Posted by alexandra_k on September 15, 2006, at 11:25:24
In reply to Re: internet, manu. of madness- anorexia {trigger} » alexandra_k, posted by Jost on September 15, 2006, at 8:08:22
Hey. I'm glad you enjoyed it. I'll admit that I was searching for another topic altogether, but that I read through that article interested in the internet stuff.
I'm not up to date on the literature either. Not with respect to that issue anyway. I guess I read the odd thing in virtue of my interest in babble, but it isn't really a professional interest.
> He seems to have a fairly nuanced view of psychiatric disorders as having a value judgment of some kind-- at least potentially-- including a positive value to those who adopt them as a form of identity--
Yeah, I guess that is so. I never thought of that...
> he addresses the instablity of the disease entities themselves, as categories--although not deeply.
Yeah. I guess he is more focused on Hacking's notion of a 'looping kind' rather than natural kinds.
> ."..As a result [of finding groups of people who identify themselves as having an illness that someone themself has, esp. on the internet], people probably become more attached to their diagnosis and iatrogenic identity. In effect, their identity becomes increasingly defined by, and inextricably intertwined with, their diagnosis. Philosopher Ian Hacking calls this process the "looping effect of kinds".
Yes indeedie do. Hacking is an interesting read, actually. I've read "multiple personality and the sciences of memory" and I've got "the social construction of what?" though I don't think I'll read the latter properly because I think that the ideas I'm interested in are fairly much captured in the former...
> The looping effect of kinds occurs when "people classified in a certain way tend to conform to or grow into the ways they are described" (Hacking 1995, 21; see also Elliott 2003, 227–234). Classification of this sort is an interactive phenomenon. ..Yeah. That is kinda cool...
Hysteria
Hysterical Paralysis
Multiple Personality Disorder
Dissociative Identity Disorder
Dissociative Fuge
Are typically thought to be paradigmatic examples of these looping kinds. In fact... The 'progression' from hysteria to hysterical paralysis to hysterical personality / hysteriod personality / borderline personality / post traumatic stress / multiple personality / dissociative identity disorder... Is supposed to be a case of looping kinds too...
> ...This is because the classifications that do the classifying "interact with the people classified by them" (Hacking 1999, 123). ...In this spiraling dialectical process, each element—the classification and the classified—mutually reinforce and sustain each other as they evolve jointly.Yeah.
There is considerable evidence that the Hacking looping effect is a genuine sociological phenomenon.
Yes indeed. When you study people... People change in virtue of being studied. So you report them the way they appear to be when you study them. Then you report your findings. Then your findings influence the concept which affects peoples behaviour which affects what you will find when you study people... And so on and so forth.
So dx can indeed be a matter of 'hitting a moving target'. At times anyway...
> .....Patient autonomy now includes the ability of patients to contest and defy the nosological edicts of medical authority.....[discusses Multiple Personality Disorder in a la Hacking, and the deep epistemic divide between that and what replaced it, Dissociative Identity Disorder...
Though he doesn't say so explicitly I'm thinking that he is gesturing towards the "right to remain multiple" movement (which - in some instances - seems to be based on an erroneous conception of what is going on...)
> although internet groups resisted change, and even when accepted it, often simply used the new name as if its meaning were identical to the old one].
That has indeed happened I can vouch for that. Most people who are sympathetic to the DID dx undervalue the distinction between MPD and DID considerably. Some therapists even. In order to... Reassure patients. I'm not sure what good it does them... But it surely does happen...
> ...Another more speculative but timely example is Borderline Personality Disorder. In this case, there are good grounds to believe that label change may happen.Given that there are... 256 ways in which to meet dx criteria (according to my memory of what fineline bob computed at any rate) I'm not surprised...
> This could cause serious harm to patients currently diagnosed with that disorder who have finally found an identity—an iatrogenic identity—through their disorder. Again, these are patients who already have problems with identity. This compounds the possible harms of label removal....
Yeah. Though... If they have problems with identity confusion already...
