Table of Contents
The most pronounced documentation on the mental disorder in modern Western world is the DSM-IV-Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association, which was established by the association of American Psychiatrics. This centrality places it as the presentation of the psychiatry’s medical jurisdiction. The documentation focuses on being useful and practical for clinicians through endeavouring for the concision of the criteria sets, clarity of the language as well as through explicit statement constructs that are exemplified in the diagnostic principles. It is a classificatory system that seeks to isolate features, to see, to recognize those that are different and those that are identical, and to classify them according to families or species. As a classification system, the documentation can be regarded as the interpretation of certain observed behaviours in the form of indicators/symptoms. These indicators are to be accredited with certain significance – diagnostic, prognostic, and anaemic. These attributes are assigned to an individual’s past, his/her present, and maybe to the future. The discourse that determines this interpretation has significant impact on the individual’s life (Fitzgerald, Zucker & Freeark 2006).
The current work supposes that the manner in which the DSM-IV constructs mental disorders effectually develops normality. This may have significant inferences for the mental healthiness nursing performs. Mental health nursing practice is significantly prejudiced by the process of the psychiatric analysis. It is frequently incorporated into the nursing discourse without critical examination of its implications for nurses and significant impacts on those who are diagnosed. Mental health nursing practices have greatly designated psychiatric discourse as the centre of practice. An argument may be developed that by having accepted the psychiatric model mental health nurses have developed their dependent role and failed to explore other possibilities for their patients. The psychiatric development of the mental distress is regarded as the mental disorder developed by a biochemical failure that may be treated through biochemical intervention recommended by a psychiatrist. Where mental health nurses continue to recommend this view, it would have unavoidable consequences, after which nursing care would consist in dispensing medication regulating the behaviours associated with the mental distress until appropriate treatment takes effect and starts helping patients to adjust their life to the inevitable mental disability from biochemical dysfunction (Silver 1999).
Language structures how individuals think, experience themselves, and define their relationships with other people. Discourses are regarded as patterns of communicating these phenomena through language. Discourses shape the meaning through which relationships and behaviours are interpreted. From the perspective of the discourse analysis, mental disorder may be regarded as the product of the meaning development by discourses. This is not just a thing that is independent of cultural and social processes. Discourses do not only describe or reflect reality, knowledge, identity, experience, social practices, and relations. More so, they have an integral role in constituting them. Discourse assessment regards not only the text itself, but also how it is generated by given knowledge and how it in turn generates this knowledge through language. This discourse recognizes that a text is not the only explanation or presentation of the topic, but that it is a possible way of understanding it. However, texts that align themselves to authoritative disorders are likely to have massive authority. The assessment assumes that discourse is constructed for a given purpose serving the interests of a given group. The language of authority originates from a process where individuals from a society participate by assuming that the same language exhibits an alignment with the values of authority (O'Brien, Kennedy & Ballard 2008).
Since psychiatry establishes beliefs about mental disorder, it also develops the knowledge of those who work in the mental field including mental health nurses. It is the objectives of the discourse assessment to explore the authority relations in-built in particular disorders and strategies applied to maintain the relations. These relations are embedded in disorders through claims of having the most expert knowledge. The relationships between patients and mental health nurses inevitably correspond to the power relations that are maintained by the claims to have this knowledge. Mental health nurses apply their professional expertise in determining the need of patients and define what is needed in terms of what is normal. This medical knowledge is based on the psychiatric discourse. Patient’s behaviours and ways of life are assessed to determine whether they can be regarded as symptomatic of mental disorder or normal. Patients and their relatives often want to be given explanation for the diagnosed mental distress and abnormal conduct. They look for professional assistance to establish the origin of the abnormality. The DSM-IV functions as the tool used to separate abnormal behaviours from normal behaviours while at the same time shaping what is considered as normality in a given society. The discourse analysis is concerned with assessing the application of language and how dominant belief systems are replicated in the discourse. It concerns means through which theories of relations and reality of power are encoded in a disorder. The potential of the discourse analysis is founded on the exploration of power relations that fortify the psychiatric practice and knowledge and strategies that maintain the analysis (Azarnoff 1983).
It is apparent that behaviours that are associated with poor social functioning, lack or excess of certain behaviours, inappropriate ego boundaries, and unrealistic thoughts are key indicators of mental disorders. To have significant understanding of these behaviours, they will be explained in topics relating to the unity, productivity, rationality, and moderation.
The Diagnostic and Statistical Manual (DSM) explains mental disorders as “the medically significant psychological or behavioural disorder that occurs in a given individual and may be associated with the current distress, disability, and with a significantly increased chance of suffering pain, death, loss of freedom, or disability.” There seems to be a supposition in the definition that physiological and biochemical factors cause a deep erection of the life making them universal, adhering to systematic patterns, and providing consistent indicators for the expected behaviours. From this explanation, it is assumed that the fault lies with the individual. According to Bourdieu, every conventional order tends to produce the naturalization of its arbitrariness. So, what appears to originate from the individual action is caused by the submersion in traditional practices. This implies that situating the individual as the cause of the mental disorder does not take into consideration how behaviours are developed by the traditional and social contexts in which they take place (Welfel & Ingersoll 2001).
