16,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Geisteswissenschaft
- Sprache: Englisch
We think we know what healers do: they build on patients' irrational beliefs and treat them in a 'symbolic' way. If they get results, it's thanks to their capacity to listen, rather than any influence on a clinical level. At the same time, we also think we know what modern medicine is: a highly technical and rational process, but one that scarcely listens to patients at all. In this book, ethnopsychiatrist Tobie Nathan and philosopher Isabelle Stengers argue that this commonly posed opposition between traditional and modern medicine is misleading. They show instead that healers are interesting precisely because they don't listen to patients, using techniques of 'divination' rather than 'diagnosis'. Healers construct genuine therapeutic strategies by identifying the origins of symptoms in external forces, outside of the mind of the sufferer. Modern medicine, for its part, is characterized by empiricism rather than rationality. What appears to be the pursuit of rationality is ultimately only a means to dismiss and exclude other forms of treatment. Blurring the distinctions between traditional and modern practices and drawing on perspectives from across the globe, this ethnopsychiatric manifesto encourages us to think in radically new ways about illness, challenging accepted notions on the relationship between sufferer and symptom.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 245
Veröffentlichungsjahr: 2018
Ähnliche
Contents
Cover
Copyright
Editor’s Note
1 Towards a Scientific Psychopathology
I The Benefits of Folk Therapy
Scientific therapy and folk therapy
Solitude
Diagnostics or divination
Statistical categories vs real cultural groups
The construction of Truth
Risky psychopathology
A clinical illustration
Continuation of the consultation
II Medicines in Non-Western Cultures
Prolegomenas on thought and belief
The idea of the symbol
The white man’s medicines
Thought is in objects
Concepts of the savage mind
Active objects
In conclusion
Notes
2 The Doctor and the Charlatan
Recovering for the wrong reasons
The power of experimentation
Who defines the causes?
A practical challenge
Notes
3 Users: Lobbies or Political Creativity?
Users: lobbies or political creativity?
Is another kind of medicine possible?
Disease mongering
A machine
Condemnation?
Hands off!
Notes
4 Doctors, Healers, Therapists, the Sick, Patients, Subjects, Users …
Therapist
The sick
Patients
Subjects
Users
Pharmaka
Notes
End User License Agreement
Guide
Cover
Table of Contents
Begin Reading
Pages
iii
iv
vii
1
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
87
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
159
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
Doctors and Healers
Tobie Nathan and Isabelle Stengers
Translated by Stephen Muecke
polity
First published in French as Médecins et sorciers © Éditions La Découverte, Paris, France, 2012
This English edition © Polity Press, 2018
Polity Press65 Bridge StreetCambridge CB2 1UR, UK
Polity Press101 Station LandingSuite 300Medford, MA 02155, USA
All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
ISBN-13: 978-1-5095-2189-0
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Names: Nathan, Tobie, author. | Stengers, Isabelle, author.Title: Doctors and healers / Tobie Nathan, Isabelle Stengers.Other titles: Medecins et sorciers. EnglishDescription: Medford, MA : Polity Press, [2018] | Originally published inFrench as: Medecins et sorciers. | Includes bibliographical references and index.Identifiers: LCCN 2017057449 (print) | LCCN 2018005531 (ebook) | ISBN 9781509521890 (Epub) | ISBN 9781509521852 (hardback) | ISBN 9781509521869 (paperback)Subjects: LCSH: Medicine--Philosophy. | Quacks and quackery.Classification: LCC R723 (ebook) | LCC R723 .N33713 2018 (print) | DDC610.1--dc23LC record available at https://lccn.loc.gov/2017057449
The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this book are correct and active at the time of going to press. However, the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate.
Every effort has been made to trace all copyright holders, but if any have been inadvertently overlooked the publisher will be pleased to include any necessary credits in any subsequent reprint or edition.