> ...The adoption of a dimensional model would represent a drastic change, a significant paradigm shift (Kuhn 1962).I disagree. Firstly, I think that is a misuse of Kuhn's notion of a paradigm shift. Secondly, I'm not sure how much the dimensional model is a 'drastic change'. The dimensional model can be interpreted into the current categorical approach (via the notion of a threshold). There are problems that arise at the symptom level the way there are problems that arise at the dx level at present...
> In some dimensional proposals, probably most current terms for these disorders would be abandoned.
I don't think that follows. Or if it does... It would be because we would have found better categories of mental illness to 'believe in'.
> Some identity seekers attempt to reinforce their sense of iatrogenic identity by indulging in their disease. This is a telling illustration of Lemert's "self-defeating deviance" (Lemert 1972, 85).
so they have 'self defeating deviance'?
surely... the function of the behaviour sould be... assessed rather than assumed...> they even appear to resist label removal of a therapeutic kind.
maybe because the label removal... isn't theraputic for the individual.
> They do no want to get well
now that is a judgement if ever i saw one...
> and instead indulge in how to be sick—more effectively.
and there is another one too...
> In this third example, the search for identity has degenerated into a full-fledged madness for identity....
hence the authors have a radically new kind of disorder that they wish to take credit for discovering...
> ...The examples we have examined show that where there exists sufficient consumer interest and solidarity, psychiatric labels and their virtual communities can be kept alive online through the technologies of the Internet.
can they be kept alive without the technologies of the internet (ie in in person meetings between like minded individuals?)
> These both validate and reinforce psychiatric diagnoses that may no longer be considered scientifically valid.
i don't have much faith in scientific validity. diagnosticians might say (in hindsight) 'you can't have BPD because people with BPD dont get better until their 40's BY DEFINITION'. they can retain their belief by saing 'you have been misdiagnosed'... or... i can maintain... no dammit i was borderline. i AM borderline... but you know what? i'm 28 and i'm doing one f*ck of a lot better than i was before. why would i retain my identiy as a borderline individual in the face of 'scientists' pleading misdiagnosis? BECAUSE IT GIVES OTHER PEOPLE WITH A DX OF BORDERLINE PERSONALITY HOPE OF IMPROVING BEFORE THEY ARE FOURTY. and given what we know about the effects of looping kinds... that might be what is required in order to MAKE people with BPD improve before they hit their 40's. and if enough people F*CKING INSIST ON IT then it will carry through to the 'scientists' observations of how 'gee people with BPD can improve in their late 20's' WHICH GIVES PEOPLE HOPE.
How can they not see / acknowledge this?
> Thus psychiatric labels may survive among consumers although they have been abolished by professionals....
No sh*t. I wonder why...
> Professionals also have not taken care to think through the effects of de-labeling these disorders, on individuals previously labeled with them-- ie whose identity is iatrogenic (ie caused by the medical profession).
Indeed.
> He regrets the power of these groups to resist reconceptualizations of mental diseases, which may provide better treatment to those who suffer them.And he doesn't see the good in the consumer movement...
> At the same time, there are ethical problems in taking away the identity that supports individuals' coping and ability to connect to others ( ie the disease they've identified with).Indeed.
> Plus he is further concerned about the effect of consumer "choice" of disease, or recruitment of individuals to their "illness"-- for example, the pro-anorexia sites, or pro-amputee sites. In his view, these sites are so strongly committed to the value of the originally-problematic disorder, that they may pressure those with uncertain identities or with great needs for social approval into adoption of harmful or at best mistaken definitions of their identity.Yeah. In my experience the most significant form of pressure is COVERT pressure. In teh form of 'you have finally stopped denying what has been apparant to us all along'. There is covert pressure in the form of INCREASED ACCEPTANCE.
> Yet (again, in his view) it may be ethically dubious, as well, as technically difficult, to locate these individuals and to try to deprive them of their present identities, under the guise of educating them about the current state of psychiatric knowledge or belief.
Locating individuals... I didn't get that at all. That is an interesting point. I thougth he was bemoaning how he couldn't frequent some of those sites in order to study the posters because the sites were illegal. But yeah... Locating individuals and...
Pushing the current medical model on them?
Didn't the last model harm them enough?
I"m not sure tha tthey consider that...
poster:alexandra_k
thread:684913
URL: http://www.dr-bob.org/babble/social/20060911/msgs/686202.html