Psychiatry As An Instrument Of Power
“ Some voices- who claim to rule, who top the hierarchy, who claim the Centre, who possess resources-are non merely heard much more readily than other, but besides are capable of bordering the inquiries, puting the dockets, set uping the rhetoric ‘s much more readily than the others ” ( Plummer, 1995:30 ) .
Critically measure this statement in relation to the statement that psychopathology is an instrument of power.
Psychiatry can be defined as “ the subdivision of medical specialty devoted to the diagnosing, categorization, intervention and bar of mental upsets ” ( Coleman, 2009 ) . In history the Greeks were the first to do sense of the construct of lunacy ( Porter, 1987 ) . Grecian philosophers recognised that by utilizing the art of ‘reason ‘ and ‘rationality ‘ order within society could be maintained, taking to the thought that the irrational in society were a job. The mediaeval period added an component of faith to the account, seeing it as a war between Satan and God for the psyche, lunacy being a penalty from God. The ‘Enlightenment ‘ during the 17th century, saw those who appeared to miss ground and reason punished for ‘foolish ‘ or ‘childlike ‘ behaviors. These irrational existences were seen as a menace to the development of a to the full functioning society, as merely the perceived sensible and rational members of society had the power to win. The period of the ‘Great Confinement ‘ saw an addition in establishments and prisons to house the irrational ( Foucault, 1995 ) . Those with ground had the power to incarcerate the mad along with the hapless and the bad members of society. One per centum of the population in Paris during this period were confined in such establishments, for this ground Foucault sees the Great Confinement as a “ deliberate policy ” ( Porter, 1987, p.16 ) . The undermentioned century saw the ‘Rise of the Asylum ‘ , where the “ insane were clearly distinguished from other ‘problem populations… ‘ ” ( Scull, 1993, p.1 ) . Refuges were established by the authorities, leting the mad to be wholly separated from society due to their freshly recognised medical jobs. Foucault ( 2006 ) refers to the refuge as a “ specialised universe ” defined by the cognition of “ medical power ” ( Foucault, 2006, p. 166 ) . The acknowledgment of lunacy as a medical status saw the debut of the psychopathology we are most familiar with today. The medical association of lunacy allowed psychopathology to go progressively “ extended, permeant and influential… ” in the twentieth century ( Bracken & A ; Thomas, 2005, p. 93 ) . Anyone who associated themselves with the mental wellness field, were finally give uping themselves to the developing discourse of psychopathology. Today, in the 21st century, psychopathology still has an influence on authorities policy ( Scull, 1993 ) . The scientific footing of psychopathology encourages the populace to believe all they say is true. The head-shrinker ‘s sensed expertness of aberrance ( unwellness ) , gives them the authorization to eliminate such members of society. The head-shrinker in bend influences authorities policy, and plays a portion in societal order or control. It is this high societal position that gives the profession of psychopathology power-which is non a good thing to those underneath it.
Power and Knowledge
Before understanding why psychopathology is an instrument of power, it is of import to foremost understand what is meant by the term power. Power has been defined as “ the exercising of control or force over an single or societal group, by other persons or societal groups… ” ( Edgar & A ; Sedgwick, 1999, p. 304 ) . Foucault ( 1976, p. 11-23, as cited in Spierenburg, 2004 ) stated that “ power is something which certain people possess, while others are excluded from making so ” . This relates to the manner in which a head-shrinker has power over his patient, the head-shrinker being at the top of the hierarchy. He believes that power allows people to be excluded and repressed through legalities ( Foucault, 1980 ) . This procedure begins when the “ map of power in society is defined… ” ( Foucault, 1980, p.90 ) , as this power is so most likely to be politicised, so ingrained into society through establishments such as psychiatric 1s. Foucault high spots that in order for a power to be established within society it requires the “ circulation and accretion of a discourse ” ( Foucault, 1980, p.93 ) . This presumably is the circulation of scientific cognition, which is seen as the truth behind the power. Roberts ( 2005 ) , discoursing a remark made by Foucault, suggests that scientific cognition allows the ‘exercise of power ‘ to be “ intensified ” . The cognition that a profession obtains is of import for the justification and ‘legitimisation ‘ of the power it exerts ( Scull, 1993 ) . Knowledge allows the profession to ‘dominate and command ‘ a certain entity, without inquiry or the demand for blessing. In history the first public exercising of power was the panoptican. The captive is seen by the guards, but can non see them so ne’er knows when he is being watched. Foucault refers to the captive as an “ object of information, ne’er a topic in communicating ” ( Foucault, 1991, p.200 ) , connoting that the captives function is to be observed, non to interact. The fact that the captive does non cognize when he is being watched ensures that order is maintained, and power remains within the cardinal tower. The observation in the panoptican enables the staff to larn how to command the behavior of adult male, therefore an addition in cognition to farther enhance power. As a bequest, panopticiscm has enabled its rules of power to be applied to subjects such as psychopathology ( Roberts, 2005 ) .
