Abstract
The dominance of the medical-model in American psychiatry over the last 30 years has resulted in the subsequent decline of the “talking cure”. In this paper, we identify a number of problems associated with medicalized psychiatry, focusing primarily on how it conceptualizes the self as a de-contextualized set of symptoms. Drawing on the tradition of hermeneutic phenomenology, we argue that medicalized psychiatry invariably overlooks the fact that our identities, and the meanings and values that matter to us, are created and constituted by our dialogical relations with others. While acknowledging the importance of medical and pharmaceutical interventions, we suggest that it is only by means of the dialogical interplay of the talking cure that the client can both recognize unhealthy and self-defeating ways of being and be opened up to the possibility of new meanings and self-interpretations.
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Notes
Unfortunately, Osherhoff returned home only to find that his wife had left him, his hospital accreditation had been rescinded, and his partner had removed him from their joint medical practice (Shorter 1997: 309).
Maintaining a position of etiological neutrality, the DSM-IV claims that the causes of mental disorders are largely unknown and could have a behavioral, psychological, or biological cause. “Whatever the original cause, it must be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual” (APA 1994: xxii).
Studies have shown that pharmaceutical companies are spending up to $3 billion a year or $10 million a day on direct-to-consumer advertising (Lane 2007: 114).
DeGrandpre and White have shown that the effect of drugs is itself conditioned by the socio-historical context of meanings in which they are taken. That is why the 50% of American troops who had become heroin addicts while in Viet Nam had no trouble overcoming their addictions, whereas ordinary street addicts have a hard time shaking their habits. Most interestingly, the authors show that rats in captivity, given the options of either stimulating the pleasure center of their brains by electrodes or eating, will starve to death, whereas rats living in the wild lose interest in stimulating the pleasure centers of their brains almost immediately. The effect of stimulation of the pleasure center seems to be almost entirely due to environmental conditions, in this case, captivity. The authors conclude that, although “psychoactive drugs … are drugs because they alter … users’ psychological experience, differences among such drugs will not be found in their molecular structures, their cerebral sites of action, or in the licit/illicit context of their use.” Instead, the differences are due to “the multiplicity for and meanings of their use” (1996: 28).
Even Spitzer (2007), the so-called architect of the DSM-III, has expressed reservations about the assumptions of medicalized psychiatry and its tendency to equate the presence of symptoms with a medical disorder without any reference to social and interpretive context.
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Acknowledgments
We would like to thank the two anonymous reviewers at Human Studies for their insightful comments on this paper. An earlier draft was presented at the Science and Medicine in Society Conference at the University of South Florida in Tampa, September 2008.
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Aho, K., Guignon, C. Medicalized Psychiatry and the Talking Cure: A Hermeneutic Intervention. Hum Stud 34, 293–308 (2011). https://doi.org/10.1007/s10746-011-9192-y
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DOI: https://doi.org/10.1007/s10746-011-9192-y