culture and illness

Sam Pawlett epawlett at
Fri Dec 18 00:22:13 PST 1998

Alec Ramsdell wrote:

> I think my last post regarding psychiatry only addressed one side.
> Obviously alcoholics and addicts deserve state-funded treatment, and
> treatment can work, even if the high statistics for post-treatment
> relapse might lead one to serious doubts. This isn't possible now, of
> course, since Clinton removed addiction and alcoholism as categories
> of disability.
> My criticism of addiction treatment is that it is too quick to accept
> the medical model of addiction, before other possible disabling
> conditions. Again, an addict should be entitled to treatment. But
> what if a patient is an alcoholic self-medicating for another
> condition? In this case mis-treatment can have devastating
> consequences. I do know addiction is complicated, serious and real.
> But the medical model of treatment at this current historical moment
> seems way off, and headed down a dangerous path, towards
> "anti-addiction" neurological implants and all that truly scary stuff.
> This is all setting aside more systemic questions of material
> conditions and social relations.
> Marta, do you think the medical model of addiction, with all its
> trappings of the essentialized disease model, and with its possible
> subsuming of other conditions, is in step with the way disability as a
> category is kept flexible for the sake of economic and political
> interests, as you write about in your book?
> -Alec
> _________________________________________________________
> Get your free address at

I have some experience with psychiatry. I was diagnosed by three seperate shrinks as a clinical depressive and as a manic depressive.I've been hospitalized for my condition( whatever it is). I learned a lot in the hospital, but got bored lawn bowling with schizophrenics. I've also overcome a drinking problem in the last year(yeah, one of those piss-tank socialists you find in Yorkshire or the coalfields of Wales-there's lots of us in Canada).The anti-depressants did it for me.

The problem with the medical model, as I see it, is its acceptance of radical( i.e. type-type) psychophysical reductionism and methodological individualism.An individual's illness or mood disorder is interpreted solely in terms of the individual himself. The problem is solely with your genes or the chemicals in your brain.While this may be part of the story, surely one must take into account social relations. Most psychiatrists do not think from the point of view of the individual in society and the relations and interactions between both. I hate to say it, but modern mainstream psychiatry is reified and undialectical. I know Laing and Cooper are maligned by just about everyone these days but I think there early work contains a lot of insight.(both were alcoholics too.) I liked the work of Peter Breggin too. When I was in the hospital, the "sane" patients had to attend seminars on cognitive therapy.Cognitive therapy assumes a crude methodological solipcism /functionalist/black box theory of the mind. The problem has nothing to do with social relations, its all in your head, your neurotransmitters and negative thought patterns.As I saw it, this had an ideological function in that it shifted attention away from social relations and onto the individual as a detached atom. This all dovetails nicely with all the rhetoric about "individual responsibility" and the defunding of treatment programs, group homes etc. I told the doctor that anyone who has there eyes open,has minimal sympathy for anyone besides themselves, and thinks about what is going on in the world is probably going to get depressed. I don't know about the specific interests behind the medical model but I basically view it as a part of conservative ideology that really explains little about illness.The book "Not in Our Genes" and the work of Steven and Hilary Rose is still classic, I guess.More later.

Sam Pawlett

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