A Field Guide to Getting the Lost Art of Unrecovery (part eight)

Filed under:UnRecovery — posted by Schizostroller on August 3, 2018 @ 8:07 am

There is a question prevalent in Honneth’s work on Verstehen with regards mutual understanding and recognition and diagnosis , especially when one takes into account the work of Michel Foucault in his book the Birth of the Clinic and the shift from the patient speaking for himself to the gaze of the physician, the therapeutic relation’s historical relation to psychoanalysis, and from there to the later history of psychiatry, to which we can add Michel Foucault’s observations with regards Pinel and Tuke and the question of a possible preference for chains rather than therapy that is later taken up in Discipline and Punish with regards his critique of Benthamite utilitarianism and the disciplinary society . It is here we get to the ideas of ‘techne’ whether Heideggerian or Foucauldian (analysed in the History of Sexuality as well as Discipline and Punish ) and we then have to tackle the relation of diagnosis and ‘recovery’ to techniques and strategies used in treatment, that are always situated from a Gramscian hegemonic point of view within an economic discourse (both supportive of any dominant hegemony and always working counter to it, it is here we can really get to grips with a Foucauldian analysis of power, and specifically to mental health we can bring in the work on the history of social movements of Nick Crossley , and his argument that these different intensities of power in the different truth claims to power of mental health social movements and psychology, social work, nursing and psychiatry are working in a competitive field of knowledge and influence, and it is here a criticism of recovery discourse really takes place). What are the methods and practices (techne) used in nursing? What is the clients’ relation to these techne, his/her experience with regards the institutional intentions of the NHS with regards his/her care?
Perhaps there is a way of looking at problems of diagnosis and cure where one thinks of the distinction between letting something be as it is, specifically as something which resists understanding, and trying to ‘understand’ something, where ‘to understand’ is equivalent to working out where something should be (i.e. categorising), Phronesis. There is a difference between the different words for understanding, Phronesis and Verstehen, as a matter of hermeneutics. A theorist who dealt with this was Habermas who when pressed for a translation into English of his use of Verstehen (as it it’s meaning is vague) said ‘consensus’. However, it also means ‘mutual understanding’ in a sense that might be closer to Honneth’s use of Recognition, where one does not have to diagnose but ‘understand something for what it is’ ‘or someone for ‘who they are’ rather than the way two subjects ‘need it [the thing] to be about’ which Verstehen can also mean, ie consensus. However, the level of ‘understanding’ that is phronesis, which is a more diagnostic gaze, may move from epistemology to ontology, or at least that is the truth claim of psychiatry in its discursive addition to knowledge of mental health as a science. There are also issues of power excavated by Foucault in his use of the word ‘gaze’ here as well, we can look to the Birth of the Clinic here as well as Discipline and Punish with regards this. The effect this has on power relations, especially two individuals in an institutional engagement and the different calls they can make on differing power and knowledge bases, not to mention economic bases. How this will affect not just the engagement, but the application of techne and the result on the subjectivity of the one with less power, bearing in mind this power is not contained merely in the two individuals participating but is contained in the broader relations to power, knowledge and economy mentioned. In a sense the individuals involved are conduits of these relations.
Giorgio Agamben’s use of Foucault’s biopolitics takes in zoe and bios . Zoe refers to life in the sense of being alive or dead, bios refers to the art of living, ethics, possibilities of personal fulfilment etc. Another way of looking at the above CS Lewis quote and its relation to a curative gaze with regards mental health issues is to see the tyranny of conscience playing out as a death wish by figuratively looking at zoe versus bios as a distinction between negative liberty and positive liberty, as defined by Isaiah Berlin . Where we see the tyranny of conscience denies the right to define one’s own bios as negative freedom in the name of a zoe death wish, the drive to cure the other limits the more autonomous possibilities of the person ‘suffering’. An example of this is David Pilgrim’s analysis of the terms ‘nuisance’ and ‘danger’ with regards the social control of people with mental health issues . Where a positive freedom, the drive to decide the other’s way of life, is aimed at such individuals as a puritan thanatos denial of vitality, attitudes that people with mental health issues are victims of their own errant behaviour rather than appreciating the potential in the struggle ‘to be’ as a libidinous Eros facing outwards concerned with their own ways to live, ideas and a positive vitalism. It is perhaps here that we can see Foucault’s ambivalence with regards the York Retreat Tuke holistic pastoral working cure for mental health illness in Madness and Civilisation , and later his criticism of the utilitarianism of Jeremy Bentham in Discipline and Punish . The soft ability to punish through ‘care’ or the ‘pursuit of happiness’ as outcome measure rather than happiness as a vital product of a life well-lived.
With Lewis’ tyranny the example is obviously aimed at religious tyranny, but I think there is another economic and political policy one that stems through the relation, or elective affinity that Max Weber outlined in The Protestant Ethic and the Spirit of Capitalism that is then reflected hegemonically within capitalism itself through techniques with regards mental health in NHS (and entrepreneurial mental health recovery – due to the instrumental pursuit of profit) for ideological reasons. This is part and parcel of the critique of instrumental reason of the Frankfurt School found in Adorno and Horkheimer’s Dialectic of Reason and Herbert Marcuse’s One Dimensional Man .
Therefore when critiquing recovery and looking for unrecovery escape vectors we specifically need to look at the use of certain more tyrannical or punitive techniques (those used ‘for your own good’) and their relation to cost effectiveness as extant within the requirements of the system rather than as a result of a more anthropomorphised understanding of the economy (i.e. beliefs that the crisis was due to banker’s greed rather than the way capitalism works – and any elective affinities that may occur between such anthropomorphisation and ideas of the individual subject vis a vis psychological discourse as a result of what are, to be honest, consumerist subjectivities required for certain hegemonic relations with the means of production without capital) or as simply nothing more than the power struggles of psychiatrists versus psychologists for territory (although this paradigmatic competition certainly exists) outside and separate from the workings of the economy.
