Showing 22 of 22 comments.
Thanks Sami – you have done a great service.
I would suggest that some may find the work of Trigant Burrow useful in thinking of a new (old) paradigm – he said that “it is futile to attempt to remedy mental disease occurring within the individual mind so long as psychiatry remains blind to the existence of mental disease within the social mind” (1926, Our mass neurosis, Psychol. Bull, 23, 305-312) (You will have to excuse his language – its a bit dated). Burrow was a founding father of American Psychoanalytic Assoc, but he was kicked out of there for his unorthodoxy. His thesis was that the “social mind” was “suffering” (our mass neurosis if you will) from what we would describe today as “Cartesianism” – the idea your mind is in your head, that you have an individual ‘mind’. He said that Freud got it wrong by saying that mother is the love object; when she is in fact the love subject. Freud thought that you became frustrated in not being able to access the breast when you wanted it, and in your rage you objectified mother; but Burrow reasoned that you retain the primary harmony and identity you have with mother in the womb, despite frustrations – and we have a primary harmony with each other as we develop (see Levy-Bruh – the ‘Primitive Mind’ – many indigenous cultures have a sense of “we” or “us” that is primary – eg the Zulu “ubuntu”). What we objectify is ourselves – we start thinking of ourselves as separate isolated minds – Cartesianism. We become divided within ourselves – constantly checking ourselves out in various mirrors (panopticism for Foucault). Burrow was doing research on divided attention versus the undivided and publishing is in Nature (a v. prestigious journal) in the 1930s – needless to say when a similar line of research occurred in the 1960s, nobody mentioned Burrow. He was terrible writer, as DH Lawrence told him, but he was praised by Lawrence and other noteworthy thinkers of his age; but not by the “psy” field (although some were plagiarising bits of his work). Wittgenstein has criticised Cartesianism (an enduring hostility to the idea of “individuated substantive self”) and he exposed Descartes philosophy of mind as containing self-referential paradoxes (similar to Epimenides ‘Liar Paradox’ – e.g ‘this is a lie’). From Witt. has come a new science of mind (this century) called enactivism (or 4E cognition) that recently explored the idea that our first consciousness is in the womb (cf Ciaunica) and instead of explaining that we are social beings because we are innately empathic, (and then its mystery as to how we are empathic), we are empathic because of this early experience. In other words Burrow is right. Burrow did not advocate a return to this primordial state of unity but reinstate a specie-wide integration of a mature and culturally advanced level. As Sami says “There is no doubt in my mind that such societies cannot happen under the umbrella of capitalism”.
Sammi, I have forwarded this chapter to all my children – who are now young parents – as it is particularly well written. Thank you for making it available on-line.
Great commentary Cabrogal (a girl from Cabramatta??) – where can I get some! Great conversation old head.
If ego death is a “curative” factor for some using psilocybin (and other entheogens) might there be a non-drug way of achieving this? The philosopher Wittgenstein, was deeply anti-Cartesian; and it was Descartes “I think therefore I am” (‘Cogito, ergo sum’) that has led to the ego being a central assumption in Western culture, especially under neoliberalism which assumes people are isolated monads (& judges you on what you do, and not on your being). Wittgenstein said the task of philosophy was to sort out conceptual confusions that prevent us from thinking clearly, and Descartes error is central to this. Wittgenstein drew our attention to the 2 ways that we use the word “I”. We use “I” to describe ourselves as an object, as in ‘I have grown a centimetre since I last measured myself’, ‘I have broken my arm’, ‘I have a bump on my forehead’. But we also use “I” as a subject. This is done to refer to our mental states and sensations, such as seeing & hearing etc, and feeling pain. This is where Descartes went wrong, he tried to objectify the use of “I” as a subject. Nietzsche drew our attention to the noun-verb structure of our language, and how it creates ghosts in our thinking, like the “it” in ‘It is raining’; or how we break up one thing into two as in “the lightening flashed”. There is of course no lightening apart from the flashing. So there is no “I” who is thinking, seeing, hearing, etc. It is just a convention of language. In his Tractatus, Wittgenstein says that the ‘I’ who is thinking or seeing (etc) is the world (just as the ‘it’ in “It is raining” is the world). He confirms that this egoless subjectivity is the mystical (of the Lao-tsu or Meister Eckhart variety).
