Nur auf Docsity: Lade filosofia della scienza und mehr Abschlussarbeiten als PDF für Philosophiedidaktik herunter!
Abstract: This paper proposes a critical analysis of ways of managing mental illness, with a particular interest in depression. The increase in the number of people suffering from these disorders since the pandemic is an indication of how there are social and structural causes to which the causes of suffering can be traced, in addition to disorders linked to the patient's clinical and family history. In support of some of the epistemological theses proposed by Jacob Stegenga in his text "Medical Nihilism", I conclude by proposing a new key to interpreting suffering which is close to Mark Fisher's political interpretation of depression. The sick body is a political body The arrival of the Sars-co-2 pandemic in 2019 represented the culmination of what Foucault described in a 1978 text as biopolitics. From a biopolitical perspective, institutional power is closely linked to the normativity and regulation of the biological body. The citizen is thus immersed in an institutional and bureaucratic network that manages and controls him not only as a political subject in the traditional sense of the term, but more broadly as a human being. Within a panoptic imaginary, every aspect that represents us as individuals is placed under control in a legislation that affects not only the will to inter-relational action but under every possible type of subjective instantiation. In this sense, the human body is placed under control both in an individual sense, because it is embedded in an economic network that objectifies it, but also in a global sense as a species that looks after the well-being of individuals under the ideological banner of modernity and the continuous and inexorable trend towards progress; where progress is the overall improvement of lifestyles. Today, in a pandemic, it is the sick body that is the focus of interest in the management of the crisis and the state of emergency. The enemy, the virus, is always present and must be fought relentlessly and without possible respite, thus justifying direct political action even on private spheres of life such as that of sociality and inter-period relations. The sphere of action is therefore the body, based on the blurred conceptual division between the sick body and the healthy body. This is an ambiguous conceptualisation, especially in the times of Covid and its variants, where care for the citizen, in most cases, concerns limiting the risk of the weakest and the 'sick' body often does not present any symptoms. Giorgio Agamben, in an article in Quodlibet in May 2020, argues that atheistic modernity has replaced Christianity with new forms of religions and dogmatic faiths. These are based on a triadic trust in science, progress and capitalism. Science too, according to the author, is based on different knowledge, forms and levels according to which it organises its structure: the elaboration of a subtle and rigorous dogmatics corresponds in practice to an extremely broad and capillary cultural sphere which coincides with what we call technology. The protagonist of this belief system is therefore medicine and the immediate object is the body of living beings.
In analysing this object, medicine borrows the concepts of biology, but in an exaggerated dualistic opposition. Reading Agamben 'There is a god or a malignant principle, disease, precisely, whose specific agents are bacteria and viruses, and a god or a beneficent principle, which is not health but healing, whose cultic agents are doctors and therapy'. As in any faith, these two principles are clearly separated and reunited in the figure of the doctor, the beneficent principle, who fights them in practice. Virology in this sense is a separate discipline, on the borderline between medicine and biology. If until now the interest that had been directed towards it beyond practice was sporadic, through the pandemic phenomenon we are experiencing it has become all- pervasive. Contagion, the nerve centre of the new millennium, is no longer a medicine to be taken or a surgical intervention: the life of the human being becomes at every moment the site of an interrupted cultural celebration where medicine stands as the protection and flag of citizens and their bodies. The practice is therefore no longer free and voluntary, but is made normative and universally compulsory from a political point of view. The power controls that medical indications are punctually and religiously observed in practice, becoming, with time, a practice rather than a rational scientific requirement. The age of the corona virus is the apotheosis of the Christian concept of permanent krisis. Secularising the theological paradigm of salvation, there is no longer an end of time to which judgement must be postponed, but it is man's life in its individuality and subjectivity that represents the field of political and voluntary action. The health emergency therefore contains within it the dual concepts of perpetual capitalist crisis and the Christian idea of an ultimate, eschatological time, towards which the extreme decision is always in progress, deferred and hopeful to govern the end that can never be resolved once and for all. It is the religion of an infected world, which is unable to decide once and for all whether it will survive or die. A hope, that of recovery, which is increasingly fragile since the enemy - the virus - is constantly changing. The epidemic, as the etymology of the term suggests (demos is in Greek the people as a political body and polemos epidemios is in Homer the name of civil war) is therefore, first and foremost, a political concept, where the terrain of politics (and of non-politics) is that of the struggle against an imperceptible evil. All nations are at war against themselves, defending a body that is also the container of an elusive and invisible enemy. The crisis, a concept that characterises our time, is not the Greek judgement through which the doctor, at a particular moment, decided whether or not the sick person would survive, but is a government instrument that serves to legitimise political and economic decisions not only on citizens but on individuals in their entirety. The political business today is the control of the conditions of human life through a new symbology through which power guarantees life, basing the lines of 'normality' and its conceptual tools in the biological sphere.