If we return to the Tuke York Retreat working cure we can return to the relationship between unemployment, the Work Capability Assessment , or moreover mental health disability and the ESA WRAG group and ‘workfare’ (especially the research showing the failings of workfare ), and from that the relation between the Protestant Ethic and the problem of what is valued as work with regards criticisms such as those of Kathi Weeks , and to the relation between recovery, diagnosis and cure from there. The relations of feminism to low paid affective labour, the right to recover – wages after all come from the relation between the supply and demand of available labour and the surplus profit that can be squeezed out of the labour-time they are for, so in this sense the time allowed to recover when related to back-to-work outcome measures will be related to that labour time and therefore recovery from diagnosis fits into the work relation of capitalist exploitation right there, when combined with ESA, WCA tests and outcome measure based recovery techne.
One can then think of not just the needs of those who have specific diagnoses and the very concrete effect austerity has had on the possibilities of autonomous ‘bios’, the possibilities of ways of living, but also hegemonically with regards discursive core beliefs that are related to attitudes towards people with mental health issues as ‘scroungers’ or ‘spongers’ (that one can analyse by looking at sado-masochistic and fascistic theories in both Freud’s Beyond the Pleasure Principle and his Theory of the Group , as well as ideas of microfascism as explicated by Deleuze and Guattari especially where this involves receipt of social security and it’s labour-time relation to diagnosis and recovery becuase one cannot receive ESA, DLA or PIP for mental health issues without a diagnosis.
As a form of techne we can look at CBT, where CBT, and its promotion in policy in a utilitarian form by Layard, is one that has been specifically targeted with regards cost cutting (not just it’s purported efficacy in Layard, and criticisms of such efficacy almost everywhere else) . Where materialist neuroscientists such as Damasio and others can show that there is indeed a relation between emotion and cognition, but the short training, the issues in therapeutic relationship (noted by Richard Bentall ) and the limited hegemonic non-discursive relation to language (a quick perusal of either Saussure or Charles S Pierce will find fault, let alone Althusser or Lacan) leads it to being a subjectivising biopower techne rather than a vitalist biopolitical one (where we use Foucault’s distinction ).
We can look at a similar point in past history to this attempt to cut costs under austerity with regards Andrew Scull’s analysis of the cost cutting behind decarceration in the ‘80s and ‘90s and its relation to diagnosis and recovery then there where medication was claimed to be the factor behind the move to care in the community, but Scull’s historical analysis shows it was costs, and we can look at the turf war between social working, nursing, psychiatry and psychology there, with some arguing that the psychiatrists won back power through CTOs .
One interesting in-road to the question of recognition is Habermas’ communicative ethics and their place in his deliberative democracy and it’s relation to Gramsci’s idea of Hegemony , the place of language in that and RD Laing’s authoritarian nexus and its place in psychosis and from there appreciate that there is the doubling effect of austerity that the average psychotic will hear in everyday life, especially those place in the WRAG who end up in workfare. If we are to look aty a vital relation to the double binds that Bateson notes as important, then outside the family nexus, for those very unwell, or distressed, who find it hard to work, find work, or stay in work, with the threats of sanctions, then given the arguments above here is the vital, zoe, life or death relation. How can a recognition-based communicative practice that looks at the social causes, issues and support involved in mental health nursing help in these circumstances?
Habermas’ communicative ethics requires a critical agency on the part of the speaker in order for the dialogue to be reasonable, from the lacuna in this everyday experience illocutionary aspects of speech will occur (Hannah Arendt would argue this is inevitable ), these illocutionary speech acts can end up, using Freud’s unfulfilled wish fulfilment as an example of a possible route to a micro-tyranny, in becoming part of this hypothetical psychotic’s everyday linguistic experience within their nexus, those aspects of everyday language use uncritical of austerity, rather than active deliberative democratic critical agency, can come across as authoritarian. This is a result of the requirements of everyday citizens to act in certain ways and hold certain relations towards each other, certain performative frameworks, in order for any form of recognition to take place in the workplace, as a result of working within the remits of a policy of austerity. As austerity requires the working class to cut what little resources they have (more and more so as inequality increases ) then these illocutionary everyday affects will tend to be more ‘austere’ with regards acts of recognition with regards shared social space and resources and will be unlikely to create solidarity without at least some cognitive dissonance, thus taking issues in the general mental ‘wealth’ out of any family group nexus to a more social issue with regards the prevalence of psychosis and recovery from it in the long run in the general population.
Unrecovery therefore is an attempt to regain some autonomy in this milieu. Honneth tries in the book Disrespect tries to wrest the fate of Kantian autonomy from the twin critiques of Freud, romanticism and Nietzsche on the one hand “pointing to the unconscious drives and motives of individual action” demonstrating that “the human subject cannot be transparent to itself in the manner claimed in the classical notion of autonomy”; and on the other hand the history of linguistics from the intellectual current of Saussure and Wittgenstein that points to “the dependence of individual speech on a pre-given system of linguistic meanings” showing that “the human subject cannot constitute or exhaust meaning in the manner of transcendental philosophy…[calling] the possibility of the individual constitution of meaning into question, thereby invalidating autonomy in the sense of the authorship of the subject.” So whilst “the psychological critique sees libidinal forces within the subject as something foreign but necessary to its action, the language-philosophical deconstruction of subjectivity is covered with uncovering the actuality of linguistic systems of meaning, and actuality that precedes all intentionality. Both dimensions, the unconscious as well as language, refer to powers or forces operative in every individual action without the subject ever being able to control them completely or even detect them. This conclusion however disturbing it might be for the subject’s narcissism, is largely accepted in philosophy today.”
In Honneth’s attempt to reconcile this thorny subject with Kant’s original thesis on autonomy. To do this he refers to theory of intersubjectivity to formulate a meaningful concept of personal autonomy. He turns to G.H Mead and Donald .W. Winnicott to find the first outlines of a position “which allows the uncontrollable powers of language and the unconscious to be grasped not as a limitation for the acquisition of personal autonomy, but as it’s enabling condition.” And it is precisely this struggle that the psychotic finds him/her/themselves in when meeting the institutions of the NHS and the DWP as well as in the marketplace that we all struggle with.

