AAPP Bulletin Vol 18 #2, 2011
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Association for the AA Advancement of Philosophy and P&P Psychiatry Bulletin Volume18, Number 2 2011 From the Editor President’s Column This issue of the Bulletin follows a Lately I have been thinking about what I know and on what basis I can know format that we have successfully used it. In particular, I’m thinking of a woman I have seen for many years: I’ll call her before—a target piece with commen- Greta. Greta has a long history of major depressive disorder with seasonal recur- taries and a response by the authors. As rences that generally respond well to antidepressants. I have observed avoidant, with previous symposia, this one has dependent, and histrionic characteristics, and family members have described how generated lively and informative dis- these personality features have kept her from pursuing some of her life goals. cussion. For that we thank both our Still, when she is euthymic, she is indeed a happy and well-adjusted person, with a authors and our commentators. career, and family and friends who love her. In this symposium, the commen- A year ago her husband passed away, and what I have observed in Greta since taries have developed in a variety of bewilders me. She grieved, as would be expected, but after six months a number directions, raising questions that are at of other changes emerged. Now in her 80s, she developed what looked like her times related to, but not at the heart of, usual depressive syndrome – apathy, anhedonia, paucity of thought, anergia, hy- the target article. That is of course all to persomnia, and passive suicidal thinking without a plan of action or real intention. the good, as the questions all involve At the risk of overpathologizing, I attributed this mood deterioration to bereave- the conceptual status of psychiatry and ment, although I did not object to the antidepressant her internist prescribed. Over mental illness. Stated in other terms, I the next months, Greta became increasingly confused and overwhelmed, but con- might say that you can’t analyze anti- tinued to tend to her household affairs, and maintain her closest relationships. Her psychiatry without analyzing psychia- therapist noticed that she had missed a number of appointments, and learned that try, and that’s what we have in the she had stopped paying her bills, recommended that Greta see a neurologist to rule commentaries and responses. out cognitive changes. The MRI showed diffuse brain atrophy advanced for With their target paper, “Getting it Greta’s age. Neuropsychological testing confirmed a diagnosis of mild cognitive from Both Sides: Foundational and impairment. Several months later Greta sustained a fall, and the emergency room Antifoundational Critiques of Psychia- evaluation showed considerable alcohol intoxication, which Greta dismissed as try,” the authors aim to divide and ana- irrelevant. Since she now lives alone, no one can confirm how much or how regu- lyze the variety of anti-psychiatries and larly she uses intoxicants. anti-psychiatrists into two related pairs: I find that I don’t know how to assess the quality of these data, or how to use on the one hand logical positivism and them meaningfully. Is this bereavement or depression, and does it matter what we postmodernism, and in a broader way call her mood changes at this point? If she is depressed, what role did alcohol use philosophical foundationalism and phi- and brain atrophy play in its development or progression, and over what period of losophical antifoundationalism. They time? Should I worry about other drugs of abuse? How do I understand her cog- view logical positivism as a paradig- nitive changes in light of the grief/depression, which could have influenced the matic example of foundationalism and effort Greta made in the ostensibly objective neuropsychological tests. And what postmodernism as a paradigmatic ex- to do with the most objective test, the MRI, which shows no focal anomalies, but ample of antifoundationalism. also provides no general schema for understanding the other clinical features of In an atmosphere of general appre- ciation, the commentators offer notes (Continued on page 38) of agreement, expansion, and at times disagreement. Cerullo is in strong agreement with the analysis but feels it Review of Books were published after these pieces were written. could be strengthened by attending to One complaint running through some of the commentaries is that the authors, contemporary variants of anti- in their critiques of the various anti-psychiatrists, are rather silent about their own psychiatry: e.g., Kramer in his early position in this discussion. Lewis suggests that they “have a philosophy that com- work, Healy, Elliot, and the President’s bines foundationalist facts with antifoundationalist values.” He is probably right in Council on Bioethics. In tune with Ce- that assumption. The authors suggest as much in the “Facts and Values” section of rullo’s remarks, It is a misfortune of their paper, and it might have useful for them to be explicit about