A Psychiatrist looks at the Uses of Abnormality
Halleck, Dr. Seymour
A Psychiatrist looks at the Uses of Abnormality by SEYMOUR HALLECK, AID. ^TVhe psychiatrist is granted more power than the ordinary man to influence standards of conduct within his community. To...
...The Elderly With the aid of modern medicine the number of people who live beyond the sixth decade has greatly increased...
...Those who are defined as abnormal lose much of their power to initiate social change...
...he is also obligated to keep this process from becoming worse...
...This probably accounts for much of their reluctance to treat the poor person with therapies that depend on verbal interaction and expansion of awareness...
...He is obligated not only to care for those who are victims of a brutal process...
...It would seem that a humane society would treat these people with special kindness...
...With rare exceptions psychiatrists have emphasized that social discrimination and prejudice rather than innate weakness or illness are the main factors contributing to the unhappiness of both groups...
...Failing strength, illness, a diagnosis which reflects hopelessness, which implies that the patient cannot communicate rationally, and which can be used to justify treatments that do not require a great deal of doctor-patient communication...
...Because he views his patient's unhappiness as a form of illness, the psychiatrist also has an insidious tendency to think of his patient's "differentness" as a manifestation of illness...
...The community may be one of great wealth or it may be one of limited comfort...
...This is not the case...
...Psychiatrists who are well educated and who were raised in middle or upper class environments will naturally have some difficulty in communicating with a relatively uneducated client...
...Thus, the psychiatric diagnosis leads to restrictions placed on the homosexual which may be as severe as those put upon the rapist or murderer...
...There is no role for older people in our rapidly changing society, no work, no sense of usefulness, and little dignity...
...It is troubling enough that psychiatrists do not offer poor people the same quality of treatment that they offer the affluent...
...His fear of impotency is especially great in our modern era because scientific research has shown that women are quite capable of enjoying sex as much or perhaps even more than men...
...What is even more disturbing is that even when psychiatrists work in a setting where ability to pay is not a crucial factor, they still tend to offer more prestigious (and perhaps more liberating) treatments, such as psychotherapy, to middle or upper class people and are likely to use potentially repressive treatments such as drug and other somatic therapy in treating poorer people...
...In either case, it is an isolated community...
...In either case, it is an isolated community...
...Deprived of close contact with their families, they seem to wander through a series of aimless distractions while they await their death...
...But most homosexuals are more discreet than heterosexuals and are far less predatory and far less violent than they are...
...It seems that if male psychiatrists had listened to their patients (or perhaps to their wives) they would have known better...
...For years most psychiatrists and psychoanalysts rigidly held to the doctrine that there was a major difference between a cli-toral and a vaginal orgasm...
...There is an implied assumption of class superiority here...
...Similar attitudes prevail towards black patients...
...They must learn to understand those who are poor or black and learn to treat them at least as well as they treat the affluent white...
...The psychiatrist who is available to interpret much of the misery of the elderly as an illness helps to justify a vicious form of oppression...
...Failing strength, illness,and the fear of death—all of which are associated with aging—are indeed formidable stresses...
...This standard can be based on data as to biological norms, on social utility, or on prevailing community mores...
...The likely community response is to restrict individuals and groups who are "different" as harshly as it restricts those who are violent...
...By failing to uncover, to dramatize, or to treat the problems of poverty-stricken or minority groups, the psychiatrist has made it easier for the society to ignore their problems...
...Furthermore, even with a growing awareness of the susceptibility of oppressed groups to emotional disorder, psychiatrists are still biased in their assessment of the ability of these people to respond to the most highly valued varieties of psychiatric treatment...
...Those who hold power in the community are reluctant to lose it...
...It was assumed that a woman could not enjoy a vaginal orgasm until she was mature, and that her maturity could only be distinguished by her willingness to be submissive and passive...
...At one time it did make a kind of social sense to confine women to a secondary position...
...His pronouncements often lead the community to believe that his definitions of normality are based on medical facts while too often he is only echoing the morality of the majority...
...This practice is reinforced by the psychiatrist's tendency to label "lower class" people as schizophrenic, a diagnosis which reflects hopelessness, which implies that the patient cannot communicate rationally, and which can be used to justify treatments that do not require a great deal of doctor-patient communication...
...There is no role for older people in our rapidly changing society, no work, no sense of usefulness, and little dignity...
...Similar attitudes prevail towards black patients...
