Beyond Liberation: Michel Foucault and the Notion of a Critical Psychiatry

Abstract

Philosophical disputes in psychiatry and psychoanalysis have traditionally been formulated in positivist (medical model) versus anti-positivist (mainly existential and hermeneutic) frameworks. Foucault's critique of positivist psychiatry, uncovering the historical, political and cultural contexts in which its basic concepts and practices were developed, is well known. This paper examines his corresponding, though less well known, critique of anti-positivism, focusing in particular on the hermeneutic re-interpretation of psychoanalytic theory developed within Critical Theory by Habermas. The basic assumption within this tradition is that human potential is repressed both individually and socially by the structures of modern capitalist society. The goal of critical social theory is to undo this repression by way of a liberation in which such repression is identified and overcome in a process of social self-reflection (reflexivity) The function of a critical psychiatry is to enact such liberation in the context of individual lives. Foucault's critique shows that applied to psychiatry, the three guiding concepts of critical theory—liberation, repression and self-reflection—are no more foundational than the corresponding guiding concepts of positivist psychiatry. However it is argued that the absence of a foundationalist philosophy does not, of necessity, lead to theoretical or therapeutic nihilism. On the contrary, it provides encouragement for the development of new ways of approaching the phenomena of madness and distress, approaches which are particularly relevant in the context of the current shift from institutional to community care.