Madness Under Modern Capitalism

Let’s talk about madness. Schizophrenia: from the ancient Greek schizo, meaning ‘split,’ and phrene, meaning ‘mind.’ But of course, in recent history, since around the 19th century, our ways of thinking about ‘schizophrenia’ have become much more complicated: a growing function of social and psychiatric progress. The history of our understanding of this complex manner of madness boomed in around the 1980s, with a neurophysiological descriptive explosion spurred on by new research, resulting in new pharmacological treatments and an eventual explosion in subtypes. This expanding bubble of complications popped somewhat in 2013, when the DSM-5 recommended dropping all subtype classifications, leaving us with alone again with just ‘schizophrenia,’ itself.

Hanging before our psychiatric institutions, our own schizoid selves.
Hanging before its religion, policing morals and condemning to Hell.

Hanging before us, quite intimately, as a reflection on the nature of the self and the possibility of our familiarity with it. Staring at us as a phenomenology of the Other – but, is it also an othering ontology? The majority consensus on schizophrenia since as early as the 19th century has been to regard it primarily as a physical disorder: today, a mental disorder symptomatically contingent upon neurophysiology and specific patterns of neurological decay. However, as Ronny Turner and Charles Edgley argue, “only after behavior is labeled as deviant can it be identified as such & diagnosed as chemically caused.”[1] The specific causal mechanisms of schizophrenia remain elusive. The neurochemicalists put social disorder at only a brain scan away from mental disorder and pharmacological normalization. Their strict materialist conception of the disease downplays or outright denies the significance of sociocultural causes. And this conception is reflected in treatment.

Never mind that recovery outcomes for people suffering from schizophrenia have been shown across a multitude of international studies commissioned by the World Health Organization to be significantly greater for patients in developing countries, where pharmacological intervention is not the standard of care, over developed countries. “Far from being mere incidental cultural music … therapeutic benefits [appear to be] forgone under circumstances of enforced supported dependency.”[2] Never mind that male African Caribbean immigrants to the United Kingdom are as much as ten times more likely to be diagnosed with schizophrenia than young Brits, in spite of the orthodox epidemiologist’s taxonomy of environmental and genetic factors predicting deviations of rates of incidence of schizophrenia within only about a single percent across cultures[3] (similar figures exist in studies of immigrants to the Netherlands.) Even differentiation between rates of early onset in males and females, for a time thought to be one robust and well-replicated result in the tome of our largely uncertain knowledge of schizophrenia, has recently been found to be a confounded finding.[4] The data is simply not as secure as we are led to believe by psychiatry and its affiliated institutions. (Perhaps the nice old owners of the pharmaceutical firms responsible for producing antipsychotic drugs have no vested interests in these matters.)

There are many questions: why the better outcomes for sufferers of schizophrenia in developing countries? Why the increased risk for culturally dislocated immigrants? Social causes and socially structured care. Perhaps these questions jointly suggest an answer, pointing to a radical reconceptualization of schizophrenia as a socially constructed disorder. Of course, this does not detract in any way from its reality, simply put. It is just that we should consider both treatments for and causes of the disease to have a fundamentally sociological character. The mental trauma endured by child sufferers of abuse can be tracked in distinct physiological characteristics of the developmental brain later on in life. Why think that the daily traumas experienced in life within the totalizing technosphere of modern capitalism could not equally mark their tracks in the brain?

We will not lapse into full-blown dealings with Deleuze, here. However, our conception of schizophrenia is determined by several of the various institutions within Western medical science, and so it is suitable to seek answers to these questions somewhere in the framework of sociopolitical assumptions that creates the context in which said institutions lay their foundations. From Levins,

The bourgeois atomistic view of society, as applied to science, asserts that progress is made by a few individuals (who just happen to be “us”) … Individualism in science helps create the common belief that the properties of populations are simply derivable from those of the uncharged atoms (genes) of populations or societies…

The specialization of scientific labor and of command functions from research creates a model of scientific organization that is easily seen as the model for the organization of the world. Nature is perceived as following the organization chart of our company or university, with similar phenomena united under a single chairman, distinct but related phenomena united under a common dean. Thus specialization in practice joins with atomistic individualism to reinforce the reductionism that still predominates in the implicit philosophy of scientists.[5]

Individualism and reductionism: sever the individual from society, reduce the cause of the patient’s condition to something entirely material, or physical. Correct neurological imbalances with powerful dopamine reuptake inhibitors, enforcing treatment within the confines of special types of prisons called mental health hospitals. In India, greater health outcomes for schizophrenics have been attributed to a highly attentive family based care model, based on the specific needs of the suffering individual and typically carried out in the home. Pharmacological interventions are significantly less common.  A recent sixteen month ethnographic study on the standards of psychiatric treatment for schizophrenics in ‘developing’ India finds that “a model of medical care that deemphasizes patient autonomy [i.e., individualization] and the rational understanding of pathology [i.e., reductionism] benefits those diagnosed with schizophrenia.”[6]

It is not that all scientists in the West are themselves bourgeois, but they are largely the ideologues of the ruling class. An inter-institutional struggle between the old Enlightenment ideals for science and its unending search for Truth, and the post-positivistic research cartels racing to some finish line just to finally get it right and to get the last word (and more often than not, to patent it as intellectual property) has created a rift between the laborers of science based on their support or repudiation of commoditization. The poor outcomes of Western medical science with respect to schizophrenia points to a point of contradiction, where the values imposed from the top-down through enforced institutional arrangements that benefit the ruling class might be exposed as oppressive. To root out these oppressive values, we must take aim at the commoditization of science. And this, in turn, will lead us squarely to a critique of the great modern romance between science, technology, and capitalism.

[1] See “From Witchcraft to Drugcraft: Biochemistry as Mythology,” in The Social Science Journal 20.4 (1983).

[2] Hopper and Wanderling, “Revisiting the Developed Versus Developing Country Distinction in Course and Outcome in Schizophrenia,” in Schizophrenia Bulletin 26.4 (2000).

[3] Jones and Fung, “Ethnicity and Mental Health: The Example of Schizophrenia in the African Caribbean Population in Europe,” in Ethnicity and Causal Mechanisms (2005), 227-61.

[4] Jablensky and Cole, “Is the earlier age at onset of schizophrenia in males a confounded finding?” in British Journal of Psychiatry 170 (1997).

[5] Levins & Lewontin, “The Commoditization of Science,” in The Dialectical Biologist (1985).

[6] Sousa, “Pragmatic ethics, sensible care: Psychiatry and schizophrenia in north India,” available in Sociological Abstracts.

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