...The most psychiatrists can say is that homosexuals, either because of their biological makeup or because of some eccentric learning experience, have failed to develop sustaining sexual attachments to members of the opposite sex and may be attracted to members of the same sex...
...By accepting the prevailing belief systems of the community and by strengthening them through psychological interpretation, psychiatrists have obscured society's need to examine this issue objectively...
...But if women are equal partners in sexual and other social relations, the male, particularly if he has been raised in American society, is likely to feel on trial during the sex act...
...The problem here is that the psychiatrist is not required to, nor does he usually trouble himself to, spell out the standards he uses in defining normality...
...For many years, psychiatrists doubted woman's capacity to have more than one orgasm during an ordinary period of lovemaking...
...Those who are defined as abnormal lose much of their power to initiate social change/' While most psychiatrists have made repeated pleas for tolerance of homosexuality, their professional attitudes towards homosexual behavior have probably not helped the homosexual's plight...
...The so-called social delinquent is assumed to be in need of education and alteration of his value systems...
...If a man is to enjoy the sex act he must have a sense of security that he is not being called upon to perform, that he is not being judged as to his sexual abilities...
...The homosexual comes to be viewed not only as a person who cannot control himself but also as a person who is potentially violent...
...Those who are old and poor are among the most wretched of men...
...Implied in this classification is the belief that the neurotic delinquent is a more unhappy, more fragile person than the social delinquent...
...At first glance the psychiatric profession's record in dealing with these groups looks good...
...In fact, in some institutions, it is still an extreme rarity for a black child to receive psychotherapy, while white children from similar socio-economic backgrounds find such treatment more readily available...
...Yet, deviant behavior seldom threatens the safety of others...
...As in the case of the poor, a great deal of this discrimination can be explained on the basis of communication difficulty between blacks and whites...
...Little mention is made of their need to be active contributors to the social order...
...Some standard of normality must be used to determine whether a given person needs treatment, to determine how he is to be treated, and to help define treatment goals...
...But by virtue of his status in the community, his power to label them as mentally ill can subject deviant individuals to rejection and oppression...
...They must cease to perpetuate myths as to the unresponsiveness of these people to certain forms of treatment...
...Unfortunately, psychiatrists have not helped clarify the situation...
...Such a behavior characteristic should be considered a problem only if the homosexual wants to see it as a problem...
...They are rarely selected for psychotherapy and they are more likely than whites to be given diagnoses which allow the psychiatrist to treat them with repressive therapies and to keep them at a distance...
...It has been fashionable in recent years to classify delinquent youth on the basis of whether sociological or psychological factors seem to be the main determinants of their anti-sociality...
...Labeling can be repressive even if only non-medical terms are utilized...
...But in a technological society physical strength has become a relatively unimportant survival factor, and there is no apparent rational purpose served by keeping women in a repressed condition...
...Many outstanding psychiatrists still refer to women in terms of their needs for passivity, their needs to be companions to men, or their needs to be mothers...
...The homosexual who is not predatory, who does not bother children, and who is discreet should never be described as a sick person...
...Perhaps, as Freud noted, "anatomy is destiny" and woman will always be unhappy if she is not at least partially dominated by man...
...They should make these criteria known to their patients, and, when their public pronouncements touch on the question of normality, they should also make them known to the public...
...He may, under certain circumstances, lose some of his rights...
...Psychiatrists insist that homosexuality should be treated as an illness...
...Those who are old and poor are among the most wretched of men...
...Psychiatrists, however, also seem to harbor a subtle kind of prejudice toward lower class persons, which increases the likelihood that such patients will be treated with non-verbal techniques...
...It is commonly assumed that people will naturally become more depressed as they grow older...
...Unfortunately, the professional therapist has often loaned his talents to perpetuating such unsubstantiated belief systems...
...Psychiatrists who are well educated and who were raised in middle or upper class environments will naturally have some difficulty in communicating with a relatively uneducated client...
...The public comes to view the homosexual as always capable of being overwhelmed by a monstrous lust...
...As long as women are discouraged from establishing themselves in the business, the academic, or the political world, men are guaranteed an advantageous position from which to accumulate power and wealth...
...The Elderly With the aid of modern medicine the number of people who live beyond the sixth decade has greatly increased...
...When placed in a medical category, the homosexual is usually diagnosed as a sexual deviate, the same category that is used to describe rapists, child molesters, and sadists...
