To: letters-AT-laweekly.com Subject: Re: "Quiet Tragedies" LA Weekly,10/23-29/98, pp.36-39 Date: Mon, 26 Oct 1998 21:09:16 EST DEAR EDITOR, Your "roundtable discussion" about mental illness, entitled "Quiet Tragedies" is banal for the way it rehashes presently dominant cliches about mental illness, shaping the discourse to disclude other viewpoints on those physio/psycho/social alienations frequently referred to as "mental disease." The opening is alarming in the way it closes off dissent and tries to bring the reader into the fold. "We now know that these conditions are biochemical." Who's "we"? I am most certainly not included in this "we", nor are the multiple thousands of others who differ. And we "know"? Well, that makes it sound as if it is established beyond a reasonable doubt. Funny, I don't remember being called to jury duty to decide that. Perhaps the jury selection was slanted. A retrial may be called for. And the notion that these conditions are "biochemical" appears to be making some sort of bold claim when in fact nothing could be more mundane. To think "I am going to go to the store" involves biochemistry. To feel a fleeting emotion of love for your spouse while you are running errands involves biochemistry. To feel yourself in the midst of a storm of passion involves biochemistry. This has been firmly established since William James who asserted that every state of consciousness has a corresponding biochemical state. So all this tells us is that the realm of consciousness and biochemistry are in a dynamic interrelation. But since consciousness itself is in a dynamic relation to the world, this complicates issues. The world includes present sociohistorical conditions, includes our relations to others, includes nature and our degree of communion or alienation therefrom. It seems increasingly obvious that by stressing the "biochemical" what is being attempted is a radical bracketing or shelving of the "world" component of the equation, which is dangerous. The modernist assumptions in a medicalization of all madness is frightening, especially in the way it silences other dissenting voices including antipsychiatric voices which contrary to media coverage did not end with R.D. Laing and David Cooper in the 70's, but continue to this day. The idea that "schizophrenia" IS -- note the Aristotelian "is" -- "a physical brain disease" that "we have to accept" confuses the issue that there is no real clear diagnostic for schizophrenia as an entity. American criteria differ from British criteria differ from all sorts of other systems. Please don't get me wrong ; there is no doubt that complex and sometimes vicious feedback loops can occur between an individual's biochemistry and their relation of consciousness to the world and their situation. The brain is a chaotic system whereby certain biochemical tendencies can further reinforce those tendencies, just as rain upon a muddy hill tends to carve out certain grooves that then reinforce water further flowing down those pathways. And it may be that there are certain chemical substances that can be introduced to help knock the brainflow out of these ruts. However, A) Such chemicals always have a number of so-called "side effects" (this term should be questioned, they are effects just as much as the supposed "main" effect) which are important to evaluate, especially in antipsychotic drugs which can cripple those who have been subjected to them, and B) our knowledge of the complexity of brain biochemistry might as well be in the Stone Ages. This is not to insult the scientists who are doing incredibly creative work to investigate this part of the equation ; it is merely to enter some humility into the record of where we stand in relation to where we may find ourselves. Brain chemistry is an entire ecology. The real questions come in relating this delicate ecology to the ecology of the individual's life and life choices, the family and sociohistorical ecology, and the ecology of the natural environment in which all of those take place. Multimilieu ecological interaction. There's also a confusion in this article between poverty and mental illness. This should come as no surprise to anyone familiar with Foucault, as he and others have charted that this is a confusion rampant since the beginnings of psychiatry. Our society needs to develop solutions to conditions of poverty. Many of those who are poor (surprise, surprise) are also troubled. The socioeconomic question of how to help out those who are impoverished in their choices and their ability to function within a capitalist socius should perhaps be analytically separated from questions about how to help those who are troubled and in emotional and mental turmoil. That way upper middle class paeans about the horrendousness of "eating out of dumpsters" could perhaps be avoided. Dumpster-diving, scavenging, etc. has long been a vocation of many individuals, poor or not. Free food is free food, and should not be equated with mental illness. Our society needs to reexamine its historical relation to gypsies and other nomadic folk before we can really come up with a creative solution to the problems of poverty and mental illness that do not impose a preconceived norm or notion of "health" upon a multiplicity of lifestyles. The bourgeois assumptions in this article about what sorts of lifestyles are healthy