This is a guest post by William. William is a psychodynamic psychotherapist currently working in an educational setting in Chicago, and a regular commenter at Feministe.
I’ve lived in Chicago my entire life. I’m old enough to know better but young enough to still imagine myself to be invincible from time to time. I’m white and firmly middle class, though I grew up in a family that moved from working class into the middle class only relatively late in my life. I’m married and have been with the same partner for more than half my life. I’m male identified, male assigned, and I perform the shit out of some masculinity. I’ve considered myself a feminist ally since college when my wife was kind enough to take me to task and kick my ass in discussion after discussion. I have a significant nonverbal learning disability (though I’m not on the spectrum), a suite of physical disabilities that come from mild cerebral palsy, and have struggled with depression for most of my life. I wear an Oppositional Defiant Disorder label like a badge of honor. I am a childhood sexual abuse survivor. I’m the front man in a band. I’m what we in the industry call an “early career psychologist.” That means I’ve busted my ass through about a decade of school, wrote the dissertation, passed the tests, did the years of clinical practice, earned the degree, gave my parents the right to say “my son, the doctor,” and have finally started paying off my loans and building a professional reputation. But now that I’ve the ritual of introduction out of the way, lets get to why Feministe has been so kind as to let me rant at you for a little bit.
One of the things that has always struck me about how we discuss madness is the terms we use. “Words mean things” has become something of a trope in the feminist world, but its especially important to remember when we’re talking about madness because, in a very real way, all we’ve got in the world of psychology is language.
“Now wait a minute,” I’m sure someone is thinking, “why madness?” A good question! Terms we have like “mental illness,” “insanity,” “pathology” and the like all come with pair of problems: they define mad persons by what they lack or their perceived deviation from the mean and they come with a built in negative value judgement of the experiential reality of mad persons. “Madness,” at the very least, observes that what it describes is something in itself rather than a lack of some privileged value. It gives a nod to madness as real, as an experience of something. “Madness” opens the door for mad persons to take ownership of, and exercise some degree of agency over, their experiences. That’s important when we talk about madness because we often lose sight of the fact that we’re talking about real human beings with real experiences and real rights.
Why spend so much time agonizing over what to call madness? For a long time there has been a battle brewing in the psychological world as to what, exactly, our (clinicians) place is in society. Are we scientists? Physicians of the mind? Healers? Secular shaman?
The answers to those questions inform our relationships with our patients. Are they sufferers of malignant unreason? Cognitive dissidents? A new class of lepers? Free men and women possessed of a different set of senses? Lazy? Confused? Criminal?
How we see our patients informs how we decide who deserves our fealty. Is it our patients? Their loved ones? Their insurance companies? Society as a whole?
The answers to these questions are vital not only for psychologists but for anyone who would use our services because they dictate not only the ways in which psychologists go about their business but also the ways in which psychology is studied, understood, and utilized in society. These questions become less academic when you realize that the answers psychology, and society, come to determine the limits of a patient’s civil rights.
Take symptoms, for instance. Everyone knows what a symptom is, right? A symptom is how we know a patient is mad, its the mark of weirdness, something that disturbs the patient or those around them enough to make them seek (or be forced into) treatment. That answer, while sufficient for saying “hey. I’ve got this symptom,” is only the very beginning of our understanding of what a symptom means and that meaning is deeply informed by how we understand madness. -warning, gross oversimplifications ahead- If we understand madness as a mistake of reasoning or perception, then a symptom is something to be disproved. If we understand madness as pathological conditioning, then a symptom is something to be trained away. These two understandings underly the thinking of Cognitive Behavioral Therapy (CBT). If we understand madness as a chemical, medical, neurological disease then symptoms become the subject of medical interventions. We could understand madness as a state of incongruence, of being out of step with one’s self as the Rogerian/Person-Centered movement does. We can, like the psychoanalysts, understand madness as an experience of personal history, with symptoms being the expressions of things otherwise incommunicable. Each of these understandings come with values and dictate very different forms of treatment.
Personally, I stand with psychoanalysis. My own view of symptoms is that they are a complicated interaction between the things someone had to do to survive trauma, the ways they have found to communicate these experiences which are not readily spoken, and the taboos which rob patients of their voice. Because of this, I don’t really treat symptoms. I avoid telling patients to stop doing this or start doing that and engage with the symptoms as if they were a part of the conversation in the same way that body language or metaphor might be worth observing. Sometimes patients keep their symptoms because they cease to be disturbing, sometimes they abandon them to have a fresh start; its up to the patient, really.
Over the next few posts I will explore the ways in which our outlook influences how we define, diagnose, and treat madness. I also plan on addressing some specific ways in which out problematic treatment of madness leads to oppression not only for mad persons, but for persons who are considered “normal.” Finally, I’ll touch a little bit on madness, education, and how school systems serve or fail to serve children who are identified as abnormal.
But first…Feministe’s vibrant discussions are what drew me into the community in the first place, so I’d like to close this post with a question that we can use as a starting point for this difficult topic: how do you, personally, define health and illness?
Note: I know that, over the years, I’ve been
a fire breathing asshole a little rough in the comments. I like discussion, I like debate, I even like it when it gets ugly. Given that I’m not commenting but posting as a guest and that I want everyone to feel like they can contribute I’m going to work hard to restrain some of the more aggressive aspects of my personality. If I step on your toes please feel free to call me out.
That said, check your isms and take
your lumps correction from the community if you inadvertently hurt someone. Don’t be a turd in the punchbowl.