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Thread: Book Review : Psychiatric Hegemony ....

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    Default Book Review : Psychiatric Hegemony ....


    In the past I have criticized psychiatry as a pseudo-science and 'mental illness' as a social construction but pointing out this fundamental hole in psychiatry is not effective because it lacks [political] theoretical engagement. Psychiatry, like the police, cannot be reformed and has no positive role to play in a Socialist society.


    Psychiatric Hegemony: A Marxist Theory of Mental Illness
    By Bruce M. Z. Cohen (Palgrave Macmillan, 2016)

    Bruce Cohen’s body of work can be read as a bridge between older critical work on psychiatry from the 1960s and 1970s, which criticized powerful social structures and controlling institutions, and newer perspectives that emphasize the practices and processes in which mental disorders are negotiated. As a research fellow at the Uni-versity of Bradford, he evaluated the Bradford Home Treatment Service as part of his PhD project Mental Health User Narratives: New Perspectives on Illness and Recov-ery (republished in 2015 in paperback) with a focus on user narratives. His new book, Psychiatric Hegemony: A Marxist Theory of Mental Illness examines the genealogy of the current hegemonic status of psychiatry in neoliberal societies. His reconstruction of stories and their historical, political,institutional, and economical embeddedness bridges the gap between conceptualizations of mental illness in the traditions of sym-bolic interactionism, social constructivism, and more classically Marxist-influenced antipsychiatry.

    In both cases, more than “just” a scientific or even a medical story, the story of psychiatry was and still is political. The mental health profession tends to dismiss its earlier work controlling masturbation and homosexuality as “false starts, early experimentations, and theoretical innovations of an emerging scientific discipline” (p. 11), as a background against which current practice can differentiate itself as “now properly scientific.” Yet, “[t]he social control function within psy-professional work practices and knowledge claims is reasonably easy to identify” (p. 33) and remains so long after hysteria, homosexuality, and political dissidents were controlled through it. Even if it seems today that the turn to a medical model is a scientific break-through, with the view to the historical development of the concept, it is definitely not. “This biological trend is part of a wider cultural shift towards understanding ourselves in a technical idiom. All sorts of human difficulties are now regarded as the rightful con-cern of psychological experts and their knowledge” (Cohen 2015:22–23). Though psychiatry’s influence is also helped by its fluidity and adaptability, psychiatric categories are shape shifters, changing with their clients and situations. This is one reason why psychiatric treatment can become very individual, very pragmatic, and very sticky for its clients, who have always tended to be found more prominently on the side of the powerless. Historically and currently alike, the vast majority of mental illness ascriptions target “the unemployed, underproductive, or politically suspect” (p. 62), where they “serve an important role in depoliticising employ- ment relations; instead of recognizing power disparities in the work environment, new and/or changing diagnostic categories of mental illness encourage workers to problematise the self rather than the organisation or wider society” (p. 104). Psychiatry also disproportionately controls women, as the history of hysteria as well as Cohen’s current work well illuminate. In the present, “the ‘plague of disabling mental illness’ ... has fallen particularly hard on young people ... with an incredible 35-fold increase between 1997 and 2007” (p. 2). Rather than alleviate a “biological” inequality through treatment and the promotion of acceptance, psychiatry has been a central actor in the reproduction of these historical inequalities. By individualizing complex social dynamics, psychiatry can perform the task of “freeing” them from responsibility for theirritations in their everyday life through ascribing them to an impersonal biological force; however, this move unloads the causal narrative on the individual after all. This is, of course, an old insight which can be found in much of Goffman’s work as well (e.g., 1971). Psychiatry has become remarkably successful and powerful in structuring narratives about everyday life, and psychiatric interpre-tations of social conflict have seeped deep into the groundwater of everyday life, where everyday behaviors of all kinds“are now closely observed and judged underthis psychiatric hegemony, and we have in turn cometo monitor and understand ourselves through this discourse” (p. 70).

    Pathologization not only creeps through social narratives to include children, it now centers aroundthem. As one of the last institutionally dominated classes that canbe openly repressed without repercussion or outrage, children can be easily pathol-ogized when they do not conform to adult expectations, which include expectations of the (future) moral normality of wage work and orderly behavior vis-ŕ-vis author-ities, especially in school contexts. The diagnostic category of oppositional defiant disorder is only the most blatant case of open inequalities dressed in medical garb. Cohen identifies another category as the most egregious and widespread tool in con- trolling unruly children, however: ADHD. “Clear within the phraseology and the ‘symptoms’ of ADHD is the concern to medicalise the behavior of unruly children in the classroom” (p. 129). Cohen shows how a focus on childhood in the very early history of modern psychiatry can be traced forward to continuously extend the inva-sion of young age and school life with psychiatric evaluation. School, Cohen notes, is mentioned 257 times in the newest edition of the DSM, a testament not only to its colonization of childhood, but also to its attempts to gain entry into everyday life narratives through making it easy for practitioners, teachers and parents to “find” their problems in the catalog, which packages complex social conflicts as easily under-standable and simplistic medical categories.

