We Need a New Psychiatry

   Louis Menand’s article “Head Case,” in the March 1, 2010 of The New Yorker asks,  “Can Psychiatry Be a Science?”

     There is no simple answer to that question.  Freud’s whole life was devoted to making psychotherapy into a science.  The immediate fragmentation of his work into multiple schools gave an indication of how fraught with ambiguities such an effort is. To make psychiatric treatment a “science” requires definitions of diseases, their origins, etiology, diagnosis and treatment that are as materially based as those applied to the treatment of physical diseases.  Instead, psychiatric efforts are dogged by ambiguity, litanies of expanding “syndromes,” some of which supposedly relate to the same “disease.” The derivations of these syndromes, as collected in the “manual” of psychiatric diagnoses, called the “Diagnostic and Statistical Manual of Mental Disorders (DSM), turns out to be more indicative of social norms than “material” conditions of disease. 

     This is no surprise.  Anyone who is familiar with the termination of persecution of witchcraft or of the wider acceptance, in some circles, of the deviant behaviors of artists, for instance, knows how social norms shape our perception of what constitutes a mental “disease” or “disorder.”  Of course, the increased diagnosis of ADD, for instance, indicates a (compensatory? – we always need our demons) shift toward increasing ascription of deviance and less toleration of disruption to the machinic processes we think of as being normal.  For the philosophers, Foucault’s Madness and Civilization speaks exactly to this issue (while his The Birth of the Clinic speaks to the social basis for the identification and treatment of what we now call disease – creating two moving targets in this discussion). 

      I see the whole discussion as stemming from a huge category mistake.  Grant that the medical diagnosis of physical diseases has merit and is effective – a proposition that also seems to be contested by holistic and homeopathic orientations.  Medical treatment of physical tissues is made possible because physical tissues are relatively stabilized into somewhat machinic, repetitious sequences and relations (still vast, not fully demarcated or understood) for which triggers and modulators, if not effective blockers, can be found. 

       Treatment by pharmaceuticals or surgery or rehabilitation is effective within prescribed ranges.  By contrast, psychic processes are completely relational and self-generating, differentiating and auto-stabilizing from moment-to-moment.  Even so-called “normal” behaviors are set in motion by complex, variable and only partially stable (within a range of internal and external limits and thresholds).  Thus, there is no firm basis on which a “disease” can be labeled (other than neuronal dysfunction or atrophy or over –production) in a way that is analogous to physical disease.  This is a largely mistaken route engendered by an over confidence in the materiality of the “mind-brain” connection. 

     This overconfidence is precisely the “affliction” that quantum mechanics and relativity and their offspring overcame in the realm of physics.  Freud’s model suffers from exactly the classical presuppositions of materiality, action/reaction and absolute space that marked the (Newtonian) physics of his time.  

The model of self-organization, the model of psychic/somatic self-generation and ordering holds great promise for re-orienting our comprehension of the mind, just as quantum physics offered whole new vistas of comprehension and engagement with the physical world. In this model (see Theren and Smith, Stuart Kauffman, Varela or Kelso, for example) there are no fixed mental parameters, only the massively collective self-organizing dynamics of self-forming engagements.  

     If Freud had the self-organizing model to appeal to, for instance, he could have cited the drive of the psyche to generate new awareness out of free flowing energies (in language and in abundant physical connection) as being constrained into certain channels, instead of having to defend “material” forces (Newtonian point-to-point constellations of motion) such as libido, sex drive and even the death instinct. 

        Instead of contemporary “anxiety” or even “depression” we might be able to embrace highly differentiated modes of engagement of an organism grappling with radical self-organization on more or less moment-by-moment bases, as opposed to “fixing” a body of machinic processes that is “supposed to” behave in prescribed ways.  From there, we could engage in ameliorative actions that all parties work through so as to foster the greatest expression of those energies, without stigma, without drugs, but with genuine prospects for “health” of that being, We could engage with each other as beings living their ways into ambiguity and community. 

       This would be a new psychiatry, a generative one for all involved, to be sure. 

       We have far to go.