Here is a discussion that Barbara and I have been having on the Coyote Medicine discussion group. I liked it and thought it would fit nicely on this blog so others could potentially read it and join in.
She's responding to an article posted by Kirmaier et al, regarding Inuit Models of Mind and Mental Health which is available at http://groups.google.com/group/coyotemedicine.
I read this article when I was thinking, why not dissolve the idea of mental illness and go back to what seems to get pathologized or at least what it is in a person that makes other people think something needs to be done.
So I really responded to the different ways of describing an illness, the idea that illness is seen as "accidental, due to the breaking of taboos, soul loss and/or the action or intrusion of evil spirits" (p. 16) and the specific nature of the illnesses that's described in the next few pages. So, there is a sense of suffering, and there seem to be various elements to it - the person does or doesn't have awareness, the suffering is permanent or brief and transitional, the suffering mind has some thoughts or none at all (seeming). Treatments within the community ranged from none (e.g. acceptance of epilepsy that it was a moment of spirit bonding) to support and prayer (for sadness) to beating a person, if they were afflicted with "Quajimaillituq: "he does foolish things and does not know what he does" (a term also used for rabid dogs during the violent phase of their illness). In this state, individuals were hyperactive or agitated, with incoherent or disjointed speech, loose associations, paranoid suspicions and compulsive rituals. They avoided sleep, were aggressive, blasphemous and might harm self and others."
I notice that both "sad, troubled, quiet" and epilepsy are considered to have possibilities of some kind of transition to the divine in them (the former mostly for men).
Mostly, I wonder if we can bring something into western discussions of madness (the preferred term these days among my friends who disapprove of psychiatric categorization) by considering the way we pathologize states of consciousness by the way we ascribe meaning to them - e.g., we reduce the meaning of most states of consciousness to a kind of binary of, 'trouble for the rest of us' or 'not trouble for the rest of us' and then medicate accordingly. A friend of mine who was diagnosed a long time ago and went off medications in the 80s is now a professor (he teaches a 'history of madness' course - an initiative that is spreading to a few universities) bemoans the intolerance for someone who just needs to withdraw for a while,for example, and suggests also that there be a mad voice at every table to provide the 'mad' perspective (another old anti-psychiatry activist I know is working to revise our conception of what hearing voices means). People I know who suffer want the relief of medications, regardless of what they suppress or toxify, and it seems arrogant of me to expect that they 'should' undergo a personal journey that could be really hard because I believe that Gaia would like it better and could benefit from the multiplicity of voices (maybe suppression of the 'mad' thoughts detracts from the beauty of the collective consciousness - but I don't want to sentimentalize mental illness). I'm making a documentary essay film to puzzle through all this.
Barbara
Also I was struck by the notion of treatment specific to the meaning of the illness. Is it fair to say we treat the social condition of 'annoying to us' rather than find healing ideas that might actually work for the troubling condition? E.G. 'needs to eat the food of home' works as it treats the illness, but is way to simple for the likes of us, I suspect. Lewis, I think you once said that to properly heal you need to expect that you will be able to heal, and that some medicine doesn't seem to carry that expectation. I think this article speaks to that idea. Barbara And I know the DSM officially requires distress to the sufferer, but I can't help feeling that the sufferer might feel a lot less distress if we were more accommodating.
Lewis MehlMadrona
Dear Barbara.
I agree. It appears to me that all cultures define pain and suffering though not all define mind or mental health or even health at all. I suspect we should revert to the position that healers exist to help with the reduction of pain and suffering and that all cultures have individuals who perform those functions. Do you know any cultures that do not have such roles for people to assume.
