19 jul 2011
Continuum
The problem with seeing things along a "continuum" or "spectrum" is that it blurs distinctions. For example, we could see depression along a continuum of suicidal despair and normal everyday sadness, or "eating disorders' along a spectrum from suicidal self-starvation to minor neuroses surrounding eating. People who want to argue that phenomena exist along a broad continuum want you to think that the milder manifestations are examples of the more extreme, never vice-versa. Statistics about the number of people suffering from mental illness are particularly slippery, if they include considerable numbers of people from the less severe end of the "continuum." I understand all the good intentions behind these arguments, but I am having none of them.
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I suspect that the language of continuums grew out of a desire not to stigmatize people who had been diagnosed with mental illness. An argument that "we're all depressed/manic/neurotic/whatever to some degree" as a way to bridge the gap of otherness or something. So the continuum has nothing to do, really, with the condition being discussed. Unless I'm wrong.
That's a good explanation. I noticed a similar shift when advocates started talking about "risk for hunger" rather than "hunger" itself. It creates a larger and more amorphous category. We are all "at risk" for mental illness, after all.
There's also the funding issue. If your "at risk" population is immense, you need more money to create programs to minimize the risk. That's the cynical explanation.
What would you suggest, considering that whatever your position is has an impact not only on the field in itself, but on public policy? And the fact that access to mental health care in the United States is already terribly restricted?
I'd suggest some intellectual honesty and a nuanced position that still advocated for increased access to mental health care, while avoiding pathologizing ordinary personality quirks (shyness, mild sadness, ordinary adolecent rebellousness, sexuality [e.g. "sex addiction], etc..).
I guess I have a different worldview. In Argentina, we don't pathologize "ordinary personality quirks" (I agree with you in the definition), but we still like to go to therapy for it. It's seen as something normal. In fact, we say half jokingly that we distrust people who don't go to therapy, because they don't want to admit they have flaws, as everybody else.
I would like to be able to go to therapy in the US, but the few times I've tried, therapist have told me there is nothing wrong with me. I know that, but there are still issues I could use some help with (like adjusting to the US, feeling lonely, etc). They do not interfere with my daily life, but I still consider them mental health issue.
I agree. Therapy is very useful for the maintenance of mental health, even in the absence of mental illness. "Curarse en salud."
From an autistic's perspective, imagining autism in terms of a "spectrum" has done a lot of damage to the autistics. We ended up with having "good" autism (or the so-called high-functioning) autism and the "bad", or low-functioning, kind. Last year, when these kinds of distinctions were officially abandoned, I celebrated because they reflected a complete misunderstanding of what autism is.
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