HPSC3023 or HPPP

HPSC3023 • This Unit of Study has 2 sections

History & Philosophy of
Psychology and Psychiatry
Dr Fiona Hibberd
Dr Hans Pols
Unit for History and Philosophy of Science
Department of Psychology
– History of psychiatry, Dr. Hans Pols
– Philosophy of psychology, Dr. Fiona Hibberd
– In psychology Honours, philosophical option
• Tutor:
– History of psychiatry: Gemma Smart
– Philosophy of psychology: Dr. Fiona Hibberd

Assessment Essay
• 1 Essay, 44% • 44%
• 1 Exam, 44% • Topic
• 12 short responses (weekly), 12 * 1% = 12% – History of psychiatry (4 options)
– Philosophy of psychology (4 options)
• Due Monday May 4, 11.55pm on Blackboard
• Hardcopy due Tuesday May 5, 9am
– HPS office Carslaw 3rd floor
– Or in class on Monday

Exam Tutorial exercises

• 44%
• Exam period
• 4 categories, 4 questions each
– 2 categories on history of psychiatry
– 2 categories on philosophy of psychology
• In each category, pick one
• Broad ideas, not details
• 12 * 1% = 12%
• Due: every week, Monday at 12.55pm
– Late submissions are not accepted
• < 200 words
• See on Blackboard under: Tutorial material
– Some readings are there too
• Submit at least 10 out of 12

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 Plagiarism Tutorials
• Just say no • 80% attendance required (university rule) (10
• Presenting the work of someone else as your out of 12)
own • Start in week 2
– Google, cut and paste – Mon 2-4, Carslaw Seminar Room 374
– Paying for essays – Mon 4-6, Eastern Ave Seminar Room 405
– Recycling your own essays submitted for another – Thur 12-2, New Law School 030
Unit of Study – Thur 2-4, New Law School 030
• Plagiarised work receives a mark of “0”, cannot
be made up

Readings History of Psychiatry

• On the library web-site, “HPSC3023”
• Some readings on Blackboard
• Some readings “linked”, see tutorial hand-outs
(for every week one)
• No course reader
• A/Prof Hans Pols
• About me:
– How I became a historian of psychiatry
• http://historypsychiatry.com/2012/04/24/new-h-madness-series-
how-i-became-a-historian-of-psychiatry-hans-pols/
– H Madness: http://historypsychiatry.com/
– Listen to: Frontier Psychiatrist (“That Boy Needs
Therapy!”):
http://www.youtube.com/watch?v=qLrnkK2YEcE&ob=av3e

History of Psychiatry
• What is it about psychiatry? 01. Why Psychiatry? Why mental
• Why no history of dermatology? Nephrology? illness
• Mental illness? Asylums, Anti-psychiatry and Labelling
– Does it exist?
Theory
– Is it frightening?
– Does it change (and get better)?
– What is normal?
– Is it a disease?

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 Mental Illness
• Psychosis
• Neurosis
I. Mental Illness
• Most attention is given to neurosis ($ spent on
health care)
• Consequences of psychosis are far more serious

• Need for more funding of mental health care in

Australia

Mental Illness
1. What is disease?
1. Suffering (subjective) • Diagnosis based on symptom patterns, not on
2. Decrease of function (inter-subjective) medical tests identifying disease (lesion,
3. Disease process (medical tests)
2. Mental illness microbes, etc.)
1. Mania: not suffering • “Depression is a lack of serotonin in the brain,
2. Disease process often not known
3. Knowledge of context needed just like diabetes is a lack of insulin in the
3. Difficult examples: blood.”
1. Gambling addiction
2. Internet addiction  The serotonin blood test does not exist.
3. Footballers behaving badly
4. Mad vs bad
Mental illness is the enigma of modern medicine

• Context important
Mental Illness
• Example: It is necessary:
– Young man, rich, works 12 hours a day • To know the social context (including generally
accepted norms of behaviour, behaviour patterns
before/after)
• To have a model of normal behaviour
• Question: can medicine / science /psychiatry /
psychology tell us what is normal?
• Where does psychiatry get its norms from?
• In what type of society does psychiatry do well?

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 Conclusions
• Mental illness: diagnosis needs to take into
account social and cultural factors (bio-psycho-
social model) II. Society
• The role of psychiatry in society
– Expectations
– Normality
• A framework to analyse psychiatry
– See how far we get.

