The Journal of Mind and Behavior

Volume 15, Numbers 1 and 2, Winter and Spring 1994 ~ Special Issue, Challenging the Therapeutic State, Part Two

Environmental Failure-Oppression is the Only Cause of Psychopathology
David Jacobs, National University
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 1-18, ISSN 0271-0137
The present paper intends to clear the way to considering all psychopathology as responses to failures in the human environment by examining three common sources of error in scientific reasoning about psychopathology: (i) the false identification of "biological considerations" with the sub-interest of organic pathology, (ii) the idea that a person could be genetically predisposed or vulnerable to psychopathology, (iii) the failure to distinguish between causal forms of explanation and explanation based upon connections of meaning and significance. For convenience, the omnibus term "environmental failure-oppression" (EFO) is introduced to refer to the totality of possible failures in the human environment.
Requests for reprints should be sent to David Jacobs, Ph.D., Center for the Study of Psychiatry and Psychology - West, 528 Fourth Street, Encinitas, California 92024.

Limitations of the Critique of the Medical Model
Ken Barney, Cambridge, Massachusetts
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 19-34, ISSN 0271-0137
A strengthened critique has thoroughly debunked the medical model, but remains limited in its explanatory power C it fails to incorporate wider sociopolitical dimensions in the analysis of both individual distress and the legitimation of the mental health system, whose power is undiminished. Critique's focus on the medical model tends to obscure the link between the mental health system and the powerful and fetishized psychological (psychologistic) perspective, which is, in turn, closely associated with the philosophy of individualism pervasive in late capitalist society. The contextualist alternative stops short of incorporating sociopolitical dimensions, especially the destructive aspects of late capitalist society, such as erosion of community and unrestrained individualism. Contextualism transcends crude medical model reductionism but not the prevailing psychologism and individualism, and the depoliticization of powerlessness, distress, and disorder.
Requests for reprints should be sent to Ken Barney, M.D., 3 Soden Place, Cambridge, Massachusetts 02139

Deinstitutionalization: The Illusion of Disillusion
Michael McCubbin, University de Montreal
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 35-54, ISSN 0271-0137
This article reevaluates the recent tendency to attribute economic causes C cost and fiscal factors C to deinstitutionalization and its subsequent "treatment in the community" mental health system. Economic determinist explanations are shown to be inadequate; instead, the primary impetus behind deinstitutionalization is seen to be the conception of a more humanistic "community care" alternative. How deinstitutionalization was transformed into a mere shadow of that model is explained by analyzing the mediation of social institutions. It is proposed that disillusionment and policy paralysis be replaced with a teleological approach to planning: a long-term strategic plan based on goals and emphasizing the policy environment.
Requests for reprints should be sent to Michael McCubbin, GRASP, University of Montreal, C.P. 6128, Succursale centre-ville, Montreal, Quebec, Canada H3C 3J7

Something is Happening: The Contemporary Consumer and Psychiatric Survivor Movement in Historical Context
Barbara Everett, Homeward Projects, Toronto
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 55-70, ISSN 0271-0137
Despite three major reform movements over the last 300 years, the mental health system has been remarkably resistant to change. Today, another period of reform is underway, only this time, new players - dissatisfied ex-psychiatric patients - are organizing to affect the process of change. This paper discusses characteristics of previous movements and examines their similarity to and difference from the present consumer and psychiatric survivor movement. It appears that the new participants have shaped the rhetoric of reform but it remains to be seen if they can affect the reality.
Requests for reprints should be sent to Barbara Everett, Homeward Projects, 125 Danforth Avenue, 3^rd Floor, Toronto, Ontario, Canada M4K 1N2

The Myth of the Reliability of DSM
Stuart A. Kirk, UCLA, School of Social Welfare, and Herb Kutchins, California State University, Sacramento
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 71-86, ISSN 0271-0137
When it was published in 1980, the Diagnostic and Statistical Manual of Mental Disorders, third edition - universally known as DSM-III - embodied a new method for identifying psychiatric illness. The manual's authors and their supporters claimed that DSM-III's development was guided by scientific principles and evidence and that its innovative approach to diagnosis greatly ameliorated the problem of the unreliability of psychiatric diagnoses. In this paper we challenge the conventional wisdom about the research data used to support this claim. Specifically, we argue that the rhetoric of science, more than the scientific data, was used convincingly by the developers of DSM-III to promote their new manual. We offer a re-analysis of the data gathered in the original DSM-III field trials in light of the interpretations that had been offered earlier for the reliability studies of others. We demonstrate how the standards for interpreting reliability were dramatically shifted over time in a direction that made it easier to claim success with DSM-III when, in fact, the data were equivocal.
Requests for reprints should be sent to Stuart A. Kirk, D.S.W., School of Social Welfare, University of California, 405 Hilgard Avenue, Los Angeles, California 90024-1452

