Asylums role in understanding of mental disorders - Essay Example

Sociology Asylums’ role in contemporary understanding of mental disorders For a long time,human society was divided inequitably on those who are considered to be normal by the majority, and on those who are not. In fact, this definition exists for now when some mental disorders (like depression) are not taken seriously. On the contrary, some of them are harshly judged. It’s fair to say, that nowadays people seem to be more open in discovering something strange. Because of the globalization and postmodern tendencies people get used to strangers. Despite that it would be unfair to think of modern people to be less prejudice to each other, in medical field change towards understanding are undeniable. In contemporary Western society mental disorders are no longer reason to be ashamed, but a health condition which is needed to be investigated carefully. To reach this idea mental disorders had traveled a long way. Historical understanding of mental disorders In Ancient Greece tradition two quite opposite thoughts existed on a subject. From the one hand, “madness had become the condition and fate of minds divided against themselves” (Porter 2001). Like in ancient plays, Greeks have seen something fatal and extraordinary in madness and associated madness with human’s soul suffering. About mental disorders were spoken “in terms of a heart or brain, blood, spirits and humors” (Porter 2001). On the other hand, on a question what can be done for a mad person, there was a strict Hippocratic answer – a medical treatment. Madness was considered as a disease which was needed to be treated in a way all sicknesses were treated. “The contrasting models of mental alienation developed by the Greeks – madness as moral perversion, madness as disease – were assimilated within Christendom” (Porter 2001). The treating process became a lot about religion. People with mental disorders were considered to be other God’s fools, or (more often) possessed by demons. For a religious group mediaeval Europe was madness considered to be demonstration of heretical thought, and people with mental disorders were treated like heretics. Even in 1621 when English author Robert Burton, who had studied own depression for years, in this book Anatomy of Melancholy spoke about Satan to be responsible for mental disorders and required praying and fasting as the treatment. There’s a clue already in Burton’s book title which discovers doctors’ view on mental disorders. Doctors and scientists were looking for a madness to be revealed through a human body. “Decartes’ philosophy […] his strict division between mind and body led physicians to concentrate on the body machine and to neglect the psychological, social and environmental aspects of illness” (Capra 1982). There were physical symptoms to be observed without a view to go deeper and distinguish the disease’s origin. According to this philosophy, every problem should be visible and evident, and only therefore, true. “Although neuroscience has undeniably revolutionized our understanding of the brain, it has failed to enumerate even one instance in which neurobiology alone can explain a psychological experience” (Deacon 2013). Foucault admits that doctors up to the later XVIII century never really were looking for a disease to be cured. An identification of the disease was more important (Foucault 1973). Somehow medicine had moved over the individual. If originally medicine existed inseparably from the human’s sufferings and in order to soothe them, later the disease itself was considered like something autonomous which was needed to be classified and observed, and described despite the individuality of a case. Illness could be found only where an abundance of symptoms was presented. Unsurprisingly, for a long time mental disorders couldn’t be studied in appropriate way within such a worldview. Social request on asylums For a social institution to exist a request on such an institution should come from the society. But up to the later XVIII century there wasn’t such a request on asylums. There were general hospitals. They were places where people whether were brought to die in a few days, or places for poor who cannot afford home medical care. There was something indecent about being in hospital, because these institutions were simple, and in mass consciousness were associated with poorness and deprivation. Indeed, as there was no classification by diseases all unhealthy people were kept together in hospitals: infections, alcoholism, mental disorders etc. “Madhouses have existed to deal with troublesome people” (Porter 2001). About hospital and madhouses were spoken in the same way as about prisons and orphanages. “In England, the family was expected to shoulder responsibility for crazy relatives. The insane was generally kept at home” (Porter 2001). Situation varied along the Europe. While in XVII century in France there were a lot of hospitalized people, in England family care was more common way up to 1850s. The same family care tendency was spread in Scandinavia, and in Poland. In Russia people with mental disorders were usually kept in religious houses. Therefore health institutions varied depending on different political systems, the