Leaving Psychiatry. J. R. Ó’Braonáin. M.D.
when the substance of the ghost is found to be meaningfully lacking. Similarly, from the revelation that psychiatric diagnoses are social constructions must follow a dissolution of all the pretences of psychiatry to science and to medicine. And the mad, bad and sad would need return to the community from whence they came as persons amongst people. Any doctor reaching for the prescription pad would need admit that s/he is practicing at best cosmetic psychopharmacology, at worst placebo medicine. An expert class of professional liars would be superfluous. Naturally with the death of psychiatry what would follow wold be the death of the link between it and the state. Society would need find other ways of managing misery and deviancy. Whether or not society is successful in this endeavour is immaterial to the fact that what is socially constructed must properly return to its home in society.
Why Psychiatry is a Secularised Exorcism?
The state and the church never separated. The church was simply replaced by psychiatry. The transaction between an enquiring patient and their doctor might go something like this.
Patient “I feel poorly and have a cough”
Doctor (having auscultated the chest, viewed the X ray and other investigations) “you have pneumonia”
Patient “and what is pneumonia?”
Doctor “in this case it is an occupation of certain parts of your lungs with bacteria and the outcome of the war between the bacteria and the immune system, that being pus and such”.
The reader will note the linearity in the explanation, and the appeal to something real. Yet take what might be a dialogue between patient and psychiatrist
Patient “I have a low mood, poor sleep, poor appetite and life has lost its lustre”
Psychiatrist “You have major depressive disorder”
Patient “and what is major depressive disorder”
Psychiatrist “major depressive disorder is when you have low mood, poor sleep, poor appetite and life has lost its lustre”
The reader will note the circularity here, that the diagnosis fails to point through, as it were, to something beyond the symptoms and signs. Rather the symptoms and signs point only to themselves, they are denotatively void. Now the reader may object and suggest the symptoms and signs of depression point towards some truly causal and explanatory event or thing in the world. Yet the thing in the body does not exist, there being for example no chemical imbalance causal to the depressed mind, no neuroplastic change in the brain causally related to an addicts drug use, no dopamine deficiency in the ADHD brain unmolested by drugs. And events in the sense of providing explanatory power are empty or at best partially formed explanations. Am I coughing and sick because I am old, or because someone similarly sick coughed upon me? This transfer of coughing does not define bacterial pneumonia. Does it really say anything to say I am depressed because I was raped or because of unrequited love, having been fired from my job or the bank to have foreclosed on my mortgage? These may play their causal roles in their way to the mood that I feel, though this is not to say depression is these events, certainly not in the way it is presented by the psychiatrist and accepted by the patient with the ontological force as pneumonia is pronounced upon the patient. Usually the antecedent events and speculations as to their causal significance are an afterthought or in any case secondary to the symptoms and signs as defining the diagnosis. And yet the shared experience between psychiatrist and patient alike, the belief, the affect, is as if none of these deep intractable problems existed. The psychiatric diagnosis is pronounced as a recognition of a “this” that is “there”, as real as a bacteria and the purulent expectoration from one’s lungs. It is as real as the invisible demon for those who believe in possession, that malevolent other that is in the patient yet not a part of them. To be sure I’m not proposing anything supernatural is going on in psychiatry. Yet to speak of persuasion and suggestion, of placebo, faith and empty belief is too banal. It does not capture the magic here when the non-existent other is invoked and given an ontological status far beyond its due. The psychiatric pronouncement makes something real that remains unreal. The magic is in the ritual and its impact upon the world. And psychiatrists, those most unholy of demonologists, create the demon whose exorcism they seek credit. This sort of bewitching can only be done be master pragmatists
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