Imagine a version of science that in conquering a subject matter and reducing it to a set of simple equations and "truths" inherently harms, if not destroys, it.
That's my personal experience of what currently seems to be mainstream psychiatry: as someone who has has lived in (justifiable and rational for me) fear of and flight from it for as long as I can remember.
It can be true that what psychiatry offers may be helpful and accurate in some contexts and circumstances, yet also that it is woefully inadequate and must be used with incredible caution, humility and restraint in others.That it's exactly the lifesaving measure that some people need and a dehumanizing violation for others if applied rigidly on its own terms with no humility about its role. It can make the suffering of some more visible and relatable, while erasing and dehumanizing the suffering of others. None of this is simple.
I know my perspective is not everyone's experience of psychiatry. For some, it fits and works. For whatever reason, the equations and "truths" it offers work for them, steal nothing away from them, and the process doesn't reenact trauma for them (thereby exacerbating the very harms they needed support for in the first place).
I have no interest in undermining that or taking any helpful tool away from anyone. And of course psychiatry has other functions (apart from healing for healing's sake) that I'm not going to address here. Bottom line: I'm more than prepared to acknowledge that it likely is a helpful tool for *some* (not my place to pre-emptively quantify how many or what proportion--we'd have to actually listen to people for that).
But not for me. And here's the thing. As a rule, my trauma and I don't "fit." It's complex and very much shaped by many of the complicated experiences I had as an "outsider."
Psychiatry isn't a value-neutral endeavour. I'm not going to argue this point because it should be painfully obvious. Nowhere is it written in some objectively discernible language what the best way to spend our limited time on earth is and what counts as a "healthy" version of that life. Value judgments (influenced by culture/gender and other norms) are at the heart of a lot of those questions, as well as complicated metaphysical questions with potential spiritual implications. Philosophers have been debating all these points since forever, and continue to do so. Literature continues to grapple with them too. We generally aim to give people space to decide how they feel about them.
Not to mention how what counts as a behavioural/psychological excess or deficiency may be very context-dependent. Some people have far more space for their impulses to be seamlessly enacted into reality because they happen to have a lot of privilege and their way of being in the world "fits" with society's norms. I could say so much more about that, but it's not the topic of this post (future post entitled "mismatch" will follow someday).
I'm not saying there are no truths. I'm not saying science and its methods may not play a role in that (although there's room for debate about the role "science" plays and what the scope/limits of "science" and its ways of knowing are generally, which I needn't get into here). I'm saying for me at least the ability to form my own views, to have autonomy, to have space to reflect, weigh, consider and choose what's persuasive for me to try is absolutely essential. Taking that away reinforces the harm for which I was seeking help.
Here's what it comes down to for me: an essential component of the harm of trauma for me was the damage to my autonomy and dignity, both in the experiences themselves and the way it situated me in relation to others who don't understand, allow space/visibility for it, and accordingly reenact it. It was invasive, coercive, and dehumanizing. And it intensified the deepest existential questions for me (some of the most horrible existential paradoxes and painful realities are imprinted in my awareness in an especially intense way).
I'm no longer in the situations that produced my trauma in the first place; however, there are few things more invasive, coercive and dehumanizing to me than having those core questions that were made even more intense by my traumatic experiences taken away from me and used by someone else (no less an entire system) to impose their own answers on me and deem me "ill" or "non-compliant" if I don't accept their highly debatable answers and approaches--if my choice of how to engage is not respected--to what extent to expose myself to someone else's "assessment" for instance--to what extent I'm permitted to decline to answer invasively personal questions, or choose to do so only when I feel safe and comfortable.
The most critical antidote for my trauma, and an absolute precondition to me being able to safely engage with anything potentially "helpful" or "healing" is space. Space for me to be human. To be free to weigh and consider difficult existential and value-laden questions in the way that works for me, in a way that accounts for what I've experienced of the world, not just what the prevailing narrative is. Space to breathe and be human with my own choices, thoughts, feelings and attitudes. To be irrational and say no. To be a bit reckless and say yes. To pause and be stuck sometimes and say "I don't know." And to sit with those feelings for as long as feels right, safe and comfortable for me. And to only move forward when I feel safe.
Yet psychiatry doesn't seem to present itself as opinion, but as some kind of independently objectively established fact. It doesn't seem to leave space for my own answers to my own questions. It invades, suffocates, and restrains by removing a lot of those questions from genuine consideration: by centring itself, its own answers, methods and ways.