For further information on Polity, visit our website: politybooks.com
Editor’s Note
This is a translation from French of the revised 2012 edition which saw the addition of the final two chapters, ‘Users: Lobbies or Political Creativity?’ and ‘Doctors, Healers, Therapists, the Sick, Patients, Subjects, Users …’. These new chapters are based on a presentation to a symposium, ‘User Responses to Psychotherapy’, organized by the Centre Georges Devereux, Paris, 12–13 October 2006.
1Towards a Scientific PsychopathologyTobie Nathan
I THE BENEFITS OF FOLK THERAPY
Today we continue our investigations with Zézé about the origin of the masks, but this time he appears not to understand.
‘The spirits of the bush must have existed at the very beginning of the world?’ I ask him.
Zézé looks at me as if puzzled by my stupidity.
‘No, no, of course not,’ he says, shrugging his shoulders. ‘We, the Zogui, did all that.’
He explains the meaning of this word, with which I had not been familiar. ‘Zogu’ literally means ‘man’, but in this particular sense ‘the great fetisher, the master of the spirits of the forest, the complete man’.
‘In the beginning of the world,’ he adds, ‘there was only water, the serpent and two medicines: Belimassai and Zazi.’ These two words in fact mean the same thing: lightning stone. But the first is used only by men and the second by women.
Pierre-Dominique Gaisseau, The Sacred Forest: The Fetishist and Magic Rites of the Toma, trans. Alan Ross, London: Weidenfeld and Nicolson, 1954, p. 99
(translation modified)
Scientific therapy and folk therapy
Psychotherapy that is called ‘scientific’ (obviously, I’m not talking about its truth value, only its method, whether Freudian, anti-Freudian or neo-Freudian, fanatical Kleinian or crypto-Lacanian, whatever …) – this type of psychotherapy, I was saying, always contains a single premise that is clear and explicit: humans are alone! We are alone in the universe, therefore alone in the face of Science, and consequently also alone in the face of the state. It is by way of this unique formula that I am able to summarize the articles of faith of the ‘science’-based psychotherapies that I know. Since the second half of the nineteenth century, all the theoretical systems that have seen the light of day flow from this idea.
And I do mean all the theoretical systems, because once you take a close look, even from a logical point of view, there is only one class of psychotherapies since they all derive from the same basic premise:
Madness is a kind of ‘illness’.
Like all illnesses, it resides in the ‘subject’: in its psyche (psychoanalysis and its countless offshoots); in its biology (psychopharmacology); in the layers of its unique history (‘existentialism’); and in its educational repercussions (‘bioenergetics’, ‘gestalt therapy’, ‘transactional analysis’).
Now, let’s imagine an astute critic – let’s say a literary type, a humanist – no doubt interested in psychotherapy, but also in cultural differences, religions and their histories, in philosophy. Let’s put this person into dialogue with me. I am sure he or she will immediately say: ‘I have no idea what you are talking about. Are we not all alone, just as we are, alone in relation to ourselves, to our destiny, to our death … so what kind of solitude are you talking about? Explain yourself!’
Solitude
A woman faints! Think first about the solution that societies like ours offer, societies with one universe. We have to think that this woman is suffering a disorder that is part of the knowable world; let’s call it hysteria for the sake of simplicity. By starting to think like this, we think of her imbued with sexual drives that she (she alone?1) doesn’t recognize. So, experts are called in – I’m not so naive that I think them particularly erudite, I simply define their function, mastering rational knowledge. So a scientist will unmask her unconscious strategies, lead her to become conscious of them and help her work out a more mature strategy for existence. Let us think for a moment. The gaze we bring to bear on this woman simplifies her character (‘regressed’, as they say). One can feel sorry for her (‘she is in pain’); lecture her (‘she is infantile’); help her out of Christian feeling (Christian … Christian? Do we need to be reminded that there are sick people who are a bit suspect, pas très catholique, as we say?); guide her, morally, out of ‘humanity’, out of duty in any case (God only knows what is set loose in sick people by these kinds of interests). Whatever the case, she remains alone – alone in the face of the ‘scientist’, therefore in the face of medicine, and of the state.
