The Banana Peel Project

Yesterday I had the chance to meet and enjoy a delicious dinner with Joel Braslow, a historian and psychiatrist who has done some great work on the history of 20th century psychiatric practices in the United States.  His first book, Mental Ills and Bodily Cures, is a fascinating look at California state hospitals in the first half of the 20th century.  It traces the development of a wide range of psychiatric practices in the context of psychiatric wards, from early attempts to calm and subdue patients using hydrotherapy, to the first use of malaria fever therapy to treat sufferers of tertiary syphilis, to the dramatic rise and fall in the popularity of the lobotomy made famous in movies like One Flew Over the Cuckoo’s Nest, to the eventual development of thorazine, the first modern psychiatric drug.  For Braslow, each of these technologies provided a support for changing ideas about the interplay between mental illness and patients’ bodies.  He points to a particular variety of “therapeutic discipline” that saw (and sees) restraint, control, and silence as both the means and the ends of psychiatric treatment.

Braslow’s work has really helped me formulate some of my own ideas about the governing and disciplining aspects of psychiatric practices.  Drugs, as Braslow makes clear, are just one more technique in a vast field of  “curative” practices intended to provide a mode of access to underlying etiologies.  In his more recent work, in which he focuses on the second half of the 20th century and the rapid growth of psychopharmacology in the world of psychiatry, he looks at how it is now the drugs themselves that are seen as the “cure,” rather than as a way of accessing “deeper” causes.  In this “symptomization” of psychiatry, drugs replace case narratives, and constitute the focal point of psychiatry and the discourse of disease and disability.

In his talk, Braslow pointed to the “consumerization” of psychiatric patients.  In the community health centers in which he does his field work, patients are increasingly understood as “consumers”–that is, as rationally self-interested individuals with both the inclination and the capacity to decide which health care options are best for them.  This consumer-patient identity, of course, is not limited to health care, but it is significant that psychiatric patients are increasingly endowed with autonomy, independence, and freedom of choice in psychiatric discourse.  Being a consumer, apparently, is less “stigmatizing” than being a “patient” or “mentally ill.”  The question, of course, is who this particular identity–this particular mode of subjectification–serves.  The pharmaceutical industry, of course.  But takes more than clever advertising to forge an identity–there’s more at work here.  At least, I hope so.

What frightens me is that “consumer” is becoming more than a label for psychiatric customers.  Do patients refer to themselves as consumers?  Apparently, that is exactly what is happening.  I’m not sure whether this is a good thing or a bad thing for patients.  My Marxism makes me suspicious, but the Foucault within me wonders if perhaps there’s more than one side to this.  What is clear is that it’s awfully complicated, and it’s going to take people like Braslow with one foot on either side of the divide to help figure it out.