be treated in the way she has. I believe it is my moral responsibility to do something about this sort of treatment but am not sure what, yet. It takes me awhile to figure out what I can and should do. I think Anonymous is in another country than I am but though I might not be able to help her personally, there is someone in my own country that I could assist, once I figure out who and where and all that. I have already started that process, and it is slow, but better than doing something stupid that doesn’t help anyone at all.

  38. Amanda,

    As with all your writings I’ve read so far, I’m struck by the spiritual honesty of what you say. Is that the right term, spiritual honesty? It sounds a bit too religious perhaps. What I mean is the way your writing makes us realise how we need to be honest to ourselves. Honest to ourselves in a world where those in power are stuck in a herd mentality, thinking in terms of manipulation and vote-winning instead of facing up to the real issues facing our planet.

    The autobiograsphy of Anonymous, for me, once again shows the cruel lie of the so-called social security safety net (which of course is full of holes) on this “septic isle” we call Britain. Those who know how to play the system get what they need, and those who don’t end up in what middle-class liberals call “chaotic lives” like Anonymous. Autistics often end up bottom of the pile because it’s harder for us to find the friends who show us how to fill in the complicated welfare forms, what to say at the benefit offices, how to deal with landlords etc. But I guess it is fundamentally no different in other countries, going by what I have read. Our free healthcare system has become a gathering ground for incompetents, doctors like mine who think Asperger syndrome is an infectious disease (as my support worker witnessed and was only slightly less speechless than me). Anonymous clearly got far more than her fair share (if such a thing can ever be described as fair) of these incompetents. The whole story makes me ashamed to be English.

  39. Anna, Amanda:

    Unfortunately, the word “empower” is part of a collection of buzzwords that are often used in a way that is meaningless. They are used instead of saying anything that makes any sense.

    Hinsberger says:

    ” My job is to help people discover the power they’ve had all along, and then help them learn to use it. Power come from taking breath.”

    This is what I mean by the term empower. He says that only an oppressor can empower; this may be true. Often there IS a power imbalance in the therapy relationship. One of the meanings, to me, of empowerment, is giving BACK to the client power that therapists have traditionally wielded in this relationship. Examples include the power to decide what the goals of therapy are, what techniques should be used, whether to embrace an aspect of client’s personality or try to change it, etc.

    There is another way to use this word, and it’s a little hard to define. It has to do with the existential concept of having the responsibility to take charge of one’s own life. This does not mean blaming someone for the problems in their life, that doesn’t seem productive. Rather, it means taking the attitude that the client, alone or with the help of the therapist, is able to make changes in his or her behavior, mood, or thoughts. It means that if you fight with your neighbor every day and it’s a big problem in your life, there are things you can do to help solve this problem. It doesn’t mean it’s your fault and not your neighbor’s.

    An example of empowerment related to autism is an ABA therapist (if one could ever make such an attitude change) deciding that rather than the ABA deciding what behaviors should be “punished,” allowing the client to set goals and decide whether, and which, behaviors he or she would like to change. This example is a little off though in that to me, the whole concept of behavior analysis and operant conditioning is dehumanizing and takes away all the power from the client.

  40. The thing is, I knew a girl who worked at a factory (not in the US). She was twelve, and the owner used to hire poor kids by promising their parents it would be part time work at good wages. Then he’d take the kids halfway across the country to a factory where they’d work ten hour days, and get locked in at night to sleep on the factory floor. The cops came in and rescued the children. They had every right to use words like “rescued” “liberated” and “freed”, because they hadn’t locked up the kids in the first place. If the owner had stopped locking the kids up, and proudly described himself as “liberating” then, talking as if it were a shining act of benenovolence and charity to simply stop abusing someone, that would be different.