In order to handle one and the same fact, namely a woman fainting, societies with multiple universes never fail to propose a solution that consists of the postulate that she has been taken over by a spirit. On the basis of this fact, and quite logically, it becomes indispensable to call for the help of a ‘connoisseur of spirits’ – master of the secret,2master of the knowledge to be gained through initiation. If he officiates according to his art, this woman will necessarily become the unknowing informant of an invisible world, one that is worth knowing about. She is an ambiguous character, potentially having multiple personalities. We can scoff at her (strange kind of person, wouldn’t you say?), fear her (she’s also a kind of ‘witch’), envy her (she has been chosen), and interrogate her (she is the interpreter of the hidden, a woman who straddles two worlds). As soon as disorder erupts, it is useful for the whole group; it helps them complicate the world and learn about what remains invisible to it.
Figure 1.1 A woman faints
The deliberate isolation of patients runs through the whole of psychological and psychopathological thought; it’s even one of its implicit presuppositions. Consider another example for a moment: a child who does not speak, rocks continually and makes strange and incomprehensible noises. As you know, these children like playing with water and sand, don’t sleep at night and have a curious preference for the company of mature men – perhaps even grandfathers – rather than that of their mothers and women in general. What would our scientist say? He or she will always come to the conclusion that the poor child is lacking, that he or she has stumbled on his way up through the stages that each child has to climb before raising themselves to the human level. He has stopped at ‘symbiosis’, they will think, or at ‘primal orality’, or more generally at pre-genitality … But the master of secret knowledge will always come to the conclusion that the child has a ‘singular nature’. This child is silent with other humans, but the ‘master of the secret’ will claim that this child has silent interlocutors and a specific essence. Douala, one of my patients who came from the Cameroons, was said to be a ‘hippopotamus child’.3 Consequently, he was deposited on an island in the middle of the river so that his fellow creatures could come to pick him up as one of their own. Perhaps the hippopotamuses didn’t want to deprive my patient’s parents of such a pretty baby. The Douala family no doubt reasoned that the hippos took their own and gave back the human child … The fact remains that, once the child had been recovered from the river, he slowly overcame his mutism ….
‘You are being selective about the facts you use,’ my well-informed critic will retort. ‘No doubt you are led astray because of your biased view of African cultures. What’s all this about multiple universe societies? Can’t we imagine there must be something there which our science can patiently explore? Can’t this thing, that we name a “hysterical” illness just for the sake of temporary convenience, be considered a possible avatar for all human development? Isn’t it the same thing that certain scientifically underdeveloped peoples still interpret metaphorically as an attack by imaginary beings? We have successfully drawn up nosographic tables, given them shape and checked their consistency – so aren’t we much better off? Isn’t it better to think of the child you are speaking of as “autistic” and humbly accept the limits of our therapeutic powers? As far as I’m concerned, I think there is a kind of moral grandeur in recognizing the limits of our omnipotence.’
‘You are so damn naive! Have you thought for a moment of the fact that a statement of that type – I agree, the most common in our profession – implies that you think there are irrational peoples in the world, with “pre-logical minds”,4 awash in a maelstrom of emotions, incapable of conceptualization, following only their natural impulses? Every day, I deal with people from such cultures; I meet them regularly and I can assure you that reason is distributed in the same way over there as it is here. I even feel a little stupid reminding you of this as it is so obvious! Honestly! We have no choice but to think that aetiologies – whether of “primitive” or scientific origin – are, as I’ve said, all rational. They can only be distinguished by the fact that each triggers a different action on the world. This is why I think that the so-called “scientific discoveries” of Professors Charcot and Freud, condemning witches, sibyls and pythonesses to the misery of hysteria, are nothing but the official stamp on the death certificate marking the demise of multiple Universes – a statement of failure, in some ways …
Figure 1.2 A child not speaking
Diagnostics or divination
In any case (has it not been said often enough?), from the very beginning of any therapeutic activity, the “master of the secret” invades the world. He doesn’t interrogate the “sick” person, just the objects related to the hidden universe. He asks the sand, shells, a palm-nut rosary5 and the Koran. Sometimes it’s enough for him to “see”, thanks to a “gift”.’
