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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
pg. 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 in vogue. 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:
There is a great deal more to say here, but what is of crucial relevance to our
inquiry is that grief was, after Freud, put on psychiatrys to-do list. When
psychiatry capitulated to the biomedical model of health and disease, grief,
therefore, was bound to go with it. So when did this capitulation occur? Given
there was no eureka moment for psychiatrys understanding grief as a
disease, it is not surprising that the capitulation defies an exact beginning.
We can though, observe that from the 1920s through to the late 1950s works
of some of the most eminent psychiatrists pushed their field towards
integration with the biomedical model. Emil Kraepelin, often dubbed the
father of psychiatry, for example, sought to establish that all psychological
symptoms, including grief, were unambiguous and had physical
foundations. (Granek pg. 55, Kraepelin 1921:115) Note this is an explicit
acceptance of the biomedical models second and third tenets we outlined
earlier. Equally influential was Lindemanns work on grief in 1944. He claimed
to have established grief as a process with an etiology that could be
predicted, managed, and subsequently treated by professionals. (Lindemann
1944:143) Again, consider the similarities with the biomedical models tenets.
Lindemann was also the first major psychiatrist to explicitly argue in favour of
psychiatric intervention for certain kinds of grieving. (Ibid. pg.147) Religious
institutions and the family were to be deemed as unqualified therapists for
grief as they would be for heart disease. (Shorter 1997)
The work of these two men was fundamental in ensuring psychiatrys
incorporation to the biomedical model. But they do not represent the whole
picture. During the 1950s psychiatry was split between Freudians who
rejected inclination towards the biomedical model and psychiatrists, like
Kraepelin and Lindemann, who embraced 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) By the late 1960s, 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) In tandem to what was happening in the United States, British
psychiatrists and psychologists similarly began to emphasis empiricism and
psychopharmacological experiments to professionalise their studies.
(Moncreiff and Crawford 2001)
That psychiatry came to adopt the biomedical model was not the result of the
actions of isolated psychiatrists, however. Institutional powers such as the
American Psychiatric Association (APA) and its enormous financial
capabilities, (endowed largely by pharmaceutical companies) looked to cut all
ties, especially in the form of research awards, with those who would not
embrace the biomedical model. 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) Psychiatry would benefit from the perception that, like other areas of
science and medicine, it had its own valid diseases and effective diseasespecific remedies. (Ibid pg. 848) This kind of institutional-protectionism saw
the APA establish 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 devolpment 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.
(Whittaker 2010a) Within a few years the organisations revenues had
doubled, and the APA began working with drug companies on medical
education, media outreach, congressional lobbying, and other endeavours.
(Deacon pgs. 848-849 ) Under the APAs direction, the while the National
Institute of Mental Health (NIMH) systematically directed grant funding
towards biomedical research while withdrawing support for alternative
sociomedical approaches. (Ibid pg. 848) The National Alliance on Mental
Illness (NAMI), a powerful patient advocacy group dedicated to reducing
mental health stigma by blaming mental disorder on brain disease, as
opposed to sociological factors, likewise developed close ties with the APA
and the drug industry. (Ibid. pg. 848) Whitaker concisely summarises the
process,
In short, powerful quartet of voices had come together by the 1980s eager
to inform the American and wider public mental disorders were brain
diseases. Pharmaceutical companies provided the financial muscle. The APA
and psychiatrists at top medical schools conferred intellectual legitimacy
upon the enterprise. The NIMH put the governments stamp of approval on
the story. NAMI provided the moral authority. This was a coalition that could
convince American society of almost anything (Whitaker 2010:280)
The development of the Diagnostic and Statistical Manual
of Mental
Disorders (DSM), headed by the APA, within this process. The DSM, commonly
called the bible of psychiatric diagnosis, has had a number of incarnations
since its inception in 1952. Building on the work of Kraepelin and Lindemann
in particular, the DSM has time and time again provided psychiatrists with the
literary backing to pathologise grief. (Deacon pg. 848-852) Its most recent
incarnation, the DSM-V, published 2013, has included 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 we
have learned from psychiatrys biomedical model that what is a mental
disorder is a disease of the brain.
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
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) Note also these interests persist today.
Only a few years ago did influential psychiatrist Alan Schatzberg highlight the
ongoing need to defend psychiatry from threats to its credibility. His
suggestion we need to be more medical to be taken seriously perhaps best
captures psychiatrys motivations in surrendering to the biomedical model
(Deacon pg. 848)
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. Freud
2. Biomedical model
3. DSM criteria
4. 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,
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.
is at odds with its no of the nineteenth century. This is our starting point.
Grief has already been pathologized. This paper locates psychiatrys
capitulation to the biomedical model at the hands of its most powerful
institutional forces as fundamental to griefs pathologisation. Only in light of
the history o
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
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.
Mourning and Melancholia included Freuds central ideas concerning grief,
ones that he had built upon from Totem and Taboo.
.
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.