Sunday, April 23, 2017
Everything that the philosopher writes – everything that I have written – is nothing but a preface to an unwritten work or – which is, in the end, the same – a postlude in which the ludus is absent. Philosophical writing cannot but have a prefatory or epilogical nature. This means, perhaps, that this has not to do with that which can be said through language, but with λόγος (logos) itself, with the pure givenness of language as such. The event, which is in question in language, can be only announced or dismissed, never said (not that it is unsayable – unsayable means only un-predictable; this coincides rather with the givenness of discourses, with the fact that men do not cease to speak to one another). That which language succeeds in saying is only preface or footnote, and philosophers, who distinguish themselves by whether they prefer the first or the second, adhere to the poetic moment of thought (poetry is always announcement) or to the gesture by which, in the end, they play the lyre and contemplate. In any case, that which is contemplated is the unsaid; the dismissal of the word coincides with its announcement.
–Giorgio Agamben, “On Writing Prefaces,” p. 131 (my translation)
In: Giorgio Agamben, Che cos’é la filosofia? [What is Philosophy]. Macerata: Quodlibet, 2016, pp. 123-131.
Sunday, November 13, 2016
Vincenzo Di Nicola, MD, PhD
Drozdstoj Stoyanov, MD, PhD
Premise of the volume:
The field of academic psychiatry is in crisis, everywhere.
It is not merely a health crisis of resource scarcity or distribution, competing claims and practice models, or level of development from one country to another, but a deeper, more fundamental crisis about the very definition and the theoretical basis of psychiatry.
Is psychiatry a social science like psychology or anthropology?
Is it better understood as part of the humanities like philosophy, history and literature?
Or is the future of psychiatry best assured as a neuroscience?
From psychiatry in crisis as a medical discipline to critical psychiatry casting for a new model …
What will be the result?
The “end of psychiatry” or its renaissance as something new and different, either as a more comprehensive theory and practice of human being or as a new branch of medicine called the neurosciences?
The two principal authors are both professors of psychiatry with mainstream academic training, activities and appointments in respected university departments of psychiatry. Both also share professional training and engaged activities in the philosophy of psychiatry. Both Europeans, one working in Europe, the other in North America, Professors Stoyanov and Di Nicola are active in national and international organizations and together bring varied international expertise to this study. From these informed perspectives, Di Nicola and Stoyanov pose some fundamental epistemological and ontological questions about the crisis of psychiatry, what they imply, and how to go about resolving them to renew psychiatry today.
Vincenzo Di Nicola, MPhil, MD, PhD
Full Professor, Dept. of Psychiatry
University of Montreal
Drozdstoj Stoyanov, MD, PhD
Professor, Dept. of Psychiatry and Medical Psychology
Medical University of Plovdiv
Proposed Table of Contents:
Foreword (by a psychiatrist or a philosopher)
Preface/Introduction by Drozdstoj S.Stoyanov & Vincenzo Di Nicola
Part I: Psychiatry in Crisis as a Medical Discipline
Drozdstoj S. Stoyanov
1. Methods for clinical evaluation in psychiatry: quantitatve decomposition of narratives vs. qualitative approach. Reconstruction of the methodological discrepancies based on an exemplary case: Major Depressive Disorder
2. Psychiatric nosology revisited: at the crossroads of psychology and medicine. Categorical vs. dimensional; nomothetic vs. ideographic classification and nomenclature; post-modern perspectives
3. Psychiatry and neuroscience: at the interface. How to incorporate scientific data from neuroscience without turning psychiatry into an applied branch of neurology
Part II: Critical Psychiatry
Vincenzo Di Nicola
1. The Beginning of the End of Psychiatry: A Philosophical Archaeology
Psychology: Introspection and Consciousness
Foundations of Modern Psychiatry
Schizophrenia: The Worm in Psychiatry’s Apple
Excursus: The History of Psychiatry is Not the History of Madness
2. The End of Phenomenology
“Who Killed Ellen West?”
A Critical Review of Ludwig Binswanger’s Foundational Case of Existential Analysis
3. The End of Psychiatry
“Psychiatry Against Itself”
A Philosophical Archaeology of Antipsychiatry
Part III: Renewal in Psychiatry
Drozdstoj S. Stoyanov in Dialogue with Vincenzo Di Nicola
Afterword (by a psychiatrist or a philosopher)
Sunday, February 21, 2016
Tentative conclusion for my essay:
PSYCHIATRY AGAINST ITSELF
Radicals, Rebels, Reformers, and Revolutionaries
A Philosophical Archaeology
médico. “Yo quisiero un Dios para curarlos, o ser el hombre de la calle que sigue de largo … Y no puedo ser ni una ni otra cosa …” (Raúl E. Baethgen, El error del professor Bodhel).