‘Come on!’, my critic will no doubt interrupt me immediately. ‘You don’t actually believe in tarot cards and other such clairvoyant stuff?’
‘Not so fast. Why do you already want to cast aspersions? Wait! Let me elaborate on my idea … If one submits to the kind of investigation that you seem contemptuous of, then disorder is necessarily seen in a particular way. It then becomes a sign of an obligation to be interested in the richness of the world and the multiplicity of beings that inhabit it. In these worlds, disorder always ends up being a tangle in the lines of communication, a crossroad, just at the point where the universes are superimposed … Ah, my friend, you have to eliminate the words “belief” or “believe” from your vocabulary. Take my word for it, no one, anywhere, believes in anything! A divinatory apparatus is always a creative act. It institutes the interface among universes; it makes them palpable and then thinkable. So, will you carry on as you were, telling yourself that these systems are made out of naive thinking, founded on the “childish” credulity of ignorant peoples? For my part, I’d rather think of them as unleashing an extraordinarily complex machinery designed to create links, a consummate art for multiplying universes. Because such inquiries, basically directed towards what is hidden, displace any interest centred on the ill person (as always, prone to stigmatization). They displace him or her:
towards the “invisible”;
from the individual to the collective;
from the inevitable to the reparable.
But for that to happen we still need the existence of a hidden world, a secret world, known only to the masters of the secret.
On the other hand, the scientist, as you know, investigates symptoms, naturally via the intermediary of the patients themselves, because no illness can escape the one real world, that described by academic psychopathology. I have recently discovered that scientific research is never trying to discover worlds, just to extend its own. In our universe, if it occasionally happens that we think that some disorder is not known, we still deem it to be potentially knowable. Perhaps the scientist will discover it one day and give it his name – “Charcot’s Disease”, “the Bleuler Syndrome”.
It is for this reason that all cultural worlds with multiple universes have recourse to divination while all those with one universe use diagnostics.’
‘That’s an interesting suggestion; it gives me food for thought. Can you tell me more?’
Statistical categories vs real cultural groups
‘I could add that, when he starts divining, the master of hidden knowledge has an implicit aim. This is to find out about the sick person’s unexpected membership attributes and thus ultimately to assign him or her to a group. For example, a particular child might be someone exceptional, likely to “eat” his own parents.6 No one knew it at the time, but when he was in his mother’s womb he was accompanied by a twin whom he devoured when they were foetuses. So he belongs to the large inter-ethnic7 family of twins, those obscure beings that are best protected, respected and honoured if one is not to ask for trouble. Rest assured, this sufferer will emerge from his course of therapy having discovered a new sense of belonging, thinking of himself in the fellowship of twins. He will submit to the protective rituals of his new group and will respect the special dietary restrictions, etc.
On the other hand, the aim of the “scientist” is always to cut the subject off from his universe and his possible affiliations and also to submit him, just like everybody else, and especially as a sole individual, to the implacable and blind “laws of Nature”.8 But what is the scientist working on here? What objective does he have in mind as he suppresses all real groups – twins, those possessed by Yoruba divinities like Ogún, Shangó or Sakpatá, sorcerers, witch-hunters, ancestors – all these groups that constitute indispensable links in the elaboration of therapies? The answer seems obvious to me: it is simply a case of him increasing his clientele. Because when it comes to psychopathology, medicine and its derivations, wherever it sets itself up with its foot soldiers (doctors), its quartermasters (pharmaceutical laboratories), its judges (the scientists who sort the “real” from the “false”, what exists and what is in the “imagination”), it always has the effect of breaking down memberships. As soon as you set up a dispensary in Bamako, you will no longer see any Bambaras, no more Dogons, nor any Puels; just “subjects”, who quickly become empty envelopes; they are subjected. They are “hooked” on prescriptions; they are Largactyl-Nozinan-Anafranil-Prozac “junkies”.’