it. timing—for both the authors and the Another issue that emerges in the commentaries is the value of the rather or- commentators— that Marcia Angel’s thogonal foundationalist/antifoundationalist division—whether it is a productive attacks on psychiatry in the New York (Continued on page 39) Volume 18, Number 2 2011 heuristic term in understanding vari- To be sure, the voluminous cri- Symposium ous critiques of psychiatry. tiques from Prof. Szasz—beginning The burden of this paper will be with The Myth of Mental Illness in to outline the historical roots of foun- 1961—have often been considered part Getting It from Both dational and anti-foundational phi- of the “antipsychiatry movement.” losophies; describe how these phi- However, Szasz has clearly and repeat- Sides: losophies have provided the basis for edly rejected this label. Szasz himself Foundational and Anti- a “double-barreled” assault on mod- employs the term "anti-psychiatry" Foundational Critiques of ern-day psychiatry; and finally, to very narrowly, as a label for the posi- adumbrate very briefly why both tion of David Cooper (1931-86) and Psychiatry kinds of attacks on psychiatry are R.D. Laing (1927-89). Szasz argues generally unfounded. First, however, that these individuals continued to use Ronald Pies, M.D. we need to provide at least a notional "...coercions and excuses based on psy- Sairah Thommi, B.S. idea of what the term chiatric authority and power" (Szasz Nassir Ghaemi, M.D. “antipsychiatry” encompasses. 2009, p. ix). Thus, for Szasz, "antipsychiatry" is merely another type (Follwing the format of other symposia A Brief Typology of Anti- of psychiatry. He avers that "...for published in the Bulletin, this sympo- pychiatry and an Apologia more than half a century, I have consis- sium will take the form of a target pa- tently asserted two simple but funda- per by our three authors, followed by As Edward Shorter’s analysis mental propositions: mental illnesses commentaries and a response to com- suggests, the construct of "anti- do not exist; and coercions justified by mentaries. Let me thank Ron Pies, psychiatry" is, at best, polymorphous; them are wrong… my writings form no Sairah Thommi, and Nassir Ghaemi, as and at worst, simply incoherent. part of either psychiatry or antipsychia- well as all of our commentators, for Nonetheless, Shorter’s synopsis of try and belong to neither" (Szasz 2009, their efforts in this exercise. the "Antipsychiatry Movement" p. x). JP) serves as a useful provisional defini- One of the authors (RP), along tion of the term: with many others, has provided several Early in the 1960s, as part of extensive critiques of Dr. Szasz’s views Introduction the general intellectual tumult of on mental illness, and these will not be the time, a protest movement belabored here (Pies 1979, Pies 2004). Modern-day psychiatry has been arose against psychiatry. Mem- Moreover, there are plausible reasons the target of numerous social, philoso- bers of the movement were by no to accept Szasz’s claim that he is not phical and scientific critiques over the means all in agreement about doc- “anti-psychiatry” in his motivation and past century, sometimes lumped to- trine; some argued that there was intention—even if, as we believe, gether as manifestations of “anti- no such thing as psychiatric ill- many of Szasz’s claims have been used psychiatry.” The aim of the present ness; others that adverse sociocul- (or misused) to denigrate, marginalize paper is to place the critics of psychiat- tural conditions exposed members and attack the profession of psychiatry. ric theory and practice in the broader of marginalized groups to political Other claims by Szasz have stirred use- framework of two philosophical tradi- oppression conducted under the ful debate and discussion; e.g., his tions: logical positivism and post- guise of medical diagnosis; still staunch opposition to the use of mental modernism . Even more broadly, we others that treating mental patients institutions as holding facilities for sex want to distinguish two “meta- against their will was unethical, offenders whose prison terms have categories” of philosophical discourse, and that electroconvulsive therapy expired (“Should states be allowed..” which we call “Foundational” and was brain-destroying rather than 1997). “Anti-Foundational.” To oversimplify therapeutic. This grab-bag of di- In this regard, we wish to empha- greatly, logical positivism may be con- verse claims and objectives came size, as D.B. Double (2000) has argued, sidered a subset of foundational phi- together under the banner that not every person or viewpoint that losophies; and post-modernism, a sub- 'antipsychiatry'. (Shorter 2005, p. is critical of psychiatry is necessarily set of anti-foundational philosophies. 22) anti psychiatry. For example, the Criti- We make the latter claim, fully aware Shorter goes on to name several cal Psychiatry Network enunciates the that the term “post-modernism” is sub- prominent critics of psychiatry, under following basic tenets: ject to many interpretations; is some- the rubric of antipsychiatry, including 1.