Tuesday, 23 November 2010

Anticapitalist Models of Health

This is an abbreviated version of an essay that appears on my website www,TonyWardEdu. com. The full version can be downloaded FREE here
 
ANTI-CAPITALIST MODELS OF HEALTH AND WELL-BEING


“The most odious form of colonisation, and that which has brought with it the greatest pain for the colonised – (is) the colonisation of the mind

Franz Fanon

“Only now, in the Twenty-first Century, are Europeran peoples just starting to appreciate the value of indigenous knowledges about health, medicine, agriculture, philosophy, spirituality, ecology and education”
                                                                                                
Joe Kincheloe

Western models of health have been penetrated by a pharmaceutical industry that makes huge profits on a model of health that in many ways has been counter-therapeutic. The 20 largest pharmaceutical and biotech companies in the world amassed profits in excess of  $110,000M in 2007, with an average net income of $504,000M each.  In 2008, the top 15 had a combined sales income of $358,302M.[1] Not surprisingly, given these staggering amounts of money it is not surprising that these companies spend millions promoting a model of health that demonstrates a need for their product. In the US alone, they promote this model, through advertising, marketing and lobbying (to influence political decision-makers) to the tune of $19 billion a year. Annually, the 1274 registered drug lobbyists in Washington DC spend approximately $150 million seeking to steer healthcare legislation their way.[2]

Since the US Health Insurance Industry also exercises enormous power and influence in which drugs are prescribed, and since they too rake in extraordinary profits from the health care system, little wonder that in Obama’s attempt to reform the system, the Health Insurance lobby spent more than $1.4million a day to ensure that public health care remained off the agenda and that their profits remained safe.[3] The success of their campaign is demonstrated by the fact that not only did Obama’s public system fail to pass a bipartisan vote, but that the result of legislation was that every citizen is now legally required to have health insurance. The insurance companies must have laughed all the way to the bank. In 2009, the year when the Health Care legislation debate was at its height, the five largest US health insurance companies set new profit records, while the greatest economic downturn since the Great Depression sent millions of Americans onto the unemployment line and into poverty.
“The five firms reported $12.2 billion in profits last year, an increase of $4.4 billion, or 56 percent, over 2008. At the same time, 2.7 million Americans who had been enrolled in private health plans the year before lost their coverage.” [4]
Given all of this, it is difficult not to conclude that America is not a good place to be sick. Nor would it be unreasonable to suspect that given the unimaginably immense financial gains to be had, the very model of what it means to be a healthy human being might itself have been shaped by the Health economy.  The biomedical model of human health that lies behind this industry and these huge profits is specific to and grew alongside western capitalist culture, through the Enlightenment philosophies of René Decartes (1596-1650) and Carolus Linnaeus' the 18th Century taxonomist whose Systema Naturæ (1st ed. 1735) divided nature into three kingdoms: mineral, vegetable and animal. Linnaeus used five ranks: class, order, genus, species, and variety to classify all the objects in his world.  His method is still used to formulate the scientific name of every species. This reductionist and mechanical view of the world saw biology through the same mechanistic lens as the parallel development of physical science. Biological systems – including that of human biology - were seen as simple machines.        

Within the framework of this model, the human body has been regarded as a machine that can be analysed in terms of the functioning of its parts; disease is seen as the malfunctioning of biological mechanisms which are studied from the point of view of cellular and molecular biology; the physician's role is to intervene, either physically or chemically, to correct the malfunctioning of a specific mechanism. The process is seen as essentially curative, where the doctor is the active participant upon a passive recipient who patient-ly (how passive is that!) awaits a cure. This model is built around the accumulation of capital through the sale of medical services. It is a direct result of the economic system within which it operates.

The Linnean penchant for taxonomising everything extended, in medicine, to all of the previously unified aspects of health – the physical and the mental, which were now treated as separate spheres of knowledge, each further broken down into smaller and smaller specialised components (paediatrics, geriatrics, Gynaecology, Oncology, etc. on the one hand, and psychiatry, psychology, psychotherapy etc. on the other). In the realm of the psyche the proliferation of sub-disciplines or practices has been staggering and with each new sphere of practice, the scale and extent of diagnosis has increased exponentially. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (better known as the DSM-IV) covers all mental health disorders for both children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches.[5]

Each form of practice – Freudian Psychiatry, Jungian Analytical Psychology, Adlerian Analysis, Rogerian non-interventionism, Psychotherapy of numerous sorts - Transactional Analysis (Berne), Gestalt Therapy (Fritz Perls), Neurolinguistics (Bandler and Grinder), Hypnotherapy (Milton Erikson), and (more recently) Poststructuralist Psychoanalysis (read “subjects” rather than “patients”) supports its own small industry, each with its own practitioners all swearing that their form of intervention is the most effective.  Yet despite all of this hoopla, it appears that there is very little measurable difference in effect between any of them. Referring to what they call the Dodo effect  (The Dodo’s verdict that ‘Everybody has won, and all must have prizes’),[6] Stiles, et. al. debunk the mythology of what has been called “Psychotherapy’s equivalence paradox” – that there is any measurable difference in effectiveness between different kinds of psychotherapy.[7]

The proliferation of these many different forms seems therefore to operate perhaps not as a response to therapeutic need but to marketplace conditions – from the need to have a distinguishable therapeutic brand. And following on from this, it would not be surprising to discover that the parallel proliferation in diagnostics and mental disorders as defined by DSM-IV is similarly market-driven.[8] Extending this critique even further, Jungian and Archetypal Psychologist James Hillman (echoing to some extent the earlier suggestions of R. D. Laing) has questioned whether the entire panoply of psychotherapies does not itself constitute a grand myth, and that what we have labelled “psychopathology” is not in fact a normal, useful and important bridge to creative life.[9] 

Capitalism as shaped all of the disciplines in this way, and the fields of biology, medicine and psychotherapy are no exception. Throughout the history of Western science the development of biology has gone hand in hand with that of medicine, and psychotherapy has tagged along for the ride. Naturally then, the mechanistic view of life, once firmly established in biology, has also dominated the attitudes of physicians and psychiatrists and psychotherapists toward health and illness.