Under the entry “physician,” Leo Maslíah cites a Uruguayan novel where a doctor confesses that, “I wanted to be a god that cures them or the man in the street that accompanies them. And I can be neither one nor the other.” The realities of medical practice reveal that neither medical hubris (the fantasy of cure) nor social solidarity (being a man of the street) is an enduring solution.
Slavoj Žižek is fond of using jokes to illustrate complex philosophical ideas, especially when they reveal inversions of logic and negations. One of my favorites about psychiatry is the joke concerning:
a conscript who tries to evade military service by pretending to be mad. His symptom is that he compulsively checks all the pieces of paper he can lay his hands on, constantly repeating: “That is not it!” He is sent to the military psychiatrist, in whose office he also examines all the papers around, including those in the wastepaper basket, repeating all the time: “That is not it!” The psychiatrist, finally convinced that he really is mad, gives him a written warrant releasing him from military service. The conscript casts a look at it and says cheerfully: “That is it!”.
The history of psychiatry (not the history of madness or society’s attempts to understand it more broadly, but the history of the profession) is encapsulated in this joke of the conscript feigning madness to avoid military service. His compulsion, as Žižek tells it, is to check all the pieces of paper, looking for the relief that comes as the punchline. But there is something wrong with Žižek’s analysis: obsessionals and compulsives do not have such clear and comforting goals. Unlike the conscript who is merely feigning mental illness, no amount of checking or verifying will bring relief to the obsessive-compulsive. Any such relief is always short-lived, without therapy at least, damning the sufferer to endless repetitions. Žižek argues that, “the paradox … is that process of searching itself produces the object which causes it.” Here, he confounds things to say the least, concluding that, “The error of all the people around the conscript, the psychiatrist included, is that they overlook the way they are already part of the ‘mad’ conscript’s game.” In the joke, the conscript manages to produce the result he seeks, a warrant to avoid military service. In reality, such a feint would not produce the conscript’s desired result. As the soldiers who wanted to leave the war discover in Joseph Heller’s anti-war novel, Catch-22, wishing to leave the battlefield to be safe is a sign of normalcy not insanity and backfires. This is the same error as the originators of the “double-bind theory of schizophrenia” made, thinking that the logic of jokes describes or predicts human behavior. That theory states that if people are put into impossible-to-resolve “double-binds” and have no power to contest them, they will become mad, as in the joke about the boy who receives two T-shirts for his birthday and when he appears with one of them, the mother asks him why he didn’t like the other one. Damned if you do, damned if you don’t. Although this is frustrating, in fact, most people respond with humor or shrug it off as absurd. They may even respond with irritation or violence if it persists, but madness? Unlikely.
Will anti-psychiatry through its negations that trigger reform and revolution in psychiatry ever find that warrant? No, because like the true obsessive-compulsive, psychiatry/anti-psychiatry is a ceaseless dialectic of opposition since each generation disseminates, iterates, and repeats its symptoms anew. Anti-psychiatry is always looking for that piece of paper that will serve as warrant, give respite, end the game. I am sympathetic to that. But defeating the military game or serving the interests of the feigned mad conscript is a mere palliative: the military machine goes on. Reforming psychiatry as a result of Basaglia’s negation of the institution is in this sense a palliative. It laudably undoes the logic of the asylum but does it address the complex determinants of mental illness?
Ultimately, the joke reflects a romantic, idealistic view of madness and of anti-psychiatry. If only we could get some misunderstanding of the mind out of the way, or neutralize the toxic effects of psychiatry, the symptom will dissipate. That is the social solidarity that the Uruguayan doctor wanted to offer. Nothing in my experience as a social scientist, psychiatrist or philosopher gives credence to such beliefs.
We may indeed correct this or that misunderstanding and improve one or another of our practices, but that was not the origin of the symptom to start with. Believing that is medical hubris, which is untenable, as the Uruguayan doctor discovered. In the joke’s frame of reference, let us not confound the military psychiatrist with military service or the military itself. I would not work in that capacity, even in the service of undermining a war I did not agree with, precisely because I refuse that conflation. Not only would I refuse to play “the ‘mad’ conscript’s game,” I would refuse to play the military’s game. If the state wants to judge who is or isn’t a fit person to serve in the military or enter as a refugee or immigrant (with PTSD for example), I refuse to make this a medical matter. There is a strange twist there: in the case of military service, one has to be of sound mind, whereas in the case of refugee claimants, one has to be traumatized. So you have to be sane to serve in the army but disturbed to qualify for sanctuary. As a psychiatrist, I want nothing to do with it. These are not medical questions but political ones.
