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The arbiter of health answers in the positive. That is, the present model of
health categorises grief as a disease of the brain and, a fortiori, a mental
disorder. To offer any remarks on the normative significance of this
categorisation, however, one must be sensitive to the motivations behind it.
This paper traces the key actors responsible for this categorisation, in
particular the institutional interests of twentieth century psychiatry, before
considering its normative value and potentially objectionable effects.
It is not for the individual to constitute disease. That I could provide my own
definition of disease and see whether grief is accommodated evades the
reality of the situation. The reality is one where disease is constituted through
medical paradigms, or models, proselytised by institutional forces. (Sheridan
and Radmacher 1992:5) There are biomedical, sociomedical, pschycomedical,
and fusion biopsychosocial models to name but a few. (Averill and Nunely
1988:86) Whichever achieves dominance for a given social context will be the
determining agent of the nature of disease. A sociomedical model, for
example, will understand alcoholism with an eye to its sociological
foundations, that is, its significance as a constituent part of a broader social
system. A biomedical, however, is likely to view it as a chemical imbalance of
an individuals brain. (Ibid. pg.86) These models then, have very practical
repercussions. We could imagine the difference in stigma and treatment of
alcoholics depending on which medical model is not just in vogue, but the
cultural imperative of the medical times. (Engel 1977:130) The first model
might understand alcoholism as a consequence of social anomie, one whose
treatment depends on undermining its sociological causes. The biomedical
model, by contrast, is more likely to treat alcoholism as a problem of the
individual unrelated to his/her social context. Chemical medication to target
the supposed imbalance may well be prescribed. (Ibid. pg.86) Given these
repercussions, for this paper to be of any practical import is must engage
with the present model of disease. Sensitivity to the medical reality of our
time, that is, psychiatrys incorporation of the biomedical model, must be
upheld less practical criticism give way to abstract philosophical musings.
To reiterate, grief already has been, and is continuing to be, conceptualised
and treated as a disease. The ascendency of the biomedical model has been
named as a primary cause. So what is a medical model? Like Kuhns
paradigms of science, medical models identify the questions that ought to
be studied and determine the research methods that may be used. (Kuhn
1962) Problems that do not fit this paradigm, or model, tend to be ignored or
considered illegitimate objects of study. (Sheridan and Radmacher pg. 3)
Professionals operating within a medical model tend to be relatively unaware
of its influence. Rather, models constitute a kind of cultural background
against which they learn to be professionals. (Engel 1980:535) In short,
medical models are pervasive conceptual frameworks that dictate the terms
of health, disease, study, and treatment.
Let us now move on to the biomedical model. Four tenets can be identified in
the following:
however, was not without resistance. By the 1960s psychiatry was becoming
increasingly divided. One the one side, to put it briefly, were Freudians and
those involved in the anti-psychiatry drive (such as Thomas Szaz and R.D.
Laing) who rejected any such swing towards the biomedical model, and on
the other, psychiatrists schooled in the works of Kraepelin and Lindemann
who actively sought it. (Deacon pg. 848) Representatives of the latter
demanded their discipline to join the prestigious natural sciences and utilize
their methods, epistemology, and experimental apparatus. (Ward 2002:43)
Psychiatry would benefit, they argued, from the perception that, like other
areas of science and medicine, it had its own valid diseases and effective
disease-specific remedies. (Deacon pg. 848) In tandem to what was going on
in the United States, British psychiatrists and psychologists similarly began to
emphasis
empiricism
and
psychopharmacological
experiments
to
professionalise their studies. (Moncreiff and Crawford 2001) Come the early
1970s, psychoanalytic theories were being increasingly replaced by a more
empirical, quantitative approach with a focus on biological orientation for
understanding and treating mental illness. (Granek pg.60)
But why, at bottom, did psychiatry feel the need to professionalise, or join
league with the natural sciences? It was, as Deacon notes, fundamentally an
attempt to legitimize psychiatrys validity as an empirical science, one that
blows with, and not against, the positivist currents of the time. (Deacon pg.
848) The biomedical model was already operating in the medical world
beyond psychiatry. To not surrender to this model would amount to
institutional suicide. Note also this fear of the end of psychiatry persists to
the present day. We need to be more medical to be taken seriously
remarked influential psychiatrist Alan Schatzberg in 2010. (Deacon pg. 848)
..
