Power/Knowledge in Mental Health: Technicalisation & Resistance

A University of Melbourne Short Essay Assignment

Under the 3rd-Year Sociology subject "Contemporary Social Theory"

Passed with High Distinction (H1)

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By Benjamin L., written during Semester 1, 2013

Tutor's Comments (E. Sayes):

I'm 7 essays from done marking, and this is the best essay thus far. Your argument is really tight, creative, and demonstrates a really solid understanding of Foucault. Your criticisms are compelling and a real challenge to Foucault. This is a really great essay. I hope you stick with sociology and are considering post-grad study. [Sociology is my minor - in theory this course is reserved for majors. He later said his opinions still stand after marking the last 7.]

INTRODUCTION

            This essay will discuss how power/knowledge and its entailing forms of domination have influenced our understanding of mental health. Since modernity, power and knowledge have become dissociable concepts and their history suggests that the ostensibly benevolent human sciences are actually forms of domination and subjugation (Cuff, Sharrock, & Francis, 1998). We will examine how power and knowledge became so intertwined, how power/knowledge is put into practice, and the relevance of power/knowledge in contemporary understandings of mental health in relation to the self. It is argued that Foucault’s power/knowledge helps us understand how the self came to be defined in the technical terms of a science (Bracken & Thomas, 2010), but this technical form of definition is being challenged in ways that undermine the foundations of the power/knowledge relationship.

Defining Power/Knowledge: Reaching the Soul through Science

            Power and knowledge first became intertwined in the late 1800s. Legal judgement was passed on the psychological dispositions behind a criminal’s acts and punishment was seen as a way to rehabilitate the ‘soul’ (Foucault, 1979). Psychological issues concerning the mind and behaviour became construed as technical problems that were amenable to objective diagnosis and intervention by scientific experts (Bracken & Thomas, 2010). This “medico-judicial treatment” (Foucault, 1979, p. 22) was intended to realign it with ‘the normal’ in society, a norm which was more moral than scientific (Cuff et al., 1998) since descriptive science cannot prescribe normative outcomes without committing a naturalistic fallacy. By understanding problems in scientific terms, power used scientific knowledge to justify its normative authority and prescribe technical solutions.

            However, basing its authority on science meant that power was delimited by the existing body of scientific knowledge since the rules regarding the right to wield power had to be legitimised through the appropriate scientific discourses (Foucault, 1980). Discourses refer to a body of systematically organised and regulated scientific statements that provide us with the lexicon to classify and prescribe (Stevenson & Cutcliffe, 2006). Hence for power to realise its normative goals, it needs to expand its knowledge base by institutionalising, professionalising, and rewarding the production of truths (Foucault, 1980). This brings us to the definition of the power/knowledge relationship: power encourages the production of knowledge, while knowledge defines the legitimate scope of power and provides it with the “techniques and tactics of domination” (Foucault, 1980, p. 102) to realise its normative ends (Cuff et al., 1998).

Power/Knowledge in Mental Health

            Psychiatry forms the scientific discourse underpinning power/knowledge in mental health. This involves a power relation where the ‘mad’ are subjected to professional control, depend on them, and come to understand themselves through this subjected identity (Roberts, 2005). The ‘bible’ of this subjection is the Diagnostic and Statistical Manual of Mental Disorders (DSM): the mental health patient is subjected to a clinical ‘gaze’ where professionals see past “the veneer of normality and interprets behaviours, attitudes, and symptoms as signs” of medical ailments in the DSM (Stevenson & Cutcliffe, 2006). Those described as ‘at risk’ are in need of intervention and the ‘ill’ person becomes reified into a subject of control and object of psychiatric science, especially if they are institutionalised. Patients also encouraged to interpret their own cognitions and behaviours in terms of the psychiatrist’s or other professional’s clinical gaze and regulate themselves accordingly (Roberts, 2005). Also, various forms of professional observations emphasise that the patient is under constant surveillance and any wayward conduct will result in corrective interventions.[1]

            The inculcation of a subjected identity stems from the asymmetrical power/knowledge relationship between patients and professionals. The psychiatrist’s power stems from his/her medical knowledge, and this knowledge provides him/her with various instruments to exercise that power. It is absurd for a patient to tell a psychiatrist to take his medication or face incarceration – the patient has neither the background knowledge to justify this nor the power to effect it. Foucault likens the power asymmetry to the religious practice of confessions, where transgressions were heard and absolved in moral terms (Cuff et al., 1998). Likewise, revelations of thoughts and feelings in psychotherapy (‘confessions’) concern pathological transgressions described in technical terms that patients/subjects are encouraged to internalise and use for self-regulation and self-understanding.

