It is Foucault who warns us that often times the most repressive functions of modern society are carried out by institutions whose mission appears to be benign, if not actually helpful. In his work, he points out the ways in which modern society has removed the most obviously brutal forms of repression in the name of social progress. For example, the contemporary narrative about institutions of incarceration and punishment argues that we have moved beyond brutal forms of punishment in favor of more humane approaches to social deviants such as delinquents, criminals, and mad people. However, Foucault argues that what we have really done is to become more sophisticated and less obvious in the ways in which we discipline and control minoritized populations.
For example, our “enlightened” account of madness describes how we now have mental health and trauma informed care rather than brutal asylums. We are told that we are working towards destigmatizing mental illness and only use institutional incarceration and forced treatment under extreme circumstances. Instead of ridiculing the mentally ill, a contemporary mantra, in today’s society, is to treat each other with kindness. Models of relational care permeate the helping professions with the admonition that we all need psychiatry and psychology to heal our trauma and toxic relationships. The common discourse is that mental health services provide enlightened and humanistic evidenced based care for those suffering emotionally and psychologically.
However, Foucault would argue that all of this is an elaborate architecture designed to create subjects amenable to psychiatric and psychological control on behalf of the logic of the existing system. I could say the “ruling class” here, but even the top echelons of global virtual capitalism are subject to internalized discourses of psychological and psychiatric pathology. If we accept Foucault’s assertion that the industry of mental health services is a facade for discipline and control, then those subject to its assistance are at risk for misunderstanding the conditions of their own oppression.
The horror of all of this is that there actually is quite a lot of dystopic lived experience across our society today. The social field of civil society is increasingly vacuous. The social structures that were designed to provide social comfort and a sense of belonging are less and less functional all the time. As a result, an increasing number of us feel psychologically or emotionally broken or inadequate. Regrettably, this very real sense of disconnection is precisely what the mental health industry is designed to exploit but not necessarily remedy.
I don’t mean to say that the practitioners of this array of mental health services are in any way pernicious or less than sincere in their efforts to be helpful. They see suffering and they do their best to alleviate that pain. It is the social architecture in which they work that is suspect, not the practitioners themselves. Of course, that is not to say that there are not less than ethical practitioners, but they are not the majority. Not are they emblematic of those whose good intentions inform their work every day.
But there is a reason for burnout that is not to be found in the toxicity of those seeking service. The frustration that underlies burnout, at the most basic level, is that workers believe that what they are doing should work. And there is enough short-term success to keep that belief in the mental health system operational. There are enough patient blaming discourses, such as the as the belief in resistance to treatment, denial of symptoms, transference, and so on to give succor to the worker when what should work doesn’t yield the desired results. However, I would argue that, at the core of burnout is the gradual realization that there is an intolerable degree of futility in all the good intentioned practices of psychiatric and psychological care.
Of course, there is research that gives an ongoing discourse of evidence-based practice that tells us that what is done is effective. And for a while, perhaps for a whole career, this belief that what we do should work can allow for a level of comfort and a blurring of our vision such that we highlight our successes and excuse our failures. However, buried in statistics and integral to the ability to find evidence-based methodologies is the ability of the system to set the parameters for success.
The question of how we measure the effectiveness of psychological and psychiatric intervention is saturated with the logic of the dominant system of virtual global capitalism. The anti-psychiatrist Franco Basaglia said that he believed psychiatry should be a practice of freedom that liberates patients. Notably he suggested that such liberation should eliminate institutional control and social exclusion. In his work on dismantling the asylums he envisioned a practice of psychiatry that focused in enhancing lived experience, sociality, and human dignity. He maintained that true healing necessitated open human connections.
Certainly, in a field such as CYC the question of true care is also reliant on lived experience, sociality, human dignity, and open human connection. But when we look at the evidenced based outcomes that indicate success in current psychological and psychiatric practice, we are largely looking at symptom reduction and behavioral compliance with social norms.
Even when fields such as social psychiatry take sociality into account, it is in the service of symptom reduction and behavioral stabilization. The question of open human connection and a richness of lived experience is often reduced to mood stabilization, emotional regulation, or a reduction in what is perceived to be psychosis. In other words, to be successful, psychiatry and psychology have narrowed the focus in such a way as to define success through observable behavioral measures. Those measures dovetail with the societal expectations of compliance and acceptance of what is considered normal under contemporary social conditions.
Of course, I could be seen as being overly critical here. Surely the helping professionals have some degree of intrinsic worth. And I would reply that the possibility is there, as indicated at the edges of mainstream psychiatry/psychology/social work. There are those practitioners whose work is centered on liberating those they encounter from the strictures of virtual global capitalism. However, too often their work is co-opted and turned to the needs of an ever more voracious marketplace of mental health remedies. The truly radical nature of work such as humanistic, critical, feminist, and transpersonal psychology is subjected to a substantive revision and turned into something as benign and socially palatable as technologies of self-help. Similarly, the liberating potentials of psychedelics are quickly being turned to creating more creative workers for corporate capital or increasing the capacity for tolerating an intolerable set of life circumstances.
