Paradigms across psychiatry, psychology and psychoanalysis

The dominant  paradigms within psychology and psychiatry, whilst far from being internally homogenous, nonetheless have more similarities than differences. Notwithstanding the division of labour between psychiatrists and psychologists in hospital settings (for instance), the two disciplines have a largely overlapping epistemic basis. Even psychology’s supposedly unique contributions – a body of knowledge about general, non-pathological psychological functioning – have been largely absorbed into psychiatry. Continue reading

Biopower and subjection: The strange and disturbing case of Martin Seligman

biopower

By now, it should be clear that the role of psychologists in organising torture for the CIA does not merely implicate a few individuals, or even a corrupt institution (the APA), but large swathes of the discipline of psychology. That is, the tortures which occurred at Guantanamo Bay and elsewhere derived directly from officially-accepted, paradigmatic implementations of cognitive-behaviourism, and were therefore in keeping (and not in conflict) with the dominant ethical and intellectual underpinnings of Anglophone psychology. Continue reading

Understanding Psychosis

The British Psychological Society has released a major report on psychosis, which pushes the debate on this topic further than anywhere else in mainstream psychology in the Anglophone world. The report calls for, among other things, listening to psychotics themselves; seeing psychotic experiences as ‘understandable’ responses to distress, on a continuum with ‘normal’ phenomena; a rethink of bioreductionism and the medical model more generally; advocacy of ‘formulation’ rather than diagnosis, and advocacy of patient rights more generally; and finally, the provision of psychotherapeutic treatments alongside pharmaceutical approaches. There are numerous online responses to this report already, some supportive, some hostile. I would like to offer a few words from a critical, psychoanalytic perspective. Continue reading

Paradigm Shifts after the Decline of the Medical Model

‘Neuroenhancement’ in its various forms, whether applied to cognitive tasks, or social functioning, looks initially like one more medical intervention. This, however, is misleading. For all of its flaws, the medical model is relatively simple and static. The idea is to identify pathology or malfunction, and to remedy it. Where the pathology in question is a positive symptom or syndrome, medical intervention is relatively free of controversy. Continue reading

The Problem with Randomised Controlled Trials (RCTs)

I have recently been debating the merits and problems of objective, quantitative research in mental health. (One of my interlocutors has posted a lengthy response here, arguing in favour of ‘objectivism’). RCTs are a methodological device introduced into mental health from general medicine. Whilst they are merely problematic in the latter, they are outright misleading in the former. Continue reading

A Short Refutation of Behaviourism

Behaviourism began with the aim – we might say Heideggerean ideal – of practicing a science which does not think. Instead of the subjective methods of interview and introspection, behaviourists constructed an ‘objective’ observational model, in which, allegedly, antecedents and consequences would be causally strung together without the need for conjecture or inference. All of this was pinned to a transformation of the human subject into an object, and moreover, an object which functioned primarily as a learning machine, and whose workings could be understood without any reference to an inner world. (Not to mention without reference to others’ inner worlds – it was not for nothing that Wittgenstein considered behaviourism a kind of solipsism). Continue reading

Biomarkers and Dualism (after Nietzsche)

To criticise the dominant, bioreductionist paradigms in psychiatry and psychology risks is to invite to supposedly scandalous epithets –  ‘anti-psychiatrist’ and ‘Cartesian dualist’.

Yet to distinguish between disciplines – on the one hand, those with historical, discursively-constructed objects (such as linguistics, or history) as against the ‘hard’ sciences (such as mathematics, or physics) – implies nothing in the order of mind/body dualism. Notwithstanding any biological correlates, psychiatric phenomena fall clearly within the first category of disciplines.

The irony is that those who trumpet their materialism and monism with an emphasis on biological correlates – or, better yet, the search for elusive ‘biomarkers’ (neural or genetic) – are in fact far more dualistic than their allegedly anti-psychiatric opponents. What is the search for biomarkers other than an attempt to look beyond the materiality of discourse to invent a kind of ding an sich, that would serve as the truth of a subjective complaint?

Supposing this quest for a psychiatrist’s El Dorado came to fruition, and biomarkers were found by our closet dualists. The clinician could conceivably ignore a subject’s speech and history, and come straight to a diagnosis by way of a biological test. In this way, the biological test would serve as the subject’s supra-sensible ‘reality’, beyond any subjectivity.

Yet what could such a biomarker (eg. for depression, or anxiety) possibly mean in the absence of a corresponding complaint? To borrow from Nietzsche: such knowledge would be as inconsequential as a chemical analysis of water must be to a boatman facing a storm.

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

Suicide, selfishness and “illness”

stavrogin

A celebrity has died, apparently by his own hand. Amidst expressions of grief and condolences to the bereaved are a profusion of obviously incorrect, deeply ideological pronouncements on the nature of suicide.

Continue reading