The influence of the Cartesian paradigm on medical thought resulting in the so-called biomedical model has constituted the conceptual foundation of modern scientific medical practice. The human body (and mind) is regarded as a machine that can be analysed in terms of its parts; disease is seen as the malfunctioning of biological mechanisms which are studied from the point of view of cellular and molecular biology; the doctor's role is to intervene, either physically or chemically, to correct the malfunctioning of a specific mechanism. The mentally disturbed “patient” must be suffering from enzyme, hormonal or other chemical deficiency or oversupply, and this condition can now be “treated” withy the latest drugs.

The result is that there has been a phenomenal increase in the prescribing of psychotropic drugs such as Ritalin (for the treatment of Attention Deficit-Hyperactivity Disorder (ADHD) over the last 20 years.[10] Our (mostly male) children are now diagnosed and medicated for “medical” conditions” that might more properly be attributable to the boredom or repetitive classroom drudgery, lack of healthy activity-outlets, enforced inactivity, suppression of creative curiosity, an isolation from risk that characterises much of American school life.[11] We blame and medicate the child but forgive and reproduce the system and the society tto which the child may be responding while at the same time falling prey to and supporting a drug and medical industry that is making billions from our childrens’ suffering. For the education system as a whole, Ritalin and its chemical alternatives has become the classroom management tool of choice.

The view of the human organism upon which this system is built contrasts starkly with that of the pre-Enlightenment era. Even the words we use betray the differences between our current Western model of health and the perception of well-being in traditional, indigenous or pre-enlightenment cultures.
  • The word health itself comes from the Old English word ha, meaning whole, or the Old Norse word helge meaning holy or sacred.

  • The Māori word for health – hauora – derives from two roots, hau, meaning breath, vital essence, and ora, meaning life, vitality (n) or to survive (v). The emphasis here is on well-being, that is, an active state in which the person plays a central role. It is a state of being-in-the-world.

  • The Lakota word got health – zanî  means to be unmolested, whole.
  •  The Cherokee word for health - tohi - is the same as the word for peace. You’re in good health when your body is at peace. The “medicine circle” which is common to most Native American cultures, has no beginning and no end and therefore represents a concept of “harmonious unity.”
  • In Myaamia, the concept of ‘health’ is constructed quite differently than it is in English.  There is not a word in Myaamia that functions like the English word ‘health’.  In other words, there isnt really a way to say ‘he is healthy’.  What one would say is: nahi meehtohseeniwita , meaning ‘he lives well, in a proper way’.  This concept is much more holistic and goes way beyond ‘body function’ notions of health that we express in English[12]

  • In the Dineé (Navajo) language,the prefix hózhó (sometimes translated as “health”) denotes the holistic aspect of the environment, the world, or the universe. It connotes beauty, harmony, good, happiness, and everything that is positive. The Dineé ritual healing practices or ‘sings’ seek to restore the individual’s state of balance in the universe, through multiple pathways, connected to the 

  • The Sanskrit word for “health” is sáhitya, and connotes association, connection , society , combination , union with, agreement or harmony.

Indigenous conceptions of health are essentially wholistic – they embrace and include all aspects of life and existence. They are also preventative, rather than curative. They suggest a state of being in balance with the universe, that is both social, spiritual and material. They infer an active participation by the individual in his or her well-being, and they also include aspects of life that the scientific/reductionist model is unable to grasp – specifically the notion of spirit or life force, that is seen as permeating the universe and at the core of each individual’s inner state. In a word, they include the spirit-ual.

The following are a few models of Health in the modern indigenous world. They are not actually traditional models, rather than attempts to describe the traditional indigenous perspectives on well-being from a modern perspective.

Māori  Models:[13]

Maui Pomare
TE PAE MAHUTONGA
A MODEL FOR MĀORI  HEALTH PROMOTION

Sir Maui Wiremu Pita Naera Pomare, (1875 or 1876–1930) was a Māori  New Zealand doctor and politician, being counted among the more prominent Māori political figures. He was well educated, receiving his professional training in the United States, and was one of the most Anglicised of Māori  leaders at the turn of the century. He was unconcerned about the disappearance of Māori  culture, going so far as to sponsor the Tohunga Suppression Act (an Act of Parliament that prohibited traditional Māori  healers fro practicing their skills). He is particularly known for his efforts to improve Māori health and living conditions. Pomare promoted a five-point strategic health plan rather than a model of health.

