The Paradox of Practice:
Using Rhetoric to Understand the Dilemmas of Psychiatric Rehabilitation
Erica Lilleleht
Seattle University

Paradox of Practice 2

Abstract

When psychiatric programs are scrutinized, there is a tendency to pay attention to either formative intent or actual practice. What can get lost in such dichotomized analyses is an appreciation of the discursive and theoretical transformations that occur as idealized goals are concretized into systematic practice. Using a rhetoric-of-inquiry framework (Foss, Foss, & Trapp, 1991; Nelson, Megill, & McCloskey, 1987) and the formative and practical texts of psychiatric rehabilitation (Anthony, Cohen, & Farkas, 1990), it is argued that four paradoxical situations emerge as psychiatric rehabilitation's 'rhetoric of intent' becomes 'rhetoric of practice.' These paradoxes are identified and discussed, as are their implications for psychiatric rehabilitation specifically, and mental health care in general.

Paradox of Practice 3

The Paradox of Practice: Using Rhetoric to Understand the Dilemmas of Psychiatric Rehabilitation

(Indent .5") As North America moves into the 21st century, the populace is increasingly aware of the social, fiscal, and familial problems that accompany chronic mental illness. At the same time, however, mental health professionals are persistently thwarted in their attempts to develop thoroughly effective remedies. In spite of, or perhaps as a reflection of, this several hundred approaches to psychotherapy exist (Corsini & Wedding, 2000), pharmacological and other medical interventions are increasing in number and popularity (Burns, Baldwin, Emsley, Kerwin, Steinberg, & Van Os, 1999; Keen, 2000), psychiatric hospitalization remains a highly utilized treatment avenue (e.g., Clarke, Herinckx, Kinney, et al., 2000; Conte, Ferrari, Guarneri et al., 1996; Haywood, Kravitz, Grossman, et al., 1995), and community mental health programs continue despite funding challenges and low visibility (Stroul, Pires, Armstrong, & Meyers, 1998).
(Indent .5") Interestingly, when any of these approaches are scrutinized (by contemporary observers or historians), there is a tendency to examine either formative intent (e.g., the approach's goals, stated and unstated, general and particular), or the specifics of actual implementation (e.g., does the program work, is it administered correctly, what external and internal forces affect application and outcome?). An example of the former comes from the antipsychiatry movement of the 1960s and '70s. Encompassing a diverse group of scholars including Szasz, Laing, Cooper, and even Foucault, this 'group' questioned the intent of all psychiatric/psychological intervention, reframing the goals and activities of its practitioners as various forms of state (e.g., Szasz, 1961), social (e.g., Foucault, 1965), and familial control (e.g., Cooper, 1972; Laing, 1972).

References

Abrahamson, D. J. (1999). Outcome, guidelines, and manuals: On leading horses to

water. Clinical Psychology: Science & Practice, 6, 467-471.

Anthony, W. A. (1977). Psychological rehabilitation: A concept in need of a

method. American Psychologist, 32, 658-662.

Anthony, W. A. (1980). The principles of psychiatric rehabilitation. Baltimore:

University Park Press.

Anthony, W. A. (1982). Explaining 'psychiatric rehabilitation' by analogy to

'physical rehabilitation.' Psychosocial Rehabilitation Journal, 5, 61-65.

Anthony, W. A. (1992). Psychiatric rehabilitation: Key issues and future policy.

Health Affairs, 11(3), 164-171.

Anthony, W. A. (2002). Psychiatric rehabilitation. Boston: Boston University

Center for Psychiatric Rehabilitation.

Anthony, W. A., & Liberman, R. P. (1986). The practice of psychiatric

rehabilitation: Historical, conceptual, and research base. Schizophrenia

Bulletin, 12, 542-559.

Anthony, W. A., Cohen, M. R., & Cohen, B. F. (1983). Philosophy, treatment,

process, and principles of psychiatric rehabilitation. New Directions for

Mental Health Services, 17, 67-79.