Now a number of subsequent Wittgenstein scholars have suggested that we cultivate an imaginary self (or socially construct an imaginary self), but that it has no substance. There is just the narrative of a self. Foucault has one of these in mind when he speaks of the care of the self. However Lao-tsu warns we should drop that readily, with his comment “accept disgrace willingly”. Schopenhauer, who had a strong influence on Wittgenstein, taught that without a self, we were naturally very caring towards each other (cf. Matthew 18:3). Foucault, I think, wants us to cultivate a self based on this more natural way of being.
Now I think, for some cases of so-called “depression”, but not all, ego-death is “naturally” occurring. If you look upon so-called “depression” as the ‘winter of the soul’, it makes some sense to imagine that some of our moods arose with the seasons. In ‘summer’ things are rosy as life blooms and buzzes, but it is followed by ‘autumn’ when it goes from being ‘wet and windy’ to ‘fine’ again, sometimes many times in a day. Then in ‘winter’ I retreat into my ‘heart’s cave’ where things ‘crystallise’ as things become very still. Of course ‘winter’ is followed by ‘spring’, and remember the ice-age even had its ‘thaw’. Nature is prolific in ‘spring’, and not everything arising makes it thru to summer. Although I have consumed my share of entheogens in my younger years, I have also experienced my share of ‘winters’, and now see more clearly.
Nev, the “hard question” of consciousness has been (imo) adequately addressed by the enactivists, see Evan Thompson or Varela.
You might find the questions asked by Solution Focused Practitioners of some help – they explore the preferred future. When asked in a context of care they often helpful.
Sorting out confusions is the domain of philosophy not science – philosophy is about elucidations, science about explanations. Science deals with causes, philosophy with reasons. This was the essence of Wittgenstein’s philosophy, but the world has been taken over by a scientism – the great hope that a scientific answer can be found to our confusions. Some psychotherapies come closer to philosophy than science – such as Open Dialogue and Solution Focused Practices – they allow confusions to dissolve (“like sugar in water” – Wittgenstein). “We are aiming at complete clarity – so all philosophical problems should completely disappear” (Wittgenstein). Scientism is rooted in Francis Bacon, when he separated “scientia” (knowledge) from “sapientia” (wisdom) and instead united it with “prudentia” (‘Knowledge is power’). Scientism looks for leverage – in mental health this generates much suffering as we all know. Both APAs approach individual confusions with institutional confusions; but they are not alone. Most social services are making a similar error.
How do the authors attribute this to neoliberalism? Mitchell Dean recently published a paper entitled ‘Foucault and the neoliberal controversy’ that outlines what Dean/Foucault said in favour of neoliberalism. I think you have taken a big club at neoliberalism and haven’t taken account of a more nuanced analysis. My 2 cents worth.
The correct Illich term is ‘conviviality’ not ‘coviviality’. I read the original, and I take my hat off to you for attempting to summarise it. Dr di Nicola has written, what amounts to a political essay, suggesting a paradigm change can occur in the “west” (or the Northern countries) if they could learn some lessons from the south. Judging by their comments, many consumers didn’t realise this is what his article is about. Most consumers want a paradigm change to occur in mental health. I think di Nicola has attempted to summarise many complicated ideas, and as Wittgenstein would say, a place is not prepared in the average reader’s minds for many of these. For example, Foucault’s term “dispositif” he summarises using Agamben reworking of it, but I think it simpler to say that it is the ideas that lead to institutions and practices that ‘disposes’ us to act in certain ways. Di Nicola is saying that the northern countries could well develop some new ‘dispositifs’ from lessons it learns from the south. For example using Illich’s conviviality, the north could learn some lessons about co-operating better. Thank you for bringing this article to my attention.
