Commentary on "Beyond Liberation"

For psychiatrists and philosophers this timely paper draws our attention to the powerful critique that Foucault offers, not only to psychiatry and the psychological therapies, but also to the "anti-psychiatric" views deriving from the 1960s. At a time when the asylum is being closed and many psychiatrists are beginning to reexamine their practical and theoretical position with regard to their patients, patients' families, other professionals, and the community, Pat Bracken is asking us a genuinely philosophical question: what is and what should be the future of psychiatry? A wide ranging paper indeed, Bracken covers critical theory and the Frankfurt School, hermeneutics, existentialism, positivism, and finally, and most importantly for Bracken, the historian and continental philosopher Michel Foucault.

Foucault's work maintains a strong commitment to psychiatry and psychoanalysis throughout. Beginning with his first essay on, and translation of, Binswanger's "Dream and Existence" (Foucault and Binswanger 1986) through Mental Illness and Psychology(Foucault 1976), to his final works on the History of Sexuality (Foucault 1979, 1986, and 1986a), which served as a genealogy of psychoanalysis, Foucault recognized the immense influence of the "psychotherapies" upon contemporary Western experience. His unique approach to the history and emergence of a wide range of cultural forms and social practices (including the prison and modes of discipline, the arrival of clinical medicine, and the contemporaneous emergence of the human sciences) grew out of philosophical questions regarding the relations between truth and experience. Foucault succinctly summarized his project at the end of his life in The Use of Pleasure (1986, 11):

It was a matter of analyzing, not behaviours or ideas, nor societies and their "ideologies," but the problematizations through which being offers itself to be, necessarily, thought—and the practices on the basis of which these problematizations are formed.

Like Merleau-Ponty before him, Foucault recognized that being cannot be known in its pure state: rather, it is always historically contingent and socially situated (Crossley 1994). Furthermore, all knowledge of being within the human sciences emerges in an already constituted field of social practices. Indeed, where Nietzsche attempted to understand the powerful influences upon our experience—from prehistory to the 19th century—of the formation of different moralities and their relations to truth, Foucault recognized that, within the Western world, the decline of Christianity brought new and equally powerful modes of interpretation and evaluation coterminous with the emergence of the sciences of "man."

In drawing on the early and later Foucault, Bracken is able to insert Foucault between positivism (primarily addressed in Madness and Civilization[Foucault 1967], and rarely mentioned in later work) and "anti-positivism" (not explicitly addressed by Foucault) in an inventive and useful manner. These two approaches certainly have their exponents in psychiatry. There are those who believe psychiatry deals with objective mental illnesses in a completely value-free way, rather like a car mechanic fixing cars and researching the causes of breakdown. And, on the other side, some regard psychiatric positivism to be nothing more than a violent objectification of the mad and dispossessed, using concepts—such as mental illness—in such value-laden ways as to render them nothing more than tools of political oppression. Foucault's work allows Bracken to examine the philosophical positions underlying these extremes, which he extends to incorporate a valuable analysis of the theoretical, practical, and ethical implications of Foucault's critique of psychiatry and the psychological/ psychotherapeutic fields.

Putting to one side the many difficulties inherent in Foucault's approach—including the "relativization of knowledge," the truth status of Foucault's "fictive" histories, and the priority given to history over philosophy—Bracken successfully uses Foucault's work to show the value-laden nature of psychiatric and psychological knowledge. Indeed, without relying on comforting professional justifications, one can view psychiatric and psychotherapeutic practices as social practices utilized by one group (professionals), to which others (patients) are subjected, and that all knowledge about the latter generated by the former is contingent upon the particular relations existing between them. Bracken is right to assert that this is not a branch of anti-psychiatry; it is perhaps more correct, at least in part, to regard Foucault as...