"There is little acknowledgment in the mainstream clinical rehabilitation literature that the relationship between clinicians and patients is also a relationship almost irreducibly marked by asymmetrical power relations (Rose, 1996). Clinicalization, that is, reinforces not only the belief that only sanctioned clinicians can understand and attend to psychiatric disability but also that this assistance can only be accomplished through a very specific, and in most cases intrinsically hierarchical, relationship. On the one hand, the clinician—whether biomedical, behaviorist or psychodynamic in orientation—remains neutral, objective, and aloof, while the patient 'confesses' his or her emotional (subjective, raw, naive) problems (cf Butchart, 1997; Foucault, 1978; Hook, 2007). Through processes of guided subjectivization—the patient's identification both as the subject that speaks and the (psychopathological) subject of speech—his or her self-experience is thus brought in line with the 'norms of psychological expertise' (Rose, 1996, p. 96). Both quantitative and qualitative research in the clinical disciplines makes this relationship even more explicit: the consenting research subject at once symbolically concedes 'understanding' of his or her disorder to the academic researcher while at the same time reifying his or her position as an informant or provider of data that will only become 'externally valid 'once it has been combined with dozens of other narratives, reports or data points and 'transformed' by expert clinical scientists (Rose, 2009; Turner & Beresford, 2005)."
-- Jones & Brown, "The Absence of Psychiatric C/S/X Perspectives in Academic Discourse: Consequences and Implications." DSQ 33.1 (2013).
I'm reading the special issue on madness studies in the DSQ and I'm finding myself just kind of bored, over, also maybe affronted by the way The Medical Institution and Clinicians are constructed as the big bad wolf in disability studies. A Foucauldian perspective on mental health, which construes the medical profession as a controlling institution and 'patients' as unthinking cogs in a machine, dominated and manipulated by a powerful state-authorized system, dismisses the voluntary inclusion in such systems by and the agency of people with mental illness. I am over scholars who want to describe me as a "consenting research subject" who "concedes" my mental health to the "academic researcher." I am tired of academics suggesting that by seeking clinical treatment I am participating in a "hierarchy" whereby I place myself "under" the control of a doctor.
Medical professionals wield enormous power, yes. I find it ironic that (Foucauldian, social-model) academic critiques of clinical psychology and psychiatry seem oblivious to the power that academics in the humanities wield. If the Medical Institution is the big bad wolf by virtue of its systemic, institutionalized authority, Disability studies scholars in English, cultural studies, American studies, etc, can not call themselves innocent pigs/prey/whatever.
More pressing issues that I want to see talked about w/r/t Madness Studies include:
1) The deeply entrenched stigma attached to seeking care and treatment for mental illness.
2) Widespread lack of access to adequate treatment and care. I have a hard time seeing The Medical Institution as a systematically powerful organization that Oppresses Mentally Ill People when so many people lack the social and financial resources to seek it out. If people are being oppressed, it's only rich people.
3) The fact that treatment for mental illness is still seen as a luxury. See: critiques of "therapeutic culture."
4) How treating or curing a mental illness might be something that a person would want. How wanting to alleviate pain and suffering does not automatically make you a person who participates in their own oppression. How clinicians have been some of my best allies.
5) How I have never, literally never, been promised a silver-bullet cure for my mental illness by a clinician, how I have only ever been given strategies for living with my fucked up brain.