...Deprived of close contact with their families, they seem to wander through a series of aimless distractions while they await their death...
...The community may be one of great wealth or it may be one of limited comfort...
...But it has frequently described such sexual behavior as evidence of emotional disturbance or immaturity, terms which have come to take on a pejorative quality...
...If this should be the case, then psychiatrists have the responsibility of training therapists who are members of oppressed groups and who can identify with them and treat the problems of individuals in such groups...
...The willingness of the psychiatrist to treat the unhappi-ness of the elderly person as an illness may serve to justify the society's unwillingness to treat the elderly person decently...
...The neurotic delinquent is usually assumed to be under greater psychological stress and in need of some kind of psychotherapy...
...It is commonly assumed that people will naturally become more depressed as they grow older...
...But in their attitudes and practices psychiatrists seem to be accepting and perpetuating the myth that black children do not suffer as much as white children...
...An individual so labeled may become a pariah...
...Yet, there is no convincing evidence that the homosexual differs in any profound biological or psychological manner from the heterosexual...
...This has a bad effect on both parties...
...This is not the case...
...When man's capacity to survive was largely determined by his physical strength, men could contribute more to the community than women...
...It would seem that instead of merely treating the depression of elderly citizens the psychiatrist should also attempt to define what factors in our society contribute to a decent and happy old age and what factors contribute to making old age a nightmare...
...His pride and self-confidence are often shattered...
...There is no way of knowing if there is something in woman's biological nature which makes her content to take a passive or submissive position towards men, or if she has been forced into this role on the basis of social needs or circumstance...
...The psychiatrist inadvertently finds himself in the position of using his professional role to diminish society's need to confront and deal with inequities in the way it distributes power...
...Oppression of Women Women occupy a second class status in American society...
...I shall describe just a few of the ways by which this process contributes to the oppression of certain members of the community: The Homosexual Indulgence in acts of physical love with a member of the same sex brings on harsh and sometimes brutal punishment in American society...
...The community, of course, may have good reason to want to control the homosexual who attacks or molests children or the homosexual who offends our taste by seeking his gratification in public...
...Psychiatrists, however, also seem to harbor a subtle kind of prejudice toward lower class persons, which increases the likelihood that such patients will be treated with non-verbal techniques...
...The tendency of men to enjoy dominating women is quite understandable...
...To begin with, he is allowed to certify the abnormality of certain people by putting them into the role of patients...
...They are more likely to become guardians of the status quo than agents of social change...
...One way they retain it is by developing and perpetuating belief systems that reassure the oppressors (and sometimes convince the oppressed) that those who are subjugated are somehow dangerous or inferior...
...The public tends to view all sex deviates as violent...
...If the elderly person has an important place in society he can live with grace and dignity...
...Conceivably the white psychiatrist who is raised in a middle class society may be incapable of providing psychotherapy to those who have markedly different origins and upbringings...
...There are now millions of Americans who live essentially non-productive lives, and who have few responsibilities other than keeping themselves alive and entertained as they approach the certainties of illness and death...
...Psychiatrists have to learn about the problems of those who are oppressed on the basis of poverty or skin color...
...The labeling process also contributes to the oppression of deviant groups by strengthening the community's beliefs that those who are different are inferior or dangerous or both...
...In dealing with the poor the psychiatrist tends to revert to the authoritarian role of the patrician or benefactor (a role more common to the non-psychiatric physician) rather than assume the egalitarian role he usually adopts with patients of his own class...
...This probably accounts for much of their reluctance to treat the poor person with therapies that depend on verbal interaction and expansion of awareness...
...He has served as resident psychiatrist at the Menninger Foundation and as staff psychiatrist at the U.S...
...Yet, behavioral scientists have learned that much "different" behavior is an effort to communicate to others the need to change something in the disturbed person's environment...
...They must learn to understand those who are poor or black and learn to treat them at least as well as they treat the affluent white...
...Implied in this classification is the belief that the neurotic delinquent is a more unhappy, more fragile person than the social delinquent...
...A woman who enters psychotherapy will usually be exposed to a whole system of values which emphasize the virtues of her passivity...
...It would seem that a humane society would treat these people with special kindness...
...It is more likely to threaten the community status quo by affronting standards of propriety or by seeming to reject the existing social order...
...He should never be considered a potential patient unless he wants to be a patient...
...Because they are alleged to have these qualities, they are more likely to be talked to than talked with...
