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

February 3, 2013 Leave a comment

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)

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Foucault “Teadmine, võim, subjekt”

Foucault, Michel 2011. Teadmine, võim, subjekt. Valik räägitust ja kirjutatust. Tallinn: Varrak

 

Mis on valgustus? 366-390

[…] kui Kanti järgi on küsimus selles, et teada, millistest piiridest peab tunnetus nende ületamise nimel lahti ütlema, siis tänapäeva kriitika küsimus peab minu arvates naasma positiivse küsimuseasetuse juurde: milline on ainulaadse, sattumusliku, meelevaldsetest piirangutest sündinu osa kõiges selles, mis on meile antud universaalse, paratamatu ja kohustuslikuna. […] kriitikat ei rakendata enam formaalsete, universaalset väärtust omavate struktuuride otsimiseks, vaid ajaloolise uurimusena sündmustest, mis on viinud meie kujunemisele, võimaldanud meil ennast ära tunda oma tegude, mõtete, sõnade subjektina. (384-385)

[…] see on eesmärgilt genealoogiline ja meetodilt arheoloogiline. Arheoloogiline […] selles mõttes, et see ei taotle mitte kõigi teadmiste või kogu võimaliku moraalse tegevuse universaalsete struktuuride eritlemist, vaid nende diskursuste käsitlemist, mis liigendavad meie mõtteid, sõnu ja tegusid kui ajaloolisi sündmusi. Ja genealoogiline on see kriitika selles mõttes, et ei tuleta mitte meie praeguse olemise võrmist seda, mida meil on võimatu teha või teada, vaid loob sattumuslikkusest, mis on teinud meist need, kes me oleme, esile võimaluse mitte enam olla, teha või mõelda seda, mida me oleme, teeme või mõtleme. (385)

Meie endi kriitilisele ontoloogiale omast filosoofilist ethos’t iseloomustaksin ma seega kui ületatavate piiride ajaloolis-praktilist proovilepanekut, niisiis kui meie endi tööd iseenda kallal niivõrd, kuivõrd me oleme vabad. (386)

Homogeenseks referentsiväljaks ei tule võtta mitte pildid, mida inimesed endast ise annavad, ega ka tingimused, mis neid nende endi teadmata määratlevad. Vaid see, mida nad teevad ja kuidas nad seda teevad. See tähendab, need ratsionaalsuse vormid, mis organiseerivad tegemise viise (see, mida võiks nimetada nende tehniliseks aspektiks), ja vabadus, millega nad neis praktilistes süsteemides tegutsevad, reageerides teiste tegevusele ja teatud piires mängureegleid modifitseerides (see, mida võiks nimetada nende toimingute strateegiliseks küljeks). (388)

Eetika genealoogiast: poolelioleva töö ülevaade. 310-354

Mina tahan näidata, et kreeka põhiprobleem ei olnud enese techne, vaid elu techne. See oli techne tou biou – kuidas elada. (321)

Idee bios’est kui esteetilise kunstiteose materjalist on midagi, mis mind kütkestab. Samuti idee, et eetika võib olla väga tugev eksistentsistruktuur, ilma et tal oleks mingit seost juriidilisega per se, autoritaarse süsteemi ega distsiplinaarse struktuuriga. (321-322)

Arvan, et meil oleks vaja vabaneda ideest, nagu oleks eetika ja muude sotsiaalsete, majanduslike või poliitiliste struktuuride vahel analüütiline või paratamatu seos. (323)

Ideest, et meie ise ei ole meile ette antud, tuleneb minu meelest ainult üks praktiline järeldus: meil tuleb luua iseennast nagu kunstiteost. (325)

Klassikalises enesehooles oli teadmistel teistsugune roll. Teadusliku teadmise ja epimeleia heautou vahel on väga huvitavaid asju, mida analüüsida. See, kes pidas enda eest hoolt, pidi kõigi nende asjade seast, mida teaduslik teadmine võimaldab tundma õppida, valima üksnes neid, mis olid temaga seotud ja elu jaoks olulised. (337)

Taheti muuta oma elu teatavat laadi teadmise objektiks, teha sellest techne – kunst. Meie ühiskonnas pole peaaegu mitte midagi järel ideest, et peamine kunstitöö, mille eest meil tuleb hoolitseda, see tähtsaim ala, kus esteetilisi väärtusi rakendada, on meie ise, meie elu, meie eksistents. (339-340)

Niisiis, kui soovite, on hypomnemata ja enesekultuuri tähelepanuväärseks kokkujooksmispunktiks just see punkt, kus enesekultuur seab endale eesmärgiks täiusliku enesevalitsemise – teatava püsiva poliitlise suhte ise ja enese vahel. (342)

Tähtis pole mitte jälitada kirjeldamatut, paljastada varjatut ega öelda ütlematajäänut, vaid vastupidi, koguda juba öeldut, korjata kokku see, mida kuuldi või loeti, ja kõike seda eesmärgil, mis pole midagi vähemat kui iseenese moodustamine. (344)

