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From Szasz to Foucault: on the Role of Critical Psychiatry Pat Bracken Philip Thomas

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From Szasz to Foucault: on the Role of Critical Psychiatry Pat Bracken Philip Thomas From Szasz to Foucault: On the Role of Critical Psychiatry Pat Bracken Philip Thomas Philosophy, Psychiatry, & Psychology, Volume 17, Number 3, September 2010, pp. 219-228 (Article) Published by The Johns Hopkins University Press For additional information about this article http://muse.jhu.edu/journals/ppp/summary/v017/17.3.bracken01.html Access Provided by Cambridge University Library at 01/08/11 2:19PM GMT From Szasz to Foucault: On the Role of Critical Psychiatry Pat Bracken and Philip Thomas Abstract: In this article, we examine the different seek to assist our attempts to understand mental ways in which Thomas Szasz and Michel Foucault have distress and how it might be helped. However, challenged dominant perspectives within psychiatry. We these discourses work with different assumptions, identify, analyze, and compare the central elements of methodologies, values, and priorities. Some are in their respective discourses on psychiatry and show that dispute with one another. At various times in the although they are often bracketed together, in fact there are certain fundamental differences between Szasz and history of psychiatry, a particular form of under- Foucault. Of most importance is their contrasting ways standing has become dominant and worked to of characterizing the nature and role of critical thought. marginalize the contributions of others. Whereas Szasz’s analysis is predicated on a number of These conceptual dynamics are related to binary distinctions, Foucault works to overcome such changing external economic, cultural, and political distinctions. In the past ten years, a new movement of conditions, to struggles between different profes- critical psychiatry has emerged. Although this shares sional groups and to changes in the relationships certain concerns with the critical psychiatry of the 1960s and 1970s, there are substantial differences. between professionals and those who are recipi- We argue that this discourse is more resonant with the ents of their interventions. As a result, psychiatry, Foucauldian approach. and mental health work in general, is (by its very nature) a site of dispute, conflict, and agitation Keywords: Antipsychiatry, binary distinctions, critical thinking, postpsychiatry, poststructuralism, psycho- (Stastny & Lehmann, 2007). Although there have therapy always been voices within psychiatry that have challenged the assumptions of the status quo, at certain times these have become more organized and coherent than others. In recent years, a new ecause psychiatry deals specifically with movement of critical psychiatry has emerged. In ‘mental’ suffering, its efforts are always cen- the United Kingdom, a group called the Critical Btrally involved with the meaningful world Psychiatry Network has been in existence since of human reality. As such, it sits at the interface 1999; both the authors belong to this group.1 of a number of discourses: genetics and neurosci- This contemporary movement shares many ence, psychology and sociology, anthropology, concerns with the critical psychiatry of the 1960s, philosophy, and the humanities. Each of these but there are important differences. As authors, provides frameworks, concepts, and examples that © 2010 by The Johns Hopkins University Press 220 ■ PPP / Vol. 17, No. 3 / September 2010 we do not speak for anyone but ourselves: this medicine and psychiatry and also to demonstrate a review is not a manifesto for the Critical Psychiatry fundamental contradiction between the individual Network. Instead, we simply aim to contrast the and the state. With regard to the latter, Szsaz’s ac- approaches of Thomas Szasz and Michel Foucault count is primarily focused on his own country, the in relation to critical thought and to look at some United States, with some references to the situation of the implications of this analysis for the project in certain European societies. Szasz understands of a critical psychiatry. Whereas most authors social progress in Enlightenment terms: increas- are aware that Foucault and Szasz approached ing individual autonomy alongside a movement psychiatry from very different angles, neverthe- to understand the natural world (including the less, there has been a tendency to lump them human body) in the language of science. together as representatives of ‘anti-psychiatry.’ A Szasz’s critique is heavily dependent on what typical example is Edward Shorter’s (1997) dis- we call ‘binary oppositions.’ Indeed, much of the missive remark: “The works of Foucault, Szasz, strength of his analysis derives from the fact that and Goffman were influential among university he is prepared to ‘draw lines in the sand’ and to elites, cultivating a rage against mental hospitals be very clear about where he stands on any par- and the whole psychiatric enterprise” (p. 275). In ticular issue. In this paper, we first provide a brief this paper, we focus on the differences between outline of how we understand Szasz’s critique Szasz and Foucault. In focusing on the work of and then question whether such binary thinking these two writers, we are not suggesting that their is adequate to the lived reality of struggling and work encompasses all of what might be regarded suffering human beings. We then go on to show as critical thought about psychiatry, but rather how Foucault’s analysis of psychiatry works in a we are using this as a device to help us tease out very different manner and leads to different an- differences in how we might conceptualize critical swers to the questions posed. We follow this by thought and its role in relation to psychiatry. outlining some elements of contemporary critical We are particularly concerned with the impli- psychiatry. We end by arguing that critical thought cations of critical psychiatry for us as medical has a positive and constructive role to play within practitioners. Is there a legitimate role for doctors psychiatry. in relation to madness and distress? Does medicine have anything to contribute when pain and suf- Szasz on Medicine, Science, fering involve thoughts, emotions, relationships and Psychiatry and behavior? Is the term ‘mental illness’ valid? We use the term ‘anti-psychiatry’ to indicate those For Szasz, there are clear, definable limits to positions in which the answer to these questions what it is legitimate to call ‘illness.’ Problems with is a simple ‘no.’ Although a number of people our bodily functions are properly understood to have articulated this view, the most sustained be pathological, but difficulties with our thoughts, anti-psychiatry critique (in this sense of the term) feelings, relationships, and behaviors are of a has emerged from Thomas Szasz.2 different order. They are not pathological, not Szasz (2007) writes that, since the 1950s, he has diseases or illnesses; they are best characterized as been involved in a “systematic scrutiny and refuta- ‘moral’ issues or simply ‘problems in living.’ His tion of the two fundamental claims of contempo- argument is based on a particular understanding rary psychiatrists—namely, that mental illnesses of the nature of human reality. For Szasz (2007), are genuine diseases, and that psychiatry is a bona human reality is like a television set that is trans- fide medical speciality” (p. 3). Szasz has challenged mitting a program: “I maintain that mental illness psychiatric orthodoxy on a number of issues, in- is a metaphorical disease: that bodily illness stands cluding the use of coercion, the insanity defense, in the same relation to mental illness as a defective and the medicalization of recreational drug use. television set stands to a bad television program” However, at the heart of his work is a wish both (p. 6). Two completely different discourses are to demarcate the boundary between scientific needed to describe the quality of the set and Bracken and Thomas / Role of Critical Psychiatry ■ 221 the quality of the programs that are transmitted more medical students into the profession?” He through it. We cannot improve the quality of a answered: “I wouldn’t” (p. 120). television program by interfering with the wiring Szasz proposes that the only legitimate profes- of the set. In the same way, according to Szasz, we sional response to states of madness and distress cannot ‘treat’ or ‘cure’ psychological difficulties is a form of free-market psychoanalysis that he by interfering with the ‘machine’ (the body) of calls ‘autonomous psychotherapy.’ He defines this the individual who experiences these difficulties. (2003) as a nonmedical process: “I have made it If we do so, he says, “It is as if a television viewer clear that I regard psychoanalysis (psychotherapy) were to send for a television engineer because he as a special type of dialogue—listening and talk- dislikes the program he sees on the screen” (p. 6). ing—that has nothing to do with doctors (medi- The content of a television program is related to cine) or therapists (persons who treat diseases) or things outside the set: scripts, acting, directing, ‘analyzing’ (any object or person)” (p. 203). In The and production values. These involve discourses Myth of Mental Illness (Szasz 1972), he combines that are very different to the technical logic of insights from Freud, Piaget, and others to develop television manuals. So too, argues Szasz, we should his own approach to understanding the origins of not attempt to use the language and logic of medi- madness and distress. He relies strongly on ideas cal pathology to frame psychological problems. about rule following and game theory. Mental When we do, he says, we end up fitting suffering illnesses do not exist, he says, only ‘problems in individuals and their problems into a framework living.’ Autonomous psychotherapy should be that causes confusion and further suffering and purchased by the client as they would purchase a oppression. book in a bookshop. It should never be provided This leads to a seemingly uncomplicated view by the state. of the world of medicine. To Szasz diseases are All of Szasz’s work is informed by a philosophi- ‘cellular pathology.’ Medicine derives its author- cal belief in individualism, which he associates ity and credibility from its basis in biological sci- strongly with free-market forms of capitalism.
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