Friday, June 19, 2020

Demarcating 'abnormality' from 'normality'

I've said before (eg. see previous post) that insisting on avoiding pathologising in mental health services can be misleading. I understand why people may want to do this because, for example, they think that pathologising mental problems implies brain disorder, when this is not the case.

Sanneke de Haan in her book Enactive psychiatry (see previous post) discusses what she calls 'sense-making' (see another previous post). Organisms need to make sense of their environment to survive. We need to understand the organism-environment as a system not an isolated individual, let alone its brain. 

How do we distinguish pathological from normal sense-making? Of course there are differences between people. It is normal to struggle with life at times. The appropriateness of sense-making depends on context and sense-making needs to be attuned to the real world. Norms can vary over time and shared sense-making or the common sense of people in cultural context is what matters. People can still be eccentric but the stance one takes on oneself and one's situation can mean that one fails to recognise the inappropriateness and inflexibility of one's ways of interacting. One's stance can become unbalanced. Problematic sense-making can cause suffering, although not necessarily so. Patterns of sense-making may be identified which are abnormal.

As I've also pointed out, the concept of illness goes back further than our modern understanding since the middle of the nineteenth century of illness as physical lesion (see eg. previous post). We use the same criteria to decide whether an illness is mental or physical and, even though the concept of illness as physical lesion is relatively recent, we tend to think that we are extending the principles of physical illness to the concept of mental illness. 

In fact, the concept of psychological illness had been opened up before the application of the anatomoclinical method in medicine (see previous post). The recognition of psychosomatic illness focused on the doctor-patient relationship creating a new space for mental pathology (see previous post). We may now have more modern understandings of psychosomatic medicine (eg. see previous post), but, as I've pointed out before (eg. see previous post), those that want to move away from the concept of mental pathology, do not seem to deal with the issue of psychosomatic pathology very well. 

Of course madness has always been recognised. Still, medical psychology created a descriptive psychopathology (see eg. previous post) and how we make sense of delusional thinking is still an important issue (see previous post). Normalising mental pathology can fail to do justice to the sense in which something may have gone wrong in mental functioning.

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