‘Ah, you are annoying me with your military and third world talk,’ my critic replies. ‘Don’t you think that you are spoiling an argument that began nicely enough by corrupting it with these criticisms of the medical establishment that must look a bit suspicious?’
‘Not at all. But I don’t like the kind of soft thinking that provides nothing to react against. I am simply trying to set out my ideas clearly. It is no doubt for this reason that they sound polemical to you. So, consider a piece of factual evidence: the psychopathological categories that are at the basis of how psychiatrists (and I include psychoanalysts and psychotherapists here) classify their patients never have their origins in real groups. Have you ever heard of groups of “obsessives” or “paranoiacs”? Have you spotted them in the same place, getting ready to undergo the same ritual therapy, recognizing each other as members, and perhaps – who knows? – even with a common ancestor? Do you know of a temple for the “hysteria” entity, or an altar for essence of “schizophrenic”? Of course not, since psychopathological categories are disjunctive concepts that only bring individuals together for statistical purposes. I can tell you, since I have frequented quite a few psychiatric institutions, that I have always heard patients complaining about being mixed with mad people. (“What am I doing here? Everyone is mad …”). And the doctors make fun of their carrying on, cleverly recognizing supposed “denials” of the illness…. In fact, and one always has to listen carefully to the exact words uttered, people admitted into psychiatric wards explicitly complain about not recognizing the group in which they are statistically classed.
This is why (believe me, I have had the experience) you can legislate all you please on the freedom for the patient to see their case notes. In psychopathology, the diagnoses, i.e. methods of extracting people (“subjects”) from their group, always remain secret.’
The construction ofTruth
My astute critic has the usual rejoinder: ‘Give me a straight answer! You know very well, as an “institutionalized” intellectual, that the “spirits” called upon by the healers don’t exist. Or at least you don’t believe in them yourself.’
‘My dear fellow, I’m afraid I have to answer that I can’t allow you this criticism. And I have at least two arguments to make the case:
First, allow me to tell you that I am hearing you speak like a divinity, not like a human! You seem to develop a thought without premises. It is very strange to ask, “Do spirits exist?”
In a single-universe world, the existence of spirits is clearly ridiculous. Just imagine spirits having problems putting on their shoes, taking a bus or waiting in a queue to order a hamburger. This would certainly be funny, but it’s absurd. Spirits have irreducible qualities; they can only be evoked in a world of multiple universes since their very evocation in and of itself calls the second universe into existence. And here is my second argument:
So you research diagnostics about nature, you report on existence, you find proofs. I am a relationship technician and, like any practitioner, I care most about effectiveness. From this position, I have learnt about the extraordinary release of creative – hence life-producing – energies brought about through multiple universe systems. A patient is like a stone. At first sight he seems monolithic, whole, perfectly smooth. Hasn’t he learnt to work at will on any imperfections? Launch into interrogation on the hidden and you will see him crack along his own specific fault lines right in front of you.
If it is necessary to appeal to spirits to trigger this system, then spirits certainly exist, at least in as much as they are the invisible heart of the setting
.’
‘So be it’, my enlightened critic will now say. ‘I am sympathetic with the second argument. Although I’m not a professional, I can imagine the suffering of someone whose job is healing, and I really want to concede that a professional prefers a system that works, even if it isn’t approved, to some other system that he knows is dysfunctional, even if this latter has been blessed by universities and churches. We know of such things in the past. So what kind of psychopathology are you advocating? Aren’t you really making a case for a return to the past, to charlatans, bonesetters, street performers, acrobats?’
