Musings of Dr. Björk

Observations, thoughts and reflections of a phenomenological psychologist in a medicalised world.

After three days at the psychiatric clinic I have already encountered some approaches and practices that makes me a bit uncomfortable. One thing that I expected is the focus on correct diagnosis, a focus that is based on the assumption that “bipolar disorder” or “attention deficit and hyperactivity disorder” or “emotionally unstable personality disorder” is something that people either “have” or “not have” and the task of the psychologist is to determine which one is true. In a embarrassingly unreflective way it is assumed that with the correct instruments and structured interviews, the psychologist can determine if a person have this or that disorder. And if a person have this or that diagnosis, that implies a certain treatment. Since psychiatry in Sweden is increasingly organised in line with diagnoses (I work at the “Anxiety Clinic”) the diagnose also determine what kind of help and treatment that is available for patients.

As a sociocultural psychologist, I take all human affairs being culturally and historically dependent, including mental illness. What people do when they suffer differs across cultures and through history. Why? Because people do what they know others do when they suffer. Why the incease in self-harm and cutting? Because the attention self-harm and cutting has gained over the last decades has made that a mainstrean repertoire of things to do when you are in emotional pain. So what are psychiatric diagnoses? They are culturally and historically dependent descriptions of what people do when they are in emotional pain or when their thoughts, feelings and/or actions diverge enough from cultural norms as to be named “mental disorder”.

This is not to fall into relativism and claim that diagnoses does not exist. It is simply an argument against the common misconception — even among psychologists — that autism or depression or obsessive compulsive disorder is not something that you either have or not have, but variations of human life forms on a continuum where the extreme ends are dysfunctional and bring significant suffering.

This has implications for psychological assessment and, in the end, how we as psychologist view the patient. That is another thing that bothers me a bit, but I'll write about that another day.

First day at my new job as a licenced psychologist at the psychiatric clinic at University Hospital in Umeå. Apart from being a bit late in the morning due to me forgetting my ID card at home, it went just well.

But working in psychiatry, isn't that a strange move by a psychologist critical of contemporary psychiatry? I have many things to say about the naïve realism, essentialism and medicalising of human suffering of contemporary psychiatry. So why am I doing this?

First, because part time I will do work psychology and almost the same thing I did at the Swedish Public Employment Service. It's carted waters, so to speak.

Second, because as a work psychologist at the Swedish Public Employment Service I found that I was a rather unorthodox psychologist with an approach to people and their problems heavily inspired by phenomenology, and somehow that approach worked surprisingly well. In fact, it worked so well that I sometimes was a bit scared for myself. What did I do that others didn't that made things happen in the therapeutic encounter between therapist and client, where others had failed?

I have some preliminary ideas, but I realised that to fully grasp how my approach differs from that of contemporary mainstream psychology and psychiatry, I have to get into psychiatry. I have to see how my phenomenological—existential approach contrasts with the reductionistic biomedical discourse of contemporary psychiatry in order to understand what I am in fact doing. And I have to learn how my fellow psychologists navigates between biomedical psychiatry and different approaches to the field of psychology, not only existential but also cognitivistic, psychodynamic, feminist, and so on.

And then I'll write a book.

That's why I work in psychiatry.