MEDICALISING DIFFERENCE WITH

PSYCHOLOGICAL / PSYCHIATRIC
CLASSIFICATION
by
Anon

ABSTRACT
This essay looks at issues of social deviancy. It examines societys norms, to find
what sort of deviancy remains on the fringes, excluded from these norms. It looks
at ways in which we make value judgements about what it means to be normal,
and ways in which we can question these judgements. We trace Foucaults
genealogical critique of the historical development of notions of psychological
deviance, to see how this ties in with current trends towards regulating society by
means of psychiatric classification of the abnormal. It appears that today notions
of normality increasingly revolve around notions of health. The antisocial
personality or psychopath is in an interesting position, as this classified personality
disorder refers to behaviour that is, quite simply, in opposition to the norms of
society. Is this simply dictating that the norms of society are healthy? We look at
how it has come about that we can classify dangerous behaviour in medical terms.
This has implications for all the personality disorders, indeed all of psychiatry; we
cover the arguments of Thomas Szasz, who dismisses notions of mental illness as a
myth perpetuated by the repressive institution of psychiatry as an excuse for social
control. The essay studies how effective criticism against categorising behaviour in
terms of health is, considering both issues of individual freedom and equal issues
of social security raised by issues like the grossly antisocial individual. Is what we
are witnessing negative psychiatric normalisation, or beneficial discoveries about
the best way for us to function? The implications for social deviancy run
throughout the work, through to a conclusion, which, though arguing for other
methods of security, rather than restrictive classification of social deviancy,
considers the irreversibility of our current psychiatric position.

CONTENTS

Introduction

The Antisocial: Transgressing the Social

11

Regulating Society: Normalization

20

Normalization Advances: Psychiatry

29

The Present Day: Individual Freedom and Social Security

(Conclusion)

35

Bibliography

46

The conduct of a societys business, as that of an individuals, may be likened to

playing a game. The religions, laws, and mores of society constitute the rules by
which people must play or else they will be penalized, one way or another.
Obviously, the simpler the games and the fewer in number, the easier it is to play
them. This is why open societies and the freedoms they offer represent an onerous
burden to many people. As individuals find it difficult and taxing to play more than
a single game, or at most a few, at any one time, so societies find it difficult and
taxing to tolerate the existence of a plurality of games, each competing for the
attention and loyalty of the citizens. Every group and this includes societies is
organized and held together by a few ideas, values, and practices which cannot be
questioned or challenged without causing its disruption, or at least a fear of its
disruption. This is why independent thought often undermines group solidarity,
and group solidarity often inhibits independent thought. We belong to a group,
says Karl Mannheim, not only because we are born into it, not merely because we
profess to belong to it, nor finally because we give it our loyalty and allegiance,
but primarily because we see the world and certain things in the world the way it
does To see the world differently from our group thus threatens us with
solitude; and to say that we see it differently, threatens us with ostracism.
Hypocrisy, then, is the homage intellect pays to custom. (Thomas Szasz, The
Manufacture of Madness, p 58)
Toward the end of the nineteenth century the great idea of criminology and penal
theory was the scandalous idea, in terms of penal theory, of dangerousness. The
idea of dangerousness meant that the individual must be considered by society at
the level of his potentialities, and not at the level of his actions; not at the level of
the actual violations of an actual law, but at the level of the behavioural
potentialities they represented.
We thus come to question the great separation made (or at least formulated) by
Montesquieu between judicial, executive, and legislative powers. The control of
individuals at the level of their potentialities, could not be performed by the
judiciary itself; it was to be done by a series of authorities other than the judiciary,
such as the police and a whole network of institutions of surveillance and
correction - the police for surveillance, the psychological, psychiatric,
criminological, medical, and pedagogical institutions for correction. This whole
4

network of nonjudicial power was designed to fulfil one of the functions that the
justice system assumed at this time: no longer punishing individuals infractions,
but correcting their potentialities. (Foucault, Power, 57)

Introduction

The Oxford English Reference Dictionary lists some definitions of society:

the sum of human conditions and activity regarded as a whole functioning
interdependently, a social community (all societies must have firm laws), the
customs and organization of an ordered community are among them. Society is a
community of individuals in interdependent relations with each other to form a
whole. To effect these relations in a coherent fashion, members of a society adhere
to a code of strict rules and regulations, practices followed that constitute part of
effective socialisation. Members of society communicate, inherit, expand and
evolve these practices over generations, and this is one of the ways in which a
society maintains its stability, coherence, and sense of itself as a society. From
legal to moral practices, from linguistic to physical practices, there are rules across
the whole range of the societal spectrum. This is a societys logic of inclusion; we
expect members of a society to adhere to its rules and codes, and pass these values
on. The logic of inclusion also works as a logic of exclusion, as that which deviates
too much from societys norms is excluded by the dominant ideology. Society
maintains its order in exclusion or subjection of the unacceptable. It retains its
centre by decentring, marginalizing, or otherwise subjecting in some form, that
which does not, cannot, or will not adhere to the principles on which the society
functions. However, societies evolve over time, during the course of which the
logic of inclusion can alter and change. In Western society, for example, over the
course of history, with the widening of intellectual endeavour and understanding,
decentred narratives have made increasingly intelligible bids for a more central
position in society. Deviance and difference have come under scrutiny from
different angles, with postcolonial debate, feminist theory, lesbian and gay studies
all making statements about the norms of the West, leading to inclusion of such
narratives in our universe of meaning, an understanding and willingness to
consider that chips away at the logic of inclusion, widening it slightly to
incorporate the new.
A humanitarian perspective would see the progress of knowledge about the
other, whatever this other is, relaxing and dissolving over the course of history.
Possibilities for a broader understanding of the human condition open up as
decentred narratives penetrate the centre and through this process widen and
6

redefine our social theories of the human, a step on the way to real social change.
Another view might argue this idea of progress is too idealistic. One might argue
the narratives included appear in an altered state, colonised in some way by the
dominant ideology, before appearing, in compromised form, amongst societys
central narratives. This interpretation would see the successes of the marginalized
as further subjection by the dominant ideology, the messages scrambled before
reception. The appearance of reform is a cunning political ploy, a pacifying
acceptance much more effective than overt denial, behind which the logic of
exclusion remains intact. The norms may have shifted a little, but the main
principles of exclusion remain, with the compromised included lending greater
weight to societys dominant ethic. There are new norms, now even stronger, but
the essentially excluded remain so.
What remains then in our societys blind spots, what becomes of them, how
are they to be resolved? Sociologist Erving Goffman remarks If there is to be a
field of inquiry called deviance, it is social deviants as here defined that would
presumably constitute its core. Prostitutes, drug addicts, delinquents, criminals,
jazz musicians, bohemians, gypsies, carnival workers, hobos, winos, show
peopleThese are the kind of folk who are considered to be engaged in some kind
of collective denial of the social order.1 All these figures are to varying degrees in
their deviant lifestyles out of sync with the progressive, capitalist ethic of Western
society. Beyond these figures on the fringes of our society are those whom we
might consider truly abnormal. Society being organised around a norm, this essay
would like to address concerns and issues raised at the point where we articulate
the abnormal, to see how this is done and the means by which, and validity of the
process that determines the deviation from the norm. As we shall see, many
intellectuals argue that contemporary societys main benchmark of normality is
now that of health, so we shall look at how definitions of the abnormal have come
to be articulated in terms of the unhealthy, and the increasing relation of the
destructive to the unhealthy.
Genealogist Michel Foucault states, There exists in our society another
principle of exclusion, not another prohibition but a division and a rejection. I refer
to the opposition between reason and madness. Since the depths of the Middle
1 Erving Goffman: Stigma: Notes on the management of spoiled identity (Harmondsworth:
Penguin, 1990) p. 171 (hereafter references to this text are cited parenthetically in the text).

Ages, the madman has been the one whose discourse cannot have the same
currency as others. His word may be considered null and void, having neither truth
nor importance, worthless as evidence in law, inadmissible to the authentification
of deeds or contracts.2 The means Foucault chooses to examine and analyse
societys logic of inclusion is that of genealogy, also termed the archaeology of
the human sciences. By means of genealogy, Foucault sought to expose the
subjective power relations linked with the logic of inclusion, and find their
expression in the exercise of knowledge in the dubious sciences, such as
psychology, psychiatry, and criminology. With genealogy, rather than interpret the
past in light of the present, the intellectual throws light on a situation or concern in
the present by tracing its historical roots. Foucault chooses to focus on disciplinary
organisations in society such as the prison or the hospital. In tracing their origins,
Foucault questions our methods of inclusion and exclusion that exist today, by
unearthing their historical formulation, which informs the way they operate today.
He explains, What I also try to bring out is that, from the Eighteenth Century
onwards, there has been a specific reflection on the way in which these procedures
for training and exercising power over individuals could be extended, generalised,
and improved. In other words, I constantly show the economic or political origin of
these methods; but, while refraining from seeing power everywhere, I also think
there is a specificity in these new techniques of training. I believe that the methods
used, right down to the way of conditioning individuals behaviour, have a logic,
obey a type of rationality, and are all based on one another to form a sort of
specific stratum.3
It is not that the disciplinary sciences are untrue, more that this truth (and
all truth, Foucault suggests) is part of the exercise of power, and not an
independent, universal entity. Foucault states this here: truth isnt outside power,
or lacking in power: contrary to a myth whose history and function would repay
further study, truth isnt the reward of free spirits, the child of protracted solitude,
nor the privilege of those who have succeeded in liberating themselves. Truth is a
thing of this world: it is produced only by virtue of multiple forms of constraint.
2 M. Foucault, The Order of Discourse in Robert Young, Untying the Text: A Post-Structuralist
Reader (Boston/London: Routledge & Kegan Paul, 1981), p. 53
3 M. Foucault, Politics, Philosophy, Culture: Interviews and other writings 1977 1984, ed. L.
Kritzman (New York/London: Routledge, 1988), p. 105 (hereafter references to this text are cited
parenthetically in the text).

