Who gets to judge the better man,
If the better man doesn’t judge?
It won’t be the better man,
Because the better man’s not for judging.
It’s merely an exploitative,
Disciplinary action
From a legitimation crisis
Of those who are for judging.
To investigate problems with the conception of schizophrenia in psychiatry,
Blackman talks of the use of what are called Type 2 syndromes in the
psychiatric literature. Type 2 in schizophrenia often refers to the negative
symptoms observed in schizophrenia. As Blackman points out this distinction is
often contested, however she argues it is a “good example of the ways in which
psychiatry, despite its heterogeneity, is attempting to provide coherent causal
explanations of psychotic experience. Thus the complex constellation of
behaviours and thought processes which are problematised within the discursive
practice, could be viewed as originating from two distinct disease categories.”
(p.25-26). Thus symptoms such as hallucinations are considered indicators of type
1 syndrome. This phase is considered to be acute but responsive to
neuroleptics. This is distinguished from a second phase, type 2, which is
considered with more chronic with flattened affect and poverty of speech. This
phase is thought to be more intractable, with a poor response to neuroleptics
and thought to be possibly irreversible and permanent. Blackman continues
“within this particular conceptual framework hallucinations appear as temporary
markers of pathology which are amenable to ‘cure’, thus offering a trajectory
which is used to explain why ‘hearing voices’ appears across the disease
classes as a ‘symptom” (p.26). Blackman argues that this conceptual framework
imposes a ‘grid’ that orders the symptom of ‘hearing voices’ encountered in
practice (but not in theory). What she means by this is that the problems that
stem from encountering contradictions in attempting to distinguish between
‘real’ and pseudo-hallucinations can be reorganised within a different rubric
providing a theory of disease that takes into account neuro-physiology
alongside the context of experience. Again, the categories that were previously
used to think through this theory of disease are duration, severity and
chronicity (along with insight). Blackman argues that this means psychiatry can
no longer be thought of in terms of control, vividness, duration etc. (as do
Rosciewicz Jr. and Rosciewicz) that more finely comprehend the complexities of
hallucination, even if the medical model still requires that the
patho-physiology of the individual be raised as a causal factor.
Thus in this new framework of explanation hearing voices is seen as an
indicator of possible psychosis but not necessarily as definitive of
schizophrenia, neither the sole diagnosis not the sole marker of a diagnosis.
Blackman suggests this is a sign of a shift within psychiatry of the
understanding of the phenomenon of hearing voices, but one where psychiatry is
still invested in issues of genetics and heredity, but that leaves space for
the creation of new perspectives, and from the point of view that I am writing
from, new ways for psychiatric survivors to write their own experience into the
discursive space opened up.
Blackman points out that there are particular assumptions in the perspective,
gaze, which psychiatry turns on the diagnosis of hallucinatory experiences. She
argues that what makes a hallucination, outside organic factors or religious
experience, is the lack of any other plausible explanation. The symptoms are
not to ‘speak of themselves’, instead there is a “conceptual grid used to divide
the normal from the pathological within psychiatric discourse, the psychiatric
gaze concerns itself with what is ‘absent’ to the immediate gaze of the
psychiatrist.” (p.28). “Psychiatric discourse has… produced a taxonomy of natural
diseases, of which certain symptoms, such as hearing voices are viewed as first
rank signs. The ‘pure’ psychotic states are those where psychotic symptoms are
viewed as signs of disease and illness, such as schizophrenia. These are often
viewed as degenerative and linked either to structural changes in the brain, or
biochemical or neurological deficit or imbalance (the type 2 syndromes).” (p.29).
However, on noting this Blackman moves on to another aspect of the psychiatric
gaze, the ‘enfeebled personality’. “This is based on a notion that there are
certain persons deemed constitutionally lacking in the so-called normal propensities
to equip them to deal with the stresses and strains of life.” (p.29). the
method by which this enfeebled personality is ‘discovered’ is the psychiatric
interview.
Blackman argues that there are two phases of the psychiatric interview; “the
first is a description of the present mental state and involves a ‘provisional’
diagnosis. The second phase of history-taking is undertaken to pinpoint any ‘patho-features’
of the person’s biography, which may have made them vulnerable, or in psychiatric
terms, ‘at risk’ to a disease process.” (p.30). It is worth noting here that in
a sense this is little difference to ‘formulation’ as an alternative to
diagnosis that is currently being promoted as a radical new approach to mental
poor health and distress. “This ‘social history’ is then used as part of the
grid of perception for making sense of the person’s experience. The discursive
space opened up to make the distinction between what is deemed normal and what
pathological is disparate and heterogeneous. It is a complex assemblage of
concepts, which attempt to make it conceptually possible to ‘think’ in terms of
disease and pathology. These include the status of the ‘personality’ of the
individual, and the context of the experience, which is rendered in relation to
the key concepts of source, vividness, control and duration. However, the most general
specification, which underpins the dispersal of concepts within psychiatric discourse
is the notion of the ‘enfeebled personality’; one who is viewed as unable to
maintain particular kinds of relations with themselves and ‘others’. This personality
is one whose ‘psychology’ is directly linked to biological inferiority or
inadequacy’.” (p.31).