...It is sometimes argued that lower class people are too impulsive, too eager to find immediate gratification, or too simple-minded to cooperate in psychotherapy...
...They must cease to perpetuate myths as to the unresponsiveness of these people to certain forms of treatment...
...Psychiatry has not labeled these practices as immoral, or even as evidence of a mental disease...
...Conceivably the white psychiatrist who is raised in a middle class society may be incapable of providing psychotherapy to those who have markedly different origins and upbringings...
...It was only after the Masters and Johnson studies conclusively demonstrated that multiple orgasms were commonly experienced by normal women that psychiatrists reluctantly conceded that women (at least in terms of their capacity to experience orgasm) were more sexually powerful than men...
...As in the case of the poor, a great deal of this discrimination can be explained on the basis of communication difficulty between blacks and whites...
...This is especially apparent in the area of sexual behavior...
...In my work in institutions for delinquent children I have noted an insidious tendency for black children to be viewed as social delinquents far more frequently than white children...
...While other kinds of unconventional sexual behavior may engender attitudes of similar repressiveness, persecution of the homosexual has become something of an American institution...
...We do not usually think of people who behave so peculiarly that they are labeled schizophrenic, paranoid, psychopathic, or addicted as people who are trying to change the social order...
...Western society has long emphasized the immorality of certain sexual practices, such as masturbation and oral-genital and homosexual relations...
...The assumption that the homosexual is ill serves to convince both the individual and the public that he cannot control his behavior...
...In dealing with the poor the psychiatrist tends to revert to the authoritarian role of the patrician or benefactor (a role more common to the non-psychiatric physician) rather than assume the egalitarian role he usually adopts with patients of his own class...
...It is hard to imagine how anyone could practice psychiatry without having some idea as to what kind of behavior is good for people and what kind is not...
...The so-called social delinquent is assumed to be in need of education and alteration of his value systems...
...Nor do we know if efforts at female liberation are only the antics of a few sexually confused feminists or if they represent a sincere and useful attempt to limit oppression which has been arbitrarily imposed upon half of the members of our society...
...Medical Center for Federal Prisoners...
...Psychiatrists "are more likely to become guardians of the status quo than agents of social change/1 The Poor and the Black Oppression of poor and black people is one of the tragic realities of American life...
...We don't really know if women are better off from a psychological standpoint if they take a secondary role to man than they are if they are allowed to assume a role as equals...
...This article is condensed from his forthcoming book, "The Politics of Therapy" (Science House, New York, $10...
...In psychiatry, diagnostic labels such as schizophrenia, paranoia, psychopathy, or alcoholism are not defined with any great degree of precision...
...But in their attitudes and practices psychiatrists seem to be accepting and perpetuating the myth that black children do not suffer as much as white children...
...They are rarely selected for psychotherapy and they are more likely than whites to be given diagnoses which allow the psychiatrist to treat them with repressive therapies and to keep them at a distance...
...Yet these labels retain powerful social meaning...
...They exist in a state of near isolation and massive boredom, practically hidden in our ghettos and rural communities...
...There is absolutely no evidence, however, that such stresses inevitably lead to depression...
...Freud saw woman as basically masochistic and passive, as needing a certain degree of masculine domination to feel comfortable and whole...
...As long as women are viewed as second class citizens the male need not be too preoccupied with his potency...
...The psychiatrist, for the most part, preaches the values of tolerance and humane treatment in dealing with deviant individuals...
...In modern society oppression of the homosexual is primarily maintained by an irrational fear that homosexuality threatens the stability of the society and by the irrational belief that tolerance of the homosexual implies weakness...
...Describing the homosexual as sick has other repressive consequences...
...Nor is there justification even in terms of social expediency for thinking of consenting adult homosexuality as an illness...
...If this should be the case, then psychiatrists have the responsibility of training therapists who are members of oppressed groups and who can identify with them and treat the problems of individuals in such groups...
...Both parties are victims of a myth, for there is nothing about the homosexual urge that makes it more powerful or less resistible than the heterosexual urge...
...The neurotic delinquent is usually assumed to be under greater psychological stress and in need of some kind of psychotherapy...
...But men also have psychological reasons for fearing woman as an equal...
...Even those who have money face formidable stresses...
...Many of the people the psychiatrist encounters in his work are not only unhappy but also somewhat different from other people...
...There is an implied assumption of class superiority here...