These are not nursing homes but simply places of segregation and exclusion where they are reduced to silence and sanctioned with forced labour for their unproductiveness. A century later the abolition of internment was demanded and so, in the period of the Revolution and the Empire, asylums officially became medical facilities. The reality is that the same repressive and humiliating practices (even those originally developed for curative purposes) continue to be used to infantilise and guilt-trip the insane, punish them at every deviant manifestation, and subject them to uninterrupted social and moral control. Madness is thus linked to moral guilt, and from aggressive behaviour, automatisms, infantilisation and regression comes psychology. But psychology can never dominate madness, because madness itself is the product of a distorted view of it. There is therefore no culture that is not sensitive to the Different and the Senseless, but each one relates to them in its own way, and it is these ways that frame the perception and recognition of madness. Neither Arab medicine nor medieval or post-Cartesian medicine contemplated a distinction between diseases of the body and the mind: the experience of the Senseless became first madness, then illness, and finally mental illness only after progressive subdivisions and distancing. But even if silenced and marginalised, madness has always had the value of a language, and denounces the very institutions that surround it. In essence, it is precisely in order to escape real coercion that the sick person takes refuge in his private world in which he finds, without recognising it, that same coercion. The paradoxes of illness, far from being autonomous, are products of the history and conditions of existence from whose real conflicts they borrow their structural models and figures. Psychology will never be able to dominate madness because madness only became such after it had already been excluded and removed, with its components of tragic laceration and freedom. All this is what I think transpires from a first and self-taught reading of a 1978 Foucauldian text, 'History of madness in the classical age'. To say that there is no 'civilisation without madness' has never been as topical as in 2022, three years into a life marked by the pandemic. There is no society that is not crazy: The social hysteria unleashed in recent years by the coronavirus is in fact an excellent example of how these theoretical assumptions manifest themselves in reality. As analyses of the growth in psychological discomfort and increases in depression, especially among young people, report, there is no better way to describe the collective social condition than with the term 'nevrosis'. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211573- https://www.epicentro.iss.it/coronavirus/sars-cov-2-salute-mentale https://www.iss.it/rapporti-covid-19/-/asset_publisher/btw1J82wtYzH/content/ rapporto-iss-covid-19-n.-23-2020-indicazioni-di-un-programma-di-intervento-dei-
dipartimenti-di-salute-mentale-per-la-gestione-dell-impatto-dell-epidemia-covid- 19-sulla-salute-mentale.-versione-del-6-maggio-2020 ) Indeed, a collective neurosis must be a shining example of the influence of collective phenomena on individual behaviour and of how the atavistic emotionality of the individual can become a pandemic phenomenon, and vice versa. In the political management of the pandemic, which is all-encompassing and characterised as described above, mental health was taken into account from the earliest stages of the development of contagions. The latest ISS report on Covid highlights all these aspects, pointing out that in the sample of population analysis there are alarming increases in post-traumatic stress disorders, social and/or generalised anxiety and depression with suicidal tendencies. “"Stressors included prolonged quarantine, fear of infection, inadequate care and information, and stigma. The same studies highlight the influence on mental health of other coexisting psychosocial risk factors, such as financial stress, unemployment, job loss, bereavement, perceived excessive burden, loss of role, homelessness, and disruption or serious impairment of significant relationships.” Yet the intervention programme does not make any concrete intervention measures explicit. The 'psychologist bonus', a sum of money to be spent on therapy, which the Italian government had made available to citizens, has been the subject of too long a debate, especially if we consider that it is precisely the sick body that is the subject of contemporary political action and debate. In fact, it is a measure that in some respects concerns only the recognition of mental well-being as a right of all citizens, even those who cannot turn to professionals working in the private sector. Again, it is about a binary division between body and mind where we cover our eyes in the face of the interconnectedness of an organic system. This system of thinking is dangerous, especially if we consider the exponential increase in the consumption of psychotropic drugs (especially anxiolytics and antidepressants) since the beginning of the pandemic. https://www.federfarma.it/Edicola/Filodiretto/VediNotizia.aspx? id=22353#:~:text=Edicola%20%3E%20FiloDiretto-,Cresce%20consumo%20di %20ansiolitici%20e%20azitromicina%2C%20i%20numeri%20nel,Aifa%20sull'uso %20dei%20farmaci&text=A%20causa%20della%20pandemia%20da,e%20Umbria %20(%2B73%25). This is not a new discourse, Jacob Stegenga, in an essay el 2018 already gave as an example the consumption and prescription of psychotropic drugs as an indication of a medical intervention aimed at cure according to the concept of magic bullet. Russian roulette where the bullets don't work: Jacob Stegenga in "Medical Nihlism" argues a counter-intuitive thesis to the collective representation of medical interventions.
