Tuesday, May 5, 2009

Pathologizing the Behavior of Victims

This may be a little disorganized and random, as I'm still processing my thoughts about it.

A close friend of mine recently accepted a job in Behavior Health Services (aka the psych ward) at a hospital. Obviously there are confidentiality concerns and employees are not supposed to talk about the patients outside of work. But the job is emotionally taxing at times, depressing, uplifting, sobering, etc. So people who work there do talk to their friends and families about it, withholding any names or details that would reveal the identity of the patients of course, because they need to "decompress" after work. So all of these fascinating and depressing stories of the individuals who find themselves there have been rolling around in my head, and here are some of the things I'm thinking.

It's disturbing to me that so much behavior that seems absolutely reasonable and normal to me, given the person's history, is pathologized. For example, most of the women who show up in BHS have been abused in one way or another. Some of them in extreme and disturbing ways. When you're in your mid-twenties and have several children by your own father, you have a right to be messed up. But although the abuse is acknowledged and taken into account by the therapists involved, this person is still diagnosed with a mental illness according to her symptoms. And this strikes me as problematic. To say that she's bipolar or schizophrenic or borderline personality suggests that something is wrong with her. Like there's something broken in her head. And this seems all wrong to me. The symptoms and coping mechanisms she's developed are just absolutely right given the violent and skewed environment she emerged from. She's not broken, her world is. Of course now she needs a lot of assistance and compassion to learn how to cope and function in the world outside of the warped one she grew up in. But that's her abusers fault, not hers. He's the one who's fucked up, but she gets labeled and stigmatized because of it.

Similarly, many young women who suffer from depression or suicidal thoughts have been systematically excluded in our culture that values women based on the beauty and usefulness of their bodies. These women are socially awkward and don't meet our strict beauty standard, so they've been cast aside and isolated by their peers. When they show up at BHS feeling lonely and sad, they're diagnosed as clinically depressed or borderline personality. Once again, the problem lies with them - they're broken; something's wrong in their heads. But I feel like this is deeply unjust. The culture they're submerged in, which can't see them and value them for who they are, is what's broken. Responding to isolation and neglect by feeling sad and lonely is not abnormal, it's not irrational, it doesn't make you sick. In fact, it's a more natural and healthy response than many other possible responses.

Men's behavior is often pathologized too. It seems like a lot of the men who show up at BHS have substance abuse issues and engage in inappropriate or violent behavior while under the influence. No doubt many of them have been abused too, but there's more stigma attached to abuse for a man than a woman in our culture, so the liklihood that they would have gotten help dealing with their abuse or PTSD is lower than for women. But substance abuse and violence are among the ways men are taught to cope with trauma, so these are the behaviors they tend to exhibit. And because of this they're often criminalized in addition to being institutionalized for mental disorders.

And many of these types, both male and female, display a lot of drug-seeking behavior and have learned what to say and how to manipulate staff to get the narcotics they crave. Of course, drug-seeking behavior is frowned upon, stigmatized, and shamed. And these patients are aware of the attitudes toward drug-seeking behavior and have internalized the associated guilt and shame. While I agree that drug-seeking behavior shouldn't be encouraged, I have real issues with the way we make it into this shameful and immoral thing. Using drugs to deal with the pain of abuse or other traumatic experiences is one coping mechanism among many. If I had experienced the kind of trauma they have, I don't doubt I would want to be drunk or high every day for the rest of my life too. It's a totally reasonable response. It's true that these people had the misfortune of seizing upon a particularly problematic coping mechanism, but we shouldn't shame them for it, but should rather see it as a simple coping mechanism and try to help them learn how to replace it with more healthy coping mechanisms. Because treating them for substance abuse and then returning them to their world without any more constructive ways of handling their pain and their issues is ineffective at best and counterproductive at worst.

I realize, of course, that the medical professionals who are dealing with these people on a daily basis have little control over the person's environment. Given this fact, it often makes sense to medicate them and make them as comfortable as possible. But this model is so limited and places so much of the problem and the stigma on victims' shoulders that it seems deeply unjust to me. Rather than taking a critical look at our culture and the way it so casually disposes of bodies and lives, we pathologize the behavior of victims and medicated them and shame them for their desire to numb the pain using substances that have been arbitrarily criminalized by the government while treating them with substances that have the government's stamp of approval because the right rich white guys are getting rich off of them. Instead of looking at the systemic causes of abuse, trauma, and the resulting "mental illnesses," we label the victims and put them in a neat little box, hoping they won't cause too much trouble or be too disruptive. And maybe, just maybe, they'll return to the gold standard of being a productive worker/consumer in our capitalist society. Because in a capitalist, patriarchal culture, the norm is established by appealing to hierarchical roles and expectations and cultural conceptions of healthy functioning, i.e. going to work everyday and being a good, non-disruptive little sheep. But that is another story for another post on another day...


