Is technology a form of psychiatry?
Is modern media technology a form of psychiatry?
Note the definition of technology:
" In the future we may see psychiatry using the latent power of its medical connection and knowledge of genetics to re-exert hegemony over the mind, but psychotherapy has broader mass appeal with its ideas self-medication, narrative structure, lies and collective control. In paying someone to assess your mental problems both practices provide solutions. If you’re paying for hierarchical structures of control, both models offer solutions." Philpott (2010)
I would like to compare and contrast the psychiatric model and the psycho-therapeutic. The first is grounded in the bio-mechanical model and has the legal facility to use drugs as an adjunct to therapy. The second is formulated on the "processes of mind" and the ability to gain access to thought process through talk, to gain control of feelings, thoughts and consequently actions.
"Mind" is an extremely slippery word. Can science locate it, all these professionals contend to "know" it?
While contending to "know," the word "professional" is used in an equally slippery way to denote "expertise" and from that "expertise" to take money. The "layman" thinks expertise equates to (psy-) "scientific" (gnosis) knowledge of the "mind"
This is very slippery ground. The models, the framing, the contexts, the results, the structures, the whole edifice is a religion of materialism in a spiritual realm.
I propose to look at the history of each model, their relationship to the society and the historical variables of the times and the personalities and proponents that lead the way. I also will look at the philosophical basis for both models and question some of the assumptions each model makes. The idea of both practices is to alleviate suffering, I would like to question this and the use of authority in the process of
“psychic” control and look at social aspects of “mental health.”
There is a historical placing of mental "health" into formulations of society. First there were mentally unwell people in smaller communities, later the communities got larger and there was a possibility of having larger numbers of people who are “unwell” in one place. When there are larger numbers of people with “mental illness” the community cannot provide for them as easily and institutions develop. These institutions warehouse larger numbers so cross referencing is possible. There is a code to this process of thinking and it is that the process is deterministic, pragmatic and experimental.
In human history the social power to give judgement and to incarcerate has been vested in powerful institutions. In this way psychiatry is born as a branch of medicine which focuses on the treatment of mental disorders. When the process of haphazardly treating the mental dysfunction of the individual reached a “tipping point,” psychiatry was born as an art and science. Art, in that the process is still “goldfish in the bowl treating other goldfish in the bowl” and science in that it is a process of experiment, measurement and tabulation.
In his book, “Madness explained,” Richard Bentall gives an interesting history of psychiatry. He advances Emil Kraepelin as the father of modern psychiatry. Teaching in psychiatry began in Leipzig in 1811. In 1865 Wilhelm Greisinger established the first modern style psychiatric department in Berlin. In 1883 Kraepelin wrote a book called “The Compendium of Psychiatry.”
“ Kreapelin assumed there was a discrete and discover-able number of psychiatric disorders” (Benthall 2003) and proposed a matrix. When Kraepelin changed the name from compendium to “Textbook of Psychiatry” we begin to see a process of psychiatric designation(or labeling), first a formulation then a tabulation, then a reason for authority. Unfortunately the formulation of symptoms indicating disease did not work so well but we still use of terms such as “dementia”, “catatonia”, “manic depressive” and “paranoia”.
There is a thread to mental disorder which still exists, to be mentally divergent to the norm of human behavior may not be a disease but to be a danger to oneself or others is a problem. This simple logic is where psychiatry has its primary use; to pass judgement on the sanity of individuals. Such a power needs careful handling and it is within the medical profession with its Hippocratic Oath and scientific and intellectual mien that the treatment of those mentally outside the norm sit.
This line of reasoning is a western European model which has gained prominence through the power of western philosophical traditions. Cartesian dualism proposes separate mind and body. Within this paradigm both of the mental health models exist. Does the body control the mind or does the mind/brain control the body or do either exist in isolation? (or at all.) The predisposition to logic as method also gives power to logical reasoning which in turn gives power to science and rational explanation. The period of scientific awakening, beginning with the renaissance and culminating in “psy-ops” and the controlled society, is my period of investigation.
Wilhelm Wundt opened the first laboratory dedicated to psychological research at Leipzig University in 1879. Afew years later Freud began to tackle psychopathology and invented the therapy of “psychoanalysis.” Freud was a neurologist and a contemporary of many of the founding fathers of modern psychiatry but his formulations are based on psychological processes. Psychoanalysis is a method of mental health therapy invented and utilised by Doctor Sigmund Freud 1856-1939. An Austrian physician who believed that mental distress or neurosis could be alleviated and cured by a process of “cognitive analysis”. He posited the notion that neuroses were the result of repression and sublimation of childhood desires.
