.............Thinking About Nothing

After reading Foucalt in college years ago, I became suspicious of psychiatric labels. They seemed to me reflective of the moral preferences of politically connected groups (especially the psychiatric establishment and the courts) and, even worse, capable of marginalizing individuals whose thinking and behavior tend to be injurious to the interests of those groups. This happens when psychiatrists segregate individuals as either 'insanity' or 'insane' and then restrict the freedom of those labeled 'insane' by subjecting them to mechanisms of control (sedation, incarceration, social ostracization, and other forms of coercion that follow from being labeled 'insane').

In other words, any entity with the power to establish the criteria for 'sanity' can be easily coopted by power-hungry institutions (governmental bodies, religious groups, industry coalitions, etc.) to suppress, control or quarantine any and all dissenters. For example, custody courts routinely appeal to psychiatric language to strip parents of their rights to raise or even visit their own children, even if the diagnosis is unproven, has no observable testing in its proof, and has never posed a material threat to the children. Without the psychiatric angle of naming a parent as 'medically insane', the burden of proof would be much higher before a parent could be legally stripped of their right to raise their own children.

In the United States of America, the government now has the power to incarcerate (e.g., in mental institutions), take away children, and administer "normalizing drugs" solely on the decisionmaking of the very people setting the standards for the burden of proof (the psychiatrists and their diagnostic manuals). Are these not the most despotic and violent forms of social coercion available to any government? And where is the accountability for these so-called "medical professionals"? Among themselves.

Control: - Take this drug or be locked in a mental home against your will. -Think and behave in ways that we have deemed "insane" and you will have your children removed from your life. - Give this drug to your child or she will be expelled from school. These are forms of coercion that would put Stalin and Hitler to shame.

In other words, as things stand now, if we don't happen to think and behave in a way that the psychiatric establishment and their institutional allies have deemed 'normal' and 'mentally healthy,' we are threatened with the deprivation of our most fundamental liberties (the right to choose our own beliefs, control what we do to our own bodies, the right to raise our own children, etc.). This power structure is not immediately obvious to most people because, by definition, a person is “sane“ if he/she believes and acts like “most people.” So if you’re part of the “sane” group, you will naturally endorse any social structure that protects your interests.

This becomes obvious in historical hindsight when the criteria for 'mental illness' are modified. Until the mid-70's, homosexuality was officially classified in the APA diagnostic manual as a treatable mental illness. If they resisted 'treatment,' homosexuals would be saddled with the social consequences of being 'insane' and were legally deprived of the right to raise children. Now it is generally agreed that homosexuality is a lifestyle choice, not a disease, so the rights of homosexuals are being returned. In the 19th century, even masturbation fell into the category of a 'mental disease' and, if discovered and deemed 'untreatable,' could easily earn you a one-way ticket to complete social ostracization.

The criteria for sanity may change over time, but the dynamics supporting the establishment of those criteria remain the same: People are labeled 'insane' if it is discovered that they think or behave in ways that conflict with common ethical preferences. For example: Teachers dealing with overcrowded classrooms will generally assume that little boys should sit quietly and “fit in” with the other boys and so, if they don’t, the parents are pressured toward an ADD diagnosis and the child is drugged back to “normalcy.“ As social scenarios change, the public conception of behavioral normalcy changes to accommodate them (hence the ever evolving diagnostic manuals for identifying “insanity“). The criteria change because they are based on value judgments and aimed at reducing the visibility of beliefs that threaten the interests of political, religious and economic powers.

These days, in response to the waning acceptance of religious justifications for social policy, a new justification is needed to convince people that the official criteria for “sanity“ are legitimate and worthy of public endorsement. This is why psychiatry began re-establishing itself under the rubric of medical science. Most people disagree on religion but can agree on the reliability of science, so medical science became an appealing option for consolidating public agreement about psychiatric claims. At the core, this has resulted in the depiction of abnormal behavior as the expression of a diagnosable disease.

But there is a very serious problem with this strategy: 'Mental diseases' like depression, post-traumatic stress, schizophrenia and social anxiety have no testable, biological correlates. Psychiatric diagnoses are based solely on the psychiatrist's subjective reading of self-reported behavior and cannot be achieved otherwise. That being the case, the appeal to medical science without the rigor of real medical science has only increased the usefulness of psychiatry as an instrument of power. The door is still wide open for value judgments to become the norms for mental disease diagnosis.