Anthony, W. A., Cohen, M., & Farkas, M. (1988). Professional pre-service training

for working with the long-term mentally ill. Community Mental Health

Journal, 24, 258-269.

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Endnotes

1 The best overviews of the Reformation period include Caroline M. Barron and Bill C. Harper, eds., The Church in Pre-Reformation Society: Essays in Honour of F. R. H. Du Boulay, (Suffolk and Doveze, NH: Boydell Press, 1985); A.G. Dickens, The English Reformation, (London: Batsford, 1989); ibid., Reformation and Society in Sixteenth Century Europe (London: Thames and Hudson, 1966); and Rosemary O'Day, The Debate on the English Reformation (London: Methuen, 1986). Older, but still useful is G. Burnet, The History of the Reformation of the Church of England (London: 1850).

2 See for example, Margaret Bowker, The Henrician Reformation: The Diocese of Lincoln under John Longland, 1521-47 (Cambridge: Cambridge University Press, 1981); Felicity Heal, "The Parish Clergy and the Reformation in the Diocese of Ely," Proceedings of the Cambridge Antiquarian Society LXVI (1975-76): 141-63; and David M. Palliser, Tudor York (Oxford: Oxford University Press, 1979).

3 B. Bradshaw and Eamon Duffy, eds., Humanism, Reform and the Reformation: the Career of Bishop John Fisher. (Cambridge: Cambridge University Press, 1989); G.R. Elton, Reform and Renewal: Thomas Cromwell and the Commonweal (Cambridge: Cambridge University Press, 1973); ibid., Reform and Reformation: England, 1509-1558 (Cambridge, MA: Harvard University Press, 1977); and Joyce Youings, The Dissolution of the Monasteries (London: 1971).

4 Stanford Lehmberg, The Reformation Parliament, 1529-1536 (Cambridge: Cambridge University Press, 1970); Diarmaid MacCulloch, ed., The Reign of Henry VIII: Politics, Policy and Piety (New York: St. Martin's Press, 1995); J.J. Scarisbrick, The Reformation and the English People (Oxford: Blackwell, 1984); Felicity Heal and Rosemary O'Day, eds., Church and Society in England, Henry VIII to James I (London: Macmillan, 1977).

5 Margaret Aston, England's Iconoclasts. Volume1: Laws Against Images (Oxford: Clarendon Press, 1988); ibid., Lollards and Reformers: Images and literacy in Late Medieval Religion (London: Hambledon Press, 1984); Susan Brigden, London and the Reformation (Oxford: Clarendon Press, 1989); Eamon Duffy, The Stripping of the Altars: Traaditional Religion in England 1400-1580 (New Haven and London: Yale University Press. 1992): and Christopher Haigh, ed., The English Reformation Revised (Cambridge: Cambridge University Press, 1987).

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Aston, Margaret. England's Iconoclasts Volume 1 Laws Against Images.

Oxford: Clarendon, 1988.

------ Lollards and Reformers: Images and Literacy in Late Medieval

Religion. London: Hanbledon, 1984.

Barron, Caroline M. and Bill C. Harper, eds. The Church in Pre-Reformation

Society: Essays in Honour of F. R. H. Du Boulay. Suffolk and Doveze,

NH: Boydell, 1985.

Brigden, Susan. London and the Reformation. Oxford: Clarendon, 1989.

Bowker, Margaret. The Henrician Reformation: The Diocese of Lincoln

under John Longland, 1521-47. Cambridge: Cambridge UP, 1981.

Bradshaw, B. and Eamon Duffy, eds. Humanism, Reform and the

Reformation: the Career of Bishop John Fisher. Cambridge: Cambridge

UP, 1989.

Burnet, G. The History of the Reformation of the Church of England.

London: 1850.

Dickens, A.G. The English Reformation. London: Batsford, 1989.

------. Reformation and Society in Sixteenth Century Europe. London:

Thames and Hudson, 1966.

Duffy, Eamon. The Stripping of the Altars: Traditional Religion in England

1400-1580. New Haven: Yale UP, 1992.