|King's College London, Waterloo Campus|
The workshop opened with a psychiatry session. Prof. Derek Bolton observed that psychiatry is to a large extent concerned with psychosocial phenomena. However, current efforts to reconceptualise “mental disorders as brain circuits” create privilegization of “brain circuitry” in causation of mental illness, leaving psychosocial factors out and thus presenting well-known reductionist epistemological pitfalls. Nevertheless, the Research Domain Criteria project (RDoC), despite creating tensions, also holds the possibility of developing new diagnostic tools. Bolton suggested that genetics and social determinants of health, for instance, as interconnected fields of mental health research, hold the promise of inclusive scope for mental health research and treatment strategies.
Dr. Mary DeSilva presented the perspective of Global Mental Health (GMH) and addressed major critiques of the movement. She emphasised that GMH promotes a biopsychosocial model. Thus, while depression is social suffering, psychiatric treatment is still an appropriate and, often in low and middle income countries, a difficult-to-provide response. To scale up interventions, adaptation and improvement of existing evidence-based approaches is needed. The aim of GMH, in cooperation with local experts, is to provide treatment and break the cycle of mental illness and poverty.
The social policy session was opened by Dr. Martin Stevens who emphasized the role of intuition, emotions and reason as equally important for ethical awareness. Research takes place in a ‘messy’ world, with varying conceptions of individuals, society and mental capacity. These are particularly important issues in mental health studies. Complex questions result from the possibly fluctuating capacity of the participant to give consent and thus participate voluntarily. Consent might be needed on a continual basis.
Prof. Jill Manthorpe argued that mental health of the older-age population is a relatively neglected field and usually research is related to the “burden thesis”. Discovery of dementia can be seen as discovery of a research focus. But the new concept of ‘frailty’ provides a conceptual basis for a more integrative model of health and as such fits well the biopychosocial generalism. From this perspective, it becomes clear that to focus not only on responsibilities but on psychology more broadly, such as coping mechanisms and self-efficacy in daily life, is key to ‘managing’ or at least understanding more of the experiences and impact of disabilities in later life.
The social science session was opened by Prof. Nikolas Rose who addressed the question of diagnosis in psychiatry and in the wider social context. DSM today has limited use in actual clinical practice but it is widely used in RCTs and as a basis for psychiatric research. DSM-5 has leaned towards the inclusion of not only new or updated psychiatric diagnoses but also risk categories. Rose noted how these developments point out various cultural and social functions of diagnosis. It is a social phenomenon. There are always contested boundaries in mental illness. Psychiatry might need a more holistic view of the disorder in its milieu, or a disease as experience of the person, not a ‘disease entity’. Drawing the boundaries between normal and pathological is a significant problem for diagnosis and as such ought to be taken seriously.
Last speaker of the workshop in the social science session was Dr. Dominique Béhague who presented her work on adolescent psychiatry in Pelotas, Brazil. Adolescence still emerges as a new formation in various localities and presents particular epistemological possibilities. Instead of sometimes uncritically assumed ideas about the globalization of biopsychiatry, the ethnography of adolescent psychiatry in Pelotas shows that psychiatric diagnostic categories can function as political tools. This leads to what Béhague refers to as ‘medical politicization’. Adolescent engagement with psychiatric or psychological therapies and specialists, instead of producing medicalized forms of life, can provide means to create political lives and engage in socio-political negotiations.
A full report on the workshop will be published in August 2014 on the Department of Social Science, Health and Medicine blog.