Leaving Psychiatry. J. R. Ó’Braonáin. M.D.

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СКАЧАТЬ with that of a scientific hypothesis that can be empirically tested within a scientific framework. The authors make no statement as to their diagnoses being a consensus held (presumably by a powerful interest group) and thus a “social” construct.

      Returning to the RANZCP guidelines and the quoted text above; we need be clear that social constructivism is essentially antithetical to metaphysical naturalism. Water as being two parts hydrogen to one part oxygen is not socially constructed. It is a fact of the world, as is its boiling point at a given pressure. As is the location of brain in the skull and not the chest and the fact that it contains certain component parts that if ablated will result in blindness etcetera. The list of these natural facts are endless. They are not established by opinion of an individual or a consensus group or contingent in any way on the same. Compare this with social construction in the ordinary language use of the term. Though both made art and placed paint upon the canvas, the distinction between the baroque and rococo periods is a matter of social construction, as are endless lists of human belief and behaviour in fashions and politics. A bone is either broken or it is not. The sport played in which the bone was broken is a social construction, as is its rules. Whether unhappiness is to be seen as part of the human condition, a challenge to change one’s life or to be medicalised as if it were disease (though it is not), this too is a social construction.

      Now the psychiatric guilds wish to have their cake and eat it too. They are forced to acknowledge that they can no longer claim all psychiatric diagnoses to be naturalistic medical facts of the world of a broken body or brain. The evidence simply is not there. Yet they hold onto pretences to scientific legitimacy and an appeal to the status quo whilst holding out a faith that “the optimal classification” would involve greater knowledge of the “pathophysiology” i.e. they are nailing their colours to the wall that mood and its disorders are naturalistic phenomena whose pathological mechanism is yet to be discovered, whilst acknowledging it isn’t at this time. The acting “as if” to a pragmatist is all that matters, as we have discussed above. Why? Because to act “as if” if directed to a given end of prosperity to the guild is the end of the journey to truth. The rest is just persuasion and propaganda, again to a desired end. It’s pragmatism through and through, where pragmatism is what one does when one has abandoned all principles. Pragmatism is the philosophy of choice for the merchant. It is a trading of the staff of Aesculapius for the caduceus of Hermes.

      Perhaps I could make my point clearer by an analogy with religion. Imagine that some grand ecumenical council were to convene and issue the following edict;

      “There is growing consensus that our faith in anything transcendent is akin to social constructivism and by extension God or Gods probably don’t exist as such. It is nonetheless appropriate for the way of life of humankind to continue practicing, living in hope and dying for faiths following the status quo mix of religious doctrines because, (i) there is broad agreement about the operational notion of the God or Gods as defined, and (ii) religious ways of life have accrued valuable meaning through sacraments and observed “miracles” (e.g. prayer, fasting, confession, healings and resurrections etc) and social processes (e.g. churches, monasteries, martyrdom, faith based wars, charities, alliances of church and state, orphanages etcetera). Using the notion of God or Gods or anything supernatural as a pragmatic organising construct should not be reified and translate into their genuine faith or belief in them as existing beyond their identity as akin to a social construct – the optimal determination of theological truth must await a quantum leap in our understanding, a miracle never before experienced”.

      Surely we would be aghast to read such a thing and question the seriousness, logical and moral coherence of those who would say such nonsense. A move towards a view of religion as socially constructed by a mortal consensus group must surely be followed in lockstep by an immediate move towards apostasy and an overnight dismantling of the church. The want to avoid a vacuum would offer no excuse to fill the void with the ghost of what came before that moment of terrible consensus, when the substance of the ghost is found to be meaningfully lacking. Similarly, from the revelation that psychiatric diagnoses are social constructions must follow a dissolution of all the pretences of psychiatry to science and to medicine. And the mad, bad and sad would need return to the community from whence they came as persons amongst people. Any doctor reaching for the prescription pad would need admit that s/he is practicing at best cosmetic psychopharmacology, at worst placebo medicine. An expert class of professional liars would be superfluous. Naturally with the death of psychiatry what would follow wold be the death of the link between it and the state. Society would need find other ways of managing misery and deviancy. Whether or not society is successful in this endeavour is immaterial to the fact that what is socially constructed must properly return to its home in society.

      Why Psychiatry is a Secularised Exorcism?

      The state and the church never separated. The church was simply replaced by psychiatry. The transaction between an enquiring patient and their doctor might go something like this.

      Patient “I feel poorly and have a cough”

      Doctor (having auscultated the chest, viewed the X ray and other investigations) “you have pneumonia”

      Patient “and what is pneumonia?”

      Doctor “in this case it is an occupation of certain parts of your lungs with bacteria and the outcome of the war between the bacteria and the immune system, that being pus and such”.

      The reader will note the linearity in the explanation, and the appeal to something real. Yet take what might be a dialogue between patient and psychiatrist

      Patient “I have a low mood, poor sleep, poor appetite and life has lost its lustre”

      Psychiatrist “You have major depressive disorder”

      Patient “and what is major depressive disorder”

      Psychiatrist “major depressive disorder is when you have low mood, poor sleep, poor appetite and life has lost its lustre”

      The reader will note the circularity here, that the diagnosis fails to point through, as it were, to something beyond the symptoms and signs. Rather the symptoms and signs point only to themselves, they are denotatively void. Now the reader may object and suggest the symptoms and signs of depression point towards some truly causal and explanatory event or thing in the world. Yet the thing in the body does not exist, there being for example no chemical imbalance causal to the depressed mind, no neuroplastic change in the brain causally related to an addicts drug use, no dopamine deficiency in the ADHD brain unmolested by drugs. And events in the sense of providing explanatory power are empty or at best partially formed explanations. Am I coughing and sick because I am old, or because someone similarly sick coughed upon me? This transfer of coughing does not define bacterial pneumonia. Does it really say anything to say I am depressed because I was raped or because of unrequited love, having been fired from my job or the bank to have foreclosed on my mortgage? These may play their causal roles in their way to the mood that I feel, though this is not to say depression is these events, certainly not in the way it is presented by the psychiatrist and accepted by the patient with the ontological force as pneumonia is pronounced upon the patient. Usually the antecedent events and speculations as to their causal significance are an afterthought or in any case secondary to the symptoms and signs as defining the diagnosis. And yet the shared experience between psychiatrist and patient alike, the belief, the affect, is as if none of these deep intractable problems existed. The psychiatric diagnosis is pronounced as a recognition of a “this” that is “there”, as real as a bacteria and the purulent expectoration from one’s lungs. It is as real as the invisible demon for those who believe in possession, that malevolent other that is in the patient yet not a part of them. To be sure I’m not proposing anything supernatural is going on in psychiatry. Yet to speak of persuasion and suggestion, of placebo, faith and empty belief is too banal. It does not capture the magic here when the non-existent other СКАЧАТЬ