7 results
15 - Social perspectives on diagnosis
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- By Peter Ferns, Thornton Heath, UK, Premila Trivedi, Thornton Heath, UK, Suman Fernando, London Metropolitan University, London, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 69-72
-
- Chapter
- Export citation
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Summary
Modern Western psychology and psychiatry arose in the context of the European Enlightenment of the 17th and 18th centuries. In the early 19th century, only two main mental illnesses were usually recognised – mania and melancholia (Shorter, 1997). As various theories of mental functioning came on the scene, new diagnoses were constructed in Europe and North America and two key diagnostic systems, the International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM), were developed. These are revised from time to time by groups of psychiatrists mainly living in the West and usually strongly influenced by pressure groups, including pharmaceutical companies wishing to market new remedies for illnesses. The first DSM (American Psychiatric Association, 1952) contained 60 diagnoses; the current edition, DSM-IV (American Psychiatric Association, 1994), lists 297; and DSM-5, to be published in 2013, is likely to have even more (American Psychiatric Association, 2010).
A few diagnoses have fallen by the wayside. For example, gone are several popularised in the southern states of the USA as peculiar to Black slaves, such as drapetomania, characterised by persistent running away from the plantations (Cartwright, 1851). Homosexuality was listed as an illness in the DSM until the seventh printing of DSM-IV in 1974 and in the ICD until ICD-10, published in 1990 (Shorter, 1997). Well into the 1960s, depression was reported as rare among Asian and African people and Black Americans, a rarity attributed to their supposed irresponsible nature (Green, 1914) and absence of a sense of responsibility (Carothers, 1953).
A multi-ethnic society includes people whose backgrounds are culturally diverse as well as people seen as different in terms of race. No psychiatric diagnosis has an established biological marker; hence, there is no way of proving objectively its accuracy or its validity as a measure of a biological reality applicable to all human beings. Kendell & Jablensky (2003) describe diagnostic categories as ‘simply concepts, justified only by whether they provide a useful framework for organizing and explaining the complexity of clinical experience in order to derive inferences about outcome and to guide decisions about treatment’. They warn against reifying a diagnosis by assuming that it is ‘an entity of some kind that can be evoked to explain the patient's symptoms and whose validity need not be questioned’.
13 - Do the power relations inherent in medical systems help or hinder in cross-cultural psychiatry?
-
- By Peter Ferns, Thornton Heath, UK, Premila Trivedi, Thornton Heath, UK, Suman Fernando, London Metropolitan University, London, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 61-64
-
- Chapter
- Export citation
-
Summary
Power relations are a structural characteristic of all social relationships, organisational systems and societies as a whole (Proctor, 2002; Dalal, 2003). Certain identities are accorded different powers and status depending on who they are as people (societal, personal and historic power) and the position they hold within a hierarchical institution or work setting (role-power; authority). In medicine, doctors (because of their education, training, experience and expertise) have the authority to diagnose and treat those they deem to be ill, with clear boundaries, systems of accountability and opportunities for others to challenge those decisions if there are breaches of a doctor's defined roles. Less obvious perhaps is the societal, personal and historic powers exerted (often unwittingly) by doctors’ values, biases and assumptions about their patients, since subjectivity is part of the clinical task. These informal values and systemic biases are not easy to identify, not necessarily limited by any formal boundaries and have no regulated system of accountability, leaving their influence to the discretion of each individual clinician. This source of influence and power is of particular significance in psychiatry, where diagnosis and treatment are determined not by an objective measurement or scientific test or biomarker, but rather by professional judgements that make positive and creative use of subjectivity (Loring & Powell, 1988; Fernando, 2010).
Psychiatry is firmly located within medical systems of authority, developed (at least initially) within Western (Euro–American, industrialised and high-income) countries and cultures; within these cultures, doctors were allocated the authority to name problematic thoughts, feelings and behaviours as illness of the mind (see Chapter 14, this volume). However, aspects of these problematic thoughts, feelings and behaviours are culturally determined and they may fall outside psychiatry's Eurocentric frame of reference. They may, however, be acceptable within their relevant cultural contexts. In such situations, misunderstandings can easily occur when psychiatrists (wittingly or unwittingly) use not only authority but also power in a way that is at least partially determined by their personal values and biases to inform diagnosis, risk assessment, treatment and management (Loring & Powell, 1988). The effects of this can be very serious and reach far beyond the confines of medicine, since psychiatrists have the authority to use medical, social, psychological, behavioural and physical interventions (by coercion if they deem this necessary).
