Biology as ideology

For over 40 years there has been an increasing momentum to the wholesale medicalisation of human and social problems

It was in the late 19^th/20^th centuries that the notion of conceiving of distress/madness as a ‘mental illness’ came to predominate. In particular, the work of Emil Kraepelin, and the notion of trying to classify distress into a number of discrete psychiatric disorders, and that these disorders were diseases of the brain, and that these diseases of the brain were categorically distinct from the normal brain and normal behaviour.

For the last hundred years biological psychiatrists have been looking for pathologies in the brain to explain the different symptoms that ‘patients’ present. What with the 1990s being declared the Decade of the Brain, and with the Human Genome Project, they have had a good twenty years to propagate their view. Indeed, for over 40 years there has been an increasing movement towards the wholesale medicalisation of human and social problems. Virtually every problem is conceived as something that can come under the scrutiny not only of medicine in general but psychiatry in particular. Who are the gurus on TV and the press to whom we turn to for solutions to our personal and societal problems—Dr. Mark or Dr. Joan! The politics is taken out of problems. It is not social conditions that require changing—it is our biology. And for ‘mental illness’, this means the resort to pills—the chemical balance of your brain needs to be adjusted.

Today, the bible of psychiatric approach to human misery is the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV). When it appeared in 1994 (only 7 years after DSM-II), it was some 900 pages long (a revision is due in 2010 and is expected to be 1250 pages). Within DSM are over 300 diagnoses. If you feel in need of a diagnostic label you are sure to find one here.

Over the years of revision from DSM in 1952 the shift has been away from a psycho-analytic perspective to a biological one. Now, the biological perspective is the dominant one, and refusal to toe the line can lead to a psychiatric career coming to an end—not only in terms of posts but also any research grants. No longer is the personal political – the personal has become biological.

The biological approach, however, has come under attack from a number of perspectives. The whole of the conceptual apparatus has been undermined by psychiatric service users, psychologists and sociologists. Yet the edifice still stands and may be gaining in strength. The general public seems to be keen on it, let alone other professional and political interests. It will be a tough nut to crack.

As more mental illness categories are added because more people are showing their misery in different ways, this provides an ideal opportunity for the commodification of happiness—with the solution to unhappiness being offered by the pharmacology industry, often referred to as BigPharma.

No place for culture

The biological approach claims that its diagnostic categories are objective and universal because they are based on the pathologies of the brain. Schizophrenia is schizophrenia in AD 2007 or 2007 BC, in Britain or Borneo. The particularities of culture have no place here.

But this is not the whole story. There are cultural psychiatrists who are opposed to this Western imperialist encroachment. Not only are there differences across contemporary culture but even in the West differences are found across time. To show the difference in how misery shows itself across cultures consider these examples of what are called culture-bound syndromes.

Koko: usually Malaysian males who believe their sexual organs are shrinking, and is accompanied by panic as this is an indication of imminent death.

Latah: experienced by Indonesians who develop an exaggerated startle response, which includes shouting rude words and mimicking the behaviour of those nearby.

Western psychiatry tries to put these cultural forms into its categories.

To show how even in the West psychiatrists have changed their mind, consider what Samuel Cartwright classified as “drapetomania” in 1851. This disease was previously unknown to medical authority, although its diagnostic symptom was well known to “our planters and overseers”. This symptom was found only in black slaves and involved “absconding from service”.

He concluded that what “induces the Negro to run away is as much a disease of the mind as any other species of mental alienation and much more curable”. The cause was not pills but “whipping the devil out of them”. The patient should be treated like a child. But he warned against being too lenient or overly severe whipping—both of which would induce “drapetomania”. The term is derived from the Greek “drapetes”— a runaway slave.

Even schizophrenia has been seen as a disorder that is of recent origin, being rarely noted before the rise of modernity, in traditional or pre-literate societies.

The biological approach is not only wrong, but it is also ideological. This is not to deny that biological factors are not prominent in certain disorders. But whatever role biological factors play, psychological interactions cannot be reduced to the biological. As biological entities, all our activities have a biological component. But psychological activities are constituted in the interaction or transaction of a biological organism and a physical social environment.

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