And it induces regular effects of power. Each society has its regime of truth.4 It
seems the truth of the disciplines mentioned here are parts of a wider, interrelated
power structure that perpetuates the logic of exclusion. This essay follows up on
this suggestion, considering aspects of the legal and medical arms of society in this
light, examining their place as a reinforcing tool and logical continuation of a
normalising society, which seeks to promote itself through the careful,
systematised exclusion of the deviant. We could argue that Foucaults critique
constitutes a more radical approach to the logic of inclusion than that currently in
place. Such critique, showing the subjective development of a naturalised aspect of
society, is similar to Barthess work on mythologies, where he uncovers old myths
that have become naturalised in everyday phenomena. We could use Foucaults
work to argue for the logic of acceptance, a voice for silenced subjects of
disciplinary power and their subjugated truths, through argument that the truths of
the norm are not universal, but a result of various discourses related to the relations
of power in a society.
Genealogical critique finds opposition to its suggestion that normalising
tendencies result from power structures, and truth is a tangible, fallible aspect of
these structures and tendencies. Critics reason that any society needs a certain
amount of social order to function smoothly, and if some form of external
discipline and control did not exist there would be disorder, which is harmful to
society. This is clear also in the dictionary definition made at the beginning of this
work, where the laws and rules that hold it together largely define society.
Foucault does not disagree, but articulates the difficulties with the debate over
power when he comments it is hard to see where, either on the right or the left,
this problem of power could then have been posed. On the right, it was posed only
in terms of constitution, sovereignty, etc; that is in juridical terms; on the Marxist
side it was posed only in terms of the state apparatus. The way power was
exercised concretely and in detail with its specificity, its techniques and tactics,
was something that no one attempted to ascertain; they contented themselves with
denouncing it in a polemical and global fashion as it existed among the others, in
the adversary camp. (Truth and Power, 58) Foucaults own approach has in turn
4

M. Foucault, Truth and Power, from Power/Knowledge, quoted in Rabinow, Paul ed. The
Foucault Reader: An Introduction to Foucaults thought (London: Penguin Books, 1984), p 73

been placed by many on the left, who see in it criticism of disciplinary power
structures and wider norms of society in terms of the restrictions they impose,
more than any validation of their function in society.
So where is the line to be drawn between individual freedom and societal
order and discipline? To pursue this question we shall look at some problems and
cases that tread a fine line between, or reflect questions of, order and chaos, cases
with which we might tease out the issues and problems with societys responses to
its upsets. We shall look at the psychological phenomena of personality disorders,
especially the antisocial or psychopathic personality. With the personality disorder,
traditional classification in terms of health and illness do not work, as the disorder
is a pattern of behaviour identifiable by medical terminology, but at the same time
difficult to describe as a full-blown illness. Here the distinctions between the sane,
dangerous, incapable and genuinely ill blur and become more unsure when
expressed in terms of illness and health. Freuds theories of the unconscious
developed from his studies of exceptions to the rule, abnormal cases, neurotics and
so forth. Similarly, in looking at antisocial acts, disordered personalities, and
transgression of social laws, as a social phenomenon, tied up with medicine and
law, we hope to see more clearly how our ideas of the social have become what
they are, and how medicine and law relate to and express our means of maintaining
the social in our community.

10

The Antisocial: Transgressing the Social

The Oxford English Dictionary lists definitions of antisocial: opposed or
contrary to normal social instincts or practices, not sociable, opposed or
harmful to the existing social order. That which is antisocial must definitely stand
outside societys logic of inclusion, as it is so by definition. Opposed or harmful to
the existing social order, it is not normal. In a very recent text, one doctor, Dr T.
Stuttaford, discusses personality disorders in these terms: People with a
personality disorder have an abnormal temperament, often characterised by
recurrent, maladaptive, inappropriate, even destructive behaviour.1 We see
abnormal and normal set up in binary opposition to each other in this quote. In a
way we might regard all the Personality disorders as antisocial to varying degrees;
they are opposed to the normal social instincts mentioned in the Dictionary, a
matter of abnormal temperament, as described in Stuttafords book. Broadly, the
personality disorders are Paranoid, Schizoid, Schizotypal, Histrionic, Narcissistic,
Antisocial, Borderline, Avoidant, Dependent, Obsessive Compulsive, and Passive
Aggressive personality. There are a one or two others, such as Self-Defeating
personality disorder and Impulse Control disorder. Considered one of the worst
personality disorders, Antisocial disorder is interesting because the description and
diagnosis for it and its effects on society are one and the same; the antisocial
personality is antisocial, pure and simple, in all the ways listed by the Oxford
English Dictionary above, and others besides. This disorder used to be termed
psychopathy, and although many in society still use the term (such as the media or
laymen) since the 1990s it passed out of medical discourse. We shall use the term
psychopath only when speaking in terms used by sources under discussion, or in
direct quote, otherwise referring to antisocial personality.
The online introduction to a Sheffield Symposium that took place just
recently (18th to 19th September 2003) on Psychiatry and the Problem of Evil
wonders about the exact nature of the distinction between the clinically antisocial
and the normally antisocial in our times. The author of the article muses On the
weekend that I prepared this introduction a brisk run through one Sunday
1

Thomas Stuttaford, In Your Right Mind: Everyday Psychological Problems and Psychiatric
Conditions Explored and Explained (England: Faber and Faber, 1999). (hereafter references to this
text are cited parenthetically in the text).

11

newspaper alone yielded stories on the following: two sons of a dictator whose
conduct included the routine torture and rape of subordinates, the beating to death
of transgressors in front of multiple witnesses (who did not intervene); the
exhibition of this pairs corpses to the media; the conduct of groups of healthy,
affluent young men, aged 20-30 years in a Far Eastern country who routinely enjoy
the gang rape of prostitutes as a form of bonding.the debate over whether a
double agent acting on behalf of domestic security services was able to kill with
impunity while acting under cover; the conduct of a man who having spent
periods in a mental hospital, became a recluse brandishing firearms before
eventually shooting a teenage burglar in the back, and other such events. The
article rightly wonders, How antisocial does a psychopath have to be to eclipse
such normality?2 We might well ask. Where do we draw the line between normal
behaviour and clinical behaviour? Let us glean some clues about the psychiatric
perspective by looking at the formulation of the concept of antisocial personality.
One of the first clinicians to write about antisocial personalities was
Philippe Pinel, an early nineteenth-century French psychiatrist. Then it was termed
moral insanity or insanity without delirium3, a pattern of socially deviant
behaviour marked by remorselessness, extremely disruptive behaviour that baffled
psychiatrists and psychologists, as it seemed to lie on the margins of reason and
insanity. It was around this period that the argument whether psychopaths are
mad or bad begun. Pinel took the line that they were insane but morally neutral,
whereas other writers have taken the line that they are fully sane, but morally
corrupt to the extreme. In his recent book Without Conscience: The disturbing
world of the psychopaths among us, Robert D. Hare gives a comprehensive
account of the disorder, results of his own psychological research into the
phenomenon. Hares text from the 1990s follows on from themes studied in depth
by Harvey Cleckley, a psychiatrist who wrote one of the most well known
psychiatric texts on the subject, The Mask of Sanity, in the 1940s. The latter is a
very large, complex medical text on psychopathy, credited in Hares work as a
valuable source of information. Cleckley also expressed this concern with where to
2

Introduction to The Sheffield Psychopathology Symposia, at

www.psychopathology.co.uk/introduction.php
3

Robert Hare, Without Conscience: the disturbing world of the psychopaths among us (New York:
The Guilford Press, 1999), p. 25 (hereafter references to this text are cited parenthetically in the
text).

12

place the grossly antisocial on the spectrum of sanity and insanity. He summarised,
Considering a longtidudinal section of his life, his behaviour gives such an
impression of gratuitous folly and nonsensical activity in such massive
accumulation that it is hard to avoid the conclusion that here is the product of true
madness of madness in a sense quite as real as that conveyed to the imaginative
layman by the terrible word lunatic With the further consideration that all this
skein of apparent madness has been woven by a person of (technically) unimpaired
and superior intellectual powers and universally regarded as sane, the surmise
intrudes that we are confronted by a serious and unusual type of genuine
abnormality4. As the text is an old one, it is possible Cleckley might have lumped
some of the personality disorders together as psychopathic, which we would now
distinguish from each other in our wider classifications. Still, Cleckleys quote is
appropriate, as the question of illness hangs over all personality disorders, clearly
so if Cleckley might have classified as psychopathic some of the other now
differentiated disorders. However, we continue to take the antisocial personality as
our prime example. We shall now look in more depth at Hares more recent work
to find exactly what characterises the psychopath or antisocial personality.
Compiling a character definition of the psychopath, Hare notes these
pieces of the puzzle form an image of a self-centred, callous, and remorseless
person profoundly lacking in empathy and the ability to form warm emotional
relationships with others, a person who functions without the restraints of
conscience. If you think about it, you will realise that what is missing in this
picture are the very qualities that allow human beings to live in social harmony
(33). According to Hare, psychopaths are not out of touch with reality; they are
sane, rational and aware of their actions. Their behaviour is one of choice, freely
exercised (22). To help what Hare terms the problem of classification of the
psychopath from other widespread antisocial behaviours in society, Hare compiled
the Psychopathy Checklist, which he claims lets us discuss psychopaths with
little risk that we are describing simple social deviance or criminalityit also
provides a detailed picture of the disordered personalities of the psychopaths
among us (33).