This surrender though was not, as stated, simply the result of Kreapelin and
Lindemanns work. Neither was it the case that every psychiatrist saw the
danger of his/her profession dying out, and so individually sought to
legitimise it via the biomedical model. (Granek 57-58) The imposition of the
biomedical model was more of a top down affair, administered by its
institutional powers. Consider the influence of the American Psychiatric
Association (APA). The APA established a division of publications and
marketing, as well as its own press, and trained a nationwide roster of
experts who could promote the biomedical model in the popular media.
(Sabshin 1981) It held media conferences, placed spokespersons on
prominent television shoes, and bestowed awards to journalists who penned
favourable stories. (Deacon pg. 848) So successful was its carefully
choreographed program, that by the 1980s the media came to hail the
scientific revolution within psychiatry, one dedicated to the development of
drugs and therapies to heal sick minds. (Franklin, 1984:1)
United by their mutual interests in the promotion of the biomedical model
and pharmacological treatment, psychiatry joined forces with the
pharmaceutical industry. A policy change by the APA in 1980 allowed drug
companies to sponsor scientific talks, for a fee, at its annual conference.
bullets. (Deacon pg. 849) Most pertinent to our inquiry is the present DSMVs inclusion of grief as a kind of major depressive disorder (MDD). Diagnosis
of an MDD must find the individual exhibiting general distress symptoms such
depressed mood, insomnia, decreased appetite, decreased interest, and lack
of concentration, for two weeks or more. (Wakefield 2013:171) These
symptoms are found nearly always in grieving individuals. (Ibid pg. 171) Such
an individual is then, a la the most recent DSM, suffering from a major
depressive disorder. And what is a mental disorder? We have by now learned
from psychiatrys biomedical model that it is a disease of the brain.
The above discussion on how grief came to be pathologised is brief.
Hopefully, however, what is of our interest to our inquiry been made clear.
That is, what was responsible for griefs being treated as a disease was not
the result of groundbreaking scientific research within the field of psychiatry.
Rather, it was the result of a constellation of institutional interests and
contingent historical events. Perhaps this is why grief as a disease lacks the
sound biological basis that the biomedical model demands of its diseases.
But what is of interest to our inquiry has, I hope, been made clear without the
need to go further into the history griefs pathologisation. That is, psychiatry
capitulated to the biomedical model not because of groundbreaking research.
What was responsible for its capitulation was not a eureka moment, but
institutional interests. (Ibid. 848-850)
Few lesions or physiological abnormalities define the mental disorders, and for the most
part their causes are unknown. - Ibid
Freud, biomedical model states mental illness are diseases of the brain.
How does grief qualify as a disease of the brain. DSM, Engel, Glass,
Stroebe
We have now seen the Freud illustrated the richness of understanding grief.
We have also seen how institutional interests guided psychiatrys capitulation
to the biomedical model. I have not claimed the story to be complete, but
these two elements are fundamental to arriving at our present biomedical
understanding of grief, that is, grief as a disease.
PARAGAPH ON DSM
1.
2.
3.
4.
Freud
Biomedical model
DSM criteria
Normative significance
If Freud put grief on the map, it was not left up to him to chart its territory. By
the 1940s a number of eminent psychiatrists had ignored his resistance to
pathologizing grief. Kraepelin, for example,)
Lindemann too,
of their lives. (FIND IN FREUD) Failure to do ones grief work, that is, the task
outlined above, was a failure to heal or recover. Now Freud did not intend
to suggest any failure to heal meant the subject was diseased. But this was
not how he was read by psychiatrists. (Granek pg. 50-52) Rather, by
introducing medicalized terminology into the discourse of grief, Freud
provided American psychiatry with a foundational lexicon with which it would
later justify the use of medical intervention. (Ibid. pg. 52) Most notable was
Helenes Deutschs 1937 conceptualization of a normal course of grieving.
