Lost in Cognition

There is a tradition among certain psychoanalytic writers and schools, to decline any engagement with the world outside of analysis. In this tradition, psychoanalytic literature becomes a continual exegesis of the master(s), devoid of reference points to the world beyond. Thankfully, Eric Laurent and his colleagues are most definitely not of this tradition, as Laurent’s new book, Lost in Cognition, demonstrates amply. Continue reading

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The Ethics & Politics of Intervention: A Critique of CBT as Ideology (Part 5

The state of ethics in psychology, in Australia, at least, is lamentably primitive, and the politics of psychological practice virtually unspoken. If psychology is presumed a science, after all, how can it be political, any more than the laws of thermodynamics, or quadratic equations? Ethics is taught as a subject to psychology students, but it amounts to little more than a few strictures and prohibitions – do not fleece patients, do not maintain conflicts of interest, no sexual relationships, etc. By themselves, these prohibitions are perfectly reasonable, but they hardly constitute a level of ethical discourse beyond that which the average five-year old might grasp. The continuities between the biopolitics of the clinic and those of the factory, the school, and the prison are invisible. Foucault, Laing, Szasz and others go unread and misunderstood; ‘anti-psychiatry’ is even used as a term of abuse, as if criticism of this or that diagnostic system was tantamount to nihilism. If academic psychology avoids direct confrontation with complex ethical questions, the same can be said of regulators, at least in Australia. The regulators certainly enforce prohibitions and punish violators, and there is plenty of evidence that they are rapidly escalating regulatory requirements (and, of course, fees). None of this gets to the heart of the matter. The more important question, generally evaded by the discipline, is what is it that is happening, ethically and politically speaking, when one does psychology? And when one does CBT, in particular? Continue reading

Psychoanalysis and the DSM – a brief discussion and critique

The following was presented at a meeting of the Lacan Circle of Melbourne in July, 2013:

 

Marie-Helene Brousse (2013, p. 24) said of diagnosis that it was considered by Lacan ‘as an act, implying a decision requiring logical argumentation and clinical confirmation’. Alas, this is not the modus operandi for mainstream psychiatry and psychology.

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Back to anti-stigma…

Returning to the contradictions of anti-stigma campaigning in psychiatry and medicine, I recently saw this article, which supports my notion that those who grasp at reductionist, anti-subjective explanations for psychiatric conditions inadvertently harm those they purport to defend. This paper is “evidence-based” (evidence here meaning statistics, for the most part, as it always does in psychology and psychiatry), but nonetheless supports what can be deduced from general principles:

Even commentators who continue to advocate for describing people as having a “brain disease” agree that “research has shown that disease explanations for mental illness reduced blame but provoked harsher behaviour toward an individual with mental illness”, that “biological explanations may also imply that people with mental illness are fundamentally different or less human”, that “there is research evidence that biological arguments may actually strengthen dangerousness stereotypes” and that “in contrast to biological arguments, psychosocial explanations of mental illness have been found to effectively improve images of people with mental illness and to reduce fear”.

In short, the bioreductionist arguments are not merely false, but also unethical and harmful, even when peddled under the aegis of dubious anti-stigmatisation. A few short points are worth making here, and perhaps I can expand on them subsequently:

1. All medical and psychiatric practice necessarily involves interpretative, conceptual interpolations (i.e. ‘labelling’) to organise symptoms, diagnosis and treatment, and this applies no less to a broken arm than to a case of melancholia.

2. To mistake the label/signifier/diagnosis for the thing itself betrays a fundamental bungling of diagnostics, as well as of basic linguistics.

3. Attempts to phrenologise psychiatric diagnosis in the name of a narrow ‘science’, whether by way of the NIMH’s biomarkers, or the correlative ‘traits’ of psychometricians, will continue to stumble over the inconvenient fact of subjectivity, and therefore continue impede, rather than clarify diagnosis.

4. There is no coherent definition of a mental disorder, and likewise, there can be no watertight notion of ‘mental health’. Even the likes of Jerome Wakefield (a contributor to the DSM) more or less concede this, despite heroic attempts at reconstituting a mythological disordered essence for clinicians to diagnose.

5. Suffering is no less real for being subjective and, in any case, as Freud puts it in Civilisation and its Discontents, pain is but a feeling.