Niisiis pole küllalt sellest, kui öelda, et subjekt moodustub sümboolses süsteemis. Subjekt ei moodustu mitte lihtsalt sümbolite mängus. Ta moodustub reaalsetes praktikates – ajalooliselt analüüsitavates praktikates. On olemas enesemoodustuse tehnoloogia, mis kasutab sümboolsed süsteemid ära ja läheb neist risti üle. (349)

Alates hetkest, mil kristlus enesekultuuri üle võttis, pandi see teataval viisil tööle pastoraalse võimu teostamiseks, nõnda et epimeleia heautou’st sai tegelikult epimeleia ton allon – teistehool –, mis oli pastori töö. Kuivõrd aga individuaalne lunastus – vähemasti teataval määral – pidi käima läbi pastoraalse institutsiooni, mille objektiks on hingede hooldamine, kadus endises mõttes ka klassikaline enesehool, see tähendab, ta integreeriti ja kaotas suure osa oma autonoomiast. (350-351)

Suhe enesega ei pea enam olema askeetlik, selleks et jõuda suhteni tõega. Tõe taipamiseks piisab sellest, kui suhe enesega paljastab mulle ilmse tõe selle kohta, mida ma enese jaoks näen. Võin seega olla ebamoraalne ja tunnetada tõde. […] Enne Descartes’i polnud võimalik olla ebapuhas ja ebamoraalne ning tunnetada tõde. Alates Descartes’ist on otsene silmanähtavus piisav. Pärast Descartes’i on meil mitteaskeetlik tunnetuse subjekt. See muutus teeb võimalikuks tänapäeva teaduse institutsionaliseerumise. (353)

Tõde ja võim. 228-262

Seda tahangi ma nimetada genealoogiaks, see tähendab niisuguseks ajaloo uurimise vormiks, mis suudab seletada teadmiste, diskursuste, objektivaldkondade jne. ülesehitamist, ilma et ta seejuures peaks viitama subjektile, mis on sündmuste välja suhtes kas transtsendentne või siis kulgeb tühja samasusena läbi terve ajaloo käigu. (239)

See, mis võimu tugevaks teeb, mis ta vastuvõetavaks muudab, on lihtne tõsiasi, et ta kunagi ei rõhu peale paljalt ei-ütleva jõuna, vaid et ta tegelikult on kõikeläbiv, et ta loob asju, tekitab naudingut, vormib teadmist, toodab diskursust; teda peab hoopis rohkem võtma produktiivse võrgustikuna, mis läheb läbi terve sotsiaalse kehami, kui negatiivse instantsina, mille funktsiooniks on ärakeelamine. (242)

Sellistes ühiskondades nagu meie oma iseloomustavad tõe poliitilist ökonoomiat viis ajalooliselt olulist tunnusjoont: tõde on keskendatud teadusliku diskursuse vormi ja nende institutsioonide ümber, mis seda toodavad; ta on allutatud pidevale majanduslikule ja poliitilisele takkakihutamisele (tõde vajab ni majanduslik tootmine kui poliitiline võim); ta on, erisugustes vormides, tohutu levitamistöö ja tarbimise objektiks  […]; teda toodetakse ja antakse edasi mõnede suurte poliitliste või majanduslike aparaatide mitte küll väljasulgeva, aga domineeriva kontrolli all (ülikool, armee, kirjutus, teabevahendid); ja lõpuks, ta on peapanus kõigis poliitilistes väitlustes ja kõigis sotsiaalsetes kokkupõrgetes (ideoloogilised võitlused). (260)

[…] tõde minu jaoks ei tähenda mitte kogumit tõeseid asju, mis tuleb avastada või omaks võtta, vaid kogumit reegleid, mille järgi tõene lahutatakse väärast ja liidetakse tõesele võimu spetsiifilised avaldused […] (260)

[…] poliitliseks peaküsimuseks pole mitte viga, illusioon, võõrandunud või ideoloogiline teadvus; selleks on tõde ise. (262)

Intellektuaalid ja võim. 170-184

Võitlus võimu vastu, võitlus võimu tuvastamiseks ja paljastamiseks seal, kus ta on kõige nähtamatum ja salakavalam. Võitlus mitte „südametunnistuse äratamiseks” […] vaid võimu õõnestamiseks ja ülevõtmiseks, üheskoos kõigi nendega, kes võimu eest võitlevad, mitte üksinda taamal, et võitlejaid valgustada. „Teooria” on selle võitluse regionaalne süsteem. (Foucault, 173)

Teooria ei totaliseeri, teooria paljuneb ja paljundab. Võimu loomuses on totaliseerida ja te ütlete väga õigesti, et teooria on loomult võimuvastane. […] Tõepoolest, see süsteem, milles me elame, ei suuda taluda kõige vähematki: see tingibki tema hapruse igas punktis, nagu ka vajaduse igakülgse repressiooni järele. Minu arvates te tegite meile esimesena […] selgeks ühe väga olulise asja: teiste eest kõnelemise väärituse. […] teooria lähtekohast peaksid lõppeks ainult otseselt asjasse segatud inimesed rääkima praktilisel moel iseenda eest. (Deleuze, 174-175)

