Pathology and the Postmodern: Mental Illness as Discourse and Experience


Edited by: Dwight Fee

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  • Inquiries in Social Construction

    Series editors

    Kenneth J. Gergen, John Shotter and Sue Widdicombe

    Inquiries in Social Construction is designed to facilitate across disciplinary and national boundaries, a revolutionary dialogue within the social sciences and humanities. Central to this dialogue is the idea that all presumptions of the real and the good are constructed within relations among people. This dialogue gives voice to a new range of topics, including the social construction of the person, rhetoric and narrative in the construction of reality, the role of power in making meanings, postmodernist culture and thought, discursive practices, the social constitution of the mental, dialogic process, reflexivity in theory and method, and many more. The series explores the problems and prospects generated by this new relational consciousness, and its implications for science and social life.

    Also in this series

    Constructing the Social

    edited by Theodore R. Sarbin and John I. Kitsuse

    Conversational Realities

    John Shotter


    edited by H. Lorraine Radtke and Henderikus J. Stam

    After Postmodernism

    edited by Herbert W. Simons and Michael Billig

    The Social Self

    edited by David Bakhurst and Christine Sypnowich

    Re-imagining Therapy

    Eero Riikonen and Gregory Smith

    Social Constructionism, Discourse and Realism

    edited by Ian Parker

    The Social Construction of Anorexia Nervosa

    Julie Hepworth


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    Notes on Contributors

    LeslieBeth Berger received her doctorate at the University of Massachusetts at Amherst, and is a developmental psychologist now working as a consultant in Sarasota, Florida. She is author of Incest, Work, and Women: Understanding the Consequences of Incest on Women's Careers, Work and Dreams (Charles C Thomas, 1998)

    Vivien Burr is Principal Lecturer in Psychology at the University of Huddersfield. She teaches and publishes in the areas of social constructionism, gender, and personal construct psychology, and is the author of An Introduction to Social Contructionism (Routledge, 1995), Invitation to Personal Construct Psychology with Trevor Butt (Whurr, 1992), and Gender and Social Psychology.

    Trevor Butt trained as a clinical psychologist and is now Principal Lecturer in the Department of Behavioural Sciences at the University of Huddersfield. He is the author, with Vivien Burr, of Invitation to Personal Construct Psychology (Whurr, 1992), and has published in the fields of personal and social constructionism. He has a particular interest in the psychology of George Kelly and the phenomenology of Merleau-Ponty.

    Dwight Fee is currently Visiting Assistant Professor of Sociology at Middlebury College in Middlebury, Vermont. In addition to his interest in mental illness, he teaches and publishes in the areas of contemporary social theory and epistemology, interpretive social psychology, and sexuality and gender studies. Having received his doctorate in 1996 from University of California, Santa Barbara, he is now working on a book that explores heterosexuality and friendship, to be published by the University of Chicago Press.

    Michael R. Fraser wrote his doctoral dissertation in sociology at the University of Massachusetts, Amherst, on the role of informal social support in the lives of individuals living with HIV. He is Senior Research Associate with the Data and Community Assessment Division at the National Association of County and City Health Officials (NACCHO), currently designing a nationwide study of public health infrastructure as well as developing information technology programs for local health departments. His articles have appeared in such journals as Demography, Evaluation Review, Contemporary Sociology, and Social Problems.

    Mark Freeman is Professor of Psychology at the College of the Holy Cross, where he also serves as Associate Dean of the College. He is the author of Rewriting the Self: History, Memory, Narrative (Routledge, 1993), Finding the Muse: A Sociopsychological Inquiry into the Conditions of Artistic Creativity (Cambridge University Press, 1993), and numerous articles on the self, autobiographical narrative, and the psychology of art.

    Kenneth J. Gergen is the Mustin Professor of Psychology, Swarthmore College, and Chair of the Program in Interpretation Theory. He is a co-founder of the Taos Institute, working at the interface between social constructionist theory and social practice, and the author of The Saturated Self (Basic Books, 1991) and Realities and Relationships (Harvard University Press, 1994).

    Simon Gottschalk is Associate Professor of Sociology at the University of Nevada, Las Vegas. His main areas of interest revolve around postmodernism, sociology of mental disorders, ecopsychology, and cultural studies. He received his BA from the University of Haifa (Israel), his MA from the University of Houston, and his PhD from the University of California, Santa Barbara. He is the author of several articles that have been published in Symbolic Interaction, Journal of Contemporary Ethnography, Studies in Symbolic Interaction, as well as several book chapters.

    Rom Harré graduated in mathematics and physics and then in philosophy and anthropology. He did his postgraduate work in Oxford under J. Austin. His published work includes studies of both natural and human sciences, such as Varieties of Realism (Blackwell, 1986), and the trilogy Social Being (Blackwell, 1993), Personal Being (Harvard, 1984) and Physical Being (Blackwell, 1991). His current research interests concern the ways that language enters into all aspects of human life, including the sense of self (discussed in Pronouns and People (Sage), with P. Muhlhausler) and the emotions. His most recent book is The Singular Self (Sage, 1998). He has also been involved in theoretical studies of the computational model of the mind popularized as Artificial Intelligence. He is currently Professor of Psychology at Georgetown University, Washington, DC, in addition to his affiliation with Linacre College, Oxford University.

