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Social amnesia stress5/11/2023 ![]() ![]() Social forces can alter psychiatric disordersĬochrane ( 23) observed that "the fluctuations in the incidence of disorders over time, place, and social category are too large to be explained away by the differential incidence of purely biomedical imbalance." A variety of social factors have been implicated in affecting the incidence and outcome of menta1 illness. As Satel ( 14) wrote about addiction, "You can examine brains all day, but you'd never call anyone an addict unless he acted like one." Because mental symptoms involve verbal communications and behaviors-that is, cultural understandings-psychiatric illness can never be transmuted into an anatomical or physiological entity in the same way as physical illness. Indeed, we can create new disease categories based on brain findings, but these categories would no longer rely on mental concepts and therefore cannot be mental disorders. Simply put, is it logical to define a contented person as "depressed" based on an abnormality in brain functioning? To use a biological marker to define a mental illness would mean that we must be willing to accept a definition based on an incidental abnormality that might be found on neuroimaging, even if the subject never manifested any symptoms. Both are necessary neither is sufficient.ĭiagnoses in psychiatry are starkly different from diagnoses in physical medicine in which asymptomatic or incidental disorders are often uncovered, such as an examination of the prostate that reveals a malignancy. Mental processes must always be social, just as they must always be biologically situated because they occur in biological beings. Thus, although it is typically assumed that there are distinct, objectively existing entities that correspond to the various categories of the mind, these categories have always depended on the use to which they were put in specific social contexts ( 13). Culture is not "out there" to be treated as an independent variable, but something that impinges on a person's thinking ( 12). Cognition, memory, perception, emotion, and anxiety vary considerably from one culture or historical period to another ( 9, 10, 11). They are intrinsically tied to the way people relate to each other ( 8). Terms that we use for mental processes such as fear, anxiety, pleasure, attention, memory, mood, and so forth are not biological but social concepts. "Mental" and "mental illness" are social conceptsĪlthough Kandel ( 2) correctly observed that "all mental processes are biological," he failed to add that all higher mental processes are also social and contextually bound. I then show how a serious re-engagement of the social realm in research and practice can provide a complement or corrective to these assumptions, adumbrate new points of departure, and suggest methods for psychiatry's expansion. Next, I illustrate how the biomedicalization of psychiatry has produced a variety of unvalidated assumptions about the etiology, course, and prevention of mental disorders. Therefore, in this article, I first describe how the social world is relevant to psychiatry. This state of affairs has potentially serious consequences for research and practice. Numerous examples exist of how the biomedicalization of psychiatry is increasingly omitting or, at best, trivializing the social components of research and practice. For example, Lieberman and Rush ( 3) called for redefining psychiatry as a "clinical neuroscience." Similarly, in recent years, a spate of articles have appeared on the future of psychiatry, and most have leaned heavily on the biomedical side of diagnosis and treatment ( 3, 4, 5, 6, 7). The social constituency of the mind is omitted. Mind is described as "an expression of the activity of the brain." Similarly, Kandel ( 2), in a lead article in the same journal, wrote that "all mental processes… derive from operations of the brain."Īlthough these writers may not have fully intended it, their statements strongly suggest that the mind is merely a reflection of the workings of the brain. In an editorial in the American Journal of Psychiatry entitled "What Is Psychiatry?" Andreasen ( 1) defined psychiatry as the medical specialty that treats disorders of the mind. The extrusion of the social realm from psychiatric discourse has been most apparent in discussions about the definition, future, and accomplishments of psychiatry.
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