Hervey Cleckley, (1941). The Mask of Sanity (St. Louis: C.V.Mosby, 5th edition 1976), p. 364

13

To sum up this list: Emotionally, the subjects are glib and superficial: Hare
mentions that, although often witty, articulate and adept at self presentation, they
are often in fact rather too much so, as a close observer is able to see them as too
slick and smooth, too obviously insincere and superficial, mechanical in their
behaviour. They are also egocentric and grandiose: with an inflated sense of self
worth, psychopaths view themselves as superior beings who are justified in
ignoring the rules of society and living by their own rules. They lack remorse or
guilt, often viewing guilt as mechanism of social control, and one any intelligent
person would ignore. They lack empathy: all the characteristics just mentioned are
closely associated with the theme that antisocial personalities see people as little
more than objects. Hare notes, in some respects they are like the emotionless
androids depicted in science fiction, unable to imagine what real humans
experience (Hare, 44). They are indifferent to family and friends alike, viewing
them more as possessions of some sort than any familial bond. This is why
psychopaths do appalling things; they have no concern for their victims, they
cannot imagine themselves in their place. Hare cites psychopaths as deceitful and
manipulative, often priding themselves on their ability to con others. When
discovered, they are unconcerned, simply making up new stories. Psychopaths also
have shallow emotions, beneath which little happens.
The above listed are the emotional aspects of psychopathy on Hares list.
Hare completes the checklist with symptoms of social deviance psychopaths
display, which overall give the impression of a chronically unstable and aimless
lifestyle marked by casual and flagrant violations of social norms and
expectations (46). They are impulsive, and do what they feel like doing with little
or no thought for the consequences as well as living day to day with little thought
for the future. They have poor behaviour controls, without the inhibitory controls
normal people have over their behaviour. Hare cites a need for excitement, which
often leads to violation of social norms in search of new thrills, be it drugs or
violence or something else. This also means an inability to handle boredom.
Psychopaths show a lack of responsibility: this lack extends to every aspect of their
lives. Hare notes psychopaths display behaviour problems from youth, such as
theft, class disruption, vandalism and violence. This leads to adult antisocial
behaviour. An appropriate quote to sum up Hares position on psychopaths is this
one: Psychopaths consider the rules and expectations of society inconvenient and
14

unreasonable, impediments to the behavioural expression of their inclinations and

wishes. They make their own rules, both as children and as adults (67).
A problematic of mental health, the distinctions and links between disease
and morality, medicine and law, already begin to develop around the deviant, for
our purposes that of the antisocial personality. Dr Thomas Szasz suggests that the
values attributed to mental health, along with the behavioural signs that designate
mental illness, are all a question of ethics rather than science, and these ethics
themselves appear to boil down to ideological power, something approaching
politics. The implication would be that our pinup transgressor, the antisocial
personality, and various other classified medical entities, might be no such thing,
but rather just individuals in conflict with a dominating, normalising discourse of
the disciplinary society. Many Critics have responded with disdain to the
psychiatric labelling of the personality disorders. One article describes the views of
J.H. Pincus, a recent author on the subject, on the matter, Recounting how a
friend suffered from chronic itching around the anus, he states that the friend was
relieved when a doctor made a diagnosis: pruritus ani. However, Pincuss friend
then looked up the words in a dictionary, only to find that they merely described
his symptoms. The Latin title pruritus ani provided no more understanding or
treatment that the English (itching of the anus). The diagnosis antisocial
personality disorder is the pruritus ani of violent behaviour.5 Peter Sedgewick,
a left wing writer and teacher, comments that in relation to all the disorders, The
label of psychopathy for example, probably represents no more than an attempt at
pseudo-medical mislabelling, for control purposes, by psychiatrists working in
tandem with the judicial authorities.6 Tautological diagnosis such as antisocial
personality disorder in psychiatric practice merely classifies behaviour for
restrictive penal reasons, rather than aiding any real medical issues in society.
Considering this let us now return to Dr T. Stuttafords book, a recent text
(published in 1999) that aims to clarify everyday psychiatric and psychological
problems for laymen and scholars alike. Looking at Antisocial personality
disorder, we see characteristics listed very similar to those produced by Dr. R.
5

J.H. Pincus, Base Instincts: What makes killers kill ( New York: W.W. Norton and Company,
2001), p. 79. Also quoted in Introduction to The Sheffield Psychopathology Symposia at
www.psychopathology.co.uk/introduction.php
6
Peter Sedgewick, PsychoPolitics (London: Pluto Press, 1982), p. 38 (hereafter references to this
text are cited parenthetically in the text).

15

Hare, and Dr H. Cleckley in their diagnosis of the phenomenon. The inability to

keep a regular job, failure to conform to normal social behaviour and the laws of
the community, irritability and aggressiveness, and inability to sustain a
monogamous relationship for more than a year, are among the ten symptoms
listed, of which four counts are needed for a diagnosis. One might wonder why a
person with three symptoms should escape categorisation, where one with four
does not. Looked at in this way, the boundaries begin to blur a bit between the
normal and abnormal, and for this particular disorder even appear a bit arbitrary.
One could begin to criticise the formulation of these behavioural practices as
symptoms in the first place; it appears that perhaps transgression of the social order
is itself the disorder. To denote failure to conform to normal social behaviour and
the laws of the community as a symptom is to warn that one must not oppose the
status quo. To note failure to keep a job is a possible symptom of illness is
obviously in the interests of the entrepreneurial capitalist society, where the
individual is obliged to give his time to the societal apparatus in daily work, which
is also a means of keeping him attached to a normalising establishment. Such
observations could be made of all symptoms in all the personality disorders. In all
the disorders, we see a combination of particular behavioural traits displayed as a
symptom of a disorder. Stuttaford notes When someones character is totally
inflexible and does not fit in with the accepted standards of the culture in which
they find themselves living, or when they are so inflexible that they cannot make
even the minor, let alone the major, changes required by everyday living, it is
considered an abnormal feature. (Stuttaford, 83). This statement works both ways,
in that the standards of the culture are therefore inflexible also, and it is a struggle
between the individual and the inflexible culture he finds himself in. There is in the
text no debate as to the validity of the classification of the deviant personality as a
personality disorder. Stuttaford goes on to state, Doctors have recently been
encouraged to group these abnormalities into three clusters. Cluster A personality
disorders are those that were previously only thought of as a cause of abnormally
eccentric behaviour. Cluster B incorporates those who have an over-emotional and
dramatic personality, whose actions can seem abnormally selfish, manipulative and
impulsive. Patients whose personality troubles are classified as belonging to cluster
C have a character associated with neurotic disorders, described as the overdependent, the avoidant, the co-dependent, the compulsive and the passive16

aggressive. (83/84) The anti social personality, previously termed the psychopath,
the psychiatrist identifies as part of cluster B. However, personality is plastic and
varies immensely across cultures and environment, so there are bound to be such
combinations within any society. It might be argued these combinations are as
natural to those who find themselves possessed of them, as more socially
acceptable personalities are to those who have the good fortune to be possessed of
these.
Stuttaford explains that symptoms may overlap between disorders. It seems
very significant that a number of traits has been set out, a particular number of
which justify classification of disorder. It shows there is a very thin, almost
arbitrary line, between the normal personality and the personality disorder. The
very use of the term abnormal in relation to personality shows the existence of a
norm around which the personality develops, deviation from which has become a
medical phenomenon. It would appear to some from this text that with the
increasingly detailed classification and development of medical terminology,
supervision and identification of behavioural traits, the norm is being drawn and
redrawn as our developed society progresses, and more medical cases are created
as more behavioural traits are identified as deviant and become medical problems,
and so on. Is it possible that the drawback of a society that monitors individuals on
their potentiality is beginning to show? After all, normalisation means very little
choice as to which potentials are valid and which are not. Peter Sedgewick
considers, In the future development of our species, we can anticipate either that
some conditions now classified as illness will be re-allocated to a different
framework of deviancy (or, more drastically, become regarded as essentially
normal and non-deviant); or that, on the contrary, conditions which are nowadays
viewed in a non-illness category of deviancy (as sins, perhaps, or as consequences
of ageing or excessive effort will be regrouped into the range of the illnesses or
diseases. (PsychoPolitics, 39) With our technological advancement and
developed methods of classification, we might see the gradual annexation of all
sorts of currently non-ill behaviour into categories of illness.
We must consider then that perhaps the psychopath, the antisocial, or
otherwise disordered personality is the evolved other of contemporary society.
The problem is not a medical one, but an ethical one, and perhaps not even this; the
antisocial personality, any personality disorder, simply counters the contingent,
17

developed norms of wider social discourse, which currently promotes the

entrepreneurial self. Szasz comments I propose to call this language of social
discrimination the rhetoric of rejection. Whenever people propose to exclude
others from their midst, they attach signifying labels to them. There are many such
labels in addition to Jew and malingerer; child, foreigner, enemy, criminal, Negro,
and mentally ill are currently some of the most important ones. Like all methods of
persuasion, the rhetoric of rejection invites its opposite: the rhetoric of acceptance.
Whenever people propose to include others in their midst, they shun and even
prohibit the use of certain stigmatising labels, especially in certain situations, such
as in courts of law, newspapers, and so forth. (Ideology and Insanity, 56)
We shall now look at a couple of cases of transgression of social codes of
conduct, to illustrate some transgressions in practice, and issues they raise. We
have picked out two severe, appalling cases, that none could fail to term antisocial,
cases that truly raise doubt as to the sanity of the perpetrators.
Jeffrey Dahmer, jailed for multiple murders in America in the late 1970s
and early 1980s, is one of the most horrifying cases of antisocial behaviour in
recent history. From Milwaukee, United States of America, he repeatedly lured
young men to his apartment to watch sexually explicit videos or to pose for photos.
He would drug them, strangle them, have sex with the corpse or masturbate on it.
He would also capture the entire experience on Polaroid film so he could
remember every moment of each murder. He then cut open their torsos, and
dismembered the bodies. He kept parts of the bodies as trophies, frequently the
genitals and the head. He claimed also to have cannibalised parts of the bodies
because he believed that the people would come alive again in him. The case of
Jeffrey Dahmer sparked immense uproar, and the case was extensively publicised.
Exactly how a man becomes a serial killer, necrophiliac, cannibal and psychopath
was a question that the public wanted answers for. Eventually the Jury found
Dahmer guilty, and perfectly sane. A judge and jury of his peers deemed him fit to
spend the rest of his life in a prison cell instead of a hospital, and the judge
sentenced him to life imprisonment. He died in prison.
The Dahmer Case occurred in the 1980s, but we shall further illustrate with
a recent case, the British Case of Harold Shipman. It is pertinent to our discussion
to include this case of modern historys most prolific serial killer. Shipman brought
about the deaths of elderly patients with an administered overdose of morphine. A
18

clinical audit commissioned by the Department of Health estimates Shipman was

responsible for the deaths of at least 236 patients over a period of 24 years. He is
now serving 15 concurrent life sentences for murder, there would be no point
indicting him on any more as he is bound anyway to be in prison for the rest of his
life. Again, countless psychiatrists and psychoanalysts speculate as to the reasons
for Shipmans behaviour. Unlike most multiple killer cases, there was no violence,
no sexual overtones and no known motive but one exception in which money was
involved. The article ends with these thoughts, Is Shipman a one-off monster as
some have suggested? There is growing evidence that he is not as rare as one
hopes him to be. Disguised in the aura of respectability that normally surrounds
medical professionals, a number of monsters like Shipman have gradually been
unmasked, but only after numerous deaths have taken place. Such cases open up
the debate a bit, as it is hard to defend such cases from the viewpoint of merely
rejecting the demands of the social order; such individuals suggest that extreme
anti-sociality does verge on the abnormal, in which case psychiatric classification
at such extremes might be valid. In our next section, we shall work on this question
through assessing the position of our judicial institutions for social security, to
better view the position of psychiatry in relation to these.

