|
Participants: Laura Cyckowski
(BMC student), Natsu Fukui (BMC student), Paul Grobstein (BMC
Biology), Xuan-Shi Lim (BMC student), Amy Malleck (BMC student),
Laura Socol (BMC student),
In lieu of significant input from practitioners at this session, an
interesting question raised in the forum about the degree to which
mental health practice does or does not continue to be dominated by
the "medical model" and the role of insurance arrangements in that
dynamic (see Sheikh and Fogel) was
raised but not fully discussed. It did, however, lead on to some
useful further discussion of what constitutes the "medical model" and
what changes in it might be desired.
Underlying the "medical model" is a presumption that one can in fact
distinguish with some "objectivity" health from illness (see A Critical Analysis of the
Scientific Model of Health). It was pointed out that this
presumption persists even if one extends the "medical model" to
include some psychological as well as cultural factors. A "biopsychosocial" model
may still retain the perhaps problematic notions of "health" as a
desired norm and "illnesses" as deviations from that norm, even as it
acknowledges the possibility that "illness" may have cultural causes
and require therapeutic measures at either individual ("biological"
and "psychological") or socio-cultural levels (or both).
There followed extended discussion of the pros and cons of an
understanding of mental health based on a presumption of norms and
well-defined ("objective") deviations from norms ("disabilities").
On the positive side, well-defined norms and disabilities are
convenient for insurance purposes, may facilitate research, and are
opted for at times by "patient groups" themselves seeking the
benefits of community and enhanced agency/power. On the other hand,
labels frequently lead to stigmatization and tend to promote a
decreased sense of agency in many individuals (contra the earlier
suggestion that mental health should promote "enhancement of the
ability of individuals to shape their own futures, to be causal and
creative agents in their own lives." The "objective" approach
also tends to diminish attention to the "subjective", to distinctive
"inner
experiences" that may be as meaningful as external measures of
well-being. Finally, it retains the idea that discomfort and pain
should be "fixed".
In this context, it was noted that many human variations
characterized as "disabilities" have not been so characterized in the
past (or in other cultures), frequently have advantageous as well as
problematic features (see, for example, Grandin and Jamison, and come in
various shades of grey in different people at different times. The
suggestion was offered that perhaps people should be thought of as
"evolving" in consequence of various states they pass through rather
than as "well" at some times and "ill" at others. From this
perspective, the task of mental health care is not to "fix" problems
but rather to facilitate continuing evolution of individuals along
their own distinctive trajectories.
The "evolution" notion of mental health is consistent with the
"enhancement of the ability of individuals to shape their own
futures" but raises new problems of its own, such as how to deal with
people who hurt themselves (act to expand their sense of alternative
behaviors?) or may be hurtful to others (pedophiles?). The question
was also raised, as in the last
session as to whether such a definition of mental health is too
culture-specific, applicable only in cultures that value individual
achievement and not in those that place greater stress on group
identity.
The group agreed that, in light of this last point, it would be
worthwhile to spend some time on cross cultural perspectives on
mental health. A set of appropriate readings for the next meeting,
to be held on Sunday, December 3, will be announced on the working
group web site in the near future.
Home
| Calendar | About
| Getting Involved
| Groups | Initiatives | Bryn Mawr Home | Serendip Home
Director: Liz McCormack -
emccorma@brynmawr.edu
| Faculty Steering Committee
| Secretary: Lisa Kolonay
© 1994-
, by Center for Science in Society, Bryn Mawr College and Serendip
Last Modified:
Wednesday, 02-May-2018 10:51:19 CDT
|