It is within this context that we find the emotional and psychological world of young women. To think about young women’s suffering and our response to it, it is important to acknowledge that the relationship between women and psychiatry has always been fraught. To say that psychiatry has a history of misogyny is to state the obvious. Women have historically been over diagnosed and incarcerated for a range of behaviors that in men were seldom questioned. Women’s suffering and women’s drive towards physical, emotional, and psychological emancipation from patriarchal society have often been pathologized.
The use of diagnosis to obscure domestic abuse, sexual assault, and incest has a troubling history dating back to the foundations of psychiatry as a medical discipline. Well into the 20th century women’ sexuality was considered a source of psychological and psychiatric dysfunction, with women being incarcerated and subjected to brutal regimes of treatment as nymphomaniacs or hysterics. Husband or fathers could legally commit women for being perceived as having too much sexual desire or being disobedient. Such commitments occurred without trial or appeal. Unmarried women who had children out of wedlock, disobedient young women or wives, sex workers, lesbians, and sexual assault survivors often faced such diagnosis and incarceration. Women who were incarcerated were subject to physical restraints, ice baths, aversive shock therapy, lobotomies, and surgical mutilation. In more recent times, most of the most draconian elements of psychiatry’s relationship with women have been significantly moderated. However, there are still significant anomalies in the diagnosis of women vs. men.
So, when young women encounter the mental health system, they enter a system that has a dubious history of being helpful to them. This is crucially important in the 21st century where there are significant indicators of stress and distress among women in general. For young women trying to make sese of the world they are inheriting, their pain and suffering makes them particularly subject to the seductions of mental health/psychiatry as a way of explaining their pain and sense of dislocation.
In a recent article in the New York Times, psychiatrist Suzanne Garfinkle-Crowell expressed her concerns about the way that young women have incorporated the language of psychiatry into the ways they describe themselves and their place in the world. She notes that previous generations avoided being diagnosed by psychiatric workers, or when diagnosed tended to hide it. The prevailing belief was that to have an identified mental illness meant there was something wrong with you.
Dr. Garfinkle-Crowell notes a significant shift in the way that young women are viewing their relationship with diagnosis. In a twist on destigmatization of mental illness, young women appear to be seeking a diagnosis as a key element in their description of who they are. She states that the young women who are coming to see her in her practice
were announcing their diagnoses — attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, depression — almost before telling me their names … The patients of this new wave were talking in therapy-speak, and their therapy hadn’t even started.
This internalization of diagnostic categories as self-descriptors used to be something CYC workers found in young people who had been in the system for many years. Such young people as veterans of social services had seen a lot of social workers, psychologists and psychiatrist and been in various forms of therapy for most of their childhood. Those of us working with these children and youth would often describe how fluent they were in “therapy speak.”
But there was always a cynical and ironic edge to the way in which these young people used the language of therapy. The most therapeutically experienced would often use their own diagnoses (and there were often many) to signal a passive aggressive anger at the futility of their encounter with mental health. Or they might use it as a method of avoidance, hoping they if they spoke the code clearly enough and seem to have psychiatric self-awareness, the worker would leave them alone.
The phenomenon that Dr. Garfinkle-Crowell is describing appears to be something else. She suggests that there is a deep acceptance of the language of diagnosis and that these young women may be using such psychiatric descriptors in a different way. Certainly, they are not using them in the way the community of helping professionals do. That is, as a scientifically-based assessment of pathology that can be linked to evidence-based treatment. Nor are these young women using their diagnosis to indict or parody the professionals trying to be of assistance. Instead, they are producing a self-narrative by finding information about diagnosis on social media and AI and then self-diagnosing. In short, they are using frameworks of psychiatric pathology as coping mechanisms to make sense of the level of suffering they are experiencing in their lives.
The use of social media as a forum for discussing young women’s experiences and feelings is often inclusive of a search for labels that can make sense of their suffering. In a society saturated with mental health discourses, it might well seem quite sensible to use the common discourse of therapy speak and diagnosis. That said, I would argue, along with Dr. Garfinkle-Crowell, that the use of this kind of cultural shorthand obscures the capacity for talking in real terms about the life struggles young women are facing. The use of psychiatric nomenclature as a significant set of descriptors inducts young women into the world of psychiatry and psychology that has seldom been kind to women. It also interferes with the world of young women talking about themselves and with each other in their own language and on their own terms.
For those of us in CYC, we know the value of young people’s unique vernaculars as a way to describe their world away from the world of domination and control that is too often the world of adults. Therapy speak and diagnostic descriptions are a massive colonial incursion into the world of young women. It is crucial to our work in CYC that we find way to undo this loss of local language. Otherwise, the capacity for the kind of relational work we aspire to will be at serious risk. If young women can’t find their own voice, then we will have lost a very important part of our socio-cultural ecology. That loss is significant and we should see it as the foreshadowing of more losses to come. And in the world today we don’t need any more losses.