    That’s the way “empowered” gets tossed around by a lot of social workers and mental health professionals, not like they’ve done something wrong all those years, removing every chance someone had to communicate honestly and decide, and are just now stopping the abuse, but like they’re Glinda the Good Witch, floating down in front of all their little disturbed Dorothys, saying “Now that you’ve progressed far enough to hear and understand this, you’ve had the power all along.”

  41. J (and others weighing in on the “empowerment” thread)

    Not to defend past practice (or to defend cases where bad practice continues today), but many of today’s younger (or at least, newer) social workers and, I presume, mental health professionals did not take part in the worst abuses, or at least, not the more “obvious” commonly recognized abuses. And are not taking part now. Or at least, they are doing their best to avoid abusive patterns of behavior, some of which may still unfortunately be entrenched in the policies of the agencies they work at. And of course, “doing their best” is not the same as actually doing it right.

    The training that is done in social work programs today is different from the training they did 20 years ago. That means newer social workers are “giving power back” or whatever phrasing you want to use from the first day of their first internship onward. Or at least they try to, to the best of their ability to recognize and understand power relations and to recognize when well-intended behavior on their part may actually feel like coercion or pressure to people who don’t have the power that ought to belong to them by right.

    (How well they succeed I guess depends partly on how well they understand power imbalances instinctively and how effective their training program is in sensitizing them further to these issues…probably mixed, on both counts. And it probably also depends partly on the extent to which they system they work for truly supports their efforts: remember that their supervisors or their supervisor’s supervisors might have been originally trained before the concept of “empowerment,” even in its imperfect form, caught on in the social work field, so they may still see little wrong with practices that others consider an abuse of power. Or their agency may be dependent on government funding, and thus on government policies about how things should be done even if the social workers there might strongly disagree. Or they may be VERY understaffed, which may mean that even a well-intended social worker willing to work 60-80 hour weeks may out of desperation resort to “short cuts” that end up dis-empowering–i.e., stealing power again. Or they “burn out” and stop trying to do the right thing. None of this is to excuse abuses. But I think it can be useful to understand WHY abuses occur so we can learn how to prevent them in the future– or at least prevent some of them.)

    And I would hope that a GOOD social worker would understand that “empowerment” is not about being benevolent, it’s simply about respecting the power that already rightfully belongs to the people seeking out (or, as the case may be, being forced to seek out) social work services. (Or “facilitating the self-empowerment of …” which is another phrase I’ve heard, intended to work around the problems with the term “empowerment” that have been raised here — whether this phrasing is any better is a question I’ll let others debate.)

    (And just to clarify here: I’m not just thinking of people seeking out mental health services, or being forced to do so. Mental health is only one possible specialization that only SOME social workers pursue, though I realize this is the way in which many of the people reading this typically come in contact with social workers. Social workers, in fact I think the majority of them, work in places like welfare agencies, child protection services, adult protection services, schools, and so forth. So if a child has been abused and removed from the home for their safety, but they think the family could be safely reunited with help, then the courts might order parents to work with the social workers before their child can be returned to them. So the mental health profession is not the only field in which some contact with social workers is coerced. And, of course, the power-relations and the potential abuses of it are probably fairly similar across all, or at least most, of the settings in which social workers work, whether coercion is involved or not.)

    If a social worker is talking about “empowerment” in terms of, “Look at me, I’m Glinda doing a kindly deed by returning the power that was stolen from people by my nasty colleagues and the system I work for,” then that’s a social worker who doesn’t get what the concept of “empowerment” was originally supposed to mean. Even if they, personally, weren’t the ones who took power away in the first place, it still shouldn’t be something special or praise worthy if they make an effort to give it back.

    If that’s the tone that you’ve been hearing from the professionals you’ve been in contact with, then I agree that isn’t a good thing. “Empowerment” by whatever name should be simply a given, not a gift.

  42. (I haven’t read every comment, by the way.)

    Empowerment doesn’t mean much, really, to me. It’s a short-term, feel-good solution. What matters is that people – autistics, especially – develop a structure around themselves that helps them foster their own happiness: primarily healthy and loving, lifetime connections to their family and friends, when and as possible.

