In my experience people tend to mean one of two very different things when they claim that mental illness is socially constructed.
The first of these is that broader social, economic and historical conditions make people mentally unwell in certain ways. This idea arguably found its most famous express in the work of the philosopher/psychoanalyst pairing Deleuze and Guattari; the rough summary of their work being that the contradictions of capitalism cause people to become schizophrenic.
This kind thought is interesting, complex and something which I obviously have a lot of time for. However it is the second meaning which I want to focus on in the remainder of this post. This meaning is perhaps better expressed as the claim that “mental illness” is socially constructed; that our concepts and understandings of mental illness are ones created through our social history and as such do not tie onto any objective external reality. The conclusion drawn from this often ends up being that we should recognize them as fraudulent and rid ourselves of them.
It is not obvious how a genealogy- a narrative which tries to explain a social phenomenon by giving a real or imagined history of how it came about- has the power to undermine said phenomenon in this way. In fact when this idea gets dredged up by evolutionary psychologists it tends to get known as the “naturalistic fallacy”, i.e. the mistake made when people treat something’s natural and evolutionary history as somehow determining anything about its current value, since the empirical and the moral are two quite different things. But what is obvious is that many “genealogists” see themselves as doing exactly that. In his genealogy, “On the Genealogy of Morals” Nietzsche makes it clear that his “real concern was with someone much more important than [his] own, or anyone else’s hypotheses about the origin of morality.. What was at stake was the value of morality.” And in revealing (or perhaps imagining) the origins of the Christian system of good and evil in a “slave revolt in morals”, stemming from weakness, impotence and “ressentiment”, his aim was to show the radical conflict between “morality”’s self-conception and the role or function it arose to play, a conflict which had to be covered up with falsehoods. “Weakness is to be transformed into a merit through lies… the impotent failure to retaliate is to be transformed into ‘goodness’; craven fear into ‘humility’; submission to those one hates into ‘obedience (obedience, that is, towards the authority who, so they claim, ordered this submission – they call him God)…; the inability to take revenge is called the refusal to take revenge, perhaps even forgiveness.” (14)
In the last book he completed before his death (“Truth and Truthfulness”), Bernard Williams argues that the “most general reason” for how genealogies are able to undermine their subject in this way is that a “truthful historical account is likely to reveal a radical contingency in our current ethical conceptions. Not only might they have been different from what they are, but also the historical changes that brought them about are not obviously related to them in a way that vindicates them against possible rivals. This sense of contingency can seem to be in tension with something that our ethical ideas themselves demand, a recognition of their authority. The tension here is made worse by a feature of modern ethical systems, that they try to combine authority with transparency.” (20) Genealogies like Nietzsche’s succeed in their aims because the Christian moral system makes claims about an objective- and to a large extent human-independent- morality (and importantly one which assigns the value of “truth” a central place.) If it turns out that the “historical changes which brought [christian ethics] about” are ones solely related to power and domination and have little to do with the appraisal of external moral truths, then it seems that Nietzsche (as the “last christian”) has brought the contradictions inherent in christianity to their logical conclusion. He has used a core value of the christian ethic, truthfulness, to unmask it.
But if “the genealogy of morals” poses a very real problem for Christianity, the two genealogies I’m going to spend the remainder of this post discussing do so even more for western psychiatry (“Madness Explained” by Richard Bentall, and “Madness and Civilization” by Michel Foucault.) Williams admits a role for fictional narrative, since “imaginary genealogies typically suggest that a phenomenon can usefully be treated as function which is not obviously so.” (21) However it is clear that genealogies backed up by historical fact (like those of Foucault and Bentall and very much unlike the genealogy of morals) are going to be able to do more “suggest a phenomenon can be usefully treated like a function”, and instead show that it it arose as such.
But on top of this, whilst the question of objectivity in ethics is one which has always been a live issue, most people who practice psychiatry see it as a branch of medical science, an endeavour capable of uncovering objective truth about the world, and not just being an expression of our own desires, values and reasonings. Because of this, any account which uncovers its contingent, social origins is going to seriously threaten its existence and continued practice.
Like Nietzsche, Foucault both aims to give an account of the social processes which gave rise to our current understandings of “madness” and to show that those processes undermine how the practice of psychiatry sees itself- as scientific knowledge put to humanitarian use. Towards the end of his long social history of madness he feels entitled to conclude that the changes in our understanding of madness “did not evolve gradually in the context of a humanitarian movement that gradually related it more closely to the madman’s human reality, to his most affecting and most intimate aspect; nor did it evolve under the pressure of a scientific need that made it more attentive, more faithful to what madness might have to say for itself. If it slowly changed, it was within that simultaneously real and artificial space of confinement. Certain imperceptible shifts in its structures, or at times certain violent crises, gradually formed the awareness of madness contemporaneous with the Revolution. No medical advance, no humanitarian approach was responsible for the fact that the man were gradually isolated, that the monotony of insanity was divided into rudimentary types. It was the depths of confinement itself that generated the phenomenon; it is from confinement that we must seek an account of this new awareness of madness.” (223.)
Confinement (the removal from society and imprisonment of “mad” and other “degenerate” people ) itself only arose to fill a void left by the decline of leprosy. “Leprosy withdrew” he writes “leaving derelict those low places and these rites which were intended, not to suppress it, but to keep it at a sacred distance, to fix it in an inverse exaltation.” (6) On top of this “madness and the madman become major figures, in their ambiguity: menace and mockery, the dizzying unreason of the world, and the feeble ridicule of men.” (13)
“During the classical period”, he continues (albeit fifty pages later) “madness was shown, but on the other side of bars; if present, it was at a distance, under the eyes of a reason that no longer felt any relation to it and that would not compromise itself by too close a resemblance. Madness had become a thing to look at: no longer a monster inside oneself, but an animal with strange mechanisms, a bestiality from which man had long since been suppressed.” (70) The confinement of madness was therefore necessary for the classical man’s reassurance about the reliability of his own reason.
This is not to say that for Foucault the “science of madness” is irrelevant. In fact he documents in painstaking detail the “explanatory myths” surrounding mental illness progressing through “what had been perceived as heat, imagined as agitation of spirits, conceived as fibrous tension” to the “neutralized transparency of psychological notions: exaggerated vivacity of internal impressions, rapidity in the association of ideas, inattention to the external world.” (129.) But he makes it clear that the role of these “explanatory images” is to serve the practices and rituals surrounding ‘madness’, and that “the enterprise did not proceed from observation to the construction of explanatory images.” (135.) His observation that the explanation for what caused madness could change so radically, and yet these practices did not, is intended to show how little work these “scientific” explanations are doing in the whole process.
(To continue reading this post https://thebeetlebox.wordpress.com/2014/05/28/two-genealogies-of-madness-part-two/)