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The Cultural Consequences of Deficit Discourse
Kenneth J. Gergen
In a social constructionist context, language loses its function as
"truth bearing," as an innocent mirror of a world out there.
Instead, the "ways we talk" are intimately intertwined with
patterns of cultural life. They sustain and support certain ways of
doing things and prevent others from emerging. From this perspective
it is of paramount importance to inquire into the effects of our
prevailing vocabularies on human relationships.
In his writing on the "Cultural Consequences of Deficit
Discourse," Kenneth Gergen addresses the sometimes undesirable
impact of our language through an in depth discussion of the dominant
deficit vocabularies of the mind. His concern is with the paradoxical
consequences of the prevailing vision of human betterment in the
mental health professions, and the pervasive hope that these
professions can improve the quality of cultural life. According to
Gergen, there is reason to believe that in their very effort to
furnish effective means of alleviating human suffering, mental health
professionals simultaneously generate a network of increasing
entanglements for the culture at large. Such entanglements are not
only self-serving for the professions, they also add exponentially to
the sense of human misery.
In his analysis of this paradox, Gergen points out that there are
important unfortunate outcomes of our mental deficit language that
lead to an overall sense of cultural enfeeblement, namely: social
hierarchy, communal fragmentation, and self-enfeeblement.
Social Hierarchy
How may I fault thee? Let me count the ways: impulsive personality,
malingering, reactive depression, anorexia, mania, attention deficit
disorder, psychopathia, external control orientation, low self-esteem,
narcissism, bulimia, neurasthenia, hypochondriasis, dependent
personality, frigidity, authoritarianism, anti-social personality,
exhibitionism, seasonal affective disorder, transvestism,
agoraphobia....
Although they attempt to occupy a position of scientific
neutrality, it has long been recognized that the helping professions
are premised on certain assumptions about the cultural good.
Professional visions of "healthy functioning" are suffused
with cultural ideals of personhood and associated political
ideologies. In this context, then, we find that terms of mental
deficit operate as evaluative devices, demarking the position of
individuals along culturally implicit axes of good and bad. The
existence of the terms contributes to the proliferation of subtle but
treacherous hierarchies, accompanied as they are by various practices
of distancing and degradation. The greater the number of criteria for
mental well-being, the greater number of ways in which one can be
rendered inferior in comparison to others.
Community Erosion
Mental deficit terms name diseases or afflictions, and, in terms of
medical logic, disease or affliction requires professional diagnosis
and treatment. Yet, as the "afflicted" enter such programs,
the "problem" is removed from its normal context of
operation and reconstituted within a professional sphere. In effect,
the mental health professions appropriate the process of interpersonal
realignment that might otherwise occur in a nonprofessional context
such as the family or the community. To give an example, marriage
partners may now carry out more intimate communication with their
therapists than with each other, even saving significant insights for
revelation in the therapeutic hour. Likewise, parents may discuss
their children's problems with specialists, or send problem children
to treatment centers, and thereby reduce the possibility for authentic
(unselfconscious) communication with their offspring or with concerned
neighbors. In each case, the tissues of communal interdependency are
injured or atrophy.
Self-Enfeeblement
Mental deficit terms inform the recipient that "the
problem" is not circumscribed or limited in time and space or to
a particular domain of his or her life; it is fully general. He or she
carries the deficit from one situation to another, and like a
birthmark or a fingerprint, as the textbooks say, the deficit will
inevitably manifest itself. In effect, once people understand their
actions in terms of mental deficits, they are sensitized to the
problematic potential of all their activities and how they are
infected or diminished. To be labeled by mental deficit terminology is
thus to face a potential lifetime of self-doubt.
The creation of social hierarchies, the erosion of communal
interdependencies and the self-enfeeblement of the person who is
defined in deficit terms, demonstrate the substantial "down
side" to existing intelligibilities. And, according to Gergen,
these problems are of continuously increasing magnitude. To amplify
the argument, he considers the growth of the mental professions over
the past century, a development that can be considered little short of
phenomenal. To illustrate, the American Psychiatric Association was
founded in 1844 by 13 physicians and hospital administrators. By the
end of the century it had grown to 377 members. Today there are over
36,000 members, some ninety-five times the number at the turn of the
century. The increase in the number of practicing psychologists in the
United States is similarly dramatic. When the American Psychological
Association was founded in 1892 there were only 31 members. By 1906,
the number had jumped to 181. Yet, within the thirty-six years that
followed, the membership expanded almost a hundredfold to over 3,000.
In the following twenty-two years (between 1942 and 1966) the figure
increased again almost twenty times over to a total of over 63,000. Of
course, not all members of the Association are directly engaged in
mental health pursuits, but even those who are not often lend
rhetorical force to these professions. How are we to explain this
expansion in the mental health professions?
If we belief in the "truth bearing" function of language,
our explanation gives an optimistic outlook. The increment in the
number of professionals represents a greater responsivity to cultural
needs; existing problems are receiving greater attention. As the
professions mature, it may be ventured, there is also an incremental
sharpening in our capacity to distinguish among the existing array of
psychological states and conditions. We know increasingly more about
psychological distress, and we have sharpened diagnostic distinctions
so that we can recognize problems to which we were once insensitive.