    What’s important is that we’re happy and healthy for the time that we’re allowed to be. And when we’re not, we work to create that structure for ourselves, and continue to communicate and improve our outlook.

    I think blogs such as this are miraculous in their ability to help people communicate in ways that previously were impossible. I am an idealist, though.

  43. ““Empowerment” by whatever name should be simply a given, not a gift.”

    Right on. Taking the approach that your clients are humans who have equal rights as you is not all there is to doing therapy. It’s just a foundation you need to be able to do anything else. And it doesn’t make the therapist a superhero, it just makes the therapist somebody who has the awareness and ethics to take the first step in making sure he or she does the right thing.

  44. Ettina, re: “And I think there should be more focus on quantifiable things like scores on actual tests (maybe not even behavior questionaires like ‘are you anxious around unfamiliar people’ but things like testing galvanic skin response to various stimuli, or asking them to arrange blocks in designs, if they have sufficient motor ability). And on what the people say about what it’s like for them.”

    That’s how personality disorders are SUPPOSED to be diagnosed, by responses to tests like the MMPI or PAI and by interviewing the person about their experiences. I know a total jerk of a psychiatrist who uses personality disorder diagnoses as revenge, based on whether he likes the client or not. Ick.

  45. Patrick: “I have Sleep Apnea, Asperger’s and Major Depressive Disorder. Without my antidepressants things are much worse.”

    Like I say, psychiatry has _little_ to offer. Many studies now demontrate the limiting effect of medication-only regimes in dealing with mental health issues such as depression. I’m depressed a good deal of the time, and would qualify for the same diagnosis, but I also know that the meds were no use… they don’t solve the underlying problem. If it’s about unhelpful thinking patterns, they don’t help with that; and it if’s a truly shitty life experience, they don’t help with that.

    In depression, meds are really best seen as a kick-start for everything else, including the psycho-educational stuff and the life-organisation stuff from social services and other support networks.

  46. Agreed absolutely with Rachel in #48.

    Re, Kevathens in #47: What you describe about people needing a way to develop a structure around themselves to foster happiness is exactly what the so-called “empowerment” approach is SUPPOSED to accomplish, at least in the long term. Though, clearly, not everything carrying the label of “empowerment” actually succeeds at it.

    If that structure isn’t there by the time someone ends a prolonged period of contact with a social worker, then I don’t care what label the social worker uses for their approach to working with people (“empowerment” or “facilitating the self-empowerment of people” or “the Completely Fictional Purple Process”) — something has gone wrong. (Same applies if the structure sort of SEEMS to be there but collapses as soon as the social worker is out of the picture.) If that structure is there, then something went right, whether it’s called “empowerment” or something else.

    The role of the social worker SHOULD be, ideally, to work with people to understand what THEIR goals for themselves are, and what barriers seem to be standing in their way. Then the social worker supports them in the process of identifying ways they can tear down those barriers. If they need skills and tools to do that, then the role of the social worker is to help them develop or obtain those skills or tools. And the social worker can also stand in their corner when advocacy needs to be done (ideally in a supporting role while the person does advocacy for themselves).

    And as Rachel says: none of this makes the social worker a superhero. Any social worker who thinks they are one should find another profession to pursue. And simply respecting that everyone has inalienable rights, even if they’re currently stuck in a system that tends to erode at some of those rights, is simply a necessary foundation for doing anything else. Any social worker who talks as if “empowerment” is a miracle cure-all in and of itself either needs to communicate themselves more clearly (I’m trying to make an allowance for the possibility that maybe some social workers come across this way because they’re trying too hard to “prove” the case for “empowerment” and are temporarily losing sight of the bigger picture), or they need to move on and learn more about the social work profession.

    (Caveat: I’m no expert on social work. I have a masters degree in it, but have never worked directly in the field.)

