The clinical significance of these findings is unclear. How adverse these apparent brains changes are requires further elucidation.
(With thanks to Mad in America research news item by Peter Simons)
Critical comment and debate about psychiatry
Critical psychiatry is the name for an approach that encourages a self-critical attitude to psychiatric practice. An adverse consequence of the term 'critical' is that it tends to have a negative connotation. In this sense, 'critical' means 'inclined to find fault, or to judge with severity'. However, 'critical' also has other meanings, such as 'being characterised by careful, exact evaluation and judgement'. Also, it may have something to do with a crucial turning point, in this sense meaning 'of the greatest importance to the way things might happen'. These latter senses are included in the way I am using the word 'critical' in relation to psychiatry.There is a problem about how oppositional to be about the current state of modern psychiatry (see eg. previous post). Critical psychiatry has never hidden the fact that it grew out of what mainstream psychiatry has called “anti-psychiatry” (see eg. another previous post).
Postmodernity is modernity coming of age: modernity looking at itself at a distance rather than from the inside, making a full inventory of its gains and its losses, psychoanalyzing itself, discovering the intentions it never before spelled out, finding them mutually canceling and incongruous. Postmodernity is modernity coming to terms with its own impossibility; a self-monitoring modernity, one that consciously discards what it was unconsciously doing.Bauman’s both/and understanding of modernity fits also with my understanding and use of Foucault’s oeuvre over the years. Unlike Scull, at least as Duncan describes his thinking (see previous post), I do not see Foucault as for or against the Enlightenment. Such broad brush, ‘metanarrative’, judgements do not do justice to the complexity and contradiction contained within particular discursive communities. When you combine Foucault’s early work on madness with his later work on discursive practice, power dynamics, and cares of the self, what you get, as I read it, is much more of a process critique than a content critique. The critical edge of concern is about who gets included in knowledge making, who is excluded, why and how are these inclusions/exclusions made, who benefits from making knowledge one way verses another way, who is hurt, who cries out in pain and protest, and how much openness is there to diversity and multiplicity of knowledge practices, world views, ways of life, and various aesthetics of existence?
A basic premise of the disability rights movement is simply this: Nothing About Us Without Us. The makeup of the Commission violates this basic principle. Just as women would not accept the legitimacy of a commission of “expert” men to define women’s needs, or ethnic and racial minorities would not accept a panel of “expert” white people to define their needs, we similarly see the Commission as basically irrelevant to our struggle to define our own needs.Chamberlin argued that Bush’s reform process lacked the “expertise on the consumer/survivor experience” as well as the “expertise of disability rights activists, those knowledgeable about the legal and civil rights of people diagnosed with mental illness, and experts in community integration”. As I see it, this work of inclusion and diversity around mental health and mental difference continues to this day.
[A]n integrated biopsychosocial approach is not specifically dependent on systems theory, as evidenced by the psychobiology of Adolf Meyer. In Meyer’s understanding of science, there is a hierarchical relation of the disciplines with the lower or simpler categories being pertinent to, but not explanatory for, higher or more complex categories. This is comparable to systems theory, but Meyer made no attempt to create an overarching theory as in general systems theory. Von Bertalanffy ... himself recognized that there had been many systems-theoretical developments in psychiatry that could be traced to Meyer and others, similar but separate from general systems theory itself.
The brain can only be adequately understood as an organ of a living being in its environment. April 23, 2020There are limits to trying to understand human action in terms of the brain:-
That doesn't mean that neurobiology is not important; nor that the explanation of human action is merely in terms of the psychosocial.The brain cannot read or write, it cannot dance or play the piano, and so on. Thus, I am rather glad not to be my brain, but to only have it. April 23, 2020
Neurobiology and all other sciences emerge as a specialist form of human practice originating in the lifeworld, yet without ever gaining a position outside of it. The familiar world of everyday experience in which we coexist with others remains our primary and actual reality. April 17, 2020
A personalistic perception of the human being does not mean a rejection or devaluation of the naturalistic attitude as such. May 5, 2020The reason that we need a personalistic perception is that:-
In a world without subjective experience there are no longer signs, nor symbols or information, representations or meta-representations, meaning or sense. April 23, 2020
Reflecting, feeling, wanting, and deciding—none of these can be found at the physiological level of description because these concepts do not exist there at all. April 23, 2020
What could be explained about people if one only described monotonous, electrochemical processes on their neuronal membranes? April 23, 2020Furthermore:-
Neuronal processes are vehicles of meaning making and merely part of over-arching life processes that include the organism as a whole and its environment. The definition of mental disorder depends on subjective and cultural factors that fall outside the domain of natural science. May 5, 2020And:-
Seen in isolation, the brain is merely a fragment; however, in the context of the organism and its environment it can become a mediator for relational and intentional processes. May 5, 2020
The brain is embedded in relational phenomena, yet it can only mediate them and not produce their meaning. May 5, 2020
The brain is a socially and historically shaped organ, whose functions of transformation and pattern formation enable biographical experiences to be turned into permanent dispositions and capacities. May 5, 2020We need to have both naturalistic and personalistic attitudes:-
It is erroneous to identify brain with human subject and to look inside for what makes up the person. Human persons have brains, but they are not brains. We have no other choice but to refer to ourselves as animate, embodied beings in 2 kinds of speech of lived and physical body. May 5, 2020
The dual aspect of the human person corresponds to two basically different attitudes: namely, those we can adopt towards ourselves, and those in relation to others. We described these as personalistic or naturalistic attitudes. May 5, 2020As I've said before (eg. see previous post) referring to Kant, the mind-brain problem is an enigma that can never be solved.
A person’s "eccentric positionality" (from Plessner) ie. the ability to adopt a reflective position in relation to himself as well as his bodily existence, means a person can never get behind his perceiving body. His self-relationship remains irreducibly ambiguous. May 5, 2020
People not only live, but they lead their life, and in this way they also form themselves. The brain is involved in these circular structures as an organ of mediation and relationships and as an organ of the human person. May 5, 2020There needs to be new approach to mental health research, as suggested by Wellcome (see previous post).
Attempt at “localization of the mind” through research into brain activities represents no future-oriented research program. An ecological neurobiology is rather obliged to draw on the integrated approaches of dynamic systems theory, psychology, cultural studies, and philosophy. May 5, 2020The final sentence in the book is:-
We are not the figments of our brains, but human persons in the flesh. May 5, 2020
physicians have ... allowed themselves to be confined within the fairy circle of antiphlogisticsm, and by that means to be diverted from the more important management of the mind (p.4)Pinel's approach which was called traitement moral (translated as moral treatment) gave preference to "ways of gentleness" and minimised the use of restraint. Essentially it involved the use of contrived situations, artifice and pious fraud. A variety of strategies were used to control difficult patients, including stern warnings, the manipulative use of food and privileges, and physical restraints, as well as various theatrical gestures designed to shock patients out of their morbid ways of thinking.