...There are now millions of Americans who live essentially non-productive lives, and who have few responsibilities other than keeping themselves alive and entertained as they approach the certainties of illness and death...
...He is approached with a mixture of awe, distrust, and sometimes fear...
...A visit to a retirement community or even to certain sections of a "retirement" state such as Florida or Arizona can be a depressing event...
...When the psychiatrist unreflectively equates deviation from community norms with illness, his work with individual patients and his public pronouncements tend to negate the kinds of changes that those who are different might bring about...
...They exist in a state of near isolation and massive boredom, practically hidden in our ghettos and rural communities...
...In my work in institutions for delinquent children I have noted an insidious tendency for black children to be viewed as social delinquents far more frequently than white children...
...Even those who have money face formidable stresses...
...It has been fashionable in recent years to classify delinquent youth on the basis of whether sociological or psychological factors seem to be the main determinants of their anti-sociality...
...SEYMOUR HALLECK is professor of psychiatry at the University of Wisconsin and director of its student psychiatric services...
...As a result, if a person happens to enjoy some unconventional variety of sexual gratification, the writings of professional therapists may cause him to feel ashamed and guilty...
...One sees thousands of old people with time on their hands, with nothing to do, and with no sense of purpose...
...The homosexual who believes that he is ill feels more driven and less responsible...
...Most psychiatrists, by virtue of their training and life experiences, are inclined to define mental health, or normalcy, in terms of acceptable community standards...
...Some of his fellow citizens will pity him, but a sizable number will fear or scorn him...
...When one reaches a certain age in our society and is able to afford retirement he goes off to live in a community of old people...
...When one reaches a certain age in our society and is able to afford retirement he goes off to live in a community of old people...
...Even today some women who experience quite powerful orgasms through clitoral manipulation but infrequent orgasms during intercourse, worry that they are defective or inadequate...
...The psychiatrist who is available to interpret much of the misery of the elderly as an illness helps to justify a vicious form of oppression...
...A visit to a retirement community or even to certain sections of a "retirement" state such as Florida or Arizona can be a depressing event...
...Because psychiatrists, through the process of determining abnormality, can so powerfully influence the social order, they must, in my opinion, critically re-examine the criteria they use in deciding whether a given behavior should be viewed as normal or abnormal...
...Psychiatrists should frankly acknowledge that they have no way of knowing whether homosexual behavior has enough biological or genetic determinants to justify calling it a disease...
...However, the psychiatric profession has also taken an implied negative stance towards these people by ignoring their mental health needs...
...Because they are alleged to have these qualities, they are more likely to be talked to than talked with...
...If she rejects these values her therapist might interpret her attitudes as immature...
...When Kinsey reported that some of his subjects frequently experienced multiple orgasms, some psychiatrists insisted that Kinsey's subjects were either lying or were emotionally ill...
...The power to define what is normal or abnormal can be used either to change or to stabilize the society...
...Psychiatrists have to learn about the problems of those who are oppressed on the basis of poverty or skin color...
...The repressive attitude of psychiatrists towards women is also apparent in their teachings with regard to the question of multiple orgasms...
...But if he does not wish to be an oppressor himself, the psychiatrist should be willing to allow his patients and other women, whom he influences through public pronouncements, a fair chance to experiment with more affirmative and more fulfilling patterns of behavior...
...Although the belief that there is any biological difference between a vaginal and a cli-toral orgasm has been proven erroneous by the Masters and Johnson research (Human Sexual Response), the teachings of psychiatrists continue to exert a powerful impact upon society...
...The assumption that aging is in itself a cause of depression may well be a social myth...
...One sees thousands of old people with time on their hands, with nothing to do, and with no sense of purpose...
...The writings and teachings of psychiatry have helped provide society with a rationale for keeping women in a subservient position...
...The psychiatric label allows those whom that person might wish to influence to ignore the content of his message and, instead, to focus on the individual's dangerousness or defectiveness...
...In fact, in some institutions, it is still an extreme rarity for a black child to receive psychotherapy, while white children from similar socio-economic backgrounds find such treatment more readily available...
...Employment may be denied to him...
...Sometimes the psychiatric position relating to the psychological needs of woman seem to be suspiciously formulated on the basis of prejudice as to the male's superiority...
...It is sometimes argued that lower class people are too impulsive, too eager to find immediate gratification, or too simple-minded to cooperate in psychotherapy...
Vol. 35 • June 1971 • No. 6
