«And I'm afraid I won't get out alive»: Illness and Unfreedom in Psychiatry

Abstract

Ever since Michel Foucault detailed the connection between psychiatric diagnosis and the cultural-historical paradigm, it has become poor form to think of a diagnosis as analogous to lung cancer or kidney stones. The organic paradigm of clinical psychiatry seemed to have been shaken, replaced by humanistic approaches inspired by existentialists such as Martin Heidegger or Jean-Paul Sartre. However, this discovery has had almost no impact on institutional psychiatric practices. The foundation of psychiatric treatment is still considered to be pharmacotherapy, and the most funded research in the field is pharmacological. Occupying a secondary role in this partnership is cognitive-behavioral therapy (CBT), which nonetheless presents itself as the predominant evidence-based paradigm for understanding the human psyche. CBT is considered most effective in treating depression and anxiety disorders. The cognitive-behavioral approach forms a specific theoretical understanding of a person, defining their place in the world and showing the limits of their influence on it. A basic premise of cognitive-behavioral therapy is positivity, an aim for proactive thinking free of logical errors, thus focusing on the individual's conclusions about reality. By working with these, the psychotherapist teaches the client correct thinking, thereby curing the illness. The illness, in this framework, is conceived as that which imposes a limitation on a person's freedom of thought. A person is free when they can think correctly and is dependent when errors are present in their thinking. Thus, modern psychiatric and psychotherapeutic discourse can be conceptualized as part of the broader philosophical debate on freedom and determinism (the subordination of humans to biology, physics, or logos). By introducing a social approach to psychiatric diagnosis, Foucault did not overcome this debate but complicated it, adding another variable to the equation: society, which defines the criteria of health and sickness. So, psychotherapeutic discourse has repeatedly only made a person dependent, but the point is to liberate them.