The psychiatric “medical model” comprises the response by today’s society in dealing with unusual modes of subjectivity; the hearing of so-called ‘voices’, the experiencing of so-called visual ‘hallucinations’ and other unusual perceptive phenomena. These modes of alterior subjectivity can manifest as both bizarre and bewildering to the experient and as frightening and confusing to those around them.
To avoid the danger of a possible violent conflagration it is thought best to segregate the experient from the rest of society via the mental institute or asylum - until such time as the individual has “recovered” their senses. It is the consultant psychiatrist who determines when a person is “fit” to rejoin the wider world; and thus, a psychiatric sojourn, once began, can, in theory, and often does, last indefinitely. The preferred mode of treatment has a deceptively simple goal; to bludgeon the sensory apparatus of the experient. Many different drugs are used of course but they all have this ultimate end in common - despite what they say on the wrapper.
Now, the closest I have come to murdering someone with my bare hands was when, as a ‘man interrupted’ in my second visit to a psychiatric ward I was told to don a pair of pyjamas, take ‘my medicine’ and prepare for a ten o’ clock nightcap. I thought of immediately crushing the nurse’s head against the wall and stamping the life out of him. The impulse to do so was so strong I didn’t think any force could prevent me from doing otherwise.
As luck would have it; I managed to restrain the “demon” within, and that man is alive today, and I, for my part, was in a position to carefully bring about the conditions of my release - some two months later. Some might be appalled and think if I were capable of doing such a thing then ‘they’ were right and there was every reason for me to be ‘locked up’. But I will tell you this; you do not or cannot then know, what the meaning of frustration in it’s essence is - of being unable to communicate your mind and thus have yourself known and understood by those around you. Worse still, is having to deal with this wall of ignorant nonsense known as psychiatry.
Now, on “release”, it was evident that inheriting the rubric of ‘mental illness’, to be placed in the position of having to use such a phrase to describe your past and present status seriously curtails your future prospects in almost every sphere of life. In reality, the concept of ‘mental illness’ is a misnomer, it has no real meaning and deserves no usage for it quite unnaturally, demarcates and effectively banishes to the nether regions a significant, yet predominantly voiceless and thus powerless proportion of our society.
You can attempt to dismiss it, as I have done for years, as an impossibly crude, hopelessly absurd and overly-simplistic ‘explanation’ for a particular period in your life, yet, despite my awareness of this fact, would-be employers still turn up their noses as though you had spent years marinating in some foul and rancid sauce. They will have the presence of mind, of course, to nod sympathetically as they are aware they should in such cases, but ultimately, your unlikely to get the call, nor indeed, should you expect to, for once you have accepted the term ‘mental illness’ as being in any way a satisfactory designation for who you are, what you were, or, what ‘Please God’, you hope never to be again, if you accept all of that, then you have what I would call a real problem; you have embraced the mythology of the psycho-pharmaceutical complex - yet another virulent offshoot of untrammelled late capitalism.
However, there is no shame in this as you have been deceived by powerful forces. What makes this particular myth so powerful, and it is a characteristic shared with all virulent falsehoods that cloud human reason, is that (a) its chief proponents, the psychiatric profession, believe substantively in the letter of its creed - I know, having spent several years in and out 'their care', I can say they never ‘blink’ - and (b) ‘Big Pharma’, the drugs companies who sponsor the research and clinical trials, provide the billions in advertising, and who incessantly lobby our politicians, are happy to continually embellish the myth; indeed the myth couldn't be sustained without their largesse. These latter group, however, cannot be said to actually believe in anything, least of all a myth of their own making.
No, their concerns are much more mundane; share values, profit margins, market penetration and 'blockbuster' drugs. This in itself is not a crime, unfortunately, and most crimes are forgivable as long as you provide jobs and taxes. In fact, it is in this sector of the economy where even the 'myth of mental illness' is eclipsed in scale only by the myth of ‘Corporate Social Responsibility’.
Of course, no self-respecting myth-making apparatus would be complete without a ‘holy book’ and in this era of neurological reductionism its text is written in the few square centimetres of ’impossibly complex’ space between your ears. Its pages, the twisting labyrinthine neural networks of axons and dentrites. Its words; anything that is zipped, zapped, ferried, shipped, hauled, transported or responsible for acts thereof within and between this admittedly wondrous architecture; to wit, trillions of neurotransmitters, potassium ions, amino acids and sundry assorted exotic molecules that fizz in and out of existence in the seething electrified soup of the synaptic junctions. Its grammar; well, its anyone's guess really - your laptop would sooner rewrite its own source code and dispatch itself to the moon - than an administered neuroleptic change who you are. Though it will make you less of what you are.
And yet, despite this, we still have knowledgeable scholars, whom we call ‘neurologists’ who seek to interpret the ‘holy writ‘, holy and sanctified because what transpires there, oddly enough, tells them just about everything they need to know about ourselves and our ‘sins’. Under the old regimes - both animist and monotheistic - we were possessed by all manner of demons whose names were, in one famous instance at least, legion; well plus ca change, Roger Blashfield writing in the Journal of Nervous and Mental Disease in 1996 and tracing the staggering expansion of afflictions documented in the pages of the Diagnostic and Statistical Manual predicted it's fifth edition would have ‘256 pages, will contain 1800 diagnostic criteria, eleven appendices and would generate $80 million in revenue for the American Psychiatric Association’.
He was of course lampooning the whole tragi-farcical evolution of syndromes, disorders and diseases each multiplying exponentially as a consequence of our 'vastly improved technologies' - MRI and PET- and each coming with a tailor-made and competitively priced solution; why three Hail Mary's and an Our Father when we now have Zyprexa and Olanzapine, or a decade of the rosary - when your nasty demons can be pacified by Syrenase or Chlorpromazine and so it goes, and so it never stops in fact, for we are now lifetime subscribers, a shareholders fantasy, a captive market (did we mention your condition was deteriorative?), battery humans in the factories of Pfizer and Novartis --- in the wards we are made to pad limply as limbic disembodied ghosts grateful for our daily benediction - a sad, appalling, grotesque charade, there is a genuine affliction here alright - its called Stockholm's Syndrome.
Now we see immediately that we are in trouble because in order to talk about a thing it is natural in trying to bring order to chaos by attempting to place it under some sort of classificatory heading. Then we may say of a thing that it is like this or that or that it belongs to this range of phenomena and so on. But how can you begin to talk about ‘psychosis’ if you start off by contending that it is not even a mental illness for all at once you have removed it from the spotlight under which it seems, it has always languished.
Let me illustrate what I mean by retelling an old Sufi teaching story;
“It is late at night. The legendary wise fool, Mullah Nasruddin, is crawling on his hands and knees under a corner street lamp. A close friend discovers him and, thinking that Mullah may be a little drunk, tries to help:‘Mullah, let me help you up! Do you need help to find your way home?’
‘No, no, my friend …. I’ve lost the key to my house. Here, get down on your hands and knees and help me look.’ Groaning, Mullah’s friend gets down onto the hard pavement and begins to crawl around. He makes a thorough search, peering into all the crevices in the cobblestones, gradually and laboriously widening his search. After what seems like hours his knees are aching. No luck.‘Mullah, I’ve looked everywhere within thirty feet. Are you sure you’ve lost your keys here?’
‘No .. actually, I think I lost them about a block away, over there.’
‘Mullah, Mullah - you idiot! Why are we wasting our time here then?’
‘Well, the light was better here ….. .’”
And so we ask ourselves who is sponsoring the wattage of this spotlight that is shining erroneously on the terrain of the brain. The question becomes central because if we cannot become aware of how a handful of institutions has so adroitly managed society’s response towards an ancient set of behaviours then we are indeed in a collective mire.
William James in his study The Varieties of Religious Experience (1902) set himself the task of approaching the matter of religion not from the point of view of its external forms; its dogmas and institutions, but from those "unique" mental states that gave rise to it in the first place;
"There can be no doubt that as a matter of fact a religious life, exclusively pursued, does tend to make the person exceptional and eccentric. I speak not now of your ordinary religious believer, who follows the conventional observances of his country, whether it be Buddhist, Christian or Mohammedan. His religion has been made for him by others, communicated to him by tradition, determined to fixed forms by imitation, and retained by habit. It would profit us little to study this second-hand religious life. We must make search rather for those original experiences which were the pattern-setters to all this mass of suggested feeling and imitated conduct. These experiences we can only find in individuals for whom religion exists not as a dull habit, but as an acute fever rather. Invariably they have been creatures of exalted emotional sensibility. Often they have led a discordant inner life, and had melancholy during a part of their career. They have known no measure, been liable to obsessions and fixed ideas; and frequently have fallen into trances, heard voices, seen visions, and presented all sorts of peculiarities which are ordinarily classed as pathological. Often, moreover, these pathological features in their career have helped to give them their religious authority and influence."
So, before we can even begin looking at the modern era we may well ask who in earlier times bore the characteristics of today's "mentally ill"? It is a sobering thought after all to think that there are millions across the world today who have undoubtedly had original experiences comparable to the founders of the great religions and who are yet subjected to that invidious form of social ostracism known as a psychiatric diagnosis. Viewed in this light there doesn't appear to be any genuine empathy or real understanding of the lives led by these founders (with whom the vast majority of us claim to identify), for if there was, surely there would be a greater attempt to understand the emotional turmoil undergone by so many found in today's psychiatric wards. James, it may be noted, shared Carl Jung's incredulity at what was been called the biological reductionist approach, further reflecting;
"Medical materialism seems indeed a good appellation for the too simple minded system of thought which we are considering. Medical materialism finishes up St. Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epiliptic. It snuffs out St. Teresa as an hysteric, St. Francis of Assisi as an hereditary degenerate. George Fox's discontent with the shams of his age, and his pining for spiritual veracity, it treats as a symptom of a disordered colon."
For the evolutionary psychologists Price and Stevens the original impulse to posit the existence of a God or gods or to improve on pre-existing notions of the aforesaid usually emerge from characters who, they are careful to mention, share much of the symptomatology of today's mental patients and 'neurotics'. In their study Prophets, Cults and Madness the "schizotypal" personality trait, a DSM classification which broadly coincides with what Freud defined as the paraphrenias, is implicated as the primary motor force in the splitting of primitive groups and the consequent development of new societies with a fresh ideological superstructure.
The schizotypal personality trait is moreover highly suited to this task because of their supposed "pathogenic" propensity to obsessively dream of new and improved systems of social organization. In the modern world the same sets of behaviours are now treated as a threat to the social order because the base from which the "experients" would have received support - the network of close affiliations and alliances characteristic of an integrated village and community life - have, in modern times, been largely eroded.
What the "madmen" (seers, prophets, shamans) of earlier times seemed to have had as an advantage, prior to the Enlightenment, and the near universal acceptance of empirical modes of enquiry to establish "the truth", was the communal acceptance of the presence of a spiritual realm; a realm which allowed for the existence of the gods, witchcraft, the supernatural and, if you like, pillars of tortoises.
In other words, some, like the shamans, had a privileged position with regard to the generation of meaning and it seems in fact that there has been a remarkable reversal of fortunes for the bearers of the condition. The body of the experient has necessarily remained the same, yet the process of signifying inscription has over the millenia conspired to invert their relative value to society. This transition or fall from grace invites all manner of interesting questions not least from the point of view of what we may call social evolutionary dynamics.
Can a genotype that was not only accepted but thrived from the earliest stirrings of human consciousness be so summarily dispensed with? To what extent has the phenotype expression of the psychotic/experient genotype altered from hunter-gatherer times to the present and what is the exact nature of the adjustments which the phenotype has felt incumbent to make? How has the genotype compensated for the radical shift in signifying inscription? This altered interface between the body of the experient and the wider social whole may be dramatised as follows;
Ancient World
Your voices tell us the thoughts of our ancestors, you shall tell us the meaning of our dreams, perform our rituals, draft our laws, and speak on our behalf to the gods. Your gifts are vital to the spiritual life of the tribe.
Modern World
Your voices tell us that you have a diseased brain. There is no cure, but this illness can be combated through the use of neuroleptics. If you had the money you could avail of a psychotherapist who can interpret your dreams and perform a ritual of cathartic cleansing. If you disagree with this diagnosis you will most probably relapse. In which case, we will have little sympathy, declare you to 'lack insight' and expose you to 'our law'; indefinite confinement. There are no gods. From an economic standpoint you are currently worthless, which reflects the level of interest I'm showing in you, hardly any, as you can tell. However, you may once again become a productive member of society. The choice is yours.
So, I wanted to talk about what has come to be called 'psychosis' but you can't begin to have a discussion when there has been so much of this accumulated interference. Strangely enough, the further back in time you go the more fitting the explanation. You come across first-hand accounts and experiences that more resemble your own. Then, somewhere around the turn of the 18th century a savage domestication had occurred; the 'condition' had been hijacked by the medical fraternity, its then specificity immolated and its ludic mysteries expunged.
In short, no particular importance should be attached to my use of the word ‘psychosis’, it is merely the present day nomenclature for the phenomenon under consideration. As we are perhaps aware ’psychosis’ is a strictly medical category and as such is grounded in the historically contingent act of handing over to clinicians the task of interpretation. For the historical development of the concept of ‘madness’ it is enough to remind ourselves that there is this history of intersecting influences, some consciously determined, others derived ‘passively’ from prevailing epistemological assumptions. These have contributed, and continue to do so, to our understandings of what is meant by, what I am tempted to describe, for the sake of a certain type of clarity, as simply x.
For the moment we will stick to the present term ‘psychosis’, whose singular failing, let us be reminded, as a satisfactory ‘signifier’ is precisely its function as a diagnostic category. In other words, as a signifier, it immediately designates the individual as belonging to this sorry tradition of belittlement, this corpus of knowledge produced by the psych-industry that diminishes and incapacitates.
Since we need to start somewhere we may as well begin with some of the concepts found in the work of the French social philosopher, Michel Foucault, since his labours have perhaps done the most to alert us to this particular hegemony’s construction of knowledge.
Divided into two distinct periods, Foucault's first phase is often regarded as the archaeological, the second as the genealogical. As he understood them, the dissemination of systems of thought and knowledge (‘epistemes’, or discursive formations) particularly as they pertain to the social field are governed by unconscious rules that make their proper apprehension lie beyond all but the most rigorous analyses. It is these ‘rules’ that determine the range of conceptual possibilities open to a society in any given period.
