PRACTICING UNDER THE INFLUENCE: THE MEDICALIZATION OF PSYCHOTHERAPY A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY Sylvia Herold Olney IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY John M. Ingham November, 2010 Copyright Sylvia Herold Olney 2010 ACKNOWLEDGEMENTS Although this project began with my own questions, it was able to come to fruition only through the cooperation and encouragement of my family, friends, teachers, and the practitioners who were willing to be interviewed. I particularly thank my dissertation committee, Professors John Ingham, Timothy Dunnigan, Karen-Sue Taussig, and Herb Laube, for their patience and for the friendship that developed over the years. I thank Loie Meier, psychotherapist, peace activist, and learned friend, who provided me with an initial contact list of practitioners. Then, Pam Johnson, who put up with being subjected to a prototype interview, and who has always kept me on the straight and narrow with her intelligence and wry humor. Next, I thank Steve Bean, cheerful presence and librarian extraordinaire. And the friends of my heart: Cathe McDonald, Kathie Allen, and again Dr. Herb Laube, willing to counter my self-doubt and offer practical guidance. Then, the midwives of an awakening that became intertwined with my academic work: Jackie Solem, a true light in the dark, who first revealed to me that the path to reality leads through one’s own psychology; and the precious teachers of A Society of Souls: Jason Shulman, Brenda Blessings, Emilie Rowan, and Gary DePice. To you I bow in gratitude. I also acknowledge my parents, Annelie and Horst, who, as immigrants out of war-torn Germany in 1955 gave their children what they could, especially literacy. It is they who always encouraged my desire for knowledge, and who patiently supplemented my schoolwork with German language at home and Latin by correspondence while we lived in the country in Australia. Today it is my younger sister Darvia Herold who inspires me with her own ability to make good use of the open educational system in the United States, and who encourages me through both the best and worst of times. Finally, there are the friends of my soul, who take me as I am: Susan Hawkinson, Stan Cronister, Annie Erickson, and Dick Cain, who plied and bribed me with poetry, i prose, wit, wine, and fine dining. But most of all, I acknowledge and thank my husband and truest friend, Doug Olney, ever patient, resourceful, and caring, who bore the brunt and loved me anyway. ii DEDICATION To my Grandmother who dreamed of archaeology, With love and deepest respect forever, Bettina Geis Buelow, 1911-2007. And to a shooting star, a fine and fiery presence, my little Grandson, Maximillian Alexander Root, June 20 - October 15, 2010 What is man, that thou art mindful of him, And the son of man, that thou visitest him? For thou hast made him a little lower than the angels, And hast crowned him with glory and honour. Psalms 8:4-5 iii ABSTRACT Using a postpositivist empirical method with meaning as central, this dissertation is based on a series of interviews with mental health workers and other professionals involved with or associated with mental health. At issue is the extent to which the biomedical model of human functioning has coopted the mental health field especially as it affects the practice of psychotherapy. I believe that this question is important because of the disablement one can observe in client/patients and others, as well as the philosophical dilemmas confronting practitioners, as a result of their collective exposure to the idea that people may be essentially powerless in the face of their own biology. This perception appears to contribute to the vested interests of the pharmaceutical and insurance industries but it flies in the face of developments in the field of psychoneuroimmunology, neuroscience, and other emerging perspectives, which validate a force-like dimension of mind or focus and intention, and which stand to free people from dominance by external agents including psychotropic medication. iv TABLE OF CONTENTS List of Tables .................................................................................................................... ix List of Figures .................................................................................................................... x INTRODUCTION ............................................................................................................... 1 SITUATION AND ARGUMENT ............................................................................. 1 The cultural problem ................................................................................... 4 The scientific problem ................................................................................. 4 The philosophical problem ......................................................................... 5 Argument ..................................................................................................... 8 ETHNOPSYCHIATRY AND HUMAN AWARENESS ............................................. 9 Knowledge and power ............................................................................... 13 Culture: The symbolic order .................................................................... 17 Dysphoria .................................................................................................. 27 The significance of human perception ...................................................... 34 The mind-body problem resurrected, or, can psychological anthropology be a science? ............................................................................................. 34 METHOD .............................................................................................................. 41 The meta question ..................................................................................... 41 The biomedical model in mental health services organization ................. 42 Research design: Anthropology by appointment ..................................... 45 Design rationale ........................................................................................ 46 Questions ................................................................................................... 48 Analytical application ............................................................................... 49 SUMMARY ............................................................................................................ 50 THE HEART AND SOUL OF THE MATTER ............................................................... 51 INTRODUCTION ................................................................................................. 51 v PRACTICING UNDER THE INFLUENCE .......................................................... 52 Disease as largely of the body .................................................................. 53 Disease as applicable to mind .................................................................. 55 Disease as unease ..................................................................................... 57 Behavioral health ...................................................................................... 60 The human person ..................................................................................... 63 The DSM ................................................................................................... 65 Treatment modalities and rationales ........................................................ 68 Disease as largely of the body ...................................................... 68 Disease as applicable to mind ...................................................... 73 Disease as unease ......................................................................... 75 Behavioral health .......................................................................... 78 Defining and attributing treatment success .............................................. 84 Disease as largely of the body ...................................................... 85 Disease as applicable to mind ...................................................... 88 Disease as unease ......................................................................... 91 Behavioral health .......................................................................... 94 THEORETICAL IMPLICATIONS ........................................................................ 96 Practitioner view of mind .......................................................................... 96 Indexicality and scientific materialism ......................................... 98 Stress and perception .................................................................. 103 Consciousness ......................................................................................... 106 Mind ............................................................................................ 107 A case in point: OCD and expanded indexicality ...................... 108 GETTING BY WITH A LITTLE HELP ........................................................................ 117 INTRODUCTION ............................................................................................... 117 vi OUR FRIENDS ................................................................................................... 119 Medicalization ......................................................................................... 122