The Emerging View of Psychosis and its Possible Implications for Stigma
Dr Tony Benning
Keywords: stigma, psychotic symptoms, continuum, normality, pathology
Much has been written on the subject of stigmatization in psychiatry in recent years and Numerous strategies have been advanced to combat it. One of the key factors underpinning and perpetuating stigma is the construction of certain groups as ‘fundamentally different’ or ‘other’. Erving Goffman, author of an influential early work on stigma , recognized the common experiences among different ‘stigmatized persons’. “ They have enough of their situations in life in common to warrant classifying all these persons together for purposes of analysis” and this exaggerated attribution of ‘otherness’ to certain groups is no less important as a factor in other areas where stigmatization is seen including race , ethics , criminality etc where discriminatory attitudes are predicated on misconceived binary models of black/white or good/evil etc . An added dimension in the phenomenology of discrimination is the erroneous assumption of ‘sameness’ or homogeneity amongst the members of ‘the other’ group members so that the group is represented , to use Gilroy’s phrase, in a monochromatic form  that denies or minimizes its internal diversity or heterogeneity. One might claim that Psychiatry’s most visible symbols of ‘otherness’ have been identified and removed. To some extent, this is the case. Mental asylums, for example, situated on the margins of cities or towns, by their very location, once served as great symbols of ‘separateness’. Prominent Parkinsonian side effects associated with the older generation of antipsychotic medication also served to accentuate and highlight the person’s ‘difference’ and the newer generation ‘atypical’ antipsychotic medication represents, in this regard, a positive development.
Despite this, there is still something fundamentally stigmatizing about the way in which psychosis has been constructed in modern societies and reproduced in the most influential psychiatric orthodoxy including classification systems that serves to accentuate rather than attenuate a psychotic person’s sense of estrangement from society. Common place assumptions about sane/insane and rational/irrational have, arguably, served to perpetuate stigma. The origins of society’s interest in such conceptualizations of the relationship between rational and irrational are, if one follows Foucault, to be traced to the European enlightenment , when society, increasingly intent on defining itself as ‘scientific’ and ‘rational’ sought to distance itself from all that it perceived as irrational. But Foucault’s ‘archaeology’ tends not to be to everyone’s taste and other writers are content to trace this dualistic trend to psychiatry’s misappropriation of a biomedical model of sickness based on notions of organ function/dysfunction . The two developmental perspectives are probably not mutually exclusive and whatever the ultimate origin, we can say at least , that this model in which madness and sanity are separated by a fundamental dividing line , perpetuating a sense of us and them , is reproduced in so called Neo- Kraepelinian psychiatry. Also referred to as the ‘disease model’ or ‘either – or model’ of psychosis, the Neo-kraeplinian model has dominated psychiatry and has governed the way in which we have conceptualized psychosis. Jaspers’ doctrine: ‘an abyss of understanding separates the schizophrenic from the normal person.’  did not help , leading to the widespread belief, held almost as an article of faith by psychiatrists for decades in the fundamental non understandability of psychosis . The position embraced by Jaspers proved influential and legitimized a rather nihilistic attitude on the part of Psychiatrists when it came to trying to understand and ascribe meaning to the person’s subjective experience. This was to prevail over the decades despite challenges from various corners. Rd Laing, for one, took particular exception to Jaspers’ view professing his aim ‘to make madness and the process of going mad comprehensible’ in the preface to The Divided Self. 
symptoms are beginning
to be seen differently. Far
from being considered un understandable, they are
increasingly being understood as reflecting a person’s real life
We may also be informed by examining the Anthropological literature. The outcome of psychosis in developing countries , where the forfeiting of role or status in society is not as inevitable a corollary of psychosis as it is in developed countries , has consistently been shown to be superior than in developed countries.  This is not to romanticize psychosis nor to be dismissive or ignorant of the suffering associated with it for the person and their carers but psychosis occurs against a backdrop which might be considered to be the ‘deep structures’ within society , as the Belgian anthropologist , Devereux called them. . these ‘deep structures’, though traditionally of interest to Anthropologists, have regrettably, tended to fall outside the concern of psychiatry. The possibility that the ‘deep structures’ in modern society, act to alienate or estrange a psychotic person more than is absolutely necessary , is not a particularly palatable one but one which anthropology / ethnography sensitizes us to considering.
Based on these tentative reflections on some aspects of the social phenomenology of stigmatization , there appears to be reason to suppose that the emerging view of psychosis represents a small step in the right direction when it comes to the amelioration of stigma experienced by people suffering with psychosis . Therapists working individually with people suffering from psychosis have employed a strategy of emphasizing the continuity of ‘symptoms’ across the illusory boundary between ‘pathological’ and ‘normal’.  In some respects then , the widespread ‘uptake’ of the continuity model the evidence for which is superficially presented above, takes these therapeutic strategies and applies them on a ‘ society wide scale’. As a continuation of this argument, it is not surprising that the very concept of ‘schizophrenia’ as a unitary entity has come under renewed attack. Linguistic categories themselves, by their very nature, when applied to people or to groups of people, perpetuate the very myths that we seek to dispel; those of distinctiveness, difference and internal homogeneity. The term schizophrenia is no exception in this regard and its dubious utility both in terms of predicting symptoms ( construct validity ) and in terms of predicting outcome (predictive validity) have been explicated by Bentall and Slade  lending support to the claim of its meaninglessness as a useful or justified concept . The term ‘schizophrenia’, as the argument goes, encompasses too diverse or heterogeneous a group of people to be a meaningful concept and the question of whether or not it has any positive function that counters its stigmatizing function needs to be confronted squarely
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