The Power of Psychiatry
Porter ( 1987 ) refers to the history of lunacy as the history of power, in the sense that lunacy can merely be controlled by the agencies of power. Hence, the get downing point in the power of psychopathology is its association with the jurisprudence. In society the power of the jurisprudence is seen to be imposed for a good ground ( Edgar, & A ; Sedgwick, 1999, p. 305 ) . The medical profession is based on a valued country of cognition ( scientific discipline ) , so is able to hold high societal power ( Allsop, 2006 ) . A deficiency of the ideal cognition does non let for one to “ find the policies ” or order the patterns within mental wellness ( Stickley, 2006 ) . Bing based on this cognition, therefore deriving credibleness, the original 1983 Mental Health Act ( Department of Health, 2009 ) could be developed and implemented with a merely ground. This policy allows the compulsory admittance and intervention of people if it is felt to be necessary ( Bracken & A ; Thomas, 2001 ; Roberts, 2005 ) , leting initial psychiatric power. Bracken and Thomas ( 2005 ) province that the mental wellness policy has the power to ‘control and except ‘ , with the discourse provided by “ medical psychopathology ” ( Bracken & A ; Thomas, 2005, p. 94 ) . Laugharne and Priebe ( 2006 ) discourse how this policy discriminates against the mentally sick, taking their power to make up one’s mind when they are treated. Psychiatric power has the purpose of “ enforcing ” a medical intercession on a patient “ against his will ” , which is allowed through this statute law ( Barker & A ; Stevenson, 2000, p.45 ) . The authorities promote its credence by the populace, through claiming the Mental Health Act sets out to protect society from ‘madness ‘ , something which has gone on for over 300 old ages. With the authorities ‘s authorization to politicise mental unwellness, it seems as though they are the true holders of power ( Calinas-Correia, 2001 ) , moving out their wants through the valid scientific discipline of psychopathology. Kogan ( 2005 ) highlights the entreaty psychopathology has, through its ability to “ undertake seeable and practical jobs ” in society. Psychiatry appears to be able to cover with issues beyond its field, through its part to public policies, which additions it power. A recent illustration of this is the development of the DSPD act ( Cordess, 2002 ; Corbett & A ; Westwood, 2005 ) . In world psychiatric power can be seen as a signifier of societal control, as there is no medical footing for psychopathology ( Foucault, 2006, p. 11-12 ) . To enable the act of societal control within society, it is of import to name mental unwellness. The cognition obtained from power allows worlds to be ‘classified ‘ therefore controlled ( Roberts, 2005 ) . Brown ( 1990 ) sees the head-shrinker ‘s power and ability to label an person, as cardinal to this. Strauss ( 1958 ) recognises that the head-shrinker ‘s position allows them to “ give more power than anyone else ” . Through diagnosing the head-shrinker has the power to specify what is normal and unnatural in society, hence is socially building the cognition of mental wellness. The DSM is the necessary tool for the footing of diagnosing, as it “ authorizes ” the remotion of an person from society ( Kovel, 1988, p.131 ) , therefore foregrounding its power. Within the text is the definition of the known mental upsets, hence in a sense it is this discourse ( DSM ) that is responsible for this building of the cognition on mental unwellness in society ( Bracken & A ; Thomas, 2001 ; Phillips, Lawrence & A ; Hardy, 2004 ) . Every betterment to the text increases the power and control to the user, farther specifying society ( Kovel, 1988 ) . The DSM, hence, is the footing for the application of psychiatric power which in bend consequences in control. The power between a physician and patient is established at diagnosing and maintained through cognition. From the oncoming the way of power demands to be defined to make instability between the physician and patient ( Foucault, 2006, p.146 ) . Without an in deepness cognition of their status, the patient is unable to inquiry or dispute the head-shrinker ( Barker & A ; Stevenson, 2000 ) . It is assumed that the mentally broken patient has a “ naif cognition ” that does non compare to the ‘scientific ‘ cognition of the head-shrinker ( Foucault, 1980, p. 82 ) . Psychiatry trades with a kind of cognition the ‘layperson ‘ would happen hard to understand, which additions it power ( Kogan, 2005 ) . The DSM is an