  • The first point was about health leadership, understanding the need for strong leadership (including his own) in improving Māori health,
  • Secondly Pomare linked health with socio-economic adversity, recognizing that ill-health and poverty were closely related.
  • The third strategy was linked to the cultural realities of Māori aligning health practice with Māori  cultural precepts and principles,
  • His fourth point was to engage politically in improving the health of Māori 
  •  His fifth strategy was to develop a sufficient team of skilled health workers;

While these were not, per se, models of Māori Health, but rather strategies for its improvement, they nevertheless point to the important relationships that prescribe what Māori health is and might be.

MASON DURIE
TE PAE MAHUTONGA. (THE SOUTHERN CROSS)[14]

Sir Mason Durie, (1938) is a New Zealand professor of psychiatry well known for his contributions to Māori health. He is known for his model of Māori  health - Te Pae Mahutonga. Te Pae Mahutonga is the name for the constellation of stars popularly referred to as the Southern Cross.  It is a key navigational aid which has been used over the centuries to help guide our direction, distinguished by the four central stars arranged in the form of a cross, and two stars as pointers.  In Mason’s model the four central stars reflect particular goals of health promotion: Mauriora, Waiora, Toiora, Te Oranga while the two pointers are Nga Manukura and Te Mana Whakahaere.



Mauriora
Access to te ao Māori
Mauriora rests on a secure cultural identity. Good health depends on many factors, but among indigenous peoples the world over, cultural identity is considered to be a critical prerequisite.

Waiora
Environmental Protection
The distinctions between waiora and mauriora are subtle but whereas mauriora encompasses inner strength, vitality and a secure identity, waiora is linked more specifically to the external world and to a spiritual element that connects human wellness with cosmic, terrestrial and water environments. Good health is difficult to achieve if there is environmental pollution;

Toiora
Healthy Ljfestyles
Major threats to health come from the risks that threaten health and safety and have the capacity to distort human experience.

Te Oranga
Participation in Society
It is now well recognised that health promotion cannot be separated from the socioeconomic circumstances. Wellbeing is not only about a secure cultural identity, or an intact environment, or even about the avoidance of risks. It is also about the goods and services which people can count on, and the voice they have in deciding the way in which those goods and services are made available. In short, wellbeing, te oranga, is dependent on the terms under which people participate in society and on the confidence with which they can access good health services, or the school of their choice, or sport and recreation. Durie also borrows from and extends Pomare’s strategic five-point programme, adding the issue of Cultural and personal autonomy – tino rangatiratanga:

Ngi Manukura
Leadership
Leadership in health promotion should reflect a combination of skills and a range of influences. Regardless of technical or professional qualifications, unless there is local leadership it is unlikely that a health promotional effort will take shape or bear fruit. Health professionals have important roles to play but cannot replace the leadership which exists in communities; nor should they.

Te Mana Whakahaere
Autonomy
No matter how dedicated and expertly delivered, health promotional programmes will make little headway if they operate in a legislative and policy environment which is the antithesis of health, or if programmes are imposed with little sense of community ownership or control. Capacity for self governance, not only for a specific health promotional programme but more importantly for the affairs and destinies of a group are central to notions of good health and positive wellbeing.

TE WHARE TAPA WHA

 
The model that Mason Durie is probably best known for is his description of te whare tapa wha - the seamless connections of spiritual, mental and emotional, physical and social well-being.  .All four dimensions are necessary for strength and symmetry. The model is based upon the typology of the traditional Māori  Wharenui or Meeting House, with each of the four dimensions being represented symbolically as one of the walls.

Taha Tinana (Physical Health)
  •  The capacity for physical growth and development.
  • Good physical health is required for optimal development.
  • Our physical ‘being’ supports our essence and shelters us from the external environment.
  • For Māori the physical dimension is just one aspect of health and well-being and cannot be separated from the aspect of mind, spirit and family

Taha Wairua (spiritual health)
    • The capacity for faith and wider communication
    •  Health is related to unseen and unspoken energies
    • The spiritual essence of a person is their life force. This determines us as individuals and as a collective, who and what we are, where we have come from and where we are going
    • A traditional Māori  analysis of manifestations of illness will focus on the wairua or spirit, to determine whether damage here could be a contributing factor.

    Taha Whānau: (Family Health)
    • The capacity to belong, to care and to share where individuals are part of wider social systems.Whānau provides us with the strength to be who we are.  
    •  This is the link to our ancestors, our ties with the past, the present and the future.
    • Understanding the importance of whānau and how whānau (family) can contribute to illness and assist in curing illness is fundamental to understanding Māori health issues

    Taha Hinengaro (mental health)
    •  The capacity to communicate, to think and to feel mind and body are inseparable.
    •  Thoughts, feelings and emotions are integral components of the body and soul.
    • This is about how we see ourselves in this universe, our interaction with that which is uniquely Māori and the perception that others have of us.

    RANGIMARIE TURUKI ROSE PERE
    Te Wheke (The Octopus)
    Dr Rose Pere is an International Educationalist with experience from Preschool through to the Tertiary Level. She embraces both traditional Māori and Western perspectives. Her monograph on the traditional modes of learning of the Māori, "Te Wheke - The Celebration Of Infinite Wisdom", is used in the USA, Canada, the United Kingdom, Australia, Europe, Japan, and has been translated into Japanese and Germany, and is used between times. Her monograph is used as a training model of education by all Government agencies in New Zealand. She has been strongly influenced by teachings that go back over 12,000 years. Traditional Māori  Health acknowledges the link between the mind, the spirit, the human connection with Whānau (family) and the physical world in a way that is seamless and uncontrived – until the introduction of Western medicine there was no division between them. The concept of Te Wheke – the octopus – is to define family health. The head of the octopus represents te Whānau, the eyes of the octopus as waiora (total wellbeing for the individual and family) and each of the eight tentacles representing a specific dimension of health. The dimensions are interwoven and this represents the close relationship of the tentacles.