The ‘social archaeologist’ through an exhaustive study of the conditions that gave rise to and support the dominant episteme will be able to expose the often contingent and non-rational manner through which they secured legitimacy. More often, what is ‘unearthed’ by this form of social archaeology will be a detailed excursus of the means by which the dominant narratives maintained their hegemony. A genealogical analysis, by contrast, but in tandem with the same overall project of emancipation attempts to unearth those ignored, subjugated, or ‘illegitimate’ narratives and by unveiling them provide a more trenchant and lasting form of social critique.
Generally, it is through the richness and diversity of these alternative narratives that the inconsistencies and contradictions of the dominant paradigm begin to announce themselves. More often too we can also detect in these ‘micro-narratives’ the incursions or territorializing of the rationale and logic of the dominant meta-narrative(s).
Their organizing or ‘master’ signifiers will announce themselves at times so forcefully that our valued micro-narratives far from being the pristene and unalloyed stories we would like them to be often instead emerge as mimetic reproductions; more influenced than influencing. This is an effect of power.
It is here too then that there must begin the project of restoring true agency, valid self-determination and genuine empowerment to the often oppressed bearers of these suppressed ‘tales from the underground’. In this respect too we may remind ourselves of the notion of the subaltern; a term originally used by Antonio Gramsci in the context of postcolonial theory to refer to marginalized or minority groups under the yolk of imperialist hegemony.
But in the work of Gayatri Chakravorty Spivak, in particular her essay, ‘Can the subaltern speak?’ the term has received a more nuanced meaning referring to the subtle ways in which a person is denied this agency or means of representation on account, not merely of their physical dispossession through the colonial process but of their linguistic dispossession as a result both of the scrambling of familiar cultural registers and the forcible imposition of a foreign language; both of which events will now forever sit uneasily with the more natural rhythms of the native indigenuous 'mazeways' and idioscapes.
In our own context we can see that the dominant narratives produced by the psych-industry have wholly co-opted the experience of ‘psychosis’. Having being brought it into being as a 'medical condition', Big Pharma has shepherded it carefully through its own studiously choreographed ‘neuroleptic revolution’ and is now watching it mature into some optimus prime real estate - evidenced by the fact that market penetration for the ‘psychosis’ product alone will inevitably spill over the two per cent demographic due to the casual ubiquity of off-label prescriptions and an increasingly expansionary diagnostic umbrella.
The United States today consumes eighty per cent of the entire global production of pharmaceutical drugs. It is an almost unimaginably lucrative market. In Pattison and Warren’s 2002 paper ‘Drug industry profits: hefty pharmaceutical company margins dwarf other industries‘, published by Public Citizen Congress Watch it was estimated that in that calendar year the top 10 drugs companies in the United States had an average profit margin of 17% compared to an average of 3.1% for all other companies in the Fortune 500.
What is altogether more remarkable is that the profits of these 10 companies ($35.9b) were more than half the combined profits of the other 490 companies ($69.6b). You cannot even begin to talk about ‘mental illness’ without reference to figures such as these. As the US market becomes increasingly saturated we may expect a steady migration of novel afflictions and disorders from across the Atlantic as US drugs companies aggressively target European markets - ADHD being the boardroom's current poster-child.
The 'subject', and I use the word deliberately, has been interpellated, for the person is no longer an autonomous actor, but is subject-to, or 'subjected to' the interpretative power of the corrosive fables emanating from these powerful institutions. Marx, who was alas, not an idiot, was among the first to deploy the notion of the interpellated subject, meaning as I have said, an individual who is been 'spoken for', deprived of autonomy; represented, but scarcely on ‘their behalf‘. And so, not for the first time in history a powerful multi-institutional complex is determining for its own ends the nature of objective reality.
When President Eisenhower, on leaving office, warned the American people to beware the disturbing encroachments of the ‘military-industrial complex’ he presumably looked to the executive and legislative branches of government as a bulwark. That the converse has occurred; the former absorbing the latter aided by rabble-rousing Cold War rhetoric and a frankly comatose electorate, should likewise have not struck him as all that shocking.
We call our own somewhat humbler, though no less ambitious Complex, ’psycho-pharmaceutical’ mainly out of respect for brevity, for in reality it contains at least three other important feeding stations; a strumpeted research sector beholden to corporate financing, a hamstrung legislative crippled by the threat of an internationally mobile capital and, certainly with respect to the framing of the discourse on ‘mental health’ we see a wholly compromised fourth estate, the mainstream media. So, sitting in the midst of these four axes, which are simply a transparent extension of its will, lie the corporate entities of ‘Big Pharma’.
This coercive interpellation of the subject has largely succeeded in depriving the individual of effective agency and so the possibility of authentic self-representation. Likewise, the system of thought and knowledge which undergirds this, at times insidious, process of disempowerment is usually most readily located wherever the concept of ‘mental illness’ is discussed as though it were a concrete and easily discernible reality.
In fact, ‘mental illness’ is no more than a cleverly conceived advertising slogan but to see it thus in all its pathetic nakedness requires divesting a complex episteme of its supporting rationale. It follows from this that the whole business of ‘challenging the stigma of mental illness’ engaged in so earnestly by advocacy groups does nothing more than further entrench the legitimacy of the psycho-pharmaceutical complex. The idea of mental illness itself is the minotaur that lies at the heart of the labyrinthine ideology of this Complex. It is, to use the phraseology of Foucault its epistemic nexus for from it flows all the irrational conceptualisations that continue to sustain the Complex’s legitimation.
Only when the acknowledged irrationality of these narratives become the accepted norm can this nexus be said to have exhausted the logical possibility of its continued reproduction. Within the corporate-controlled ‘medical’ discipline of psychiatry, the raw experience is quickly appropriated on scarcely concealed disciplinary grounds and its ‘reality’ is demarcated within a pseudoscientific neurological framework for the purposes of creating a captive market of life-time subscribers for its pharmaceutical products and the resultant commercial exchanges are facilitated and conducted under the legitimating veneer of the modalities of the doctor-patient relationship; the former now being in the position of the ‘subject supposed to know’.
Likewise, in the psychotherapeutic relationship an artificial hegemony is established based upon this false attestation of ‘knowledge‘. The therapist’s epistemological certainties of this artificially contrived category of ‘psychosis’ are accrued and corroborated through the exposure to and contemplation of ‘clinical case studies’ themselves constructed through the lens of the ‘expert‘. This knowledge is not informed by experience but is in the main arrived at through the attempt to rationally apprehend a phenomenon whose points of fixity have already been predetermined by the so-called expert.
Psychotherapy also, perhaps fatally, shares with psychiatry the presumption of ‘pathology’ and so proceeds to ‘fix’ what it is not necessarily broken. It is true that in the past there have been some innovative ‘therapists‘, for instance Carl Rogers, who foreswore the application of theoretical considerations in favour of‘empathy’ and ‘unconditional regard’. Yet even today it may be seen that these simple precepts have been swallowed up by the march of methodological enhancements, thereby unnecessarily systematising an approach which demanded from the onset innovations that increased emotional rather than intellectual sensitivities.
It really isn’t that difficult after all; if you approach the phenomenon of ‘psychosis’ from the point of view that you know absolutely nothing then you could at least be assured of being untethered from a host of common misperceptions. The problem exists precisely because the approach to the problem is situated as Lacan says ‘on the plane of understanding’, and the pretence to especial knowledge is the first veil that will be torn down by the ‘psychotic’.
This is an early ‘insight’, if you like, into a methodology, precisely because it is the reactionary stance taken towards ‘knowledge’ and ‘meaning’ that lies at the heart of the condition. Let us then first orientate ourselves within this field by sampling some of the ways in which the grand explanatory 'metanarratives' of madness have altered themselves over the centuries and begin by revisiting with Foucault the asylum at La Salpetriere at the end of the 18th century;
“Madwomen seized with fits of violence are chained like dogs at their cell doors, and separated from keepers and visitors alike by a long corridor protected by an iron grille; through this grille is passed their food and the straw on which they sleep; by means of rakes part of the filth that surrounds them is cleaned out.”
Foucault likewise reports the impressions of one Francois Fodere on a visit to the 'hospital' in Strasbourg in 1814;
“…he found a kind of human stable, constructed with great care and skill: ‘for troublesome madmen and those who dirtied themselves, a kind of cage, or
wooden closet, which could at the most contain one man of middle height, had been devised at the ends of the great wards."
We are further told;
“These cages had gratings for floors [over which] was thrown a little straw upon which the madman lay, naked or nearly so, took his meals, and deposited his excrement"
Foucault ‘s aim is to draw our attention to the conceptions of madness that lay underneath these methods of confinement. Or, perhaps it would be more accurate to say the complete lack of a conception for the mad were regarded as ‘no longer men whose minds had wandered, but beasts preyed upon by a natural frenzy’, who had ‘managed to rejoin, by a paroxysm of strength, the immediate violence of animality’.
The asylums were essentially conceived of as security systems against the violent outbursts of the insane. Their behaviour was regarded as a social danger but most important, for Foucault, is that this danger is conceived in terms of an animal freedom;
“The animality that rages in madness dispossesses man of what is specifically human in him; not in order to deliver him over to other powers, but simply to establish him at the zero degree of his own nature. For classicism, madness in its ultimate form is man in immediate relation to his animality, without other reference, without any recourse.”
What is completely striking then is that in modern psychiatric conceptions this primal vigour, this ‘presence of animality’ became;
“the sign…indeed, the very essence….of disease. In the classical period, on the contrary, it manifested the very fact that the madman was not a sick man. Animality, in fact, protected the lunatic from whatever might be fragile, precarious, or sickly in man. The animal solidity of madness, and the density it borrows from the blind world of beasts, inured the madman to hunger, heat, cold, pain. It was common knowledge until the end of the eighteenth century that the insane could support the miseries of existence indefinitely.”
I am foregrounding this Foucauldian critique for one simple reason, and it is this; it will be apparent to all those with even a passing interest in the psychiatric literature designed for the consumption of outpatients and their families how the ‘patient’ of the modern era is consistently represented in terms of a profound ‘lack’. There is always an unmistakeable fragility of ‘being’ implied. I am not interested at present in assessing the validity of this apparent consensus through the only manner in which it can be resolved; that of a frank and direct series of interviews with a sizeable proportion of those who have sampled the pleasures of a psychiatric sojourn.
What I am interested in is how this particular form of narrative explication has managed to supplant the explanatory discourses that justified the forms of incarceration as detailed by Foucault. To answer this question we are clearly in need of a robust socio-theoretical model from which we can chart these deviations in ideological emission. But this I foresee will not come easily for the very words we chose, those that spring the quickest to our mind, are themselves the haunted emissaries of a thousand battles. Our narrative of deficiency, we are reminded, is put forward, by now, in an automatic fashion denoting as always the structuring presence of unconscious determinants, a factor that should at all times arrest our interests.
I think we are beyond reminding ourselves that the dominant discourses in any era as they are viewed contemporaneously are especially marked by a certain invisibility of effect. They appear as the wholly natural representations of a ‘self-evident’ reality. It is only when the storm is past that we have the wherewithal to assess where the prevailing wind has been sweeping us so let us try for once to intercede at a point prior to this natural buffeting.
Before we begin swishing about in the deep end, however, which I will refrain from defining for the present, let us practice our ‘stroke’ by taking a look also at some of the ripples of discontent that are beginning to emerge from within developmental psychology. Let us look briefly at the calls for a ‘post-Kraepelinian’, or symptom-orientated approach. Richard P. Bentall, a Cambridge psychologist of contemporary vintage, whose ‘Madness Explained’, of course, does nothing of the sort, but instead displays an encyclopaedic awareness of all the rubbish that has been written on the subject (though this is not meant as a criticism of Mr. Bentall’s actual analysis as it pertains to the wonderfully circumscribed universe in which he has chosen to deliver it)) he nevertheless identifies Adolf Meyer as a pioneering figure in the development in that trend, which adopts a sceptical attitude towards the pursuit of any taxonomic ‘purity’;
“Meyer’s later writings, mostly published after his death in 1950, advocated a holistic approach to psychiatry in which biological, psychological and sociological approaches were considered to be equally important…. he became pessimistic about the value of psychiatric classification, arguing that ‘We should give up the idea of classifying people as we do plants’. He felt that psychiatric categories did little justice to the complexity of patients’ problems, their individual histories, and the social circumstances in which their problems arose. He also objected to the superstition that a diagnosis led automatically to a choice of treatment and suggested that, rather than grouping different behaviours under one name, clinicians should base their treatment decisions on a concrete specification of the various problems from which the patient suffered”.
One of the many experimental approaches which gave impetus towards the calls for a symptom-orientated approach, as we learn from Bentall, is that of discriminant function analysis first used by Kendall and Gourlay in 1970. In this study they compiled the symptoms of 300 patients who had been previously diagnosed with both schizophrenia and affective disorders. Assigning negative scores to ‘schizophrenic’ symptoms and positive scores to those given an ‘affective’ diagnosis it was found that most patients fell in the middle range, close to zero, indicating the existence of a continuum rather than the presence of two discrete ‘illnesses‘.
More comprehensive analyses have since been carried out corroborating these initial findings. Much can gleaned from the response of the compilers of the DSM; instead of proposing a fundamental re-evaluation of their theoretical suppositions they have instead responded with a further proliferation of diagnosticcategories. Perhaps the most crucial upshot of this diagnostic uncertainty is the implications it has for guiding research; a difficulty already foreseen by Meyer in his objection that a diagnosis was believed to lead automatically to a choice of treatment. For which ‘schizophrenic’, after all, is receiving the MRI scan that will indicate ‘structural’ or ‘functional’ abnormalities’.
Is it the senile, almost autistic version espoused by Emil Kraepelin or the linguistically-challenged, emotionally discordant subject of Eugen Bleuler? Or is it in fact a hazy conflation of both these ‘signifieds’? What has occurred in this interim between the classical conception of madness defined by Foucault as ‘man established at the zero degree of his own nature’, a zero degree that is marked, above all, by a ‘primal vigour’ and the ‘patient’ of modern times who is systematically emasculated by the competing explanatory discourses that comprise the psych-industry.
In Foucault’s later work ‘The Archaeology of Knowledge’, there is an attempt to provide a new grammar for ideological analysis. The archive is a term which he has used to describe that which is determined to lie ‘at the very root of the statement event, and in that which embodies it, defines at the outset the system of its enunciability….’
Within the archive itself the language (langue), ‘defines the system of constructing possible sentences’, and the corpus ‘passively collects the words that are spoken’. He goes on;
‘It is obvious that the archive of a society, a culture, or a civilization cannot be described exhaustively; or even, no doubt, the archive of a whole period. On the other hand, it is not possible for us to describe our own archive, since it is from within these rules that we speak, since it is that which gives to what we can say - and to itself, the object of our
discourse, - its modes of appearance, its forms of existence and coexistence, its system of accumulation, historicity and disappearance.’