    This critical tradition has somewhat slowed since its heyday in the 1970s and 1980s in the critical social sciences. While critical psychology and psychiatry have filled that void (e.g., Caplan 1996; Kirsch 2009; Moncrieff 2007) and point to the absurdities and power structures inherent in allowing medicine to police social normality, the social sciences have been comparatively quiet. Cohen brings a basic insight back: that the psychiatric reading can neither portray and represent the complexity of social reality, nor can it address the connection between professional knowledge and the knowl-edge of the everyday world. These medicalizations of social conflicts not only delete the social, structural, and power aspects from everyday life and strip those who can-not call themselves experts in the field of a voice in discussing the subject, and thereby of discussing their life and their own position in the lives of others. They also betray the continuing pathologization of the institutionally powerless and cause, as Cohen (p. 85) notes, institutionalization of a “permanent condition of vulnerability (Furedi 2004:130)”—another role that serves to curtail the very autonomy that late modern rhetoric ascribes to all participants in the market economy as a necessary, compul-sory self-narrative. The bio-medical model can neither ask these questions nor can it talk about the way psychiatry addresses social problems. And it can only be con-sidered malicious that psychiatry is unwilling and conceptually unable to understand the consequences of its work for the people who trust them. That the middle-classstereotyping concept of mental illness highly depends on questions of economic fac-tors, age, gender, and/or ethnicity is a fact, which is as difficult as cruel to deny. At one point, the sociology of psychiatry was at the epicenter of critical, decon-structive sociology skeptical of institutionalized, dominant forms of knowledge. Critical scholarship showed the hidden power structures underpinning psychiatric diagnoses and the ways in which pathologization defended bourgeois normality against insurgencies, from the way hysteria diagnoses controlled unruly women, to how schizophrenia diagnoses were used to tackle political dissidents and those with different lifestyles. While classical critical approaches showed how psychiatry supports dominant social norms and structure, interactionist scholarship showed how psychiatric ascriptions work in micro-settings to defend a local “normal,” most famously in the works of Erving Goffman and Thomas Scheff. Cohen’s work is of one cloth: his earlier work on narratives continues into hisnewer work on psychiatric hegemony. What are organizations if not calcified narratives? More than that, however, Cohen opens up a wide field of inquiry, where different institutional and private actors construct narratives together, without this construction being necessarily one-sided; contemporary discourses see clients and would-be-clients of psychiatry claiming narrative authority for themselves, over and against psychiatric practitioners, teachers, social workers, and other actors whocould classically claim definitional authority though without, at this point, reallyquestioning the definitional authority of a disease catalog that is also obviously the cobbled-together work of humans (cf. Dellwing 2019; Kirk and Kutchins 1992;Kutchins and Kirk 2003). Cohen opens up the sociology of psychiatry for fruitfulcollaboration between different approaches to the social sciences and connects it to classical interactionist work as well. Finally, and not least, in a present in which psychiatry is well-integrated in progressive discourses and the support of psychiatrycounts assupport for the oppressed, Cohen’s work reminds us that critical challenges to psychiatric hegemony were once, and should again be, a progressive cause.

    REFERENCES
    Caplan, Paula. 1996. They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide
    Who’s Normal. Boston: Addison-Wesley.

    Cohen Bruce, M. Z. 2015. Mental Health User Narratives: New Perspectives on Illness and Recovery.
    London: Palgrave Macmillan.

    Dellwing, Michael. 2019. “Eine halbe Befreiung.” Pp. 170–192 in Pathologisierte Gesellschaft: Bei-
    heft zum Kriminologischen Journal, edited by Michael Dellwing and Martin Harbusch. Wein-
    heim: Beltz.

    Furedi, Frank. 2004. Therapy Culture: Cultivating Vulnerability in an Uncertain Age. Hove, UK:
    Psychology Press.

    Goffman, Erving. 1971. Relations in Public: Microstudies of the Public Order. New York: Penguin.
    Kirk, Stuart A. and Herb Kutchins. 1992. The Selling of DSM: The Rhetoric of Science in Psychiatry.
    Hawthorne: Aldine De Gruyter.

    Kirsch, Irving. 2009. The Emperor’s New Drugs: Exploding the Antidepressant Myth. London: The
    Bodley Head.

    Kutchins, Herb and Stuart A. Kirk. 2003. Making us Crazy: DSM: The Psychiatric Bible and the
    Creation of Mental Disorders. New York: Simon and Schuster.

    Moncrieff, Joanna. 2007. The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment.
    London: Macmillan.

    ABOUT THE CONTRIBUTOR(S)
    Martin Harbusch does research and works at the University of Kassel and the University of Hagen
    in Germany. In addition to his present project, “Psychiatric Categories as Traveling Objects,” he
    teaches in the fields of sociology of knowledge and qualitative methods at the Leibniz University
    Hanover and Leuphana University Lüneburg.https://sci-hub.se/10.1002/symb.452

    Michael Dellwing teaches qualitative methods at Leuphana University Lüneburg and does research
    in the fields of the sociology of psychiatry, online research, and games. He is co-author of an introduc-
    tion to ethnography in online research (with Alessandro Tietz and Marc-André Vreca) and co-editor
    of a collection on the role of pathologization on modern societies.

    Last edited by JamesBond007; 12-03-2021 at 02:57 AM.

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