Over at Catallaxy, on the thread about Foucault, Rafe claimed that Foucault’s theses about medicine and social control were invalid. He offered little argument in support of this view, claiming only that humanitarian niceness in State mental institutions showed that they were. I’m not going to defend Foucault as such in this post, but I want to draw on some Foucauldian work about the medicalisation of all sorts of character traits in late modern society - a phenomenon we see in Prozac Nations, ADD epidemics, and very interestingly at the intersection between the law and psychiatric medicine. One of the points Foucault made was the intrusion of medical rationalities and concepts into the body of the law - most notably in a rather obscure work, I, Pierre Riviere, Having Slaughtered My Mother, My Sister, and My Brother which developed from the collective work of a seminar he led at the College de France on interrogations and confessions of a 19th century parricide. Should we worry when psychiatric or psychological factors are introduced into the criminal law as either mitigating factors or defences? We’ve seen similar arguments in the 1990s about claimed biological bases for male violence run in Scottish Courts, but focussing on the particular issue at hand, this case is perhaps important:
In 1980 Thomas Szasz testified for the prosecution in the trial of Darlin June Cromer, a 34-year-old white woman charged with kidnapping and murdering Reginald Williams, a 5-year-old black boy. There was no question that Cromer, who attracted suspicion because she had a history of talking about “killing niggers” and trying to lure black children into her car, had abducted Reginald from an Oakland, California, supermarket, strangled him, and buried his body near her home. She had told police as much when they questioned her. Neither was her motive in doubt. She explained that “it is the duty of every white woman to kill a nigger child,” telling a jail psychologist she hoped to ignite a race war.
But as the San Francisco Chronicle reported, Cromer’s attorney argued that “his client killed because she is consumed by schizophrenic paranoia ‚Äînot hate for blacks.” Or as the lawyer put it, “This case does not involve racism; it involves insanity.” To help undermine this claim, the prosecutor enlisted the assistance of Szasz, the iconoclastic psychiatrist famous for rejecting the insanity defense, involuntary commitment, and the very concept of mental illness. At the trial, Szasz explained the difference between a medical diagnosis and a psychiatric diagnosis: “Medical diagnoses deal with objective and demonstrable lesions of the body, broken bones, diseased livers, kidneys, and so on. Psychiatric diagnoses deal with behaviors that human beings display, and they have to be interpreted in moral, cultural, and legal terms and, therefore, different interpreters will arrive at different judgments.” He pointed out that “homosexuality was recognized as a mental disease until a few years ago” and that smoking, previously considered a habit, had recently been classified as a mental disorder.
Szasz, whose book The Myth of Mental Illness has many resonances with Foucauldian work, went on to stigmatise the choices this woman had made, indicating his continued grounding in an individualising paradigm rather than one which recognises the social origins of racism and also of criminality. But his broader point is important:
Yet Torrey, a prominent advocate of involuntary psychiatric treatment, concedes “there is no single abnormality in brain structure or function that is pathognomonic for schizophrenia” and therefore “we do not yet have a specific diagnostic test.”
That limitation should give Torrey pause in light of the concerns he expressed in his 1974 book The Death of Psychiatry, quoted in Szasz Under Fire. He argued that “it is better that we err on the side of labeling too few, rather than too many, as brain diseased. In other words, a person should be presumed not to have a brain disease until proven otherwise on the basis of probability. This is exactly the opposite of what we do now as we blithely label everyone who behaves a little oddly ’schizophrenic.’ Human dignity rather demands that people be assumed to be in control of their behavior and not brain diseased unless there is strong evidence to the contrary.”
While the identification of schizophrenics may be less casual today than it was three decades ago, psychiatric labels have multiplied since then, and a significant part of the population is still forcibly treated, whether in mental hospitals, through outpatient commitment, or in drug treatment programs fed by the criminal justice system. In other words, there is still a need to guard against invasions of liberty justified in the name of mental health. The approach Torrey suggested seems about right to me, although much hinges on what counts as “strong evidence” of brain disease. Szasz continues to make a powerful case that a psychiatric diagnosis is not enough.