In ‘Madness and Civilization', Foucault went to considerable lengths to unearth the archive that lies behind contemporary statement events such as ‘you have a mental illness’. Like a skilled chiropodist dealing with a troublesome ferruka he realised that only a root and branch analysis could possibly lead to the eventual erasure of the system of its enunciability for this is clearly what is intended and what is at stake. Roy Porter, the medical historian maintained that ‘its insights have still not been fully appreciated or absorbed’.
The subtitle of Foucault's work; ‘Insanity in the Age of Reason’ tells us that our present understanding of madness as the quintessential condition of unreason or insanity was itself forged in that period where faith in human reason was held to be absolute.This is important to note because once the dichotomy has been established the condition of ’madness’ is being actively created as the negativised mirror-image of the idealised ‘man of reason’.
If we were to grossly oversimplify and characterise the folly of an age we would say here that man presumed himself to possess all the relevant variables and if they were not immediately available they could readily be found through the exercise of reason. For example, it was in this era that the empiricist mode of enquiry was established in the natural sciences. This entrusted the human senses to objectively collate, compare and contrast data and then select from the myriad possible forms of nature a workable experimental hypothesis which could then, through repeated testing, be either proven or disproven. Hence, general laws could be established and these laws were given the privileged status of ‘knowledge’.
In philosophy, the same self-confidence can be noted through the preponderance of the ‘axiomatic’ or ‘self-evident’ assertion of first principles characterised most famously by Descartes assumption of the self-aware or self present ‘I’ from which he deduced the ‘ontological proof for the existence of a benevolent God’. This notion of the stable and centred ’I’ was itself derived from a subtle reformulation of Platonic dualism whereby the ‘I’ as ‘thought’ or ‘mind’ became in Descartes hands a property of the res cogitans (eternal thinking substance) and the material body partook or belonged to the res extensa (measurable, extended in space, materiality).
To place these observations within the context of our own discussion it may be useful to ask ourselves what assumptions lie behind the following blurb for Samuel Barondes ‘Mood Genes’:
‘Should people (and foetuses) have their mood genes examined to assess their predisposition to mood disorders? Will new treatments of mood disorders adversely affect positive character traits such as creativity? In dealing with the specific issues raised by mood disorders, Mood Genes is a compelling introduction to genetic studies of human behaviour.’
The first and most obvious assumption being made here is that extreme fluctuations in mood, in and of themselves, constitute not merely a ‘disorder’ but an ‘illness’ and ‘disease’. From these assumptions that of course fly in the face of the avowed scientific methodology of deducting from solidly established first principles a prescriptive thematic is adopted throughout and the grand narrative of heroic scientific endeavour quickly
supplants any lingering doubt of a connectivity between ideation, behaviour and any specific environmental triggers that may be present. These are terms that are used continuously throughout the work and ‘the illness’ or ‘disease’ rapidly become shorthand descriptions for the constructed set of symptoms that have become known as ‘manic-depression’ or, more lately, bipolar ‘disorder’.
Thomas S. Szasz, the Hungarian born US psychiatrist, has, in a series of works provided in modern times what many regard as the most trenchant critique of ‘the myth of mental illness’. In his preface to the book of the same title he regards his mission as ‘laying bare the sociohistorical and epistemological roots of the modern concept of mental illness.’
In Foucauldian terms this may be seen as an attempt to alter the landscape of the archive, to challenge the system of it’s enunciability, which, we can say, has become so crystallized that it has made it impossible for us to conceptualize the range of phenomena associated with ‘psychosis’ other than mentally equating them with a pathological aetiology.
In his introduction Szasz writes;
"It is widely believed that mental illness is a type of disease, and that psychiatry is a branch of medicine; and yet, whereas people readily think of and call themselves ‘sick’, they rarely think of and called themselves ‘mentally sick’. The reason for this, as I shall try to show, is really quite simple: a person might feel sad or elated, insignificant or grandiose, suicidal or homicidal, and so forth; he is however not likely to categorize himself as mentally ill or insane; that he is, is more likely to be suggested by someone else. This then is why bodily diseases are characteristically treated with the consent of the patient, while mental diseases are characteristically treated without his consent."
Szasz
continues;
"Individuals who nowadays seek private psychoanalytic or psychotherapeutic help do not as a rule consider themselves either ‘sick’, but rather view their difficulties as problems in living and the help they receive as a form of counselling. In short, while medical diagnoses are the names of genuine diseases, psychiatric diagnoses are stigmatising labels."
It is, in fact, bewildering to behold the manner by which wisdom such as this is so readily debunked. It seems the best way to fight your fiercest opponent is to dismiss them as though they are somehow beneath response. It may be declared; ‘clinical trials have demonstrated the efficacy of neuroleptics in treating psychosis’, or ‘depression has been shown to be endogenous’ and therefore it is to be assumed that Szasz’s arguments have been somehow undermined. Even if, some far distant day in the future all the sub-disciplines currently concerned with the understanding of the body and the complexity of events that take place therein were to announce that a new supercomputer could track all the thousands of variables that gave rise to a singular feeling in time that feeling will not and cannot be expressed by the experient in the language of ‘molecules’.
The multiplicity of events that have taken place within the body to give rise to the ‘emotion’ are rendered by the experient in condensed metaphorical form through the vehicles of language and behaviour. There has been a translative leap from an extremely complex ’low-level’ set of interactions to a ‘higher’, more manageable code. What seems to have escaped behaviourists in particular, who maintain that body gesture alone communicates most of what can be known about an individual is that there is an incalculable amount of surplus expression merely constrained by the physical limitations of the bodily form.
The arguments of Szasz, however, remain the same, and the words above are as true today as they were first written over fifty years ago. The only difference however is that they do not receive any exposure or legitimation by the psycho-pharmaceutical complex for the perfectly understandable reason that if his ideas were absorbed and acted upon, ‘it’, along with its myth-making apparatus would quite simply cease to exist. I certainly don’t recall any instance whereby Szasz made assertions of having any especial knowledge with respect to the interaction of ‘ions’, ‘molecules’ or ‘acids’ with ‘neurons’ and their trillion odd tributaries in the brain. It was perfectly obvious that in reality he didn’t need to have any knowledge of such things.
So we have ingeniously determined that ‘energies’ are being transferred from one structure to another. We have given these structures and their related processes thousands, indeed millions, of different names to differentiate them and this we regard as ‘knowledge’ and the most fluent expositors of such ‘information’ we generally deem to be ‘knowledgeable’, perhaps even ‘expert’ and yet we can say no more of the substance that binds them all; energy, other than that it is a ‘force’. Where ‘it’ came from we are simply at a loss. In fact, it is best not to ask at all, as one may well ‘go mad’.
In reality, no-one has the faintest idea of how the brain produces ‘a thought’ and no clinician, psychiatrist or neurologist has any real understanding of what is happening to the brain when neuroleptics are introduced - in fact, the only empirically discernible real-world changes wrought by the over-prescription of these poorly understood psycho stimulants are the healthier stock options for pharmaceutica. inc.
In point of fact I don’t think Szasz has gone far enough in his denunciation of psychiatric diagnoses and the stigma that is of course necessarily attached to them. When mental health associations and even patient advocacy groups decry ‘the stigma attached to mental illness’ they do so in a manner that suggests they are little aware that the greatest source of stigma that may be encountered by someone who is undergoing difficulties in living is to have their struggles reduced to and being called a ‘mental illness’.
The stigma emerges directly from the description itself and thus the battle-cry ‘we wish to challenge the stigma attached to mental illness’ is as fine an example of an oxymoron as one could wish to encounter. From the point at which this dominant signifier is brought into play an entire network of unhelpful auxiliary associations are mobilised in the minds of the average person which no amount of awareness raising, educational leaflets or destigmatizing talk sessions can possibly erase. To the sympathetic layperson the entire set of problems will ultimately spring from a ‘mental illness’ regardless of how humanistic, holistic or comprehensive are the successive ‘supplementary’ explanations. And why would they not think so given that the groups set up specifically to look out for the interests of those who have difficulties in living are themselves choosing this most unhelpful and ultimately misleading of terms.
For them the dominant rubric chosen is done so obviously to point out the basic reality that lies behind the condition This is in fact the phrase that they themselves appear happy to use to convey to the world the nature of their difficulties. What is worse, because of their prominence in the media and their copious usage of the phrase it is implied that others who have been through the psychiatric system are themselves content to have their experiences thus compounded and designated. It is well known that when scientists, researchers or explorers encounter a new entity, place or condition they select carefully the new ‘signifier’ that will henceforth come to represent the phenomenon.
For example, the term ‘malaria’ was chosen from the mediaeval Latin mal aria or ‘bad air’ because it was then thought that the disease somehow had its origins in the putrescent vapours that were common in the swampy regions where people were afflicted. The 16thc anatomist Giulio Aranzi wisely declined to name the hippocampus, after any supposed function it may have and instead opted for a signifier based upon its visual resemblance to a seahorse. (from the Greek; hippo = horse and kampos = monster) Likewise, when Eugen Bleuler bequeathed the world the term schizophrenia, literally ‘split mind’, deeply unfortunate though the subsequent connotations have proven to be, he had at heart at least the noble intention of attempting to improve the living conditions for the patients on his ward. He tried to emphasise that a particular form of cognitive ‘impairment’; the loosening of associations or linkages between thoughts were giving rise to the observed symptoms.
It is perhaps little known outside of the small circle of historians concerned
with the development of the psychiatric diagnoses that Bleuler was directly influenced by the work of both Freud and Jung. Freud’s work on the unconscious, essentially the search for ’associations’ compelled Bleuler to join, albeit briefly, the newly formed International Psychoanalytical Association. This decision can only have been prompted by the recognition that these fragments of speech experienced by the listener as ‘loose’ or close to meaningless isolates were only the outward manifestation of a rich and complex inner world which bore a striking resemblance to the ‘unconscious’ of Freud. Carl Jung, who was Bleuler’s colleague at the Burgholzi was engaged in his pioneering work on word association tests at a time when Bleuler was evidently becoming increasingly dissatisfied with Kraepelin’s notion of dementia praecox (literally: premature dementia, and which shouldn’t come as a surprise given the living conditions that were endured). Jung had also begun to pay close attention to those patients who seemingly fitted Kraepelin’s category of dementia praecox.
He (Jung) listened carefully, night after night, day after day and soon determined that the speech of these forgotten souls, most of whom had been kept for years on end at the Burgholzi, and who had previously been regarded so desultorily as ‘incurably catatonic’ or ‘hebephrenic’ was not ‘inchoate babble’ as previously thought but had a sense and meaning that could be understood given the proper qualities of skill, time and patience in the physician. In time, a quiet revolution took place in the Burgholzi that brought the inmate, now ‘patient’, back into the fold of the properly human domain.
For it stood to reason that if sense and meaning could be found in these utterances then a ‘cure’ may be better effected once a line of rudimentary communication was established. I place the word ‘cure’ in inverted commas on this occasion to emphasise the type of approach which is required in order to satisfactorily begin this communication. You cannot start off on the assumption that the mental region inhabited by the patient is some kind of locus desperatus for this is where nature has seen fit to deposit them and in response to what exigencies we can only begin to guess. The code to this fortress likewise should not be pursued in the spirit of the safecracker who will ungratefully bolt once he is thought to have secured the Oedipal diamond. If this is all that is being valued then quite rightly the whole process will bear the hallmarks of an unwanted intrusion. Having a pre-prepared schematic of what constitutes the unconscious; what is by definition the unspoken, the unarticulated, the unknown and then foisting these ill-conceived fumblings atop our patient will only result in the process being experienced as just another form of mental colonization.
It may be useful at this point to recapitulate briefly Szasz’s position with respect to the development of the notion of ‘mental illness’. First, though, a word of caution is required. Because of his potent arguments that seek to dismantle the notion of “mental illness”, Szasz has quite often and quite mistakenly been associated with the aims of the 60’s anti-psychiatric movement, a movement which he actually sought to distance himself from. Both challenged the notion of ‘mental illness’ but as we shall see, for somewhat different reasons. Szasz locates the expansion of the category “mental illness” during the tenure of Jean-Marie Charcot at the same Salpetriere asylum that was under the microscope of Foucault though on this occasion we have moved forward almost a hundred years. It is Paris, the late 19th century. Prior to Charcot’s influence the term “mental illness” was only properly applied to those who had identifiable lesions or structural abnormalities found after a post-mortem analysis of brain tissue.
For the rest, the term ‘neurosis’ was used to apply to nervous diseases without apparent organic causes. Because of this lack of physical evidence, however, a considerable body of opinion, rejected the label, arguing that they were simply ‘charlatans’ or ‘malingerers’ who were feigning the symptoms for their own ends. In ‘Nerves and Narratives: A Cultural History of Hysteria in 19th Century British Prose’, Peter Melville Logan, provides us with an intriguing account of how the ‘nervous’ body came to be represented and understood in the period just prior to when Szasz has taken up his argument in “The Myth of Mental Illness”.
Having described the contributions of several physicians during this period Logan provides us with his own summary view on how the ‘neuroses’ were then conceived; for him the malady was more like a 'social document';
"The essential quality of the nervous temperament, thus, is that it destroys the body’s assumed ability to resist the ill-effects of impressions. It creates an overly inscribable body, one that is too easily written upon by the stimulus of its day-to-day experience. These gradually accumulated impressions create a narrative within the nervous body that details its interaction with the larger social order. Within each nervous body lies the story of the social conditions that created it and, having created it, compel it to act out its nervous fit. This narrative is also a history of its own production, a somatic bildungsroman that tells the story of how it came into being, of how this particular body came to have a story to tell."
For instance, we hear of George Cheyne, physician to Samuel Richardson who had argued in ‘The English Malady’ (1733) that most of the aristocracy had fallen victims to a variety of nervous conditions; ‘spleen’, ‘vapours’, ‘lowness of spirits’ ‘hysteria’ and ‘hypochondria’. They were regarded as the victims of their own success however as Cheyne determined the origin of these afflictions to lie in too many luxuries; spicy foods, sensual pleasures and indulgent excesses. ‘Nervous Disorders’, he declared are ‘the Diseases of the Wealthy’. We can see here that the ‘nervous disorder’ is aligned with that ‘exquisite sensitivity’ or ‘delicacy of constitution’ that had become a commonplace description during the Romantic Era. As for the generality of the population, the working-classes or labourers, their ‘roughly hewn constitutions’, according to Cheyne could hardly be associated with such a delicacy of feeling:
‘I seldom ever observed a heavy, dull, earthy, clod-pated Clown, much troubled with nervous Disorders, or at least, not to any eminent Degree; and I scarce believe the thing possible, from the animal oeconomy and the present Laws of Nature’.