  1. It's my understanding that organic mental disorders can be triggered by the environment one is surrounded by. So it's not like doctors are arbitrarily prescribing medication to patients to treat a larger problem; in some cases, these patients may have actual disorders that need attention. However, I agree with your point that for the most part, it's our culture that's broken, not the people seeking help. But then again, as someone who is medicated as the result of a broken society, I feel that using that medication (and therapy) is a way to empower myself to make the best decisions I can for my own life in what is often an unjust and unfair world.

  2. Meg'n5/05/2009


    I think your point is consistent with what Rachel said, especially the last paragraph. It does seem clear that once a person has been mistreated to the point where they're depressed or acting out in the only way they know how, they do need help and often medication. But it doesn't seem like it's necessary to always label them with a mental illness. A friend of mine lost her twin sister, and took a long time to work her way out of the grieving process, so she was diagnosed as clinically depressed and given a number of medications. I think the medications did help her, but now she has "a history of mental illness" when in fact she was grieving the loss of someone who was very close to her, which is not pathological. So I agree with Rachael's point that we should view responses to trauma and abuse (and loss) as healthy and normal, and try to help people work through them without necessarily labeling them.

  3. Tori,

    I have heard that at times the brain undergoes basic organic changes due to abuse or trauma. For one thing, I know that people respond to stress hormones differently post-trauma, so I don't doubt that this is often the case. I've also read about how in countries (like ours) that have the PMS construct, women who are in abusive relationships or have a history of abuse experience very severe symptoms of PMS. In this case I think it's partially a matter of appealing to the explanatory mechanisms available to you via your cultural mythology to explain away your problems, and partially due to actual changes in the brain that affect how you respond to stress and fear and anger.

    But what bothers me is how many young women come in feeling sad and lonely and are immediately diagnosed as depressed or borderline personality due to a history of bad or unstable relationships and poor self-esteem. To me this is so obviously a symptom of the culture, not the person. But they're all almost immediately diagnosed and medicated, and these diagnoses stick for life.

    I was also really irritated that the woman in the first case I mentioned told the staff that she couldn't move her lower body and that she was hallucinating, and even though they later saw her moving her legs when she thought nobody was around, they went ahead and diagnosed her as schizophrenic, as she had undoubtedly hoped. I suspect she was looking for a diagnosis that would require a longer stay and keep her away from her abusive family situation and hopeless home environment for as long as possible, which is a totally rational strategy for someone in her position. But instead of asking if they could help her obtain legal intervention and find her a better living situation with appropriate counseling and support, they diagnosed her and started her on meds. So now according to the system, the problem is that she's schizophrenic, not that she has an abusive father with an enabling mother and three kids she feel overwhelmed by. I just don't see how that helps anyone.

    And I do think that as a society it's easier to medicate those who become cultural wreckage rather than address the true underlying problems. However, that doesn't mean I think the experiences and issues of individuals in the system are not real or not legitimate. Rather, I think we delegitimize their very valid and rational responses by pathologizing them.

  4. Tanner5/05/2009

    I'm with you on the schizophrenic case. This is obviously a cry for help and an indirect way to say "please don't send me home." But in the medical model, the template is diagnose-treat-discharge, and any variation from that would throw a giant monkey wrench in the works. Also, the diagnose-treat-discharge pattern makes a lot more moola for the medical-industrial-complex.

  5. Serendipity5/05/2009

    Slightly off topic **sorry**

    You keep mentioning this theory that PMS is a social construction and I'd love to read more about it. Pwetty pwease won't you post on it? *bats eyelashes sweetly*

  6. Rachel, you seriously think this is random and disorganized? I'm afraid your years in philosophy have warped your views on writing. To get them back on track, feel free to come grade Eng 1010 papers with me this weekend. That will educate you on what random and disorganized really looks like.

  7. Serendipity,

    Give me a minute and I'll dig up and repost an old Feministing post I wrote on this.

  8. I really expected you to start talking about rationalized systems and the colonization of the lifeworld there at the end...

    It would be really interesting to do a critique of the mental health systems in advanced capitalist societies as rationalized systems. I'm sure it's been done before, but I have yet to read it.