illustration of the hard cognition of psychopathology. Through its medical professionalism the DSM can non be questioned ( despite the grounds that it is undependable ) due to its perceived credibleness ( Baker and Stevenson, 2000 ) . The power relationship between the head-shrinker and patient, allows the care of the powerful “ dominant discourse ” within psychopathology ( Stickley, 2006 ) . Foucault ( 1995 ) negotiations of how the patient sees the head-shrinker as a ‘thaumaturge ‘ , person with a marvelous power to bring around. This feeling is gained through his apparently limitless cognition of psychopathology, ensuing in the patient ‘s credence of all the physician says and therefore reenforcing his position of power. Through this trust of the head-shrinkers abilities the patient has been said to “ renounce his ain logical thinking capacity ” ( Freidson, 1970, as cited in Scull, 1993, p.382 ) , due to the lower status of the patients knowledge. If the patient efforts to dispute the physician, this is where institutional powers are used ( Scull, 1993 ) . Institutional powers are a signifier of disciplinary action, coercing patients to co-operate- in other words panopticiscm. Within a psychiatric infirmary the head-shrinker is the chief keeper of power, at the top of the administrations hierarchy ( Strauss, 1958 ; Rushing, 1964 ; Lunbeck, 1994 ; Spierenburg, 2004 ; Stickley, 2006 ) . This implies that the patient is at the underside, having direction and power from all higher degrees. Power being exercised from the top down makes certain that opposition is avoided. Rushing ( 1964 ) states that nurses lack the power to differ with a head-shrinker, being his subsidiary they must obey his orders. The head-shrinker replies all inquiries at all degrees ( Scull, 1993 ) . Lunbeck ( 1994 ) high spots that one time a patient is admitted to a psychiatric ward, they belong to the professionals. All personal ideas and Hagiographas are to be taken, and used for appraisal of the patient ‘s status. This would look to be portion of the head-shrinker ‘s occupation, but Lunbeck points out that it is merely an exercising of power. It about seems that on admittance, the patient forfeits all of his or her rights ( or power ) , as a consequence of their status.
The Power of the Patient
Through admittance of being sick, the patient efficaciously gives up his ain power. However, psychopathology gives the patient the power of unwellness ( Barker and Stevenson, 2000 ) . Psychiatry has the power to reenforce the ‘sick function ‘ , in society ( Haug & A ; Lavin, 1981 ) . The label given to the patient defines who they are socially, and is a elusive signifier of subjugation ( Kovel, 1988 ) . The patient is seen as being their unwellness ( e.g. being a Schizophrenic ) , non as individual with an unwellness, therefore it seems to depict them as a whole and stigmatizes them ( Nelson, Lord & A ; Ochocka, 2001 ) . Bracken and Thomas ( 2001 ) recognize how damaging a diagnosing of a mental unwellness can be compared to a diagnosing of a physical unwellness, i.e. : being diagnosed with diabetes will non ensue in the powerful detention of being diagnosed with schizophrenic disorder. Person with diabetes will experience as if they can independently command their unwellness, opposed to a schizophrenic who is being treated like a minor under changeless ticker. In order for a patient to derive power back from the head-shrinker, authorization is needed ( Barker & A ; Stevenson, 2000 ) . This authorization helps to re-establish the equality of the patient and doctor/nurse power relationship ( Price & A ; Mullarkey, 1996, as cited in Barker & A ; Stevenson, p. 27 ) . While the patient ‘s cognition lacks medical position, they will ne’er be perceived as equal to the head-shrinker ( McQueen, 2002 ) . The scientific cognition of psychopathology has the power to except other valid signifiers of cognition e.g. life experience ( Robertson, 2006 ) . In the past what the patient had to state was deemed irrelevant, due to their deficiency of ground as a consequence of being mentally ill. Porter ( 1987 ) refers to the manner in which it was believed that the “ words and motions of the mad were merely automatic cramps of the vocal chords… ” ( Porter, 1987, p. 33 ) . This is still true today as Haug and Lavin ( 1981 ) found that few trefoils are willing to listen to the demands of a patient. Support for this comes from Rose ( 2008 ) who, in her clip spent in a psychiatric infirmary, found that in aerating her positions resulted in degrading remarks. She