19

Regulating Society: Normalisation

We see here two major cases of transgression of societal laws and codes. At
least one, if not both these cases, is by current standards of an antisocial
personality. The judicial system judged them, psychiatrists debated over them, and
finally a judge jailed them for life for their dangerous and threatening behaviour, as
a disruption of the social order and a danger to other members in society. Let us
now look at the system that upholds the values of society in the courts and the
hospitals to see where we place these individuals and how society operates to
counter such destructive behaviour. In an essay on criminality, The dangerous
Individual, Foucault looks at the involvement of medicine and psychiatry in penal
justice, examining the growth of penal psychiatry since the nineteenth century, and
the relationship between crime and insanity. Foucault points out in this essay that
If psychiatry became important in the nineteenth century, it was not simply
because it applied a new medical rationality to mental or behavioural disorders, it
was also because it functioned as a sort of public hygiene.1 Foucault notes that the
relationship between crime and insanity has become such that, at least at the
boundaries of insanity, there is crime, absolute crime to which Foucault
attributes the term homicidal mania. The Dahmer case involved a huge debate over
whether Jeffrey Dahmer was responsible for his crime or not. Pleading guilty,
Dahmers defence was that of insanity, the defence claiming that only an insane
man could do such appalling things. The defence argued that Dahmers mental
problems prevented him from knowing the nature of his crime. The prosecution
countered that Dahmer was sane, but morally corrupt, without conscience, an
antisocial personality or psychopath. He knew perfectly well what he was doing,
but did it anyway. The trial psychiatrists debated extensively over whether the
perpetrator of such a crime was deliberately transgressing societies law, or if such
absurd, horrific transgression must be a result of some illness. The prosecution
insisted he was less the runaway train than the engineer, that Dahmer was fully
responsible. In the event, the jury found him guilty, without insanity, fully
responsible for his actions.
1

M. Foucault, The Dangerous Individual, in Politics, Philosophy, Culture: Interviews and other
writings 1977 1984, ed. L. Kritzman (New York/London: Routledge, 1988), p. 134 (hereafter
references to this text are cited parenthetically in the text).

20

Dahmer had a personality disorder. Those with a personality disorder are

considered sane and responsible by law. The personality disorder is less a
description of illness than a medical classification of patterns of behaviour that are
opposed to the norms of society. Although both found to be sane, there was a
thorough investigation into the backgrounds of both Shipman and Dahmer, in
order to explain how they came to do what they did. Newspapers write of
Shipmans trauma at the slow death of his mother, when he was just 17. They
speak of how he spent evenings by her bedside, often watching her doctor give her
a morphine injection to dull the pain, watching her get weaker and weaker until she
passed away. There is speculation his crimes were a form of masochistic repetition
as he practiced this death scene on victims, in his role as doctor. Dahmers father
brought out a book after his sons conviction, in which he sought reasons for the
path his son chose through life, offering up to the public Jeffreys mothers
ailments and highly strung nature, or the family divorce when Jeff was eighteen.
What all these references to the life of the criminal, all the heavy focus on
the history of the individual in the aftermath of the crime, have in common, be they
fact or fiction, is a need for explanations, and more explanations, of the otherwise
unpredictable, sudden rupture of societies norms and codes. Foucault points out in
The Dangerous Individual that when a man comes before his judges with
nothing but his crimes, when he has nothing else to say but this is what I have
done, when he has nothing to say about himselfthen the judicial machine ceases
to function (The dangerous Individual 151). In these cases, as with many
others, the criminals silence is filled with history attributed to the central
characters by relatives and acquaintances, stories and memories, all overshadowed,
told in light of, and perhaps influenced, by the crime in question. Why is this?
Foucault offers us the idea that the legal systems operatives cannot really play
their role unless they are provided with another type of discourse, the one given by
the accused about himself, or the one which he makes possible for others, through
his confessions, memories, intimate disclosures (128). What is the discourse that
we build around the crime, which we validate by disclosure and explanation of the
individual? It is the discourse of the dangerous individual, the abnormal individual,
the unpredictable individual, part of the moralising discourse that seeks to
distinguish firmly between the criminal and the non-criminal, the sane and the
insane, society and the deviant, by firmly establishing, once a crime is committed,
21

that no one else could have committed it, it was somehow in the individuals
immoral nature.
Our society is normalised to be predictable and ordered, as part of the
judicial apparatuss prevention of crime and social disturbance. The crimes above
need investigation because they represent failures of the social order, the
individuals tried are not normalised enough not to have committed these crimes.
The law and society can only comfortably understand these horrific glitches in the
normalisation of society by means of discovery of abnormal elements in
upbringing or history. Thus the interest in the criminals history, especially in these
particular cases; with no outer signs of abnormality (indeed Shipman was an
educated man of good social standing) proof of flaw, that the person cannot be
human to the extent we are, has to be sought in the history constructed around the
individual, the history provided by the accuser. According to Thomas Szasz, the
labelling process in psychiatry comes about because of our need to predict other
peoples behaviour; people who are labelled are far less easy to predict and others
find this disturbing. One article notes, Attaching a diagnostic label represents a
symbolic recapture and this may be followed by a physical capture
(hospitalisation, drugs, etc.). Our psychiatric labels and diagnosis represent a new
total identity, which not only describes people but also describes how they should
be treated and viewed by others. Therefore, psychiatric diagnosis is a form of
action, and it is action against the socially deviant. Szasz had in mind an illness
like schizophrenia. In these particular cases however, the unpredictability cannot
be found anywhere except in the individuals incredible actions. What is interesting
about the label of psychopath is that it describes no clear signs of madness, but
rather their danger to society, and the scale of their disregard for society. The
labelling process goes as far as this though, as without such a term, there is no
difference between a man like Dahmer and the rest of us who judge him, other than
metaphysical unpredictability, and for many that is a chilling thought.
Therefore, society must distinguish between the normal and the deviant, to
avoid unpleasant surprises like the above cases, and to deny their relation to the
rest of society when they occur. The normalisation of our society, supported by the
legal systems judgement of the abnormal individual, is also pursued by the medical
arm of a society that looks increasingly for classification of deviant behaviour in
psychiatric terms to distinguish it from normal behaviour. Foucault follows up on
22

this when he states that the judicial apparatus has set up normality to be primarily
in opposition to danger, by engineering the concept of dangerousness as an
abnormality: when you look closely at the penal code, whether it is of an AngloSaxon or a Napoleonic type, danger has never constituted an offense. To be
dangerous is not an offense. To be dangerous is not an illness. It is not a symptom.
And yet we have come, as if it is self-evident, and for over a century now, to use
the notion of danger, by a perpetual movement backward and forwards between
the penal and the medical. The penal says: listen, I dont really know what to do
with this man, Id like your opinion about him is he dangerous? And if the
psychiatrist is told: come now, you must reply to this question, will reply:
obviously, danger is not a psychiatric notion but it is the question asked me by
the judge. And there you are! If one considers the whole thing, taken together, one
sees that it all functions on the notion of danger.2
Dahmer and Shipman are dangerous, and they are imprisoned. However,
this is not all that happens, the judicial process extends further than this; we
investigate their lives, we draw up histories about them, sensational stories are
told, they are labelled psychopathic and antisocial personalities, psychological
profiles declare their abnormal natures, coupled with their sanity, theirs is a
baffling position on the fringes of reason. The worse the crime, the more frantic
and powerful the exploration of the individuals deviance, for the more deviant an
individual can be found to be, the more right society has to eliminate him from
their midst. The outcry against extreme cases of social transgression that come to
public attention are protests at the judicial processes failure to curb the antisocial,
to find this deviant before the event, to secure the harmonious for society as a
whole. For developed societies, the prime concern is the harmonious functioning
of society, and quickly identifying and removing elements that are dangerous to
that society is seen as the best way to sustain this harmony. However, something
else is tied up with this, which is to control the way the society operates, to control
the way the individual develops, in order to monitor what is thought and done
within a society. The centralised institutions in society developed for this reason
also, as well as their specific areas of expertise. They guide the community
ideologically as well as physically, passing on the normal values of that society;
2

M Foucault, Politics, Philosophy, Culture: Interviews and other writings 1977 1984, ed. L.
Kritzman (New York/London: Routledge, 1988), p. 190/191

