This year marks the 50th anniversary of the philosopher Foucault’s influential book ‘Madness and Civilization’. In discussing the development of the concept of ‘madness’ as a consequence of the scientific rationality of the Enlightenment, it suggests that ‘mental disorders’ should be viewed as a social construction rather than the medical condition they are typically seen as within contemporary Western society.
Indeed, this is the view proposed by the controversial psychiatrist Szasz, who argues that mental illness is a myth, and that such diagnosis and forcible treatment is predominantly a means of social control. Indeed, compulsory psychiatric hospitalisation has historically been used in this way to oppress dissidents by various regimes across the world.
Although it may seem counter-intuitive in the age of Prozac, ‘mental disorders’ are much less well defined ‘medical conditions’ than they may first appear. The ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM) of the American Psychiatric Association typically lists large number of symptoms for any given condition, and it is only necessary to present a small number of these in order to be diagnosed. Indeed, the difficulty in making such a diagnosis is illustrated by the classic psychological study of those being sane in insane places.
Furthermore, it can be seen that what constitutes a ‘mental disorder’ can vary both over time and culture. Perhaps obviously, drapetomania, the ‘disorder’ that caused black slaves to want to flee captivity, together with the woman specific ‘disorder’ of ‘female hysteria’, are not longer considered to be the problems they once were. Somewhat more surprisingly, however, is the fact that homosexuality was similarly regarded as a ‘mental disorder’ until as recently as the 1970s.
Conversely, ‘post-traumatic stress disorder’ (PTSD) was only defined following the Vietnam war, and the new condition of ‘internet addiction’ is a potential candidate for the forthcoming 5th edition of the DSM. The consequences of redefining ‘normality’ in this manner can have a dramatic effect as to how people are categorised. For example, the historical figure Joan of Arc, in claiming to hear voices from God, would nowadays be regarded as suffering from schizophrenia, rather than being considered a divine messenger.
Furthermore, a culture-bound syndrome such as ‘koro’, or ‘genital retraction syndrome’ (GRS), which occurs in parts of Africa and south-east Asia and involves the belief that one’s external genitals are disappearing, may appear strange and somewhat unlikely to those used to Western ‘disorders’.
A more familiar condition such as depression, however, can only be regarded as a ‘disorder’ if happiness and contentment are thought to be ‘normal’. This is only a relatively recent expectation, with Freud himself concluding “that the intention that man should be ‘happy’ is not included in the plan of Creation”.
From a cynical standpoint, it can be seen that pharmaceutical companies clearly have a lot to gain from promoting particular constructions of ‘normality’, as illustrated by the development of ‘puppy Prozac’ to treat the previously unidentified condition of ‘separation anxiety’ occurring in pet dogs.
‘Madness and Civilisation 50th anniversary’ on ABC Radio National
Psychiatry and mental illness
Avdi, E. & Georgaca, E. (2009). Narrative and discursive approaches to the analysis of subjectivity in psychotherapy