(Deutsch 1937) The failure to do ones grief work, she wrote, was a deviation
from this course. Such a failure was represented, crucially, in either excessive
grieving or a lack of grieving. (Ibid. pg.12) This idea was pivotal in the
process of griefs pathologisation. That pathological grieving could manifest
itself in intense outpourings of loss, or the absence of any symptoms
introduced the notion that all grievers are potentially ill and need to be
monitored for the process of their grief work. (Granek pg. 54) Deutschs
suggestion that grief work must be done less it resurface elsewhere put the
onus of responsibility on the grieving subject to self-monitor or risk becoming
ill. To illustrate how influential Deutschs appropriation of Freudian concepts
as medicalized terminology, consider the much later (separate) works of
Archer and Stroebe, both of whom invoke the notion of failed grief work to
justify medical intervention. (See Archer, 1999 and Stroebe et al,. 1992)
One neednt have chartered grief as something to be worked through,
however, in order to locate it as a potential disease. We must turn to the work
of Emil Kraepelin, and his subsequent popularization of the biomedical model,
to gain a further, parallel insight into griefs pathologisation.
One did not need to buy into the notion of grief work, however,
It was, though,
Kraeplin
Lindemann
Legitimization of psychiatry by capitulating to the medical model. APA 1980s
and pharmaceutical revolution Deacon / Engel .77
Modernist condition?
World War II.
Consider the following quote from Walter, The notion of a mental illness
would have been considered an anathema. (Walter, 2005-2006:63)
In the 19th century, grief was a condition of the human spirit or soul. It might
sometimes be viewed as a cause of insanity, but it was not itself a mental
illness.
plan
What is the bio model?
How did psychiatry come to incorporate it?
Deacon industry
Granek Book on Modernist condition/Foucault medicalisation
subsequent pathologisation of grief. The first was the focus on everyday life
as sources of interest to psychoanalysis. (Granek pg. 51) Slips of the tongue,
dreams, infantile sexuality, not to mention the power of the unconscious to
effect ordinary behavior, phenomena that was not considered worthy of
psychological interest, were suddenly deemed to be objects of intense
scrutiny. (Freud 1909:1990) Illouz remarks the inclusion of these supposedly
unimportant instances of human behavior as fundamental to psychological
analysis represented the making of the meaningful, the trivial, and the
ordinary, full of meaning for the formation of the self. (Illouz 2008:38) It is no
surprise then, that grief, one of the more everyday phenomena, was on its
way to being an object of considerable psychological interest.
he made between the realm of the everyday and peoples health. (Granek
pg. 51) He suggested health and pathology occupied a continuum without an
overt distinction. The effect of this was to blur the division between the
normal and the abnormal. CUT THIS PARAGRAPH?
The foundations for the biomedical model of health and disease had been
laid. A revolutionary epistemological stance that was broad enough to
encompass everything and anything.
SAY WHY/HOW THIS RELATES TO RISE OF BIO MODEL. See also the continuum
reason.
WHAT IS A DISEASE
WHY WOULD A SOCIOMODEL NOT INCLUDE GRIEF AS DISEASE?
the three main causes I will focus on include the rise of Freudian
psychoanalysis, 20th century modernism, and
Difference between the rise of this model and griefs absorption into it.
By this point [1988], grief had become so completely ingrained into the
psychological purview it no longer required a justification to be studied or
treated like a psychological object.
Our definitions of health, of disease, and of grief are largely derived from the
output of healthcare professionals, and so, with this in mind, I am not going
to try and answer whether grief really is a disease (whatever that really is
means). Instead, I will look to how grief came to be classified as a disease in
the first place, ending with some remarks on the normative significance of
this classification.
Consider Walters remark, In the 19th century, grief was a condition of the
human spirit or soul. It might sometimes be viewed as a cause of insanity,
but it was not itself a mental illness. (Walter 2006:73) The question is why
the shift in understanding?
Bibliography
Andreasen, N. C (1985) The Broken Brain: The Biological Revolution in
Psychiatry. New York: Harper and Row
Averill, J. R. and Nunley, E. P. (1988), Grief as an Emotion and as a Disease: A
Social-Constructionist Perspective. Journal of Social Issues, 44: 7995.
doi:10.1111/j.1540-4560.1988.tb02078.x
Engel, GL. The need for a new medical model: a challenge to biomedicine.
Science 1977;196: 12936.
-
The biomedical model is one psychiatry tried to base itself on. GRANEK
Is grief a disease?