This association of ‘melancholia’ and ‘madness’ with the 'upper classes' and their attendant attributes of despair and artistic inspiration had a long history stretching back to at least Renaissance times and received its fullest exfoliation with the Byron’s’, the Shelley‘s’, and the Keats’ of the Napoleonic Age. We hear also, in Logan’s account of the Scottish physician William Cullen (1710-1790) who coined the term ‘neuroses’ defining them as “all those preternatural affections of sense or motion.”
A neurotic condition thus originally conceived comprised a disturbance of one or both of the functions of the nervous fibres. These functions were believed to quite simply relay messages from the brain to the motor impulses thereby coordinating the musculature and to send messages from the body to the brain. Logan also details the contributions of Robert Whytt (1714-1768), a contemporary of Cullen who summed up the limitations of the time with respect to their knowledge of the manner by which these messages were conveyed. An ‘ethereal fluid’ passing through ‘nervous tubes’ was the most common perception;
“But altho’ the minute structure of the nerves, the nature of their fluid, and those conditions on which depend their powers of feeling…lie much beyond our reach; yet we know certainly, that the nerves are endued with feeling…and I have thought it better to stop short here, than to amuse myself or others with subtile speculations concerning matters that are involved in the greatest obscurity” .
Also of note is the work of the physician Thomas Sydenham (1624-1689) which signalled the first shift in the view of hysteria as an affliction of the mind rather than the body but as we can plainly see from Whytt’s own description, some fifty years later, the condition is still viewed primarily in bodily terms that centre around ‘sensations’ and ‘feelings’.
When Szasz thus describes Charcot’s act of throwing his weight behind hysteria as an ‘illness’ as opposed to an instance of ‘malingering’ it is well to remember that there was already a considerable body of work published which was in the process of sectioning hysteria and hypochondria into a mind-focused medical problem. This ‘omission’ on Szasz’s behalf enormously benefit’s the argument he is about to put forward in the second half of ‘The Myth’, which is for the adoption of a universal moral code of ethics applicable to all and most particularly to those who would have been formerly identified as mentally ill and who did not have any structural or functional abnormalities. The impression one takes away having read Szasz’s description of Charcot’s tenure at the Salpetriere asylum is that he genuinely believes that the majority of those who have no physically identifiable abnormalities are, in fact, genuine ‘malingerers’.
In the absence of any experimentally verifiable proof Szasz would have the ‘malingering’ mentally ill of today treated with precisely the same laws that apply to everybody else; in such circumstances he suggests even the use of the insanity plea would have to be abolished. So, Szasz is mistakenly taken for a political radical because of his attacks on the psychiatric establishment for in doing so he is necessarily ceding the authority lost in that arena to the altogether more powerful domain of the State; and this is where he parts company with the anti-psychiatry movement for they wish to see the powers of the psychiatric institution and the state eroded.
Moreover, they both diverge strongly in their conceptualization of the ‘mentally ill’. The anti-psychiatry movement, following Laing, would tend to see the ‘breakdown’, as a positive formative event and regard the family dynamic as the primary dysfunctional element with the wider socio-political framework being chiefly culpable for its role in reproducing these ‘alienating’ social structures. It is in this sense that Szasz cannot be said to be a ‘spokesman’ for the movement. Nonetheless, despite this double edged sword from the point of view of patient advocacy, Szasz’s arguments against the construction of ‘mental illness’ are still relevant today and as he himself says; ‘it marks the beginning of the modern study of so-called mental illness’ as well as ‘the major logical and procedural error in the evolution of modern psychiatry’.
"Individuals who nowadays seek private psychoanalytic or psychotherapeutic help do not as a rule consider themselves either ‘sick’, but rather view their difficulties as problems in living and the help they receive as a form of counselling. In short, while medical diagnoses are the names of genuine diseases, psychiatric diagnoses are stigmatising labels."
It is, in fact, bewildering to behold the manner by which wisdom such as this is so readily debunked. It seems the best way to fight your fiercest opponent is to dismiss them as though they are somehow beneath response. It may be declared; ‘clinical trials have demonstrated the efficacy of neuroleptics in treating psychosis’, or ‘depression has been shown to be endogenous’ and therefore it is to be assumed that Szasz’s arguments have been somehow undermined. Even if, some far distant day in the future all the sub-disciplines currently concerned with the understanding of the body and the complexity of events that take place therein were to announce that a new supercomputer could track all the thousands of variables that gave rise to a singular feeling in time that feeling will not and cannot be expressed by the experient in the language of ‘molecules’.
The multiplicity of events that have taken place within the body to give rise to the ‘emotion’ are rendered by the experient in condensed metaphorical form through the vehicles of language and behaviour. There has been a translative leap from an extremely complex ’low-level’ set of interactions to a ‘higher’, more manageable code. What seems to have escaped behaviourists in particular, who maintain that body gesture alone communicates most of what can be known about an individual is that there is an incalculable amount of surplus expression merely constrained by the physical limitations of the bodily form.
The arguments of Szasz, however, remain the same, and the words above are as true today as they were first written over fifty years ago. The only difference however is that they do not receive any exposure or legitimation by the psycho-pharmaceutical complex for the perfectly understandable reason that if his ideas were absorbed and acted upon, ‘it’, along with its myth-making apparatus would quite simply cease to exist. I certainly don’t recall any instance whereby Szasz made assertions of having any especial knowledge with respect to the interaction of ‘ions’, ‘molecules’ or ‘acids’ with ‘neurons’ and their trillion odd tributaries in the brain. It was perfectly obvious that in reality he didn’t need to have any knowledge of such things.
So we have ingeniously determined that ‘energies’ are being transferred from one structure to another. We have given these structures and their related processes thousands, indeed millions, of different names to differentiate them and this we regard as ‘knowledge’ and the most fluent expositors of such ‘information’ we generally deem to be ‘knowledgeable’, perhaps even ‘expert’ and yet we can say no more of the substance that binds them all; energy, other than that it is a ‘force’. Where ‘it’ came from we are simply at a loss. In fact, it is best not to ask at all, as one may well ‘go mad’.
In reality, no-one has the faintest idea of how the brain produces ‘a thought’ and no clinician, psychiatrist or neurologist has any real understanding of what is happening to the brain when neuroleptics are introduced - in fact, the only empirically discernible real-world changes wrought by the over-prescription of these poorly understood psycho stimulants are the healthier stock options for pharmaceutica. inc.
In point of fact I don’t think Szasz has gone far enough in his denunciation of psychiatric diagnoses and the stigma that is of course necessarily attached to them. When mental health associations and even patient advocacy groups decry ‘the stigma attached to mental illness’ they do so in a manner that suggests they are little aware that the greatest source of stigma that may be encountered by someone who is undergoing difficulties in living is to have their struggles reduced to and being called a ‘mental illness’.
The stigma emerges directly from the description itself and thus the battle-cry ‘we wish to challenge the stigma attached to mental illness’ is as fine an example of an oxymoron as one could wish to encounter. From the point at which this dominant signifier is brought into play an entire network of unhelpful auxiliary associations are mobilised in the minds of the average person which no amount of awareness raising, educational leaflets or destigmatizing talk sessions can possibly erase. To the sympathetic layperson the entire set of problems will ultimately spring from a ‘mental illness’ regardless of how humanistic, holistic or comprehensive are the successive ‘supplementary’ explanations. And why would they not think so given that the groups set up specifically to look out for the interests of those who have difficulties in living are themselves choosing this most unhelpful and ultimately misleading of terms.
For them the dominant rubric chosen is done so obviously to point out the basic reality that lies behind the condition This is in fact the phrase that they themselves appear happy to use to convey to the world the nature of their difficulties. What is worse, because of their prominence in the media and their copious usage of the phrase it is implied that others who have been through the psychiatric system are themselves content to have their experiences thus compounded and designated. It is well known that when scientists, researchers or explorers encounter a new entity, place or condition they select carefully the new ‘signifier’ that will henceforth come to represent the phenomenon.
For example, the term ‘malaria’ was chosen from the mediaeval Latin mal aria or ‘bad air’ because it was then thought that the disease somehow had its origins in the putrescent vapours that were common in the swampy regions where people were afflicted. The 16thc anatomist Giulio Aranzi wisely declined to name the hippocampus, after any supposed function it may have and instead opted for a signifier based upon its visual resemblance to a seahorse. (from the Greek; hippo = horse and kampos = monster) Likewise, when Eugen Bleuler bequeathed the world the term schizophrenia, literally ‘split mind’, deeply unfortunate though the subsequent connotations have proven to be, he had at heart at least the noble intention of attempting to improve the living conditions for the patients on his ward. He tried to emphasise that a particular form of cognitive ‘impairment’; the loosening of associations or linkages between thoughts were giving rise to the observed symptoms.
It is perhaps little known outside of the small circle of historians concerned
with the development of the psychiatric diagnoses that Bleuler was directly influenced by the work of both Freud and Jung. Freud’s work on the unconscious, essentially the search for ’associations’ compelled Bleuler to join, albeit briefly, the newly formed International Psychoanalytical Association. This decision can only have been prompted by the recognition that these fragments of speech experienced by the listener as ‘loose’ or close to meaningless isolates were only the outward manifestation of a rich and complex inner world which bore a striking resemblance to the ‘unconscious’ of Freud. Carl Jung, who was Bleuler’s colleague at the Burgholzi was engaged in his pioneering work on word association tests at a time when Bleuler was evidently becoming increasingly dissatisfied with Kraepelin’s notion of dementia praecox (literally: premature dementia, and which shouldn’t come as a surprise given the living conditions that were endured). Jung had also begun to pay close attention to those patients who seemingly fitted Kraepelin’s category of dementia praecox.
He (Jung) listened carefully, night after night, day after day and soon determined that the speech of these forgotten souls, most of whom had been kept for years on end at the Burgholzi, and who had previously been regarded so desultorily as ‘incurably catatonic’ or ‘hebephrenic’ was not ‘inchoate babble’ as previously thought but had a sense and meaning that could be understood given the proper qualities of skill, time and patience in the physician. In time, a quiet revolution took place in the Burgholzi that brought the inmate, now ‘patient’, back into the fold of the properly human domain.
For it stood to reason that if sense and meaning could be found in these utterances then a ‘cure’ may be better effected once a line of rudimentary communication was established. I place the word ‘cure’ in inverted commas on this occasion to emphasise the type of approach which is required in order to satisfactorily begin this communication. You cannot start off on the assumption that the mental region inhabited by the patient is some kind of locus desperatus for this is where nature has seen fit to deposit them and in response to what exigencies we can only begin to guess. The code to this fortress likewise should not be pursued in the spirit of the safecracker who will ungratefully bolt once he is thought to have secured the Oedipal diamond. If this is all that is being valued then quite rightly the whole process will bear the hallmarks of an unwanted intrusion. Having a pre-prepared schematic of what constitutes the unconscious; what is by definition the unspoken, the unarticulated, the unknown and then foisting these ill-conceived fumblings atop our patient will only result in the process being experienced as just another form of mental colonization.
It may be useful at this point to recapitulate briefly Szasz’s position with respect to the development of the notion of ‘mental illness’. First, though, a word of caution is required. Because of his potent arguments that seek to dismantle the notion of “mental illness”, Szasz has quite often and quite mistakenly been associated with the aims of the 60’s anti-psychiatric movement, a movement which he actually sought to distance himself from. Both challenged the notion of ‘mental illness’ but as we shall see, for somewhat different reasons. Szasz locates the expansion of the category “mental illness” during the tenure of Jean-Marie Charcot at the same Salpetriere asylum that was under the microscope of Foucault though on this occasion we have moved forward almost a hundred years. It is Paris, the late 19th century. Prior to Charcot’s influence the term “mental illness” was only properly applied to those who had identifiable lesions or structural abnormalities found after a post-mortem analysis of brain tissue.
For the rest, the term ‘neurosis’ was used to apply to nervous diseases without apparent organic causes. Because of this lack of physical evidence, however, a considerable body of opinion, rejected the label, arguing that they were simply ‘charlatans’ or ‘malingerers’ who were feigning the symptoms for their own ends. In ‘Nerves and Narratives: A Cultural History of Hysteria in 19th Century British Prose’, Peter Melville Logan, provides us with an intriguing account of how the ‘nervous’ body came to be represented and understood in the period just prior to when Szasz has taken up his argument in “The Myth of Mental Illness”.
Having described the contributions of several physicians during this period Logan provides us with his own summary view on how the ‘neuroses’ were then conceived; for him the malady was more like a 'social document';
"The essential quality of the nervous temperament, thus, is that it destroys the body’s assumed ability to resist the ill-effects of impressions. It creates an overly inscribable body, one that is too easily written upon by the stimulus of its day-to-day experience. These gradually accumulated impressions create a narrative within the nervous body that details its interaction with the larger social order. Within each nervous body lies the story of the social conditions that created it and, having created it, compel it to act out its nervous fit. This narrative is also a history of its own production, a somatic bildungsroman that tells the story of how it came into being, of how this particular body came to have a story to tell."
For instance, we hear of George Cheyne, physician to Samuel Richardson who had argued in ‘The English Malady’ (1733) that most of the aristocracy had fallen victims to a variety of nervous conditions; ‘spleen’, ‘vapours’, ‘lowness of spirits’ ‘hysteria’ and ‘hypochondria’. They were regarded as the victims of their own success however as Cheyne determined the origin of these afflictions to lie in too many luxuries; spicy foods, sensual pleasures and indulgent excesses. ‘Nervous Disorders’, he declared are ‘the Diseases of the Wealthy’. We can see here that the ‘nervous disorder’ is aligned with that ‘exquisite sensitivity’ or ‘delicacy of constitution’ that had become a commonplace description during the Romantic Era. As for the generality of the population, the working-classes or labourers, their ‘roughly hewn constitutions’, according to Cheyne could hardly be associated with such a delicacy of feeling:
‘I seldom ever observed a heavy, dull, earthy, clod-pated Clown, much troubled with nervous Disorders, or at least, not to any eminent Degree; and I scarce believe the thing possible, from the animal oeconomy and the present Laws of Nature’.
This association of ‘melancholia’ and ‘madness’ with the 'upper classes' and their attendant attributes of despair and artistic inspiration had a long history stretching back to at least Renaissance times and received its fullest exfoliation with the Byron’s’, the Shelley‘s’, and the Keats’ of the Napoleonic Age. We hear also, in Logan’s account of the Scottish physician William Cullen (1710-1790) who coined the term ‘neuroses’ defining them as “all those preternatural affections of sense or motion.”
