The past week--when I've had time away from rearranging paperweights and making a PowerPoint presentation about it at work--I've been reading a lot on the subject of
anti-psychiatry. Now that I've had the chance to spend quite a bit of time in mental healthcare environments the past five years, including several psychiatric wards (though not as a patient--yet anyway!), it is a deep feeling in me that some fundamental reforms still need to take place regarding the field of psychiatry, much less our fundamental notions about what defines mental illness.
Last night, I re-read an article by Thomas Szasz entitled
Mental Illness: Psychiatry's Phlogiston, in which (as the title says) he says that psychiatry, in order to be a science of human behavior, must rid itself of the false concept of mental illness just as chemistry abandoned the concept of phlogiston to describe combustion in order to become a more authentic natural science. As interesting as I think this analogy is, it's interesting in very different ways for me than it is for Szasz. I feel like his ideas are too narrow, collapsing the analogy's potentials down to a few specific jabs at what Szasz sees to be psychiatry's major shortcomings. They're interesting ideas, to be sure. Such as Szasz saying psychiatry has a kind of schizophrenic system of principles it employs to deal with mental health and illness: "healthy" behaviors are attributed to reasons (assuming a rational, pro-active agent) and "ill" behaviors to causes (caused by the disease, not the passive, irrational agent). And from there he goes on to flesh out the specifics of his argument, and reclaim the purposive agency of the mentally "ill" individual.
There's a lot I agree with in this article, and in other articles I've read of his in the past. But is he really showing why mental illness is psychiatry's phlogiston? Medical studies do show that there are brain structures that appear to operate in a certain fashion and have certain distinguishable configurations in what could be called healthy versus unhealthy individuals. For example, reduced volume of frontal lobe structures have been observed in schizophrenics compared to supposedly normal brains, or lesions observed as correltates with other mental disorders. I guess I'd get the point of his supporting the analogy in the way he does if he offered some alternative hypothesis, some other way of defining the challenging psychological-physiological situations that many individuals do deal with, and that are at present referred to as mental illness.
So maybe I don't agree with such a dramatic metaphor of mental illness as being psychiatric phlogiston after all. Schizophrenia, bipolarism, and other challenging brain-mind conditions have their reality that is lived and experienced by many people. However, as Szasz says, to remove a person's agency or even intrinsic value of they themselves or as integral members of society by defining them as helplessly "ill" does cause problems. Not to mention causality, which is one area I get pretty emotional about--perhaps my own disorder at work? If many factors could actually be taken into perspective--environmental elements, intersubjective dynamics, family history, nutrition, genetics, social issues, beliefs, spiritual or metaphysical components--a quite new perspective would come to us. Instead, biochemical processes are taken not as correlates but as causes, and other correlated phenomena are drained of their own life and value in order to keep the perspective in "reality"I guess it really does come back to implementing more "integral" modes of working with reality, just as Ken Wilber and Don Beck and the rest are currently making very clear. Bearing Wilber in mind, psychiatry is yet another field that has become increasingly imbalanced, wobbling on the weight of the overly fed half of reality it investigates and invests in. Until it either topples or finally brings back into its comprehension that other half (kind of like the separation of Upper-Lower Right from Upper-Lower Quadrants if you're into that kind of thing).
It's much too late now, and the alarm goes off much too soon, so more on this later.