Robert Castel, Francoise Castel, Anne Lovell “The Psychiatric Society”

Castel, Robert; Francoise Castel; Anne Lovell 1982. The Psychiatric Society. New York: Columbia University Press.

 

Part Three: Psychamerica

With the advent of mental medicine, the lunatic came to be seen as a patient suffereing from a malady. For the first time, a distinction was made between the mentally ill individual and others belonging to such miscellanous categories as social deviants, delinquents, vagabonds, vagrants, debauchees, wastrels, idiots, criminals, and others guilty of violating social and sexual norms. (171)

The nosographic classifications of mental illness have always been dubious, however. They are based on the assumption that there is a clear divdiding line between people who are „ill“ and therefore within the purview of psychiatry, on the one hand, and people who are „normal“ – though they may come under the jurisdiction of some other repressive agency, such as the courts – on the other hand. (171)

The people who seek these new services exhibit symptoms that are signs not so much of a specific pathology as of a malaise in daily life: exaggerating somewhat, one might say that what must be cured is normality. Now that we have reached the point of „therapy for the normal“, virtually all of social space has been opened up to the new techniques of psychological manipulation. (172)

 

Chapter 6: The Psychiatrization of Difference

In many police departments social workers are on call around the clock. There are „roving medical teams“ which include a psychologist and an intern who work for the police. This gives mental health personnel access through the police to people who would never have thought of seeking psychiatric help on their own, particularly in the ghettos and other poor areas. (177)

American courts confront a basic contradiction. Unable to mete out the prison sentences provided for by law, they discharge their responsibilities by sending lawbreakers to community treatment programs, most of which the judges know to be shams. What makes this deceit credible is that the concept of „treatment“ is invoked – in other words, the contention is that techniques based on medicine will be used to rehabilitate delinquents. Were it not for this safety valve, perhaps the fiction that justice is being done by the courts would have been exploded long ago, and people might then have been willing to look more closely at the foundations of a legal system (and a society) so conceived that nearly a third of the nation’s young people violate its laws. Rather than raise basic questions about the system, people have cast about for dubious alternative to what are ostensibly the most brutal forms of punishment. What is paradoxical about all but a few of these „alternatives“ is that they have done nothing to empty the prisons while augmenting the number of people mixed up with the courts. (183)

[…] the legal criterion for accepting or rejecting experimentation of this sort turned on the degree to which the technique in question was genuinely „medical“. (188)

According to some estimates, however, the number of addicts was most likely higher in the early twenties than it is today, perhaps nearly as high as one million. But addiction was not yet recognized as a social scourge. What has happened lately is not so much a drug „epidemic“ – a term suggestuve of the medicalization of the problem – as a stepping up of coordinated efforts to control certain social groups. (190)

In retrospect, the nineteenth and realy twentiet centuiries have been called a „drug addicts’ paradise“: morphine and heroin were widely used both for medical purposes (in the treatment of alcoholicm, as sedatives, and for „women’s troubles“) and simply for pleasure. The definition of a substance as a drug is a social act and goes hand in hand with efforts to restrict its use. (191)

[…] methadone has two decisive advantages in connection with drug control policy: there is no withdrawal, so users are less likely to be drive to violent crime in search of drugs or money to satisfy their craving, and users become dependent on methadone and are thereby forced to submit to daily scrutiny by the medical personnel who dispence the drug. Official documents recognize the fact that methadone users are in a dependent state and hold that this is one key to its effectiveness. One stated that many addicts have difficulty forming close relationships, and if they were not dependent on metadone, they would find it difficult if not impossible to go to the dispensary every day and establish a long-term relationship with the staff. Thus the dependence created by methadone is crucial to establishing a potentially therapeutic and rehabilitatice relationship with the addict. (197)

The new techniques have made it possible to tighten surveillance and control and extend their range. If prisons are beginning to look like hospitals, this means that their claim to provide therapy is not incompatible with their repressive function. (202)

For children even more than adults, psychiatric labels are often thin disguises for difficulties in adjusting to specific social, family, or scholastic situations rather than descriptions of clear-cut pathologies. (202)

The present goal is not merely to segregate abnormal individuals but also to detect potentially troublesome cases early on. One element of the new stategy is to examine everyone belonging to certain specific social groups or age categories. (204)

Schools are increasingly being used to separate the wheat from the chaff, the normal from the pathological, and growing numbers of specialists are being trained to assist, cousel, and treat what might be calles „abnormal pupils.“ (206)

Thus it seems clear that the real target of the treatment is the child’s disruptive behavior per se. The therapeutic excuse for the use of these drugs has been abandoned, and they are now openly accepted as instruments of control. As one pediatrician has put it, the object of medication is to improve the functioning of the brain so that the child becomes more normal in his thinking and responses. (209)

