Peer review of paper number 123
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Dear Paul, I really liked your paper – and your presentation at the conference, by the way. Below are a few remarks to clarify or develop your main argument, that are mostly questions that arose when reading of your text. p. 1 [all page references = if printed out from the web site] 1st §, l.1. “…were helping themselves and others…”: I think that you could here explore and play on the double meaning of “helping oneself,” that is “self-help” AND “self-service”. It would not simply be a word game, I suppose, but a possible way of re-articulating some of your central claims and complicate the psychiatry-capitalism nexus you underscore. For instance, how do you see the injunction to “help oneself” in relation to: a) the Socratic “know thyself” – also in reference to the “cognitive antidote” that you mention in § 8, l.2, quoting Hurley; b) the location of material and symbolic resources within the self, which means that political the economy of disorder is not only “out there” embodied by Mental Health Inc., but just as much within, as the soul itself and the body, it seems, could be figured in terms of political economy as well. In this respect, you might be willing to reconsider your rather one-sided emphasis on the “language of deficit” (p.3., 1st §, l. 2). Here again, you might pause longer and unpack the economy of deficit versus profit. p. 1, 8th §: about the second “key ingredient identified by Hurley”, that is the “acceptance of an ideology”: could it be rephrased as “it’s not my fault, it’s in my neurochemistry, my genes, etc.?”. My point here is that I am not entirely happy with your way of presenting the patients as capitalizing or making recourse to an already available biological reductionism. I would like here to mention two examples, where patients or association of patients and relatives became active agents in making their issue a scientific one, themselves rallying the scientists to their cause. a) First example, I’m thinking of the making of transsexuality as a biological problem by individuals who wanted to change sex as a way of producing a new “medical subject”, so as to have access to hormonal treatment and surgery. This is at least an argument presented by Bernice L. Hausman in Changing Sex. Transexualism, Technology and the Idea of Gender. Durham and London: Duke University Press, 1995. See esp. Chapt. 4 “Demanding Subjectivity” (NB: the book is highly problematic in other regards, such as to the presumed material resistance of the body to the scalpel…, but it is worth to have a look at it.) b) Second example: Consider the mapping human genome project in France and the setting of a laboratory (the Généthon Laboratory) entirely devoted to mapping the whole genome. This project, which means from conception to fund raising (through TV as telethon…), the building of the lab and the politics of its science was a product of an initiative launched by a patient association, the French Muscular Dystrophy Association. Alain Kaufmann (from the University of Lausanne, Switzerland) conducted a fieldwork in the 1990s. The publication of his conference paper entitled “mapping the Human Genome at Généthon Laboratory: the French Muscular Dystrophy Association and the Politics of the Gene” (presented the workshop “Mapping Cultures of 20th Century Genetics” at the Max Planck Institute for the History of Science, Berlin, March 1-4, 2001) is pending (if not already out) in the proceedings of the above workshop. In short, this is to ask you to consider the possible co-production of mental health disorder between patients, psychiatrists (and there are a distinction in practice between clinicians and researchers) and scientific research conducted in labs, whether these are part of a pharmaceutical complex or not. In my view, this would involve reworking the framework of some ideological “influence” (see p. 2, 2nd §) onto the ways in which D-S mental health organizations construct the “meaning” of disorder (ibid.) towards a questioning of the modes in which patients are, in a way, doing science, producing what are (from a biological standpoint) mental disorder and health, and not only what they mean. In this regard, and to come back to the example of transsexualism, it is a fact that candidates to sex change are very well informed and very proficient in the science of sexual differences, even more than the doctors to whom they address their demands for treatment. I hope this may be helpful and look forward to reading your response, if any. Best, Cynthia Kraus (Lausanne, Switzerland, November 15 2002)
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