Hi Laurell, NZ Maori have the 4 minds as the physical (tinana), spiritual (wairua), emotional-thinking (hinengaro), and the social (whanau). It would seem that you intuitively combined thinking and emotional, but you omitted the social ‘mind’. I think this is closer to the division of the 4 “minds” to many indigenous peoples, and I think it is typical of western culture to omit the social mind. I think the reason was identified by Foucault in his comments on “the cartesian moment”, and it has been commented on by the anthropologist Clifford Geertz (p.59, 1983, Local Knowledge). Thank you for your article.
Nobody has commented much on the risk factor that the article mentions. The governments are keeping psychiatry alive and in power due to their claim that they can assess risk to society. Indeed in the middle of the nineteenth century, when arguments were being held whether you needed medical specialists in the new built asylums, let alone running them, the medics argued strongly that only they could detect dangerousness, at 50 paces if you like, even when it wasn’t apparent to others. This gave them key to the asylum, and they have held them ever since. No other profession or body, other than the courts, have made this claim. Until this is addressed psychiatry will rule the casino.
Hi Jay – have read your work over the years and wondered why you haven’t taken an ethics complaint against Nancy Segal with the APA?
Yes Bradford is on to it.I agree with David Clark that service users should be able to access outcome data of clinicians – but David Clark is producing dodgy outcome statistics. In a parallel with the drug companies, Clark is not independent from the outcomes he’s reporting – and indeed it is very difficult to get someone who is. MJ Scott – ‘IAPT the need for radical reform’ – JHealthPsychology, 2018, 23(9) 1136-1147 is one of the rare individuals standing apart from the IAPT making comment. Scott Miller and Barry Duncan have been producing outcome informed therapy articles for nearly 20 years – their measures are simple, fit for purpose (unlike the IAPT tools), etc. Bruce Wampold even delivered a key note at the IAPT conference pointing out that the NICE guidelines are tram tracks hampering effective therapy. There is bad politics in IAPT, showing that psychologists are just as prone to institutional corruption as the psychiatrists are.
It is difficult to find any reviews of the IAPT that are not written by someone who has a vested interest in this – ie in the case guild interest. Here is one I found MJ Scott 2018 Improving Access to Psychological Therapies (IAPT) – The need for radical reform. (Journal of Health Psychology 23, 9: 1136-1147 doi: 10.1177/1359105318755264) Basically the author is saying that there are too many restrictions around the protocols of how it is administered – the results are not what they are cracked up to be – There seems to be a case here for “institutional corruption” in a similar way to Robert Witaker book ‘Psychiatry under the Influence’ – but here it is psychology – showing they can be corrupted similarly – Lets not have the Greens in NZ rush in with this waste of tax payer dollars – lets develop some thing different.
A timely report Robert. I think one of the most compelling accounts of the mental health epidemic in general is Wilkinson & Pickett’s latest book on wealth disparity (The Inner Level). They cite research that found threats to social status pushed up the stress hormones the most of all anxiety inducing situations. They then reviewed status anxiety research in relatively equal and unequal societies; and not surprisingly found that mental disorder increased a society’s wealth disparity increased. But not only does status anxiety increase as equality goes out the window, but so too does community life. As sense of community goes, interpersonal trust lowers, and the level of violence (as measured by homicide rates (and I dare say suicide rates)) increase.
Look at Wilkinson & Pickett – ‘The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyones Wellbeing’ – they argue that it is not poverty per se that is causing the stress, so much as the disparity between the wealth disparities – the same applies in very poor countries – if there is wealth disparity there is increased mental disorder etc – if there is greater equality there is greater community life, trust, willingness to help each other, and low levels of violence,
Here is a 5 minute read
It appears to me that a great many people who have commented haven’t understood the article or are just giving their usual response we read frequently on MiA- its a justifiable argument to present the Szasz anti-psychiatry argument – and I can understand how many of you are angry at what psychiatry has done – but it seems that it is arguments like Joanna is writing that is going to dismantle psychiatry – not just your expressions of anger. I would like to hear from some more philosophers, especially those with a Wittgenstein bent. I think he holds a key because unlike Descartes he starts out from a position of social unity, whereas Descartes starts with individualism.
