I have recently read an interesting paper titled: Liberating People From Psychiatric Diagnoses: Exploring Severe Mental, Behavioral, and Emotional Disturbances Through Biographic Documentaries. The author is Stephen Wong, PhD, Emeritus Associate Professor, Florida International University. The piece was published in Ethical Human Psychology and Psychiatry, Volume 23, Number 2, 2021. Here are some quotes from the paper, interspersed with my thoughts and comments.
Here’s the abstract:
“This article posits that the DSM-5 and its psychiatric diagnoses are a monumental artifact of social power rather than a useful system for naming, describing, classifying, or understanding mental disorders. Two biographic documentaries, ‘Crumb’ and ‘Jupiter’s Wife’, are examined as alternative information about people with severe mental, behavioral, and emotional disturbances, which ordinarily would be diagnosed as schizophrenia or a related psychotic disorder. In contrast to the disease processes implied by psychiatric diagnoses, these detailed documentaries revealed particular social (e.g., lack of positive role models, bullying), environmental (e.g., poverty, homelessness), and historical (e.g., child abuse, failure in school) factors that might have brought about the individual’s personal problems. Seeing people in the actual places where they live and hearing about their struggles first-hand can evoke sympathy and empathy in viewers, potentially freeing them from the technical abstractions and pathological attributions inherent in psychiatric diagnoses.”
Psychiatry dominates the field.
“The universal acceptance of these terms is a triumph of the psychiatric profession because reliance on this nosological system for the labeling, defining, and organizing of these social problems implies that these disorders are essentially biological in nature and that medical science is the preeminent authority for understanding and treating these problems.”
The author points out the inherent incongruity in this state of affairs, in that no biological test, pathological lesion, genetic abnormality, or other physical defect has ever been reliably associated with any mental disorder. The author draws the obvious conclusion:
“Hence, the prevailing belief that mental, behavioral, and emotional disturbances are fundamentally physical diseases and the rightful domain of psychiatry is not grounded in scientific research, but rather based on medicine’s institutional power and influence.”
This power and influence is wide ranging and is used routinely to bolster psychiatric hegemony.
“The APA’s creation, copyright, and repeated expansions of the DSM, the authoritative list of mental disorders, both signals the organization’s supremacy over mental health services and serves as a mechanism by which the APA acquires and maintains that power. The diagnostic manual influences thinking and actions of psychologists, social workers, nurses, police and court officials, public and private insurance agents, clients and their family members, and whomever else uses this psychiatric jargon.”
“When doubts or questions arise regarding a disturbed person’s actions, what might be causing his or her behavior, how to deal with these disturbances, or the person’s future prospects, interested parties automatically turn to psychiatric experts for additional information.”
“The dominant psychiatric and biomedical discourse, however, is biased and minimizes social, environmental, and personal history factors that can contribute to or mitigate against the development of severe mental, behavioral, or emotional disturbances.”
AN ALTERNATIVE PERSPECTIVE
The author stresses the need to develop non-medical terms and concepts to discuss mental, behavioral, and emotional problems.
“One potential source of such needed examples is the biographic video documentary. Biographic documentaries are in-depth studies of people and the life experiences that shaped them. These studies often explore an individual’s childhood and early formative influences, including family and peer relationships, local customs and lifestyle, and living conditions in the individual’s home and neighborhood. Biographic documentaries are also likely to examine obstacles encountered and accomplishments achieved as an adult. These biographic accounts can show severe disturbances experienced by the main subject of the film or by his or her family members, and uncover relationships between these disturbances and social, environmental, and personal history factors such as domestic violence or family conflict, isolation or social maladjustment, absence of positive role models, school failure or loss of employment, homelessness, physical or sexual abuse, and other adverse conditions. Such biographic analyses can provide a needed counterweight to the dominant discourse that continually advances putative biological causes for mental, behavioral, and emotional disorders.”
THE VIDEO BIOGRAPHIES
Dr. Wong goes on to describe two video biographies: “Crumb”, a film about the cartoonist Robert Crumb (Lynch and Zwigoff, 1998), and “Jupiter’s Wife” a film about a previously homeless woman, Maggie Cogan, (Block, Weiner, & Negroponte, 2003).
Dr. Wong provides detailed accounts of both movies, and elucidates links between what happened to the main characters and their subsequent difficulties.
“Psychiatric diagnoses would not have informed the viewer about the [Crumb] brothers’ history of severe physical abuse by their father and rejection by peers at school, the absence of positive role models for sociosexual, vocational, and avocational skills, constrained activities imposed by the brothers’ eccentric fraternal subculture, or other situational factors contributing to the brothers’ difficulties. Nor would medical diagnoses have suggested desirable skills that the brothers might have acquired to mitigate or compensate for their personal problems. To the contrary, reductive psychiatric labels would have ignored the richness and complexity of the Crumb family’s structure and interactional patterns while replacing them with hypothetical and unverified biomedical defects or disease processes.”
“Pathologizing Maggie’s unusual speech or other odd behavior while simultaneously ignoring her talents, past accomplishments, and varied deprivations makes sense for biomedical organizations that are geared for the delivery of psychotropic drugs and ancillary psychiatric services, but are disinterested in peoples’ living situations or creative ways of enhancing their level of functioning. In stark contrast to this, segments of the film showed how well Maggie performed (e.g., caring for her adopted dogs or participating in a rigorous yoga class) when given a little social support or material assistance. These latter sorts of interpersonal and tangible aids represent humane, practical, and nontoxic means of assisting persons with severe mental, behavioral, and emotional disturbances.”
“Given that biographic documentaries examine the intricate social, environmental, and historical events that could engender severe mental, behavioral, and emotional disturbances, they can inspire the planning and implementation of humane, supportive, and educative interventions for these complex socio-ecological problems. Such alternative interventions are desperately needed during the present reign of the biomedical model of mental illness, which for decades has promoted a parade of harmful drugs (Breggin, 1991, 1997; Jackson, 2009) with dismal outcomes (Moncrieff, 2009; Sparks, 2016; Whitaker, 2010). At the very least, these lifelike records deserve greater attention as untapped resources for broadening our knowledge about people’s mental, behavioral, and emotional disturbances.”
Dr. Wong’s paper is relevant, timely, and resonant with society’s growing disillusionment with psychiatric concepts and practices. Commercial biographical movies have always contained the germ of the notion that the child is father of the man. But such ideas and perspectives are generally eclipsed by considerations of acclaim and box office revenue. The leading character’s flaws and errors are usually minimized and he/she is ultimately vindicated as a heroic figure.
By contrast, the kind of biographical videos outlined in this paper depict real people, the plights and quandaries in which they find themselves, and their – sometimes ineffective – efforts to extricate themselves from their counter-productive habits and lifestyles.
A great deal of what is considered schizophrenic speech and thinking stems, not from a failing in the “patient”, but rather from a failing in the listener. My guess is that a biographic movie maker would be a more sensitive and empathic listener than a psychiatrist. In addition, the movie maker does not need to elicit a DSM “diagnosis”, which is the primary objective of a psychiatric evaluation.
It has been my objective in this post to communicate the core features of Dr. Wong’s paper. But my efforts cannot do justice to the richness and value of the paper itself. The interested reader can download a free copy of the paper here, and copies of the videos can be rented from Amazon Prime Video for about $4 or $5 each. They might also be available from your local library.
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Disclosure: I have no financial interest in either video.