[…] childhood in general has become the prime target of an indiscriminate hunt for anomalous behavior. (210)

William Ryan has used the phrase blaming the victim to describe the ideologies and practices that have been used in the United States against deprived groups and individuals suspected of menacing law and order. This is how it works: „First, identify a social proble,. Secon, study those affected by the problem and discover in what ways they are different from the rest of us as a consequence of deprivation and injustice. Third, define the differences as the cause of the problem itself. Finally, of course, assign a government bureaucrat to invent a humanitarian action program to correct the difference.“ (210-211)

If we are right in thinking that we are now witnessing a transition to a new and more effective level of technological manipulation of marginal social groups, hten criticism of social control policies must also shift its ground to focus on the manipulative uses of the „scientific“ approach. (213)

 

Chapter 8: Psy Services and Their New Consumers

One comes away with an impression that everyday life is utterly suffused with interpretations stemming from medical psychology; the methods are now so flexible that nothing further stands in the way of their unlimited proliferation. The political implications of this colonization of social life by psychology are enormous. (257)

The same society that welcomed Freud as the messiah continues to celebrate his lesser epigones. Why? Because the role that psychoanalysis played in the United States was not limited to dominating, as it once did, the narrow field of mental medicine. Psychonanalysis was the main instrument for the reduction of social issues in general to questions of psychology. (261-262)

With the arrival of the post-psychoanalytic era it has become possible to speak of „therapy for the normal“ on a much wider scale. This is an important change, for it implies that anyone and everyone now falls within the purview of one of the new types of therapy. (264)

[…] behavior modification has been used as a way of imposing scientifically designed controls on the daily routine of many people; it therefore lends itself to a virtually unlimited range of applications. With some exaggeration, perhaps, it might be said that behavior modification turns all of life into an educational and disciplinary institution. (266)

„Therapy for the normal“, then, uses an array of mental and, particularly, physical tehcniques to maximize the „human yield“ of each individual; it is not aimed at healing, as standard therapies presumably are. The goal is not to get well, but to become healthier (that is to experience more pleasure, to „get in touch with one’s feelings“, to become aware of one’s body, etc.). Medical healing gives way to personality growth: Encounter groups are designed for people who are functioning normally but who wish to impove their relationships with others. (282)

To earn the right to treatent (as psychoanalysis had suspected), the normal individual must exhibit neurotic symptoms. But what is a symptom? „A psychic symptom today is no longer a symptom but a sign that life lacks joy.“ Normal life – social life – is sick, it requires therapy, therapy for nomrality, and techniques to develop human potential and foster autonomy and enhance pleasure in a sad and alienated world. Adjustment, then, has been supplanted by a normative notion of normality – normality seen, in this new light, as the product of „working on“ one’s own personality. (282-283)

If a man’s social status is merely a product of the way he lives his life, then it is possible to use technical means to manipulate the factors that enter into his choices. With regard to relations between social groups, this outlook has led unions, for wxample, to take a particular line, namely, to make demands aimed at enabling the category of worker they represent to „play the game“ successfully within the system, i.e., to compete successfully in the struggle for advancement. With regard to the lowest strata in the society, it has led to a welfare policy that seeks to minister to individual shortcomings without touching the structural conditions that may be responsible for them (293)

What is being worked out, in short, is a completely rational concept of man, a concept perfectly attuned to the dominant notion of what is rational. The problem then ceases to be one of healing the sick, reeducating the guilty, ot controlling deviant behavior (these goals remain, of course, but as objectives allied with new techniques). Instead, „normal“ man has come to the fore as the center of attention in a society whose only passion is to produce earnestly and efficiently. To heal is good, to precent is better, but to maximize output by adjusting each individual to his social role and by calibrating change to the social dynamic as required by the necessity to reproduce the social order is surely the ideal of policy without politics. (295)

 

Conclusion

Underlying the boldest attempts to standardize behavior is a conception of a sort of „scientific“ utopia: to achieve happiness for both the individual and the community by means of rational planning carried out by technical experts. (316)

If the study of recent changes in psychiatry proves anything, it is how much the present expansion of psychiatry’s sphere of influence owes to those who have come one after another to work on the fringes of the profession, pushing back its boundaries by „moving beyond“the old models, which they descrube as archaic, coercive, prescriptive, and so forth. (319-320)

Psychiactric sociaty: No longer a society in which psychiatry takes care of a few patients, whether really ill or merely purported to be, in any case defined bu a starky contrast between the normal and the pathological; but rather an organization of everyday life in which manipulative techniques, more often than not developed and popularized mental medicine, become coextensive with all aspects of social life. No longer the manifestation of naked power exerted directly to repress social and political differences; but rather diffuse pressures of many kinds, which invalidate such differences by interpreting them as so many symptoms to be treated. Not the country of gray dawns in which state commissars drag dissidents out of bed at the crow of the cock; but rather a padded world watched over night and day by squads of skilled specialists, many of them well-meaning. Skilled at what? At manipulating people to accept the constraints of society. (320)

Robert Castel “From Dangerousness to Risk”

Castel, Robert 1991. From Dangerousness to Risk. – Burchell, Graham; Gordon, Colin; Miller, Peter (eds). The Foucault Effect: Studies in Governmentality. Chicago: The University of Chicago Press: 281-298.

