something about "The Birth of the Clinic" by Michel Foucault

In The Birth of the Clinic, Michel Foucault mines late 18th and early 19th century changes in medical practice (this, significantly, is around the time of the American and French Revolutions, following on the heels of the Enlightenment). These changes shaped modern medicine.

The discourse on human rights inspired by these revolutions led to an overall concern with society and health; and the move toward egalitarianism pushed physicians (and teaching physicians) out of the the aristocracy and reassigned them to general society.

The new imaginings of hard science dictated that we let truths reveal themselves to us. In The Birth of the Clinic, Foucault feels out what he calls the medical gaze--a way of seeing in which the physician allows the disease to reveal its own truth. The human body gives off signs, and the physician uses his knowledge and observations of the body to translate the reality of the disease.

The physician talks to the patient, observes him, examines him, orders tests and whatnot. Mysticism is abandoned for a discussion of the body; the physician relies less on bookish medical wisdom and instead reads the body. The physician's eye sees in space symptoms and physical signs.

The physician’s observations affect the gaze; the gaze affects the physician. Doctors systematically describe diseases using medical jargon. The physician's power is now his experience rather than his status. The gaze has scientific credibility. And we've successfully achieved truth in spite of the doctor's status, not because of it. (So we think.)

something about psychology, in general

All psychology is armchair psychology.

about needs

Threads of pain drape from my spine, fold and disappear under my shoulder blades. What do you need?

briefly about "Mortality" by Christopher Hitchens

British-American author and public intellectual Christopher Hitchens was diagnosed with cancer in the summer of 2010 and died December 2011. Mortality is his final work, a meandering collection of essays penned during his painful physical decline. Mentally and emotionally, however, judging by this book, Hitchens stayed the picture of health. In these pages he imparts the experience of dying slowly, offers up a couple memories and lessons learned, and renews his atheism. Hitchens subtly urges us to appreciate health--our speaking voice, in particular. And, about that health, he aims to disabuse us of the idea that what doesn't kill us makes us stronger. This last point is not to say that Hitchens regrets his steady flow of cigarettes, scotch, wine, and the late nights he spent with friends; it just seems that life--his especially--necessitates many loosely calculated risks. In the way of an end-of-life perspective, he writes,

So we are left with something quite unusual in the annals of unsentimental approaches to extinction: not the wish to die with dignity but the desire to have died.

about "Psychiatric Power: Lectures at the College de France, 1973-1974" by Michel Foucault

In these lectures, Foucault defines psychiatric power as "that supplement of power by which the real is imposed on madness in the name of a truth possessed once and for all by this power in the name of medical science, of psychiatry". This definition hints at the areas Foucault explores: reality and truth, systems of power, and the disciplines of science and the human sciences. The lectures serve as an important follow up and, in some key respects, an amendment to his early work, Madness and Civilization: A History of Insanity in the Age of Reason. Reading this and staying engaged was a struggle. The reason for that is largely a matter of context: the practice of psychiatry (and administration of asylums) and the schools of thought therein have a complicated and rich history in Europe, particularly in France and Italy. Foucault digs into and entrenches himself in that history, but, as a student, there is no required preliminary reading to reference. Nevertheless, Foucault does impart many insightful points of brilliance:

• The appropriation and use of reality as a form of power

• The medicalization of children, and the creation and expansion of the concept of development as it pertains to rationality and moralizing, retardation, madness, and defining the normal and abnormal

• Foucault's redefining the abnormal, the retarded, etc, as individuals who act on instinct

• How psychiatry changed from a practice that confined, controlled, and sometimes corrected madness to a power that defines, controls, and sometimes corrects the abnormal, thereby expanding its power into the domain of normality

• The role of psychiatry and asylum administration in capitalism and maintenance of the workforce

• How medical science provides justification and grounds for power, but does not inform psychiatric practice

• The history of the concept of truth, and truth's development and role in science

This is not be a good starting read for people interested in Foucault. And people interested in pschiatry (or anti-psychiatry) should probably also not read this without some background in Foucault.