The dialectic psychiatry/anti-psychiatry is the engine of negation compelling change in my field but it is not in itself a theory of psychopathology, nor a map for a new vision of the person, mind and relation, and their vicissitudes. That is the subject of another discussion about evental psychiatry. Psychiatry and anti-psychiatry are part of what I call trauma psychiatry, addressing trauma and the closing down of possibilities. A psychiatry of the event which poses a new theory of the subject and of the event opens up new possibilities for psychiatry.
 Leo Maslíah, Diccionario Privado (2014), p. 138.
 Slavoj Žižek, The Sublime Object of Ideology (1989), p. 160; cited in Žižek’s Jokes (2014), p. 125.
 Ibid., p. 160.
 Ibid., p. 161.
 Gregory L. Bateson, Steps to an Ecology of Mind (1972).
 See: Didier Fassin and Estelle d’Halluin, “Critical evidence: The politics of trauma in French asylum policies.” Ethos, 2007, 35(3): 300-329. I have steadfastly refused to work for the courts, even in the “best interests of the child,” and hold that those who do so are in an ethical, moral and legal conflict of interest. An example of how to deal with such demands is documented with verbatim transcripts, see: Vincenzo Di Nicola, “A Garden of Forking Paths: Exploring a Family’s Alternities of Being,” in A Stranger in the Family: Culture, Families, and Therapy (1997), pp. 237-292.
This is the tentative conclusion of a forthcoming chapter:
Pedagogy of the Event:
A Revolution in Medical Education
Vincenzo Di Nicola
Žižek and Education
Edited by Antonio Garcia
Foreword by Creston Davis, Afterword by Slavoj Žižek
Rotterdam, Netherlands: Sense Publishing
“Transgressions: Cultural Studies and Education” Series
Conclusion: Education is an Event
What will philosophy say to us? It will say: ‘We must think the event.’ We must think the exception. We must know what we have to say about that which is not ordinary. We must think change in life.
Just as Badiou the philosopher tells us to think the event, to think change in life, Jaspers the physician-philosopher reminds the physician that philosophy is unavoidable for the practice of medicine. In his groundbreaking textbook of phenomenological psychiatry, Jaspers concluded a century ago that:
If anyone thinks he can exclude philosophy and leave it aside as useless he will be eventually defeated by it in some obscure form or other.
Medicine is the judicious and balanced use of science and technology, humanity and experience in the service of solving biomedical problems and promoting health. It works through aporias to achieve euporia, the balance that philosophy calls sophrosyne, being of sound mind and judgment. Empiricism alone, raw data and technique cannot be the basis of medical practice. Sophrosyne calls on the physician to go “beyond the information given,” to make clinical decisions, to find the courage to intervene. Once the evidence is before us, there are choices to make. In spite of its pretensions, evidence-based medicine does not offer algorithms and heuristics for medical practice but strategies for reducing the contingency and complexity of human predicaments. For a medical practice based on discernment that embraces subjectivity along with science, we need medicine informed by philosophy; clinical practice requires critical thought.
The faithful physician begins with a pedagogy of the event in order to engage in problem-based learning and continual change in the practice of medicine. A critical pedagogy militates against the repetition of authority. Such a pedagogy will not invoke tradition as authority and traumatically shut down possibilities but will rather open possibilities, in what Badiou calls novation, to create a pedagogy of truth.
A pedagogy that prepares us for novation and is open to the event that creates the possibilities of genuine “subjects to the truth,” faithful to the event, is a pedagogy of truth. A pedagogy of the event is a pedagogy of truth.
In a pithy distillation of all my activities – as a medical educator, as a therapist, and as a critical thinker – I wish to conclude with a statement that is neither an identity nor a tautology but a tesselated series of proposals:
Education is therapy is change is event is subject.
. Alain Badiou, Polemics, trans. and with an introduction by Steve Corcoran (2006), p. 8.
. Karl Jaspers, General Psychopathology, trans. by J. Hoenig and Marion W. Hamilton (1997), p. 770.
. Jerome Bruner, Beyond the Information Given: Studies in the Psychology of Knowing (2010).
. My formulation of the tripartite task of the physician is: the effort to understand, the courage to intervene, and the challenge to integrate understanding and practice. See: Vincenzo Di Nicola, Letters to a Young Therapist: Relational Practices for the Coming Community (2011), p. 17.
