Culture, Mind & Brain Program
Division of Social & Transcultural
Psychiatry
McGill University
Does Social and Transcultural Psychiatry
Have a Political Agenda?
Should It?
Vincenzo Di Nicola, MPhil, MD, PhD
Professor titulaire
Département de psychiatrie et
d’addictologie
Université de Montréal
Clinical Professor of Psychiatry
The George Washington University
Argument
“After
the upheavals of the twentieth century, philosophy has lost the privilege of
existing in a realm that was somehow above politics.”
–
Peter Sloterdijk, What Happened in
the Twentieth Century? (2018, p. 127)
If philosophy lost the privilege of
floating above politics, medicine and social science have never had that
privilege. A contemporary “quietism” which holds philosophy as a kind of
therapy for humanity’s confusion, uncontaminated and undeterred by linguistic errors
and “pseudo-problems,” initiated by Ludwig Wittgenstein (2002) and upheld by
American pragmatist Richard Rorty (2010; cf. McDowell, 2009), no longer seems
possible. The vision of a non-partisan, and to the extent that such a thing is
possible, a non-ideological evidence-based study of “human nature” (cf. Steven
Pinker’s The Blank Slate, 2002) is
now evaporating (cf. Raymond Tallis’ Aping
Mankind, 2014). Despite a growing nativism and biologism, medical and
social sciences cannot reach for immutable laws, independent of historically-shaped
social relationships (cf. Antonio Gramsci, 2011; see Codevilla, 2016).
Social and transcultural psychiatry
understood in its best iteration, a systemic understanding of relationships,
the social determinants of health and their cognate approaches and studies, now
compel psychiatry to consider the political.
What I am talking about is the
Western tradition of the polis - politics
as an understanding of the organization of social life. There precisely is
where the error began. We inherited from Aristotle a fundamental dichotomy between
natural and political, private and public life. In a series of detailed
historical and philosophical studies of Homo
Sacer, Giorgio Agamben (1998, 1999c, 2005) argues that the separation of
natural and private life from the political has allowed the state to politicize
biological life, creating a crude “bare life,” denuded of human qualities. In Agamben’s
(1999c) profound testament, Remnants of
Auschwitz, he attempts to give testimony if not voice to the living dead,
the Muselmänner, reduced to bare life
in the Nazi death camps.
Michel Foucault (1997) opened these
questions with his notion of “biopolitics.” Extending that line of inquiry, Agamben
(1998) argues that this separation of biological life from the polis culminates in a “lasting eclipse”
of politics today.
Applying Agamben’s analysis, we
will consider the cases of two key figures in 20th century
psychiatry – Martinican revolutionary psychiatrist Frantz Fanon (1925-1961; Fanon,
2008) and Italian psychiatric reformer Franco Basaglia (1924-1980; see Basaglia,
2010; de Girolamo, et al., 2008). We will examine their legacy and recall the
impact of eugenics: Stephen Jay Gould, The
Mismeasure of Man (1996); and the uses and abuses of psychiatry for
political purposes both in the West and the USSR – psychiatrists E Fuller
Torrey (1999) who documented Ezra Pound’s insanity defense against charges of
collaborating with Italian Fascists, and Walter Reich (1983) who investigated schizophrenia
in the Soviet Union and the notorious case of General Grigorenko. And we will identify
such contemporary issues such as migration and trauma, borders and belonging,
about which psychiatry has or should have much to say (cf. philosopher Thomas
Nail on migrants and borders, 2015, 2016).
All this will be put to the test in
brief readings of two contemporary texts by thoughtful clinicians and social
scientists who accompany psychiatry’s work. Didier Fassin (2011), a French physician-anthropologist,
has given us a trenchant study of “humanitarian reason,” and American
psychologist Martin La Roche (2013) in his work on cultural psychotherapy
argues that we should not only advocate on behalf of patients but foster their
own advocacy and militancy through empowerment.
And, finally, what conclusions are
warranted by such an investigation? I am a student of dichotomies; in fact, I argue
that Western philosophy is the study of the binary thinking we inherited from
the Hebrews, the Greeks and the Romans – and their emanations. We must give up
the hope of reintegrating that which was “cast asunder,” in a return to some preternatural
Edenic whole. Rather than a therapeutic intervention of curing dichotomies through
linguistic philosophy (Wittgenstein) or integrating the strands of psychiatry
in a promised but failed biopsychosocial synthesis (Engel, 1977; Ghaemi, 2009),
I would argue for a new politics and a new psychiatry.
What would such a politics look
like to us? Following Agamben (2000), I work for a “politics of means without
ends,” of singularities without identity, of beings with no necessary “nature,”
no given task and no biological destiny. This is a potential politics, based on potenza
or potentiality, that can overcome the warring forms of inclusion and exclusion
that arise in communities founded on identity. A psychiatry embracing this
potential politics becomes a psychiatry of potenza
– always possible yet radically contingent. In this view, the human being
is that being which cannot exhaust itself (and cannot be defined or reduced to
categories and criteria) in its potential as its confronts its impotenza – impotentiality, the
possibility-not-to (be or do). What does this mean? Just as for Agamben (1999a), a canonical
case of potenza-impotenza is Bartleby
the Scrivener’s negation, “I would prefer not to,” for me the cases that define
my work as a psychiatrist are what I call “syndromes of denial” – anorexia
nervosa, selective mutism, depersonalization and dissociation – associated with
Victor Turner’s (2017) liminal people, “betwixt and between” potenza and impotenza.
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