Redcat: âWhy hypothesize that patients are different than the average american? I find the book club kinda heavy as an activity.â
SP: âI hope Milan takes your suggestion seriously. And I hope a âpatientâ is âallowedâ to run the classâŠ. perhaps cooking classes would have built a better âcommunityâ and caused a shift in âwhatâ and âwhoâ to think about.â
I think the idea of a communal BBQ is great. An inspiration for beginning the reading group was the Institutional Psychotherapy movement from France, in particular at La borde clinic and Saint-Alban under the guidance of Tosquelles and Oury. Here, a major conviction was that social and psychological problems should be simultaneously broached. Within the institutions they attempted to do so through a horizontal, radically democratic therapeutic approach. In practise: everyone at the institution became part of the community, rotating through material chores (housework, cooking, farming, bookbinding, editing) therapeutic sessions, and also, to get back to your point, taking part in communal dinners. These were considered just as worthwhile as an individual psychoanalytic session, that were also held throughout the day, as were reading groups, art sessions and many more.
However, and here we diverge, you are all framing it very black and white as an either / or situation. Why? Sure, maybe the âaverage personâ has no interest in philosophy, but should that mean we are satisfied once we have catered for the average? What of those who donât like BBQâs, but would prefer to sit in a reading circle and discuss Nietzsche?
As to the point re. who runs the class, I think I addressed this in my article: I gave the participants every opportunity to seize control over what and how the reading group should be run, but nobody took it upon themselves to do so.
Patients and staff almost always address one another with the formal pronoun.
Iâm not sure if you misunderstood my last sentence, but I by no means support the hierarchy between âhealthy staffâ and âill patientsâ, on the contrary, this is the basic concept which we as a reading group attempted to revise. On this point we are in agreement.
Your next point is, in my opinion, problematic. By suggesting staff are delusional, you are in effect establishing a new hierarchy on the rubble of the one we had just knocked down: now it is no longer âhealthy staffâ against âill patientsâ, but âhealthy patientsâ against âill staffâ. I think any kind of hierarchy is misguided.
We could instead conceive of the trialogical framework between patients, family/friends and professionals as a continuum, where we all inhabit any of these three (or more) roles in alternation, always depending on the individual situation. This would divert the emphasis from the oversimplified notion of âhealthyâ against âillâ and rather focus on actuality: are we currently affected ourselves? A member of our family? A friend? And: do we have insights into these phenomena?
“So how would you define a âmental illness,â? How would you distinguish it from ânormal suffering?”
This is an ancient question which many have tried and largely failed to answer, both personally and collectively. For this reason I canât give you a universal definition, only my own understanding of this temporary condition.
In an important book for the psychiatric reform movement in Germany from the 70âs, ‘Irren ist menschlich’ (which canât really be translated, but âMad to be normalâ comes close, and thatâs probably where they took the Laing film title from), the authors offer this definition:
âA mentally ill human is a human who, in attempting to solve an age-appropriate task, gets stuck at a dead end. This result we call illness, affront, disturbance, suffering, deviation. It is a universally humane possibility; that means it is, for all of us under certain inner or outer circumstances, a means of expressing that a situation âcanât go on like thisâ. Hence this possibility is internally accessible and fundamentally known to us all.â
I think theyâre onto something with this. And importantly, it addresses the notion of external abuse and oppression which you highlight: Why is it an âillnessâ if the circumstances are oppressive? Why is it an âillnessâ if the cause is man-made?
The âillnessâ is the personal reaction expressing that a situation canât go on like this. And regardless the cause, this is not primarily an expression on a societal, or communal, or even familial level, but deeply personal: I canât go on like this. It is the personal suffering, taken as a prerequisite for any definition of mental illness, that comes to light.
To ensure change, I think it is helpful to name this temporary condition. Sure, we can then argue about which term is best used, but first we need to agree on the phenomena we are trying to elucidate, and I think âmental illnessâ goes a long way in enabling such a common language.
âPeople need to be disabused of the idea that there ever has been anything like ~mental illness~â
If this is the outgoing position from which you base your arguments then I think we have reached an irreconcilable point in our discussion. From all conceivable points in my imagination and experiences so far, both personal and professional, I disagree with you.
