Psychiatry against the family

The psychiatric attitude towards the family is connected with the psychiatric methodology: if the methodology is not conversational and organic, if it does not reject what Lacan calls ‘master discourse’ and seeks commonalities with the interlocutor, if the psychiatric approach is ‘doctorly’ and suggests that it cures an illness by the application of a known medical method, then such psychiatry is anti-social in the same way in which extreme professionalism and institutionalism are anti-social. There is an important sense in which sticking to a professional ethics runs contrary to enjoying one’s work understood as one’s calling, and this particularly applies to some professions as opposed to others. In the helping professions, the very word ‘professionalism’ detract from the effectiveness of the helping interventions. Such interventions are meant to be familial, communitarian and embracing of a set of values which the helper can share with the person being helped. Whilst we use the term ‘client’ and ‘provider’, in practice neither philotherapy as a whole, nor any specific type of psychotherapy, which make up philotherapy as a composite area, appear professional: they appear friendly. Once professionalism intrudes too much in the counselling process, the warmth and support inherent in this process diminish. The same situation applies to psychiatry: once the psychiatrist approaches the client, or patient, without wonder about how the patient’s difficulties relate to their own life condition, and with a view that they are in possession of ‘tools’ to ‘cure’ the client from their view of life, that psychiatric intervention is lost on the client. Furthermore, it can easily turn the client into a victim, rather than a person being helped. This often happens with psychiatric interventions, which end up being socially violent, because they are either imposed on people, or their content is such that they inflict restrictions on those they are supposed to ‘help’ (such as in involuntary hospitalisations, or in the hospitalisation regime that is imposed upon voluntary hospitalisation).

There is a secret of organicism in interpersonal and group relationships: it is that organic communication requires not only empathy for the plight of those suffering, but also the ability to relate to their narrative directly, to be inquisitive about how another person’s difficulties might elucidate potential issues of our own, even if that is not immediately obvious. For example, when working with an apparently psychotic person, organicism requires that we keep in mind that we might be psychotic as well, or that we might one time in the future be more psychotic than this person is now, and to always inquire as to whether we, as a person, can discover something about ourselves from our work with the client. A psychotic client will afford us more opportunities to query ourselves than a client who is not psychotic: proper therapy is always at the same time auto-therapy, or self-therapy. Only if we always see another’s problems as potentially our own will we be immunised from judgement and stigmatisation of the client, and will we be able to establish an emotional and cognitive resonance with her so as to help her reorganise her symbolic resources and handle the unbearable emotional experiences that throw her off balance. This is how organicism in human communication has always worked. However, it has been largely repressed by medical training in which strong identification with the client and self-query based on therapeutic encounters is systematically discouraged.

Aleksandar Fatić