This article provides an innovative reading of the relationship between social work and the regulatory bodies mandated to register and regulate it, which has hitherto remained largely untheorised. It achieves this by utilising Hegel’s illustrative tale of ‘lord and bondsman’. This narrative outlines the development of consciousness through dialectical struggle. We argue that the relationship of domination and servitude that has developed between the profession and the regulators is incapable of delivering a satisfactory self-consciousness for either. For the social work profession, consciousness is limited to an enforced ‘being-for’ the regulatory bodies, which appropriate the ends of practice through the labour of the profession. For both to achieve full self-consciousness, each must transcend itself and the other through a dialectical movement in which each is simultaneously ‘negated’ and ‘preserved’. The article highlights ways in which social work can more courageously address its own historical development within such a struggle.

In his chapter, Murray K. Simpson argues that studies of disability in cinema often tend to focus on negative imagery, connecting impairment with undesirable moral or other character traits that are intended to induce the disapprobation or pity of the audience. These 'representational' approaches never bring a semiotic approach to the analysis of how corporeal variation functions in an overall economy of signification, intersecting with elements such as gender, class, race, the mise-en-scène and direction. In this chapter, three characters with disabilities, from two films by notorious 'exploitation' director, Russ Meyer, are considered – Mudhoney and Faster Pussycat! Kill! Kill!. By situating them in the overall context of the films, the complex interaction of impairment – deafness, intellectual disability and paraplegia – with sexuality, gender and morality reveals the impossibility of trying to isolate disability as a discrete element. The analysis demonstrates that taking 'representation,' rather than 'signification,' as the key analytic concept, creates ambiguities and contradictions that are avoided with an alternative, more semiotically informed, approach.

Since the early 2000s, in a development since mirrored throughout much of the Anglophone world, social work across UK jurisdictions has been subject to external regulation. Whilst a key justification for regulation was to enhance professional identity, there is little evidence that it has done so. Indeed, a growing literature points out conflictual and unproductive relationships between the social work profession and its regulators, within which a marked power imbalance in favour of the regulator is apparent. In this article, we illustrate the nature of this imbalance theoretically by drawing upon the classic philosophical narrative, developed by Georg Willhelm Friedrich Hegel (1770–1831), of the ‘lord and bondsman’. We seek to demonstrate the utility of the Hegelian narrative using data from a study into the views of social workers on how they understand their professional identities, focusing specifically on those aspects of the study that address the place of regulation in this process. Whilst exposing some fundamental problems in the regulatory relationship, the lord and bondsman narrative may also offer some possibility of a way forward through identifying these dialectics as a step towards a more self-conscious professional maturity.

Since its first formulation in English, the ‘principle of normalization’ has had a profound impact on policy and practice in the field of intellectual disability. Over the past fifty years, normalization, and Social Role Valorization, have drawn on liberal humanist philosophy, adopting varied and complex positions in relation to it. This article will consider an apparent structural correspondence between a discourse of ‘liberal equality’ with versions of normalization that emphasised conformity to social norms, and those drawing primarily on ‘liberal autonomy’, emphasising independence and self-determination of people with intellectual disabilities. Despite this seeming correspondence, the article eschews a structuralist account in favour of a discursive and rhizomatic model, in which the philosophical elements are seen as tactical forces deployed in the pursuit of wider strategic ends. The article concludes by highlighting paradoxes in contemporary thinking that can be traced to the legacy of normalization, specifically, the tensions between sameness, difference, equality and independence.