    Te Wheke


    THE MEDICINE WHEEL
    Native American Model of Health
    The tradition of the Medicine Wheel is ancient. The example at Bighorn, Wyoming (below) is between 300-800 years old and is part of a larger complex going back 7,000 years. It is thought to have been used for astronomical purposes and for ritual performances.[15]

     
    Medicine Wheel, Bighorn County, Wyoming

    There are many versions of the Medicine Wheel, and not all tribal groups attribute the same characteristics to it. For simplicity, I will refer to the Lakota Medicine Wheel (below).



    In traditional Lakota society, the Medicine Wheel is represented as a circle or hoop divided into four quadrants – one for each of the Four Directions – East, South, West and North. Each quadrant is represented by a different colour ( in counter-clockwise order – (yellow, white, black and red), four gifted elements, (fire /sun, air/animals, earth/minerals and water/plants), different aspects of being (Spirit, Mind, Physical and Emotion) and four different periods of life (infancy, adolescence, adulthood, Elderhood).

    While the quadrants are apparently in opposition to each other, they are all connected by the hoop, which represents the circle of life. The centre of the Medicine Wheel is the locus of the Self, where all of the different elements of personality are resolved and where, in microcosm, the macrocosmic (worldly) aspects of life find their expression. In our modern world we tend to allocate different aspects of our lives to different specialists. The spiritual aspect is assigned to the priest, the mental aspect to the teacher or psychiatrist, the physical to the physician and the emotional aspect of our lifes is shared with our friends and relatives. This places the locus of control external to the individual. By comparison, in the Medicine Wheel, the individual is placed at the centre of the wheel, at the locus of control, and is therefore seen as responsible for their own spiritual, mental, physical and emotional health.

    Within this conceptual framework, illness is seen as a state of imbalance between the four areas of life. The role of the traditional healer being to help the individual regain balance through prayer (spirit), meditation (mind), herbal medicine (plants) and getting in touch with their emotions.

    There are attempts current to integrate the Medicine Wheel cosmology with elements of western psychotherapy. A leading proponent of this movement is Dr. Joseph Gone, a member of the Gros Ventre Nation of Montana.  He is an associate professor of Clinical Psychology and American Culture (Native American Studies) at the University of Michigan at Ann Arbor, specialising in finding more appropriate ways of treating his Native American clients.[16]

    THE DINE´E (NAVAJO) MODEL
    Similar to the Four Directions/Sacred Hoop model suggested by Joe Gone, the Dineé or Navajo model of health usually are in the form of a circle, usually including the Four Directions, often in the form of sand paintings like the one below. Unlike Gone’s model, they involve multiple symbolic representations, each expressed differently and used in differing ritual practices to achieve ‘balance’ in the universe, The many complex Navajo healing ceremonies or "ways" use songs, chants, sand paintings, sacred objects, and dance to recreate or enact stories and events that link ceremonial participants to their sacred origins, thus connecting them to the spirit world where balance can be restored. Each different design or model is used for a different ceremony, officiated and facilitated by a hataali (singer). Ceremonies or ‘sings’ can take days and may involve the entire extended family of the seeker in the process. Preparations can take months, and the process of bringing everyone together plays an important part in the reestablishment of balance in the social realm. Such ceremonies are time-consuming and expensive and are rarely performed in modern times, save in times of dire need.[17]

     
    Navajo sand painting: The Slayer of Alien Gods[18]  

     
    Singer building a Whirling Log sand-painting[19]

    MANDALA
    There is an interesting relationship between the Sacred Hoop/Four Directions model, the sand-paintings of the Dineé ritual practices and the Mandala (a Sanskrit word meaning “circle”) commonly associated with Tibetan Buddhism, which are also used in ritual practices to “restore balance” – in this case through an identification with and ultimately the achievement of a transcendent statein which Maya - the “veil of illusion” is removed and the ultimate reality of the universe is apprehended. The mandala thus operates as a gateway or connection between the macrocosm or outer world and the microcosm or inner world of the individual.

    The basic form of most Hindu and Buddhist mandalas is a square with four gates containing a circle with a centre point. Each gate is in the shape of a T. In some forms of Tibetan Buddhism, mandalas have been developed into sand-painting similar to the Dineé practice.  Mandala are key instruments in creating a sacred space for the practice of meditation, or trance-induction the goal being the attainment of a state of Enlightenment through offering access to progressively deeper levels of the unconscious, ultimately assisting the experience of a mystical sense of oneness with the ultimate unity from which the cosmos in all its manifold forms arises.[20]


     
    Vajradhatu Mandala

                                                                                 Sri Yantra Mandala

    The use of the mandala has also played an important role in nthe development of some Western forms of psychotherapy. Taking his lead from the ancient Taoist text, The Secret of the Golden Flower, the Swiss psychoanalyst Carl Jung saw the mandala as "a representation of the unconscious self."[ Working with schizophrenics, he believed his paintings of mandalas enabled him to identify emotional disorders and work towards wholeness in personality.[21] He also believed that the construction of mandalas enabled individuals towards a state of individuation through a process of action and reflection.[22]

    WESTERN ADAPTATION OF TRADITIONAL MODELS
    All of these pre-Enlightenment models – Te Pae Mahutonga (the Southern Cross constellation), the Whare Nui (Meeting House), Te Wheke (the Octopus), the Ayurvedic system, Sacred Hoop and Four Directions and the  Mandalas - all share common features.