I ran accross an article (below) that nicely summarizes this position. It is written by a renound (ex)psychiatric researcher from NYU who, after Foucalt, was the first to offer an intellectually rigorous critique of psychiatry and its alliance with the social establishment. Above the article, I have posted a link to a UTube video summarizing his core argument. If you find this interesting, other links follow the article below (including one about the clinically insane and socially deviant Martin Luther King, Jr.).

Video clip (get past the accent and the guy is pretty good):

http://www.youtube.com/watch?v=Qj7GmeSAxXo

THE CONTROL OF CONDUCT:
AUTHORITY VERSUS AUTONOMY
Thomas S. Szasz, M.D.

     There is only one political sin:
independence; and only one political virtue:
obedience. To put it differently, there is
only one offense against authority: self-
control; and only one obeisance to it:
submission to control by authority.

     Why is self-control, autonomy, such a
threat to authority? Because the person who
controls himself, who is his own master, has
no need for an authority to be his master.
This, then, renders authority unemployed.
What is he to do if he cannot control others?
To be sure, he could mind his own business.
But this is a fatuous answer, for those who
are satisfied to mind their own business do
not aspire to become authorities. In short,
authority needs subjects, persons not in
command of themselves -- just as parents need
children and physicians need patients.

     Autonomy is the death knell of authority,
and authority knows it: hence the ceaseless
warfare of authority against the exercise,
both real and symbolic, of autonomy -- that is,
against suicide, against masturbation, against
self-medication, against the proper use of
language itself!(1)

     The parable of the Fall illustrates this
fight to the death between control and self-
control. Did Eve, tempted by the Serpent,
seduce Adam, who then lost control of himself
and succumbed to evil? Or did Adam, facing a
choice between obedience to the authority of
God and his own destiny, choose self-control?

     How, then, shall we view the situation of
the so-called drug abuser or drug addict? As
a stupid, sick, and helpless child, who,
tempted by pushers, peers, and the pleasures
of drugs, succumbs to the lure and loses
control of himself? Or as a person in control
of himself, who, like Adam, chooses the
forbidden fruit as the elemental and
elementary way of pitting himself against
authority?

     There is no empirical or scientific way
of choosing between these two answers, of
deciding which is right and which is wrong.
The questions frame two different moral
perspectives, and the answers define two
different moral strategies: if we side with
authority and wish to repress the individual,
we shall treat him as if he were helpless, the
innocent victim of overwhelming temptation;
and we shall then 'protect' him from further
temptation by treating him as a child, slave,
or madman. If we side with the individual and
wish to refute the legitimacy and reject the
power of authority to infantilize him, we
shall treat him as if he were in command of
himself, the executor of responsible
decisions; and we shall then demand that he
respect others as he respects himself by
treating him as an adult, a free individual,
or a 'rational' person.

     Either of these positions makes sense.
What makes less sense -- what is confusing in
principle and chaotic practice -- is to treat
people as adults and children, as free and
unfree, as sane and insane.

     Nevertheless, this is just what social
authorities throughout history have done: in
ancient Greece, in medieval Europe, in the
contemporary world, we find various mixtures
in the attitudes of the authorities toward the
people; in some societies, the individual is
treated as more free than unfree, and we call
these societies 'free'; in others, he is
treated as more determined than self-
determining, and we call these societies
'totalitarian.' In none is the individual
treated as completely free. Perhaps this
would be impossible: many persons insist that
no society could survive on such a premise
consistently carried through. Perhaps this is
something that lies in the future of mankind.
In any case, we should take satisfaction in
the evident impossibility of the opposite
situation: no society has ever treated the
individual, nor perhaps could it treat him, as
completely determined. The apparent freedom
of the authority, controlling both himself and
subject, provides an irresistible model: if
God can control, if pope and prince can
control, if politician and psychiatrist can
control -- then perhaps the person can also
control, at least himself.

