Commentary on "Moralist or Therapist?"

There is more than one Foucault. A prominent figure in contemporary philosophy, his interests extended to many other fields of Western culture (for a review, see Dreyfus and Rabinow 1982). If there is a common theme to his work, it is the critical examination of the historical development of the basic concepts by which we structure our understanding of the world and our place in it.

First, there is Foucault the epistemologist. This is the Foucault of his early books. These explore the historical roots and cultural relativity of our shared, everyday scientific beliefs (Foucault 1970 and 1973). Through an examination of a number of different fields, Foucault shows that truth itself, even scientific truth, is a culturally relative phenomenon. We assume that science establishes a truth that is objective and independent of the social context in which it proceeds. Foucault showed that science is, rather, a product of power relations (Foucault 1979 and 1984, 51-75). Then, in his later work, we find Foucault the practical philosopher. In studies of our modern lifestyle and self-concepts, he proposes a set of values for the conduct of life. In this, of course, he risks contradicting his earlier relativistic critique (Foucault 1984, 333-72; Foucault 1989, 203-331). Finally, there is Foucault the highly politicized reformer, fighting injustice in the prisons and elsewhere. Even here he maintained that his values represented not objective truth, but a truth created through practice.

All these Foucaults are important for psychiatry. The epistemologist reminds us that in the field of mental health, our concepts (in psychopathology, in classification, and in therapeutics) are shaped by history; and that here, too, political and other values often are allowed to masquerade as "objective standards" (Radden, 1994). The political philosopher speaks more to our personal and professional lifestyles, prompting us to recognize in what way and to what extent we influence our patients' decisions. And the political activist shows us that psychiatry is a political arena, in which we have to be ready to fight injustice.

All these Foucaults, too, and for similar reasons, are important for anti-psychiatry. Indeed, as Matthews points out, Foucault has been connected more with anti-psychiatry then with psychiatry. Focusing on an early work, Madness and Civilisation (Foucault 1967 [1965]), he examines the truth claims of Foucault's epistemology. Here, as Matthews rightly indicates, is one of the strongest philosophical justifications of the anti-psychiatry movement. Hence an assessment of the validity of Foucault's argument is an assessment of the validity of anti-psychiatry. And, as Matthews shows, while there is value in judging psychiatry in the light of its historical development, the strong claim that mental illness is no more than a myth fails to stand up to critical scrutiny.

It is worth adding that Matthew's key distinction—between moralist and therapist—perhaps does not do full justice to either Foucault or anti-psychiatry. In Foucault's understanding, therapy, just to the extent that it is scientifically based, is not wholly objective. Morality and therapy are, on the contrary, alike in being practices and therefore subjective. What are the real differences then? How should we understand the way in which values come into psychiatry? What is the significance of this, for diagnosis? For psychiatric ethics? For medical jurisprudence? Matthews' analysis of Foucault's arguments challenges us to a new and more open critical reappraisal of questions such as these.

Related Articles

Feature Article: Moralist or Therapist?: Foucault and the Critique of Psychiatry

Commentary: Commentary by Heinze

Commentary: Commentary by Kovel