Note

• The edition I have does offer some good historical context on psychiatry.

a thing about the movie "Flight" (with spoilers)

Flight follows William "Whip" Whitaker, a crackerjack airline pilot struggling to admit to his alcohol and drug addictions in the aftermath of a plane crash. Part of the immediate dilemma for the audience and for Whitaker is that (1) the crash resulted from hardware failures, not pilot error, and (2) no other pilot could have negotiated the crash landing with as much skill, and saved as many passengers' lives as he did, sober or otherwise.

The film is about one man's struggle for redemption, but what we see from our theater seat is a struggle for control of truth. In Whitaker's mind, his functionality, his brilliance excuses the behavior that so many rush to judge irresponsible. That is his truth. But under threat of litigation and penalty for the lives lost, the airline and Whitaker's other adversaries use the discourse of medical knowledge, appealing to that discipline's knowledge-making authority, which justifies policies that were violated, and deems Whitaker unfit. The co-pilot, who chooses not to reveal Whitaker's drunkenness on record, appeals to the Word of God; God reveals the Truth, and Whitaker must face that truth.

Finally, after a slew of verbal confrontations, Whitaker is faced with the most intimidating of rhetorical situations--a hearing by the National Transportation Safety Board, an independent Federal agency "charged by Congress with investigating every civil aviation accident in the United States". Here, Whitaker surrenders control of the truth. He cannot speak another lie, he says. Whitaker's truth goes from belief in himself with a confident rejection of medico-juridical labels to, ultimately, the discourse of confession. He adopts the narratives spun about him by others, and finds himself now a craven denier of truth, and no longer a hero airline pilot.

Notes

• This was a fantastic movie. Every performance is spot on; Whitaker is played to perfection by Denzel Washington, and even John Goodman's over-the-top dealer works well, providing relief from the main character's ongoing struggles and tension. And Wikipedia notes, "Flight is (Robert) Zemeckis' first live-action film since 2000's Cast Away and What Lies Beneath, and his first R-rated film since Used Cars in 1980."

• Above, quoting the NTSB's Web site regarding the agency's purpose.

Abuse your illusions

In addition to events in your personal life, this year's Carrier IQ story and revelations about mental illness and its treatment show that everything that seems good is actually bad. And if not actually, then eventually. But that won't change anything.

(Taking the Carrier IQ story to its logical conclusion, in the not-too-distant future we'll have contact lens computer screens. Soon after that, thoughts can be harvested and stored on Google servers. Then thoughts will be stored on a centralized, searchable database. Scary!)

Happy New Year!

Together at any cost

The New York Times interest piece "Navigating Love and Autism" (1) establishes romantic relationships as a normalizing force and (2) documents an effort to normalize autistic people. The story begins with college-aged Kirsten dating a young man who offers her some much needed coaching in the social graces. She chafes under his direction and is soon drawn to another young man, Jack, who shows no interest in such social conventions. Comforted by the lack of expectations each felt from the other, Jack and Kirsten strike up a relationship. Soon, though, she realizes she needs more affection and understanding than her new beau can give. He has Asperger syndrome, and, turns out, she sort of does, too. They push on together, usually either arguing or just keeping one another company. She starts learning to cope and eventually he lets her get a kitten.

We're supposed to assume that being in a troubled relationship is preferable to being alone, and that this couple is to be congratulated even though their partnership is fraught with difficulties. From the article:

The months that followed Jack and Kirsten’s first night together show how daunting it can be for the mindblind to achieve the kind of mutual understanding that so often eludes even nonautistic couples.

The story continues: After establishing a presence on an advice web site for Autistic people, Jack and Kirsten are somehow invited to speak publicly about relationships. Kirsten is quoted as saying  “Parents always ask, ‘Who would like to marry my kid? They’re so weird.' But, like, another weird person, that’s who." The people who approached them for advice feel anxiety about their own relationship prospects.

The message: They may not be happy but at least these autistic people can try to be normal by having a relationship.

Since the earliest diagnoses, the prevailing wisdom has said that people with Aspergers were mostly unable to have meaningful personal relationships. So, now, the general narrative spawning this article and Jack and Kirsten's efforts is supposed to be that "the overarching quest of many (new adults) in this first generation to be identified with Asperger syndrome is the same as many of their nonautistic peers: to find someone to love who will love them back." Before establishing this narrative we might first check whether we share a common definition of love and value the same things in relationships. What we consider a traditional relationship may not be the shoe that fits Kirsten or Jack.