  47. So many thoughts and I should be in bed (just got home from babysitting).

    Re: the medical model wherein the patient doesn’t actually know what they need. I’ve experienced this, perhaps in mild form. Last time I went in to see my doctor, to get put back on Dexedrine and to raise my Cipralex dose, he basically reprimanded me for telling him what I wanted until I told him I’d discussed the situation with my psychologist first, and this was what she had suggested. And don’t even get me started on the lack of concern doctors have shown about my right ear.

    Re: therapy culture. I’m no longer in counseling, and I’m doing pretty well now, thanks to my meds and having learned lots about how my brain works and how I work. Unfortunately, my roommate is still in counseling and is on antidepressants, and has been for years (longer than I’ve been in counseling), and half the things I tell her that any other friend would have excited questions about are met with “And how do you feel about that?” *sigh* I don’t have the heart to tell her to stop using therapy-speak on me, because I know how ingrained it must be at this point. (My opinion is that she needs a new psychologist, one who is going to actually teach her the tools she needs in order to change her life, but that’s just me. I’m very action-oriented.)

  48. Jannalou: “My opinion is that she needs a new psychologist, one who is going to actually teach her the tools she needs in order to change her life, but that’s just me. I’m very action-oriented.”

    Odd you mention this. A pal of mine has been seeing a ‘system’ therapist (who works for the local mental health office) for ages and getting nowhere with his difficulties; then he told this therapist to ‘bugger off’, and got to see a private cognitive therapist in another town, and inside two sessions he’s actually learning tools to help him with his issues.

    Talk therapies generally aren’t useful if they do not lead to learning.

  49. The thing is: OCD is not a 70s diagnosis. The disorder was there, but there was zero recognition by the therapy establishment. And certainly not the nascence of any definition, which appeared only in the mid 1980s.

  50. An interesting side note – a friend of my mother’s who does psychological evaluations of school-age kids says Asperger Syndrome has become a fad diagnosis, and she sees many kids referred to assess for it that clearly aren’t on the spectrum.
    I wonder how to deal with the issue of various diagnoses being ‘fads’. How do we get some more meaningful way of describing various groups of people?

  51. Ettina,

    I think there’s two ways. One is to have a better general knowledge pool of psychology. That way you don’t have a teacher who doesn’t know anything about psychology suddenly acquire “Asperger-colored glasses” because that’s the only disorder she knows about that causes a kid to be really interested in dinosaurs.
    The other way is to make sure the people doing the assessments are well-trained and put forth real effort to make sure people get diagnoses that are as accurate as possible. That way when you get 15 kids referred for an Asperger’s screening, they aren’t rubber-stamped into carrying a label that may affect their lives profoundly.

    Say what you will about the DSM, at least with a set of criteria psychologists should, in theory, have some kind of agreement about what to call a certain constellation of behaviors.

  52. I have met social workers outside the mental health system. In child protective services, and in “community development” in poor third world communities.

    The ones in child protection mostly used empowerment to mean “the kid’s doing well, and if we throw more buzzwords on the report, we’ll get more funding and staff which we need since we’re overworked and underfunded.” I understand using it in that context (just like I understand reshuffling the money to meet the medical bills due NOW, out of funds for the recreational activities that you can postpone and having the recreational activities when the medical bill money finally turns up), but I think the system shouldn’t work like that. It should give them better choices, at which point they should stop.

    Some used “empowered” to describe the kids in their custody (another inherently coercive relationship, even when it’s better than the abusive home) when the kid did something positive for herself, and the adult wanted credit. They’d claim to have “empowered” the kid, and “facilitated” her accomplishments, by not actively impeding it. I didn’t see much to admire there.

