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  • Toward a More Constructive (and Historical) View of the Harmful Dysfunction Theory?
  • Pierre-Henri Castel (bio)
Keywords

Harmful Dysfunction, OCD, naturalism, constructivism, Foucault

It is no easy task to answer Jerry Wakefield’s comments, for I feel at risk of merely pitting two major (and legitimate) paradigms in the history and epistemology of psychiatry against each other: the one historical/anthropological, the other epistemological/naturalistic. Fortunately, Wakefield and I do share enough to find a middle ground. This commonality should allow me to reconcile his opinions and mine, by dissipating a few misunderstandings, and also to state more clearly why I am dubious about some of his proposals.

First, let me repeat that, in my argument, the lived experience of having (I would not say enjoying) an inner mental space is not primarily a psychological phenomenon—at least in the sense of being understandable as an essentially individual phenomenon. It is, at bottom, a social expectation in a world in which self-constraint gradually came to replace physical constraint, a world in which people are enjoined to find ‘within’ themselves both the incentives to purposeful action and the means to regulate such action.

Obviously, there is no direct empirical test or simple quantitative measure of interiorized self-control. The degree, style, and normative content of interiorized self-constraint only appears through cultural and historical comparison. In my article, I followed Norbert Elias’s hypothesis about the ‘civilizing process’ (Elias 2000) in suggesting that, whereas Westerners were not the only ones to idealize self-constraint as the standard of civilized behavior (think of imperial China, for instance), there does not seem to be any other culture (at least to my knowledge) in which the excesses of self-constraint have led to the establishment of specific institutions (spiritual, psychological, medical) whose purpose is precisely to cure these excesses. In imperial China, one may very well have felt the inner torment of intense self-constraint (and been affected by it in one’s body, emotions, and brain). But only Westerners live in a world in which those experiences came to be valued as the ultimate source of truth and also the ideal for ‘conscientious individuals.’ Also, only Westerners have invented [End Page 357] a whole class of consciousness experts dedicated to coping with this excessive scrupulosity—psychoanalysts claiming to treat obsessional neurosis, as well as cognitive-behavioral therapists treating obsessive–compulsive disorder (OCD)—together with the formidable body of scientific, moral, and psychological literature on which these experts rely. It is problematic to uproot the issue of obsessions from the wider anthropological context as understood in Elias’s (although not Foucault’s) perspective, that is, from the questions: how did we become ‘individuals?’ And what is an ‘individualistic society?’ Like Alain Ehrenberg and Marcel Gauchet (notwithstanding our obvious differences), my inquiry on obsessions originates from a sociological (though psychologically informed) reflection grounded in the perspectives of Emile Durkheim, Marcel Mauss, and Louis Dumont.1

Hence, my first disagreement with Jerry Wakefield. Contrary to his claim, I certainly do not use OCD “to reveal hidden norms” (Wakefield 2014, 353) of individualistic societies en général. What is crucial in my argument is, in fact, the comparison of specific types of individualism—with individualism understood as a complex and highly variegated form of social bond in which the value of the individual is paramount (by contrast with holistic societies). Only through such comparisons can we hope to understand, perhaps even to deduce, why a particular symptom of excessive self-constraint could come to be deemed psychologically or spiritually crucial in a particular sociocultural, and even political context, and be treated in one fashion rather than another. Indeed, I regard it as a conceptual impossibility to isolate what could even count as an obsession or a compulsive ritual (an obvious prerequisite for going on to characterize its neurobiological or Darwinian basis) without first taking into account the anthropological and historical context of its emergence.

This, in fact, brings me rather close to Jerry Wakefield’s useful characterization of (mental) disorder as harmful dysfunction (HD). Indeed, we both agree, I believe, on the inadequacy of any theory of mental disorder that would reduce the...

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