Life in north Korea

[Jana]

Interesting documentary.

[JamesBond007]

Interesting documentary.

That seems like stupid capitalist propaganda. I watched a few minutes of it before I turned it off. The Narrator literally called the entity 'North Korea' by the label 'paranoid schizophrenic' the sine qua non of modern day Capitalist propaganda :

Deconstructing the “Science” of Psychiatry

...This section surveys the main issues with the current state of psychiatric knowledge—namely, the disagreements over aetiology and treatment of mental illness, the lack of agreement on what “mental illness” is, and consequently the lack of validity to any category of mental disorder. This deconstruction of psychiatric knowledge claims will lead us to question what the purpose of the psy-professions in capitalist society actually is. A recent review of the science behind the psychiatric discourse concluded that “no biological sign has ever been found for any ‘mental disorder.’ Correspondingly, there is no known physiological etiology” (Burstow 2015: 75). This conclusion also became clear to the APA’s own DSM-5 task force when they began work on the new manual in 2002. As Whitaker and Cosgrove (2015: 60) record, in reviewing the available research evidence it was plain to the committee members that “[t]he etiology of mental disorders remained unknown. The field [of mental health] still did not have a biological marker or genetic test that could be used for diagnostic purposes.” Furthermore, the research also showed that psychiatrists could still not distinguish between mentally healthy and mentally sick people, and consequently had failed to define their area of supposed expertise. This issue was recently highlighted with reference to comments made by Allen Frances, the chair of the previous DSM-IV task force. When the DSM-IV (American Psychiatric Association 1994: xxi) was published in 1994, it stated that “mental disorder” was conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. However, as the architect of the DSM-IV, Frances was later quoted by Greenberg (2013: 35–36) as stating of the above definition, “[h]ere’s the problem … There is no definition of a mental disorder … it’s bullshit … I mean you can’t define it.” The lack of knowledge on mental health and illness has haunted the entire history of psychiatry. Some have dismissed critics who highlight this fundamental hole in the science of psychiatry as “antipsychiatry” or “mental illness deniers.” Such attacks on scholars who attempt to investigate the accuracy of the central pillars of psychiatric knowledge should further concern us, as it perhaps signals that plenty in the profession are already aware of the flimsy nature on which their “expertise” continues to rest. Together with an understanding of the history of the psychiatric profession—summed up by Scull (1989: 8) as “dismal and depressing”—I would argue that it should be the duty of all social scientists concerned with the mental health field that, in good conscience and putting the needs of the public first, they remain highly sceptical of a psychiatric discourse that poses as expert knowledge on the mind but produces little actual evidence to back up the assertions made. Though at first glance historical mental disorders such as masturbatory insanity (Chap. 2), drapetomania (Chap. 7), hysteria (Chap. 5), and homosexuality may appear as evidence of the profession reflecting the dominant norms and values of wider society, they are argued by the official historians of psychiatry to be examples of the false starts, early experimentations, and theoretical innovations of an emerging scientific discipline. It is suggested that this history is evidence of medical and scientific progress within the area of mental health to the current point where we know more about mental distress than ever before. Yet problems in the legitimacy of psychiatry’s vocation have remained, and reached crisis point at the cusp of deinstitutionalisation in the 1970s. At the time, a number of significant studies demonstrated the rofession’s inherent tendency to label people as “mentally ill,” to stigmatise everyday aspects of a person’s behaviour as signs of athology, and to make judgements on a person’s mental health status based on subjective judgements rather than objective criteria. The study that had the most direct impact on the psychiatric profession—as well as public consciousness—at this time was David Rosenhan’s (1973) classic research On Being Sane in Insane Places which found that psychiatrists could not distinguish between “real” and “pseudo” patients presenting at psychiatric hospitals in the United States. All of Rosenhan’s “pseudo” patients (college students/researchers involved in the experiment) were admitted and given a psychotic label, and all the subsequent behaviour of the researchers—including their note-taking—was labelled by staff as further symptoms of their disorder (for a summary, see Burstow 2015: 75–76). This research was a culmination of earlier studies on labelling and mental illness which had begun in the 1960s with Irving Goffman (1961) and Thomas Scheff (1966). Goffman’s (1961) ethnographic study of psychiatric incarceration demonstrated many of the features which Rosenhan’s study would later succinctly outline, including the arbitrary nature of psychiatric assessment, the labelling of patient behaviour as further evidence of “mental illness,” and the processes of institutional conformity by which the inmates learned to accept such labels if they wanted to have any chance of being released from the institution at a later date. Scheff’s (1966) work on diagnostic decision making in psychiatry formulated a general labelling theory for the sociology of mental health. Again, his research found that psychiatrists made arbitrary and subjective decisions on those designated as “mentally ill,” sometimes retaining people in institutions even when there was no evidence to support such a decision. Psychiatrists, he argued, relied on a common sense set of beliefs and practices rather than observable, scientific evidence. Scheff (1966) concluded that the labelling of