Traditions establish a consensus of the meaning of a given action that individuals constituted in a given tradition take for granted as common sense and a way of understanding the world and actions of others. Cultures determine normative criteria for what an acceptable conduct is within given traditions. These cultural norms are internalized as constructions of reality by individuals of that traditional set. Disorders that are strong enough to establish categories in behaviours within or without the norms may tend to do this by situating individuals as faulty if they do not adhere to traditions. The process of classifying what constitutes a mental disorder using DSM involves the development of the criteria in the groups of behaviours that are regarded as symptomatic of certain disorders. Every classified mental disorder is supported by a number of criteria that define given experiences and behaviour. This experience or behaviour is regarded as the indication of the disorder.
The DSM has a broad range of experiences and behaviours assuming that they are the result of a syndrome appearing in an individual while ignoring the possibility that they may be caused by different factors. There are three parts in the definition of the mental disorder, which are indicative of the weakness in the relation to the establishment of validity. It is evident that the definition stresses that the impairment is an unreliable criterion of the discourse; the ‘dysfunction’ part of the definition assumes the knowledge of the functions of mental processes even where such knowledge is readily available. There is also a lack of precision in the diagnostic criteria to confidently demarcate a given diagnosis from another and mental distress from mental disorder. It is not clear in what way all behaviours and experiences cited in the diagnostic group may be legitimately regarded as the evidence of the mental disorder as different from the responses to life occurrences. The DSM does not have a consistent requirement that daily behaviours applied in the diagnostic classification should be the result of mental disorder and not the result of other life experiences (Fortinash & Holoday-Worret 2000).
The significant premise in the definition of the mental disorder is that disorder occurs in an individual, thus suggesting that it may be caused by a certain fault within the individual. This excludes the possibility that it is the response to the external stimuli. The definition of a mental syndrome assumes that identification of a given disorder is determined by the subjective involvement of distress where these subjective involvements of distress are symptoms of a mental disorder.
This is a self-referential process depending on the classification of disorders and a pursuit of signs that may be interpreted as symptoms in order to validate the subjective appraisal of a disorder. This illustration of a disorder is supported by the process of reasoning that starts by the consideration of individual’s experiences in isolation from other aspects of life. These separate experiences are then reconceptualised as the signs of an unobservable and underlying disorder. They are disabilities that can only be identified by means of the very experiences on which the initial diagnosis is based. In most societies, naming the disorder takes precedence over understanding experiences of the distress in the context of an individual’s life and their interactions with the social world. However, a mental disorder is not observed in the same way as a diagnosis of a fracture. It is observed and described from the observation of behaviours. A number of inferences may be drawn from any behaviour observed. The DSM assumes that the underlying pathology is creating the disorder, but there is no refutable evidence that this pathology exists. There are assumptions that the mental disorder occurs within an individual without necessarily having evidence to support the idea. For example, there is no laboratory findings that have been identified and that may be used as diagnostics of Schizophrenia; there is also no such findings that are available for Major Depressive Episode (Repper & Perkins 2003).
The medical connotation is positioned as fundamental to the diagnostic course by the DSM. This medical significance is determined by the medical judgement that ought to be regarded as subjective in the absence of the decisive scientific proof. The mental disorder clinicians’ values and beliefs could be regarded as main influences in the diagnostic procedure. These values and beliefs are shaped by the discourse and authoritative discourses determine the process. Certain discourses are authorised within the medical environment, thus approving what is regarded as the mental disorder. Specialised acculturation processes and regulation ensure that only those skills and knowledge reflecting the dominating disorder are endorsed as the competent medical practice. Norms of the professional culture are internalised by medical practitioners during acculturation into the profession and the clinical tradition that shapes individual’s attitudes and behaviours. The medical significance as established by the medical judgement may be regarded as illustrated by the disorder. The process of broad determination of the disorder may not necessarily create a problem, though it needs to be acknowledged rather than be covered under the scientific objectivity. The significant effect of this psychiatric implication is attached to different behaviours. These effectively construct certain behaviours as normal and others as abnormal (Silver 1999).