At the risk of adding yet another view to this long train – it took a couple of hours to read it thru – and adding to the confusion – let me offer this. When I began training as a psychotherapist I was attracted to the Mental Research Institute’s (MRI – Haley, Watzlawick, etc) take on problems; that most problems are attempted “solutions” to some other life difficulty that hasn’t been successful; and some of us began writing the word “problem”, or “depression”, or “panic”,etc in strikethrough (which I don’t seem to be able to do on this site). I later discovered it was the “sous-rature” style of Heidegger and Derrida, the view that the word was “under erasure”. This is the Easter Bunny dilemma that others raise, if there are no mental health disorders then what are these woes? It seemed to me that this view enabled me (and others) to stop pulling the noose of diagnosis tighter, and review such situations as wrongly formulated. My friends in psychiatry insisted I pull the noose of diagnosis tighter. Later I was encouraged by Solution Focused Brief Therapy, and by simply exploring the preferred future there was no need to know of the problem, and I found problems (under erasure) dissolved literally like sugar in water as people began realising their preferred future.
Lawrence, you offer an analysis of the reason d’être for psychiatry pulling the noose tighter as changing historical conditions. If I get it – once it was to warn others that there is no escape from the factories of industrialisation (you can’t get out of the social contract that way!); but this has mutated into a disabling profession thats become parasitic on producing increasing numbers of disabled. You cite Foucault, and no doubt you are aware of his analysis (eg Society must be Defended) that since Machiavelli governments have moved resources here and there that have contributed to the thriving of some sectors of the population and the decline of other sectors of the population. As I understand it he gives the psychiatric rationale as “we can detect dangerousness at 50 paces, so allow us to lock these people up” (Society must be Defended). Todays world is, presumably, perceived by psychiatry as more dangerous, and hence more people are disabled – you got to admit their strategy is simple – get the people pulling their own nooses tighter.
You cite the social contract theories of Rosseau, Locke, Hobbes, as a rational behind the politics of this. But have you looked at Wittgenstein? The social contract theories stem from Descartes individualism – I can know my own mind, but not others, with certainty. From this individuals got together like some sort of Rotary club. But Wittgenstein reverses all this – you don’t join society you are already part of it! And I know your mind better than my own. Consider pain. In fact I know you are in pain immediately (most of the time); I don’t make an inference you are from your grimacing or because I have an internal Theory of Mind that I consult to understand you. I react as if I myself was in pain (especially my kids), no pause here for interpretation. I comes out of we. Dan Siegel has this neurological terms. Indigenous cultures have this as central – ubuntu in Zulu, whanuangatanga in NZ Maori, Shimcheong in Korean. If we are to recover as a culture – from greedy individualism in all its forms, we must humble ourselves to our indigenous people. Social contract theories are surrendered, ethics first (Levinas).
So we see in Seikkula’s Open Dialogue a “treatment” that utilises this sense of “we-ness” or dialogicity. If there’s one thing we know, anyone coming near a psychotic (in strikethrough) person with an agenda, is treated with suspicion – and the most successful treatment is those where the “alliance” is good. If we look back at Pinel in Paris he tried to manipulate people into change by having Pussin rattle chains etc. He gave birth to psychiatry. But when we look back at Tuke in York, he built relationships of respect. Like Soteria he advocated lay treatment. No giving them a noose.
Its now a hundred years since Wittgenstein, but he said it would take that long before he was understood. We are seeing glimpses of the Wittgenstein philosophy of mind permeating our intellectuals wine bars and cafes today, and the disappearance of Descartes…
Joannna, what do you make of Stephen Porges ‘Polyvagal Theory’ as a biological marker of mental distress; the idea that one’s vagal tone is a measure of how “uptight” or “depressed” one is? Its early days yet, but this idea looks promising.
The idea that mental disorders are the domain of medicine is I think, an accident of history. If we had followed Tuke and not Pinel, we may well have placed mental disorder under the welfare, as Tuke was closer to Seikkula. Its a breakdown of human caring – and as Tuke and Seikkula have adequately demonstrated ‘being there’ is what makes a difference. Psychiatry offered the government with a mechanism to predict dangerousness, and this is what gained to the key to the asylums (even though they couldn’t).
