The current system envisions abnormal psychiatric conditions as affecting encapsulated individuals. While cultural differences in the incidence of unwanted conduct are well known, and some patterns of behavior are culturally specific, as anorexia is to modern industrially advanced cultures, the goals of treatment, as well as the interpretation of the problem, rarely extend beyond the distressed individual. Although the stresses of poverty, for example, may increase the incidence of many abnormal conditions, current practice assumes that abnormal behavior happens to individuals independent of social contexts. To take more seriously conditions such as poverty, and to make them medically relevant, one can of course add a note to the diagnostic statement, codified as the marginally salient Axis IV in DSM-IV. An impartial examination of demographic data of persons diagnosed as psycho-pathological would suggest that the mental health professions should advocate as therapeutically relevant such conditions as full employment, adequate welfare safety nets, and a livable minimum wage. But this practice is marginal exactly because taking it seriously would require economic, political, and governmental intervention rather than psychiatric or psychological attention. The entry of the treatment professions into politics would undermine the value-free pretenses of the diagnostic system. Such political involvement, especially since it pretends to be scientific rather than political, runs many risks already revealed to us in the awkwardness of courts of law where psychiatric (diagnostic) testimony becomes a part of society's decision to blame wrongdoers—or to excuse them. The risks already incurred by our diagnostic pretenses to scientific accuracy could stretch wildly the current legitimacy of the treatment professions. There is, of course, no simple solution to these problems, but it is clear they are made much worse by the notion of discrete diseases, some of which traditionally supply an excuse, others of which do not.
Empirically demonstrable is the fact that such socioeconomic variables as poverty can be relevant to diagnosis, a fact that cannot be acknowledged so long as mental illness is seen as an individualistic phenomenon. Behavior that has traditionally been labeled mental illness is hardly a private matter analogous to such patently medical conditions as diabetes or cancer where internality and physicality are demonstrable.
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