From a social constructionist perspective however, the explanation
starts with a negation that mental deficit terminology is tied
referentially to discriminant states of the psyche. There is little to
support the view that the professions have burgeoned in response to
the deficient state of people's psyche or that over time they have
become increasingly sensitive to the failings of the mind. In this
view there is no pattern of illness to which the professions are
responding; rather, the conception of illness functions in ways that
link the professional and the culture in an array of mutually
supportive activities. A symbiotic relationship between the mental
health profession and the culture, leads to a cyclical process that
expands the domain of deficit to an ever-increasing degree. Gergen
calls this the Cycle of Progressive Infirmity, in which he
distinguishes four separate phases:
The Cycle of Progressive Infirmity
Phase 1: deficit translation
We begin at the juncture that
the culture accepts both the possibility of "mental illness"
and a profession responsible for its diagnosis and cure. When life
management seems impossible in terms of everyday understandings, the
client seeks professional help or, in effect, more
"advanced," "objective," or "discerning"
forms of understanding. Thus, the question for help leads to a
translation of problems understood in the profane or marketplace
language of the culture into the sacred or professional language of
mental deficit. A person whose habits of cleanliness are excessive by
common standards may be labeled "obsessive compulsive," one
who remains in bed for the whole morning becomes
"depressive," one who feels he is not liked is redefined as
"paranoid," and so on. The client may willingly contribute
to these reformulations, for they assure him not only that the
professional is doing a proper job but that the problem is well
recognized and understood within the profession. The final outcome -
translation into a professional or mental deficit vocabulary - is
inevitable from the outset.
Phase 2: cultural dissemination
Once a problem is translated
into mental deficit vocabulary, it can be recognized and categorized
in the domain of mental illness. And because there are illnesses at
stake, there are also public threats to be confronted. Now it becomes
a professional responsibility to alert the public to unrecognized or
unrealized instances. People must learn to recognize the signals of
mental disease so that they might seek early treatment, and they
should be informed of possible causes and likely cures. Over time this
educating process becomes part of the culture: national magazines and
newspapers disseminate news of mental disorders, mental problems are
popular fare in television dramas and soap operas, and books on
psychological self-help are now mainstays in the publishing industry.
The result is a continuous insinuation of professional language into
the sphere of daily relationships.
Phase 3: the cultural construction of illness
As
intelligibilities of deficit are disseminated to the culture, they
become absorbed into the common language. They become part of
"what everybody knows" about human behavior. And as deficit
terms make their way into the cultural vernacular, they become
available for the construction of everyday reality. Shirley is not
simply "too fat," she has "obese eating habits";
Fred doesn't simply "hate gays," he is
"homophobic"; and so on. As deficit terms increasingly
infiltrate everyday intelligibilities, that world becomes increasingly
framed by a sense of deficit. As forms of "illness" are
depicted by the media, educational programs, public talks, and the
like, their symptoms come to serve as cultural models. In effect, the
culture learns how to be mentally ill. Where people's actions are
increasingly defined and shaped in terms of the language of mental
deficit, the demand for mental health services increases: in the
twenty-year period between 1957 and 1977 the percentage of the US
population using professional mental health services increased from 14
percent to over a quarter of the population. Although mental health
expenditures were minuscule during the first quarter of the century,
by 1980 mental illness was the third most expensive category of health
disorder in the United States, accounting for more than $20 billion
annually. By 1983, the costs for mental illness, exclusive of
alcoholism and drug abuse, were estimated to be almost $73 billion.
Phase 4: vocabulary expansion
The stage is now set for the
final revolution in the cycle of progressive infirmity: a further
expansion of the vocabulary of deficit. As people increasingly
construct their problems in the professional language and seek help,
and as professional ranks expand in response to public demands, more
individuals are available to convert everyday language into a
professional language of deficit. There is no necessary requirement
that such translating be conducted in terms of the existing categories
of illness, and, indeed there are distinct pressures on the
professional to expand the vocabulary. Within the profession, the
discovery of a new disorder will be applauded as a contribution to
scientific progress, and in the eyes of the educated client the
profession maintains its legitimacy. Thus, the professional is under
constant pressure to "advance" understanding, to spawn
"more sophisticated" terminology, and to generate new
insights and new forms of therapy. The outcome is a rate of expansion
of deficit terminologies that is suspiciously similar to those
encountered in the case of mental health professionals and mental
health expenditures. For instance, in the thirty-five-year period
since the publication of the first Diagnostic and Statistical Manual
of Mental Disorders of the American Psychiatric Association, the
number of recognized illnesses more than tripled (from around 60 to
more than 180).
To summarize, when the culture is furnished with a professionally
rationalized language of mental deficit and people are increasingly
understood according to this language, the population of
"patients" expands. This population, in turn, forces the
profession to extend its vocabulary, and thus the array of mental
deficit terms available for cultural use. In this way more problems
are constructed within the culture, further help is sought, and the
deficit discourse again inflates.
Where the mental health professions are concerned with the quality
of cultural life, the question now arises, how we can intervene in
this cycle of progressive infirmity. Not surprisingly, Gergen seeks
his answers in the realm of language. First of all awareness can be
raised that our words for mental deficit do not stand in a pictorial
relationship to processes or mechanisms in the head. In other words,
people do not actually possess mental processes such as depression or
obsession, we have only named them thus. Second, we can develop
vocabularies of relatedness that do not trace problematic behavior to
psychological sources within single individuals, but place such
behaviors within arrangements of social interdependency instead. When
we shift our attention to the larger system of interdependencies in
which evaluations are generated, we can reconsider the relationships
between the profession and the culture of which the spiral of deficit
is itself a result.
Cooperrider, D. L. (1990). Positive Image, Positive Action:
The Affirmative Basis of Organizing. In Srivastva, S., &
Cooperrider, D. L. (Eds.). Appreciative Management and Leadership: The
Power of Positive Thought and Action in Organizations (pp. 91-125).
San Francisco: Jossey-Bass Publishers.
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