Conclusion

In this chapter I very much wanted to explore from the psychotic subject’s point of view the narrative arc self-expression can take in not just contemporary late capitalist society but specifically under austerity, something I argue is a new economic policy with respect to post-WWII economics, a period in which the discourse of ‘recovery’ has changed massively, largely in relation to the NHS and welfare state that did not exist previously, but specifically under threat of that social support structure being lost to those who require for reasons of their mental distress. So there is the double quandary of both its institutional governance but also the threat of the removal of a safety net that on humanitarian terms is an improvement on the free market of the Victorian era. As such I have resorted to the linguistic cultural knowledge of society’s musical and other cultural undercurrents: black urban music culture, the Hardcore continuum, hip hop, dance and jazz, as well as the history of the baby of the blues; rock n’ roll, especially punk in order to speak this subaltern but British condition .
There is a thesis that Wright and Bartlett and the contributors involved suggest in the book Outside the Walls of The Asylum that there has been a hidden history of mental health care that goes back through nursing to midwifery and witchcraft, or at least herbal healers, the original community care, hints of the relation to this can be found in Silvia Federici’s book Caliban and the Witch which she traces in relation to the history of capitalism and primitive accumulation. There is a sense where the psychotic is Wolf-head , banished but blameless, who doesn’t quite fit into an iron cage required of the outlaw shaman by the market. A relation to the requirements of personal autonomy that makes the tick box outcome measures of the Recovery Star quite pointless.

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