Finding Jesus in the Storm. John Swinton

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СКАЧАТЬ and provides no contextual, relational, experiential, or cultural information. Statistics also provide thin descriptions. So, for example, we might note that one in four people will experience mental health challenges over a lifetime. This emphasizes at a general level the fact that mental health challenges are a significant issue in the population. However, this statistic tells us very little about the particularities of either the one or the four. Thin descriptions provide us with high-level insights but no low-level details. Another example might be Google Translate, a web-based program that translates typed words into a different language. Through this process, you do get a rough understanding of what words mean in other languages, but that understanding is extremely limited and can even be quite badly skewed. It is an understanding of language stripped of culture, experience, history, or linguistic subtleties and idioms. It is too thin to provide more than a very basic level of insight into the language.

      As we enter the world of mental health, it will quickly become clear that thin descriptions abound, both within public conceptions of people’s experiences and within the mental health professions. In what follows, I examine four key areas where thin descriptions have become particularly problematic:

      1 Stigma

      2 The DSM diagnostic system

      3 The turn to biology

      4 The field of spirituality in mental health care

STIGMA AS THIN DESCRIPTION

      We find a particularly powerful and devastating example of a thin description and its dangers in the phenomenon of stigma. Stigma is one of the most destructive aspects of living with unconventional mental health experiences and one of the most painful experiences that people have to endure. Stigma occurs when a person is reduced from being a whole to being a mere part; from being a full human being to being the sum of a single part. The sociologist Erving Goffman informs us that the concept of stigma originated in the Greek slave trade. After a slave was purchased, the slave was branded and, in branding, was reduced (or thinned down) to the size of the brand. The slave was no longer described as a person, a citizen, a friend, or a family member but was now simply property. Stigma functions in the area of mental health in a very similar way. Stigma reduces people living with unconventional mental health problems to the shape and form of their diagnosis, or more accurately, to people’s perceptions and caricatures of the implications of their diagnosis. In this way, stigma thins down or reduces people’s descriptions to impersonal caricatures based on the connotations of their diagnoses. People cease to be perceived as persons and become “schizophrenics,” “depressives,” “neurotics,” or any other thin diagnostic facade that people choose to project when they don’t want to engage with real individuals.

       A Spoiled Identity

Goffman describes stigma as a phenomenon that occurs when an individual with an attribute deeply discredited by his or her society is rejected as a result of that attribute: “While a stranger is present before us, evidence can arise of his possessing an attribute that makes him different from others in the category of persons available for him to be, and of a less desirable kind—in the extreme, a person who is quite thoroughly bad, or dangerous, or weak. He is thus reduced in our minds from a whole and usual person to a tainted, discounted one. Such an attribute is a stigma, especially when its discrediting effect is very extensive.”6 Stigma is most powerful when it urges us to “reclassify an individual from one socially anticipated category to a different but equally well-anticipated one, and the kind that causes us to alter our estimation of the individual downward.”7 Such a powerful stigma redescribes individuals in negative ways that move them from one socially anticipated category to a different and lesser social category.8 Stigma is thus a malignant mode of social description that is very often aimed at some of the most vulnerable people within society.

      One of the problems with mental health diagnoses is that they are highly stigmatized categories that take their meaning not only from their clinical descriptions but also and sometimes primarily from the negative cultural accretions that accompany such descriptions. This is particularly true in the Western world, which has a preoccupation with intellect, reason, and clarity of thinking. In such a cultural milieu, mental health challenges can easily be perceived as challenging each of these socially valued attributes and, in so doing, challenging our conceptions of what it means to be fully human.

Tanya Luhrmann notices this particularly in the diagnosis of schizophrenia in America: “One of the challenges of living with schizophrenia in the United States is the clear identity conferred by the diagnostic label itself. To receive care in a society so acutely aware of individual rights is to receive an explicit diagnosis. A patient has the right to know. But the label ‘schizophrenia’ is often toxic for those who acquire it. It creates not only what Erving Goffman called a ‘spoiled identity,’ but an identity framed in opposition to the nonlabelled social world.”9 Describing someone as having schizophrenia or being a “schizophrenic” has significant social and relational consequences, at least in Western cultures. As Esmé Weijun Wang put it in relation to her personal experience of living with schizoaffective disorder: “Giving someone a diagnosis of schizophrenia will impact how they see themselves. It will change how they interact with friends and family. The diagnosis will affect how they are seen by the medical community, the legal system, the Transportation Security Administration, and so on.”10

      Importantly, this “spoiled identity” stands in direct opposition to those claiming to bear witness to “normality.” This is why schizophrenia can be so alienating. Built into the description is an assumption of distance and presumed Otherness. However, this is not true in all cultures, as we will see. Indeed, in certain cultures it is not possible to be “a schizophrenic”; constructing people in this way is just not what such cultures do. A question we will explore in various ways as we move on is this: What is it about Western culture that constructs schizophrenia (and other forms of mental health challenge) in such a way as to make it so dehumanizingly stigmatic?

       Stigma Is Pathogenic

      It is clear that thin stigmatized descriptions produce spoiled identities and force expectations downward. Stigma is thus pathogenic (it causes pathology) in that once it is named, the stigmatic description actively causes harm. Stigma dehumanizes people living with mental health challenges. But it also dehumanizes the stigmatizers, who are trained to see only parts of other people without caring for the whole of them (like the doctor in my opening vignette). Stigma thins our vision and hardens out hearts. It is destructive for all concerned.

      The issue of stigma will come up throughout this book. For now, we just need to notice its devastating impact and the ways it thins people out and hurts them.

MAKING UP THIN PEOPLE: THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

Psychiatry is a hermeneutical and descriptive discipline. It describes and interprets unconventional mental health experiences and responds in ways that bring hope, healing, and relief. We will focus on the issue of interpretation later. Here we concentrate on the descriptive dimensions of psychiatry. Historically via psychiatrists such as Karl Jaspers,11 and in contemporary times through the detailed work of Andrew Sims,12 СКАЧАТЬ