Challenging Power/knowledge

            However, the analytical utility of power/knowledge faces at least two constraints today. Firstly, Foucault’s primary focus was on power relations in an institution/asylum but a significant proportion of subjects are outpatients living outside institutional settings. They are not as dominated as inpatients and a significant proportion even refuse psychiatric referrals or stop attending their treatment programs (Fenger et al., 2011). A second, more fundamental issue is that patients and even professionals have resisted the fundamental power/knowledge asymmetry in psychiatric practice in ways Foucault did not foresee.

            Professional power is now challenged by the increasing legitimacy of patients’ knowledge derived from their experience as sufferers (Stevenson & Cutcliffe, 2006). Foucault acknowledged that the subjective identities imposed by power/knowledge might be resisted by subjects (Roberts, 2005) and different experts may adopt conflicting positions within the same discursive field (Cuff et al., 1998). The nascent service user/survivor movement goes even further and questions the validity of psychiatric discourse itself. Power/knowledge presumes a scientific objectivity (Bracken & Thomas, 2010) and a monolithic sense of the ‘normal’ (Cuff et al., 1998), but the service user movement challenges these by constructing new ways of understanding human experiences and psyches from the patients’ point of view and questions the certainty of biomedical perspectives in understanding mental health (Sapouna, 2012). It therefore moves beyond resisting the forms of control enacted through power/knowledge and attacks the epistemological premises that justify such a relationship between power and knowledge.

CONCLUSION

            In conclusion, it has been argued that power/knowledge is a relationship where power encourages the production of knowledge, while knowledge defines the legitimate scope of power and provides it with the “techniques and tactics of domination” (Foucault, 1980, p. 102) to realise its normative ends (Cuff et al., 1998). In mental health, this is evident in the way the patient becomes a subject of psychiatric power and an object of scientific knowledge. It can also be seen in the way he/she internalises the psychiatrist’s clinical gaze and comes to understand him/herself as a ‘pathologic’ subject who should, accordingly, engage in self-regulation (Roberts, 2005). In contemporary society, this method of understanding the self is challenged: knowledge of an experiential or existential nature is used to challenge scientific knowledge and professional power (Stevenson & Cutcliffe, 2006) in a way that attacks the assumptions of normality and scientific objectivity which underpin the foundations of the power/knowledge relationship. If psychiatric expertise does lose its perceived truth-value among the wider public, it is yet unclear if another authoritative or ‘scientific’ means of defining mental health will revive power/knowledge in new forms.

REFERENCES

Bracken, P. & Thomas, P. (2010) 'From Szasz to Foucault: On the role of critical psychiatry'. Philosophy, Psychiatry, & Psychology, Vol. 17, No. 3, pp. 219-228.

Cuff, E.C., Sharrock, W.W., & Francis, D.W. (1998) 'Michel Foucault', Perspectives in Sociology (4th ed.). London: Routledge.

Fenger, M., Mortensen, E.L., Poulsen, S., & Lau, M. (2011) 'No-shows, drop-outs and completers in psychotherapeutic treatment: Demographic and clinical predictors in a large sample of non-psychotic patients'. Nordic Journal of Psychiatry, Vol. 65, No. 3, pp. 183-191.

Foucault, M. (1979) 'The body of the condemned' in Discipline and Punish: The birth of the prison. New York: Penguin.

___________(1980) 'Lecture two: 14 January 1976'. In C. Gordon (ed.) Power/Knowledge: Selected interviews and other writings 1972-1977. London: Harvester Wheatsheaf.

Roberts, M. (2005) 'The production of the psychiatric subject: Power, knowledge and Michel Foucault'. Nursing Philosophy, Vol. 6, pp. 33-42.

Sapouna, L. (2012) 'Foucault, Michel (2001) Madness and Civilization: A History of Insanity in the Age of Reason, London, Routledge Classics'. Community Development Journal, Vol. 47, No. 4, pp. 612-617.

Stevenson, C. & Cutcliffe, J. (2006) 'Problematizing special observation in psychiatry: Foucault, archaeology, genealogy, discourse and power/knowledge'. Journal of Psychiatric and Mental Health Nursing, Vol. 13, pp. 713-721.

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[1] Foucault uses the analogy of the Panopticon to describe the relationship between external surveillance and internal self-regulation. Word limits prevent the elaboration of this concept. We will instead focus on its material aspects.