a person with a “mental illness” was contingent on the violation of social norms by low-status rule-breakers who are judged by higher status agents of social control (in this case, the psychiatric profession). Thus, according to these studies, the nature of “mental illness” is not a fixed object of medical study but rather a form of “social deviance”—a moral marker of societal infraction by the powerful inflicted on the powerless. This situation is summated in Becker’s (1963: 9, emphasis original) general theory of social deviance which stated that deviance is not a quality of the act the person commits, but rather a consequence of the application by others of rules and sanctions to an “offender.” The deviant is one to whom that label has successfully been applied; deviant behavior is behavior that people so label. The growing perception that psychiatric work was “unscientific” and, in turn, “mental illness” was a label of social deviance was further amplified in the 1970s by the APA’s very public battle over the continuation of homosexuality as a classification of mental disorder in the DSM (for a full discussion, see Kutchins and Kirk 1997: 55–99). As with the rationale for the profession labelling this sexual orientation as a mental illness in both the DSM-I (American Psychiatric Association 1952: 38–39) and the DSM-II (American Psychiatric Association 1968: 44), the successful decision to subsequently remove the label from the manual in 1973 was anything but scientific. On the contrary, Burstow (2015: 80) records how a mix of disruptive protests by gay rights campaigners, along with an internal power struggle between psychoanalysts and biomedical-orientated psychiatrists, brought about the change in APA policy. The end result was a decision based not on research evidence but rather a simple postal vote of APA members (Burstow 2015: 80). With institutional psychiatry in decline, community alternatives developing, and related mental health disciplines encroaching on traditional psychiatric territory, the profession entered a period of political and epistemological crisis. To regain credibility, the APA needed to prove the robustness of its knowledge base and convince the public as well as policy makers of their continuing usefulness and expertise. The solution was to boost the scientific credibility of the field through improving the reliability of mental illness categories—that is, the identification and agreement among different practitioners of patients presenting with a specific disorder—which would then aid in validating such pathologies as real disease rather than professionally produced constructions. As Whitaker and Cosgrove (2015: 45–46) state of the importance of the reliability and validity concepts, In infectious medicine, a diagnostic manual needs to be both reliable and valid in order to be truly useful. A classification system that is reliable enables physicians to distinguish between different diseases, and to then prescribe a treatment specific to a disease, which has been validated—through studies of its clinical course and, if possible, an understanding of its pathology—as real. Under the leadership of Robert Spitzer, the APA carried out extensive field trials with the aim of testing the reliability of different diagnostic categories towards the creation of a more robust and scientifically sound DSM (to be released in 1980 as the DSM-III). Spitzer and Fleiss’ (cited in Kirk and Kutchins 1994: 75) own assessment of the reliability of categories of mental disorder in the DSM-I and the DSM-II was that none of them were more than “satisfactory,” frankly admitting that [t]here are no diagnostic categories for which reliability is uniformly high. Reliability appears only satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories. To rectify this situation, Spitzer’s team coordinated a number of large-scale pieces of research on psychiatric classification, including “the largest reliability study in history” (Burstow 2015: 77; for full details, see Williams et al. 1992) involving 592 people—both psychiatric patients and those without a previous history of mental health problems—being interviewed by pairs of psychiatrists spread over six sites in the United States and one in Germany. Kirk and Kutchins (1994: 83) have described the time, planning, and resourcing that went into this study as “the envy of researchers who attempt to conduct rigorous studies in clinical settings.” Subsequently, the data was claimed by the developers of the DSM-III to be of “far greater reliability” for most classes of mental disorder than that utilised in previous DSMs; the results showed a generally “quite good” level of agreement between psychiatrists, especially on the classic categories of schizophrenia and major affective disorders (American Psychiatric Association, cited in Kirk and Kutchins 1994: 79). On its release in 1980, the DSM-III was hailed as a great success for the discipline—a document which would finally silence detractors through accurately demonstrating the effective scientific progress of the discipline in the twentieth century. Consequently, the DSM-III has come to mark a “revolution” within the discipline (Decker 2013: xv). For western psychiatry, the manual was the “book that changed everything” (Lieberman 2015: 134). It was, however, a revolution based on a scientific lie. The DSM-III field trials were “[b]latently rigged” (Burstow 2015: 77) by Spitzer’s task force to produce higher rates of reliability. A summary of the research biases in the construction of the studies—including the non-representative nature of the samples—has been noted by Whitaker and Cosgrove (2015: 48–49), following extensive meta-analysis of the original field trial data by Kirk and Kutchins (1992). However, Kirk and Kutchins’ own evaluation of the DSM-III research revealed something even more surprising—namely, that there was no improvement in the previous poor levels of diagnostic reliability. In fact, in some categories of mental disorder, there were even greater levels of disagreement between psychiatrists than there had been with previous DSMs (Kirk and Kutchins 