14 - Recovery and well-being: a paradigm for care
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- By Peter Ferns, Thornton Heath, UK, Premila Trivedi, Thornton Heath, UK, Suman Fernando, London Metropolitan University, London, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 65-68
-
- Chapter
- Export citation
-
Summary
The World Health Organization (2001: p. 3) defines health as ‘a state of complete physical, mental and social well-being’. What is meant to any individual by well-being, mental health and what constitute mental health problems, and to some extent mental illness, is largely determined by the cultural and social circumstances of communities in which the individual in most instances is immersed (Fernando, 2010). In multicultural situations, different interpretations exist side by side, but which ones dominate will be determined by the power relations that exist between the different cultural groups (see Chapter 13, this volume). The closest we can get to studying well-being and mental health as experienced by people in particular cultural/multicultural and social settings is therefore to explore not only the meanings that are given by each constituent community, but also how some meanings are privileged over others and how this can serve to diminish or invalidate others. By the same argument, the meaning of recovery from mental health problems must also be defined within specific cultural/multicultural and social contexts.
The terms well-being and mental health capture different concepts: the former encompasses personal, social and spiritual aspects of life and functioning in society, whereas the latter implies a biomedical understanding of how a person's mind functions. The focus on well-being has grown rapidly in recent years and is justified on the grounds that, in contrast to assessments of mental health by experts, well-being: (a) is based on standards and values chosen by people themselves; (b) reflects success or failure in achieving norms and values that people themselves seek; and (c) includes components dependent on pleasure and the fulfilment of basic human needs, but also includes people's ethical and evaluative judgements of their lives (Diener & Suh, 2000). At a personal level, well-being, sometimes called subjective well-being or happiness (Diener, 1984), is a positive state of mind brought about by satisfaction of personal, relational and collective needs (Prilleltensky et al, 2001). However, there is another approach (the capabilities approach) to well-being, which is more about what people can do as agents and are in terms of lived experience – the emphasis being on their having the capability (i.e. the practical choice) to function (Sen, 2008).
15 - Social perspectives on diagnosis
-
- By Premila Trivedi, Mental Health Service User, Trainer and Advisor, Thornton Heath, UK, Suman Fernando, Honorary Professor, Faculty of Social Sciences and Humanities, London Metropolitan University, London, UK, Peter Ferns, Training Consultant and Social Worker, Thornton Heath, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 69-72
-
- Chapter
- Export citation
-
Summary
Modern Western psychology and psychiatry arose in the context of the European Enlightenment of the 17th and 18th centuries. In the early 19th century, only two main mental illnesses were usually recognised – mania and melancholia (Shorter, 1997). As various theories of mental functioning came on the scene, new diagnoses were constructed in Europe and North America and two key diagnostic systems, the International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM), were developed. These are revised from time to time by groups of psychiatrists mainly living in the West and usually strongly influenced by pressure groups, including pharmaceutical companies wishing to market new remedies for illnesses. The first DSM (American Psychiatric Association, 1952) contained 60 diagnoses; the current edition, DSMIV (American Psychiatric Association, 1994), lists 297; and DSM-5, to be published in 2013, is likely to have even more (American Psychiatric Association, 2010).
A few diagnoses have fallen by the wayside. For example, gone are several popularised in the southern states of the USA as peculiar to Black slaves, such as drapetomania, characterised by persistent running away from the plantations (Cartwright, 1851). Homosexuality was listed as an illness in the DSM until the seventh printing of DSM-IV in 1974 and in the ICD until ICD-10, published in 1990 (Shorter, 1997). Well into the 1960s, depression was reported as rare among Asian and African people and Black Americans, a rarity attributed to their supposed irresponsible nature (Green, 1914) and absence of a sense of responsibility (Carothers, 1953).
A multi-ethnic society includes people whose backgrounds are culturally diverse as well as people seen as different in terms of race. No psychiatric diagnosis has an established biological marker; hence, there is no way of proving objectively its accuracy or its validity as a measure of a biological reality applicable to all human beings. Kendell & Jablensky (2003) describe diagnostic categories as ‘simply concepts, justified only by whether they provide a useful framework for organizing and explaining the complexity of clinical experience in order to derive inferences about outcome and to guide decisions about treatment’. They warn against reifying a diagnosis by assuming that it is ‘an entity of some kind that can be evoked to explain the patient's symptoms and whose validity need not be questioned’.
13 - Do the power relations inherent in medical systems help or hinder in cross-cultural psychiatry?