Sure, I canât offer you any kind of proof to support this, and I understand that all of my own beliefs and consequent arguments are anchored within explanatory models that remain just that: models, always falling short of an absolute truth. And so while Iâm in so way sure that I wonât turn out to be wrong, and will always try to remain open to this possibility, I can only argue based on my own conceptions of humanity, and hence every discussion on the institutional, or philosophical, or political backdrop of mental healthcare in which I engage takes the acceptance of mental illness as a tenable phenomenon for granted.
With this in mind, I donât think thereâs any point in a continuing discussion, which now appears devoid of a common language.
For several reasons I donât agree with the âhard line stanceâ you outline. That doesn’t mean I donât agree with some of your arguments (although frankly Iâm not really sure I understand some of them), but they lead me to different conclusions.
At the end you write: âpolitical involvement is always the replacement for the therapistâs couchâ. The essence of a political struggle into which mental healthcare is embedded shouldnât be overlooked in any reform, however radical it may be, where a common ethic, or morality, or notion of humanism is at the forefront of our aims and actions â this, I completely agree with you, should always be what necessitates change. And I agree that a greater emphasis on the social nature of mental suffering would surely diminish much unnecessary, perhaps even harmful treatment.
Anchoring our discussion to this shared premise, I can respect the fact that you personally disagree with any deviation from the âhard line stanceâ: no drugs, psychotherapy, or recovery programs. But how can you be so sure that this stance applies for everyone else, too? How do you know there arenât people who actually profit from precisely these therapies? The use of drugs is a good example: if I have a stomach ache I can take a PPI, if I have a headache paracetamol. Likewise if I canât leave the house as Iâm too anxious or depressed, the voices return or sleep just wonât come â there are medications which can help to alleviate certain symptoms in the short term. These are not usually long-term solutions, and we shouldnât pretend that they are, but they are tools which enable a sustainable change. To be opposed to drugs no matter what is, in my opinion, not just counter-productive, but ignorant as to what it means to be necessarily embodied, and scienceâs progress and insights into many aspects of this basic fact.
More fundamentally â and now forgetting for a brief moment everything institutional, medical, and political â I think your argument of abolishing the mental health system forgets the one aspect of mental health treatment which we should never forget: the fact that it is built upon a basic human need of discussing emotional hardships with others. You may argue that we need not institutionalise this need. But I think that disregards the reach of an institution, especially one which is governmentally supported and especially when considering the astounding forms of isolation which society generates.
“I am not averse to the mental health system, I am 100% opposed to it.”
What do you propose in its stead? And I mean this question completely sincerely, for I think we do share a common notion of rejection of the status quo, and I am open to the necessity of radical, institutional change
âFoucault is the one who recognised the problems with this and best explained them first.
âPersonal Responsibilityâ is just pedagogy, lecturing to people as though they were children. Must show no tolerance towards this.â
I donât think weâre talking about the same thing. What I mean by âpersonal responsibilityâ is very different to how you are describing it. This is a nice illustration of what I mean, taken from an article by Camille Robcis (who is currently writing a book on Institutional Psychotherapy), where the idea of âpersonal responsibilityâ can be substituted for âholding someone accountableâ:
You raise some interesting points and objections, but I see things very differently.
With regard to your more general aversion towards those working within the mental health system â the âenforcing arm of the stateâ, the âlicensed officer of the stateâ, those who âwant you to accept abuse and injusticeâ â I think you are making it too easy for yourself by asserting a simple good vs. bad generalisation.
Picking up on your metaphor: it seems you are judging a personâs stance on the notion of slavery according to a certain category, and not their belief. As ants are enslaving bees, all ants must be of the belief that slavery is, ultimately, beneficial. It matters not to you whether the individual ant in question shares that view, or if, in fact, the polar opposite is true â what you are saying is: if an individual is an ant, then they must be in favour of slavery. Nothing else is conceivable.
The same thus applies for the mental health system: your aversion seems to run so deep that it is inconceivable for an âenforcing arm of the stateâ not to âwant you to accept abuse and injusticeâ. I donât agree with this.
And another thought: where does Foucault fit into this? As a trained psychotherapist, was he, too, not thereby a âlicenced officer of the stateâ? Or Tosquelles, Oury, Lacan, Basaglia, even Cooper, Laing and Huber?
