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Tuesday, January 26, 2016

Anti-Psychiatry – “Negation & Its Vicissitudes”

Anti-Psychiatry – “Negation & Its Vicissitudes”[1]

There are many varieties of experience of lack, or absence, and many subtle distinctions between the experience of negation and the negation of experience.
—R.D. Laing[2]

The negation of anti-psychiatry is complex and embraces several elements defined in psychoanalysis and philosophy (see: Excursus on Negation). Sometimes, anti-psychiatric negation disavows or rejects some aspect of psychiatric theory or practice. For example, institutionalization and coercive treatment in psychiatric practice were countered by Franco Basaglia’s anti-psychiatric measures to deinstitutionalize psychiatric patients in Italy and offer voluntary treatment with truly informed consent and real choices.

At other times, anti-psychiatry uncovers some masked truths and psychiatry responds with a negation that confirms the truth of the belief or practice. R.D. Laing and Jacques Lacan, for example, both rejected Karl Jaspers’ notion of a phenomenological chasm[3] between psychiatrist and psychotic patient, arguing for the accessibility and intelligibility of psychotic experiences, however complex and laborious, and their writings are full of such efforts. Psychiatry responded to this negation of the phenomenological chasm with a series of negations that do not bring us back to square one and leave us unconvinced. The first negation argues that the psychotic produces a kind of unintelligible “word salad.” Second, when the likes of Silvano Arieti[4] in psychoanalytic psychiatry and Gregory Bateson[5] in anthropology and family therapy attempted to show that schizophrenic communication may be meaningful, psychiatry answers that it is too difficult, time-consuming and ineffective. Third, psychiatry answers that in any case, the diagnosis is not based on the bizarre content of thought and speech but the abnormal form of it, reflecting a biological disease process of the brain. This is reminiscent of  “kettle logic,” based on Freud’s invocation of the joke about the borrowed kettle whereby the neighbour, accused of returning a kettle in damaged condition, responds with a series of incompatible and irrational denials – viz., that he had returned the kettle undamaged, that it was already damaged anyway, and finally, that he didn’t borrow it in the first place! Denial, opposition and contradiction are mixed uncritically in the logic of dream-work, where, as Freud famously asserted, there is no “No” and the law of non-contradiction is violated.[6] In a scientific discourse and in the construction of an ethical profession, on the other hand, we expect rationality even in the face of unreason.

Alienation is a Negation

[I]t is not accidental that aliené, in French, and alienado, in Spanish, are older words for the psychotic, and the English “alienist” refers to a doctor who cares for the insane, the absolutely alienated person.
—Erich Fromm[7]

Living and fighting in wartime Martinique and Europe, training in medicine and psychiatry in France, then practicing in France and Algeria, Frantz Fanon confronted even more complex instances of negation. In the context of colonialism there was a double alienation where the alienation of the psychiatric patient was compounded by the alienation of colonization. Fascinating to note that alienation takes on both a psychiatric and a political dimension and we find in all European languages the alienation of social and political theory along with the mental alienation treated by alienists, an older term for psychiatrists.[8] And just as we can invert psychiatric alienation as a kind of separation from a “sane” (that is, authentic and healthy) way of living, whereby it can be understood as an understandable response to an alienating environment, so too we confront the topsy-turvy logic of colonization imposing foreign medical and social categories of living to pronounce on the alienation of the locals perceived by aliens (foreigners) and alienists (psychiatrists). Fanon dissects these forms of alienation with clinical precision, examining first how the native patients respond to the clinical situation with a negation of their inmost selves – wearing, in the arresting image of his first book, “white masks” over their “black skins.”[9] Fanon then examines with growing political awareness how the alienists themselves are separated from their patients in spite of their medical tasks which are at odds with local culture, including and perhaps most painfully in the case of the alienist who comes from the same culture and by dint of his training in European medicine and psychiatry, comes to attend to his countrymen, a situation creating a negation (the native co-opted by colonizer) of a negation (European colonization) of a negation (psychiatric alienation).

[1] Cf. François Baudry, “Negation and its vicissitudes in the history of psychoanalysis: Its particular impact on French psychoanalysis,” Contemporary Psychoanalysis, 1989, 25(3): 501-508.
[2] R.D. Laing, The Politics of Experience & The Bird of Paradise. Harmondsworth, UK: Penguin Books, p. 32.
[3] Karl Jaspers, General Psychopathology (1997).
[4] Silvano Arieti, Interpretation of Schizophrenia, 2nd ed. (1974). Winner of the US National Book Award in Science, this masterful review of the available evidence on schizophrenia – from individual and family studies, to social and transcultural studies, and the biological aspects known at the time – concludes that it is not a disease in the classic sense and is amenable to psychological understanding and treatment.
[5] Gregory Bateson, et al., “Towards a theory of schizophrenia,” in: Steps to an Ecology of Mind (1987); pp. 205-232. This is the famous “double bind” theory of schizophrenia.

[6] Jon Mills, ed., Rereading Freud: Psychoanalysis Through Philosophy (2004).
[7] Erich Fromm, Beyond the Chains of Illusion: My Encounter with Marx and Freud (1962), p. 41.
[8] Cf. Roland Littlewood and Maurice Lipsedge, Aliens and Alienists: Ethnic Minorities and Psychiatry, 3rd ed. (1997). Joaquim Maria Machado de Assis, a Brazilian mulatto and son of freed slaves, wrote a famous novella about an alienist who applies his ever-growing criteria for mental maladies to more and more of the population until he ends up admitting himself in his own asylum, The Alienist (2012).
[9] Frantz Fanon, Black Skins, White Masks (2008).

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