"Mirar las cosas de cara, ser capaces de sorprendernos, tener curiosidad y un poco de coraje; saber preguntar y saber escuchar; evitar los dogmas y las respuestas automáticas; no buscar necesariamente respuestas y aún menos fórmulas magistrales" (Emili Manzano)

viernes, 28 de febrero de 2014



In most parts of the world psychiatry is not recognized as a medical discipline equal to others. Its practitioners are often considered to be charlatans unable to provide real help and likely to do evil things. People suffering from mental illness are not seen as people requiring help, but as weaklings, evil doers or simulants. Their human rights are often not respected, and the care they receive is usually sub-optimal. 

There are many reasons for this lamentable situation. They include ignorance of the decision makers about the nature of mental illness and ways of dealing with it. But psychiatry also bears a part of the blame. 

Thomas Szasz and others concluded that mental illness is a myth because is different from bodily illness. Robert Kendell and others concluded that at least some of the conditions widely regarded as mental illnesses are essentially similar to bodily illnesses; hence, ADHD is very far from being a fraud. 

The main problem is that bodily illness is not transparent in meaning because it is not defined, straihtforwardly, to factual/scientific norms. Only few moths ago The American Medical Assn. voted to declare obesity a disease, ... voted, no evidence. 

Problems for any old or new medical diagnoses (e.g., ADHD, obesity, restless legs syndrome) : 

- If we want to ensure that limited healthcare resources are appropriately distributed we must have a reasonably clear idea, first what a disease is, and second, which diseases are most worth the investment of time and money 

- How do we distinguish properly between real diseases, and human behaviours or characteristics that we just happen to find disturbing? 

- As the business literature shows, new clinical diagnoses are often welcomed primarily as opportunities for market growth 

- Biomedicine’s contemporary power means that it can no longer adopt ambient ideas about disease and disability without running into tricky areas of ambiguity and, potentially, ethical difficulties 

- The personal experience of disability is not always predictable, and it can be very different from the experience of disease 

One take-home message here is that although disease and disability are regularly lumped together, conflating them is often misleading. Another is that science never simple reflects cultural understandings; it simultaneously helps craft the definition as well. Choices of such mundane things as disease models and diagnostic criteria, then are not just about research agendas or commercial influences. At their heart they embody profound ethical debates about identity, human rights and the tolerance of diference. 

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