    • They are all concerned with prevention rather than cure – with “living right” at every level of existence.
    • They are all integrative, encompassing all aspects of material, emotional and spiritual existence.
    • They see all of these aspects as seamlessly connected, so that (in terms of treatment) it is possible to move between these aspects, perhaps influencing one (the physical) through the medium of another (the spiritual).
    • They all speak to the issue of relationships - to individuals, to family, to society, to the environment and to the world of spirit.
    • They also each draw on symbols and metaphors that are of direct cultural relevance to their respective peoples, (for Māori , the Southern Cross, the Octopus, the Meeting House etc.) and these symbols too, speak about relationships – the relationship of the economy, of the environment, of a strong and autonomous cultural identity, of harmonious human relations, of the ability to openly express feelings, and of the ability to pursue creative thought and action – to the issue of personal health.
    •  They all imply the active participation of the individual through “right living”
    • They all either implicitly or explicitly refer to the concept of balance.
    • They all suggest implicitly that the “cure” for an “illness” may require the readjustment or rebalancing of these relations and that the “individual” has an active part to play in the process.
    • They all contrast strongly with the Western biomedical model of health which sees the physician as the dispenser of commodified cures to a passive and “patient” recipient.
    • They all characterize the individual not as an isolated entity but rather as a social identity – enmeshed (constructed one might say) in a web of relations (social, cultural, family etc.

    A MOMENTARY REFLECTION: R. D. LAING
    The anecdotal evidence seems to be that the application of Western biomedical models to indigenous communities has limited and possibly detrimental effect in that they cuts across cultural belief systems that are closely linked to identity.  And indeed, if the statistics are to be believed, then minority indigenous peoples in all of the colonized countries (America, Canada, Australia and New Zealand etc.) place them at the very bottom of the well-being tables. They suffer the highest rates of drug and alcohol addiction, suicide, imprisonment and physical ill health.

    Psychologists and psychiatrists like Joseph Gone – who are members of indigenous communities who have learned their professional disciplines in Western academies face a dilemma. Recognising the close link between culture and identity, they struggle to apply Western biomedical models in situations where these can be counterproductive, and where they may even directly conflict with the cultural beliefs and heritage of the clients they work with. Two examples will suffice to make the point.

    1. Western models of the Self are largely influenced by the models created by the Developmental Psychologist Jean Piaget. Piaget developed his theories through work with white middle class Swiss children  (including his own). The models conceive of the self as an autonomous being whose development follows predictable and uniform patterns that bear no relationship to the context in which they are shaped. Deviations from the developmental pattern are automatically labeled “abnormal” even though, in a different cultural context (let’s say a tribal setting with extended families and very different cultural and ritual practices) they may be very normal indeed. An acceptance of the Piageian model automatically predisposes a colonising Eurocentric interpretation (and imposition) of normality across cultural boundaries.
    2. Using a Western analytic, the “normal” diagnosis for a person who hears voices of people who are not present would be that he or she is possibly schizophrenic. To an indigenous person engaged in ritual practices, the hearing of voices may signify the beginning of dialogue with ancestors or spirit guides which might be extremely beneficial to that person’s life and future actions.


    In the 1960s and 1970s the Scottish psychiatrist R. D. Laing gained a degree of fame and notoriety because of his radical views about schizophrenia – views that resonate with these two examples. The theories that he developed revolved around issues of identity and family relations in ways that support somewhat the pre-Enlightenment and indigenous perspectives that I have described.

    Laing had graduated in Medicine from Glasgow University, before joining the army as a psychiatrist. From there he moved eventually to the Tavistock Institute for Human Relations, where he worked until 1964 and where he developed his theories of family relations and psychosis. Much like the Marxist psychiatrist Erich Fromm, Laing developed a theory of psychosis that was linked directly to and critical of the social processes and structures of capitalism. He began at the Tavistock by engaging in research (with colleagues Aaron Esterson and Phillip Lee) that charted the interactions and communications within families. They discovered that these (mis)-communications could lead to schizogenic experiences of family members that were connected to family politics and exclusions. Extrapolating from this research he drew parallels with the processes and structures in the wider society. At the core of his theory was the process by which someone is labelled psychotic. From this Laing formulated theories that linked definitions and categorisations of madness with structures and processes of power, implicating in the process the entire discipline of psychiatry as a repressive system of social control.

