Modernity, Suffering and Psychopathology

Executive Summary

Modernity, Suffering and Psychopathology

The elements that constitute modernity are heterogeneous. Among many factors, a strong reliance on science has been —and still is— the totem of Western modernity. The rise and dominance of new forms of science (biology, medicine, psychiatry, anthropology, psychology, and sociology) have led to the pre-eminence of certain models in the ways people's suffering, pain and distress are commonly constructed by researchers and clinicians.

We are concerned with the ways in which a wide range of suffering, distress and illness comes to be identified in the scientific and clinical literature, as diseases characteristic of modernity. Why, for instance, does epidemiological research conclude that Attention Deficit Disorder (ADD) is on the rise in North America, while in other countries like Japan, it is a seldom recognised condition? Other mental health problems: self-inflicted injuries and selfdestructive behaviours; trauma-related disorders; dissociative disorders; drug addiction, etc. that are often considered to emerge as a direct result of our contemporary collective ways of life and value system raise similar questions.

Our first goal is to study the scientific process through which major psychosocial problems come to be defined either as psycho-pathology or socio-pathology by bio-medical and health professionals as well as by social scientists. Our second goal is to examine and better understand the systems of knowledge and practices developed by individuals, families and communities in order to manage, cope with, assign meaning to, and interpret mental health problems.

We think it is mandatory to continue building an interdisciplinary framework —between medicine and psychiatry, medical anthropology, the history of medicine and sociology of science— in order to investigate how prevalent scientific categories used by bio-medical and health social scientists are constructed. Concurrently, it is essential to assess local systems of knowledge in mental health and mental illness that have been developed by communities, organisations and groups. Time has come for combining contributions from the biological and the social sciences as well as for merging both "expert" and "lay" knowledge, professional ideas and practices as well as alternative popular knowledge.

We propose to rely on a three-sided analytical model consisting of : (1) an ethnographic approach to study diagnostic categories, as well as theories and ways of thinking which prevail in contemporary psychiatry and health social sciences; (2) a culturally-grounded study of the local ways (popular idioms of distress, explanatory models, semiologies, systems of meaning) through which suffering, pain and illness are expressed, interpreted, reacted to, and managed on a daily basis by individuals, families and communities; and (3) a perspective inspired by the social determinants’ approach used to understand the relationships between modern conditions of life, contemporary family patterns and social organisation, new cultural values and the prevalent disease categories defined by researchers and currently used by health professionals.

This triangular analytical model should permit to produce relevant research results which will help to: (a) lay out guidelines for addressing mental health policy issues and designing innovative models of practice at local, regional and national levels; (b) facilitate the development of socially relevant and culturally sensitive mental health services by building on both professional science and lay knowledge and practices developed by communities; (c) generate proposals for reorienting the training of mental health researchers and health workers within the framework of a genuine "bio-psycho-social-cultural" psychiatry; and (d) make acquired knowledge available to policy makers, planners, administrators and health providers in the public, private and community sectors. All this should lead to improve the present situation of mental health patients across Canada and to alleviate the burden of illness put on the shoulders of patients’ families and society.

For a few decades scientists have steadily argued against all sorts of reductionistic theories that try to model the study of persons and human cultures to an animal model. They have reminded their colleagues that the problem of signification (meaning) is tied to human beings’ self-definition and that the practice of human sciences thus necessitates the inclusion of semiology and hermeneutics. The benefits of transdisciplinary co-operation appear convincing within areas such as contemporary genetics, evolutionary biology and neurology of regulatory processes, and contribute both to consolidate the biological pole of contemporary social sciences and to open biology to the impact of the social and historical context. We have entered an era dominated by biology that links the brain-mind complex with environment and history, both at collective and individual levels. Biology is thus seen as dynamic, interpersonal, historical and evolutionary. Eisenberg (1995). Both types of research have contributed to undermine the viability of any dichotomy between biology and social environment in the modeling of child's personality and psychological characteristics (Brown, 1997).

Our research group does not consider it necessary to create an Institute which, as a mandate, would address the questions of our concern, even if these questions appear to be of major importance in the planning of multi-sectorial interventions in health, and more specifically, in mental health. If an Institute for "mental health" or one in the area of the "determinants of health" were to be put in place, the perspectives proposed herein could be effectively incorporated into and constituted as a nucleus from which the research process could eventually diffuse towards other Health Institutes.

Our reflections within the team, our personal experience of collaboration within diverse research groups, and an analysis of existing interdisciplinary networks and partnerships have led us to formulate several recommendations which apply both specifically to our field of interest as well as to a more general range. Here are a series of ideas which may help structuring the CIHR:

  • The idea of creating a structural linkage between the researchers and the practice milieu is of key importance not only for the purpose of maximising the operationalization of research results, but also and above all, in order to connect the research milieu with the complexities of intervention and thus provoke new questions, necessarily interdisciplinary.
  • The integration of multiple disciplines and actors across networks and organisations is not, however, without risk. We may anticipate the effects of standardisation, which would eventually lead to the homogenisation of theories, methods and research instruments, resulting in monolithic, rigid research organisational structures.
  • Our research group is inclined towards an approach in which Health Institutes should be constituted as dynamic "spaces" where we could create, promote, maintain and cultivate heterogeneity in the production of knowledge. This could facilitate the emergence and parallel development and interaction of creative tensions, favouring the constant questioning of the foundations of scientific culture instead of tending to self-confirmation.
  • In creating Health Institutes, it seems preferable not to arbitrarily multiply the number of Institutes according to a given number of disease categories and age groups, but to give them, an identity of their own with relatively permeable boundaries, consolidating existing alliances and networking researchers who are already engaged in research domains and themes in which they already excel. Health institutes should be conceived from the bottom-up, as dynamic spaces that favour dialogue between current thinking, fostering heterogeneity and the coexistence of diverse disciplinary approaches.