23

the socialised individual in a society is conditioned to be so. It goes without saying

that values harmful or opposed to a societys dominant ethic are excluded from
these institutions, and it is hoped by this means to exclude them from the nature
and minds of the individuals trained within these institutions.
Foucault suggests that some of the subjects we teach in our schools and
universities, our very sense of what knowledge is, developed as part of the
operation of power on the individual to ensure social cohesion. As quoted in the
passage at the beginning of this essay, Foucault suggests that human sciences
such as sociology, psychology, criminology and psychoanalysis developed as an
arm of the judicial process of our society, a means of correction. These institutions
correct the individual at the level of his potentialities, and operate by means of the
examination. For an individual to be a part of society the individual must be
guided and normalised from the outset in institutions such as the school, the
church, the army. If he should stray from the path, the correctionary arm of the
same normalising process are on hand to bring him back in line, those of the
prison, the hospital, and the asylum. The police is there to keep order and control
deviance, and the open society is geared towards public expression and public
living, so behaviour is all the more readily exposed and more easily monitored.
Foucault refers in detail and more effectively, than I can to the exact nature of this
observing society in this quote, when he speaks of the Panopticon. The quote is so
appropriate to our project I have decided to include it in its entirety: We live in a
society where panopticism reigns. Panopticism is a form of power that rests not on
the inquiry but on something completely different, which I will call the
examination. The inquiry was a procedure by which, in judicial practice, people
tried to find out what had happened. It was a matter of reactualising a past event
through testimony presented by persons who, for one reason or another, because of
their general knowledge (savoir), or because they were present at the event, were
considered apt to know.
With Panopticism, something altogether different would come into being;
there would no longer be inquiry, but supervision (surveillance) and examination.
It was no longer a matter of reconstituting an event, but something or, rather,
someone who needed total, uninterrupted supervision. A constant supervision of
individuals by someone who exercised a power over them schoolteacher,
foreman, physician, psychiatrist, prison warden and who, so long as he exercised
24

power, had the possibility of both supervising and constituting a knowledge

concerning those he supervised. A knowledge that now was no longer about
determining whether or not something had occurred; rather, it was about whether
an individual was behaving as he should, in accordance with the rule or not, and
whether he was progressing or not. This new knowledge was no longer organized
around the questions: Was this done? Who did it? It was no longer organized in
terms of presence and absence, of existence and non existence; it was organized
around the norm, in terms of what was normal or not, correct or not, in terms of
what one must do or not do.
So we have, in contrast to the great knowledge of the inquiry organized in the
middle of the Middle Ages through the appropriation of the judicial system to the
state, consisting in assembling the means to reactualize events through testimony, a new knowledge of a completely different type, a knowledge characterised by
supervision and examination, organized around the norm, through the supervisory
control of individuals throughout their existence. This examination was the basis
of the power, the form of knowledge-power, that was to give rise not, as in the case
of the inquiry, to the great sciences of observation, but to what we call the human
sciences psychiatry, psychology, sociology (Power, 59)
Foucault shows that the norm that regulates our society includes as it
excludes. Behaviour is supervised and organised, discipline works from the top
down, through central institutions, dispersing itself through society. One of the
reasons appalling cases as the ones listed earlier spark a lot of interest, besides the
moral issues of murder and human value and all the rest of it, is because here we
have crimes in which individuals behaviour was not recognised before the event,
the individuals potentialities were unpredictable, they escaped observation. The
crimes are evidence of the failure of the panoptical to prevent, predict, identify and
control deviant behaviour before it progresses to such extremes as in the cases
mentioned earlier. These people managed to evade our normalising ideology, and
furthermore, disguised this fact from the judicial arm and its many extensions.
They progressed through life in deviancy unimaginable to the mass public, until
finally curbed by the forces that be, which went into frenzied action upon
discovery of these unthinkable individuals in their midst. Foucault contrasts
modern panopticism with the inquiry of the Middle Ages, but we might consider
that the inquiry remains in all its force. Panopticism might normalise the
25

individuals behaviour in space but if it fails, (and crime is most always such a
failure) the inquiry comes in to chart the individuals passage toward the event in
time. The discourse of the inquiry is also for the benefit of the judicial process to
better understand how such a thing came about, how one flew over the cuckoos
nest for so long. Prevention having failed, the inquiry takes over, and sentencing
takes place. Subtle normalisation having failed to have an effect on these
individuals, the supervision becomes more blatant, intrusive and compulsory, the
institution to which these individuals are attached more openly correctionary.
Foucault explains, In the age were concerned with, the aim of all these
institutions factories, schools, psychiatric hospitals, prisons is not to exclude
but, rather, to attach individuals. The factory doesnt exclude individuals: it
attaches them to a production apparatus. The school doesnt exclude individuals,
even in confining them: it fastens them to an apparatus of correction, to an
apparatus of normalization of individuals. The same is true of the reformatory or
the prison: even if the effects of these institutions are the individuals exclusion,
their primary aim is to insert individuals into an apparatus of normalization of
people. The factory, the school, the prison, or the hospitals have the object of
binding the individual to a process of production, training (formation), or
correction of the producers. Its a matter of guaranteeing production, or the
producers, in terms of a particular norm. (Power, 78)
We could say, as in the Nietzsche quote at the beginning of this essay, that
the norm struggles against the exception, and we redraw the lines for this struggle
constantly, as society rearticulates and reformulates itself in light of developments
in knowledge, and changing ideas about the normal, the deviant, and the
dangerous. We might say of the psychopathic or antisocial personality, or any
other classified personalities, that, though different from each other, they are all
similar in that they all lie too far beyond our social and behavioural norms.
However, we might also investigate, without prejudice, that this objective
judgement of disorder of the personality is entirely contingent, based on arbitrary
notions of what constitutes an ordered personality. We draw up knowledge of
individuals from psychological profiling and behavioural examination, but we
should consider the origins and results of this method of knowing in more depth.
Foucault suggests that the social sciences are part of the operation of power upon
individuals. Unlike the natural sciences, in psychiatry and psychology, where the
26

mind is concerned the terrain is a lot more difficult to chart. Let us avoid here the
ethical problems raised by the murderers mentioned earlier. These cases, useful
examples though they are, might cloud our ability to look clearly at some of the
problems that spring up around the deviant personality in contact with the
normalising forces. These cases are in an incontestable ethical position by our
societys standards. We would possibly need a different example to further
consider the problems with deviancy, law and medicine. An eccentric, but not
criminal, case perhaps, one that was ethically more debatable for our period. This
is because we must be willing to consider the other as a part of our society, and the
morally repulsive facts of the cases mentioned make it difficult to view them in
this light, we get into moralising discourses about human nature and suchlike that
are not the object of this section. We do not understand transgression on such a
scale merely in terms of social deviance, as I now come to discuss, but in terms of
what it means to be human. Still, we shall carry on with our discussion; let us
develop the connection between deviancy and disorder.
Approaching the topic of deviancy, Foucault came to see that although
humans are self-interpreting beings, cultures always restrict human possibilities, so
that we might consider any given variation mad in one culture and not in another.
In The Psychopath: an essay on the criminal mind, William and Joan McCord
point out that in some societies upbringing and social structure creates individuals
whose relation to others, although normal within their society, would in this
society be termed antisocial. The text suggests that a social science like
psychology, springing from a power structure within this society, is still perhaps
very culturally relative, and if applied to other societies, it should be with care.
Foucault notes that only in our modern, western culture has madness, entrapped by
the code of normality developed by the judicial arm of society, come to be
regarded as illness, something that is negative and needs to be altered, something
to be taken control of. In our society each person is led to seek the truth about
himself, and by this means to make sure that all his actions and even his thoughts
in every area of life do not deviate from what science has shown to be normal,
healthy, and productive. Foucault believes this endless self-analysis, encouraging
the subject to speak in order to be available to inspection and correction, may now
be causing us more harm than good. He muses on the dreadful dangers inherent in
authorising the law to intervene against individuals because of what they are; a
27

horrifying society could emerge from that (The Dangerous Individual, 151). We
shall discuss what he might mean by that as part of the next chapter.

28

Normalisation Advances: Psychiatry

Let us look further into how our societys normalisation of individuals, and
the control of socially disruptive deviance in law, crosses over into the field of
medicine in our culture. Foucault suggests a distinction between mental and
organic pathology, in that mental pathology needs methods of analysis different to
organic pathology, and it is only by an artifice of language that we attribute the
same meaning to illnesses of the body and illnesses of the mind.1 The problem with
mental illness Foucault gives as whereas the idea of organic solidarity enables one
to distinguish and to unite morbid damage and adapted response, the examination
of personality in mental pathology prevents such analyses. (Mental Illness and
Psychology, 12) Examining what we have made of madness, Foucault observes
that about the middle of the seventeenth century, in 1650, a change took place,
where madness ceased to be tolerated, and became excluded. It was around this
point that internment houses were created to receive not simply the mad, but all
sorts, such as the poor and disabled, who to modern society would be distinguished
as very different from each other. i.e. It was around this time that Western society
began to incarcerate and control those who in relation to the order of reason,
morality, and society, showed signs of derangement (Mental Illness and
Psychology, 67). From here on in the division between the sane and the insane
began to be laid down, the sane able to speak of the insane, but the invalidated
insane unable to pronounce anything of itself. In the 18th Century, society
discovered a link between madness and crimes of passion, and in the 20th Century,
madness is discovered to have at its nucleus guilt and aggression. Foucault is
sceptical of our knowledge about what we call madness: All this is not the
gradual discovery of the true nature of madness, but simply the sedimentation of
what the history of the West has made of it for the last three hundred years.
Madness is much more historical than is usually believed, and much younger too
(Mental Illness and Psychology, 69).
Besides Foucaults anti-history of psychiatry, others have taken the
approach that madness in a normalising society is merely the more extreme forms
of social deviance, which we seek to gain control of by classification. R.D Laing
1

M. Foucault, Mental Illness and Psychology, Trans Alan Sheridan (Berkeley: University of
California Press, 1987). p. 10 (hereafter references to this text are cited parenthetically in the text).

29

argued for a better understanding of the schizophrenic experience, and Erving

Goffman criticised the institutions that contain the mentally ill. Another, and most
relevant for us at this point, is Dr Thomas Szasz, an American psychiatrist who has
consistently argued for decades that the Western conception of madness is, largely,
pure myth. Szasz goes so far as to assert, The belief in mental illness, as
something other than mans trouble in getting along with his fellow man, is the
proper heir to the belief in demonology and witchcraft. Mental illness thus exists
or is real in exactly the same sense in which witches existed or were real.2
Szasz maps out his argument along the lines that psychiatry, in its perpetration of
the myth of mental illness, hopes better to achieve the normalization of society in
the exclusion of deviance. He states The concept of insanity or mental
illnessenables the sane members of society to deal as they see fit with those of
their fellows whom they categorize as insane. Having divested the madman of
his right to judge what is in his own best interests, the people and especially
psychiatrists and judges, their medical and legal experts on madness have
divested themselves of the corrective restraints of dialogue. In vain does the
alleged madman insist that he is not sick; his inability to recognize that he is, is
regarded as a hallmark of his illness. In vain does he reject treatment and
hospitalisation as forms of torture and imprisonment; his refusal to submit to
psychiatric authority is regarded as a further sign of his illness. In this medical
rejection of the Other as a madman, we recognize, in up-to-date semantic and
technical garb, but underneath it remarkably unchanged, his former religious
rejection as a heretic. (Preface to The Manufacture of Madness, xvi). Szasz notes
the hold of psychiatry is not easy to shake, as it is well entrenched. No fresh
observations can undermine it, but new facts are always on hand to justify its
prevalence.
We can link Szaszs specific position to Nietzsches more general one,
Nietzsche being one of the philosophers who heavily influenced Foucaults
concept of genealogy. Generally, part of Nietzsches philosophy is the idea that
Christianity gave way to science, which then undermined the very beliefs of
Christianity, while remaining itself in its will to knowledge essentially moralistic
2

Thomas Szasz,. The Manufacture of Madness: A Comparative Study of the Inquisition and the
Mental Health Movement (London: Routledge & Kegan Paul, 1971), p. 21 (hereafter references to
this text are cited parenthetically in the text).