1994: 82–83). In large part, the claimed success of the DSM-III was due to a “linguistic sleight of hand” (Whitaker and Cosgrove 2015: 49) in which Spitzer and his task force re-phrased the same statistical levels of agreement between psychiatric professions (in this case, defined by kappa mean values between 0 and 1, where 1 is complete agreement and 0 complete disagreement) in different ways when comparing the DSM-I and the DSM-II with the DSM-III. For example, a mental disorder in the previous DSMs with a kappa score of .7 had been presented as “only satisfactory,” but was then redefined in the DSM-III as a “good” level of inter-rater agreement (Whitaker and Cosgrove 2015: 49). Thus, Kirk and Kutchins (1994: 83) concluded that “despite the scientific claims of great success, reliability appears to have improved very little in three decades.” The DSM-III can therefore be seen as the success of the rhetoric of psychiatry rather than the result of any actual scientific progress within the discipline (Kirk and Kutchins 1992). Predictably, subsequent research has shown no improvement in inter-rater reliability and, in many cases, has produced kappa scores below those reported in the original DSM-III field trials (Whitaker and Cosgrove 2015: 50). The implications for the DSM on which psychiatry bases its claims to scientific rigour are clear—“the latest versions of DSM as a clinical tool,” state Kirk and Kutchins (1994: 84), “are unreliable and therefore of questionable validity as a classification system.” As the authors proceeded to document with the DSM-IV, rather than attempt to tighten mental illness classifications, the APA actually loosened them further, thereby increasing the potential number of people who could be labelled under each mental disorder (Kutchins and Kirk 1997). Following the DSM-III field trials, subsequent DSM task forces have abandoned the reliability issue, believing it to have been solved despite ongoing criticisms from health researchers and social scientists. And, lest we forget, even if psychiatry did one day solve the reliability problem, it still does not solve the validity issue for mental disorder classifications. After all, “[t]he fact that people can be trained to apply a label in a consistent way,” Burstow (2015: 78) reminds us, “does not mean that the label points to anything real.” Psychiatric insiders have openly admitted the lack of science to their area of operations. Allen Frances (cited in Whitaker and Cosgrove 2015: 61), for example, has recently stated that the mental disorders given in the DSM are “better understood as no more than currently convenient constructs or heuristics that allow [psychiatrists] to communicate with one another.” This has included the classic constructs of schizophrenia and bipolar disorder (formerly manic-depression), of which the mental health researcher Joel Paris at the Department of Psychiatry, McGill University, has admitted “[i]n reality, we do not know whether [such] conditions … are true diseases” (cited in Whitaker and Cosgrove 2015: 61). Even National Institute of Mental Health (NIMH) director and strong advocate of biomedical psychiatry, Thomas Insel (cited in Masson 2015: xii), announced on the release of the DSM-5 in 2013 that the categories of mental disorder lacked validity and NIMH would no longer be using such diagnoses for research purposes. Despite the claims to “progress” made by official historians of psychiatry such as Lieberman and Shorter, there is no evidence for the supposed “science” of psychiatry. There is no test for any mental illness, no proof of causation, no evidence of successful “treatment” that relates specifically to an individual disorder, and no accurate prediction of future cases. Thus, the claim that psychiatric constructs are real disease has not been proven. Consequently, it is necessary to utilise the existing evidence to more accurately theorise the real vocation of the psy-professions in capitalist society. As the faulty knowledge claims of the DSM are summarised by Burstow (2015: 78, emphasis original), “reliability cannot legitimately function as a validity claim and no studies have established validity”; therefore, “it follows that … no foundation of any sort exists for the DSM categories. This is a serious issue that calls into question the power vested in psychiatry.” It necessarily leads us to consider such institutions as moral and political enterprises rather than medical ones (Szasz 1974: xii) because psy-professionals make historically and culturally bound judgements on the “correct” and “appropriate” behaviour of society’s members. This is a point summated by Ingelby (1980: 55, emphasis added) when he states that what one thinks psychiatrists are up to depends crucially on what one thinks their patients are up to; and the latter question cannot be answered without taking an essentially political stand on what constitutes a “reasonable” response to a social situation. In the same manner, British psychiatrist Joanna Moncrieff (2010: 371) agrees that a “psychiatric diagnosis can be understood as functioning as a political device, in the sense that it legitimates a particular social response to aberrant behaviour of various sorts, but protects that response from any democratic challenge.” Even Shorter (1997: viii) accepts that the profession is responsible for policing social deviance when he remarks that “[p]sychiatry is, to be sure, the ultimate rulemaker of acceptable behaviour through its ability to specify what counts as ‘crazy.’” Likewise, the concept of “health” within the mental health system is understood as whatever counts as “normal” within a specific historical epoch and cultural setting. Sayers (cited in Christian 1997: 33–34) states of this relative concept of “health” that [t]he society and the individual’s role within it are assumed to be normal (that is to say, “healthy”: “normality” is a common synonym for “health” in psychiatry as in other areas of medicine). Indeed, the prevailing social environment is made the very criterion of normality, and the individual is judged ill insofar as he or she fails to “adjust” to it.