Lest anyone think that concern with claims that deviant behaviour is biologically determined is only a concern of the left, one could in fact construct a strong argument that the avoidance of responsibility involved in the pathologisation of many behaviours - every day ones and not just criminal ones - is a key social issue. I’d argue, however, that we need to look at the social nature of our responsibility for the other, and the degree to which all of us are implicated in societies which construct pathologies and individual problems of whatever dimension. That requires an acceptance that many such behaviours are in fact normal in our society, and a willingness to get to their underlying causes. It’s a lot easier probably, to lock people up, or give them a pill.
Yay! The blogextravaganza goodness is here! After Liam’s excellent post, we now have Kim’s excellent post. And timed just before BB Uplate! Cool - I can relax and thesify in the knowledge that LP is probably providing better reading matter than I’ve been able to furnish it with of late!
We’re aiming high for your standards, MB, though I think Kim’s out-intellectualled me. Kim, I suppose this makes you the Iron Intellectual French?
I recall an article recently—whose details I’ve disgracefully neglected—about John Curtin, which argued that although he probably didn’t suffer from what psychiatrists would call clinical depression, he nevertheless had a ‘melancholic’ personality. It was a lightweight Fairfax piece but it got me to thinking.
Isn’t the idea of psych as social control that such ordinary things as not feeling too good are medicalised and given names?
Well, history and social theory are somewhat different in style, Liam, but equally intellectual I’d say.
The argument about Curtin was no doubt based on John Edwards’ recent bio - one of my last Troppo posts talked about that point. And C.L. made some similar points about political leaders last year, but his blog lacks a search button and I couldn’t easily find them in the archives.
I’d tip my beret to you too, Liam, if I owned any French headgear. Perhaps I should obtain a cap of liberty?
Great post Kim. In some ways I think medicalising everything gives people a sense that they no longer need take personal resposibility for things themselves. Once its a named condition someone else can solve it for you.
You classify a problem as an illness. You treat an illness with drugs. The danger is that illness become associated with your ability to reason there is concern about errosions of liberty.
An aquaintance of mine was working in a job where he didn’t get on very well with his co-workers and was under a lot of pressure. Unsuprisingly he became depressed and eventually approached a psychiatrist who subscribed a course of anti-depressents. It helped a bit, but he still wasn’t really happy. Eventually he got another job offer to somewhere else and went. He got on well with others here, it was less stressful etc, and found he no longer needed the pills (unsuprisingly). I find the idea that you treat someone with drugs who is depressed merely because of their situation rather than addressing the cause and how they need to change their situation quite incredible.
Of course the medical establishment is not the entire driver of this. Friends of mine regularly complain with frustrations about patients who really just need to eat better diets and exercise more being dissatisfied with this advice as they come to a doctor to get some kind of pill. Many of these people go to alternative medicine where they get much the same advice and now following it, because after all this is an alternate treatment not pills, miraculously feel better.
Thanks very much, Steve.
I’m a bit tired tonight so I might respond at greater length tomorrow but one quick observation is that the downside of most anti-depressants is that there’s little upside - they flatten out your moods rather than make you happy so you don’t feel despair but you don’t feel joy either!
Steve, I think there’s a certain circularity going on in our culture at the moment - we are encouraged to think of our problems as medical, and doctors, drug companies and all sorts of psy professionals and pseudo-professionals (life coaches etc) market pills for our (perceived) ills. At the most extreme, we get the continuing belief that being gay is a disorder to be cured.
As a psychologist I can see both sides of the issue under discussion here. I believe we do have diagnosible psychological disorders but I also agree that my profession, but more particular psychiatry (see the DSM-IV-TR), can over-medicalise what may be better termed problems of living.
I think Steve made a very important point when he mentioned the lack of situations (environment) being considered when assessing someones psychological status. In the biopsychosocial model allfacets should be considered and this most defiately includes the psychosocial factors impinging on an individual at that present time. To ignore this is to the detriment of the patient in my opinion.
That’s sound advice, Mark. I think also medication is often a substitute for the more difficult work of getting to the underlying issues.
On another mental health/social control note, Four Corners tonight looks interesting.
I’ve read the thesis and I don’t see any point one should reject. This is my personal opinion.