30

in nature. More specifically, Szasz claims that as science undermined one of these
beliefs, namely that of witches, this particular religious ideology shifted to a
scientific one, that of psychiatry, but one that had at its roots the same motives,
that of the elimination and control of social deviance. Szasz continues, Social
deviance is thus a term naming a vast category. Which kinds of social deviance are
regarded as mental illnesses? The answer is, those that entail personal conduct not
conforming to the psychiatrically defined and enforced rules of mental health. If
narcotics-avoidance is a rule of mental health, narcotics investigation will be a sign
of mental illnessHowever obvious this may be, its implications for our
understanding of mental illness and Institutional Psychiatry are vastly
unappreciated. The fact is that every time psychiatrists formulate a new rule of
mental health, they create a new class of mentally sick individuals just as every
time legislators enact a new restrictive law, they create a new class of criminals.
(Introduction to The Manufacture of Madness, xxvii) This statement relates to our
earlier considerations of the boundaries and limits of the logic of inclusion. We
must wonder again whether society creates an imaginary ethical line that the
deviant is doomed to cross by nature, or if the lines are universal, a natural part of
any society. Are there such things as universal laws? If so, how to distinguish
between the transient evolved and the universal, and further, how to determine
which developments need to be from those which need undoing, remains a
problem.
Szasz also expresses concerns about present society that are very similar to
those made by Foucault, about the results of a society based on panopticism,
allowing intervention based on what an individual is, or his potentialities. Szasz
remarks, One of the most terrifying features of the general witchcraft belief was
the fact, Christina Hole reminds us, that no one knew for certain who was, or was
not, a witch. The same may be said for our present situation: No one knows for
certain who is, or is not, mentally ill. Hence the former need for witch-finders,
witch prickers, and inquisitors, and the present need for psychiatrists,
psychologists, and social workers. (Manufacture of Madness, 36) Medical
classification of human behaviour is becoming the most effective method of
normalising our society. Szasz points out We have seen that the terms mental
health and mental sickness designate ethical values and social performances.
The mental hospital system thus serves, however covertly, to promote certain
31

values and performances, and to suppress others. Which values are promoted and
which suppressed depends, of course, on the nature of the society sponsoring the
health care. (Ideology and Insanity, 42).
Society runs on the logic of inclusion and exclusion. Medicine and law,
involved with deviancy, be it physical or mental, are bound to follow the paths of
this logic. The languages of law and medicine filter down to the public, and at
points where health becomes politicised, the objective role of these key
institutions becomes difficult to separate from the political and ethical interests in
them. The media often use medical and psychiatric terms in their campaigns
against a public figure, or in order to explain the behaviour of any individual
whose behaviour has arrested the attention of the public. There was speculation
about Princess Diana being a Borderline or Histrionic personality; and Stuttaford
suggests Robert Maxwell, a public figure who won acclaim in the war for his
bravery, then worked for the British Government in Berlin before moving to
London where he led an expensive life, was probably an antisocial personality:
his work record, his lawlessness, his indifference to the social norms, whether in
the boardroom, the bedroom or on the benches of the House of Commons when he
was an MP, revealed the flaws in his personality. A recent example in the news:
after the burial of Idi Amin the Ugandan dictator, the media released speculation
from British government officials that the late dictator had some sort of mental
illness. Unfortunately in some such cases, it seems to me that medical
terminology has a blatant political aim. However, if the psychiatrist may use the
term, it is difficult to prevent the media from using the same terms for their own
ends. Even when psychiatry and psychology genuinely try to aid societal order,
progress and peace, without judgement and in the interests of the patient and
society together (we do not suggest there are never any real patients, just that
there are some problems with this), this function is all too easily distorted once it
passes into public use.
In a society that functions by the logic of inclusion and exclusion,
revolving around norms in every occupation and lifestyle, there must be a
dichotomy between the patient and the normal, where the patient is by
definition always excluded. This makes it very difficult for psychiatry to work
entirely in the interests of the patient. We can see this in language, in the
derogatory medical terms hurled at public figures that come into disrepute, which
32

must further perpetuate the split between the proposed function of psychological
and psychiatric classification, and the results of such classification. Only in a more
tolerant society where acceptance of difference is the rule would psychiatry always
be able to operate in the interests of the individual and the state simultaneously.
Several intellectuals argue that they are opposed to each other, the state operating
as a normalising institution, to which the free will, speech and thought of the
individual are a threat. Those perceived to be mentally deviant enough to warrant
classification, then, and the language created around the classifications of
deviance, become derogatory once they filter into social use by a normalised
public. This happens with physical deviance too, with terms such as cripple being
derogatory in popular usage. Indeed this happens with all deviance, such as those
mentioned in the introduction to this essay; sexual and racial deviance is referred
to with words such as queer, faggot and paki, which remain derogatory terms
across society long after the social recognition of the minorities of which they are
the subjects. Perhaps that the words still hold their power as abuse is a further sign
that such recognition of the marginalized is only apparent, rather than actual.
Other, more jovial references to difference are found in words such as blonde,
and Irish, or even Essex in our local jokes and anecdotes, but these still throw
up interesting questions of how we view deviance and how we seek to harness and
control it through naming and language. However, to get too heavily involved in
this dense topic would take us too far from our discussion. Of interest to us here,
and our example, are specifically psychiatric terminologies used, devoid of their
medical significance, by the public. Words like schizo, paranoid, maniac and
psychopath3 are thrown around, devoid of their original meaning or purpose by
the public, jumbling together to refer to any sort of behaviour that one happens to
be baffled by or disagree with. We reinforce our sense of normality by naming
others with various terms which, like a game of Chinese whispers, have lost all
their original meaning, distorted and surrounded by an aura never intended in their
original formulation, given up and lost to the language of the logic of exclusion.

Where Cleckley is quoted earlier in this work (page 7) commenting that the psychopath displays
madness in a sense quite as real as that conveyed to the imaginative layman by the terrible word
lunatic, today the imaginative layman commonly labels erratic behaviour with the terrible word
psycho (psychotic) or psychopath. New psychiatric fuels for the modern mind eclipse the
terrible words of old.

33

Its language appropriated on all sides against the deviant individual in

defence of the norm, how can psychiatry ever claim real objectivity? There seems
to be a regular opposition in the psychiatric situation between the interests of the
individual and the interests of the state - that is, between individual freedom and
state security - an opposition Szasz predicts will affect and divide the future role of
the psychiatric institution. Psychiatry will split into similar roles to those now
available in the court of law, as the lines between personal freedom and social
security become more clearly pronounced. Szasz outlines notions of the Defence
Psychiatrist (or D-Psychiatrist) and the Prosecuting Psychiatrist (or PPsychiatrist). The defence psychiatrist would work in the interests of the voluntary
patient, and the prosecuting psychiatrist would work in the interest of the
government and social security. Szasz explains, Considerations such as these
point to intimate connections between economics and politics on the one hand, and
psychiatry on the other. Clearly, the D-psychiatrist can exist only in capitalist
countries, and his work will be valued to the extent that economic and personal
freedom are valued; whereas the P-psychiatrist has a place in both capitalist and
socialist countries, and his work will be valued to the extent that economic
planning and the security of society are valued. (Ideology and Insanity, 238)
Szasz concludes that this would point the role of psychiatry progressively away
from medicine and the natural sciences and towards politics and ethics. (238)
Szaszs work has been very valuable in its criticism of the institution of psychiatry,
and its defence of individual freedom in the face of repressive norms. We shall
continue our discussion, asking if state interests and those of the individual must
always collide. Whether normalisation is always a lack of freedom, or if perhaps
we need normalisation in order to have any real freedom, is something we will
consider in our next chapter.

