Tentative conclusion for my essay:
PSYCHIATRY
AGAINST ITSELF
Radicals,
Rebels, Reformers, and Revolutionaries
A Philosophical Archaeology
Envoi
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!”.[2]
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.”[3] 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.”[4] 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.[5] 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.[6]
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.
[2] Slavoj Žižek, The
Sublime Object of Ideology (1989), p. 160; cited in Žižek’s Jokes (2014), p. 125.
[3] Ibid., p. 160.
[4] Ibid., p. 161.
[5] Gregory L. Bateson, Steps to an Ecology of Mind (1972).
[6] 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.