    With colleague David Cooper he formed the Philadelphia Association, devoted to the non-abusive and non-repressive care of the emotionally disturbed. In the tradition of Franz Fanon and along with Cooper, Foucault, and Thomas Szasz, Laing became renowned as one of the proponents of Anti-Psychiatry and their work remains up to the present a benchmark of critical analysis and an indictment of the psychiatric profession and the state institutions and pharmaceutical companies that it supports. His critical analysis tied the person’s state of well-beingness to the social, political, economic, material and emotional environmental. Rather than focus on the separated individual, Laing looked to the society and environment in which that person lived, and, like Fromm, he came to the conclusion that we live in a largely insane world, and that the labelling and diagnosis of mental illness constituted a form of social control with racist implications. He linked all of these (psychotic) systems back to the exigencies of capitalism, without directreference to the Marxist Base-Superstructure metaphor. Along with colleague and fellow existential psychoanalyst David Cooper, he attempted to explicate this relationship by reconciling the Existenjtialism of Sartre with Marxism.[23]

    A WESTERN INTERPRETATION AND INTEGRATION.
    In 2000 I was invited by Ngati Porou Hauora - a small Māori  Tribal Health provider (situated on the remote East Coast of the North Island of Aotearoa-NewZealand) – to develop a refurbishment and development plan for their small hospital at Te Puia Springs. Working closely with the Māori  community and with the staff of the hospital, we (my undergraduate Architecture students and I) developed a model of Health that seemed to encapsulate all of the characteristics that are so common to indigenous systems and at the same time so different from the western biomedical model, while at the same time not being tied or linked to any geophysical or cultural symbology or metaphor.



    The model was useful in that it allowed us, as a group of architects, planners and designers, to engage with the issue of Māori  Health in a multi-disciplinary way, ensuring that we did not corral ourselves into a mindset suggesting that a building solution might be the only option. We were able in this way to look at the building design as a means to creating employment in the community, at the potential for institutional self-sufficiency and the sustainability of natural resources. The building itself was able to be designed to incorporate important features of spirituality (like the constant views of Hikurangi the sacred tribal mountain) as well as social and cultural factors (a separate room for Whānau to live-in, a community library, staff and elderly housing, etc.) Yet beyond these practical matters, we also took the design process itself into the community so that the discussions around issues of community health and well-being could become empowering to the community, could reinforce its sense of cultural autonomy and identity.



    WHĀNAU ORA

    Responding to the relatively poor health statistics for Māori, the Māori  community has been successful in initiating a new policy of Healthcare that largely addresses the previous disparities between the Western biomedical model and the indigenous models I have described. In June 2010, the New Zealand Government – at the insistence of the minority Māori  Party initiated a new programme of wellness intervention – Whānau Ora, designed specifically to aid Māori  families, but available to all New Zealanders. Whānau Ora is an inclusive approach to providing services and opportunities to whānau (families) across New Zealand. It empowers whānau as a whole, rather than focusing separately on individual whānau members and their problems.

    • Whānau Ora is an inclusive, culturally-anchored approach to provide services and opportunities to Whānau and families across New Zealand.
    • The Taskforce on Whānau-Centred Initiatives identified six goals that suggest that Whānau outcomes will be met when Whānau are: self-managing; living healthy lifestyles; participating fully in society; confidently participating in Te Ao Māori; economically secure and successfully involved in wealth creation; and cohesive, resilient and nurturing.
    • It empowers Whānau and families as a whole, rather than separately focusing on individual family members and their problems.
    • It also requires multiple Government agencies to work together with Whānau and families rather than separately with individual family members

    The intention is to deliver healthcare for Māori, by Māori in a Māori way, consistent with Māori beliefs and cultural practices. The new legislation brings about a fundamental structural change in the Health delivery system, consistent with the needs of New Zealand’s indigenous population. The programme cannot fail to be successful in many of its aims, yet it remains to be seen whether improvements will carry through into the areas of labeling, diagnostic stigmatizing, over-proscription of mind-altering medications, and the (political and) social control functions of the pharmaceutical industry. We are fortunate, in New Zealand, that the Ritalin plague has not yet fully inundated our shores, and this despite the fact that in 1984, New Zealand was the first of the developed countries to engage in the now-failed global free-market experiment..

    CAPITALISM AND HEALTH
    The displacement and attempted destruction of traditional indigenous health perspectives and practices was not the first cultural assault in the colonization process. It only happened after the first genocidal strategy – the destruction of self-sufficient indigenous economies and the forced dependence upon the State. In the US this was accomplished by displacing agrarian communities and by the strategic eradication of the great bison herds upon which the nomadic communities depended. Elsewhere, as in New Zealand, the confiscation of native lands was the primary genocidal strategy.[24] The attempted destruction of indigenous culture followed the destruction of indigenous economies. Fortunately the process was never completely successful, and indigenous communities have retained their cultural identities and many of their cultural beliefs and practices down to the present time. Yet they still face an increasing threat from the effects of globalization and free-market economic ideologies that continue to promulgate modes of chemical social control and (when that fails) criminalization.

    The question must therefore be asked, whether these indigenous perspectives on different aspects of cultural existence – health, education, justice etc. have anything to offer beyond the identity needs of their own communities? Do they provide a vehicle whereby we might reinvigorate the life of the wider community, reinstating a more holistic approach to our conception of what it might mean to be a healthy human being? Is the promise of the Whānau Ora programme to serve the needs of all New Zealanders – Maori and non-Maori - realistic, and if so, can it go some way to reconstructing the quality of life that has been so diminished over the last twenty years of economic assault?

