When is ‘Normal’ a pathology?

23rd April, 2012 by Jon Chapman

The continuing story of the medicalisation of ‘normal’ experiences…

An article in this month’s edition of ‘Therapy Today’ examines the intense debate surrounding the latest proposed revision of the American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders. It;s thinking has already started to influence practice in the UK.

The implications of the revision seem to be that physical or biological causation is no longer necessary for a psychiatric diagnosis – so that what are generally accepted to be normal (if distressing) human experiences, such as symptoms of grief in the months immediately following a bereavement – are now categorised as a treatable psychiatric condition. This in turn allows the psychiatrist to prescribe medication, when some form of therapy or other support may be equally if not more effective. Equally disturning is the growing trend to prescribe to children for a growing range of ‘disorders’ such as ‘oppositional defiant disorder’ – symptoms for which would seem to fit nearly every teenager in the country at some time in their adolescence.

To some this is nothing less than an ideological battle centred on the medicalisation of everyday experiences. ‘You can’t be sad any more; you have to be depressed. You can’t be shy any more; you have to have social anxiety disorder……psychiatry and therapists have jumped on the bandwagon because it creates more ‘patients’ for them to treat, and so we make money out of people’s distress.’ (Pete Sanders, trustee of Soteria Network).



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Coriolanus and the Hole-in-Role

28th January, 2012 by Jon Chapman

I went to see Ralph Fiennes’ production of Coriolanus at the Picturehouse in Cambridge today. Afterwards we discussed the film, and how we never cease to be amazed at Shakespeare’s extraordinary insights into human psychology.

Here, before our eyes, is acted out the dynamics of a Hole-in-Role if ever there was one.

Coriolanus is a mother’s boy. He has grown up meeting her ideal of a warrior son, and she is quite prepared to see him risk his life in order to achieve martial honour:

“had I a dozen sons, each in my love alike, and none less dear than thine and my good Marcius, I had rather had eleven die nobly for their country than one voluptuously surfeit out of action.”

A grown man, offered to supreme honour of being  elected Consul by the people, Coriolanus finds himself unable to bow to the demands of political compromise. he is what he is, and people must take him or leave him at that. His omnipotence is his ruin, as he is banished by his people. At the same time he is unable to bear being praised in public, unable to take in love from the people and, more poignantly, his wife and young son.

Having joined with his former enemy to defeat his old city, Coriolanus is persuaded by his mother to accept peace, but in his arrogance is unable to comprehend the sense of betrayal among his new friends, by whom he is finally put to death.

The omnipotent sense of being ‘the only one’, the inability to accept love in the here and now, and the thralldom to a mother who simply does not and cannot see what she has done, are a remarkable illustration of some of the characteristics of the hole-in-role dynamic.

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