The binary relationship between ‘intellectual disability’ and ‘mental illness’ is widely regarded as self-evident and long-established. This chapter demonstrates that the historical, and continuing, relationship between intellectual disability and psychiatry is, in fact, ambiguous and inconsistent. Beginning with the nosology of William Cullen in the latter part of the seventeenth century, the chapter explores the dispersal of madness across all the branches of disease and illness. The advent of alienism and Pinel’s nosology of madness, at the beginning of the eighteenth century, produced much flatter conceptual structures, in which idiocy was one of the various forms of madness. As psychiatry developed, the position of idiocy shifted. Maudsley located it in a separate branch, though still not separated in a binary manner from insanity. Lastly, the nosology of the neurologist Spitzka became more nuanced and layered, though still without a binary separation of idiocy. The chapter takes the view that the lack of any consistent underlying paradigm in psychiatry will continue to make the presence and position of intellectual disability impossible to fix. Psychoanalytic and neo-Jasperian psychiatry thoroughly exclude it as an object of investigation.

The Subject of Intellectual DisabilityA Reply to Clegg, Murphy, & Almack Murray K. Simpson (bio) As a starting point, Clegg, Murphy, and Almack contend that frameworks of policy fail both to engage with ethical theory and to fit with the complex realities of how services are delivered. Both of these points are well-supported both in their engagement with literature and in the research presented. Their Deleuzoguattarian analysis and Deleuzean ethical alternatives provide fresh and challenging insights. The key question in this rejoinder is whether their critique goes too far, or not far enough. To begin, however, it is worth making a comment on terminology. Clegg et al. begin with a passing comment to the effect that ‘intellectual disability’ was ‘formerly learning disability in the UK and mental retardation in the United States’ (p. 359). Although this is clearly a gloss on an issue that may not be central to the paper, to overlook changes in terminology can miss important other conceptual and political shifts. One of the most important aspects of ‘ID’ is that it marks a coming together of the academic field for the first time since the beginning of the twentieth century. In the UK, the highly contested shift to ‘learning difficulties’ in the 1980s, and, to a lesser extent, ‘learning disability,’ was marked by the fact that it was the first time that people to whom that term was applied were active in promoting it. By uncritically shifting to ID and seeming to assume that it refers to the same thing, the opportunity to keep terminology available as a political weapon for those caught in its net is unfortunate. Second, however, it cannot be regarded as a new signifier for the same concept since ‘learning’ is an activity, a practice, whereas ‘intellectual’ returns the signifier to what is assumed to be inside either the brain or mind. If the shift in academic terminology to ID does take place, and there are certainly good arguments for it, then we ought not to take this as unproblematic and neither should we anticipate that there must be a corresponding shift at the policy and service level. The central premise of Clegg et al.’s paper is the ‘slippery’ nature of choice for people with ID and its general promotion without attention to varying levels of capacity. However, herein also lies the key problem of the paper. Choice is regarded as less than straightforward for people with ID because of their reduced capacity for making ‘informed’ choices. Central to this critique lies the troublesome figure of the liberal subject and the failure of people with ID to fit its strictures—by definition, [End Page 373] it has been argued (Simpson, 2014). The authors’ position here evinces a number of problems. The first issue arises from a failure fully to follow through the critique of the liberal subject. Following Reinders (2000), the authors identify liberalism’s emphasis on autonomous human agency as intrinsically problematic for people with ID. People with ID, it is argued, lack the necessary capacity for the kind of rational self-determination assumed and required in a consumer society, albeit to varying degrees. However, the paper repeatedly invokes choice and the assertion that people with ID have an impaired ability to practice it, and, in doing so, fails to kill off the modern subject, as Deleuze and Guattari (1984, 1987) attempt to do. Instead, the modern subject is constantly deployed as the silent standard against which people with ID have pathological subjectivity. Hence, the specter of the liberal subject still haunts the paper as the putative norm for those who do have full mental capacity and from which deviance is determined. This is evident in the assumption that the ideology of choice does bear a close relationship to how choices are generally made, and that choice is the fundamental driver in human behavior—so, for example, the questioning of whether certain choices can be regarded as ‘reasonable’ makes implicit recourse to an assumed measure of reasonableness. Žižek highlights the condition of the modern subject: [B]eing compelled to make decisions in a situation which remains opaque is our basic condition. We know the standard situation of...