Where does this "quest" come from? Why the anxiety about being alone?

Notes:

• I heard Asperger syndrome won't appear in the next Diagnostic and Statistical Manual of Mental Disorders (this would be volume five). Instead the diagnosis will fall under the general Autism spectrum.

• The best part of the article comes when the question is put to Jack: Did you ever fear being alone? He answers, “I have no doubt if I wasn’t dating Kirsten I would have a very hard time acquiring a girlfriend that was worthwhile.”

One Flew Over the Cuckoo's Nest

Reading Ken Kesey's One Flew Over the Cuckoo's Nest. Early in the novel our freewheelin' protagonist McMurphy approaches the insecurely effeminate and possibly homosexual patient Harding following the latter's humiliation during group therapy. McMurphy aims to open Harding's eyes and expose the cruelty of Nurse Ratchet. Harding protests at first, defending the therapeutic methods of the clinic by asserting that its practitioners' expertise is too much for any layman to critique. In other words, the medical community's knowledge is their power. But McMurphy persists, using analogy and his gruff but down-home brand of empiricism to bring Harding to realize that Ratchet's clinic seeks to instill and maintain order through shame. Harding is won over, but then one-ups McMurphy by claiming that they are both peons, separated only by a few degrees.

I can't tell if, in Kesey's mind, Ratchet represents merely a bad apple within the system or if she is the system. Another observation: Having seen the movie many times, I'm surprised by how important a role gender plays in the original story.

Their death, their salvation

The CNN piece "A safe place to drink, or just giving up?" depicts wethouse residents while asking, "Are wet houses a way to keep late-stage alcoholics safe, or do they just give up on a treatable disease?"

When considering the former answer, the author suggests that residents are being kept from the streets and the streets are being kept from the potentially destructive residents. When considering the latter answer, the article reveals that a resident interviewed in the piece subsequently died, and that death there is common. Additionally, quotes supporting each answer are collected from two professionals in the health and treatment industry.

The article's question isn't answered explicitly, but the primary conclusion was made long before its words were committed to paper: That these residents are symbols of tragedy and shame whose salvation comes from health professionals.

The residents depicted in the article feel tremendous guilt for the personal and public costs of their living. The article discusses each man's loneliness and poverty, and it summarizes the tax savings wethouses can bring by avoiding hospitalization and incarceration.

In all, the article (1) emphasizes the self-shaming felt by those of fail to embody the esteemed value and ideology of self-reliance, and (2) re-establishes modern medicine and psychology as the valid and dominant sources of that ideology, and as leaders in prescribing correct ways of living.


Article discussed: http://www.cnn.com/2011/HEALTH/05/11/minneapolis.wethouse.alcoholics/

Alienation to alienated

When reading Madness & Civilization, know that a lot of people considered normal today would have been diagnosed mad in previous centuries. For example, Foucault spends a great deal of time discussing melancholics, known today as people suffering from depression.

Anyway, finished reading Madness & Civilization. The closing of chapter IX, "The Birth of the Asylum", includes this wonderful sentence--the parentheticals are mine:

He (Freud) did deliver the patient from the existence of the asylum within which his "liberators" had alienated him; but he did not deliver him from what was essential in this existence; he regrouped its (the asylum's) powers, extended them to the maximum by uniting them in the doctor's hands; he created the psychoanalytical situation where, by an inspired short-circuit, alienation becomes disalienating because, in the doctor, it becomes a subject.1

Here, I think Foucault is saying something like this: The structures and practices of the asylum gave doctors moral authority over the mad; doctors objectified the mad in those asylums, thereby alienating them, making them outsiders in the real world of reason. But once patient care fell to psychiatry--most notably with Sigmund Freud--doctors' authority transferred from those structures to the personage of the doctor. The doctor then exercised his authority in the psychiatrist's office. There, the alienation that was, in the asylum, only a side effect of being the anomaly became itself a neurosis to be studied and speculated on.

Pure rad.

His arguments probably don't play well when taken in pieces like this, but one can see how rich the content of his writing is. I could spend three days unpacking this one sentence and still not feel the thing fully fleshed out.

I think the prevailing opinion is that Foucault was not much of a writer. I disagree, although I have only translations to judge by.

1"Madness & Civilization" by Michel Foucault