With regard to the more specific notion of personal responsibility, I completely agree with your emphasis on the problematic status quo, perhaps a neoliberal tendency, of reducing the causality of individual suffering to a personal responsibility â what you call a âself-reliance ethicâ. This diminishes the impact of political and structural conditions which are as relevant for mental health as anything else.
But, and I think this is the point at which we diverge, I donât think the argument should be made as an either / or situation: the political and structural conditions must be addressed whilst simultaneously accepting a personal responsibility inherent to each human being.
And that leads back to suicide: the discussion of suicide in this essay has not been specific to mental health. I have tried to argue for the individual right to self-determination â even if an individual wants to use this right to end their life â regardless what the reason is.
This was taken at a cemetery in San Francisco, where the photographer met a group of film-makers trying out their new drone. He spent several hours with them and took this picture, amongst many others. So far as he remembers neither the cemetery as a personification of death nor death as such were the focus of the time spent there, and nor was any motion of mental illness. The reason I chose this picture is a personal association I made when seeing it, an emotional response which, in my opinion, builds nicely upon the thoughts discussed in this essay
Not sure I follow your point. Imagine the opposite â if psychiatric professionals didnât propagate the advantage of continued life, then surely suicide would be even more common?
And the torturous path you mention: are you not disposing the responsibility of each individual, who often seeks psychiatric help and not the other way round?
Itâs a very good point, Steve. I wonder if you have any suggestions as to how to approach this double bind in the future?
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Redcat: âWhy hypothesize that patients are different than the average american? I find the book club kinda heavy as an activity.â
SP: âI hope Milan takes your suggestion seriously. And I hope a âpatientâ is âallowedâ to run the classâŠ. perhaps cooking classes would have built a better âcommunityâ and caused a shift in âwhatâ and âwhoâ to think about.â
I think the idea of a communal BBQ is great. An inspiration for beginning the reading group was the Institutional Psychotherapy movement from France, in particular at La borde clinic and Saint-Alban under the guidance of Tosquelles and Oury. Here, a major conviction was that social and psychological problems should be simultaneously broached. Within the institutions they attempted to do so through a horizontal, radically democratic therapeutic approach. In practise: everyone at the institution became part of the community, rotating through material chores (housework, cooking, farming, bookbinding, editing) therapeutic sessions, and also, to get back to your point, taking part in communal dinners. These were considered just as worthwhile as an individual psychoanalytic session, that were also held throughout the day, as were reading groups, art sessions and many more.
However, and here we diverge, you are all framing it very black and white as an either / or situation. Why? Sure, maybe the âaverage personâ has no interest in philosophy, but should that mean we are satisfied once we have catered for the average? What of those who donât like BBQâs, but would prefer to sit in a reading circle and discuss Nietzsche?
As to the point re. who runs the class, I think I addressed this in my article: I gave the participants every opportunity to seize control over what and how the reading group should be run, but nobody took it upon themselves to do so.
Report comment
Patients and staff almost always address one another with the formal pronoun.
Iâm not sure if you misunderstood my last sentence, but I by no means support the hierarchy between âhealthy staffâ and âill patientsâ, on the contrary, this is the basic concept which we as a reading group attempted to revise. On this point we are in agreement.
Your next point is, in my opinion, problematic. By suggesting staff are delusional, you are in effect establishing a new hierarchy on the rubble of the one we had just knocked down: now it is no longer âhealthy staffâ against âill patientsâ, but âhealthy patientsâ against âill staffâ. I think any kind of hierarchy is misguided.
We could instead conceive of the trialogical framework between patients, family/friends and professionals as a continuum, where we all inhabit any of these three (or more) roles in alternation, always depending on the individual situation. This would divert the emphasis from the oversimplified notion of âhealthyâ against âillâ and rather focus on actuality: are we currently affected ourselves? A member of our family? A friend? And: do we have insights into these phenomena?
Report comment
“So how would you define a âmental illness,â? How would you distinguish it from ânormal suffering?”
This is an ancient question which many have tried and largely failed to answer, both personally and collectively. For this reason I canât give you a universal definition, only my own understanding of this temporary condition.
