A social constructionist view of knowledge (continued)

Social constructionism
• Meaning is constructed
• We can understand our view the world as through a lens

Social constructionism is a post-modern view of knowledge. Rather than being understood as a progression to an absolute truth, knowledge is understood to be represented in meaning which is constructed in social interaction through generations and day to day. While starting off with innate reflexes and behaviour patterns a new baby learns to attend preferentially to what is important to its parents. This is in contrast to the idea of knowledge being 'found' by objective study and looking underneath (an approach found unrewarding in subatomic physics). Meaning is embedded in language. To describe oneself as a clinician, or this document as an academic paper, subsumes a range of cultural understandings and is unlikely to be conveyed by holding up a mirror. In a simplistic way we can describe language and shared constructions as lenses through which we perceive the world. Our sense of ourselves and reality is socially constructed.

Constructions are value laden and can serve power groups. For example, feminists describe the qualities identified as feminine, nurturing, non-confrontative, in need of protection, as supporting male power. Karl Marx, in describing religion as the opium of the masses was identifying how religious ideas prioritise the morality of one’s actions and hopes for the afterlife over attaining an equitable share of resources in this life, as serving the interests of the capitalists. Diagnostic systems such as DSM IV and ICD 10 can be seen as serving the interests of mental health professionals by increasing the number and availability of diagnostic labels, thus increasing the perceived credibility and sphere of influence of psychiatry.

Constructions can be evaluated by usefulness and effect but do they work? Evidence- based practice has considerable claim to be valued on this basis. Resonance with people’s understandings and values supports the Recovery Approach.

The value of social constructionist epistemology for collaborative practice
• Multiple knowledges evaluated by usefulness
• Let go of underneath explanations
• Diagnoses as potentially usefully ideas, not fact

A social constructionist epistemology frees us from a modernist epistemology where there is a truth so some people will be more right than others. It opens us up to the possibility of multiple viewpoints, each with validity. It gives us a way of understanding people’s knowledge as sitting beside ours, rather than having to let go of one to take up the other. Knowledge constructions can be evaluated according to their usefulness in the value system of the people using them.

It allows us to let go of the idea of the 'underneath' explanation which leads us to pathologising formulations in terms of individual and family pathology. It opens us to the possibility of a range of systemic explanations which can be taken up as they are found useful, empowering and supporting movement. For example with adolescent disorders such as Anorexia and Deliberate Self Harm one might support the person and family to identify self reinforcing cycles precipitated by the worry and distress for the family members in response to the illness behaviours and look at how they can be instrumental in changing these patterns and supporting the young person. Such formulations are more likely to be empowering and support movement than explanations based on individual and family pathology.

It gives form to the understanding of diagnoses as ideas, rather than real entities. DSM IV and ICD10 are explicitly developed constructions designed to be useful within the context of evidence-based practice. The process of developing diagnostic labels is not understood as a process of discovery of disease entities in the world and connecting them to the correct label. It is understood as developing constructions which are helpful, in communicating, focusing research effort, etc.

The term 'Schizophrenia' is an interesting example. While effective among professions in communicating, focusing research, etc, it has considerable stigma attached to it which means that workers and researchers working in the area of early intervention of psychotic illness tend to use the generic term 'psychosis', rather than 'Schizophreniform Disorder' or 'Schizophrenia'. A social constructionist view of knowledge makes sense of offering a diagnostic label as a potential way of understanding an issue, rather than as a statement of fact.