challenged by randomised clinical trials, the main testing tool for the pharmaceutical industry's products. By highlighting the interest that pharmaceutical companies have in handling results from the testing of their own products to which they have intellectual property rights, Stegenga directs our attention to the very real fraud, bias and financial conflicts of interest in the design, conduct and reporting of RCTs. In addition to reshaping the results of the analyses, the author points out that there is also the issue of external validity or extrapolation into the real world of disease treatment. Even after demonstrating a statistically significant result in testing the study drug against placebo, the question of clinical significance remains. It is important to emphasise that medical nihilism is not about a general and unjustified distrust of any kind of medical intervention but rather to show how the possibility of manipulation of evidence is a serious concern in a society that places blind faith in science. Central to the text is providing the reader with tools to understand how the result of disease propaganda, industry-sponsored testing, financial conflicts of interest and marketing campaigns contribute to massive over-diagnosis and over-treatment in high-income countries where evidence shows that it is mainly hygiene, nutrition and socio-economic status, not drugs, that have accounted for the greatest advances in health and longevity since the 19th century. Stegenga's proposal is then a new, 'gentle' medicine, active more on lifestyle than on drugs. active more on lifestyle than through medical interventions. Although depression or psychiatric disorders are not the main focus of interest in the text "Medical Nihilism" but are proposed more as examples in the framework of the argument described above, there are some points proposed by the author that in my opinion fall within the discourse that I try to pursue in my paper. First of all, the author points out that these diseases are difficult to fit, from an epistemological point of view, into the concept of disease. Stegenga writes that it is especially disorders such as depression that escape both a naturalistic and a hybrid conceptualisation of illness. Although many people try to attribute the causes or explain the discomfort they cause from the point of view of abnormal biological functioning, recent studies have shown that this explanation is not really valid in reality. It is very limiting to attribute them to a 'simple' deficit in the hormonal framework or to a specific lack of serotonin, as the prescription of Prozac or other psychotropic drugs described as 'specific' and 'direct' seems to do. Most people diagnosed with depression do not have deficits in serotonin levels, and research into the efficacy of pills that are supposed to modify serotonin levels shows that they are barely effective in modulating depressive symptoms.
If we do not know the 'constitutive causal basis' of many diseases for psychiatric disorders, it is even more difficult. They could only be explained after a previous conceptualisation of what consciousness is or, even more, what the 'normal' psychological state should be. It is important to dwell on this last point: for psychiatric illnesses there is no "reference class for assessing normality" that would allow the "basis of harm" to be determined. Precisely because we cannot take for granted the presence of alleged biological dysfunctions among people suffering from depression, it is difficult to express an opinion on what should be the effects or functioning of psychopharmaceutical drugs. Prozac has been prescribed for years as a treatment for these disorders, increasing its use in the US by 600% since the 1990s. The idea behind the pill is said to be to target seratonin receptors, increasing seratonin levels and giving immediate relief to the patient. Yet, as Stegenga reports in the text, the Hamilton Depression Rating Scale (HAMD), one of the most commonly employed instruments in trials testing the effectiveness of antidepressants, is multifaced. This is a questionnaire consisting of seventeen questions, each of which has three to five possible answers with a corresponding numerical score, and the sum of these scores is interpreted as a measure of the severity of depression. These scores are determined for subjects in a trial, and if an antidepressant is effective, one would expect to observe a greater decrease in the mean score for subjects in the experimental group than for subjects in the control group. However, this scale is a non-specific instrument with regard to the measurand of interest, namely, the intensity of depression. This is because many of the questions included in the HAMD are mostly irrelevant for this measurand. To simplify the discussion, let us take an example for all: the answer to the question "Do you suffer from depression?" awards two points whether you answer yes or no. It goes without saying how ambiguous and vague an instrument it is to measure the effectiveness of an anti-depressant when a person who does not suffer from depression at the beginning of the trial but reports some depressive symptoms at its conclusion and a patient who reports the disappearance of depressive symptoms at the end of the trial have the same score. Yet the publication of studies based on this instrument in recent years has contributed greatly to the overestimation of the efficacy of many psychotropic drugs, contributing to their administration even to patients under the age of eighteen... even though there were indications that some of these drugs increased suicidal tendencies in some patients. (^12 One enrichment strategy is called a run-in period, which involves the exclusion of placebo-respond- ers before the trial begins. Here is an example mentioned in Chapter 8. Of een trials analyzed by the FDA regarding antidepressant use in children, only