Ask a Tahitian and hell answer in the positive. (SC 85.) The same can now be
said of psychiatrists. (Granek 49) Grief has already become, or at least, is in
the process of becoming a known disease among healthcare experts. What is
of interest to this essay is how grief came to be categorised as a disease. I
argue the categorisation of grief, as a disease or as something else,
expresses a value-judgement, a judgement derived very much from
institutional factors.
After raising issues of definitions I offer a brief genealogy of grief-as-disease,
with some final remarks on the normative significance of categorising grief in
this way.
Let us begin with some housekeeping nomenclature. By grief I mean do not
mean bereavement. Bereavement tends to be understood as the loss that
has been suffered. (Ibid. pg. 2) Grief, or mourning, meanwhile, concerns
the reactions that follow to this loss. At the same time, however, we must not
locate disease as a synonym of bereavement.
XYZ suggests an interesting formulation of disease. He suggests disease is
the while illness the
But this will not work for grief. The illness is the phenomenology of the
disease. If one loses someone they love, they are going to be forever
diseased, even as the distress, or phenomenology, of their grief rescinds. We
would be permanatly diseased. This is at odds with the present grief
literature, which suggests as our grieving declines, our health recovers. If
recovery is a possibility, then diseases being permanent is an impossibility.
Moving on, note how the ways in which grief is treated is a historical
contingency. Babies in brazil. The aforementioned Tahitians. In Japan, the
positive aspect of grief is emphasised (Cooper).
None of this though warrants the conclusion grief itself is a contingent social
construct. What appears the construct is the varying ways in which societies
deal with grief. (SC paper)
the way in which normal grief was expressed was variable and as far as
Durkheim was concerned, Mourning is not a natural movement of private
feelings wounded by a cruel loss; it is a duty imposed by the group. One
weeps, not simply because one is sad, but because one is forced to weep
(1968:568).2
I want to suggest that the classification of grief represents a kind of value
judgement.
Our present context, meant in a broadly Western sort of way, does clarify
grief as a disease. Or at least it does at the level of experts. In this essay I
want to explore some the reasons grief has become categorised as a disease,
and whether this presents a category mistake. In other words, I want continue
from where the knowledge that grief is already understood as disease within
our social contexts leaves off, and ask why is it understood as a disease, and
ought it be so?
an interesting spatial and
PLAN
Anti phenomenology man
Mourning vs bereavement vs grief
Culture bound syndromes
What is disease/health - SCs 3 models.
Prominence of biomedical model Granek / modernist functioning /WWII /
Freud / rise of psychiatry in the everyday.
Freuds famous 1917, and his psychoanalytic theories more generally, found
particular influence in the US with regard to shifting the focus of psychiatry.
NEW PLAN
Engel/XYZ
Then why this is not sufficient
Then genealogy
I cant help feel like Nietzsche must have when he heard people discuss the
good life.
My problem with these approaches is that they do not explain why grief has
come to be classified as a disease. They outline some various objections
against such classification and then offer some plausible responses. But this
Socratic dialogue technique never sees either author venture beyond an
abstract conception of grief, or disease, or health. What is treated as disease
in society is not as sensitive to these conversations as their authors might
like to think.
Grief, for example, was already treated in Tahiti as a disease prior to their
publications. Even in social contexts nearer to our own, in the 20 th century US
and UK, for example, forces had been set in motion responsible for classifying
grief as a disease scores of years before their writings.
It reminds me very much of Socrates inquiry into virtue in Platos Meno. It is
all very well and good to debate what virtue really looks like, b
What they do is operate within a given criteria of disease and compare grief
alongside it. Not once do they ask themselves whose criteria they are using,
or for whose gain does this criteria lend itself to?
SEE THE QUESTION BEGGING ANSWERS
They assume there are reasons in favour
NOWHERE DO THEY ASK WHY IS GRIEF CLASSIFIED AS A DISEASE OR NOT AS
A DISEASE,
What it is about grief that has led to its classification as a disease lie beyond
the arguments presented by Engel.
Psychiatrys yes response to our question, I shall argue, comes from the
biomedical model of healths ascendency in the 20 th century.
during the 20th century.
NEW PLAN
1 intro
2. Paradigm intro / no atemporal health
3. Psychiatrys new paradigm was the biomedical model
4. On this model, grief can quite obviously be accommodated as a disease,
given the definitions of grief and of disease. See Engel and Hoffer.
5.