    When phrased like this, the answer must be a resounding No! Whatever benefits the programme may have (and they may be many) they will still not address the root cause of our health problems – the impoverishment of the wider community by an elite capitalist class who have bled the poor in their lust for increased profit. The impact of the shift in the global economy has been most strongly felt by the poor and the disenfranchised. The myth of the “trickle down” economy has been well and truly blown as the poverty gap has widened and as increasing numbers of the middle class have fallen below the poverty line. In the face of high domestic unemployment and the creation of a global labour market. Labour itself has become dramatically polarized as increasing numbers of women, minority indigenes and people of colour become trapped in low-paid insecure work or welfare dependency.  As Mclaren rightly notes, in the face of an apparent victory for global capitalism, the predisposition of critical theorists to focus on issues of difference, voice and cultural identity at the expense of class is to collude with the power status quo.[25] While issues of cultural identity may be crucial at the local level, they tend to insignificance at the global level, where the shifts in capital have occurred. And while it is possible to discuss and even address issues of environmental and economic sustainability locally, it must never be forgotten that the greatest unsustainability of all – capitalism and the private ownership of global resources – is the ultimate cause.
    Yet there is a danger here too, that all too often, Marxist theorists have neglected to embrace at their cost. The predisposition to consider class as an overriding social category at the expense of culture has contributed to some notable socialist failures. Following the Nicaraguan Revolution in 1979, the Sandinista Government failed to address the concerns of the Atlantic Coast Miskito, Sumo and Rama Amerindian peoples, who in December 1981 found themselves in conflict with the authorities following the government's efforts to nationalize Indian land. Their concerns included:
    • Unilateral natural resource exploitation policies which denied Indians access to much of their traditional land base and severely restricted their subsistence activities.
    • Forced removal of at least 10,000 Indians from their traditional lands to relocation centers in the interior of the country, and subsequent burning of some villages.
    • Economic embargoes and blockades against native villages not sympathetic to the government.
    Under the banner of national unity and in an attempt to forge a national socialist economy, the Sandinistas failed to address issues of cultural and geographical autonomy to their cost. The Indians instead aligned themselves with the counter-revolutionary forces (the Contras) who were funded and trained by the Reagan administration and the CIA, and the continuing counter-insurgency war (as well as the US initiated economic blockade and the mining of Nicaraguan harbours) drained the Nicaraguan economy and ultimately led to the demise of the Sandinista Revolution.[26]
    The balance, then, between the global socialist imperative, and the need to address local issues of cultural autonomy and self-sufficiency is key to any attempt to forge an anti-capitalist movement. This balance cannot be universally prescribed, but has to emerge from a dialogue in which global causes can be compared to local effects, and where local grievances can be addressed without resorting to the imposition of totalizing strategies. Academics have a role to play in this dialogue, but to do so, they must engage with the community directly in a shared attempt to demystify causes and effects and to develop consensus solutions. For academics, the development of anti-Capitalist programmes, strategies and coalitions must therefore be an essential component of their theorizing in this globalised capital Empire. The amelioration of the pain and hardship experienced by the poor through programmes such as Whānau Ora can only be a stepping-stone in this long journey back to health and sanity

    Tony Ward
    November 2010

    [1]         “Top 50 Pharmaceutical Companies Charts & Lists”, Med Ad News, September 2007.
                  Has the Pharmaceutical Blockbuster Model Gone Bust?, Bain & Company press release, December 8, 2003
    [2]          R. Jeffrey Smith and Jeffrey H. Birnbaum, “Drug Bill Demonstrates Lobby’s Pull”, Washington Post, Friday, January 12, 2007

    [3]         Dan Eggen and Kimberly Kindy, “Familiar Players in Health Bill Lobbying: Firms Are Enlisting Ex-Lawmakers, Aides”, Washington Post, Monday, July 6, 2009