such as sadness, translating them into the diagnostic category of depression (the latest example of this tendency is the inclusion of pain in new editions of diagnostic manuals such as the DSM and ICD). The truth is that there is a comfort in the diagnosis of depression: by linking the malaise to a chemical imbalance in the brain, it gives momentary meaning to a meaningless misery. The suffering takes on a name and a cause: a lack of serotonin. But this cause has causes in the system that remain undiagnosed and untold. It is through the investigation of these causes that I take the liberty of inserting the main thesis put forward in my paper: the history of depression is the history of the modern capitalist world. The mental health crisis is an expression of the current social, political, economic and ecological crisis. "The perpetuum mobile of capitalism and its depletion of resources also affects mental resources. The economic and the psychological seem to have become indistinguishable from each other, as the double meaning of depression would also suggest." (footnote). The construction of a psychopathology of depression as well as other mental illnesses must be contextualised in a critique of capitalism. Only in this narrative framework does it become possible to construct an idea of a possible cure as to what needs to be done. Not only that, an adequate diagnosis of depression - and its context
- is not sufficient in itself. A diagnosis does not necessarily imply a cure. To paraphrase Ann Cvetkovich in 'Depression: a public feeling': just because we know what's wrong doesn't mean we'll be able to deal with it; on the contrary, one of the main symptoms of depression is that what you have to do is precisely what you can't do, at least not on your own and on your own. Diagnosis: Today, one of the best analyses of depression is by Mark Fisher, a British philosopher who died of the same illness he analysed so well in 2017. In "capitalist realism", now a classic of literature, the diagnosis of the disease is linked to what he calls capitalist realism: "the widespread sense that not only is capitalism the only viable
political and economic system, but also that it is now impossible even to imagine a coherent alternative to it". Depression, according to Fisher, is a paradigmatic case of how capitalist realism operates, a symptom of our stuck and bleak historical situation. It is a political depression based on the belief that there is no alternative, that there is nothing to be done about the current state of affairs when this is a real basis for social conflict within a capitalist economy of debt and financial speculation. Scrive: “It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causation. If it is true, for instance, that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low levels of serotonin. This requires a social and political explanation; and the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism”. Throughout his work, personal experience is closely intertwined with social and political experience, describing his experience with the disease as characterised by a 'mocking "inner" voice' that accuses you of self-indulgence: 'you are not depressed, you are just looking for excuses for yourself, to avoid work or, in the infernal and paradoxical logic of depression, to hide the fact that you are unable to work, and that there is no place for you in society'. A voice that becomes progressively more important, making its condition public. (footnote). While the dominant school of thought in psychiatry locates the origins of these voices in the malfunctioning of brain chemistry and psychoanalysis finds the roots of this mental distress in the family environment, according to Fisher, the most likely cause of this feeling of inferiority is social power. This form of power is similar to class power: a sense of ontological inferiority defined by being a type of person who cannot fulfil the role assigned to the dominant group. For those who have been accustomed from birth to thinking of themselves as inferior, the acquisition of qualifications or wealth are rarely enough to erase - both in their own minds and in the minds of others - the primordial sense of worthlessness that has marked them out for life since their origins. Anyone who moves outside their intended social sphere is always in danger of being overwhelmed by feelings of vertigo, panic and fear: 'you are
perhaps come to rethink human activity beyond this one dimension and through political action of resistance to power. A collective, not individual, therapeutic project: resistance to the alienation of the contemporary subject and the claiming of a full, non-alienated life, the satisfaction of needs and desires, health and happiness. It is about inventing new forms of collective involvement, converting individual disaffection into politicised anger The crisis embodied by the depression is a symptom of a historical and capitalist crisis where the future seems frozen, in relation to a capitalist world to which there seems to be no alternative, as Thatcher triumphantly declared. While it is true that we are not all in the same boat, it is important to recognise the common sea in which we sail. To the 'there is no such thing as society' that seeks to problematise the problem of mental illness, it is imperative that we begin to problematise the identification of mental illness. "Before we can throw bricks through windows, we have to be able to get out of bed". (footnote)
