ASYLUM POLITICS
This POST has TWO parts. Click here for the second part, “FLIGHT PATH”.
ThIS POST IS THE FIRST IN the DIALECTICS OF LOCKDOWN series. CLICK HERE FOR THE SECOND POST, “DIGITAL WASTE LAND”. CLICK HERE FOR THE THIRD POST, “CONCENTRATION CAMP WORLD”.
1. Ken Kesey, One Flew Over the Cuckoo’s Nest (1962; London: Penguin Classics, 2005), p. 233.
2. Byung Chul-Han, The Palliative Society: Pain Today, trans. Daniel Steuer (2020; Cambridge: Polity Press, 2021), p. 11.
3. Asylum (Peter Robinson, 1972).
4. Psychiatry Inside Out: Selected Writings of Franco Basaglia, ed. Nancy Scheper-Hughes and Anne M. Lovell, trans. Ann M. Lovell and Teresa Shtob (New York: Columbia University Press, 1987), p. 195.
5. D. L. Rosenhan, “On Being Sane in Insane Places”, Science, new series, vol. 179 no. 4070 (January 19, 1973), p. 253.
6. Ibid., p. 256.
7. Mark Fisher, “Good for Nothing”, Occupied Times, 19 March 2014: https://theoccupiedtimes.org/?p=12841.
I
UNDERCOVER
It is presumably true these days that psychiatry is both a valid science and a profession with many conscientious practitioners. Probably it is also true that some people’s lives are made easier by the pseudo-psychiatry of mindfulness and the like. Nevertheless, both psychiatry and pseudo-psychiatry are also apparatuses (Althusser) of a wider regime of psychosocial control. Call it capitalism, neoliberalism or simply sovereignty (Agamben)—maybe it doesn’t matter what the name is, the problem is whether to accept that in this field even well-meaning diagnoses and treatments serve a system of domination, that their care is double-edged.UNDERCOVER
In The Palliative Society (2021), Korean philosopher Byung-Chul Han wrote:
The neoliberal dispositif [i.e. mode of dominating] of happiness distracts us from the actually existing form of domination by forcing us into psychological introspection. It ensures that all are preoccupied with their own psyches rather than interested in critically questioning their social conditions. The suffering society creates is privatized and psychologized. What must be fixed, some would have us believe, are not social but psychological conditions. In fact, the call for psychological optimization is a way of adapting us to the existing form of domination and veiling social ills. Thus, positive psychology marks the end of revolution. Instead of revolutionaries we have motivational speakers, who come on the scene in order to ensure no anger, or even discontent, arises.2
In line with Han’s argument, it can be claimed that the asylum has been universalised. Where once there were staffed buildings to confine and treat a relatively small number of patients in, now the work of managing subjective discontent has been expanded and outsourced. It has become everyone’s responsibility to maintain their own “mental health” (whatever that is) by suppressing negative thoughts, which is why self-regulating techniques like mindfulness have gone mainstream. Treatment today no longer requires professional intervention. As with online banking or supermarket checkouts, we have learned to do the pseudo-psychiatric work ourselves; and like freelancers we do it on our own initiative, continuously nudged by news and social media but without direct line-management. Thus it can be said that the mental hospital, supposed to have been phased out, exists everywhere, in an invisible, dispersed and evolved form, and we have all become patients.
Serious questioning of the whole “mental health” business has been less longlasting. What is anxiety anyway? Who defines it? Might it be inevitable and valuable? Is it caused within someone or does it come from society? In other words, the kind of questioning the anti-psychiatrists undertook in relation to “schizophrenia”, which they dismissed as a made-up diagnosis involving institutional violence against people who already had to deal with being scapegoated in their families. The anti-psychiatrists argued that schizophrenia was a social, interpersonal phenomenon not a medical one; a problem in the final analysis of politics, which they tackled radically by dismantling the relationship between the patient and medical professionals. “If you’re interviewing a patient in a mental-hospital ward,” R. D. Laing said at the start of the documentary Asylum (1972), “then you have a key in your pocket to get out, and the patient hasn’t. The gulf in power, in position, is enormous.”3 The anti-psychiatric idea was to see what could happen when power, or at least obvious hierarchical power, was taken out of therapy, to be replaced by something resembling friendship on the journey towards metanoia (psychic refashioning); to be replaced, in a word, by community.