34

The Present Day: Individual Freedom and Social Security

So we see Szasz divides the practice of psychiatry in two, the totalitarian

pole of Institutional Psychiatry set up against the benevolent, libertarian ideal
which is a voluntary, contractual therapeutic liaison between two people of equal
standing, where therapy is voluntarily exchanged for a fee. On the surface, this
might sound appealing, but, as with any criticism, this has its faults. Peter
Sedgewick views Szaszs blanket criticism of all concepts of mental illness as
powerful to a certain extent, but insists that its absolutism renders it impotent to
calculate the complex relations between means and ends, risks and benefits which
hold in real life. (PsychoPolitics, 155) In other words, Szaszs work is confined to
theory, the realm of ideas; if applied to real life, Only the mildest mental disorders
could possibly be handled within this framework, for one well-known consequence
of emotional illness is an extreme dependency that is often manifested towards the
therapist. Consequently Szasz is saying that the whole defensible psychiatry is that
which can be practised with those who need it least. Towards those who are in
most need of psychiatric (as of ordinary medical) treatment the chronically ill
who cannot earn the fee that ignites the engines of Contractual Psychiatry Szasz
offers nothing. (PsychoPolitics, 155) Szasz does not argue his case on
humanitarian grounds, but rather rejects state control in favour of individualism
and capitalist market enterprise, and his views on compulsory psychiatric
incarceration are in line with this. Sedgewick criticises the fact that Szasz does not
propose any solution for those constrained by psychiatry, he is advocating a right
wing, laissez faire, Social Darwinist perspective of man against the elements, with
minimum intervention by the state. A huge cause of disagreement is that Szasz not
only advocates a laissez faire attitude to mental illness, but also to the poor, and to
social problems like narcotics addiction and suicide. Sedgewick scathingly
remarks, in Szaszs world not only could the unfortunate choose contractual
psychiatry, they might drown, hang or drink themselves to death quite freely, so
long as no one intervenes with their liberty.
Sedgewick continues, Szaszs philosophy of the state is likewise one of
minimum government rather than no government. Only psychiatric force requires
total abolition: the judicial coercions of imprisonment and the seizure of property
through the apparatus of both civil and criminal law is not only presumed but
35

encouraged as the ultimate mode of conflict resolution. (169). The state is there to
check aggression of one individual against another, but we must avoid any attempt
to dictate our moral perspectives through psychiatric control. Szasz argues that all
adults are perfectly responsible for their behaviour, there are no exceptions
whatsoever to this. The individual ought to be fully accountable in civil and
criminal law; ideally, psychiatrists would never argue an individual was unfit for
trial due to insanity, or diminished responsibility, or anything else. In issues of
responsibility and non-responsibility, according to Szasz the deviant individual is
always responsible. Although acknowledging Szaszs contribution to criticism of
psychiatry, Sedgewick dismisses the whole, concluding that His game-playing,
behavioural analysis deals only in what the patient does to other people, never in
the personal anguish, alienation or stupor which predates the sufferers
communication with others. Mental illness is a language: but it is also the sick
ones inability to use a language. It is, to be sure, a social status, but before that, it
is a private hell. Szasz attains his role as proxy spokesperson for the rights of the
mental patient by ignoring, simply, what it is to be a mental patient.
(PsychoPolitics, 158)
Sedgewick leads us to consider the need for an effective system of care,
and suggests that the social role of psychiatry today is not wholly repressive as a
commentator like Szasz believes, but its additional role of protection and genuine
care for society is more prominent now. To see psychiatry as merely control of the
deviant is backward. Commentators like Walter Gove explain psychiatry has
changed since the 1950s; the number of inpatients has decreased and the number of
outpatients has increased as patients now have more freedom to come and go as
they please. The anti-psychiatrists have had a great influence in psychiatry, and
some would argue that the institution of psychiatry has changed accordingly.
Walter Gove remarks that the labelling theorists are arguing an old position if they
fail to take into account the changing nature of psychiatry in the latter half of the
twentieth century. Psychoanalysis has become so deeply ingrained in American
society that it is a source of humour in the country, seen in the work of Woody
Allen, or sitcoms like Frasier, or series like The Sopranos recently aired in this

36

country.1 Whether or not there exist behind the happy free market of voluntary
psychoanalysis the dark processes of psychiatric control is debateable. We might
consider that increased reliance and belief in psychiatry on one level makes it
harder to dispel its myths when the classifications are more severe, on deeper
levels to do with transgression of societal order and compulsory psychiatric
intervention.
Peter Sedgewick suggests, Psychiatry is left with two seeming
alternatives: either to concur with the view that personal, psychological and
emotional disorders are really states of the body, objective features of the brain
tissue, the genes, the organism-under-stress, or what have you; or else to deny that
disorders of the psyche are illnesses at all. If the latter, then the way is open to treat
mental illnesses as the expression of social value judgements about the patient, and
psychiatrys role will not belong to the disciplines of objective, body-state
medicine. Instead, it will be analogous to the value-laden and non-medical
disciplines of moral education, police interrogation, criminal punishment or
religion (depending on how low or how lofty a view one takes of the values
inherent in psychiatric practice). (PsychoPolitics, 37) One can imagine the future
of psychiatry, as a moralising discourse that is culturally relative, would allow
classification without claim to absolute truth. Antisocial personality disorder, for
example, would not be a medical phenomenon, but very clearly an injunction to
adapt to societys codes, or risk judicial intervention. In this way psychiatric
judgement would not have the monopoly it does now, and its fallibility as a means
of categorisation, its position as a value judgement, perhaps more easily
acknowledged. If one believed in personality disorders or not, both decisions
would be moral and political ones, questions of lifestyle and social cohesion, rather
than any question of the objective, superior truth. Perhaps in this way the way
would be clear for beneficial aspects of psychiatry to operate freely, side by side

The Sopranos is especially interesting: Tony Soprano is a mafia boss, considered an antisocial
personality by his psychiatrist. This voluntary relationship is humorous as it is uncommon, the
prime medical representative of societys values in liaison with the representative of the criminal
underworld. Their conflicts in opinion largely reflect their different social roles, but as the show
plays out, we see the humanity of both sides of the social divide. This scenario appears in recent
films also, such as Analyze This. Whether this is meant to reflect psychiatrys increased ability to
relate to all parts of society, or give a more human perspective of the antisocial, or a mystification
and softening of the reality of psychiatric control in society, is for the viewer to decide.

37

with criticism of its more repressive aspects or debateable classifications of the

social deviant.
The anti-psychiatric message has largely been that psychiatric medicine is
not on a par with physical medicine, and its value judgements should not be
intruding into areas of social discourse where they do not belong. Sedgewick
introduces another slant on the idea of deviancy and mental illness, proposing the
whole concept of illness is manufactured, part of the logic of inclusion and
exclusion, and in this respect physical illness is no different from mental illness.
Where Szasz and Laing draw distinctions between the natural-scientific, value-free
language of physical medicine and the socially and politically loaded language of
psychiatry, Sedgewick sets out to show the values inherent in physical medicine
also. He comments, Yet the problem remains: We cannot review the social
institutions of mental illness independently of, or prior to, the institutions and
constructions that society has elaborated for the case of plain illness. What, then, is
illness? It will be recalled that critical theory in psychiatry has tended to postulate
a fundamental separation between mental illnesses and the general run of human
ailments: the former are the expression of social norms, the latter proceed from
ascertainable bodily states which have an objective existence within the
individual. (PsychoPolitics, 28). Sedgwick suggests that all diseases are social
constructs, not just the psychopathological ones. He points out that in nature there
are no diseases or epidemics, just natural processes, but we are so used to our
technical medical concepts we tend to apply them to the natural world also. He
goes on to assert that the medical enterprise is from its inception value-loaded; it
is not simply an applied biology, but a biology applied in accordance with the
dictates of social interest (PsychoPolitics, 31). Following on from this, Sedgewick
suggests that if we look closely we will see that Social and cultural norms also
plainly govern the varying perception, either as essentially normal, or essentially
pathological, of such characteristics as baldness, obesity, infestation by lice,
venereal infection, and the presence of tonsils and foreskins among children
(PsychoPolitics, 33). During this essay we have highlighted the control and
classification of the personality disorders by looking at one, antisocial personality,
and the way in which issues this disorder raises echoes issues and problems of
social transgression and deviance found in all the personality disorders, and, as
argued by some anti-psychiatrists, in all of psychiatry. Sedgewick takes the idea of
38

psychiatric medicine representing specific values which have been mystified and
objectified further, bracketing the anti-psychiatrists as to a certain extent also
mystified in failing to see the very concept of illness as invention. The
physicalistic psychiatrists are wrong in their belief that they can find objective
disease-entities representing the psychopathological analogues to diabetes,
tuberculosis and post-syphilitic paresis. Quite correctly, the anti-psychiatrists have
pointed out that psychopathological categories refer to value judgements and that
mental illness is deviancy. On the other hand, the anti-psychiatric critics
themselves are wrong when they imagine physical medicine to be essentially
different in its logic from psychiatry. A diagnosis of diabetes, or paresis, includes
the recognition of norms or values. Anti-psychiatry can only operate by positing a
mechanical and inaccurate model of physical illness and its medical diagnosis. It
follows, therefore, from the above train of argument that mental illnesses can be
conceptualised within the disease framework just as easily as physical maladies
such as lumbago or TB. (PsychoPolitics, 38)
It would appear in our normalising society physical medicine does not
escape our value judgements about what it means to be a fully functioning, valid
and capable human being in society. Our debates about personality disorders on
the front of psychiatry are a scratch on the surface of a philosophy of
differentiation between the normal and abnormal, distinctions between the deviant
and the non deviant that have been developing in the forms and concepts of
medicine for centuries. However, Sedgewick is not arguing we should therefore be
campaigning against all of medicine, in comparison to which psychiatry is on the
fringe. Rather, if social value judgements about deviancy are made at all levels of
the social spectrum, physical as well as psychological, then Sedgewick argues that
psychiatry can be validated in its place on this spectrum, as a continuation of our
societys logic of inclusion and exclusion, and for this reason something can be
made of it. In the same way as physical medicine is useful to society, we must not
rule out psychiatry as there are perhaps useful elements in its extension of our
social value judgements.
The debate over the status of the antisocial personality, indeed of
psychiatry and our medicalising discourses as a whole, remain very relevant for
our times. I see two recent trends developing, both attempts to regulate excess
deviancy in our society, by large centralised institutions, namely the government
39

and psychiatry, that are causing increased consternation. We have mentioned both
during the course of this essay; one is increased classification by psychiatry, and
the other is the panoptic state the gradual normalisation of our total environment,
of course, but also the visibly (some would argue intrusively) increasing methods
of technological surveillance used throughout our society today. An article in The
Guardian published late in 2002 remarks, Increasingly, however, our freedom to
define a private space for ourselves is being restricted. The government and its
agencies, while keen to keep their own secrets, are less willing to allow us ours,
handing themselves new powers that let them steadily map our private lives. Just
as chilling is how much is known about us by corporations which are busy
compiling extraordinarily detailed databases of our everyday transactions. The
result is that the most trivial nuggets of data are taken out of our control and
scrutinised to almost microscopic levels by hundreds of different organizations.2
We all get more concerned with privacy as the space that is the private shrinks,
replaced by the culture of disclosure, public confession and the ever-present media.
In politics, David Blunkett, the home secretary, comments on this difficult position
in a debate over state surveillance measures in 2002, How we balance this
entitlement to both liberty and security is more pressing now than at any time since
the second world war. On the one hand, we have the spectre of global terrorist
networks, perpetrating outrages beyond our wildest fears. At the same time we
have an explosion in communications, expanding the horizons of our working and
personal lives, while offering to a deadly minority greater ability to work across
national borders and outfox national security and policing services. There is a
broader concern, however, that in tackling the murderous minority, we are
trampling over the rights of the peaceful majority, giving the security services
powers they have hankered over for years.3 This question of privacy and security
relates very much to the psychiatric classifications of the personality disorders. In
medical surveillance, our normalising processes allow contemporary society to
bring the overly deviant personality to psychiatric attention, where he receives
classification and often therapy, or detention in cases of dangerous behaviour.
2