The Urgency of Marxist Theory
....

It has been left to a small handful of Marxist scholars to outline a fundamental truth of the mental health system: that its priorities and practices are fundamentally shaped by the goals of capitalism (see, e.g., Brown 1974; Nahem 1981; Parker 2007; Roberts 2015; Robinson 1997; Rosenthal and Campbell 2016). As Brown (1974: 1) has remarked of psychology, it is “more than just a professional field of work. It is also a codified ideology and practice that arises from the nature of our capitalist society and functions to bolster that society.” This is less surprising, states Nahem (1981: 7), when it is understood that, as with psychiatry, “[p]sychology arose and developed in capitalist society, a class society. In all class societies, the dominant social, cultural and political views are those of the dominant class.” And more so, with the continuing expansion of the psy-professions, Parker (2007: 1–2) argues that psychology has become an increasingly powerful component of ideology, ruling ideas that endorse exploitation and sabotage struggles against oppression. This psychology circulates way beyond colleges and clinics, and different versions of psychology as ideology are now to be found nearly everywhere in capitalist society. The dominant norms and values of the ruling classes are reflected in the psychiatric discourse on human behaviour and the workings of the mind. Consequently, the psy-professions are responsible for facilitating the maximisation of profit for the ruling classes while individualising the social and economic conditions of the workers. The mental health system seeks to normalise the fundamentally oppressive relations of capitalism by focusing on the individual—rather than the society—as pathological and in need of adjustment through “treatment” options such as drugs, ECT, and therapy. These arguments will be discussed in further detail in the chapters that follow. To end this section, however, I briefly want to highlight a key problem with previous Marxist literature. Almost all of the Marxist scholars cited above come from inside the psy-professions (usually psychology), and for that reason most attempt to still rescue their discipline from capitalism. For example, Nahem (1981: 7) speaks of the mental health system as being “co-opted” by capitalism, a situation in which the true evidence-based practice of psychiatry and psychology has been replaced by the ideology of the ruling classes. Similarly, Robinson (1997) and Rosenthal and Campbell (2016) argue that the psy-professions have been tainted by capitalism, and that, consequently, a socialist society would have “a genuinely scientific psychology [which] will constitute an essential part of human culture” (Robinson 1997: 77). However, the idea of a “new psychiatry” or “new psychology” based on Marxist principles (as suggested in Brown 1974) is fundamentally incompatible with the socio-historical reality of these institutions (Chap. 2). As I argue throughout this book, the psy-professions are a product of capitalism; they were created to police dissent and reinforce conformity, not to emancipate people. Thus, they cannot be reformed or rescued from capitalism; they are and will always be institutions of social control, and for that reason they have no positive role to play in a socialist society (Chap. 8). As important as the previous Marxist scholarship on mental health has been, this book avoids the potential biases of the reformed therapist, psychologist, or psychiatrist in assessing the history and current expansion of the psy-professionals.