Thursday, January 28, 2016
PSYCHIATRY AGAINST ITSELF Radicals, Rebels, Reformers & Revolutionaries - A Philosophical Archaeology
Journal of the International Association of Transdisciplinary Psychology
PSYCHIATRY AGAINST ITSELF
Radicals, Rebels, Reformers, and Revolutionaries
A Philosophical Archaeology
Vincenzo Di Nicola
This essay inverts the logic of anti-psychiatry to describe various movements critical of the profession as psychiatry against itself. Like Alain Badiou’s contrast of philosophers with anti-philosophers, anti-psychiatrists compel the established tradition of psychiatry to confront fresh problems with new perspectives to renew psychiatric thought. The dual themes that emerge from this study are: tradition vs. innovation and negation vs. affirmation.
This thesis is threefold: (1) What is intriguing about the psychiatrists associated with the anti-psychiatry movement and what unites them is negation. In each case, their work proceeds by a key critical negation, to the point that the defining characteristic of anti-psychiatric psychiatrists is precisely negation. (2) Each negation and how it was practised made each anti-psychiatrist, depending on his temperament and circumstances, into a rebel, a radical, a reformer or a revolutionary anti-psychiatrist. (3) Each anti-psychiatrist wielded an instrument for change that I have coined Badiou’s sickle. Based on a key critical negation, each anti-psychiatrist resisted the suturing of psychiatry to a given subdiscipline, regional practice, or dominant ideology by separating it gently or more forcefully with Badiou’s scalpel, scissors, shears, scythe or sickle to liberate psychiatry as a general theory and practice and return it to its originary task.
Four key 20th century Western psychiatrists who were critical of their field are examined through their basic attitudes and contributions to the redefinition of psychiatry. Scotsman Ronald David Laing (1927-1989) was a radical psychiatrist-psychoanalyst, returning psychiatry to its clinical roots, with his trenchant critiques of Ludwig Binswanger’s existential analysis and psychiatric practice generally, calling for social phenomenology, negating the mystification of mental illness by placing the suffering of the self in social, family, and political context. The French Jacques Lacan (1901-1981) was both a subversive psychoanalyst and a psychiatric rebel, affirming the centrality of Freud in his construction of psychoanalysis while rebelling against both the psychoanalytic and psychiatric establishment, negating the institutionalization of psychoanalytic practice, whether in the academy or in psychoanalytic institutes. Italian psychiatrist Franco Basaglia (1924-1980) was a reformer who instigated psychiatric deinstitutionalization around the world with his key text, L’Istituzione negata, “The Institution Negated” (1968) and by joining the Radical Party in the Italian Parliament that reformed Italy’s mental health legislation. As a psychiatrist, philosopher and revolutionary, Martinican Frantz Fanon (1925-1961) negated nothing less than the claim of European psychiatry to universalism in his radical critiques of the psychology of colonization and identity formation, offering a more humane psychology on which to found psychiatry in a revolutionary program for a new society. Fanon’s critiques were far more trenchant than other anti-psychiatrists, with far-reaching impacts on critical theory, post-colonial studies and Marxist political theory, yet his project remained unfulfilled when he died all-too-young, bequeathing us psychiatry’s unfinished revolution.
Two other critical thinkers are examined to complete this study. One is Hungarian-American Thomas Szasz (1920–2012) whom I characterize as a reactionary psychiatrist in the guise of a progressive who negated the reality of psychiatric disorders. Szasz trivialized mental and relational suffering as mere “problems in living,” arguing against the majority of psychiatric disorders having biomedical origins, thus promoting the medical model in its most reductive form. In contrast with the other anti-psychiatrists, Szasz’s negation was destructive, leading the way to greater stigmatization of mental illness and diminished resources and services. Finally, the work of French psychologist and philosopher Michel Foucault (1926-1984) overshadows the entire discourse of anti-psychiatry, just as he informs and impels us to reorder medical perceptions and psychiatric thought, upending the very “order of things.” Foucault’s negation was the most disturbing to psychiatric thought because he questioned the very basis for imagining madness and reason/unreason.
 Prepared for a seminar on “Psychiatry and the Humanities” at the University of Montreal Department of Psychiatry that is also offered as a course in the Faculty of Medicine. The ideas were elaborated as part of my philosophical investigations for a doctorate in philosophy at the European Graduate School, Trauma and Event: A Philosophical Archaeology (Di Nicola, 2012b). This essay sets out some of the key ideas I will explore in a forthcoming book with the working title, Deconstructing Crazy: Letters to Young Psychiatrists.
 Vincenzo Di Nicola, M.Phil., M.D., Ph.D., F.R.C.P.C, F.A.P.A., is a psychologist, psychiatrist and philosopher. Di Nicola is a tenured Full Professor of Psychiatry at the University of Montreal where he is Chief of Child and Adolescent Psychiatry and founder of a seminar and course on Psychiatry and the Humanities.