Sunday, February 12, 2012

Abnormal Discussion Week 4: The Mirror of a Body of Disparity and Infinity

Question I

What are the advantages of using multiple perspectives and integrating these perspectives whenever possible in studying something as complex as psychopathology?

As we read about the content, framework and background of various theoretical perspectives in Chapter 4, the authors provide commentary on widely recognized strengths and limitations of each perspective. Each of us may, of our own accord, come up with additional strengths and limitations that we perceive. Just as each of us is a complex individual, so, too, is the whole of humanity complex - and so, too, is psychopathology a complex field. Perception itself is an infinitely variant and complex phenomenon that we, as humans, only understand on a very basic level. Can we see through each other's eyes? Can we see the spectrum of color seen by a frog? If we can, can we also see it as the frog sees it? No, we're limited by our perception.

Perception is so much about degrees of light, degrees of seeing, ways of seeing. In the same vein, the study of mental disorders, which can be considered a respondent to phenomena related to or resulting from human perception in its many manifestations, is about degrees and ways of looking at or interpreting mental disorders. We may think of studying as a purely academic process. The concept may conjure up images in your mind of textbooks and terminologies; however, studies can be both investigations conducted by inquisitive gatherers of knowledge and portrayals of detailed and highly complex bodies of knowledge. If knowledge can be described as a body (or an amassment), is it not also a mirror of its subject and its investigator? Psychopathology is knowledge(or body)-centered and also forms a body of knowledge on the subject of its study. Think of a study - not the kind in which an experiment is conducted but an actual room designated for the act of studying.

The room, the study, which houses the act of studying (the body of information in the collector, the body of information outside the collector, the body of information in the study-room, and - with a computer connected to the internet - a body of information beyond the study-room), is a body of an act of a body of a vast amount of information. And now, with the Internet, information so often seems to show traces of its limitless infinite nature. When we cannot find an answer to something in cyberspace, does it not exist? Of course not. It's just another wall with a mirror attached that is showing us, in some small way, the limits of our perception and reflecting back an image of the seeker.

The mirror shows the seeker: YOU are the limit, your perception is the limit, your perception is the wall you cannot advance beyond. Yet, even something limitless and unknowable and ungraspable can be considered an amassment of "something" (of infinity? As if infinity is a thing...). As humans, we seek as much information as is possible in order to form bodies (or one universal body) of knowledge. It's almost as if we're trying to grasp onto or hold of something outside of ourselves and as if we believe that what we obtain through that grasping will lead to a final end. But it never will. And so we move within our body of knowledge. We move within our perception as individuals. We move within our perception as humankind. We're ever reaching and ever limited.

Grabbing hold of knowledge or information is like grabbing hold of air. It's only possible to do so if the air is contained in some other form (in a balloon, for instance). If we can contain the information, we can feel it. Feeling it in its container makes us feel like we know it and possess it; but it's always beyond our reach. If we want to truly experience and feel what's in the container, we will lose our ability to observe it because we will be touching it, part of it - in it - and it will no longer be a form outside of us, in our possession and under our control, that can be felt and experienced (i.e., perceived) through out containment of it. Information when it comes down to it is just matter.

Matter, when it is not contained by our perceiving minds, is just matter. It is not an entity separate from us - it IS us. WE are matter, we are the information, we are the perceivable, we are the limitless, we are the infinity. Given the infinity of ourselves, how can we not use and integrate multiple perspectives? We ARE multiple perspectives (multiple, infinite perceiving minds full of multiple ideas). We are as complex as psychopathology - it was created by, for and about us. It's a product of our complexity, and as such, complex and varying perspectives arise in response to it. Psychopathology is a product of our perception, it is -as all things- the mirror.

The treatment-oriented nature of psychopathology brings up interesting issues. Is the goal of psychopathology treatment? Is the study all for the purpose of treatment? Is humanity ill and in need of treatment, or can the natural and man-made (also natural) causes of sickness and death be seen as anything other than an illness in need of treatment? I guess it brings up the issue of a psychology of illness. I wonder how humanism (or humanistic perspective) might respond to or address the issue of a language of disease. If there were no disease, then there would be no need for treatment. If there were neither disease nor treatment, would there by psychopathology? Maybe when it comes down to it, disease/illness is really just a label for perceivable differences among humans.

My partner said if anyone actually reads my discussion posts, they deserve extra credit. I just thought that was funny. I don't mean to be so didactic (she also called me that!). If you get something from this, take it. If you don't, leave it behind. I process things and learn through the act of writing. This is how I think.