It is notable that anti-psychiatry developed as it did, and failed as it did. This oppositional movement was a struggle. First of all Laing, David Cooper and others wanted to reform psychiatry, but to no avail. In 1972 Laing told Franco Basaglia: “I had a choice either to stay in the system and try to accomplish what I wanted, without succeeding, or to get out. I got out.”4 Laing’s high profile helped push psychiatry to modernise but as time went on, both he and Cooper lost their cultural influence. Laing embraced New Age ideas while Cooper went to the extremes of revolutionary thinking. Marginalised, they each grew troubled personally, as though their struggle taxed them more than they could finally bear. The point is that opposing a system of domination comes at a steep cost. In what can be called the asylum universe, which arguably surrounds us all now, resistance may at any moment backfire or even, in the worst case, serve the structure it aimed to undermine. A tragicomic force of unpredictability comes into play; curious dynamics of collusion, masochism and panic hijack conscious intent. D. L. Rosenhan’s scientific paper “On Being Sane in Insane Places” (1973) and Ken Kesey’s novel One Flew Over the Cuckoo’s Nest (1962, filmed by Miloš Forman in 1975) both depicted entanglement and the uncanny reversal of rebellion occurring in enclosed hospital spaces. Looked back at today, these anti-psychiatric texts raise the question of how the same ironic force of disempowerment might operate in the much larger realm of a whole hospitalised society.
Rosenhan, a Stanford psychologist and Laing admirer, wanted to test the credibility of hospital psychiatry. He assembled a team for the purpose of getting admitted to asylums under a false flag. Three psychologists, two physicians, a painter, a housewife and Rosenhan himself went separately to different mental hospitals, each imposter complaining in scripted phrases about hearing voices. Every one of these pseudo-patients, as Rosenhan called them, was diagnosed as insane and committed for between seven and fifty-two days (see also “The X Process”).
Inside, they noticed that staff pounced on any sign of individual pathology but discounted context. There was a constant rule of deflection at work, according to Rosenhan’s paper: “behaviors that are stimulated by the environment are commonly misattributed to the patient’s disorder.”5 In short, patients were belittled, ignored and blamed. Setting out to expose psychiatry as basically an artifice, the pseudo-patients had first to experience for real how the fiction of diagnosis could cause the craziness it invented. The researchers soon felt humiliated and frightened at having their status as competent citizens stripped away. They began behaving erratically. One of them tried to seduce a nurse and compulsively offered other inmates psychotherapy (self-promoting gambits which staff might well have regarded as the typical grandiosity of a mentally ill person). The team members simply weren’t prepared for the coercive, negating impact of the hospital regime at first hand: “Neither anecdotal nor ‘hard’ data can convey the overwhelming sense of powerlessness which invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital,” wrote Rosenhan.6
What was recounted in “On Being Sane in Insane Places” wouldn’t have been out of place in the conspiracy films of the time, the kind of film in which a horrified everyman character discovered a respectable organisation’s involvement in a sinister plot against the population. Rosenhan’s researchers stumbled into something just as daunting: they were turned into nonpersons. For as long as they were locked up they were subject to the hospital’s authority to define their sanity however it pleased. Like anyone put at such a disadvantage, like anyone in the clutches of overwhelming power, they quickly became demoralised and distressed. These not-so-pseudo-patients realised they had to demonstrate their obedience in order to be released, and so they did.
It is interesting how closely the main technique of mental-hospital browbeating—“behaviors that are stimulated by the environment are commonly misattributed to the patient’s disorder”—anticipated what Mark Fisher called responsibilisation and Byung-Chul Han characterised as adaptation to domination,7 with the work of misattribution now moving inward, self-management taking over from staff bullying. But if the asylum has indeed been universalised, it follows that there is no longer any bureaucratic discharge procedure or defined exit into freedom. The outside disappears when a hypnotic phantom institution moves into people’s minds. In such a psychosocial grey zone the pressure to capitulate which mastered Rosenhan’s team has potentially become all-encompassing.
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