Caseness and Narrative: Contrasting Approaches to People Who are Psychiatrically Labeled
Michael A. Susko, Essex Community College, Maryland
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 87-112, ISSN 0271-0137
This article contrasts the Caseness and Narrative approaches for treating individuals who are psychiatrically labelled. In Caseness a "mental health professional" negatively values those symptoms believed to be caused by a physical pathology. In the subsequent labeling of the "patient" a transfer of ownership of the person's body to the "medical system" occurs. Intervention ensues, by coercion and force if deemed necessary, to stop symptom expression. In contrast, the Narrative approach looks upon periods of distress as potentially transformative experiences within the context of a life story. The complexity captured by a "narrative web," the emphasis on a dynamic self able to make choices, and a sense of closure are among the properties that Narrative highlights. This approach also helps redress the power disparity inherent in Caseness by letting the distressed person establish the discourse from which a dialogue can ensue. This article argues that the Narrative approach provides a more humane and healing context for people who are psychiatrically labeled.
Requests for reprints should be sent to Michael A. Susko, 1927 St. Paul Street, Baltimore, Maryland 21218

Blaming the Victims: Silencing Women Sexually Exploited by Psychotherapists
Catherine D. Nugent, Treatment Exploitation Recovery Network
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 113-138, ISSN 0271-0137
This paper articulates a radical feminist analysis of psychotherapist-patient sexual exploitation, a problem that has affected an estimated one million North American women. I argue that such exploitation is rooted in misogynous attitudes that pervade the major institutions in contemporary culture, including the mental health professions. I examine ways that mental health professionals use sexist constructs and language to blame victims for their abuse. Through textual analysis of a series of letters and articles by prominent psychiatrists, I show that the male writers attempted to silence victims and their female advocates by subjugating the women's voices to their rhetorical control and by indirectly drawing on the power of deeply-held cultural stereotypes of women. This analysis of therapist-patient sexual exploitation and the blaming of its victims points to the broader problem of oppressive androcentric bias in psychiatry's ideology, epistemology, and discourse. The article closes with a suggestion for correcting psychiatry's harmful biases and with recommended strategies for preventing psychotherapist-patient sexual exploitation.
Requests for reprints should be sent to Catherine D. Nugent, 3920 Blackburn Lane #43, Burtonsville, Maryland 20866

Neuroleptic Drug Treatment of Schizophrenia: The State of the Confusion
David Cohen, University of Montreal
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 139-156, ISSN 0271-0137
This article contends that the enterprise of neuroleptic drug treatment of schizophrenia is conceptually and clinically - though not economically - bankrupt. Although new drugs spur hope and reinforce the dominant treatment paradigm, evidence from reports published during the last five years in leading psychiatric journals suggests that psychopharmacologists do not know what are the optimal doses of the most widely-used neuroleptics; that most patients do not "respond" to neuroleptic treatment; that toxic effects are routinely misdiagnosed; that prescribing guidelines may have no impact on actual prescription patterns; that claims that the popular "atypical" neuroleptic clozapine is free of extrapyramidal symptoms are completely false; and finally, that penetration of the double-blind in studies of the effectiveness of psychotropics over placebos may be a common occurrence. In the light of these findings, it is argued that the field is in crisis and that major, paradigmatic change is absolutely necessary.
Requests for reprints should be sent to David Cohen, Ph.D., Director, GRASP, University of Montreal, C.P. 6128, Succursale centre-ville, Montreal, Quebec, Canada H3C 3J7

Determining the Competency of the Neediest
Jonathan Rabinowitz, Bar Ilan University
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 157-176, ISSN 0271-0137
This is a qualitative descriptive study of how competency to take care of oneself and one's financial affairs was evaluated in New York City during the years 1989-1991 by the Human Resources Administration's Visiting Psychiatric Service (VPS). Most VPS clients are indigent senior citizens. A visit by VPS can result in forced institutionalization or lost control over one's finances. Data were collected from interviews with key informants (e.g., staff of VPS, chairperson of the City Council Committee on General Welfare, attorneys and staff of the City Council), written materials about VPS, court cases and a report summarizing a recent City Council investigation of VPS. Major problems concerning how VPS operated were found. VPS conducted competency evaluations in such a way that some people's rights may have been suspended inappropriately and others may not have been given the type of intervention they needed. These problems appear to stem from several interlocking factors: VPS operates with very little public exposure of its work. Most clients served had in essence little recourse to respond through legal channels to VPS recommendations that may have been based on faulty evaluations. In most cases the court approved the actions recommended by VPS. This study highlights dangers of the system and the need to change the way that competency is evaluated.
Requests for reprints should be sent to Jonathan Rabinowitz, D.S.W., School of Social Work, Bar Ilan University, Ramat Gan, Isreal

ECT: Sham Statistics, the Myth of Convulsive Therapy, and the Case for Consumer Misinformation
Douglas G. Cameron, World Association of Electroshock Survivors
The Journal of Mind and Behavior , Winter and Spring 1994, Volume 15, Numbers 1 and 2, Pages 177-198, ISSN 0271-0137
This paper emphasizes that, contrary to the claims of ECT experts and the ECT industry, a majority, not "a small minority," of ECT recipients sustain permanent memory dysfunction each year as a result of ECT. The paper exposes the convulsion hypothesis, upon which ECT is allegedly based, as mythological. Finally, through hidden and comparative electrical parameters, it exposes the extreme destructive power of today's "new and improved" ECT devices.
Requests for reprints should be sent to Douglas G. Cameron, World Association of Electroshock Survivors, P.O. Box 343, San Marcos, Texas 78667