Risky psychopathology
‘My dear fellow! You must be aware of the ideas of our invaluable Isabelle Stengers on the characteristics of a science. You remember that she shows that a science is the activity of a group of scientists who have agreed to take a risk – I should say, agreed to submit their thought to risk.9 Answer this question honestly: to what risks are our psychopathologists exposing their thought models? Now tell me, who has any device to hand that could possibly contradict them? They decree the existence of an object that only they are able to perceive; they alone make the instruments designed to describe the object and make it opaque to any outsider; then they themselves validate the adequacy of their instrument. So the loop is closed, and even padlocked. Here we have thought without any risk. But the master of secret knowledge, using divination rather than diagnostics, exposes himself permanently to risk, and first of all by being contradicted by the real expert which the sufferer de facto becomes in this setting. Try carrying out such a curious experiment yourself by making a clear and unambiguous statement about someone. Say to your tobacconist, “Sir, I ‘saw’ that you are the oldest of five brothers …” Go on, do it! Do it and you will feel your stomach tighten when he says to you, “No way! I am an only child!” I imagine your feelings being far more perturbed if he replied, “Oh! But how do you know?” It’s only through such an experiment that you will understand, and from the inside, the way divination puts your thinking at risk. Now describe to me what intellectual risk a psychologist crazy about the Rorschach test is taking, or a psychiatrist obsessed with the Diagnostic and Statistical Manual of Mental Disorders (DSM). Recourse to these instruments has the sole aim of disqualifying other types of experts: the ill person, their family or their environment.
Figure 1.3 The construction of truth
In my opinion, psychopathologists need to take risks to bring about the creativity that is an indispensable characteristic for building up a scientific account of things. What happens in societies with multiple universes is very telling on this point. For example, if I start to divine, the locus where the drama of knowledge plays out is myself. People ask, “How does he know? What method is he using?” But when I do a diagnostic procedure, the drama is happening within the patient in the absence of any witness likely to be called upon to testify. That’s just one simple example. Obviously, I don’t expect that simply replacing diagnostic methods with divination strategies would allow psychopathology to rise to the status of a science (though it would help a lot). I just want to draw attention to the fact that these “wild” practitioners would be more inclined to get involved in “risky” procedures.
In short, any psychopathology that is interested in the sick, whose main concern is to objectify “illnesses”, necessarily distances itself from the tensions that permit a science to be constructed. So, to answer your question, I do advocate a psychopathology that takes risks, that makes a really fine-tuned description of therapists and therapeutic techniques, but not of the sick people. Because in this domain, all that can be observed are the therapists and their objects – and of course I mean all the objects: tools, but also theories, thoughts and even supernatural beings ….’
‘Speaking of which, tell me something: these supernatural beings – forgive the loose expression – are specific for every human group. I believe some of them are located in the water of rivers, others deep in the dark forest, yet others in underground tunnels or in abandoned dwellings … So you would have to be au fait with each group and with each specific modality of interaction with these invisible beings. And in addition, you would have to work in the patients’ mother tongues because I don’t think that the names and characteristics of the spirits would translate easily. Would a psychopathologist have to know many languages, cultures and specific modalities to enter into relations with spirits? Come on, be reasonable! Your position might be intellectually seductive, but it is totally unrealistic, I’m sorry to say.’
‘I’m surprised how willing you are to oversimplify. Any naive person can easily understand that when it is a matter of modifying someone’s whole being, this is only possible from within their language, along with its referents and its divinities.10 There lies, I think, both the greatness and all the difficulty of our profession. Before establishing “general laws” on the nature of disorders, psychopathology should first get busy for each culture, describing systematically the activities of a certain category of person that their group has entrusted with modifying the internal functioning of other people. We condescendingly call these people “healers”, reserving for ourselves the noble term “doctor”. But:
they are in fact our colleagues;
they are the repositories of knowledge that we first have to acquire before we can aspire to be scientific at all.’
‘Ah, now I know what you are up to! You have a way of turning things around …. So, according to you, the healers retain real knowledge, while psychopathologists are struggling with ideological thought? Isn’t that what you are thinking?’
‘Naturally, since we are talking about “technical knowledge”! Who would have it, if not healers? They are virtuosos who have refined their know-how over millennia.’
‘Could you tell me more about technique, then? I challenge you to tell me how you go about making these systems function that are so foreign to your training, and especially in the middle of an academic context.’
A clinical illustration
University Paris-VIII, the Centre Georges Devereux. One Tuesday morning at 11. A large hall with a very high ceiling …