Critic: Thomas S. Szasz Psychiatry in Society

• Mental illness does not exist (it is not a disease)
• Role psychiatry: managing deviance
– Example: treatment of political dissidents in Soviet Union
– Same in Western societies
• Psychiatrists are priests, police, prison officers, teachers
– They deal with behaviour that breaks social conventions
– Then they dress it up as medicine (mad/bad)
Don’t be fooled!!!!!
Psychiatry is a form of social control
1. The role of psychiatry in society: adjusting
individuals to the social order & excluding
those who do not adjust
2. Psychiatry and social protest: mental hygiene
3. Mental illness as a form of resistance
4. The role of psychiatry in society
- Critique & liberation
- Stricter norms of emotional expression and
behaviour

The Myth of Mental Illness The Myth of Mental Illness

Psychiatry criticised
Thomas S. Szasz 1. There is no such thing as mental illness
Anti-psychiatry 2. Hysteria as model
1. Definition: patient complains; doctor cannot find
The Myth of Mental Illness
anything.
Consult: http://www.szasz.com (The Thomas 2. Manipulation, escape of responsibility. Easy way
S. Szasz Cyber-Center for Liberty and
Responsibility) out.
3. Mental illness is defined by symptoms
4. Psychiatric treatment is a way of enforcing
conformity

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•MAD vs Other Critics: Michel Foucault
History of psychiatry
BAD
The Enlightenment and the
great confinement
• Problem 1960s: how to treat criminals in mental
hospitals Enlightenment: reason
• Problem 2010s: so many prisoners are mentally Do away with “unreason”
ill

Ronald Laing Thomas Scheff

Schizophrenia is an Labeling theory
authentic human 1. Labels are attached to
experience, a journey of individuals who break the
discovery rules
If you are well adjusted, 2. The individual accepts the
you are sick. label
“Turn on, tune in, and 3. Join a sub-culture or
segregation
drop out.”

Disability in USA
• Unemployment benefits paid by the states
• Disability insurance paid by the federal
II. Money talks government

 States safe money to “make” the unemployed

disabled
• Specialised business: “we can find you a doctor”

http://apps.npr.org/unfit-for-work/

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 Disability in Australia
• Wealthy private schools have highest disability
rates
• Why?
– Rating of school depends on exam results
– PTSD: untimed exams  better results
– Full-time school counsellors

III. Why do YOU want to be •MAD vs BAD

your mental illness?

• Student: “I am not lazy …”

• 1. Redemption model Doing it all wrong: Lance Armstrong

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 Doing it right: Matthew Newton
• 1. I have been a bad man
• 2. I do confess
– To Oprah, and to everybody
• 3. I am coming clean (…)
• 4. …. ???????
[I have been abused as a child; my mother rejected me;
I only got food when I won a price; I was bullied; I
was beaten; I was an altar boy]

1. I have been a bad man

Get out of prison for free!
2. I want to confess to Oprah (and everybody) • Affluenza
3. I am coming clean
4. I am suffering from … bipolar disorder
5. ALL IS FORGIVEN!!!!
Moral pariah  role model

Public confession
No priest, but Oprah; no gospel, but psychiatry

• 2. Explanation model
– Blaming can stop, understanding can start
– It is my brain, not me
• Legal context: diminished responsibility because
of mental illness
– Alien abduction
• Expert witnesses
– Now I understand myself!
• Non-existing diagnosis
• Not in DSM-V • It does not work:
Saminaden, Annick, Stephen Loughnan, and Nick Haslam.
“Afterimages of Savages: Implicit Associations between
‘Primitives’, Animals and Children.” British Journal of Social
Psychology 49, no. 1 (2010): 91-105.
• Yet …

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• 3. Identity model
– Asperger’s syndrome no longer exists
– In US, >90% of individuals with Asperger’s are self- • 4. Compensation
diagnosed – I fought in Afghanistan
– Asperger internet forums

– Same: identity disorder

– Internet fora

Psychiatry
• Social control, regulating deviance
• Money talks
– Disability IV. Asylums
• Attractive to individuals
– Avoiding blame and punishment
– Understanding
– Identity
The start of psychiatry: physicians were
– Compensation
invited to asylums (later: mental hospitals)
 What does this have to do with psychiatry?
Before 1970: mental hospital was hallmark of
psychiatry

1. Rosenhan
David Rosenhan, “On 1. Psychiatrists can be fooled
being sane in insane 2. Labels are sticky
places.” 1972 3. The Mental Hospital is not a good place to be:
It maintains an (arbitrary) diagnosis, rather
than helping underlying distress.

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 2. The experiment repeated
Lauren Slater, Opening
The Experiment Repeated: Pandora’s box,
Robin Winkler, 2004
Australian Radical
Psychologist
UNSW, (1973)

3. Asylums
1. Psychiatrists can still be fooled • Ervin Goffman
2. Diagnostic Fashions Change - PTSD replaces – If you are not insane when you enter an asylum, you
Schizophrenia will when you stay there
– Total institutions
3. Drugs are main treatment resource
– Examples:
4. It is now virtually impossible to get admitted • Auschwitz
- “revolving door treatment” • Prisons
• Military training camps
• Mental hospitals

Conclusions
• The nature of mental illness: the enigma of medicine
• 1970s: deinstitutionalisation – Biological, social, psychological, cultural
• No more asylums • The critics: Psychiatry in society: adjusting individuals
• Mental hospital as problem
• Mental illness
• Problem solved?
– Physicians
– Pharmaceutical companies
• Not really – Patients/consumers
– Schools
– Mental illness, homelessness
– Etc.
– More than medication needed
• Placing psychiatry in context