In an important book for the psychiatric reform movement in Germany from the 70âs, ‘Irren ist menschlich’ (which canât really be translated, but âMad to be normalâ comes close, and thatâs probably where they took the Laing film title from), the authors offer this definition:
âA mentally ill human is a human who, in attempting to solve an age-appropriate task, gets stuck at a dead end. This result we call illness, affront, disturbance, suffering, deviation. It is a universally humane possibility; that means it is, for all of us under certain inner or outer circumstances, a means of expressing that a situation âcanât go on like thisâ. Hence this possibility is internally accessible and fundamentally known to us all.â
I think theyâre onto something with this. And importantly, it addresses the notion of external abuse and oppression which you highlight: Why is it an âillnessâ if the circumstances are oppressive? Why is it an âillnessâ if the cause is man-made?
The âillnessâ is the personal reaction expressing that a situation canât go on like this. And regardless the cause, this is not primarily an expression on a societal, or communal, or even familial level, but deeply personal: I canât go on like this. It is the personal suffering, taken as a prerequisite for any definition of mental illness, that comes to light.
To ensure change, I think it is helpful to name this temporary condition. Sure, we can then argue about which term is best used, but first we need to agree on the phenomena we are trying to elucidate, and I think âmental illnessâ goes a long way in enabling such a common language.
Report comment
âPeople need to be disabused of the idea that there ever has been anything like ~mental illness~â
If this is the outgoing position from which you base your arguments then I think we have reached an irreconcilable point in our discussion. From all conceivable points in my imagination and experiences so far, both personal and professional, I disagree with you.
Sure, I canât offer you any kind of proof to support this, and I understand that all of my own beliefs and consequent arguments are anchored within explanatory models that remain just that: models, always falling short of an absolute truth. And so while Iâm in so way sure that I wonât turn out to be wrong, and will always try to remain open to this possibility, I can only argue based on my own conceptions of humanity, and hence every discussion on the institutional, or philosophical, or political backdrop of mental healthcare in which I engage takes the acceptance of mental illness as a tenable phenomenon for granted.
With this in mind, I donât think thereâs any point in a continuing discussion, which now appears devoid of a common language.
Report comment
For several reasons I donât agree with the âhard line stanceâ you outline. That doesn’t mean I donât agree with some of your arguments (although frankly Iâm not really sure I understand some of them), but they lead me to different conclusions.
At the end you write: âpolitical involvement is always the replacement for the therapistâs couchâ. The essence of a political struggle into which mental healthcare is embedded shouldnât be overlooked in any reform, however radical it may be, where a common ethic, or morality, or notion of humanism is at the forefront of our aims and actions â this, I completely agree with you, should always be what necessitates change. And I agree that a greater emphasis on the social nature of mental suffering would surely diminish much unnecessary, perhaps even harmful treatment.
Anchoring our discussion to this shared premise, I can respect the fact that you personally disagree with any deviation from the âhard line stanceâ: no drugs, psychotherapy, or recovery programs. But how can you be so sure that this stance applies for everyone else, too? How do you know there arenât people who actually profit from precisely these therapies? The use of drugs is a good example: if I have a stomach ache I can take a PPI, if I have a headache paracetamol. Likewise if I canât leave the house as Iâm too anxious or depressed, the voices return or sleep just wonât come â there are medications which can help to alleviate certain symptoms in the short term. These are not usually long-term solutions, and we shouldnât pretend that they are, but they are tools which enable a sustainable change. To be opposed to drugs no matter what is, in my opinion, not just counter-productive, but ignorant as to what it means to be necessarily embodied, and scienceâs progress and insights into many aspects of this basic fact.
More fundamentally â and now forgetting for a brief moment everything institutional, medical, and political â I think your argument of abolishing the mental health system forgets the one aspect of mental health treatment which we should never forget: the fact that it is built upon a basic human need of discussing emotional hardships with others. You may argue that we need not institutionalise this need. But I think that disregards the reach of an institution, especially one which is governmentally supported and especially when considering the astounding forms of isolation which society generates.
Report comment
“I am not averse to the mental health system, I am 100% opposed to it.”
What do you propose in its stead? And I mean this question completely sincerely, for I think we do share a common notion of rejection of the status quo, and I am open to the necessity of radical, institutional change
Report comment
You wrote:
âFoucault is the one who recognised the problems with this and best explained them first.