With this offering, Goodey continues to assert his position as one of the most important and trenchant critics of learning disability. In many respects, this work builds on his earlier volume, A Hi...

Edward Shorter's latest contribution to the history of psychiatry is an attempt to critique current psychiatric nosologies – as exemplified by the latest version (5th) of the American Psychiatric Association's Diagnostic and Statistical Manual – and to recover lost and altered historical knowledge of mental illness as a basis for an alternative. Indeed, Shorter's claim here is nothing less than that medicine has failed in its attempts to classify mental diseases adequately, or even coherently, and that ‘it's time for the historians to have a go’ (p. 8). While it would be inaccurate to describe Shorter's body of work as Whiggish, a story of perpetual progress through science and discovery, his various contributions have certainly stood in stark contrast to the various strands of critical historiography that have dominated texts since the 1960s. Indeed, What Psychiatry Left out of the DSM-5 does not engage with any of psychiatry's other principal historiographers, from Foucault and Szasz to Scull and Ussher. Nonetheless, Shorter's attitude to the evolution of psychiatry is not entirely uncritical or straightforward. His starting point, on this occasion, is the purported tendency of psychiatry to forget the strengths of the previous epoch and to begin each time anew. Furthermore, Shorter sees his own endeavours as unabashedly strengthening the ‘medical model’ of psychiatry. In this respect, Shorter's purpose here is much more than simply to add to research on the history of medical psychology. Rather, it is the fundamental reassessment of DSM-5 in relation to historical diagnoses that ‘should have been included’ (p. viii), but which were left out, and those that ought not to have been incorporated, but were. The main focus of the book is on ‘real diseases that are found in nature’ (p. 1), which seems in tension with the broadly pragmatic approach to nosology that he adopts. Shorter attributes the inability to give greater precision to psychiatric disease entities to the ‘contamination’ and ‘spillover’ (p. 2) of concepts into real pathological objects. To the loss of certain diagnoses, such as melancholia, he posits their lack of fit with dominant paradigms, rather than any more objective assessment of their merits. Some of Shorter's targets are diseases that psychiatry has forgotten over the years, such as ‘malignant catatonia’ – ‘the only fatal disease in psychiatry’ (p. 48) – while others are misguided inclusions in DSM-5. Perhaps the most controversial example of the latter is the contention that bipolar disorder is a non-existent disease created by Karl Leonhard, an ‘obscure German’ (p. 79), in 1957. Drawing on evidence from the 19th and 20th centuries, Shorter contends that the division between bipolar and monopolar disorders is essentially one of degree and individual variation, rather than of fundamental type. This confusion adds to the ‘urban myth’ (p. 93) in psychiatry that bipolar disorder should never be treated with antidepressants, only with mood stabilisers, despite clinical evidence to the contrary. Shorter tries to create his own nosology on the basis of biology and historical integrity, although acknowledging the lack of a clearly identifiable biological basis for most psychiatric conditions, and also eschewing a symptom-disorder approach. Hence, the biological basis is more assumed than established. In any event, Shorter's assumptions about the nature of the connection with history is dubious. Shorter suggests that, hitherto, or in a former age, the development of knowledge involved some form of sifting process in which the best of extant knowledge was kept and false or unreliable knowledge was replaced by better. Furthermore, he states, DSM-5 has decisively abandoned all such ambition and, with it, nosological credibility in psychiatry. Shorter writes in a very informal and engaging style. This enables him to introduce his arguments and the diagnoses he describes to even the most unfamiliar reader. However, there are also some sweeping and simplistic statements that are not always grounded in evidence; namely, about the degree to which paradigms dispense with the past; about the characterisation of certain innovations as classification by committee, full of compromise; and about the diagnostic power of pharmaceutical companies. Shorter also has a distinct tendency to valorise other factors, from which he takes more succour, without any clear basis for doing so. The problems with Shorter's argument become all too clear in the erratic slalom between nosology based variously on symptoms – ‘the medical model’ – the form or ‘course’ of disease, and organic lesion; all of which are endorsed at some point or other. In his own proposed model, Shorter seems happy to make certain divisions based on prognosis, such as adolescent versus older-onset ‘chronic psychosis’ (currently coming under the single heading of schizophrenia), though it would seem odd to split any other disease on the sole grounds that prognosis varied with age or influenza, for instance. In addition, there are questions to be asked about Shorter's own inclusions and exclusions in his choice of examples. Intellectual disability is particularly apropos as an illustration of the problems of the DSM-5 though, curiously, Shorter does not take it up. Any psychiatric paradigm that coheres to a lost or diminished psychic unity – such as psychoanalysis, or critical psychiatry – can find no logical space for intellectual disability. Nonetheless, intellectual disability has a persistent presence in psychiatric nosology. Most people with intellectual disability have no accompanying diagnosis of clinical pathology, and of those who do, each could be considered an entirely separate ‘disease’. Furthermore, DSM-5 makes no mention of organic pathology as a diagnostic criterion. The underlying problem here, and the one that silently pervades Shorter's book, is the impossibility of either a coherent non-paradigmatic psychiatry, or a paradigmatically unified one that could encompass all that psychiatry claims to itself. The question of just what psychiatry is, could be, or ought to be is not dealt with at all here. Why have psychiatry at all? The answer to this question cannot be found in the defence or rejection of individual diagnoses. Overall, Shorter's book is lively and challenging. However, he arguably becomes carried away with his own rhetoric and bias. It is unlikely that the nosology, which he only sketches, will materialise, not least because Shorter fails to consider psychiatry as a whole and contemplate those bigger factors that continue to make it the most contested of all medical specialisms.

