242 Timothy J. Beck and Jacob W. Glazier
movement more generally, never came to fruition. By 1977, there were just
around 650 community mental health centers in America (Koyanagi &
Bazelon, 2007)—less than half of what was called for in Kennedy’s bill.
And while there was some renewed hope with President Jimmy Carter’s
Mental Health Systems Act signed in 1980, the bill was quickly repealed
by President Ronald Reagan in 1981 along with other cuts in social
services.
Today, it is generally agreed upon by most mental health professionals
that community mental health services remain underfunded and that a
greater reliance on pharmaceutical interventions has come by and large to
fill this obvious void in care (Miller, 2015). Indeed, the transition away
from psychoanalytic topologies of neurosis, perversion, and psychosis,
toward more complex categorical taxonomies, was initiated as much by
pressure from health insurers to justify treatment as it was by
pharmaceutical companies hoping to expand their market (Mayes &
Horwitz, 2005). Since the publication of the DSM-III, moreover, there
have been increasingly concerted efforts to bridge the research-practice
divide in abnormal psychology by coupling neuroscientific research with
pharmaceutical intervention. If one accepts the basic premise that cultures
are composed of social practices, which incorporate specific sets of objects
or tools, then systems of mental health care in America can be understood
as professional cultures that rely on certain combinations of biomedical
and clinical tools. Spurred by the social consequences of
deinstitutionalization, it thus follows that the trajectory of Western
colonialism has taken the guise of medicalization.
In this context, medicalization refers to a specific theory or worldview
that understands abnormality to be a result of an organic or biological
deficiency. Sometimes also referred to as the disease or pathology model,
psychiatry has conceptualized this deficiency specifically in terms of
reward circuits in brain chemistry. Here certain psychoactive drugs, such
as Selective Serotonin Reuptake Inhibitors (SSRIS), Serotonin and
Norepinephrine Reuptake Inhibitors (SNRIS), Monoamine Oxidase
Inhibitors (MAOIS), and Tricyclic Antidepressants (TCAS), are
administered to alter the level of particular neurotransmitters in the brain.