When these roles are institutionalized, the problems begin. My sense is that the healer role has been corrupted by contemporary global modernist cultures into a different role than indigenous societies intended. The current role is more expert-salesperosn than healer. I turn to Foucault for illumination on this. His perspective that current events can best be understand from the history of how they came about -- a sort of archaeology as it were, makes sense to me. Foucault talks about knowledge production enterprises which encompasses Medicine. Medicine produces products and experts, both of which need consumers. Foucault's perspective that the labeling and isolation of madness arose with th petite bourgeoisie because a consciousness of the need for appearances arose and wherever you go, there are people who annoy and irritate others. These people are dealt with when the annoyance and irritation becomes sufficiently great, as in the Inuit paper when they beat someone who is agitated (having the desired effect of the person calming down). Before pharmaceuticals, exclusion was sufficient, a kind of quarantine approach to the annoying and the irritating. Then a brainstorm occurred. A profession of experts could be created to ride herd over these individuals -- shepherds if you will. These shepherds came to be called psychiatrists eventually. Naturally these shepherds had to do what they could to consolidate their position as experts and to increase their status in the eyes of other experts and other knowledge systems. They had to dominate the various available knowledge systems. So this is what I see today -- psychiatrists have found ways to dominate all other theories and have relied upon what they uniquely (at least in the past) could do, which is prescribe drugs. It works for the pharmaceutical industry which is a self-fulfilling prophecy of promising drugs to ease all pain and suffering and using its power and money to infect the public with the "better living through chemistry" story. So people demand "better living through chemistry" and now the "expert-salespeople" try to accomodate them.
I see that what some of us are trying to do is to hold onto another vision of healing -- an indigenous vision that re-posits the healer as a role separate from the knowledge-expert system of psychiatry and independent of the pharmaceutical industry, which psychiatry is not. We must, I believe, keep separate the conversation about biology and mind and brain from the expert-knowledge system that is called psychiatry. For me, we all have brains and brains are shaped and maintained in their present configurations by environment, past and present. We can believe in brain without believing that drugs are the only ways to change brains. Social interaction, I believe, changes brains more powerfully than chemistry.
My conclusion is that we are minority voices, stories that need to be told and maintained for the good of society, because diversity is important. We need biodiversity to enhance survival potential. I suspect that the story that modern global psychiatry tells is unsustainable. The costs are too high for the planet to maintain. The social interactionist story, as in the WHO studies of schizophrenia, or the psychosis projects of Altoonen, Burke, Laing, Mosher, Perry, etc. are more sustainable. Humans helping humans is less profitable overall but more affordable in the long term. People need meaning and jobs more than pharmaceutical company stockholders need dividends and more than psychiatry experts need status and power. However, the economy will have to get much worse before than becomes a trend. Perhaps the third world countries are lucky in this regard.
That's why I started these discussion groups and my other collaborative online projects (see My Projects at http://mehlmadrona.mysite.com). Because we minority voices (post-modern, semi-urban, neo-shamanic healers) need each other to keep a little toe hold in the world. We are as annoying and irrtating to the mainstream as are "the mad" to the petite bourgeoisie. So we must keep telling each other our stories and hold each others hands in an unbroken circle and keep doing our projects and demonstrating that our stories also work (though I am very unimpressed with the pharmacological story for suffering in that it rarely works without creating as much suffering in the form of side effects as it purports to relieve; and I admit exceptions, like a couple of people I see who were very paranoid and were helped by risperidone and quetiapine, respectively, to suffer less. Interestingly, they had no side effects. I suspect that enveloping them in a loving human community, the ultimate holding environment, would have worked better. But it just wasn't available. And this is the most interesting aspect to me about the knowledge-expert system of psychiatry, that it aims to become unemotional. That it promotes a kind of social aim to make love and community and emotion bad or disturbing. I suspect this is so because people consume more if they are isolated and unfeeling and disconnected. I suspect that it's in the service of global capitalism. Certainly, the modern "psychotherapies" lack soul -- like CBT or IPT, and are proud of their lack of soul or warmth or humor or love or connectedness (though I know people who do CBT who demonstrate all these qualities, so my argument is about the "official" presentation of the technique rather than what people actually do, since I actually use all the CBT "techniques" and have for years without calling them CBT.). Enough for now.
This has been the start of a good discussion and I hope others join us.
Lewis
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