The DSM is used in measuring the likeness of behaviours observed in the medical context of a given category from which a hypothetical generalization may be made. Behaviours are given meaning by medical practitioners who ascertain how different or similar they are to the behaviours described as the principles of mental disorders. The meanings attributed to these behaviours by the DSM describe them as normal. The DSM requires that medical practitioners monitor behaviours that describe certain diagnostic standards with chances that other behaviours that may cloud the picture are eliminated. In its construction of the mental disorder, the DSM authenticates particular behaviours as normal by invoking the status of scientific information. By defining a mental disorder and its categories, the DSM establishes a privileged meaning of given signs that are interpreted as mental disorder symptoms. The investigation of diagnostic standards in the DSM indicates clusters of specific behaviour and language characteristics that are considered as abnormal rather than reliable characteristics of a mental disorder, for example, poor occupational or social functioning, poor ego boundaries, lack or excess of a given behaviour, and unrealistic speech and thinking. The DSM locates the parameters of abnormality and normality, demarcating professional and institutional limitations of the social regulation and the treatment system. It also approves of the medicine in dealing with individuals on the behalf of the entire society. Diagnostic standards of the DSM establish limitations for what may be regarded as a normal or abnormal behaviour in a society. The analysis of a mental disorder indicates that the categorising system should be established in relation to productivity, moderation, unity, and rationality (Wieseler, Hanson & Siperstein 1999).
The DSM-IV supports a normative anticipation that people function productively within a given society. The predominant neo-rational and liberal economic ethos that permeates contemporary cultures requires individuals who are able to contribute to the economic wellbeing of their society. When the achievement of the society is evaluated on the basis of economic standards, it becomes critical that each person must participate in enterprises of reproduction and production. Thus, productivity may be regarded as issues of practical efficiency in the achievement of objectives that are accepted as rational. Though productivity is a greatly esteemed aspect, it is not certainly available to all individuals in the society (Repper & Perkins 2003).
Social conditions often ensure that these opportunities are available to some privileged categories, thus authorizing this freedom while alienating others. As a behavioural aspect, productivity may be defined as the application of time and space in culturally approved ways to meet the culturally determined objectives.
There are assumptions that a certain pattern of appetite, sleep, interaction, speech, decision making, and objective-oriented behaviours should be maintained consistently to ensure productivity, not regarding the environmental and social framework. The DSM IV marginalizes the framework within which poor behaviours may occur, such as traumatic life and developmental occurrences, altered relationship with others, and unsustainable and unsafe living environment. When a person fails to focus on the objective efficiency, directedness, rationality, and occupation of space in given ways, his/her behaviour may be constructed as a sign of such mental disorder as:
- Dysfunction in the productivity of speech and thought;
- Reduced concentration or difficulty in decision making;
- Significantly reduced participation or interest in the activities;
- Impulses that are severe enough to be time consuming;
- Tiredness, decreased energy, and fatigue are also common (Repper & Perkins 2003).
Individual is constructed by and expected to determine loyalty to cultural interpretations of the reality, which shows the rationality. There are traditional assumptions that there is just one authorized version of framework or reality for interpreting human experiences. The irrationality and madness are identical since an important feature of what is regarded to be madness involves the disappearance of roles as a coherent factor in the organization of individual’s experience and conduct. Rationality, as illustrated by the scientific discourse, needs realistic confirmation. To be recognized as real, experience must be amenable to the linguistic expression that demonstrates literalness, fixity, and objectivity. An expected construction of language is informed by the belief in the objective reality and authorised facts that are captured in language (Rolland 1994).
This may be a restricted perspective of language and speech to assume that it is literal. In the language, there are no recognized indicators that permit judgement between metaphors and non-metaphors. At the same time, there can never be a clearly literal speech, rather all speech acts move between the literal language and the figurative language. In most contexts, speech consists of floating signifiers whose implication may be interpreted from several conversational positions. In experiences and situations of vulnerability, individuals construct speeches that inform of coded metaphors that speak to inconsistent features of social life, expressing sentiments, feelings, and ideas that would otherwise be underdeveloped. The figurative speech provides a means of conveying what may be unacceptable and too painful in a literal form by establishing ambiguity, developing instability of shifting meaning, and creating uncertainty of boundaries (O'Brien, Kennedy & Ballard 2008).
The principles of rationality may be categorised into three pervasive modes: instrumental rationality, cognitive rationality, and juridical rationality. Common aspects of these modes are impersonality, objectivity, consistency, and the penchant for the arithmetical. To be attributed with rationality, the personal perception of the reality ought to be in line with these features. If people do not see reality in the manner that is in line with cultural norms or their language patterns do not have the requisite literalness, these may be perceived as a mental disorder. The symptoms of this syndrome are (Silver 1999):
- Gross impairment in the reality testing;
- Unusual perceptual experiences;
- Bodily illusions;
- Feeling of inappropriate or excessive guilt;
- Exaggeration and distortions of perception.
Categorization of the human behaviour and speech as disordered has the implication of creating distinction between people experiencing mental disorders and the normal strata of the society. The work of mental health practitioners is to attend to the significance entrenched in the descriptions of those they care for when attempting to establish connection and recognition. This may involve focusing on attempting to restore the individual’s connection to the human society. In attempting to establish this connection, one will re-establish measures of participating in the community of other individuals. There is a significant need to establish an understanding of possibilities to gain knowledge of others’ needs and to integrate psychotherapeutic and clinical skills to meet the requirement of mental disorderliness in the society.