    For “community development” social workers, nearly always very young social workers, were sent out to communities to encourage them to develop themselves. There, “empowerment” meant “solving your problems without looking at your oppressors or acknowledging that you’re oppressed”. It meant trying to figure out how to educate the children without asking why the government took taxes, but didn’t build a school close enough for kids to walk to, or roads smooth enough to drive over. It meant asking people who work ten hours a day, six days a week, harvesting rice or scrubbing floors to keep their children nourished by growing a garden in their spare time, and not asking why they didn’t have money to buy enough food or time and space to grow it. So I wasn’t impressed with that, either.

    There might be a perfectly lovely theoretical meaning of empowerment that’s supposed to leave people “empowered”. But it’s also a great word to distract people, to create the illusion of progress, and even to blind people to seeing their opressors.

  53. J,

    This reminds me of a great quote I saw:

    “When I give the children food, they call me a saint. When I ask why the children have no food, they call me a communist.”

  54. Both my husband and I have been on anti-depressants at some point.

    In each case, the regular doctor prescribed the antidepressants and regular appointments were scheduled to monitor that; and there was a referral to a psychologist, NOT a psychiatrist. That worked reasonably well for us (it helped that each of us found a psychologist good for what we needed at the time), and if that option is available, it may very well be highly preferable to seeing a psychiatrist. Also, it kept the number of people prescribing medications to a minimum, and made it easier to avoid bad drug interactions.

    So, psychiatry? Never used it, per se. Psychiatric medications and therapy? Can definitely be useful.

  55. and she sees many kids referred to assess for it that clearly aren’t on the spectrum. I wonder how to deal with the issue of various diagnoses being ‘fads’. How do we get some more meaningful way of describing various groups of people?

    I am really not sure if there is a way. Various diagnoses cycle in and out of favor, for both children and adults, and it’s been that way for the past century (for example: almost no one has ever heard of “neurasthenia” any more, but it was a very popular thing to be diagnosed with in the early 20th century). “Bipolar” seems to be the big one for adults now, the thing that everyone’s getting diagnosed with. In a nutshell, I think the cycles of fad diagnoses are more an inevitable by-product of the way the system works than separate and unrelated phenomena in and of themselves. Nothing will change unless the system changes. Today’s popular diagnosis will just be replaced by another one in ten years, if the status quo remains.

    …although the Asperger misdiagnosis/overdiagnosis thing bothers me because it’s led a certain number of people to conclude that it’s a “fake bullshit diagnosis” which people talk doctors into applying to themselves to have an excuse for being rude. Don’t get me wrong, I think the whole Asperger/autism distinction is arbitrary, but anyone who thinks it’s so easy to talk a doctor into diagnosing you with anything is really clueless about the nature of how power in the system works. Although from what I’ve seen, it is easier for parents to twist a few arms and hand over money in the right places to secure a specific diagnosis for a child, even an adult under “guardianship.”

  56. Odd you mention this. A pal of mine has been seeing a ’system’ therapist (who works for the local mental health office) for ages and getting nowhere with his difficulties; then he told this therapist to ‘bugger off’, and got to see a private cognitive therapist in another town, and inside two sessions he’s actually learning tools to help him with his issues.

    Excellent, David! :) Every so often, I make an encouraging comment to my roommate about how a different type of therapy might help her more. I’m trying to keep from pushing her too much.

    Re: “fad diagnoses” – I agree with Riel (hope it’s okay to shorten your name like that)… I don’t know if there’s a good way to get rid of the problem. I personally think that a proper needs-based support system wouldn’t use actual diagnoses for any of it, rather using assessment results to indicate strengths and weaknesses (and interests!) in order to develop the individualized services required. Of course, that’s radical.

  57. This reminds me of that stupid “Tourette’s Guy” fad that used to be so popular.
    I’d really like to laugh at those videos, but even if the adventures of the drunken faux-Tourettic were a cartoon show without real people yelling that filth at each other, it would still be incredibly insulting to the disability community.