âPersonal Responsibilityâ is just pedagogy, lecturing to people as though they were children. Must show no tolerance towards this.â
I donât think weâre talking about the same thing. What I mean by âpersonal responsibilityâ is very different to how you are describing it. This is a nice illustration of what I mean, taken from an article by Camille Robcis (who is currently writing a book on Institutional Psychotherapy), where the idea of âpersonal responsibilityâ can be substituted for âholding someone accountableâ:
âAccording to Tosquelles, [Hermann] Simonâs greatest contribution was to change the attitudes of doctors and nurses vis-Ă -vis the patients. Work was not simply a distraction for the patients and it certainly was not a âmoral treatmentâ. Rather, work was a way to hold the patients accountable: âholding the patients accountable for Simon meant trusting them and trusting the existence of a general law of all living beings, a âlogosâ that regulated and ordered everything.â This general law was not a morality, Tosquelles insisted, but more like an ethics, a way of life. As Tosquelles put it, âthe point was not to âmake patients workâ to alleviate this or that symptom but to make the patients and the staff work to cure the institution.â It is this ethical â and fundamentally social â understanding of psychiatry that Tosquelles brought to Saint-Alban and that was particularly influential for thinkers such as Jean Oury and FĂ©lix Guattari.â
And then Robcisâ footnote (35) at the end of this quote is interesting:
âIt is in this sense that Michel Foucault referred to Anti-Oedipus as âa book of ethics, the first book of ethics to be written in France in quite a long time.â (Gilles Deleuze and FĂ©lix Guattari, Anti-Oedipus: Capitalism and Schizophrenia)â
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You raise some interesting points and objections, but I see things very differently.
With regard to your more general aversion towards those working within the mental health system â the âenforcing arm of the stateâ, the âlicensed officer of the stateâ, those who âwant you to accept abuse and injusticeâ â I think you are making it too easy for yourself by asserting a simple good vs. bad generalisation.
Picking up on your metaphor: it seems you are judging a personâs stance on the notion of slavery according to a certain category, and not their belief. As ants are enslaving bees, all ants must be of the belief that slavery is, ultimately, beneficial. It matters not to you whether the individual ant in question shares that view, or if, in fact, the polar opposite is true â what you are saying is: if an individual is an ant, then they must be in favour of slavery. Nothing else is conceivable.
The same thus applies for the mental health system: your aversion seems to run so deep that it is inconceivable for an âenforcing arm of the stateâ not to âwant you to accept abuse and injusticeâ. I donât agree with this.
And another thought: where does Foucault fit into this? As a trained psychotherapist, was he, too, not thereby a âlicenced officer of the stateâ? Or Tosquelles, Oury, Lacan, Basaglia, even Cooper, Laing and Huber?
With regard to the more specific notion of personal responsibility, I completely agree with your emphasis on the problematic status quo, perhaps a neoliberal tendency, of reducing the causality of individual suffering to a personal responsibility â what you call a âself-reliance ethicâ. This diminishes the impact of political and structural conditions which are as relevant for mental health as anything else.
But, and I think this is the point at which we diverge, I donât think the argument should be made as an either / or situation: the political and structural conditions must be addressed whilst simultaneously accepting a personal responsibility inherent to each human being.
And that leads back to suicide: the discussion of suicide in this essay has not been specific to mental health. I have tried to argue for the individual right to self-determination â even if an individual wants to use this right to end their life â regardless what the reason is.
Report comment
This was taken at a cemetery in San Francisco, where the photographer met a group of film-makers trying out their new drone. He spent several hours with them and took this picture, amongst many others. So far as he remembers neither the cemetery as a personification of death nor death as such were the focus of the time spent there, and nor was any motion of mental illness. The reason I chose this picture is a personal association I made when seeing it, an emotional response which, in my opinion, builds nicely upon the thoughts discussed in this essay
Report comment
Not sure I follow your point. Imagine the opposite â if psychiatric professionals didnât propagate the advantage of continued life, then surely suicide would be even more common?
And the torturous path you mention: are you not disposing the responsibility of each individual, who often seeks psychiatric help and not the other way round?
Report comment
“We must not be torturing people into suicide, via psychiatry and psychotherapy.”
What do you mean by this?
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