A neurotic condition thus originally conceived comprised a disturbance of one or both of the functions of the nervous fibres. These functions were believed to quite simply relay messages from the brain to the motor impulses thereby coordinating the musculature and to send messages from the body to the brain. Logan also details the contributions of Robert Whytt (1714-1768), a contemporary of Cullen who summed up the limitations of the time with respect to their knowledge of the manner by which these messages were conveyed. An ‘ethereal fluid’ passing through ‘nervous tubes’ was the most common perception;
“But altho’ the minute structure of the nerves, the nature of their fluid, and those conditions on which depend their powers of feeling…lie much beyond our reach; yet we know certainly, that the nerves are endued with feeling…and I have thought it better to stop short here, than to amuse myself or others with subtile speculations concerning matters that are involved in the greatest obscurity” .
Also of note is the work of the physician Thomas Sydenham (1624-1689) which signalled the first shift in the view of hysteria as an affliction of the mind rather than the body but as we can plainly see from Whytt’s own description, some fifty years later, the condition is still viewed primarily in bodily terms that centre around ‘sensations’ and ‘feelings’.
When Szasz thus describes Charcot’s act of throwing his weight behind hysteria as an ‘illness’ as opposed to an instance of ‘malingering’ it is well to remember that there was already a considerable body of work published which was in the process of sectioning hysteria and hypochondria into a mind-focused medical problem. This ‘omission’ on Szasz’s behalf enormously benefit’s the argument he is about to put forward in the second half of ‘The Myth’, which is for the adoption of a universal moral code of ethics applicable to all and most particularly to those who would have been formerly identified as mentally ill and who did not have any structural or functional abnormalities. The impression one takes away having read Szasz’s description of Charcot’s tenure at the Salpetriere asylum is that he genuinely believes that the majority of those who have no physically identifiable abnormalities are, in fact, genuine ‘malingerers’.
In the absence of any experimentally verifiable proof Szasz would have the ‘malingering’ mentally ill of today treated with precisely the same laws that apply to everybody else; in such circumstances he suggests even the use of the insanity plea would have to be abolished. So, Szasz is mistakenly taken for a political radical because of his attacks on the psychiatric establishment for in doing so he is necessarily ceding the authority lost in that arena to the altogether more powerful domain of the State; and this is where he parts company with the anti-psychiatry movement for they wish to see the powers of the psychiatric institution and the state eroded.
Moreover, they both diverge strongly in their conceptualization of the ‘mentally ill’. The anti-psychiatry movement, following Laing, would tend to see the ‘breakdown’, as a positive formative event and regard the family dynamic as the primary dysfunctional element with the wider socio-political framework being chiefly culpable for its role in reproducing these ‘alienating’ social structures. It is in this sense that Szasz cannot be said to be a ‘spokesman’ for the movement. Nonetheless, despite this double edged sword from the point of view of patient advocacy, Szasz’s arguments against the construction of ‘mental illness’ are still relevant today and as he himself says; ‘it marks the beginning of the modern study of so-called mental illness’ as well as ‘the major logical and procedural error in the evolution of modern psychiatry’.
Now, as we have said, it is
easy to derive from Szasz the impression that not only does he not agree with
the designation of ‘functional nervous illnesses’ for those who behave as though
they had an organic nervous illness when in fact no lesion or abnormality can be
found but also that he doesn’t believe in the reality of the ‘symptoms’
underlying the phenomena regardless of what label is applied to them. This is
because, as we have suggested, he doesn’t believe that they should be regarded
as ‘symptoms’ at all, in so far as this term automatically situates the
discussion for him within the purview of an expanded psychiatrism and therefore
the fostering of further medicalised constructions that take us away from an
examination of the real phenomenon itself.
For Szasz, the ‘real phenomena’ revolves around the question of individual moral culpability; everyone should be held accountable for their own actions; ‘What were the effects of Charcot’s insistence that hysterics were ill and not malingering?’, he asks. The focus of his denunciations become more explicit in what follows where we can see that this early territorializing of the ‘founder of modern psychiatry’ (Charcot), has shifted perceptions with regard to ‘the nervous body’. As we have done our research we know that the potential social critique embedded and inscribed in the ‘nervous body’ of the early 19th century has ceased to become a reflecting mirror, a document of contradictions in the social body, but has instead itself become the original repository of disease.
As Szasz points out;
"Charcot made it easier for the sufferer, then commonly called a malingerer, to be sick …….. Charcot, Kraepelin, Breur, Freud, and many others lent their authority to the propagation of this socially self-enhancing image of what was then ‘hysteria’ and what in our day has become the problem of ’mental illness’ ……… labelling people disabled by problems in living as ‘mentally ill’ has only impeded and delayed recognition of the essential nature of the phenomena. At first glance, to advocate that an unhappy or troubled person is ’sick’ seems ‘humane’ for it bestows upon him the dignity of suffering from a ‘real illness’. But a hidden weight is attached to this viewpoint which pulls the suffering person back into the same sort of disrepute from which this semantic and social reclassification was intended to rescue him.’
And that it appears to me is as good a summary of our present difficulties as we are likely to find. This hidden weight that Szasz speaks of has only grown heavier in proportion to the distance we have travelled from the original social need that was addressed by introducing this ‘semantic and social reclassification’. They are ‘sick’ and they are ‘ill’ as opposed to, shall we say different. For whom where these, no doubt, palliative words, uttered for, again and again, as we approached the turn of the century, bearing in mind the work of Logan which made it clear that the ’inferior orders’ were at least spared, for the time being anyhow, these early posturings of the pan-European Victorian upper-class.
Freud certainly wasn’t sluggish in swathing his brand new ‘science’ with terms derived directly from the medical textbooks. The study of the unconscious was to become, of all things, the study of pathology, for, after all, the young master must earn, not only his own keep, but that of a whole generation of encrusted lightfoots. But how grotesque an art it is that must find pathological determinants in every corner of the ‘newly discovered’ psyche. Jung, to his credit, found the entire charade somewhat unsettling and finally took his leave just before the outbreak of the war. But, let us return to Szasz whom we have disturbed far too often. The ‘disrepute’ of which he speaks is the impossibility of their ‘narrative’ ever being heard outside of this all-embracing context of ‘mental illness’.
Think of this. A diseased mind. An ill mind. I once heard the noted biologist Richard Dawkins being asked what was his one worst fear and he replied that to lose the ability to think, the faculty of reasoning was in many ways a fate that he would have the most extreme difficulty in reconciling himself to. What then, of those, who are falsely assumed by others, because of a historically determined ‘semantic and social reclassification’ to have a congenitally faulty thinking apparatus and yet know themselves that their thinking and perceptions are equally as clear if not more so than the general populace.
What, to put it most simply, is a disease? I have randomly selected from Google three short definitions which probably coincide with most people’s conceptions of the principal characteristics of a ‘disease’.
------- ‘A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.’ Dictionary.Com
-------- ‘A condition of the living animal or plant body or of one of its
parts that impairs normal functioning and is typically manifested by
distinguishing signs and symptoms.’ Merriam-Webster Online.
--------- ‘An illness of people, animals, plants, etc., caused by infection
or a failure of health rather than by an accident’. Cambridge Dictionaries
Online
It’s clear from the above that what we are presented with as a ‘disease’, that is to say, what is commonly understood by the term is that of a physical defect that impairs the normal functioning of the organism. Viewed from the vantage point of someone who hasn’t been afflicted with the designation ‘manic-depressive’ or ‘schizophrenic’ the constructed symptomatology, to the casual observer at least, does indeed appear sufficiently unattractive as to warrant the description of an ‘illness’; on the one hand we are told of ‘social withdrawal’, ‘lack of motivation’ and ‘low energy levels’ and on the other we have the equally subjectively determined appellations of ‘manic exuberance’, ‘ideas of reference‘, ‘delusional ideation’ and so on. The precise analysis of how these constructions came into being is a separate study in itself and Bentall’s ‘Madness Explained’ is a useful primer, but I would only add for the moment that many within the psychiatric community must wince at their own literature which appears at times to derive its understanding of the outside world from a fifth form civics textbook.
It was the ‘medical gaze’ of Charcot, Kraepelin, Bleuler and Freud that have bequeathed us these interpretations of idiosyncratic modes of ‘being’. What we are left with is a very impressive ‘construction’ of aberrant forms of ‘thinking’ and ‘behaviour’ but nothing whatsoever has been said about ‘feelings’. In my own experience I have found that it has been my feelings which have guided my thoughts and it is my thoughts in turn which have influenced my behaviour. The language and tone of the psychiatric literature generally reveals an extraordinarily superficial depiction of the dynamics of social life; the social domain is almost conservatively frozen in time, free of contesting voices, movements, institutions or historicities. It is from this constructed, idealized and therefore false and contestable image of what constitutes the social that the correspondingly constructed deviations, our aforementioned behavioural symptoms, are brought forward, obviously in the most negativised form imaginable, and, as the implied antithesis of what constitutes the wholesome good citizen and perhaps more worryingly, economic producer.
In schizophrenia, as we have said, the first set of descriptive categories are referred to as the negative symptoms and the latter regarded as the so-called positive symptoms. Likewise, almost the same sets of descriptions are respectively associated in the case of bipolar disorder with the so-called ‘low’ and ‘high’ phases. This embarrassing overlap, from the point of view of diagnostic clarity, has seen its attempted resolution through the
creation of a new medical entity; ‘schizoaffective disorder’ but this itself has found difficulty in being accepted because of the power and influence of the original Kraepelinian dichotomy of the old paranoias into the affective (manic-depression) and cognitive (schizophrenia) disorders.
Now, in ‘Mood Genes’, Barondes makes an early declaration of interest;
‘…in the case of manic-depression for which there are some effective medications, such as lithium and Prozac, these drugs have many drawbacks. Treating a mood disorder with them is like treating an infection with aspirin: symptoms may be relieved but the fundamental problem remains unaddressed…. Finding mood genes will change all this.’
Well really?? Needless to say there are many social accolades and financial rewards awaiting for those who can demonstrate the efficacy of their work in conquering an 'outstanding' social problem. And, of course, the greater the problem is perceived to be, or trumped up to be, the greater will be the reward. In this case we see highlighted the competing claims of the pharmaceutical industry and a commercialized science of genetics. Some opponents of the medical model may regard the difference as only superficial given that both start off on the basis that the basic problem resides in an abnormal body chemistry.
Well, if geneticists discover, for instance, a region on a particular chromosome responsible for encoding the production of an amino acid that is involved in the metabolic pathway of a neurotransmitter that is found to be overabundant in a region of the brain of a patient who is in say, a ‘manic state’, and then after a course of gene therapy alter that chromosome to ensure thatit no longer produces said acid, the change initiated becomes long-term and obviously renders superfluous the further intake of medication. For Barondes particular struggle here is to try and highlight the primary causative role of our genes and the relative efficacy of gene therapy over drug therapy.
So, if you were to regard the ‘manic’ symptoms as the manifestation of a ‘disease’ then the geneticists approach is entirely logical and would presumably mean in most cases the end of the drug-taking regimen. Simply isolate the ‘pathogenic substance’, in this case, the area of the chromosome concerned with the production of our hypothetical amino acid, neutralize its capacity to produce, and then wait for the expected behavioural changes to occur. However, both geneticists and the advocates of pharmaceutical interventions are obviously protecting a vested interest in their declarations that the cause, the primum mobile of the observed behavioural differences lies in an altered biochemistry rather than residing in the person’s subjective interaction with their environment.
The message as I’m receiving it is quite clear; there are those among us who feel so strongly and so deeply, who carry so hard the cross of an ‘overly-inscribable’ body, that their capacity to engage in normal day to day activities has somehow become compromised. Can this though be said to be constitutive of a disease or is it not rather a sentiment of being? or, as I will argue elsewhere and in a wholly different context an enforced exclamation of being?
Besides which, how have we come to the point that we are so blinded by the fact that what we are confronted with are extremes of emotional states; love, joy, sadness, anger, frustration. It should be the task of any humanist intervention worthy of the name to register first the primacy of ‘feelings’ over thinking and behaviour for it is the one that causes the other.
To my mind the irrational narratives of corporate sponsored ‘biochemical reductionism’ have all the logic of a hypothetical traffic corps in la-la's ville pulling over the driver of a speeding car and concluding that the cause of the excessive velocity is to be found in a depressed accelerator. Instead of actually confronting the person behind the wheel the matter is then, wholly illogically, passed on to technical specialists who after further analysis compile an impressive report detailing ignition timing, fuel to air ratios and combustion cycles. These findings are then questioned by a rival team of specialists who declare that insufficient attention has been paid to the role of the ‘intake manifold’, while yet another team point to the centrality of the ‘manifold vacuum’, and all this was before the input of the carburettor team and the piston crew. No single body of research held the day, arguments remained inconclusive yet all agreed that their time was not wasted, valuable contributions had been made to our overall understanding of engine capability. The research was then, as usual, sold to one of the big car manufacturers and just before the case was declared closed one naïve young observer asked whether we should not perhaps ask the driver of the car why he was speeding.
To which came the reply; ‘Don‘t be absurd. Do you honestly believe he has any insight into the complex mechanisms that are under discussion here. What on earth would his opinion contribute to the discussion at hand. Besides, the answer would be much less informative from a scientific standpoint, you understand.’ Yes, but if you wish to prevent him from speeding in the future, would it not be wise to ask him why he was doing it on this occasion. Perhaps he had a valid reason. ‘Listen, the precautions taken consist of the adjustments we have made to the vehicle. In the future it will impossible forhim to speed. He will no longer be a danger to himself or to others.’
Fine, but this I'm afraid is an ethical issue.
For Szasz, the ‘real phenomena’ revolves around the question of individual moral culpability; everyone should be held accountable for their own actions; ‘What were the effects of Charcot’s insistence that hysterics were ill and not malingering?’, he asks. The focus of his denunciations become more explicit in what follows where we can see that this early territorializing of the ‘founder of modern psychiatry’ (Charcot), has shifted perceptions with regard to ‘the nervous body’. As we have done our research we know that the potential social critique embedded and inscribed in the ‘nervous body’ of the early 19th century has ceased to become a reflecting mirror, a document of contradictions in the social body, but has instead itself become the original repository of disease.