     The conflicts between those who have
power and those who want to take it away from
them fall into three distinct categories. In
moral, political, and social affairs (and I of
course include psychiatric affairs among
these), these categories must be clearly
distinguished; if we do not distinguish among
them we are likely to mistake opposition to
absolute or arbitrary power with what may,
actually, be an attempt to gain such power for
oneself or for the groups or leaders one
admires.

     First, there are those who want to take
power away from the oppressor and give it to
the oppressed, as a class -- as exemplified by
Marx, Lenin, and the Communists. Revealingly,
they dream of the 'dictatorship' of the
proletariat or some other group.

     Second, there are those who want to take
power away from the oppressor and give it to
themselves as the protectors of the oppressed --
as exemplified by Robespierre in politics;
Rush in medicine; and by their liberal,
radical, and medical followers. Revealingly,
they dream of the incorruptibly honest or
incontrovertibly sane ruler leading his happy
or healthy flock.

     And third, there are those who want to
take power away from the oppressor and give it
to the oppressed as individuals, for each to
do with as he pleases, but hopefully for his
own self-control -- as exemplified by Mill, von
Mises, the free-market economists, and their
libertarian followers. Revealingly, they
dream of people so self-governing that their
need for and tolerance of rulers is minimal or
nil.

     While countless men say they love
liberty, clearly only those who, by virtue of
their actions, fall into the third category,
mean it.(2) The others merely want to replace
a hated oppressor by a loved one -- having
usually themselves in mind for the job.

     As we have seen, psychiatrists (and some
other physicians, notably public health
administrators) have traditionally opted for
'reforms' of the second type; that is, their
opposition to existing powers, ecclesiastic or
secular, has had as its conscious and avowed
aim the paternalistic care of the citizen-
patient, and not the freedom of the autonomous
individual. Hence, medical methods of social
control tended not only to replace religious
methods, but sometimes to exceed them in
stringency and severity. In short, the usual
response of medical authority to the controls
exercised by non-medical authority has been to
try to take over and then escalate the
controls, rather than to endorse the principle
and promote the practice of removing the
controls by which the oppressed are
victimized.

     As a result, until recently, most
psychiatrists, psychologists, and other
behavioral scientists had nothing but praise
for the 'behavioral controls' of medicine and
psychiatry. We are now beginning to witness,
however, a seeming backlash against this
position, many behavioral scientists jumping
on what they evidently consider to be the next
'correct' and 'liberal' position, namely, a
criticism of behavioral controls. But since
most of these 'scientists' remain as hostile
to individual freedom and responsibility, to
choice and dignity, as they have always been,
their criticism conforms to the pattern I have
described above: they demand more 'controls' --
that is, professional and governmental
controls -- over 'behavior controls.' This is
like first urging a person to drive over icy
roads at breakneck speed to get over them as
fast as possible, and then, when his car goes
into a skid, advising him to apply his brakes.
Whether because they are stupid or wicked or
both, such persons invariably recommend fewer
controls where more are needed, for example in
relation to punishing offenders -- and more
controls where fewer are needed, for example
in relation to contracts between consenting
adults. Truly, the supporters of the
Therapeutic State* are countless and tireless --
now proposing more therapeutic controls in the
name of 'controlling behavior controls.'(3)

     Clearly, the seeds of this fundamental
human propensity -- to react to the loss of
control, or to the threat of such loss, with
an intensification of control, thus generating
a spiraling symbiosis of escalating controls
and counter-controls -- have fallen on fertile
soil in contemporary medicine and psychiatry
and have yielded a luxuriant harvest of
'therapeutic' coercions. The alcoholic and
Alcoholics Anonymous, the glutton and Weight
Watchers, the drug abuser and the drug-
abuseologist -- each is an image at war with its
mirror image, each creating and defining,
dignifying and defaming the other, and each
trying to negate his own reflection, which he
can accomplish only by negating himself.

     There is only one way to split apart and
unlock such pairings, to resolve such
dilemmas -- namely, by trying to control the
other less, not more and by replacing control
of the other with self-control.

     The person who uses drugs -- legal or
illegal drugs, with or with or without a
physician's prescription -- may be submitting to
authority, may be revolting against it, or may
be exercising his own power of making a free
decision. It is quite impossible to know --
without knowing a great deal about such a
person, his family and friends, and his whole
cultural setting -- just what such an individual
is doing and why. But it is quite possible,
indeed it is easy, to know what those persons
who try to repress certain kinds of drug uses
and drug users are doing and why.