For me, what I need is the right kind of space within which I can be permitted the autonomy, dignity and safety that were taken away from me in the past--not a supposedly "correct objective answer" that adds even more coercion, erasure, and damage to what I've already endured: that takes away the one safe space I had to potentially call my own: my own mind, my own attitudes/feelings, my creativity, my own attempts to make sense of what I've been through and what it means for how I choose to move forward. Of course it's complicated because even this space often doesn't feel free because trauma invaded it, but it's still mine at least sometimes and in some ways. The last thing I need is my last refuge (however imperfect it may be) taken from me. Rather I need any "helper" to de-centre themselves and whatever "system" or "answers" work for them. And join me in helping to assist me in finding my own answers and my own experience of that beautifully buffering zone of safety: my place to explore what it means for me to be human in a profoundly imperfect world.
So speaking only for myself: I have no interest in any pre-packaged answers or systems. I welcome tools, offerings and suggestions. But I need space. I can't be healed without it.
Am I "anti-psychiatry" then? Yes and no and maybe. I'm opposed to anything systematically cloaking itself in neutrality and objectivity to cover over deep philosophical questions that are anything but neutral. They're value-laden and how we answer many of them can very much depend on how we are situated and whether we "fit." So yeah psychiatry in that sense is something I'm deeply not okay with.
Yet as a tool that can humbly help people who choose and want its assistance, I'm all for it. As a potential set of tools that knows its own limits, it can be lifesaving for some people. I applaud those success stories and want them to continue. But its value depends for me on its humility. There's a huge difference between someone who says "Here's something you may wish to try" and lets me decide to take it or leave it vs. someone who says "Here is the answer." Psychiatry for me to be beneficial must realize and embrace the ways in which it is NOT pure science--it straddles the border between mind and body with all the philosophical paradoxes and uncertainty that may invoke for some of us. It has a set of science-y tools at the ready for those who find them helpful, but should (to be potentially helpful to me) be ready to simply be there and allow space for those who need to sit with those uncertainties in their own unique ways that can't readily be reduced to a scientific equation, protocol or procedure.
Accepting a potential need for space for uncertainty/paradoxes/conflicting possible answers to the biggest questions can be part of what's required for some of our healing. Space to not be comprehensively assessed, diagnosed and prescribed (what to do and feel). Yet I don't see psychiatry handling this well. In my view embracing the limits and inherent uncertainty of its foundations rather than trying to be a science exactly like the others could make psychiatry so much better. It could have all the benefits of the science-informed aspects (possible tools) without the dehumanizing, coercive reductionism/erasure.
So basically my question is this: what if the essence of healing for some of us includes the ability to experience a collaborative space where paradoxes and uncertainties are held and endured with gentleness? Where we get to decide how quickly and deeply to engage and explore?
And what if psychiatry invades that space, thereby reenacting the very same trauma that stole our ability to safely experience it in the first place? How does psychiatry handle that? Does it destroy the very thing we need help with? For me, speaking only for myself, it does and for me it's inexcusable. But it wouldn't have to if it could learn to accept (and perhaps prescribe to itself) a large dose of humility.
I'm glad the tools and the answers psychiatry gives help some people, but that's no excuse to exclude those of us who are harmed from the conversation just because we complicate the issue for those who are helped. Just because it fits some people's experience doesn't mean it's balanced. Something that reenacts trauma for many isn't justified simply because it works for some. It can be held onto as a tool for the people who wish it without its conquering assertion of supremacy tearing down those necessary tentative gentle spaces for those of us who need them.
My concerns aren't limited to psychiatry though it's the most oppressively invasively space-eliminating force that I've encountered. I'd say the same to many "evidence-based" therapy modalities that presume to have the answers. As well as a lot of folk wisdom, societal norms, overbearing well-wishers, or anything that threatens to take that space (autonomy/dignity) away.
Being human is inherently complicated. There are a lot of deep painful mysterious profoundly personal existential questions we all may sometimes need or choose to cope with or flee from in the way that works for us. The differences in how we do so aren't a problem to be conquered so that the one "true" answer or approach that works for all can be enacted.
Embracing uncertainty can enable us to embrace diversity, autonomy, and dignity of those who don't "fit" the way others do--often the very same people who've seen the worst that humanity and society have to offer.
There are all sorts of complexities in the above. I'm addressing it only from a perspective of healing (assuming the person isn't harming other people in their lives--for whom "healing" may become about more than just themselves in ways that could get complicated).
So those are just some rambling reflections for today. Not really even a full post. I may delete and reformulate later. And these are subjects I've already written about so if I say anything here that sounds outrageously different than what I've said in the past, the past writing is likely more accurate...
