Once, to show that diagnoses were constructed was to resist reification, to remind psychiatry of its entanglement with culture, politics, and values. Now, the same refrain is repurposed by movements that reject the reality of disability and ridicule professional attempts to alleviate suffering. The very tools of critique, once marshaled against premature certainty and biomedical hubris, are redeployed to erode trust in any psychiatric knowledge whatsoever. What has critical psychiatry become when its gestures of suspicion are indistinguishable from the paranoid accusations of medicine’s most fraudulent enemies? (View Highlight)
Bruno Latour
The traditional gesture of critical psychiatry was to pour the acid of suspicion on the facts cherished by the field: to dismantle the authority of diagnostic categories, to reveal the fragility of trial results, to show how treatments and theories were shaped by culture and commerce. To criticize psychiatry by moving away from its facts, by treating every diagnosis as illusion, every trial as propaganda, leaves us with nothing but rubble. (View Highlight)
If critique has grown sterile, it is because psychiatry has been forced to live between two impoverished poles of fact and fetish. Diagnoses are either nothing but projections or they are immutable truths. Treatments are either instruments of domination or they are disease-remedying interventions. Why not break the binaries? We need not reduce depression or schizophrenia to empty constructs nor canonize them as disease entities but treat them as tentative, preliminary steps in our organization of knowledge, a fragile gathering of symptoms, histories, neurochemistries, and cultural narratives, steps that coexist and collaborate with other such tentative, preliminary, fragile epistemic efforts. (View Highlight)
The creation of knowledge is a delicate, collective process. It requires avenues of criticism, uptake of criticism, public standards, and tempered equality. It requires a diversity of fallible standpoints. Let critique make room for the voices of patients, for the ambiguities of neuroscience, for the textures of culture, for the uncertainties of practice, and for the wisdom of clinicians. If something in psychiatry is constructed, this should be taken not as proof of its falsity but as a sign of its fragility as well as its strength—it’s something in need of care to exist and something that is made strong by virtue of that concern. (View Highlight)