interprets this as the voice of irrationality still being inferior to the voice of ground, as the users ‘ remarks ( cognition ) apparently lacked scientific footing. Not listening to patients can be potentially detrimental as certain instances what the patient has to state ( narrative ) , may be the key to recovery. White ( 2002 ) suggests that that if the head-shrinker and the patient portion their cognition, it will ensue in a better system of intervention. With equal cognition the patient has the ability to derive some power back, to undertake their unwellness with the physician. There is grounds to propose that the cyberspace is cut downing the cognition spread between the head-shrinker and patient ( Dooley & A ; Malone, 2004 ) . Tann, Platt, Welch and Allen ( 2003 ) found that patients that used the cyberspace to self diagnose, and so discussed their findings with their physician had a better relationship during intervention. The cyberspace enabled the power to be every bit distributed, something which some head-shrinkers object to. Tann et Al. ( 2003 ) found that some head-shrinkers felt that patients utilizing the cyberspace doubted their expertness, which possibly is a manner of stating they felt their power was being taken off from them. There is a demand for a alteration in the type of linguistic communication used between the patient and physician. Goffman ( 1963, as cited in Vante & A ; Holmes, 2006 ) suggests that the linguistic communication used in psychiatric establishments is of a ‘diagnostic ‘ nature, which ‘stigmatizes ‘ against the patients. The medical and scientific linguistic communication used by the head-shrinker highlights his power over the patient ( Barker & A ; Stevenson, 2000 ; Stickley, 2006 ) , as the patient lacks understanding of what is being explained to them. In some instances the linguistic communication ( hence cognition ) barrier between the patient and head-shrinker is so great that inaccurate decisions can be drawn from what is being explained by both parties ( Brown, 1990 ) . It has been suggested, to eliminate the linguistic communication barrier, that head-shrinkers should “ travel from soliloquy to dialogue ” in audiences ( Seikkula, Aaltonen, Alakare, Haarakangas, Keranen & A ; Sutela, 1995, as cited in Barker and Stevenson, 2000, p. 28 ) . This remotion of soliloquy refers to the manner in which the head-shrinker frequently dictates to or talk his patient, seldom offering the patient a opportunity to take part in conversation. Predominating the conversation, allows the head-shrinker to keep his power throughout the audience. Most significantly the patient wants the head-shrinker to work with them ( Barker & A ; Stevenson, 2000 ) , despite the head-shrinker being seen as “ superior ” to them ( Foucault, 2006, p147 ) . The patient does non desire to be a ‘subordinate ‘ to the head-shrinker ( Nelson et al. 2001 ) , as the head-shrinkers commanding power can restrict the healing procedure. The patient wants the power to be in control of their intervention, understanding their unwellness and being able to take what medicine and therapies they have. However this goes against the usual power of the head-shrinker to order an appropriate intervention, which the patient must ‘accept ‘ . Through leting the patient to do their ain determinations, will let the transportation of some power back to the patient ( Hamann, Leucht & A ; Kissling, 2003 ; Masterson & A ; Owen, 2006 ) .
The acknowledgment of lunacy in history has allowed the development of the ‘necessary ‘ powers to command it. The turning scientific apprehension and cognition of mental wellness, has resulted in the power of psychopathology to be intensified, as the “ psychiatric power and medical metaphors associated with it have manufactured lunacy ” within society ( Roberts & A ; Hitten, 2006, p. 786 ) . The power of psychopathology is engrained in society through the development of establishments and authorities backed policies, as it is responsible for the “ corruptness ” of non merely the head-shrinker, but the “ patient and community ” ( Barker & A ; Stevenson, 2000, p. 53 ) . The patient needs empowerment, but it has been suggested that the construct of ‘service user engagement ‘ has been reinforced by the “ dominant discourse ” ( Stickley, 2006 ) proposing this will ne’er go on. However, while mental unwellness is prevailing in society psychiatric power will ever be accepted, as the head-shrinkers vast cognition and powers are finally ‘relevant to his occupation ‘ ( Barker & A ; Stevenson, 2000, p. 52 ) .