The new strategies dissolve the notion of a subject or a concrete individual, and put  in  its  place  a  combinatory  of factors,  the  factors  of risk. […] The essential component of intervention no longer takes  the  form  of the  direct face-to-face  relationship  between  the  carer and the cared, the helper and the helped, the professional and the client. It comes instead  to  reside in the  establishing  of flows  of population  based on the collation of a  range  of abstract factors deemed liable to  produce risk in general. (281)

The examination of the  patient  tends  to  become  the examination of the  patient’s  records  as  compiled  in  varying  situations  by  diverse professionals and specialists interconnected solely through the circulation of individual  dossiers. (281-282)

For classical  psychiatry,  ‘risk’  meant essentially  the  danger  embodied  in the  mentally  ill  person  capable  of  violent  and  unpredictable  action. Dangerousness  is  a  rather  mysterious  and  deeply  paradoxical  notion, since  it  implies  at  once  the  affirmation  of a  quality  immanent  to  the subject  (he  or  she  is  dangerous),  and  a  mere  probability,  a  quantum  of uncertainty, given that the proof of the danger can only be  provided after the  fact,  should  the  threatened  action  actually  occur. (283)

Hence the  special unpredictability  attributed to the  pathological  act:  all  insane  persons,  even  those  who  appear  calm, carry~a threat, but one whose realization still remains a matter of chance. (283)

Such  a  shift  becomes  possible  as  soon  as  the  notion  of  risk  is  made autonomous  from  that  of danger.  A  risk  does  not  arise  from  the  presence  of particular precise danger embodied in a concrete individual or group. It is the  effect of a  combination of abstract factors  which render more  or less probable  the occurrence  of undesirable  modes  of behaviour. (287)

One  does  not  start  from  a  conflictual  situation  observable  in experience,  rather one  deduces  it from  a  general  definition of the  dangers one  wishes  to  prevent. (288)

These preventive policies thus promote a new mode of surveillance:  that of systematic  predetection.  This  is  a  form  of surveillance,  in  the  sense  that the  intended  objective  is  that  of  anticipating  and  preventing  the emergence  of  some  undesirable  event:  illness,  abnormality,  deviant behaviour,  etc.  But  this  surveillance  dispenses  with  actual  presence, contract,  the  reciprocal  relationship  of watcher  and  watched,  guardian and  ward,  carer  and  cared. (288)

What the  new  preventive policies  primarily  address  is  no  longer individuals  but  factors,  statistical correlations  of heterogeneous  elements. […] Their primary aim is  not  to  confront a concrete  dangerous situation,  but  to  anticipate  all  the  possible  forms  of irruption of danger. (288)

1)      The separation of diagnosis and treatment, and the transformation of the caring function into an activity of expertise;

2)      The total subordination of technicians to managers. (290-291)

Instead of segregating and eliminating  undesirable  elements  from  the  social  body,  or  reintegrating them  more  or  less  forcibly  through  corrective  or  therapeutic  inter-ventions,  the  emerging tendency is  to  assign  different  social  destinies  to individuals  in  line  with  their  varying  capacity  to  live  up  to  the requirements  of competitiveness  and profitability.

But  one  has  to  ask  whether,  in  the  future,  it  may  not  become technologically feasible  to programme populations themselves,  on the basis of an  assessment  of  their  performances  and,  especially,  of  their  possible deficiencies.

[…] it would be possible thus  to objectivize absolutely any type  of difference, establishing on the basis of such a factorial definition a differential  population  profile. (294)

The  profiling  flows  of population  from  a  combination  of characteristics  whose collection depends on  an epidemiological method suggests  a rather  different  image  of  the  social:  that  of  a  homogenized  space composed of circuits laid out in advance, which individuals are invited or encouraged  to  tackle,  depending  on  their  abilities.  (In  this  way,  marginality itself, instead of remaining an  unexplored or rebellious  territory, can  become  an  organized  zone  within  the  social,  towards  which  those persons  will  be  directed  who  are  incapable  of  following  more  com-petitive  pathways.) (295)