Blackman suggests that there is a split in psychiatric discourse between the
natural and the social. “The natural (body) is made intelligible through
particular ways of thinking about the body and biology, derived in part from
evolutionary theory. Biology is viewed as a static, invariant set of
characteristics which predispose persons to particular forms of thought,
behaviour and conduct. Biology then sets limits on how a person is able to
interact with the social and also the levels to which the social can impact or
impinge upon the individual.” (p.31). these assumptions are then overlaid by
other dualisms such as “inherited/ environmental, somatic/ psychological, psychotic/
neurotic and even the pseudo-hallucination/ hallucination.” (p.31-32). Blackman
reminds us that psychiatry is not simply biologically reductive, but that it
combines this ‘hard’ biology with ‘softer’ psychologically oriented science. Psychiatry
makes possible its particular way of thinking about ‘hearing voices’ by
targeting biology and the social in a way that conceives biology as its originary
point. “Biology is opposed to the social, and the social becomes a measure of
the individual’s competence in social interactions. Social and psychological
life ultimately is explained with reference to biological causes.” (p.32). It
is from this position in psychiatry, that I hope to move to the conception of
voice hearing in ‘psychology’ before returning to phenomenology of voice haring
,and from thence a return to the dreamwork of Freud as an approach to voicework
in hearing voices.
Springtime.
Taking a Dionysian stroll
During Rogation.
The air is fecund.
Twice-wyrded
As a bistort.
I am very aware my writing is ‘loaded’, in some of the prose series I try to get at language and its relation to psychosis, and in my poetry (still improving hopefully) I try to play with language and ‘hidden meaning’.
As it happens a friend asked me to parse some of my writing, so I have copied and pasted my explanation here as a sort of guide.
The orginal pice of writing that I parsed was:
“Is not the problem with ‘just words’ that they can be unjust?
Today, I was enjoying a country walk, listening to the birds and the bees, thinking of the difference between the pleasure of a ‘petit-mort’ and the microaggression of a ‘petite-turie’. “
Here is my exegesis of the meaning behind it:
The first line refers to when people use the discount (a discount is a term i take from Clarke and Dawson’s book Growing up Again: Parenting Ourselves, Parenting Our Children, they are ways to subtly demean people by diminishing thir experience), ‘they are just words’ when someone is clearly wounded by what is said. I play, as you are aware on different interpretations of the possible meanings of the semantics, the intention of the phrase is that they are no more than words but in fact having wounded someone they are clearly more than that, thus a discount. I often use the ‘come back’ “Well, if they are just words they are not worth defending”, but people can be dogamtic in their hypocrisy, so it is worth knowing that the phrase can be parsed with an understanding of the word ‘just’ in relation to ‘justice’, and thus we have the above word play… words are not ‘just’ words (neither demeaned as nothing much nor ‘just’ as in ‘ethical’) but in fact ‘unjust’. What’s more in doing so we indicate that in fact words are not ‘just’ words but aspects of the symbolic lodaded with significance that are not merely the authority of one perspective.
Then i play with words to indicate they are not just words, I talk of a country walk (many academic authors play with the idea of the ‘schizo’s stroll’ it sets a scene), but it is in the country and I am listening to the ‘birds and the bees’ this can indicate nature, it also implies voices, but it also implies ‘sex’. It is spring here and nature is currently noisy with fecund activity. However as in the human nature excuse, where human nature is used as a discount for bad behaviour (it’s just human nature) that implies some human nature overrides other human rights ignoring the need for certain norms to guide social behaviour in one sense, whilst at the same time being a norm that polices any defence against such ‘bad behaviour’ (this is before we get to a distinction of the difference between ‘human nature’ and the ‘human condition’ due to mediation and artifice in everyday lived experience. I was in the country but it was farmland, historically where i am farmland that has been farmed for 4,000 years). boys will be boys is used in the same way, as is ‘birds and the bees’. Except ‘birds and the bees’ relates to consumerism in denial of the deferrence of the death instinct – it is a ravenous undead beast), whereas death is also part of the ‘circle of life’ so to speak.
So this leads me to think how the French have less of an issue with this as their phrase for an orgasm (‘petit-mort’) implies death already. Something the phrase ‘birds and the bees’ lacks 9although of course birds and bees do die). I then move to the phrase in my mind ‘petit-tué’ which means ‘little kill’, rather than death, the state of being dead, it relates to the act of killing, and thus microaggressions that can be understood as discounts, which the phrase ‘just words’ can be. Thus we are left with the issue of just killing or unjust killing – murder – or as Schreber called it ‘soul murder’.
image: detail of installation by Bronwyn Lace