As Szasz points out;
"Charcot made it easier for the sufferer, then commonly called a malingerer, to be sick …….. Charcot, Kraepelin, Breur, Freud, and many others lent their authority to the propagation of this socially self-enhancing image of what was then ‘hysteria’ and what in our day has become the problem of ’mental illness’ ……… labelling people disabled by problems in living as ‘mentally ill’ has only impeded and delayed recognition of the essential nature of the phenomena. At first glance, to advocate that an unhappy or troubled person is ’sick’ seems ‘humane’ for it bestows upon him the dignity of suffering from a ‘real illness’. But a hidden weight is attached to this viewpoint which pulls the suffering person back into the same sort of disrepute from which this semantic and social reclassification was intended to rescue him.’
And that it appears to me is as good a summary of our present difficulties as we are likely to find. This hidden weight that Szasz speaks of has only grown heavier in proportion to the distance we have travelled from the original social need that was addressed by introducing this ‘semantic and social reclassification’. They are ‘sick’ and they are ‘ill’ as opposed to, shall we say different. For whom where these, no doubt, palliative words, uttered for, again and again, as we approached the turn of the century, bearing in mind the work of Logan which made it clear that the ’inferior orders’ were at least spared, for the time being anyhow, these early posturings of the pan-European Victorian upper-class.
Freud certainly wasn’t sluggish in swathing his brand new ‘science’ with terms derived directly from the medical textbooks. The study of the unconscious was to become, of all things, the study of pathology, for, after all, the young master must earn, not only his own keep, but that of a whole generation of encrusted lightfoots. But how grotesque an art it is that must find pathological determinants in every corner of the ‘newly discovered’ psyche. Jung, to his credit, found the entire charade somewhat unsettling and finally took his leave just before the outbreak of the war. But, let us return to Szasz whom we have disturbed far too often. The ‘disrepute’ of which he speaks is the impossibility of their ‘narrative’ ever being heard outside of this all-embracing context of ‘mental illness’.
Think of this. A diseased mind. An ill mind. I once heard the noted biologist Richard Dawkins being asked what was his one worst fear and he replied that to lose the ability to think, the faculty of reasoning was in many ways a fate that he would have the most extreme difficulty in reconciling himself to. What then, of those, who are falsely assumed by others, because of a historically determined ‘semantic and social reclassification’ to have a congenitally faulty thinking apparatus and yet know themselves that their thinking and perceptions are equally as clear if not more so than the general populace.
What, to put it most simply, is a disease? I have randomly selected from Google three short definitions which probably coincide with most people’s conceptions of the principal characteristics of a ‘disease’.
------- ‘A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.’ Dictionary.Com
-------- ‘A condition of the living animal or plant body or of one of its
parts that impairs normal functioning and is typically manifested by
distinguishing signs and symptoms.’ Merriam-Webster Online.
--------- ‘An illness of people, animals, plants, etc., caused by infection
or a failure of health rather than by an accident’. Cambridge Dictionaries
Online
It’s clear from the above that what we are presented with as a ‘disease’, that is to say, what is commonly understood by the term is that of a physical defect that impairs the normal functioning of the organism. Viewed from the vantage point of someone who hasn’t been afflicted with the designation ‘manic-depressive’ or ‘schizophrenic’ the constructed symptomatology, to the casual observer at least, does indeed appear sufficiently unattractive as to warrant the description of an ‘illness’; on the one hand we are told of ‘social withdrawal’, ‘lack of motivation’ and ‘low energy levels’ and on the other we have the equally subjectively determined appellations of ‘manic exuberance’, ‘ideas of reference‘, ‘delusional ideation’ and so on. The precise analysis of how these constructions came into being is a separate study in itself and Bentall’s ‘Madness Explained’ is a useful primer, but I would only add for the moment that many within the psychiatric community must wince at their own literature which appears at times to derive its understanding of the outside world from a fifth form civics textbook.
It was the ‘medical gaze’ of Charcot, Kraepelin, Bleuler and Freud that have bequeathed us these interpretations of idiosyncratic modes of ‘being’. What we are left with is a very impressive ‘construction’ of aberrant forms of ‘thinking’ and ‘behaviour’ but nothing whatsoever has been said about ‘feelings’. In my own experience I have found that it has been my feelings which have guided my thoughts and it is my thoughts in turn which have influenced my behaviour. The language and tone of the psychiatric literature generally reveals an extraordinarily superficial depiction of the dynamics of social life; the social domain is almost conservatively frozen in time, free of contesting voices, movements, institutions or historicities. It is from this constructed, idealized and therefore false and contestable image of what constitutes the social that the correspondingly constructed deviations, our aforementioned behavioural symptoms, are brought forward, obviously in the most negativised form imaginable, and, as the implied antithesis of what constitutes the wholesome good citizen and perhaps more worryingly, economic producer.
In schizophrenia, as we have said, the first set of descriptive categories are referred to as the negative symptoms and the latter regarded as the so-called positive symptoms. Likewise, almost the same sets of descriptions are respectively associated in the case of bipolar disorder with the so-called ‘low’ and ‘high’ phases. This embarrassing overlap, from the point of view of diagnostic clarity, has seen its attempted resolution through the
creation of a new medical entity; ‘schizoaffective disorder’ but this itself has found difficulty in being accepted because of the power and influence of the original Kraepelinian dichotomy of the old paranoias into the affective (manic-depression) and cognitive (schizophrenia) disorders.
Now, in ‘Mood Genes’, Barondes makes an early declaration of interest;
‘…in the case of manic-depression for which there are some effective medications, such as lithium and Prozac, these drugs have many drawbacks. Treating a mood disorder with them is like treating an infection with aspirin: symptoms may be relieved but the fundamental problem remains unaddressed…. Finding mood genes will change all this.’
Well really?? Needless to say there are many social accolades and financial rewards awaiting for those who can demonstrate the efficacy of their work in conquering an 'outstanding' social problem. And, of course, the greater the problem is perceived to be, or trumped up to be, the greater will be the reward. In this case we see highlighted the competing claims of the pharmaceutical industry and a commercialized science of genetics. Some opponents of the medical model may regard the difference as only superficial given that both start off on the basis that the basic problem resides in an abnormal body chemistry.
Well, if geneticists discover, for instance, a region on a particular chromosome responsible for encoding the production of an amino acid that is involved in the metabolic pathway of a neurotransmitter that is found to be overabundant in a region of the brain of a patient who is in say, a ‘manic state’, and then after a course of gene therapy alter that chromosome to ensure thatit no longer produces said acid, the change initiated becomes long-term and obviously renders superfluous the further intake of medication. For Barondes particular struggle here is to try and highlight the primary causative role of our genes and the relative efficacy of gene therapy over drug therapy.
So, if you were to regard the ‘manic’ symptoms as the manifestation of a ‘disease’ then the geneticists approach is entirely logical and would presumably mean in most cases the end of the drug-taking regimen. Simply isolate the ‘pathogenic substance’, in this case, the area of the chromosome concerned with the production of our hypothetical amino acid, neutralize its capacity to produce, and then wait for the expected behavioural changes to occur. However, both geneticists and the advocates of pharmaceutical interventions are obviously protecting a vested interest in their declarations that the cause, the primum mobile of the observed behavioural differences lies in an altered biochemistry rather than residing in the person’s subjective interaction with their environment.
The message as I’m receiving it is quite clear; there are those among us who feel so strongly and so deeply, who carry so hard the cross of an ‘overly-inscribable’ body, that their capacity to engage in normal day to day activities has somehow become compromised. Can this though be said to be constitutive of a disease or is it not rather a sentiment of being? or, as I will argue elsewhere and in a wholly different context an enforced exclamation of being?
Besides which, how have we come to the point that we are so blinded by the fact that what we are confronted with are extremes of emotional states; love, joy, sadness, anger, frustration. It should be the task of any humanist intervention worthy of the name to register first the primacy of ‘feelings’ over thinking and behaviour for it is the one that causes the other.
To my mind the irrational narratives of corporate sponsored ‘biochemical reductionism’ have all the logic of a hypothetical traffic corps in la-la's ville pulling over the driver of a speeding car and concluding that the cause of the excessive velocity is to be found in a depressed accelerator. Instead of actually confronting the person behind the wheel the matter is then, wholly illogically, passed on to technical specialists who after further analysis compile an impressive report detailing ignition timing, fuel to air ratios and combustion cycles. These findings are then questioned by a rival team of specialists who declare that insufficient attention has been paid to the role of the ‘intake manifold’, while yet another team point to the centrality of the ‘manifold vacuum’, and all this was before the input of the carburettor team and the piston crew. No single body of research held the day, arguments remained inconclusive yet all agreed that their time was not wasted, valuable contributions had been made to our overall understanding of engine capability. The research was then, as usual, sold to one of the big car manufacturers and just before the case was declared closed one naïve young observer asked whether we should not perhaps ask the driver of the car why he was speeding.
To which came the reply; ‘Don‘t be absurd. Do you honestly believe he has any insight into the complex mechanisms that are under discussion here. What on earth would his opinion contribute to the discussion at hand. Besides, the answer would be much less informative from a scientific standpoint, you understand.’ Yes, but if you wish to prevent him from speeding in the future, would it not be wise to ask him why he was doing it on this occasion. Perhaps he had a valid reason. ‘Listen, the precautions taken consist of the adjustments we have made to the vehicle. In the future it will impossible forhim to speed. He will no longer be a danger to himself or to others.’
Fine, but this I'm afraid is an ethical issue.
Psychiatry participates in a
grotesque erasure of an individual's personhood. There is an almost palpable
denial of active volition and self-conscious agency on the part of the
‘experient’ and an almost wilful ignorance of the immediate social circumstances
in which s/he is a participant that have contributed to the formation of the
‘symptoms’. The seemingly impeccable credentials of the biological reductionist
argument (the touchstone of psychiatry) are vaunted disproportionately because
of the supposedly scientific nature of its explanation yet the science has taken
over at the onset from a falsely deduced point of causation thereby rendering
their conclusions, at best, of only secondary importance to a proper
consideration of the primary phenomenon. Carl Jung raised the same concern
almost a hundred years ago and may be said to have predicted the present over
emphasis on neurobiological causation;
"Psychiatry has been charged with gross materialism. And quite rightly, for it is on the road to putting the organ, the instrument, above the function - or rather, it has long been doing so. Function has become the appendage of its organ, the psyche an appendage of the brain. In modern psychiatry the psyche has come off very badly. While immense progress has been made in cerebral anatomy, we know practically nothing about the psyche, or even less than we did before. Modern psychiatry behaves like someone who thinks he can decipher the meaning and purpose of a building by a mineralogical analysis of its stones."
This is the type of analogy which has been used by many in an attempt to critique this bewildering conflation between internal mechanisms and our subjective experiences and its appreciation is absolutely critical in grasping the nature of the psychiatric enterprise. When we see the hairs rise upwards on the back of a cat who has taken fright our response is not to investigate the properties of follicular verticality but instead we attempt to assuage the creature that his fears are misplaced. For it is a fact that is too little remarked upon that each of us everyday, through the normal business of social interaction are the unwitting dispensers of active mood altering agents. Merely by validating the presence of another, by listening to what is being said do we initiate a positive ‘functional’ chemical change in the brain.
Likewise, when we undermine an individual’s sense of ‘being in the world’ through all those stratagems that most healthy adults are, unfortunately, thoroughly versed in, do we by the same token, also initiate ‘functional’ chemical changes in the brain; though this time of the deleterious sort. In other words, by positively affirming a person’s sense of ‘being in the world’ however this may be initially presented and construed by us to be, it is vital that it is at least validated. Now, there is no point here in splitting hairs by raising the objection that if we were to ‘validate’ the monologue of a ‘delusional’ or a ‘crank’ or a ‘social misfit’ we would in the long run only be providing a disservice to the individual concerned. And what in practice is the effect of this thoroughly slovenly approach if not a ‘drugs, drugs and more drugs’ regime that seeks to functionally alter a ‘chemical imbalance’ that one’s aloof attitude is in contrary fashion only exacerbating anyhow?
How many clinical trials have been conducted to date that monitor the positive effects of a daily fifteen minute conversation with someone who listens, affirms, validates, is non-judgemental and does not seek to pigeonhole your difficulties into a pre-prepared smorgasbord derived from either developmental psychology, psychoanalysis or neurobiological reductionism. Theory necessarily informs practice but it is essentially an artifice erected to keep our minds attuned to certain recurring problematics; the real issues revolve around the therapists' encounters with ‘the patient’ as another human being. In this regard I am reminded of an extraordinary exchange between R.D. Laing and a clearly ambitious young graduate student in clinical psychology:
Graduate student: "Dr. Laing. Can you outline for us please the basis of your approach?"
R.D. Laing: "Certainly. The basis is love. I don't see how you or I can be of any help to our clients in a visionary state unless we are capable of experiencing a feeling of love for them. Therapy, as opposed to mere treatment, requires that we have a capacity for loving kindness and compassion."
Graduate Student (perplexed): "But Dr. Laing, what is your clinical
methodology for developing this approach?"
I mean ?? It is this addiction to empiricist claptrap taken here to it's nth degree that underpins the 'honest' sections of the psychiatric venture.
Laing was unfortunately a rare breed among practitioners and would often go to great lengths to procure the confidence and trust of a patient, reportedly spending hours in some cases sitting in silence with them showing by his presence alone that his thoughts were with them. When I listen to accounts of commitment such as this I am far more inclined to pay attention to what is being said from a theoretical standpoint.
In a similar vein, Al Siebert has written about how he reformed his own 'interview technique' by stumbling upon the apparently outlandish notion of actually empathising with his patient;
"When I was a staff psychologist at a neuropsychiatric institute in 1965, I conducted an experimental interview with an 18-year-old woman diagnosed as "acute paranoid schizophrenic." I'd been influenced by the writings of Carl Jung, Thomas Szasz, and Ayn Rand, and was puzzled about methods for training psychiatric residents that are unreported in the literature. I prepared for the interview by asking myself questions. I wondered what would happen if I listened to the woman as a friend, avoided letting my mind diagnose her, and questioned her to see if there was alink between events in her life and her feelings of self-esteem. My interview with her was followed by her quick remission."
That this perfectly obvious 'intuition' of Siebert's caused such an excitement that he felt prompted to commit his thoughts to paper sums up I think the woeful inadequacy of psychiatric training in general. When has it ever been revelatory for a physician to conclude that by actually listening to a patient 'as a friend' that some progress may in fact be made?
Empirically-speaking, if we must continue to talk as though there are exactitudes and measurable quantities and proportions, the cardinal error (from this narrow rationalistic perspective) is committed, of drawing attention away from the basic phenomenon. In the first placem, the ‘condition’ is evidently psycho-environmental, hence the importance of combining in those cases where there is established an absolute need a properly mediated empathically-based response followed by a much more reflexive course of psychotherapy. Secondly, the ‘illness’, the manner in which it finds verbal expression, through what has come to be called the ‘delusion’, is, as I shall try to demonstrate later, a complex metaphor for a whole range of issues not all of which can be related to the subject‘s personal psychogenesis.