This “repression” would become mutated and transferred through later relationships causing disease. Treatment is psychologically based in the inner world of the patient. The process of development itself is a process fuelled by the libido or life energy. This energy fuels the drive for self preservation and procreation.
Psychoanalysis differs in form to later psychotherapy in its qualitative nature.
Later theorist, Carl Jung in his theories diminished the sexual basis for neuroses. Jung believed that there is a personal and collective unconscious. The utilisation of archetypes and symbolism to illuminate belief is Jungian in origin.
Behaviorism” is a slightly different concept to the preceding two approaches. It is concerned with “operant conditioning” whereby the client approaches a “reinforcing stimulus” which increases the “operant” or makes you just a bit worse than you already were. Simply, it infers cognition of an event that is associated with meaning for the client. This meaning gives the event a resulting perception to the client that dictates his response to this event.
The classic example is Pavlov’s dog where a dog will salivate at the sound of a bell if he is conditioned to associate the sound with the immanent arrival of food. Modern cognitive behavioural therapy used by the N.H.S. is based on this method. The advantages are that results can be graded and C.B.T. sessions can be coducted over shorter periods.
“The Person centred approach” to mental health is founded on a perspective of “self actualization” Humanists approach behaviour as personal and subjective. This process deviates with the determinism and “illness” perspective of psychodynamic theory. The person becomes the healer. “Inter-subjective verification” or the agreement that one idea can be communicated between different observers’ is a central component to Carl Roger’s hypothesis.
Rogers was a psychologist and in this aspect his work further moves control of the “mind” away from medical profession.”He goes further, allowing that it is the ‘clients’ who are in the best position to heal themselves.
To quickly return to psychiatry, bearing in mind that Freud and his ideas would also have a impact on psychiatry we see that Karl Jaspers tried to bring together biological and psychological processes in an attempt to objectively explain and subjectively understand a patient in his work “General Psychopathology.” The question now is; having theories proposing understanding of processes in the mind, do we have repeatable scientific proofs that psychiatry works?
The answer is in debate, not because we cannot define “madness” but that the formulations seem to have a very loose fit and the bio-chemical processes in the brain that control the actions an individual are still being mapped out.
The first world war created a huge increase in admissions to hospitals. The psychiatric wards were overloaded with “shellshock” victims and the forms of hospital designs used to house previous populations became impractical. It is at this point I would like use Thomas Kuhn’s phrase “paradigm shift” to indicate that the previous theories and formulations were held in abeyance and new ideas were given experimental licence, “behaviourism,” drugs and new forms of therapy could be tried with impunity to sanction, given the lack of information or lack of success with various forms of mental distress heretofore.
The advances that created effective, low side effect drugs had not yet evolved. In the theory of “emergence” (how new complex patterns evolve out of relatively simple interactions) it would be possible to ground a cogent hypothesis, that psychiatry was still rudimentary but the war gave excellent possibilities for trial, error and learning.
After the time of the second world war, the American Psychiatric Association had formulated the Diagnostic and statistical manual of mental disorders, (published in 1951), concurrently with English becoming the language of scientific papers and the “American dream” becoming the global dream. Bentall calls it a triumph for the doctrine of “truth by agreement” and I would argue that it is this publication and its subsequent versions which gives psychiatry its institutional power today.
A codified rule book of illnesses, which can be applied cross culturally giving us a formulation for ‘madness’. Other classification systems of mental illness also exist but the “DSM” and its larger revisions has reached a wide, global, audience.
It is at this point I can leave the historical perspective and look at psychiatry as it is today, a branch of medicine dealing with neurosis and psychosis. The connection with the law remains. The need for a criminal case to have a “mens rea” or guilty mind presupposes a legitimate legal authority that can comment on the mind. To be “sectioned” or sent to mental hospital is an action with legal controls. It has became possible with the advent of "reliable drugs" to treat the individual in the community.
In a glance to the future, the use of psychology to control ordinary or normative populations is now well underway. In this full circle approach I may be able to address modern psychotherapy/counselling/psychology as it is now known and see how it has gained as different place to psychiatry in our lives.
The use of psychology as a process of mass control began with Freud’s nephew Edward Bernays. Bernays was heavily involved in the propaganda effort of both world wars and later moved to assist governments to control their own people.
“If we understand the mechanism and motives of the group mind, is it not possible to control and regiment the masses according to our will without their knowing about it?”