Nice deconstruction Bob – so scary to see this. You attribute the motivation more strongly to guild interests than Big Pharma interests – but have you considered both of these as expressions of political interests? Foucault’s “Society must be defended” lecture series and other works of that time argues that ever since Machiavelli societies have allowed or facilitated the slaughter (Foucault’s word) of some of its population in order to govern – usually by the withdrawal or supply of resources – allowing some to flourish and others to be left to wither. Following the apparent success of Pinel & Tuke (1800) asylum building took off with a flourish – and the medics got to be in charge, not because Pinel (a medic) was more successful than Tuke (a non-medic) but because the doctors convinced legislators they could detect dangerousness even when it was not obvious to the naked eye. Not only that, as Foucault also showed, Western societies have increasingly (since the 12th century) been governed (ordered) by keeping people in a constant state of self-observation and self-discipline, fabricating (Foucault’s term) the excessive individualism their economic systems were built upon. So DSM psychiatry facilitates this self-diagnosis/discipline (as the confession once did).
Seikkula is not only showing us how to respond to psychosis, but also to our collective madness. His thinking is closer to Tuke’s moral philosophy than Pinel’s medical engineering approach, as it stresses “being with” than “doing to”. This way of thinking is now finding expression in 4E cognition – the idea that “mind” is not in the head (noun-like), but embodied (verb-like) – and socially, group cognition precedes individual cognition (as Merleau-ponty saw – and Descartes didn’t). ‘We’ comes before ‘I’ – as most indigenous cultures recognise (e.g. ubuntu). Recognition of our humanity – our “we-ness” (as the Delphic Oracle suggested) leads to the kind of self-discipline we see in most pregnant women, who give up smoking and drinking with ease -(where care of self and care of other take in each other’s washing). In turn this leads to social ordering processes that are heart-felt and closer to James Cameron’s Na’vi, than the current panopticism does. Tuke comes closer to this ‘way of the heart’ due to the influence on him of Francis Hutcheson’s moral philosophy.
So from this perspective neo-kraepelinian psychiatry is a keystone to maintaining a particular political agenda that is now well-entrenched in Western cultures – one which will no doubt see such continuing rationalisations as Lieberman (its difficult not to make fun of that name) has provided here, reminding us of the rationalisations of the tobacco industry as the evidence mounted. I suspect that as the social implications of 4E cognition mount neo-kraepinianism may find itself in a similar position.
Nice article Jock – any chance of getting it published in a peer review journal – perhaps one of the English critical psychiatry ones?? I came upon this article of yours whilst out hunting for those elusive outcome statistics for mainstream MH – we have great stats from Seikkula – but I would be nice to be able to compare them with other clinics – it would make his findings more newsworthy. You’ve got some here – but also you need to tie down the figures to location – like when you say $2.5 billion in psychiatric research – where? – this is an international forum – is that 2.5 Oz or international or what?
Yes – If medicine is to have a role in madness, it shouldn’t be lead – the anaesthetist shouldn’t be in charge in the theatre of mind – other disciplines are better suited.
What I think Bob and Allen both need to do is look through some other lens on this – Foucault for example portrays this as a symptom of an industrialised society where the ‘self’ is fabricated by social forces (“normal self” is the water fish swim in and are unconscious of) – we are all a little out of touch with reality – the ecological disaster should provide ample evidence that mechanised society – the Empire – is a menace. Then look at Wittgenstein’s attraction to Spengler’s Decline of the West – “Even in Brahms I can hear the machine” – and his claim that he (Witt.) was writing for 100 years hence (in 1930) when “culture” might be returning. In Indigenous cultures ‘self’ is centred in Other (heteronomy not autonomy)- and the dialogicity of Seikkula etc – shows this return of responsivity as the path out of madness – The Jedi showing this path are appearing – the Empire continues to convince you that its risk management processes are not a protection racket……But the move from the cartesian-kantian empire to the Wittgensteinian-Levinasian culture is gathering momentum, and we look for outcome monitoring as accountability rather than process adherence. enough – this key is getting to large for you to weild….