[Jana]

That seems like stupid capitalist propaganda. I watched a few minutes of it before I turned it off. The Narrator literally called the entity 'North Korea' by the label 'paranoid schizophrenic' the sine qua non of modern day Capitalist propaganda icard2

You seem mentally troubled, to put it lightly.

[JamesBond007]

You seem mentally troubled, to put it lightly.

[Komintasavalta]

This is an accurate depiction of US white phenotype (long downturned nose, round bug eyes, pointy protruding chin, narrow elongated face with poor definition of the facial skeleton):

[Jana]

This is an accurate depiction of US white phenotype (long downturned nose, round bug eyes, pointy protruding chin, narrow elongated face with poor definition of the facial skeleton):

Another patient escaped the hospital...

[JamesBond007]

Another patient escaped the hospital...

Surely you mean escaped the prison , instead ? as the use of the use of the term 'hospital' is disingenuous ? The Chinese/Korean Communist party will liberate me from your Capitalist pig prison !

[Jacques de Imbelloni]

Looks cleaner than any city of my country.

[travv]

This is an accurate depiction of US white phenotype (long downturned nose, round bug eyes, pointy protruding chin, narrow elongated face with poor definition of the facial skeleton):

Looks churkoid.

[Davy Jones's Locker]

I am intrigued by North Korea and enjoy watching analysis of that nation. I don't know if you're familiar with B.R. Myers or Michael Malice, Feiichy, they have produced interesting content about the DPRK. Anyway it gets to the stage where it feels like one has viewed all broadcasts on the country, so it's great if you find something you've not seen previously.

This is an accurate depiction of US white phenotype (long downturned nose, round bug eyes, pointy protruding chin, narrow elongated face with poor definition of the facial skeleton):

That caricature also features in propaganda posters. I don't remember the name of the documentary, however I recall a North Korean tour guide showing a western visitor around a building and exactly this type of picture was displayed on the wall. When the guide noticed she subtly removed it.