    Mental disabilities are either setups for the main characters to show touching displays of pity towards, or gag fodder, in the world of pop culture-a lot of the “idiot” bit players in Dilbert have traits common to autistic people. Let’s not forget Strong Mad from Homestar Runner, who intermittently fulfills both stereotypical disability roles.

  58. “This is someone who’s been living alternately homeless, filthy, starving, and in jail because she can’t get the assistance she needs”

    This is something I don’t get about your blog. You oppose the existance of psychology, psychiatry, counselling etc. yet you don’t deny that people like this woman need help. I agree that labelling is unimportant in itself (although sometimes the labels help people work out what kind of help someone needs). Speakng from my own experience, I owe my life to psychs. I don’t mean that in a metaphorical sense. I don’t mean I owe them my quality of life. I mean that I cannot see any way I would still be alive without them. There was a time when I wanted to die. I needed help to learn how to want to live. I know that a lot of psyh syste in a lot of places are run in such a way that the only way you can get that kind of help is by submitting to mental abuse (often coupled with physical abuse and neglect.) But I belive there are ways of making the psych system work so it’s not like that, because I’ve experienced it. And I can’t imagine any other kind of help that would have saved my life. I had help from family and friends and it was not eough to stop me wanting to die. I talked to people who had “been there” and it was not enough to stop me wanting to die. Therapy and meds were the only things that worked. Psychs were the only people who told me that my disabilities were NOT figments of my imagination, or laziness, or attention-seeking.

    There are good reasons why “a lot of autistic people see psychiatric classifications of people as a value-neutral system that is essentially benevolent, scientific, accurate, and probably useful in understanding the way that human beings operate.”
    http://parnassus.co.uk/?p=101
    http://parnassus.co.uk/?p=88
    http://www.autismvox.com/autism-and-depression/

  59. You can’t be categorically against all psychology. A lot of the theory is good. Some of the people who practice it are compentent. I’m well aware that it’s often too dangerous to try to access services from psychologists without first doing a lot of research to be sure they are some of the (perhaps minority) ones who treat people decently.

    I’ll admit I’m biased: I’m fascinated with psychology and neurology, as it’s part of what’s let me understand myself and other people, truly, for the first time in my life. I didn’t actually learn my psychology from a psychologist; books and journals worked just as well for me.

    What I see is just a huge disparity between what is, and what could be. The way I was treated at the hospital and by many of the people who have alternately put me down and claimed to be helping me, is such a huge distance from the application of psychological theory to helping actual people. It’s kind of funny, actually, as I’ve gotten more help from people who don’t have a great deal of formal training–a pastor, a social worker with a counseling certificate, a sympathetic student nurse–than from the people who are supposed to know the most. It seems to me that if only we could connect the psychological theory that helped me understand so much, to the people who still need to understand themselves and the world, then we could do a lot of good.

  60. Doing a bit of blog maintenance — for anyone wanting to read my answer to Rito’s comment, read my very long comment (it’ll be obvious which one, it starts with the words “In answer to your first comment here”) on this page.

    None of those links above really explain the thing you say they explain, though. The quote you’re talking about is a question I asked in reference to a bunch of people spending a bunch of time speculating in a pejorative manner about a woman’s psychiatric label (and they were using personality disorders, not anxiety or depression), right after she just described the negative (and non-benevolent, non-neutral, non-scientific) usage of those terms, and the effects of those labels on her life. I asked why it is that they could possibly see those terms as value-neutral, benevolent, etc. Descriptions of anxiety, depression, and what looks like a rant against psych survivors and ex-patients (attributing many things to such people that are probably not their real motivations at all — especially that stuff about people being afraid of healing or just having had one bad psychiatrist) don’t make the idea of diagnosing Anonymous by Internet, with some of the most dangerous and least scientific forms of psychiatric labels, make any more sense to me, or seem even a tiny bit more ethical.

  61. I think rito’s mind was probably slightly clouded by emotion, but I don’t think s/he was defending internet dignosis. I thinks/he isdefending th practice of psychiatry.

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