Stuart Millar, Looking Forward in Big Brother: Someone, Somewhere is Watching You,
supplement to The Guardian (07/09/2002), also at
http://www.guardian.co.uk/bigbrother/privacy/0,12377,783005,00.html
3
David Blunkett, Civic Rights, The Guardian Saturday 14/09/2002, also at
http://www.guardian.co.uk/bigbrother/privacy/statesurveillance/story/0,12382,790138,00.html

40

In the realm of psychiatry the debate is especially relevant today: the

government published a white paper on a new Mental Health Act in December
2000, and it seems soon this act will be passed, the key elements of which are
compulsory care in the community and proposals for managing a group known as
dangerous people with severe personality disorder, or DSPD. The government
would hope to apply this act to the control of such personalities, especially to allow
psychiatrists to detect and treat the antisocial, and justify the further detention of
such individuals in prison in psychiatric terms. Comments from this article echo
Foucaults prediction of the medicalisation of danger: As the continuing detention
of such individuals in order to protect the public could not otherwise be justified,
the Government hopes to justify detention in psychiatric terms. The power
therefore has to be based on a psychiatric diagnosis as a cause of an unacceptable
risk to the public. Powers of psychiatric detention framed in this way can be used
to compulsorily detain individuals, even when they have not actually committed an
offence.4 The author of the article is apprehensive about the extension of state
control in the bill proposed, commenting, The detention of individuals who have
not yet proved themselves to be dangerous is essentially unscientific. The
predictive power of risk assessment, whether performed clinically or through an
actuarial process, remains poor. Few offences will be prevented in this way, and
genuinely dangerous individuals will be missed. Moreover, extending the
European Convention notion of unsound mind to the very fringes of psychiatric
diagnosis, as this Bill seeks to do, is likely to be challenged under the Human
Rights Act. Unsound mind originally referred to insanity or mental illness.
Expanding on the exceptions to the right to freedom and security simply for
reasons of dangerousness was strongly criticised by the European Court of Human
Rights.5 We see here a recent case of individual freedom or human rights against
state control and legislation. We are unsure whether it is necessary to extend our
notions of unsound mind to the fringes of psychiatric diagnosis; again, the worry
is that the rights of the innocent majority will be denied in attempts to control the
violent minority.

Philip Sugarman, Pitfalls in Detaining the Dangerous in The Practitioner: the essence of
general practice, March 2002, Volume 246 (Symposium: Psychiatry), p. 145
5
Philip Sugarman, Pitfalls in Detaining the Dangerous in The Practitioner: the essence of
general practice March 2002 Volume 246 (Symposium: Psychiatry), p 145

41

Anti-psychiatry views involuntary treatment or medication as an

infringement of individual liberty. However, questions of social security provided
by instances like those of the murderous people discussed in our first chapter
above make the anti-psychiatric stance on intervention problematic. This essay
perceives that the extremes of antisocial personality represent a severe breach of
social security and it is difficult to concede to anti-psychiatry that deviancy of this
sort should go entirely unregistered. Of course, Dahmer and Shipman did go
unregistered as there was no evidence of their potentialities in their natures, they
did not have antisocial written all over their faces. This would suggest that
preventative classification is no solution, as it has no real bearing on helping to
discover who the genuinely dangerous are.
A blustering youth who smashes a few windows and has a fight or two is
not necessarily capable of murder, whereas, as the Shipman case shows, a perfectly
respectable, private person like Dr Shipman is capable of just that. It seems
increased surveillance and psychiatric freedom has the right intention but all too
often ends up intruding into the privacy and free choice of the normal (or shall we
say normalised) citizen, promoting an intolerant, rigid society where your first
indiscretion might easily be your last. We cannot predict where deviancy will
extend beyond our boundaries of the norm next if these boundaries are
essentially arbitrary, it is bound to happen, but if we spend all our time watching
for it, we will miss the vast areas of social life where it does not. All we can do is
demonstrate why society operates in the way that it does, and trust human
judgement to provide the rest.
Positions, such as Szaszs on the myth of mental illness claim grossly
antisocial deviancy does not qualify for diminished responsibility on psychiatric
grounds, as psychiatry is just a value judgement. However, recent developments in
the neurosciences increasingly produce information that claims to inform questions
such as those over the personality disorders; it is possible the severely antisocial
has a different brain from most of us, for example that a dysfunctional
ventromedial or orbitofrontal prefrontal cortex (or amygdala) results in antisocial
behaviour. There are implications for this physical research into the neuroscience
of antisocial conduct, if neuroscience should provide an explanation for such
conduct, might it mitigate responsibility? Might it, in a sense, replace moral evil
with another form of natural evilto what extent is the factor that they have
42

identified so causal that no other outcome might have emerged? Sedgewicks

position is valuable for countering implications for diminished responsibility even
though we find natural grounds. If all of medicine involves value judgements,
then the idea that the antisocial is not responsible because of brain function is a
judgement also; one on how normal the brain has to be to be acceptable in our
society. Moreover, that the normal brain is preferable to the abnormal brain
becomes a judgement on the same scale, as that normal behaviour is preferable to
abnormal behaviour. Foucault speculated about a society developing that
discriminates against the individual based on what he is; maybe that has always
been the case. After all, we still have a choice in accepting the ability of scientific
research to determine what is natural for us and what is not. If our physical
classifications are as unnatural as our psychiatric ones, such discoveries should
have no radical effect on our other value constructs of criminal and judicial control
and security in our society. The question for us becomes not whether biological
discoveries about deviancy affect our objective judicial treatment of the subject,
but rather what these discoveries mean for us, which depends on how widely we
personally spread our nets of definition between normality and deviancy.
The problem, I reiterate, is when to argue, as Foucault does, for an
acceptance of difference, a dialogue between reason and unreason that involves the
revealing of subjugated truths, and where we need to consider action against the
excessively deviant in the interests of social security. It seems with the extension
of psychiatry, state measures of surveillance and so on, we are well on the way to
Foucaults dystopia where we discriminate against individuals based on what they
are. Let us bear in mind, however, that this trip has benefits as well as drawbacks.
One critic, Zbigniew Kotowicz, points out that although Sedgewick very
effectively criticizes all the anti-psychiatrists, Sedgewicks own arguments reduce
the problem to the question of dealing with the mentally disabled, without ever
analysing how people get to the stage of chronic disablement.6 Still, the focus on
the benefits psychiatry can have for the mentally disabled or, if one considers
mental illness a myth, its social capabilities as an aid to those with problems in
living, are an important contribution to the discussion. Sedgewicks criticism is
important; he asks that we consider the social implications of extreme deviancy, as
6

Zbigniew Kotowicz, R.D. Laing and the Paths of Anti-Psychiatry (London & New York:
Routledge, 1997), p. 98

43

well as the position of unintentional deviants who cannot fall into step with
society, such as the grossly hallucinating schizophrenic with such a narrow grip on
our notions of reality, it is difficult to communicate with or understand him at all.
Instead of viewing the idea of a psychiatric arm of the state as repressive, in
conflict with the interests of the state, we should also consider the individuals
right to be protected by the state. Freedom does not just mean protecting the sane
individual from the dangerously ill, but also protecting the hallucinating ill
individual from an aggressive society with no time for or understanding of him.
Although we might speak of the reason inherent in what we repressively term
unreasonable, Sedgewick asks that we look at the reality of living in close
proximity as a community, where some normalising is necessary, indeed essential,
for social cohesion. The dialogue of reason with unreason proposed by Foucault
might be feasible phrased in terms of the oppressed unreasonable, but it wavers
around the absolute disruption threatened by the predatory fringes of reason like
Dahmer and Shipman.7
I feel the validity of psychiatric aid in particular cases should be
recognised, but I do believe our society is brainwashed with psychobabble, and
increased psychiatric classification does not help this situation; Szasz has a point
that many of us are on the look out for disorders all over the place. On the other
hand, perhaps a time will come when classification extends so far that declaring
some sort of personality disorder will be perceived similarly to how being left
handed is today, in which case the original negativity of these judgements of the
deviant personality will be irrelevant, deviancy being the norm. We must be
careful though, of increasing both state surveillance and the reaches of psychiatric
classification. State surveillance is at least clear in its intentions, but psychiatric
classification is more deceptive. In the interests of social security I think state
surveillance is more effective than psychiatric definition, I would rather society
opted for minimal psychiatric classification because it is dubious, especially with
the cultural differences across the globe and the (potential) plasticity of the
personality. Far better, we approach deviancy without classification, than limit
social options in psychiatric classification of types. There are all sorts of
currently legitimate deviancy which might come into question if we take the road

44

of classifying deviancy, the individual has a right to be different just as he has to

be the same, let us not interfere with the creative workings of a varied society with
ethics that seek to capture the essence of unpredictable individuals. Ideally, I
would remove the personality disorders from classification completely, thus
including them within our psychiatric norms. Individual cases could be handled by
judicial or the voluntary psychiatric services, depending what sort of anguish they
cause (for the individual or for the society), but this be clearly punishment or
guidance, without all the complexities of categorisation attached. In practice, I
would agree with Sedgewick, if we may believe that one day, perhaps a genuine
communion between Reason and Unreason can be restored, it will be within a new
form of society which will see, as one of its natural consequences, the liberation of
human thought from psychology. In the here and now, we are left with no hopes
for a reformed or even radicalised psychology of madness, and no choice, in
working with patients, except to use the psychologised descriptions which have
been bequeathed to us as the deposit and the disguise of social classifications made
by previous centuries. (PsychoPolitics, 21)

45

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