His quote alludes to the psychological work of Jung and his idea of group consciousness, behaviorism and its ideas of stimulus response and the impact of “emotion” or motive on the social control of human beings. We can see too a change in the relative status in models at this point as it becomes apparent that there are great benefits to studying group psychology while psychiatry becomes ring fenced by its power to incarcerate and it’s hospital setting. In contrast the mass appeal of Freud is as much due to his prodigious literary output and the nature of his salacious subject matter.
In the 1960s a reverse information flow occurred, the mass appeal of psychoactive drugs gave psychiatrists something new to try when all else failed. The “MKULTRA”trials by Dr. Ewan Cameron 1901-1967 (former president of american psychiatric association) in Montreal showed the C.I.A. that even though drugs and torture could unmake the mind, the power to reintegrate was still lacking. In his book “Awakenings,” Oliver Saks showed what could happen when drugs were given to catatonic patients. Unfortunately for Saks the effect of chlorpromazine wore off and had side effects while in use.
There may be a line too where the psychiatrist does not venture beyond. S/he treats the patient, the illness is biologically based and the symptoms are in the book. The psychotherapist can access dreams, family, social conditions, feelings, and many of the personal constructions of the person. If we understand also that the psychotherapist is seen in a less serious light and has a more positive ambiance in his role than the psychiatrist we see a developing schism between the two roles. Modern psychology has an extensive role, from selling “free range” eggs to training astronauts and everything in between.
So how did it occur that psychologists developed a modern theory of “being.” Firstly I think the death of religion, a social power structure that was giving mass populations structure, meaning and direction to life. The central tenet of secular capitalism or the accumulation of goods and status does not alone seem to create mental health.
In this too a reflection that psychiatrists are digging in the wrong place, if humans are evolving survival machines they need to access ways of mentally adapting better rather than being judged as “ill” The notion of “objective truth has also fallen into philosophical debate in these postmodern times. Psychiatry in being forced into objective definitions of illness, which lead it into categorization and stasis.
The provision of care is I think a little misleading. Modern society is being computerised and it possible to argue that humans adapt to systems. Madness or “chaotic” behavior seems to run counter to this type of society. Foucault, in his book madness and civilization says;” Our philanthropy prefers to recognize signs of benevolence towards sickness when there is only condemnation of idleness” He further states that it is the “animality of madness” which requires confinement and even today I think this notion of ourselves(the sane ones) as “rational” pervades our consciousness. In this I do not think that psychiatry is actually a business of care but more “correction.”
The contrast with person-centered psychotherapy is that the duty of care is mediated in a different way. The counselor is required to listen and interpret. The requirements of the role are that the listener be empathetic and offer unconditional positive regard so the person may find their own cure. As talking therapy, it a has a legal duty to cause no harm (psychiatry research does not confer the same nuance, even though it is distilled from the medical coda). It is the relationship between client and counsellor in a “healing environment” that brings about positive change.
To conclude we could ask if psychotherapy is simply a “new age confidence trick?” or if psychiatrists are police of the mind? Defining a few areas of comparison between both models, mind control (in its good and bad sense,) authority to diagnose and a professional, educated elite who trade as experts.
The contrasts were less obvious historically but psychotherapy is growing into a field of its own in our modern individualist society. Psychiatry still holds the power of forced detention and drug use. In the future we may see psychiatry using the latent power of its medical connection and knowledge of genetics to re-exert hegemony over the mind, but psychotherapy has broader mass appeal with its ideas self-medication, narrative structure, lies and collective control. In paying someone to assess your mental problems both practices provide solutions.
If you’re paying for hierarchical structures of control, both models offer solutions.
Bentall, Richard,P.;“Madness Explained” Published by Allen Lane 2003
Foucoult, Michael: “Madness and Civilization”. Published 1967 by Tavistock publications ISBN No. 0415040183
Kirchenbaum, Howard; “The life and works of Carl Rogers” Published by Oxford University Press 2007 ISBN No. 9781898059
Klein, Naomi; “ The Shock Doctrine” Published by Allen Lane 2007 CIP No. 9780141024530
Porter, Roy; “Madness, A Brief History” Published by Oxford University Press 2002 ISBN No. 0192802666
Sacks, Oliver: “An anthropologist on Mars” published by Picador 1995 ISBN No.330343475
Sacks, Oliver : “Awakenings” published by Duckworth 1973 ISBN No.71560709x
Rifkin, Jeremy: “ The Age of Access” Published by Penguin 2000 ISBN No.0140296123
Wright, Robert: ” The Moral Animal” Published by Abacus 2004 ISBN No. 0349107041
Yalom, Irving: “Loves executioner…” Published by Penguin (1991) ISBN No. 0140128468(616.8914YAL)
Donald Ewen Cameron
referenced also by Naomi Klein p 25- p 463