Psychoanalysts see in "delusion" the sophisticated architecture of a surfaced unconscious, a signifying tapestry that, when decoded, reveals (to them) an improperly negotiated Oedipal transition whereas psychiatrists look at the social expression of a biochemical anomaly only among those individuals who wind up in their care and universalises from this (scarcely representative) sample pool that the anomaly itself needs to be expunged. The anomaly, the difference, has been attributed a meaning and the growth and evolution of this meaning, is in the hands, not of the experients themselves but of the corporate-endowed psychiatric establishment, and, to a lesser extent, the psychological sciences.
However, what is produced in the ‘reveries of deliria’ is the story of ‘everyman’ and it amounts to at best a misunderstanding to take these products that deserve to be called common since their potentiality is latent in all of us and present them as derived entirely from a ‘malformed’ or ‘diseased’ psychogenesis. The language we adopt must display an awareness of the psychosocial, environmental and somatic determinants of the phenomenon. The perceived threat of which I mentioned earlier was in the past undoubtedly more palpable; related perhaps to the encroachments of a Palaeolithic predator, the onset of battle, or the tracking of a mammoth. In today’s postmodern milleu it is generally a concatenation of stressors that push us into ‘battle-mode’; an unfortunate melange of trigger events may be present.
However, because of our myriad divided roles it is often fiendishly difficult to pinpoint the precise cause of our unease which is why in the debris of post-"psychosis" many are willing to embrace, if only for a certain type of relief that it affords them, the first set of explanations that are presented and this is why we are justified in referring to the current manner in which psychiatric care is conducted as being designed to induce a form of Stockholm’s Syndrome - to use a phrase that the medical fraternity are themselves familiar with.
"Psychiatry has been charged with gross materialism. And quite rightly, for it is on the road to putting the organ, the instrument, above the function - or rather, it has long been doing so. Function has become the appendage of its organ, the psyche an appendage of the brain. In modern psychiatry the psyche has come off very badly. While immense progress has been made in cerebral anatomy, we know practically nothing about the psyche, or even less than we did before. Modern psychiatry behaves like someone who thinks he can decipher the meaning and purpose of a building by a mineralogical analysis of its stones."
This is the type of analogy which has been used by many in an attempt to critique this bewildering conflation between internal mechanisms and our subjective experiences and its appreciation is absolutely critical in grasping the nature of the psychiatric enterprise. When we see the hairs rise upwards on the back of a cat who has taken fright our response is not to investigate the properties of follicular verticality but instead we attempt to assuage the creature that his fears are misplaced. For it is a fact that is too little remarked upon that each of us everyday, through the normal business of social interaction are the unwitting dispensers of active mood altering agents. Merely by validating the presence of another, by listening to what is being said do we initiate a positive ‘functional’ chemical change in the brain.
Likewise, when we undermine an individual’s sense of ‘being in the world’ through all those stratagems that most healthy adults are, unfortunately, thoroughly versed in, do we by the same token, also initiate ‘functional’ chemical changes in the brain; though this time of the deleterious sort. In other words, by positively affirming a person’s sense of ‘being in the world’ however this may be initially presented and construed by us to be, it is vital that it is at least validated. Now, there is no point here in splitting hairs by raising the objection that if we were to ‘validate’ the monologue of a ‘delusional’ or a ‘crank’ or a ‘social misfit’ we would in the long run only be providing a disservice to the individual concerned. And what in practice is the effect of this thoroughly slovenly approach if not a ‘drugs, drugs and more drugs’ regime that seeks to functionally alter a ‘chemical imbalance’ that one’s aloof attitude is in contrary fashion only exacerbating anyhow?
How many clinical trials have been conducted to date that monitor the positive effects of a daily fifteen minute conversation with someone who listens, affirms, validates, is non-judgemental and does not seek to pigeonhole your difficulties into a pre-prepared smorgasbord derived from either developmental psychology, psychoanalysis or neurobiological reductionism. Theory necessarily informs practice but it is essentially an artifice erected to keep our minds attuned to certain recurring problematics; the real issues revolve around the therapists' encounters with ‘the patient’ as another human being. In this regard I am reminded of an extraordinary exchange between R.D. Laing and a clearly ambitious young graduate student in clinical psychology:
Graduate student: "Dr. Laing. Can you outline for us please the basis of your approach?"
R.D. Laing: "Certainly. The basis is love. I don't see how you or I can be of any help to our clients in a visionary state unless we are capable of experiencing a feeling of love for them. Therapy, as opposed to mere treatment, requires that we have a capacity for loving kindness and compassion."
Graduate Student (perplexed): "But Dr. Laing, what is your clinical
methodology for developing this approach?"
I mean ?? It is this addiction to empiricist claptrap taken here to it's nth degree that underpins the 'honest' sections of the psychiatric venture.
Laing was unfortunately a rare breed among practitioners and would often go to great lengths to procure the confidence and trust of a patient, reportedly spending hours in some cases sitting in silence with them showing by his presence alone that his thoughts were with them. When I listen to accounts of commitment such as this I am far more inclined to pay attention to what is being said from a theoretical standpoint.
In a similar vein, Al Siebert has written about how he reformed his own 'interview technique' by stumbling upon the apparently outlandish notion of actually empathising with his patient;
"When I was a staff psychologist at a neuropsychiatric institute in 1965, I conducted an experimental interview with an 18-year-old woman diagnosed as "acute paranoid schizophrenic." I'd been influenced by the writings of Carl Jung, Thomas Szasz, and Ayn Rand, and was puzzled about methods for training psychiatric residents that are unreported in the literature. I prepared for the interview by asking myself questions. I wondered what would happen if I listened to the woman as a friend, avoided letting my mind diagnose her, and questioned her to see if there was alink between events in her life and her feelings of self-esteem. My interview with her was followed by her quick remission."
That this perfectly obvious 'intuition' of Siebert's caused such an excitement that he felt prompted to commit his thoughts to paper sums up I think the woeful inadequacy of psychiatric training in general. When has it ever been revelatory for a physician to conclude that by actually listening to a patient 'as a friend' that some progress may in fact be made?
Empirically-speaking, if we must continue to talk as though there are exactitudes and measurable quantities and proportions, the cardinal error (from this narrow rationalistic perspective) is committed, of drawing attention away from the basic phenomenon. In the first placem, the ‘condition’ is evidently psycho-environmental, hence the importance of combining in those cases where there is established an absolute need a properly mediated empathically-based response followed by a much more reflexive course of psychotherapy. Secondly, the ‘illness’, the manner in which it finds verbal expression, through what has come to be called the ‘delusion’, is, as I shall try to demonstrate later, a complex metaphor for a whole range of issues not all of which can be related to the subject‘s personal psychogenesis.
Psychoanalysts see in "delusion" the sophisticated architecture of a surfaced unconscious, a signifying tapestry that, when decoded, reveals (to them) an improperly negotiated Oedipal transition whereas psychiatrists look at the social expression of a biochemical anomaly only among those individuals who wind up in their care and universalises from this (scarcely representative) sample pool that the anomaly itself needs to be expunged. The anomaly, the difference, has been attributed a meaning and the growth and evolution of this meaning, is in the hands, not of the experients themselves but of the corporate-endowed psychiatric establishment, and, to a lesser extent, the psychological sciences.
However, what is produced in the ‘reveries of deliria’ is the story of ‘everyman’ and it amounts to at best a misunderstanding to take these products that deserve to be called common since their potentiality is latent in all of us and present them as derived entirely from a ‘malformed’ or ‘diseased’ psychogenesis. The language we adopt must display an awareness of the psychosocial, environmental and somatic determinants of the phenomenon. The perceived threat of which I mentioned earlier was in the past undoubtedly more palpable; related perhaps to the encroachments of a Palaeolithic predator, the onset of battle, or the tracking of a mammoth. In today’s postmodern milleu it is generally a concatenation of stressors that push us into ‘battle-mode’; an unfortunate melange of trigger events may be present.
However, because of our myriad divided roles it is often fiendishly difficult to pinpoint the precise cause of our unease which is why in the debris of post-"psychosis" many are willing to embrace, if only for a certain type of relief that it affords them, the first set of explanations that are presented and this is why we are justified in referring to the current manner in which psychiatric care is conducted as being designed to induce a form of Stockholm’s Syndrome - to use a phrase that the medical fraternity are themselves familiar with.
To this end we need to acquaint
ourselves fully with the notion of today’s postulated postmodern ego or ‘I’
embedded in a variety of social structures, discursive formations and necessary
material relations of productivity. For the first set of explanations given to
our patient are packaged and produced by the grand narrative of the
psycho-pharmaceutical complex. What we need to adopt in respect to this
narrative emanating from a very particular locus of power is the scepticism of
the postmodern subject; Lyotard’s ‘incredulity towards
meta-narratives’.
Many post-structuralist and postmodernist writers have drawn attention to this power of dominant narratives to inveigle their way into our consciousness and thinking. In many ways they can be seen to structure our goals, motivations, desires and even our basic concepts as to who we are and this is principally because we have been exposed to them so often and no alternative viewpoints are admitted into the debate. In time, a ‘community consensus’ is established around the structuring locus of the grand narrative. The grand narrative we may be reminded has assumed its position of legitimacy not by virtue of the inherent logic of its arguments but because of an asymmetry in power relations.
Thus the task of a properly post-structuralist analysis would consist of undermining the arguments and rationalisations of the dominant narrative(s). It would also take notice that suppressed narratives, such as for instance, psychology, harbour all the credentials to become just as claustrophobically authoritative as the psychiatric narrative it is attempting to displace. One way of doing this is to expose and give credence and legitimacy to the individual ‘micro narratives’ that are continually being suppressed and delegitimised. Because the medical model’s aim is to delegitimise the ideational content of a psychosis by dismissing it as an illness the recovering patient is left with a uniquely perplexing dilemna. How do I properly renegotiate my identity? How do I portray myself to the world bearing in mind that in the light of the best scientific evidence my emotional crisis which involved the entirety of my being has been deemed to be the index of an underlying illness?
It is astounding that among the supposed building blocks, the literature ‘helpfully’ provided to explain to people what has happened to them during what is often a crucial period of identity reconstruction, that this literature makes mention of such thoroughly depressing ‘scientific truths’ such as ‘chemical imbalances’ ‘white matter shrinkage’, ‘larger ventricles’ and so on. Apart from being preposterous fabrications designed to induce drug dependence these are quite often the only concepts with which the neophyte psyche has to make sense of their experience. The most basic precepts to be observed when someone is undergoing emotional distress is to highlight the positives and banish the negatives. So fundamental a reaction is this and so commonly found in normal everyday life we may well characterise it as an instinctive human response.
In this sense the institution of psychiatry hasbecome something of an abomination and if we were to seek further clarification for the rising suicide rates in Ireland, in particular, we may look no further than the unholy alliance it has formed with the pharmaceutical industry. This is not, we may add, because of the preponderance of any malevolent intent on the part of practitioners but rather arises from both institution’s insistent promotion of ‘hard science’ as the solution to a condition whose roots lie, quite clearly, in the emotional domain.
Being social beings more than biological machines most of us enjoy those simple pleasures derived from this warmth of genuine human contact as expressed for instance by Shaftesbury; “to search for that simplicity of manners, and innocence of behaviour, which has been often known among mere savages; ere they were corrupted by our commerce” However, the pressures caused by the collapse of the social contract are experienced differentially.
A Palestinian whose ancestral home has been carved up and redistributed by international consensus may dislike the terms of this macro-level ‘social contract’ but his wrath will be ameliorated through the mutual recognition among his brethren of a shared struggle. What is so disagreeable about the terms of the social contract for those in the affluent nations of the West who are largely unencumbered by the dangers of their national territory being subsumed by foreign interests, if not the observation that we all start out in life with differential access to all kinds of emotional and material resources; love, health, money, housing, education; the list is perhaps endless. Thus when we say a condition is psychosomatic let us bear in mind that the psychological dimension entails a dialogue with a complex social environment.
Freud himself was surprisingly ambivalent about the possibilities of advances in neurology finally revealing a satisfactory correlation between somatic processes and his psychoanalytic ‘metapsychology’. Perhaps this was because, as a neurologist himself he had developed a deeply intuitive picture of the nervature operating as a total system, that is to say, in today’s terminology he had a profoundly holistic appreciation. He viewed the system of which he was a specialist in terms of its interaction with other systems; the external environment. This was going far beyond the call of duty and, in fact, in time necessitated the birth of a new science; psychoanalysis.
Few perhaps could make such a leap today given the bewildering range of specialisations present in each field and few also can doubt that the interdisciplinary exchange of ideas has suffered as a consequence. Whatever the socio-economic factors that drive research interests, a result of this expansion of the objective field of study into several seemingly hermetic and discrete disciplines, who appear to be both unable and unwilling to communicate (the mastery of their respective ‘core’ signifiers evidently requiring a too-lengthy apprenticeship) has been to create for the layman-patient one further dilemma; Amidst the plethora of interpretive frameworks available s/he is left with the question: How should I signify my experience?
One of the fresher responses to this ‘overdetermined’ site of contestation that constitutes our object of study has come from Prof. Phil Barker, a former psychiatric nurse, who encourages mental health professionals to adopt the view that patients ‘own their own experiences’, that they themselves are the best judges of how this crucial period in their lives should be ‘signified’. This philosophy lies at the core of the Tidal Model of ‘mental health reclamation’ developed by himself and his wife Patty Buchanan-Barker in the mid 90’s. The approach is explained as follows;
“Psychiatry has established a professional vocation, and a powerful oligarchy, which purports to explain to people the meaning of their experience, primarily by attributing unusual, remarkable, enlightening or socially disturbing experiences to abstract notions of ‘mental illness’ or ‘mental disorder’. It is self-evident that people own their experience.
Although others may frame views of their perception of the experience of others, only the person can ever come to know what such experiencesreally mean - in the context of their whole life.”
Barker also details many of the concrete social problems that accompany people’s ‘breakdowns’; marauding youth gangs, racial abuse, domestic violence, rape, intimidation, issues around drugs (not the socially sanctioned variety), in fact all the unpleasant realities that accompany life in those areas where development planning has been less than visionary. Instead of the incipient ‘crisis point’ or ‘ontological juncture’ being regarded as a complex metaphor in whose contours and shadings may be observed an ingenious coping strategy and if one cares to look an actual critique of these socially embedded problems the entire by now ‘psychoticised’ or ‘schizophrenesized’ episode has become an epiphenomenon of a genetically determined disease.