major thought was clear: mental disorder is a family business. How to deal with the mad relative it’s up to family to decide. It was the change in politic life in France that pushed medicine towards institutionalization, Foucault says (Foucault 1973). After the revolution at the end of XVIII century a lot of incompetent doctors appeared from nowhere and therefore, a social request on a governmental control for the medicine had appeared. An argument on a subject of medical theory studying and practice began. Also after the era of Enlightenment there was firmness that between “healthy” political system and health nation there’s a tight connection. People diseases come from poor conditions of life and general ignorance. “Political thought or the mentality of government since the 18th century has been concerned with the population and the economic and social health and well-being of the individuals of which it is comprised” (Nettleton 2002). So despite that family care was a cheaper way for a government to provide medicine, institutionalization process began. Discovering mental disease Before the end of the XVIII century mental disorder had not implicated an obligate hospitalization, firstly because from the doctors’ point of view family care was better. Doctors thought, patient in his natural environment would be better cared. With the institutionalization process on going, doctors’ cooperation and communication increased. The scientific medical thought rose in order to discover the truth about diseases, and started to settle appropriate conditions (Foucault 2008). It was first discovered in clinics, that the idea of keeping mad people in their natural environment was wrong from the scientific point of view. Symptoms could abscond because of the family care while in clinic patient were in “scientific environment” therefore, ready for an analysis and studying. Foucault points, that in clinics doctors at last received a full access to human body, meaning an access to a living body (Foucault 1973). That is what caused a revolution in a medical thought. Before clinics, doctors both had limited access to a living person and were unable to analyze individual symptoms, or doctors had full access to already dead bodies. Mental disorders could be analyzed only while the patient is alive. Mental disorder may leave no marks after the death. When anatomy alone had failed to explain some of the diseases, the question rose naturally: what if there are diseases which are located nowhere in the body? Reading symptoms was no longer a satisfied answer. There were symptoms, but no origin. Doctors began to think that there must be another area, somewhere beyond organs. And also there must be diseases which can only be studied and distinguished while patient is alive. This discovery had forever divided diseases on organic and nonorganic (mental) ones. It had reasoned doctors to go further, deeper in patients’ individuality. Patient was no longer a subject of own disease, he had turned into an individual object again. Foucault says this finding that the death not necessary reveals the disease and indeed, quite opposite may hide a disease for ever, has established an important relation between life, disease and death (Foucault 1973). “Clinical experience […] that opening up of the concrete individual, for the first time in Western history, to the language of rationality” (Foucault 1973). Order for disorder As there was no an obligate hospitalization, there never was a determined treatment for mental disorders. Usually, patients were required either to walk spending more time with the nature, relaxing, traveling in order to calm mad thoughts, or on the contrary, patient’s disillusions were increased by doctors in order to reveal those disillusions before the patient. “Mental health is particularly prone to negative judgments, because the very definition of the problem is linked to persons’ self or behavior” (Bury 2005). Foucault admits that hospitalization increased when in XIX century society had started to think about madness as of disorders of feelings, and about an “ill will”. Clinics than were considered to be those places where an “ill will” can become normal again under the control of the “normal” orthodox will of a doctor (Foucault 2008). That means one human’s will should be suppressed by another human’s will in order to put an “ill will” within “normal” desires and rules again. Hierarchic relationships in asylums were established. There were very strict rules and punishments for patients who neglected subordination and commands. And yet at the same time clinics were the places where doctors practiced their theories on patients. Foucault comes with the metaphor of a theatre (Foucault 1973). He stresses on the duality of clinics’: “manifestation of truth in accordance with the norms of knowledge and of a production of truth in the form of the test” (Foucault 2008). With Louise Pasteur’s discovery of microorganisms, there was a revolution in organic diseases treatment. Foreign organisms just were needed to be removed from patient’s body and then patient will be cured. It was impossible and absurd to do the same with nonorganic diseases, when there were no foreign bodies in mentally disordered individuals. Yet some attempts were