Monday, 20 July 2009

Psychiatry and politics

One more reply to Will:

No need to apologize! As mentioned, I'm not an angel, me neither. And I've actually enjoyed this conversation too. I like conversations with people, who are open-minded. BTW, Gianna is right. There is a whole lot of judgement and anger, even hatred, out there. On both sides. I recently read a comment on a Norwegian blog, that stated that about 90 per cent of this world's population were traumatized, in one way or the other. It's certainly just an estimation, but in my opinion a very realistic one. Unfortunately. And if trauma isn't made conscious and worked out it gets acted out. Which means war. Like in the war against terrorism, the war against drugs, the war in Iraq,... you name it.

On juge un société à la manière dont elle traite ses fous. -Lucien Bonnafé

Of course it is society that makes psychiatry possible. And I want to emphasize, that I distinguish between the mental health system and psychiatry. It goes without saying: psychiatry was established in order to pathologize certain, unwanted behaviors and ideas, that couldn't be criminalized. Pathologizing behaviors and ideas means to declare them null and void. This quote from Jani's father's blog is one of the most obvious illustrations of what medically diagnozing behavior and ideas aims at: "With schizophrenics, you always have to try to rationalize with them. You have to try and point out where their thinking is irrational. It doesn’t work right then and there but the hope is that it will sink in over time and that Jani will learn to question her own thoughts." (my italics)

BTW, there lies an interesting contradiction in psychiatry's practice of pathologizing and declaring certain thoughts to be "irrational", while no one ever seems to doubt the report of "symptoms" by the identified "patient" to be other than rational.

Well, the thing is, that "psychosis", "schizophrenia", is a reaction to having one's thoughts and feelings declared null and void (because they're unwanted). I dare say, that every single individual who has experienced "psychosis" as a result of psychological trauma (and usually physical abuse involves psychological trauma as well) - in contrast to those, whose "psychotic" symptoms are a reaction to purely biological stressors, food allergies, adverse reactions to drugs, etc. - has had their own thoughts and feelings invalidated in one or the other way. To an extent, that eventually makes them doubt the value of their own, genuine thoughts and feelings themselves. And the moment one's true self starts to protest this invalidation, psychiatry steps in, and accomplishes what others weren't able to accomplish. Because they couldn't scientifically prove one's thoughts and feelings to be without value. Psychiatry can. Or, it claims to be able to. The invalidation of one's personality is scientifically, and thus, taken the status of science in our society into account, indisputably and irrevocably justified. That's why psychiatry has to be a (medical) science. Religion doesn't have that power anymore in our society today. Although it once had: what psychiatry is to our modern society, the Inquisition was to Pre-Enlightenment society. Notice that psychiatry emerges about at the same time as society enters the age of Enlightenment, and the Inquisition comes to an end.

When more and more people turned away from religion as the truth, and instead enthusiastically embraced science, the Inquisition was no longer an acceptable tool to control and oppress unwanted behavior and ideas. It needed to be replaced by a tool, that at least on the surface gave the impression of being scientific in order to be acceptable to an enlightened society.

Psychiatry is one of society's tools to enforce our culture's ideology on people. Probably the most effective one. Where educational institutions for example have great but nevertheless limited influence on individual perception, psychiatry's influence is virtually unlimited. Any kind of being in this world can be defined a mental illness (cf. homosexuality, or being a runaway slave), and while it wouldn't occur to anyone to remove real illnesses like the flu or cancer from the ICD, or to add any diagnoses that lack scientific proof of being an illness to it, psychiatric diagnoses are added to and removed from the DSM faster than you can say "DSM"... always perfectly in line with current cultural norms and values.

Now you'll maybe object, and say that people do suffer and need help. I agree. But the help people really need, is to have their suffering validated, not invalidated. To blame individual biology for suffering, that is caused by cultural norms and values, is to invalidate the suffering.

The vast majority of people I know, I myself included, know that they suffer and are in need of help. It isn't true that they lack insight by definition. The only idea they lack insight in regard to, is the idea that they would suffer from a brain disease and would need medical treatment. Non-psychiatric alternatives like Soteria don't need to force anybody, or lock as much as one single door. Because, in contrast to psychiatry, they validate people's suffering, so people stay voluntarily. Just as I didn't cancel, was late for, or missed out on one single therapy session. Because I felt that both my suffering and my being in general was validated. Not entirely - for example, I experienced being referred to as a "patient" as an invalidation - but enough to have me stay.

As for psychotherapy in general, and your experience in particular, that I've heard countless parallels to over time, it is dominated by psychiatry's (society's) ideology. That is, it doesn't validate the individual in crisis and his/her (human) experience. It pathologizes both. And once you and your (human) experience are declared pathological, it can't be you, but has to be the therapist, who knows all the answers. It doesn't work out for the individual in crisis, but it does for society. Society prefers to put up with a growing number of people on disability, people who aren't chronically ill, but chronically denied their true answers, their true selves, to being confronted with these true answers.


WillSpirit said...

Now you are onto a new topic: the history and role of psychiatry. A full response to that issue will need to wait until another time. You won't be surprised that I agree with parts, but also disagree with parts. Until the day when I get to this topic in more detail, however, let me state for the record that it's quite a stretch to say the practice of psychiatry stands as a replacement for the inquisition! I obviously can't dissuade you, but there are some weaknesses in the analogy (and you're going beyond analogy to contend it's serving the exact same purpose), to say the least.

Marian said...

Yeah, I took your remark, that it is our culture that has to be held accountable for the harm psychiatry does, not psychiatry itself, and ended somehow up at this comparison - that Thomas Szasz has written a whole book about. So, no wonder my post here has its shortcomings...

I think, one reason why we hesitate to make the comparison is that thinking about the Inquisition usually makes us shudder today. It seems the embodiment of inhumanity to us. Since we have moved beyond the belief system the Inquisition was part of, and are no longer participants but onlookers, we see the Inquisition's inhumanity a lot more clearly, than people whose thinking was controlled by the belief system of that era were able to do. People back then believed, that the Inquisition both protected society from evil, and saved the souls of those, who were the devil's allies. That is, that it actually was a beneficial institution. Another parallel...

As I see it, today, we haven't abandoned belief systems as such. We just replaced the Christian belief system with the rational, scientific one. While every belief system needs its Inquisition...

I wonder, what people will think of psychiatry, the moment humanity moves beyond the rational, scientific belief system. "Geez, how could they! How barbaric!"? Probably. Which doesn't mean, that this future era would have no belief system of its own, and thus no Inquisition...

On another note, what I initially had in mind to write about was in how far psychiatry itself is or is not to blame for the harm it does. Well, that will be another post.

Institutional psychiatry is a continuation of the Inquisition. All that has really changed is the vocabulary and the social style. The vocabulary conforms to the intellectual expectations of our age: it is a pseudo-medical jargon that parodies the concepts of science. The social style conforms to the political expectations of our age: it is a pseudo-liberal social movement that parodies the ideals of freedom and rationality. -Thomas Szasz

Mark p.s.2 said...

People are judged "broken" by their bizzare behaviour . If too weak a financial or social status the broken person is sent to the repare factory. The repare factory that only makes crazy people. If/when the broken person is "functioning" sufficiently they come out of the factory. Very simple.