“the distinction between myself as the individual people encounter, and the social role and character they expect to encounter”

I have been reflecting on this of late. It is a truism that “the Therapist” (in the sense Alasdair MacIntyre is using the term and also in the actual, clinical sense) is the locus for all sorts of projections – not just from clients/patients/”service users” but from other professions and society at large.

This is writ large in psychiatry, but is no doubt the case not only in the helping professions but across the board in life. We all encounter each other running the risk of mistaking the social role with the person.

Of course, this is somewhat inevitable in day to day life, especially in briefer encounters focused on a specific practical transaction. Indeed, entering absolutely into a deeply personal encounter with everyone you meet runs the risk of a certain paralysis.

However, I wonder how much organisational demoralisation is due to the dehumanising effect of this in encounter after encounter, especially in work – which is where a very high proportion of our working life is spent?

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Vampirism as Mental Illness: Myth, Madness and the Loss of Meaning in Psychiatry

This  is certainly the academic paper I have been involved with which has garnered the most media attention. Brendan Kelly and myself intended to write a nuanced paper on how psychiatry conceptualised vampirism, when it occurred as a clinical presentation, and how this changed over time. This reflected wider changes in psychiatry (and probably, though this wasn’t part of the paper, society itself) in that the meaning ascribed to symptoms was increasingly devalued in favour of a “checklisting” approach. Something similar has happened to dreams, in the psychiatric context.

Did we succeed in this? Here is the abstract :

 

Vampirism, as a clinical presentation, was formerly much discussed in psychiatric literature. In recent years this has not been the case. This article begins by exploring the history of vampiric phenomena and the various medical theories of vampirism. It discusses the change in emphasis in psychiatry from a psychotherapeutically-influenced exploration of the meaning of a particular symptom to a more ostensibly evidence-based, checklist approach. This reflects a wider shift in psychiatric culture. Articles from the psychiatric literature dealing with vampirism are reviewed in depth. The article argues that the clinical interpretation of vampirism may be useful as an indicator of shifting attitudes within psychiatric discourse.

And here is how The Sunday Times covered the article:

2016-07-27

Perhaps not that surprisingly, this provoked a backlash from the online vampyre community, none of which seemed based on actually reading our article but on the Sunday Times and Irish Central’s even more misleading take. (most of the links to the vampyre forums where we were attacked seem to have broken.

Brendan has talked further about the paper in various forums such as here , and has discussed this media and online reaction.

I know How Journalism Works. I know that the headline is chosen by a subeditor, not the author of the article. I know that “Doctors write nuanced article on changes in how psychiatrists see vampires over time” is not a headline.

In a way, this coverage illustrates that for the media as well as in day to day a life, a psychiatrist is character with a somewhat predetermined role and that, if a psychiatrist is writing about vampirism, it must be through the prism of mental illness and of treatment. Even in cases where the psychiatrist is trying to do the direct opposite. Alasdair MacIntyre wrote (quoted in the blog post linked immediately above):

Contrast the quite different way in which a certain type of social role may embody beliefs so that the ideas, theories and doctrines expressed in and presupposed by the role may at least on some occasions be quite other than the ideas, theories and doctrines believed by the individual who inhabits the role.

 

 

The individual, “characters” and social roles

Recently I read Alasdair MacIntyre’s “After Virtue.” On my other blog I have posted a range of quotes from that I found stimulating and provocative. One chapter, “Emotivism: Social Content and Social Context”, draws heavily on the work of Erving Goffman and also Philip Rieff’s work on therapeutic culture. In this chapter, which I found possibly the least convincing of the book (though perhaps for my own reason), MacIntyre discusses the notion of moral “characters” – the Therapist, the Rich Aesthete, the Manager. Most of his argument is around the Manager as character, in what is an assault on the idea of managerial culture and expertise.  Characters are not the same as social roles:

Characters specified thus must not be confused with social roles in general. For they are a very special type of social role which places a certain kind of moral constraint on the personality of those who inhabit them in a way in which many other social roles do not. I choose the word ‘character’ for them precisely because of the way it links dramatic and moral associations. Many modern occupational roles – that of a dentist or a garbage collector, for example – are not characters in the way that a modern bureaucratic manager is.

aftervirtue

For MacIntyre, the Therapist is one of those characters with dramatic and moral associations, although with a caveat you don’t always find in this kind of discourse:

It is of course important that in our culture the concept of the therapeutic has been given application far beyond the sphere of psychological medicine in which it obviously has its legitimate place… Philip Rieff has documented with devastating effect a number of the ways in which truth has been displaced as a value and replaced by psychological effectiveness.

This specific point is not one I am going to discuss at length now. The passage from MacIntyre I have found most helpful in this chapter – and one which perhaps offers a resolution of the somewhat uncomfortable air of “being a Character” is the following:

Contrast the quite different way in which a certain type of social role may embody beliefs so that the ideas, theories and doctrines expressed in and presupposed by the role may at least on some occasions be quite other than the ideas, theories and doctrines believed by the individual who inhabits the role. A Catholic priest in virtue of his role officiates at the mass, performs other rites and ceremonies and takes part in a variety of activities which embody or presuppose, implicitly or explictly, the beliefs of Catholic Christianity. Yet a particular ordained individual who does all these things may have lost his faith and his own beliefs may be quite other than and at variance with those expressed in the actions presented by his role. The same type of distinction between role and individual can be drawn in many other cases. [MacIntyre describes a trade union official who in his role acts in a way that “generally and characteristically presupposes that trade union goals … are legitimate goals” but who “may believe that trade unions are merely instruments for domesticating and corrupting the working class by diverting them from any interest in revolution.

As a psychiatrist, one is very often confronted with a certain response; in practice, in daily life, even in literature and the media. recently I read Patrick Leigh Fermor’s book on monasticism, A Time to Keep Silence.

timetokeepsilenceIn it he suddenly imagines a discourse between “a psychiatrist” and the monks, in which the psychiatrist seems keen to dismiss their lives as an expression of various neuroses etc. I can’t imagine, as a psychiatrist, ever doing such a thing; partly Leigh Fermor is reflecting the norms of his time (the 1950s). I have found it helpful, since reading MacIntyre’s passage, to reflect on the distinction between myself as the individual people encounter, and the social role and character they expect to encounter.