Psychiatry between medicine and policing?

The problem with psychiatry is not that it is medicine. Nor is it that it is ‘normalizing’ and in a broad sense of policing in the sense of social control (that of what Jacques Rancière in Disagreement calls “the police,” meaning every kind of governance or management, as distinct from the political proper, which is problematizing and open-ended in ways that are irreducible to management). The problem is that capitalist management, policing, or social control is unusually repressive, and of course this has become more visible recently because of the crises of neoliberal capitalism, and the outright killing of black and poor people, which is related to the fact that the police now are like an army that is being used to violently occupy our urban ghettoes.

People subjected to psychiatric treatment in very pronounced ways often seem slowed, dulled, cautioned, frustrated, anxious and depressed; and doctors expect them to stay that way. Those on hospital wards are very slowed and dulled; these are placed of enforced boredom, and that is as true today as it ever was.

Moreover, there are signs that psychiatric medical treatments and especially confinements are used at least sometimes in this country much as they were in the Soviet Union from Stalin on. There was a movement of dissidents concerned with this, much as there was around the same time (the 60s and 70s) in the West (especially in Italy, France, England, and the United States), though it took a somewhat different form. There it was more explicit; here the discourses about the practices, if not also those themselves, are apparently more sophisticated. There was a broad movement about this in America at one time; it seems to have disappeared, and even social democrats like Bernie Sanders seem not to have heard of it or much credit it, content instead to call for “more” medical care. Which is probably both wrong and right, depending.

Doctors are ideally, and normally, people who want to help people with problems with which they have expert, scientifically-based, knowledge. And they should be able to do so. Capitalist psychiatry, especially under neoliberal regimes, minimizes medical care at the expense of social control or policing. It is mostly that. It can be seen this is true of psychiatric hospitals and hospital wards (and in rather extreme ways), and of the primarily pharmacological uses of psychiatric medical judgment, and also of the psychotherapies that are in common practice.

Should psychological treatments, medical or others, be directed at norms of uses of the mind that include things like artistic creativity? Or is the norm to enable people to do their job, and live their lives in some minimal way suitable to capitalist policing regulations? It is easy to see that they aim at the latter.

The exception to this rule is psychoanalysis, at least in some of its forms.

It is remarkable to speak to a medical doctor in any area of specialty in one’s capacity as patient and be treated like a normal citizen, like someone who can expect to trust and be trusted, not someone who is treated with suspicion, and with the doctor writing up dutifully, as hospital and poor people’s clinic doctors generally do, what amounts to or approaches a police report. It is also remarkable to speak to a doctor who understand that in some sense he or she is working for you, and not you for them. You could be forgiven for thinking that at a hospital or poor person’s clinic, especially if you are there for your “mental health.”

The uses of the concept of mental health today are so squalid that one can wonder if it does not bear the same relationship to illness as notions of the biopolitics, or a politics of enhancing or preserving life, may now often bear to the thanatological, or the politics of managing the minimal life of those who are basically being warehoused until they die. Concentration camps of the more humane kind, such as refugee camps, detention facilities for undesirable immigrants (as in the American southwest) or minorities (as in China), have a tendency to be like that.

Many things are good in moderation and dangerous in excess. Perhaps psychiatry is one of them. It is a bad religion. Health is probably not quite a replacement concept for the good, and virtue. As bland as it is, the traditional concept of happiness may be better, but unlike morality and justice, happiness is not easily normativized, though health is. There is no getting around the fact that any idea of sickness is a medical concept of abnormality.

I find it tonic to consider that in a democratic socialist society one would see one’s doctor for a problem one wants help with, and not as a kind of police interrogator or probation officer with medical knowledge.

That contemporary conditions reduce many well-intentioned doctors, nurses, social workers, and therapists to this role is something that I find surprising enough that I wonder why more of them to do not want to protest and resist this high-paid de-professionalizing proletarianization.

There is a name for the use of medicine to hurt, injure, or threaten people. This name should be used sparingly. But it is a fact that such uses of medicine, including in particular psychiatry, as well as epidemiology and a set of epidemiological and weaponized medicine, was a major aspect of the Third Reich and its particular ethnic and social cleansing project. It was a ‘health’ regime; health of bodies and minds was its pagan God.

”But our country is nothing like that!” Indeed; but such insistently contented declarations, are they mere representations and statements of fact, or performative ones that should be treated as admonitions?