made by psychosurgery and psychopharmacology. With less success and with much pain for the patients biomedical treatment was applied up to the middle of XX century. Among the main questions which XIX century psychiatry had raised, was this one: if doctors when treating mental disorders should interfere with the patients’ psychic, then how far can they go? Foucault reminds an example of famous neurologist of the XIX century Jean-Martin Charcot and says his patients soon began to suffer from duality of clinics’ functions: they had started to demonstrate those symptoms they were expected to demonstrate according to the description of a mental disorder (Foucault 2008). That meant the doctor was interfering into patients’ reality and dictating the way of behavior. Naturally, the question, how doctors’ interference could be exposed, had raised concerns, and there was no answer. Post-structuralism and antipsychiatry “In the XIX century the limited success of the biomedical approach to mental illness inspired an alternative movement - the psychological approach - which led to the founding of the dynamic psychiatry and psychotherapy of Sigmund Freud and brought psychiatry much closer to the social sciences and to philosophy” (Capra 1982). Some modern tactics then were discovered, like laying on a lounge and talking constantly in order of opening consciousness before the doctor. Payment for the treatment serves as a guarantee that a doctor won’t harm his patient by interfering in patient’s reality etc. (Foucault 2008). But the most revolutionary were poststructuralists’ thoughts on a subject. If we admit that we live in post-modern society, then we shares contemporary concerns about rationality, discipline and control, and think about social structures to be re-organized in case suppress individuals (Williams, Gabe and Calnan 2002). The main subject of Foucault’s concerns is a control upon human’s mentality and individuality, especially in those environmental conditions (as asylums) where it is socially approved. As a poststructuralist, Foucault sided with “leaders of antipsychiatry movement launched in 1960s – notably Ronald Laing in Britain and Thomas Szasz in USA – who denied that madness was a disease”, but another form of social control upon people who are different (Porter 2001). The idea of antipsychiatry is to slash doctors’ power and reject the duality which exists in original asylums. People with mental disorders should not be kept in any specific institutions, and these specific institutions should go through a self-reorganization. Actually, there’s a lot of “self-” in antipsychiatry, like “self-care” and “self-help”, because “modern western health care advanced liberal rationality” (Bunton 2002). For a patient there’s the main role, not for the doctor. Antipsychiatry is abdicant of patients’ responsibilities on a treatment by giving patients knowledge about their conditions honestly and discovering ways in which mental disorder can be improved up to normal. But all decisions patient makes by himself. He treats himself, and either stays disordered or cures (Foucault 2008). What most important, antipsychiatry abandon the whole idea of mental disease and that social isolation mentally disordered individuals usually experience. “Once someone attracts psychiatry diagnosis they often find themselves subjects to other’ decisions making and others’ definitions of their needs and problems – even when they are not subjects to compulsory admission to hospital and the others are friends as well as mental health professors” (Bames and Bowl 2001). With the time passing, people with mental disorders have traveled a long way to make the society understand a singularity of their condition. New challenge for them is to be accepted by the society, and not isolated again. Scientific development, contemporary postmodern cultural tradition and especially globalization tendency open a great ground for this acceptance. Reference list Barnes, M., and R. Bowl, 2001. Taking Over the Asylum. Palgrave Macmillan, New York. Bunton, R. 2002. “Popular health, advanced liberalism and Good Housekeeping magazine”, in Bunton, R. and A. Petersen (eds.) Foucault, Health and Medicine. Routledge, London, pp.223-249. Bury, M., 2005. Health and Illness. Polity Press, Cambridge. Calnan, M., Gabe, G. and S. J. Williams (eds.) 2002, Health, Medicine and Society: Key Theories, Future Agendas. Routledge, London. Capra, F., 1982. The Turning Point: Science, Society and the Rising Culture. Simon and Schuster, New York. Deacon, B. J., 2013. “The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research”, Clinical Psychology Review no 33, pp. 846-861. Foucault, M. 2008, Psychiatric Power: Lectures at the College de France, 1973 – 1974. Picador, New York. Foucault, M., 1973. The Birth of Clinic. Routledge, London. Karban, K. and B. Fawcett, 2013. Contemporary Mental Health, Theory, Policy and Practice. Routledge, London. Nettleton, S. 2002. “Governing the risky self: how to become healthy, wealthy and wise”, in Burton, R. and A. Petersen (eds.) Foucault, Health and Medicine. Routledge, London, pp.207-223. Porter, R. 2001, “Mental Illness” in Porter R. (ed.) The Cambridge Illustrated History of Medicine. Cambridge University Press, pp.278-304. Read More