-
- By Peter Ferns, Training Consultant and Social Worker, Thornton Heath, UK, Premila Trivedi, Mental Health Service User, Trainer and Advisor, Thornton Heath, UK, Suman Fernando, Honorary Professor, Faculty of Social Sciences and Humanities, London Metropolitan University, London, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 61-64
-
- Chapter
- Export citation
-
Summary
Power relations are a structural characteristic of all social relationships, organisational systems and societies as a whole (Proctor, 2002; Dalal, 2003). Certain identities are accorded different powers and status depending on who they are as people (societal, personal and historic power) and the position they hold within a hierarchical institution or work setting (role-power; authority). In medicine, doctors (because of their education, training, experience and expertise) have the authority to diagnose and treat those they deem to be ill, with clear boundaries, systems of accountability and opportunities for others to challenge those decisions if there are breaches of a doctor's defined roles. Less obvious perhaps is the societal, personal and historic powers exerted (often unwittingly) by doctors’ values, biases and assumptions about their patients, since subjectivity is part of the clinical task. These informal values and systemic biases are not easy to identify, not necessarily limited by any formal boundaries and have no regulated system of accountability, leaving their influence to the discretion of each individual clinician. This source of influence and power is of particular significance in psychiatry, where diagnosis and treatment are determined not by an objective measurement or scientific test or biomarker, but rather by professional judgements that make positive and creative use of subjectivity (Loring & Powell, 1988; Fernando, 2010).
Psychiatry is firmly located within medical systems of authority, developed (at least initially) within Western (Euro–American, industrialised and high-income) countries and cultures; within these cultures, doctors were allocated the authority to name problematic thoughts, feelings and behaviours as illness of the mind (see Chapter 14, this volume). However, aspects of these problematic thoughts, feelings and behaviours are culturally determined and they may fall outside psychiatry's Eurocentric frame of reference. They may, however, be acceptable within their relevant cultural contexts. In such situations, misunderstandings can easily occur when psychiatrists (wittingly or unwittingly) use not only authority but also power in a way that is at least partially determined by their personal values and biases to inform diagnosis, risk assessment, treatment and management (Loring & Powell, 1988).
14 - Recovery and well-being: a paradigm for care
-
- By Suman Fernando, Honorary Professor, Faculty of Social Sciences and Humanities, London Metropolitan University, London, UK, Premila Trivedi, Mental Health Service User, Trainer and Advisor, Thornton Heath, UK, Peter Ferns, Training Consultant and Social Worker, Thornton Heath, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 65-68
-
- Chapter
- Export citation
-
Summary
The World Health Organization (2001: p. 3) defines health as ‘a state of complete physical, mental and social well-being’. What is meant to any individual by well-being, mental health and what constitute mental health problems, and to some extent mental illness, is largely determined by the cultural and social circumstances of communities in which the individual in most instances is immersed (Fernando, 2010). In multicultural situations, different interpretations exist side by side, but which ones dominate will be determined by the power relations that exist between the different cultural groups (see Chapter 13, this volume). The closest we can get to studying well-being and mental health as experienced by people in particular cultural/multicultural and social settings is therefore to explore not only the meanings that are given by each constituent community, but also how some meanings are privileged over others and how this can serve to diminish or invalidate others. By the same argument, the meaning of recovery from mental health problems must also be defined within specific cultural/multicultural and social contexts.
The terms well-being and mental health capture different concepts: the former encompasses personal, social and spiritual aspects of life and functioning in society, whereas the latter implies a biomedical understanding of how a person's mind functions. The focus on well-being has grown rapidly in recent years and is justified on the grounds that, in contrast to assessments of mental health by experts, well-being: (a) is based on standards and values chosen by people themselves; (b) reflects success or failure in achieving norms and values that people themselves seek; and (c) includes components dependent on pleasure and the fulfilment of basic human needs, but also includes people's ethical and evaluative judgements of their lives (Diener & Suh, 2000). At a personal level, well-being, sometimes called subjective well-being or happiness (Diener, 1984), is a positive state of mind brought about by satisfaction of personal, relational and collective needs (Prilleltensky et al, 2001). However, there is another approach (the capabilities approach) to well-being, which is more about what people can doas agents and arein terms of lived experience – the emphasis being on their having the capability (i.e. the practical choice) to function (Sen, 2008).
From passive subjects to equal partners: Qualitative review of user involvement in research
- Premila Trivedi, Til Wykes
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- Journal:
- The British Journal of Psychiatry / Volume 181 / Issue 6 / December 2002
- Published online by Cambridge University Press:
- 02 January 2018, pp. 468-472
- Print publication:
- December 2002
-
- Article
-
- You have access Access
- HTML
- Export citation
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Background
The Department of Health and UK funding bodies have suggested that clinical academics work closely with mental health service users in research projects. Although there are helpful guidelines on the issues that have to be dealt with, there have been few examples of how this partnership research might be undertaken.
AimsTo illustrate the challenges in joint research projects.
MethodWe subjected the process of user involvement to ten questions which arose in the development of a joint research project. The answers are an amalgamation of the user and clinical researcher considerations and are affected by hindsight.
ResultsThe involvement of the user-researcher changed the focus of the study and its design and content. More attention was paid to the intervention itself and the way in which it was delivered. This process increased the amount of time taken to carry out and write up the project as well as incurring financial costs for user consultation payments and dissemination.
ConclusionsThis experience has clarified the contribution that users can make, for example by raising new research questions, by ensuring interventions are kept ‘user friendly’, and the selection of outcome measures.