Such a practiced approach ensures that the institution of psychiatry remains part of the problem rather than the solution. Instead of being a vital register of the maladies that afflict society thereby being a potential harbinger of positive societal change, it;
(i) offers in too many cases no state-subsidised course of psychotherapy for low income groups and the unemployed - this pays for itself in the long run.
(ii) offers a dogmatic ‘nature’ over ‘nurture’ philosophy that ensures a steady stream of lucrative drugs contracts for pharmaceutical companies at the expense of the taxpayer.
(iii) offers the ‘genetic deficit card’ guaranteeing that the individual now becomes a lifetime ‘service-user’ and worst of all;
(iv) psychiatric practice is guilty of feeding into a patient’s insecurities by inserting this genetic sword of Damocles over their heads at precisely the most vulnerable moments in their lives; immediately after a so-called psychotic episode.
It is precisely the peculiar nature of the ‘psychotic’ journey itself, being at its most fundamental level a titanic struggle over ‘meaning’ that engages the individual’s resources to the point of exhaustion and that makes its aftercare (if aftercare in a medical setting is what we must have), necessarily a species of intervention that demands an obviously competent individual or team who at least have some idea of what this experience may have felt like. From the moment the ‘neophyte’ psyche struggles to assert itself in the fog of thinking that comprises this appalling neuroleptically-induced feebleness it is exposed to the most desultory and depressing range of literature, explanations and enforced behaviour imaginable. In the end the ‘will’ itself becomes eroded; routinization, daily ritual, the inescapable pressure of consensus, all of these things and more besides soon have our emotionally vulnerable patient happily joining in with the chorus of other patients in extolling the virtues of this tablet over that tablet.
Yet, underneath all of this, should lay gestating another creature, actively siphoning the energies from all the previous incarnations; commandeering them, allotting them and proportioning them out for a task perhaps greater than any of the imaginary struggles involved in the so-called ‘psychotic’ episode; escape.
If a means were established whereby we could provide ‘a common language’, a new set of language tools that more accurately describes some of the feelings that accompany these alterations in subjectivity we would have travelled a long way in making the experience less terrifying, less alienating and more within the bounds of an understandable human response to a distressing situation. If a common set of phrases, or helpful descriptions were made available in the literature that were themselves obviously taken from the accounts of other experients, then the post-psychotic period of rehabilitation would be less a silent trial of self-recrimination and more the shared recognition of a mutually survived traumatic experience.
And yet it is depressing to note the lack of response, particularly in the practice of public-sector psychiatry, to the wealth of evidence amassed on this importance of the environmental or ‘nurture’ factor. The common defence, which cites lack of financial resources for the absence of in-house psychotherapy, regardless of theoretical orientation, rings particularly hollow when we think that drugs companies can charge the exchequer up to eighty euro per patient daily. The pervasive influence of big business can be easily glimpsed when the promised efficacy of the latest neuroleptics is amply-advertised on cups, notepads, calendars and other paraphernalia in mental health settings or through sponsored symposia in surroundings that contrast sharply with those enjoyed by ordinary patients. The vast profits to be made from the crisis of an individual’s ‘failure’ to adapt to the world around them ensures that the idea of ‘mental illness’ will continue to be viewed in almost exclusively biochemical, neurological and genetic terms.
If the onset of psychosis is evidently a psychosomatic phenomenon then no one seems to have told the politicians and public servants who continue to underwrite enormous cheques on the exchequer’s behalf. It’s little wonder that recurrent hospitalisations and relapses occur when only half the problem is being addressed in the first place. But even this is to concede that something proper, after all, is being done. If the problem is being treated only with recourse to physical explanations then this implies either a fundamental misunderstanding of the nature of ‘psychosis’ by psychiatry in general or the perception that psychological ‘insights’ are too complex to be grasped by the majority of mental health ‘users’ thereby rendering practitioners impotent in the face of severe disturbance.
There are some ‘professionals’ to whom the former charge isundoubtedly applicable; the pseudo-scientific neurological reductionist ‘spin’ has become so alluring that they’ve forgotten where the ball has come from - a corporate sponsored research lab. In the main, we would like to say that psychiatry like most other professions is composed of well-intentioned souls who operate admirably under the usual occupational constraints but in Ireland at least the only cause to which the psychiatric profession has publicly rallied and dedicated their energies has been the blockage of the effective implementation of the 2001 Mental Health Act - a long overdue piece of legislation that seeks to guarantee some basic human rights to involuntary patients.
Can the subaltern speak? Not yet, apparently.
Many post-structuralist and postmodernist writers have drawn attention to this power of dominant narratives to inveigle their way into our consciousness and thinking. In many ways they can be seen to structure our goals, motivations, desires and even our basic concepts as to who we are and this is principally because we have been exposed to them so often and no alternative viewpoints are admitted into the debate. In time, a ‘community consensus’ is established around the structuring locus of the grand narrative. The grand narrative we may be reminded has assumed its position of legitimacy not by virtue of the inherent logic of its arguments but because of an asymmetry in power relations.
Thus the task of a properly post-structuralist analysis would consist of undermining the arguments and rationalisations of the dominant narrative(s). It would also take notice that suppressed narratives, such as for instance, psychology, harbour all the credentials to become just as claustrophobically authoritative as the psychiatric narrative it is attempting to displace. One way of doing this is to expose and give credence and legitimacy to the individual ‘micro narratives’ that are continually being suppressed and delegitimised. Because the medical model’s aim is to delegitimise the ideational content of a psychosis by dismissing it as an illness the recovering patient is left with a uniquely perplexing dilemna. How do I properly renegotiate my identity? How do I portray myself to the world bearing in mind that in the light of the best scientific evidence my emotional crisis which involved the entirety of my being has been deemed to be the index of an underlying illness?
It is astounding that among the supposed building blocks, the literature ‘helpfully’ provided to explain to people what has happened to them during what is often a crucial period of identity reconstruction, that this literature makes mention of such thoroughly depressing ‘scientific truths’ such as ‘chemical imbalances’ ‘white matter shrinkage’, ‘larger ventricles’ and so on. Apart from being preposterous fabrications designed to induce drug dependence these are quite often the only concepts with which the neophyte psyche has to make sense of their experience. The most basic precepts to be observed when someone is undergoing emotional distress is to highlight the positives and banish the negatives. So fundamental a reaction is this and so commonly found in normal everyday life we may well characterise it as an instinctive human response.
In this sense the institution of psychiatry hasbecome something of an abomination and if we were to seek further clarification for the rising suicide rates in Ireland, in particular, we may look no further than the unholy alliance it has formed with the pharmaceutical industry. This is not, we may add, because of the preponderance of any malevolent intent on the part of practitioners but rather arises from both institution’s insistent promotion of ‘hard science’ as the solution to a condition whose roots lie, quite clearly, in the emotional domain.
Being social beings more than biological machines most of us enjoy those simple pleasures derived from this warmth of genuine human contact as expressed for instance by Shaftesbury; “to search for that simplicity of manners, and innocence of behaviour, which has been often known among mere savages; ere they were corrupted by our commerce” However, the pressures caused by the collapse of the social contract are experienced differentially.
A Palestinian whose ancestral home has been carved up and redistributed by international consensus may dislike the terms of this macro-level ‘social contract’ but his wrath will be ameliorated through the mutual recognition among his brethren of a shared struggle. What is so disagreeable about the terms of the social contract for those in the affluent nations of the West who are largely unencumbered by the dangers of their national territory being subsumed by foreign interests, if not the observation that we all start out in life with differential access to all kinds of emotional and material resources; love, health, money, housing, education; the list is perhaps endless. Thus when we say a condition is psychosomatic let us bear in mind that the psychological dimension entails a dialogue with a complex social environment.
Freud himself was surprisingly ambivalent about the possibilities of advances in neurology finally revealing a satisfactory correlation between somatic processes and his psychoanalytic ‘metapsychology’. Perhaps this was because, as a neurologist himself he had developed a deeply intuitive picture of the nervature operating as a total system, that is to say, in today’s terminology he had a profoundly holistic appreciation. He viewed the system of which he was a specialist in terms of its interaction with other systems; the external environment. This was going far beyond the call of duty and, in fact, in time necessitated the birth of a new science; psychoanalysis.
Few perhaps could make such a leap today given the bewildering range of specialisations present in each field and few also can doubt that the interdisciplinary exchange of ideas has suffered as a consequence. Whatever the socio-economic factors that drive research interests, a result of this expansion of the objective field of study into several seemingly hermetic and discrete disciplines, who appear to be both unable and unwilling to communicate (the mastery of their respective ‘core’ signifiers evidently requiring a too-lengthy apprenticeship) has been to create for the layman-patient one further dilemma; Amidst the plethora of interpretive frameworks available s/he is left with the question: How should I signify my experience?
One of the fresher responses to this ‘overdetermined’ site of contestation that constitutes our object of study has come from Prof. Phil Barker, a former psychiatric nurse, who encourages mental health professionals to adopt the view that patients ‘own their own experiences’, that they themselves are the best judges of how this crucial period in their lives should be ‘signified’. This philosophy lies at the core of the Tidal Model of ‘mental health reclamation’ developed by himself and his wife Patty Buchanan-Barker in the mid 90’s. The approach is explained as follows;
“Psychiatry has established a professional vocation, and a powerful oligarchy, which purports to explain to people the meaning of their experience, primarily by attributing unusual, remarkable, enlightening or socially disturbing experiences to abstract notions of ‘mental illness’ or ‘mental disorder’. It is self-evident that people own their experience.
Although others may frame views of their perception of the experience of others, only the person can ever come to know what such experiencesreally mean - in the context of their whole life.”
Barker also details many of the concrete social problems that accompany people’s ‘breakdowns’; marauding youth gangs, racial abuse, domestic violence, rape, intimidation, issues around drugs (not the socially sanctioned variety), in fact all the unpleasant realities that accompany life in those areas where development planning has been less than visionary. Instead of the incipient ‘crisis point’ or ‘ontological juncture’ being regarded as a complex metaphor in whose contours and shadings may be observed an ingenious coping strategy and if one cares to look an actual critique of these socially embedded problems the entire by now ‘psychoticised’ or ‘schizophrenesized’ episode has become an epiphenomenon of a genetically determined disease.
Such a practiced approach ensures that the institution of psychiatry remains part of the problem rather than the solution. Instead of being a vital register of the maladies that afflict society thereby being a potential harbinger of positive societal change, it;
(i) offers in too many cases no state-subsidised course of psychotherapy for low income groups and the unemployed - this pays for itself in the long run.
(ii) offers a dogmatic ‘nature’ over ‘nurture’ philosophy that ensures a steady stream of lucrative drugs contracts for pharmaceutical companies at the expense of the taxpayer.
(iii) offers the ‘genetic deficit card’ guaranteeing that the individual now becomes a lifetime ‘service-user’ and worst of all;
(iv) psychiatric practice is guilty of feeding into a patient’s insecurities by inserting this genetic sword of Damocles over their heads at precisely the most vulnerable moments in their lives; immediately after a so-called psychotic episode.
It is precisely the peculiar nature of the ‘psychotic’ journey itself, being at its most fundamental level a titanic struggle over ‘meaning’ that engages the individual’s resources to the point of exhaustion and that makes its aftercare (if aftercare in a medical setting is what we must have), necessarily a species of intervention that demands an obviously competent individual or team who at least have some idea of what this experience may have felt like. From the moment the ‘neophyte’ psyche struggles to assert itself in the fog of thinking that comprises this appalling neuroleptically-induced feebleness it is exposed to the most desultory and depressing range of literature, explanations and enforced behaviour imaginable. In the end the ‘will’ itself becomes eroded; routinization, daily ritual, the inescapable pressure of consensus, all of these things and more besides soon have our emotionally vulnerable patient happily joining in with the chorus of other patients in extolling the virtues of this tablet over that tablet.
Yet, underneath all of this, should lay gestating another creature, actively siphoning the energies from all the previous incarnations; commandeering them, allotting them and proportioning them out for a task perhaps greater than any of the imaginary struggles involved in the so-called ‘psychotic’ episode; escape.
If a means were established whereby we could provide ‘a common language’, a new set of language tools that more accurately describes some of the feelings that accompany these alterations in subjectivity we would have travelled a long way in making the experience less terrifying, less alienating and more within the bounds of an understandable human response to a distressing situation. If a common set of phrases, or helpful descriptions were made available in the literature that were themselves obviously taken from the accounts of other experients, then the post-psychotic period of rehabilitation would be less a silent trial of self-recrimination and more the shared recognition of a mutually survived traumatic experience.
And yet it is depressing to note the lack of response, particularly in the practice of public-sector psychiatry, to the wealth of evidence amassed on this importance of the environmental or ‘nurture’ factor. The common defence, which cites lack of financial resources for the absence of in-house psychotherapy, regardless of theoretical orientation, rings particularly hollow when we think that drugs companies can charge the exchequer up to eighty euro per patient daily. The pervasive influence of big business can be easily glimpsed when the promised efficacy of the latest neuroleptics is amply-advertised on cups, notepads, calendars and other paraphernalia in mental health settings or through sponsored symposia in surroundings that contrast sharply with those enjoyed by ordinary patients. The vast profits to be made from the crisis of an individual’s ‘failure’ to adapt to the world around them ensures that the idea of ‘mental illness’ will continue to be viewed in almost exclusively biochemical, neurological and genetic terms.
If the onset of psychosis is evidently a psychosomatic phenomenon then no one seems to have told the politicians and public servants who continue to underwrite enormous cheques on the exchequer’s behalf. It’s little wonder that recurrent hospitalisations and relapses occur when only half the problem is being addressed in the first place. But even this is to concede that something proper, after all, is being done. If the problem is being treated only with recourse to physical explanations then this implies either a fundamental misunderstanding of the nature of ‘psychosis’ by psychiatry in general or the perception that psychological ‘insights’ are too complex to be grasped by the majority of mental health ‘users’ thereby rendering practitioners impotent in the face of severe disturbance.
There are some ‘professionals’ to whom the former charge isundoubtedly applicable; the pseudo-scientific neurological reductionist ‘spin’ has become so alluring that they’ve forgotten where the ball has come from - a corporate sponsored research lab. In the main, we would like to say that psychiatry like most other professions is composed of well-intentioned souls who operate admirably under the usual occupational constraints but in Ireland at least the only cause to which the psychiatric profession has publicly rallied and dedicated their energies has been the blockage of the effective implementation of the 2001 Mental Health Act - a long overdue piece of legislation that seeks to guarantee some basic human rights to involuntary patients.
Can the subaltern speak? Not yet, apparently.