     As the war against heresy was in reality
a war for 'true' faith, so the war against
drug abuse is in reality a war for 'faithful'
drug use: concealed behind the war against
marijuana and heroin is the war for tobacco
and alcohol; and, more generally, concealed
behind the war against the use of politically
and medically disapproved drugs, is the war
for the use of politically and medically
approved drugs.

     Let us recall, again, one of the
principles implicit in the psychiatric
perspective on man, and some of the practices
that follow from it: the madman is a person
lacking adequate internal controls over his
behavior; hence, he requires -- for his own
protection as well as for the protection of
society -- external restraints upon it. This,
then, justifies the incarceration of 'mental
patients' in 'mental hospitals' -- and much else
besides.

     The drug abuser is a person lacking
adequate internal controls over his drug use;
hence, he requires -- for his own protection as
well as for the protection of society -- external
restraints upon it. This, then, justifies the
prohibition of 'dangerous drugs,' the
incarceration and involuntary treatment of
'addicts,' the eradication of 'pushers' -- and
much else besides.

     Confronted with the phenomena of 'drug
abuse' and 'drug addiction,' how else could
psychiatry and a society imbued with it have
reacted? They could respond only as they did --
namely, by defining the moderate use of legal
drugs as the result of the sane control of
resistible impulses; and by defining the
immoderate use of any drug, and any use of
illegal drugs, as the insane surrender to
irresistible impulses. Hence the circular
psychiatric definitions of drug habits, such
as the claim that illicit drug use (for
example, smoking marijuana) causes mental
illness and also constitutes a symptom of it;
and the seemingly contradictory claim that the
wholly similar use of licit drugs (for
example, smoking tobacco) is neither a cause
nor a symptom of mental illness.

     Formerly, opium was a panacea; now it is
the cause and symptom of countless maladies,
medical and social, the world over. Formerly
masturbation was the cause and symptom of
mental illness; now it is the cure for social
inhibition and the practice ground for
training in heterosexual athleticism. It is
clear, then, that if we want to understand and
accept drug-taking behavior, we must take a
larger view of the so-called drug problem.
(Of course, if we want to persecute 'pushers'
and 'treat addicts,' then information
inconvenient to our doing these things will
only get in our way. Drug-abuseologists can
no more be 'educated' out of their coercive
tactics than can drug addicts.)

     What does this larger view show us? How
can it help us? It shows us that our present
attitudes toward the whole subject of drug
use, drug abuse, and drug control are nothing
but the reflections, in the mirror of 'social
reality,' of our own expectations toward drugs
and toward those who use them; and that our
ideas about and interventions in drug-taking
behavior have only the most tenuous connection
with the actual pharmacological properties of
'dangerous drugs.' The 'danger' of
masturbation disappeared when we ceased to
believe in it: we then ceased to attribute
danger to the practice and to its
practitioners; and ceased to call it 'self-
abuse.'

     Of course, some people still behave in
disagreeable and even dangerous ways, but we
no longer attribute their behavior to
masturbation or self-abuse: we now attribute
their behavior to self-medication or drug
abuse. We thus play a game of musical chairs
with medical alibis for human desire,
determination, and depravity. Though this
sort of intolerance is easy, it is also
expensive: it seems clear that only in
accepting human beings for what they are can
we accept the chemical substances they use for
what they are. In short, only insofar as we
are able and willing to accept men, women, and
children as neither angels nor devils, but as
persons with certain inalienable rights and
irrepudiable duties, shall we be able and
willing to accept heroin, cocaine, and
marijuana as neither panaceas nor
panapathogens, but as drugs with certain
chemical properties and ceremonial
possibilities.

REFERENCES
1. Szasz, T.. The Second Sin. Garden City,
N.Y.: Doubleday, 1973.
2. Mises, L. von. Human Action: A Treatise
on Economics. New Haven: Yale University
Press, 1949.
3. See, for example, S. Auerbach, 'Behavior
control' is scored, Miami Herald, Dec. 28,
1972, p. 15-A.

.............Thinking About Nothing

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Friday, December 5, 2008

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