The small number of studies on alcohol use among adults with intellectual disabilities shows their usage is significantly less than average, with very high levels of abstinence. Despite this, the literature focuses almost to exclusion on the very small number of people who do have problems, and neglects to question the possible reasons for this differential pattern of consumption. This article reviews the extant literature, showing that it constructs an inherently pathological view of drinking in people with intellectual disabilities, framing it entirely within a discourse of risk and as a personal behaviour, rather than as a social and cultural one. As a counter to this perspective, the article opens up new lines of exploration around the significance of abstinence, why it might occur to such a high degree and whether, in fact, it might itself be and also point towards the cultural exclusion of people with intellectual disabilities.

Journal Article Working with Adults at Risk from Harm Get access Working with Adults at Risk from Harm, Margaret Greenfields, Roger Dalrymple and Agnes Fanning (eds), Maidenhead, McGraw Hill/Open University Press, 2011, pp. 196, ISBN 9780335241224 (pb), £22.99 Murray Simpson Murray Simpson School of Education, Social Work and Community Education, University of Dundee Search for other works by this author on: Oxford Academic Google Scholar The British Journal of Social Work, Volume 42, Issue 5, July 2012, Pages 1007–1009, https://doi.org/10.1093/bjsw/bcs110 Published: 01 July 2012

• Summary: This article provides a critique of the epidemiological research that currently informs mental health social work with asylum seekers. Most of the literature that currently informs social work practice with asylum seekers with mental health difficulties comes from psychiatric studies which are largely underpinned by a medical model. • Findings: It is argued that aetiological accounts, predominantly deriving from psychiatry and based largely on biological causation, are untenable. A more comprehensive model is presented, which considers both biological causation and a social perspective and locates the mental health difficulties experienced by asylum seekers in a much wider context. The model is further divided into pre-, post- and migratory stress factors. • Application: The aim is to provide social work with a practical tool to make sense of the mental health difficulties faced by asylum seekers, help in the development of assessment tools, and help multidisciplinary agencies to define the roles and remit of staff as well as contribute towards the development of policy and practice.