and appropriate reek from the page. This is not to romanticize other lifestyle choices. Many other lifestyle choices by necessity of the fact that they are marginalized also face impoverished conditions. But to fail to see the creativity in the reappropriation and detournement of the shopping cart, the marvelous theatre of "garlands in his hair and radio antennae" is to miss out on vital singularities that madness births, even in the midst of misery. The psychotic "break" is often an attempt to "break out" of constrictive and strangling norms. This is not to say that the mad consciously construct these breaks as some sort of nonconformist art, but rather to say that the unconscious is itself a differentiate artist that will use multiple strategies to live the life streams the individual brings together into a nexus. Often times these multiple strategies emerge out of desperation, for necessity is the mother of invention. When these "breaks" or "schizzes" occur, they are often dense, cubist, compressed, and confused. But it may be possible to help midwife an unconscious art into a more conscious art of differentiation. It would behoove us all to give a good historical reexamination of our relation to the mad. Why is the biochemical model dominant in this historical period? That's relatively easy to demonstrate. Such a model is profitable for pharmaceutical and medical interests, thus gets more funding for advertising, promotion, and media coverage. Those who have dissenting viewpoints simply don't have the campaign managers to get their viewpoint into the mainstream media. So by simply flooding the public awareness with one model, we make it seem as if that were the only model a sane , modern person would accept. As if even the biochemical studies weren't subject to multiple interpretations from multiple models! Mark Ragins makes some excellent points when he encourages a more phenomenological approach of "seeing the world from my side instead of from yours". The dominant model of psychiatric intervention is analogous to the policy of nation states towards terrorists : to refuse to negotiate, to dictate terms, to neutralize the problem. The whole notion of dialogue and interaction has been taken out of the picture. Maybe because the so-called "delusions" or alternative per/con/ceptions of reality their clients are experiencing are too foreign for them to relate to and make them uncomfortable. It's curious that psychiatric training includes no exposure to changing set across different interpretive channels. It would behoove practitioners to expose themselves to a wide variety of beliefs, so that these beliefs don't seem so bizarre or unacceptable. In context, most of these delusions make "sense", meaning they have consistency. People are natural scientists. They make hypotheses to explain phenomena they are experiencing, and their hypotheses usually emerge from things they know about in their experience. So "delusions" are usually attempts to explain anomalies using known categories. We can help such people by entering into the anomaly itself and finding alternative hypotheses, perhaps hypotheses that are even falsifiable, and by validating the possibility of the delusions, but wanting to assess their probability. Certainly in the 90's we know that the CIA and FBI DOES follow people, there's ample documentation on all sorts of spying activities, so for a person to reach out to this knowledge to try to explain anomalies in their experience is not so unusual after all. In fact, it may make perfect sense. The question then becomes one of determining whether the FBI is actually spying on one or whether there is a more elegant way of approaching the problem. How many psychiatric technicians have actually gone to the trouble of figuring out whether they themselves are being watched by the FBI? But why ask questions or upset your own sense of reality when you could simply dispense a pill? The idea of "forced treatment" "making sense" simply allows deviance to be dealt with coercively. Why not medicalize everyone who differs from the norm? After all, it's often a very grey area between the realms of "eccentricity" and "madness", between radical differentiation and "psychosis". If we want to institutionalize Reality Police, let's be clear about the fascism this implies, no matter how "do gooder" it may seem. Is anyone questioning the sadism of professionals like Amenson who exposes fantasies of tying his son up in a room, of sprinkling meds on his Post Toasties? When professionals start speaking in this delirious sort of manner, we need to really question who it is who truly has the delusions. I hope that the abusive metaphors implied in the statement that "as a father I would strap him in a room and do whatever I had to do" are troubling to Weekly readers. This is psychiatry at its darkest and most intrusive. I sincerely hope that the Weekly will welcome dissenting viewpoints to this article. It is frightening to think that this coercive and overly pharmaceutical model is being touted as some sort of "roundtable" that comprehensively covers the issues. With forced medicalization on the agenda, "kindness" cannot mask the attempts of the dominant privileged to impose their worldview and interests upon any who differ. (un)leash --part0_909454296_boundary--
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