Socialist Standard June 2008 - World Socialist Movement

Biology as ideology
For over 40 years there has been an increasing momentum to
the wholesale medicalisation of human and social problems
It was in the late 19 th /20 th centuries
that the notion of conceiving
of distress/madness as a ‘mental
illness’ came to predominate. In particular,
the work of Emil Kraepelin,
and the notion of trying to classify
distress into a number of discrete
psychiatric disorders, and that these
disorders were diseases of the brain,
and that these diseases of the brain
were categorically distinct from the
normal brain and normal behaviour.
For the last hundred years biological
psychiatrists have been looking
for pathologies in the brain to explain
the different symptoms that ‘patients’
present. What with the 1990s being
declared the Decade of the Brain,
and with the Human Genome Project,
they have had a good twenty years to
propagate their view. Indeed, for over
40 years there has been an increasing
movement towards the wholesale
medicalisation of human and social
problems. Virtually every problem
is conceived as something that can
come under the scrutiny not only of
medicine in general but psychiatry in
particular. Who are the gurus on TV
and the press to whom we turn to for
solutions to our personal and societal
problems—Dr. Mark or Dr. Joan! The
politics is taken out of problems. It
is not social conditions that require
changing—it is our biology. And for
‘mental illness’, this means the resort
to pills—the chemical balance of your
brain needs to be adjusted.
Today, the bible of psychiatric
approach to human misery is the
Diagnostic and Statistical Manual of
the American Psychiatric Association
(DSM-IV). When it appeared in
1994 (only 7 years after DSM-II), it
was some 900 pages long (a revision
is due in 2010 and is expected to be
1250 pages). Within DSM are over
300 diagnoses. If you feel in need of a
diagnostic label you are sure to find
one here.
Over the years of revision from
DSM in 1952 the shift has been away
from a psycho-analytic perspective
to a biological one. Now, the biological
perspective is the dominant one,
and refusal to toe the line can lead
to a psychiatric career coming to an
end—not only in terms of posts but
also any research grants. No longer is
the personal political – the personal
has become biological.
The biological approach, however,
has come under attack from a
number of perspectives. The whole of
the conceptual apparatus has been
undermined by psychiatric service
users, psychologists and sociologists.
Yet the edifice still stands and may
be gaining in strength. The general
public seems to be keen on it, let
alone other professional and political
interests. It will be a tough nut to
crack.
As more mental illness categories
are added because more people
are showing their misery in different
ways, this provides an ideal opportunity
for the commodification of
happiness—with the solution to unhappiness
being offered by the pharmacology
industry, often referred to
as BigPharma.
No place for culture
The biological approach claims
that its diagnostic categories are
objective and universal because they
are based on the pathologies of the
brain. Schizophrenia is schizophrenia
in AD 2007 or 2007 BC, in Britain or
Borneo. The particularities of culture
have no place here.
But this is not the whole story.
There are cultural psychiatrists who
are opposed to this Western imperialist
encroachment. Not only are there
differences across contemporary
culture but even in the West differences
are found across time. To show
the difference in how misery shows
itself across cultures consider these
examples of what are called culturebound
syndromes.
Koko: usually Malaysian males
who believe their sexual organs are
shrinking, and is accompanied by
panic as this is an indication of imminent
death.
Latah: experienced by Indonesians
who develop an exaggerated startle
response, which includes shouting
rude words and mimicking the behaviour
of those nearby.
Western psychiatry tries to put
these cultural forms into its categories.
To show how even in the West
psychiatrists have changed their
mind, consider what Samuel Cartwright
classified as “drapetomania”
in 1851. This disease was previously
unknown to medical authority,
although its diagnostic symptom
was well known to “our planters and
overseers”. This symptom was found
only in black slaves and involved
“absconding from service”.
He concluded that what “induces
the Negro to run away is as much a
disease of the mind as any other species
of mental alienation and much
more curable”. The cause was not
pills but “whipping the devil out of
them”. The patient should be treated
like a child. But he warned against
being too lenient or overly severe
whipping—both of which would
induce “drapetomania”. The term is
derived from the Greek “drapetes”— a
runaway slave.
Even schizophrenia has been seen
as a disorder that is of recent origin,
being rarely noted before the rise of
modernity, in traditional or pre-literate
societies.
The biological approach is not
only wrong, but it is also ideological.
This is not to deny that biological
factors are not prominent in certain
disorders. But whatever role biological
factors play, psychological
interactions cannot be reduced to the
biological. As biological entities, all
our activities have a biological component.
But psychological activities
are constituted in the interaction or
transaction of a biological organism
and a physical social environment.
Socialist Standard June 2008
June 08.indd 9 20/5/08 10:39:41