Question II

Mental disorders do not discriminate; however, there are many disparities when it comes to the treatment of mental health. How might these disparities affect different cultures, races, and gender?

Generally speaking, mental disorders do not discriminate; however, sometimes they do. There seem to be some major patterns that suggest that some individuals are are more prone to certain mental disorders than others, based on defining criteria (e.g, genetic makeup, socioeconomic status, sex, race, geographic location, ethnicity, etc.). In particular regions, certain mental disorders might be more prevalent than in others. While there aren't many explicitly discriminating mental disorders, sometimes there are clear cases in which differentiation in mental disorders is evident. Usually it's a matter of emergent patterns and incidences that challenge the idea that mental disorders are indiscriminate. Unfortunately, determining, or quantifying, the degree of discrimination between mental disorders presents its own set of problems. If, for instance, research shows that depression is more prevalent among women than men (a sex-based discrimination), that scientific finding might be called into question on the basis of a reporting error (maybe it's not that more women are depressed, it's just that more women report their depression symptoms). On the other hand, there may very well be a biological basis for sex differences in depression that exists but is obscured by the inadequacy of data collection (cause by disparities and inaccuracies in reporting). How can we ever know whether or not measurable discrimination exists between mental disorders, when the measurement tools are themselves fallible?

Regardless of the degree of differentiation among mental disorders, disparities among forms of mental health treatment are, perhaps, more reliably measurable. Inequities that exist and are perpetuated in Westernized health care present themselves on multiple levels. A system of inequality is at work, and like in any system, there are many levels and dimensions that are created by and serve a function within that system. It's hard to know the degrees and manifestations of disparities across cultures, races, gender and sexual identities, and other divides. I know, for instance, that certain groups of individuals have low-level access to healthcare based on their socioeconomic status. An African American individual living in an impoverished community does not have the same level or type of access to certain parts of the healthcare system in America as a European American living in a wealth suburban community. The statement I just made is still based in generalizations, and does not take into consideration several factors, such as geographic location, gender identity, sexual identity, medical history, or family history. If we try to be more specific and imagine that the individual is a male to female seventeen year old transgender woman who identifies as a lesbian and whose family has financially and emotionally disowned her; we still don't have a full picture of the individual. We don't know her medical history, we don't know where or how she is living, we don't know whether or not she has an income. We don't know much about her. We might assume, based on what we know, that this individual is not in a position to afford her own healthcare. Imagine what kind of position you would be in to afford your own healthcare, let alone to even have knowledge of the issue of access or the ability to TRUST in the system of available healthcare, if you grew up in an environment of poverty, were completely disowned (and, therefore, on your own) at seventeen, and were forced to face social discrimination based on gender identity AND sexuality. If you've never been THAT individual in THOSE circumstances, then how can you really know the level or nature of the effect of disparity that exists?

A woman who moved to the United States from India with her husband (who she met just a day before their arranged marriage) might benefit from a transition-centered form of therapy to deal with the social isolation and cultural disconnect that she might experience; yet would she even know that such a service existed, would the gender role prescribed to the region of India from which she came allow her to speak about and seek assistance with her completely-understandable struggles, would her family in India understand and have empathy for the issues of cultural isolation, culture shock and cultural assimilation that she might be experiencing, would her role as a wife allow her open access to mental health services? These are things we cannot determine entirely based on a general understanding of cross-culturalism. We can know that disparities in treatment exist, but it's hard to know the way in which they exist. Even if we did know as much as we could possibly know (as outsiders), we would face another set of limitations with regard to the role of the available healthcare itself. We might be able to make judgments about the healthcare facility for which the woman has access, but we do not know much about the individual facility (a system within a system) itself.

What are the conditions, physical and structural, of this particular system? What are the medical histories and success rates of the medical staff working in the facility? What are entry requirements and policies? We cannot just assume that just because a facility is government-funded that is it congruent with another government-funded facilities. We cannot even assume that high success rates and low rates of patient dissatisfaction are valid and verifiable indicators of the general success of a facility. If we know all there is to know about an individual and all there is to know about a facility and all there is to know about the overriding system in which these two meet or fail to meet, we are still in a position of unknowing. We can try to understand the way in which these various entities meet and interact (or fail to meet and fail to interact). We can draw conclusions to the best of our abilities with the available information, yet we cannot do so definitively and we cannot make sweeping assumptions based on what we think we know. So what can we assume? Very little. Perhaps the only thing we can safely assume is that disparities do, indeed, exist across socioeconomic and other divides.

And on the issue of discrimination in mental disorders, check out this article on variation in the incidence of Schizophrenia:

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