    [4]            Health Care for America Now, “Health Insurers Break Profit Records as 2.7 Million Americans Lose Coverage”, Report, Feb. 2010. http://healthcareforamericanow.org/site/content/reports/
    [5]          The DSM was first published in 1952. At that time, it contained only 66 disorders with short lists of symptoms for each and some discussion of the believed cause of the various disorders (Holmes). In 1968, the number of disorders was expanded to just over 100 with the publication of Edition II. Edition III of the Manual (1979) introduced a multiaxial diagnostic system of five scales. The DSM-IV is the current edition of the manual and was first published in 1994. This edition presents nearly 400 disorders. DSM-5 is currently being compiled and can be expected to identify substantially more disorders.
    [6]          Lewis Carroll, Alice in Wonderland, 1865/1946, p. 28;( italics in original)
    [7]        William B. Stiles, Michael Barkham, Elspeth Twigg, John Mellor-Clark and Mick Cooper, “Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practiced in UK National Health Service settings” in: Psychological Medicine, Cambridge University Press 2006, 36, 555–566. See also: William B. Stiles, David, A. Shapiro and Robert Elliot, “Are All Psychotherapies Equivalent?”, American Psychologist, February 1986, pp. 165-180.
    [8]          For a brief overview see: Psychiatry is a Mental Disorder at: http://www.youtube.com/watch?v=bPOrD6xfDNo
    [9]          James Hillman, The Myth of Analysis, Harper Perennial, 1972. See also: R. D. Laing, The Politics of Experience and the Bird of Paradise, Penguin Books, Harmondsworth, 1967,
    [10]        “While ADHD drug treatment was generally on the rise throughout the 1970s and 1980s, use of psychiatric drugs to treat behavior problems increased dramatically after the U.S. Department of Education determined in 1991 that children with ADHD could qualify for special education services under the Individuals with Disabilities Education Act (IDEA). In the 1990s alone, there was over 700 percent increase in the use of Ritalin, with the U.S. consuming nearly 90 percent of the world’s supply of the drug. 2 By the year 2000, nurses delivered more medications in American schools for mental health conditions than for any other chronic condition, and more than half of all such medications were prescribed specifically for ADHD.” See: Gretchen B. LeFever, Increased Use of Psychiatric Drugs in American Schools,
    www.lexingtoninstitute.org/library/.../increased-use-psychiatric-drugs.pdf
    [11]     Between 1993 and 1997, neurologist Fred Baughman corresponded repeatedly with the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), Ciba-Geigy (now Novartis, manufacturers of Ritalin), and top ADHD researchers around the country - including the National Institute of Mental Health - asking them to show him any article(s) in the peer-reviewed scientific literature constituting proof of a physical or chemical abnormality in ADHD and thereby qualifying it as a disease or a medical syndrome. Through sheer determination and persistence, Dr. Baughman eventually got these entities to admit that no objective validation of the diagnosis of ADHD exists. See: John Brteeding PhD., Does ADHD Really Exist, The Natural Child Project : http://www.naturalchild.org/guest/john_breeding.html and:
    Fred Braugman, MD., Attention Deficit Hyperactivity Disorder: Exposing the Fraud of ADD and ADHD., http://www.adhdfraud.com/
    [12]        Personal Communication with Daryl Baldwin, Director of the Myaamia Project. 10th Nov. 2010.
    [13]        These examples are taken directly from Maori Health: http://www.maorihealth.govt.nz/moh.nsf/fefd9e667cc713e9cc257011000678d8/1c22c439ddc5f5cacc2571bd00682750?OpenDocument
    [14]        Durie, Mason (1999), ‘Te Pae Mahutonga: a model for Māori  health promotion’, Health Promotion Forum of New Zealand Newsletter 49, 2-5 December 1999.
    [15]        http://solar-center.stanford.edu/AO/bighorn.html
    [16]        Joseph Gone, The Red Road to Wellness: Cultural Reclamation in a Native First Nation Treatment Center. Invited colloquium presentation, Department of Psychology, Miami University, Oxford, OH. Octiober 2009. See also: Joseph Gone, Psychotherapy and Traditional Healing for American Indians: Exploring the Prospects for Therapeutic Integration. The Counseling Psychologist, 38(2) 166–235,  2010 SAGE Publications; James B. Waldram  (ed.) Aboriginal Healing in Canada: Studies in Therapeutic Meaning and Practice, National Network for Aboriginal Mental Health Research, 2008.; Richard L. Roberts, Ruth Harper, Donna Tuttle-Eagle Bull and Lynn M. Heidman-Provost, “The Native American Medicine Wheel and Individual Psychology: Common Themes”, The Journal of Individual Psychology, Vol. 54, No.1, Spring, 1998, pp. 135-145; Robert C. Twigg and Dr. Thomas Hagen, “Going Back to the Roots, Vo: Usingn the Medicine Wheel in the Healing Process”, First Peoples Child and Family Review l. 4, No. 1, 2009, pp. 10-19.
    [17]        Locke, R. F., The Book of the Navajo, Mankind Publishing Co., Los Angeles, 1979
    [18]        Madelyn Iris, “Life in Balance”, The Park Ridge Center for Health, Faith and Ethics. See: 
                   http://www.parkridgecenter.org/Page126.html
    [19]        From: José and Maria Arguelles, Mandala, Shambhala, 1995.
    [20]        David Fontana Meditating with Mandalas, Duncan Baird Publishers, London, 2005, p. 10.
    [21]        Carl J. Jung, The Secret of the Golden Flower, Routledge & Kegan Paul, London. 1979.
    [22]        In Jung’s analytical psychology - individuation is the process through which a person becomes his/her 'true self'. Hence it is the process whereby the innate elements of personality; the different experiences of a person's life and the different aspects and components of the immature psyche become integrated over time into a well-functioning whole. Individuation might thus be summarised as the stabilizing of the personality. Individuation has a holistic healing effect on the person, both mentally and physically.  Besides achieving physical and mental health, people who have advanced towards individuation tend to be harmonious, mature and responsible. They embody humane values such as freedom and justice and have a good understanding about the workings of human nature and the universe. See: http://en.wikipedia.org/wiki/Individuation. A comprehensive (and illustrated) version of this process can be found in: Kristine Sodersten and Williams, C., Both Sides of the Door, University of Queensland Press, Brisbane, 1981.
    [23]        R. D., Laing, The Divided Self, Tavistock Publications, London, 1959;
    R. D., Laing,, The Self and Others, Tavistock, London, 1961;
    Laing, R.D. and Cooper, D.G. (1964) Reason and Violence: A Decade of Sartre's Philosophy. (2nd ed.) London: Tavistock Publications Ltd.
                  R. D., Laing., H. Phillipson, and A. R., Lee, Interpersonal Perception, Harper and Row, New York, 1966;
    R. D., Laing., The Politics of Experience and the Bird of Paradise, Penguin Books, Harmondsworth, 1967.
    Erich Fromm, The Sane Society, Fawcett, Greenwich, Conn, orig. Holt Reinhart, Winston, New York, 1955
    [24]       Tony Ward, Colonialism, 2997. http://www.tonywardedu.com/content/view/227/123/
    [25]       Peter McLaren, “The Future of the Past: Reflections on the Present State of Empire and Pedagogy” in: McLaren, P. and Kincheloe, J., Critical Pedagogy: Where Are We Now? Peter Lang 2007, p.292,
    Posted by at 2 comments:
    Subscribe to: Posts (Atom)