Vangla on ainus paik, kus võim saab ennast ilmutada alastu kujul oma kõige äärmuslikumates vormides ja õigustada ennast sealjuures kõlbelise jõuna. (Foucault, 176)

[…] kui inimesed hakkavad tegutsema ja rääkima iseenda nimel, ei vastanda nad ühte esindamist (olgu see või pea peale pööratud) teisele, nad ei vastanda uut esindamist võimu väärale esindamisele. Näiteks meenub mulle, kuidas te ütlesite, et pole olemas rahvakohut, mis vastanduks tavalisele kohtule; see toimub hoopis teisel tasandil. (Deleuze, 177)

Võitlusdiskursus ei vastandu teadvustamatule: ta vastandub varjatule. […] Terve rida arusaamatusi on seotud mõistetega, nagu „peidetud”, „tõrjutud” ja „mitteöeldu”, mis lubavad odavalt „psühhoanalüüsida” seda, mis peaks olema võitluse objekt. Varjatut on tõenäoliselt keerulisem esile tuua kui teadvustamatut. (Foucault, 181)

Seega ei taga võitluste üleüldist iseloomu kindlasti mitte see totaliseerumisvorm, milles te äsja kõnelesite, see teoreetiline totaliseerimine „tõe” kujul. Võitluse üldise olemuse tagab võimu enda süsteem, kõik võimu teostamise ja rakendamise vormid. (Foucault, 184)

Foucault “The Use of Pleasure”

Foucault, Michel 1992. The Use of Pleasure. The History of Sexuality Volume 2. Penguin Books

Freedom and truth

This individual freedom should not, however, be understood as the independence of a free will. Its polar opposite was not a natural determinism, nor was it the will of an all-powerful agency: it was an enslavement – the enslavement of the self by oneself. To be free in relation to pleasures was to be free of their authority; it was not to be their slave. (79)

In order not to be excessive, not to do violence, in order to avoid the trap of tyrannical authority (over others) coupled with a soul tyrannized by desires, the exercise of political power required, as its own principle of internal regulation, power over oneself. (80-81)

This freedom-power combination that characterized the mode of being of the moderate man could not be conceived without a relation to truth. To rule one’s pleasures and to bring them under the authority of the logos formed one and the same enterprise […] (86)

The relationship to the logos in the practice of pleasures:

1)      There was a structural form: moderation implied that the logos be placed in a position of supremacy in the human being and that it be able to subdue the desires and regulate behavior. (86)

2)      Instrumental form – since one’s domination of the pleasures ensures a use that is adaptable to needs, times, and circumstances, a practical reason is necessary in order to determine, as Aristotle says, “the things he ought, as he ought, and when he ought.” (87)

3)      The ontological recognition of the self by the self (88)

[…] be it in the form of a hierarchical structure of the human being, in the form of a practice of prudence or of the soul’s recognition of its own being, the relation to truth constituted an essential element of moderation. […] this relation to truth never took the form of a decipherment of the self by the self, never that of a hermeneutics of a desire. It was a factor constituting the mode of being of the moderate subject; it was not equivalent to an obligation for the subject to speak truthfully concerning himself; it never opened up the soul as a domain of potential knowledge where barely discernible traces of desire needed to be read and interpreted. The relation to truth was a structural, instrumental, and ontological condition for establishing the individual as a moderate subject leading a life of moderation; it was not an epistemological condition enabling the individual to recognize himself in his singularity as a desiring subject and to purify himself of the desire that was thus brought to light. (89)

Now, while this relation to truth, constitutive of the moderate subject, did not lead to a hermeneutics of desire, it did on the other hand open onto an aesthetics of existence. And what I mean by this is a way of life whose moral value did not depend either on one’s being in conformity with a code of behavior, or on effort of purification, but on certain formal principles in the use of pleasures, in the way one distributed them, in the limits one observed, in the hierarchy one respected. (89)

The principle according to which this activity was meant to be regulated, the “mode of subjection”, was not defined by a universal legislation determining permitted and forbidden acts; but rather by a savoir-faire, an art that prescribed the modalities of a use that depended on different variables (need, time, status). (91)

In the Christian morality of sexual behavior, the ethical substance was to be defined not by the aphrodisiac, but by a domain of desires that lie hidden among the mysteries of the heart, and by a set of acts that are carefully specified as to their form and their conditions. Subjection was to take the form not of a savoir-faire, but of a recognition of the law and an obedience to pastoral authority. Hence the ethical subject was to be characterized not so much by the perfect rule of the self by the self in the exercise of a virile type of activity, as by self-renunciation and a purity whose model was to be sought in virginity. (92)

Putting it schematically, we could say that classical antiquity’s moral reflection concerning the pleasures was not directed toward a codification of acts, nor toward a hermeneutics of the subject, but toward a stylization of attitudes and an aesthetics of existence. (92)