Listening, Acting, and the Quest for Alternatives: A Response to Charland and Bracken

The challenge is not to replace one certitude . . . with another but to cultivate an attention to the conditions under which things become 'evident,' . . . ceasing to be objects of our attention and therefore seeming fixed, necessary, and unchangeable.

(Rabinow on Foucault 1997, p. XIX)

I do not know whether it must be said today that the critical task still entails faith in Enlightenment; I continue to think that this task requires work on our limits, that is, a patient labor giving form to our impatience for liberty.

(Foucault 1997, p. 319)

IN RESPONDING TO MY PAPER, Bracken and Charland raise a number of interesting points. Through discussing Tuke's York Retreat (Charland) and Foucault's "regimes of truth" (Bracken), the character of moral treatment, the value of a Foucauldian analysis, the importance of listening (as well as its limits), and the necessity of taking action are all raised as important issues when considering the history and current status of psychiatry. In my response, I shall focus on the latter two issues, namely, the possibility of listening and the necessity of action. I will make the argument that although action can, and often should, follow listening, having action as its necessary (and immediate) goal brings with it a set of pressures and practices that can render both experiences difficult, if not impossible.

First, let me share my understanding of Bracken and Charland's main theses and arguments. For Patrick Bracken, the main purpose of any critique, but particularly a critique of current psychiatric practice, is to present readers with a new way of listening and understanding. It should, to paraphrase Bracken, open things up for deeper analysis. The Foucault he is listening to, then, is a man in whose "hands history becomes philosophy". This transformation is important because as it occurs new "discursive spaces" open up, thereby presenting readers of his work with new voices (e.g., patients, less-than-famous psychiatrists, priests). This incursion of the new does not necessarily, however, invalidate the old. Bracken substantiates this by making the important point that Foucault did not simply reject Enlightenment reason (an old and highly persistent voice), but rather "challenged the idea that we have to choose to be for or against" it. Bracken further points out that listening to these voices, old or new, is never a completely "clean" practice. In Bracken's words, "there is no neutral, asocial or apolitical vantage point from [which] we can judge the validity of one position over the other." This means that in listening to the "other" (as patient, friend, argument, or psychiatric practice) we must maintain a kind of double consciousness, one in which we attend to this other voice while at the same time being aware that neither of us are speaking from within a neutral, clean space (devoid of political, social, and/or cultural pressures or implications). Maintaining this kind of awareness is difficult for obvious reasons. In mental health practice and for Bracken, however, this difficulty can be worthwhile if it results in formerly silent participants having "their voice heard in debates about service development and the nature of progress."

Although I doubt Louis Charland would disagree with the idea that listening is important, he does take the function of critique one step further. Specifically for Charland, critiques of psychiatric practice, past and particularly present, should result in the identification of alternative solutions. Failing to do so can indicate that the critique "borders on a lack of depth." If one extends this assertion about my analysis to Foucault's own work, we find that Charland is not alone. For example, Hoy, in his introduction to his edited Foucault: A Critical Reader (1992), states that "Foucault's continued refusal to specify either a prescription or a prognosis for social illnesses he diagnoses suggests to some readers that genealogy is as unserious and irresponsible as archeology" (p. 7). This point emerges...