Abstract
On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing: the title says it all. Owen Whooley throws down the gauntlet to psychiatrists. Their claims to a knowledge of the soul, the psyche, the ego, the mind, or the brain, he says, were never more than a thin veil covering over their profound ignorance. The various “revolutions” punctuating the history of psychiatry like clockwork every 30 to 40 years—inclusive of the present genetic turn—were nothing but 150 years of promissory science (pp. 17–19). They repeatedly have “borrow[ed] credibility on the promise of repaying this trust in the future” (p. 4), but the promise went unfulfilled or worse—Whooley reminds us of some of the worst abuses perpetrated by psychiatrists, from sterilization through lobotomy to horrific neglect—preparing the ground for another round of soul-searching and reinvention.
Given this checkered history, Whooley poses the survival or even the periodic flourishing of psychiatry as “a serious puzzle in need of explanation” (p. 5). The answer, he argues, is paradoxically this very ignorance itself, or, more precisely, psychiatry’s “more or less successful management of its basic ignorance, its ability to mitigate its effects and stave off a final reckoning” (p. 9).
As every good pastor knows, the first step in the management of ignorance is to come clean about it (p. 15). One of the most illuminating aspects of Whooley’s book is his meticulous documentation of how psychiatrists themselves have periodically and predictably taken their own profession to task over its ignorance.
The second step is to qualify ignorance, to give it a particular character “as temporary, as necessary, as damning” and to identify its locus and boundaries. The specific qualities and scope with which ignorance is endowed are “an emergent property of the struggle between interested parties,” and they directly shape the kind of knowledge sought in remedy (p. 13). This is, incidentally, exactly what Foucauldians mean by “problematization.”
The third step—in the best tradition of American religious revival—is reinvention. The sinner, who has appropriately confessed her sins and described them in detail, provides herself with absolution by promising that she will become an altogether new person. Reinvention, Whooley says, is not just rhetorical. It has been also an organizational process, “by which reformers transformed the fundamental purpose and character of the profession, so much so that it appears to be something new altogether” (p. 15). The engine of reinvention, however, is not new knowledge, but the management of ignorance. “Faced with recalcitrant ignorance, psychiatry reinvents itself, over and over” (p. 16).
How many times can an incorrigible shyster reinvent himself and make new promises before the public finally turns their back on him? Apparently five times, but no more (pp. 20–21). The last chapters of Whooley’s book convey the unmistakable sense that the “owl of Minerva flies at dusk”; that he has been able to formulate this bold thesis because psychiatry’s credit for reinvention has finally been depleted. The National Institute of Mental Health, for one, refuses to be taken in any longer. It has declared psychiatry’s vaunted “bible,” the classificatory system of the DSM, to be useless for the purposes of research, mere verbiage covering over profound ignorance as to the ontology of mental disorders (p. 191). Unlike previous reinventions, this one is coming from outside psychiatry, representing a profound threat to its hold over its jurisdiction.
Psychiatry’s time has run out. Its history has been one of habitual reinvention, in which it has “staggered from vision to incommensurable vision. It never achieves its promises, but it does stay one step ahead of attempts to dismantle it” (p. 21). But no longer. The compulsion to repeat the past’s mistakes (there is an unmistakable Freudian storyline to Whooley’s thesis) has caught up with this shapeshifter, who is reflexive enough to look back on its own biography and recognize the arc of collective self-deception (p. 207).
But what is the source of this ignorance that both animates psychiatric reinvention and dooms it? Whooley throws down another, even more explosive, gauntlet. When we look back and recollect this history of repeated reinvention, with its promises and catastrophic failures, we cannot escape the conclusion that it is caused by the fact that psychiatry’s object, “mental distress,” is unknowable (p. 21). While Whooley qualifies this point on the next page—you don’t have to take a firm stance on the knowability of mental distress, he says, in order to appreciate the central role that the management of ignorance played in the history of psychiatry (p. 22)—he returns to it at the end. Ignorance, he says, is “not just built into the role of psychiatry; psychiatry is premised on it” (p. 223). This is because of the stuff of which its object—mental distress—is made. Others have noted as well that when a psychiatric condition is fully understood biologically, it is removed from psychiatry’s jurisdiction and becomes the province of medicine proper (p. 218). So when the object is knowable, it is no longer psychiatry’s. This delicious little paradox indicates that psychiatry’s object is not made of the ailments and complaints of the sufferers themselves, but of the collective fears, insecurities, and incomprehension of the sane, who thereby marginalize, reject, and neglect the sufferers (pp. 219–23).
If this sounds Foucauldian, it is because it is a thoroughly Foucauldian thesis (and Whooley cites the famous, pathos-filled opening lines of Madness and Civilization (p. 219). Yet the force that animates Whooley’s indictment is more personal. In the acknowledgments to the book, he tells the reader about his own father’s struggles with depression, and about the impact this had on Whooley as a young boy. “A chasm of misunderstanding . . . came between me and my father” (p. xi). The full significance of these words only becomes clear at the end of the book, when they gather to themselves the added force of Foucault’s “serene world of mental illness,” where “modern man no longer communicates with the mad man,” to culminate with the claim that “we are all complicit” in psychiatry’s ignorance, failings, and abuses (p. 224).
Owen Whooley has written a magnificent book, but it is not complete. The central conceit of the book—analyzing how psychiatry manages its ignorance—has led him to treat this ignorance itself as (mostly) a constant, an ever-present feature of psychiatry’s ecology that is itself left mostly uncharacterized, undescribed, and unanalyzed. If psychiatry’s ignorance is caused by the fact that its object is a “moving target” made up of both the large-scale campaigns and everyday little dramas of incomprehension and rejection, then it is sociologically knowable. As Goffman argued long ago, who becomes “mentally ill” is a function of sociologically analyzable “contingencies.” Similarly, what becomes of “mental distress” in any given era; what is problematized and what is not; what institutional “funnels” function to convey certain individuals, but not others, toward psychiatric intake; what shape, therefore, ignorance takes and how it impinges on the psychiatric profession—all of these are sociologically analyzable. While Whooley has made some astute observations about these processes in the book (as well as in his earlier work), they are not integrated into the book’s framework, which focuses on psychiatry, rather than on its full ecology. With this insightful, closely argued, and moving book, however, he has indicated the road forward for other sociologists to follow in his footsteps and venture even further.