    John P. Hewitt is Professor of Sociology at the University of Massachusetts at Amherst, where he has taught since 1970. He is the author of Self and Society: A Symbolic Interactionist Social Psychology (7th edition, Allyn & Bacon, 1997), and of Dilemmas of the American Self (Temple University Press, 1989). The latter won the 1990 Charles H. Cooley Award of the Society for the Study of Symbolic Interaction. His most recent book is The Myth of Self-Esteem: Finding Happiness and Solving Problems in America (St Martin's Press, 1998). His current interests include English real ale, the American West, especially the Sonoran Desert, and his grandchildren.

    Fred Newman received his doctoral training in philosophy of science at Stanford University. A psychotherapist and a playwright, he is currently director of training, East Side Institute for Short Term Psychotherapy, and artistic director of the Castillo Theatre, both in New York City. He is author of Performance of a Lifetime (Castillo International, 1996), Let's Develop! A Guide to Continuous Personal Growth (Castillo International, 1994), and The Myth of Psychology (Castillo International, 1991). With coauthor Lois Holzman, he has published The End of Knowing (Routledge, 1997), Unscientific Psychology: A Cultural-Performatory Approach to Understanding Human Life (Praeger, 1996) and Lev Vygotsky: Revolutionary Scientist (Routledge, 1993). An edited collection of Newman's plays, Still on the Corner and Other Postmodern Political Plays, was published in 1998.

    Jackie Orr is Assistant Professor of Sociology at Syracuse University. She has published work on women, panic, and postmodernity, and on the techno-poetics of Black-urban rap music. She received her PhD from the University of California, Berkeley in 1999. Her dissertation, Panic Diaries: Psychiatry, Cybernetics, Psychiatry, and the Technoscientific Control of Social Dis-Ease, examines the genealogy of collective and individual ‘panic’ in the Cold War crucible of atomic culture, cybernetic science, and normalizing psycho-power. She also experiments with multimedia performance as a method for exploring connections between bodies, memory, power, and communications media.

    Steven R. Sabat has been at Georgetown University since earning his doctorate at the City University of New York, where he specialized in neuropsychology. The main focus of his research has been on the remaining intact abilities of Alzheimer's Disease sufferers, the experience of having the disease from the sufferer's point of view, and the ways in which communication between the afflicted and their caregivers may be enhanced. In addition, his interests include the epistemological basis of our understanding of the effects of brain injuries on human beings.

    Jane Ussher is currently Associate Professor of Critical Psychology in the Centre for Critical Psychology, University of Western Sydney, Nepean. She also practices as a clinical psychologist, part-time. Her publications include: The Psychology of the Female Body (Routledge, 1989), Women's Madness: Misogyny or Mental Illness? (Harvester Wheatsheaf [and the University of Massachusetts Press], 1991), Gender Issues in Clinical Psychology (Routledge, 1992), The Psychology of Women's Health and Health Care (Macmillan, 1992), Psychological Perspectives on Sexual Problems (Routledge, 1993), Body Talk: A Material-Discursive Analysis of Madness, Sexuality and Reproduction (Routledge, 1997), and Fantasies of Femininity: Reframing the Boundaries of Sex (Penguin 1997).

    Janet Wirth-Cauchon is Assistant Professor of Sociology at Drake University. In addition to gender and mental illness, her research and teaching interests include feminist theory, identity and culture, and the intersections between psychoanalysis, the body, and technology. She is currently working on a book, Borderlines: Gender, Madness, and Psychiatric Narrative.


    It may seem reckless for someone with no direct training or clinical experience in psychiatry, psychopathology, or abnormal psychology to embark on a project which critically confronts much of the dominant thinking in those very areas. But the situation is hardly new. Sociologists have made significant contributions to the conceptual, empirical, and policy-oriented problems within mental health research, and it was developments in feminist theory, deviance studies, and symbolic interactionism, broadly conceived, that defined the sociological legacy in the area primarily in terms of external critique and reform advocacy. However, in the 1960s and '70s, when more explicit lines were being drawn within debates about psychiatric diagnosis, stigma, and institutionalization, it was often those in the psychological sciences and in mental health work who themselves became most noticeable in their opposition to developments within their own fields. This volume reflects contemporary developments in both of these realms of inquiry.

    It is my sense that there is a renewed and widespread desire to explore and question established positivist approaches to mental disorder and its contemporary expositions. This claim might seem questionable when considering the recent influx of psychopharmacology and other technologies that are, in some sense, attempting to ‘conquer inner space,’ as Jackie Orr discusses in her chapter here. However, despite these developments – and perhaps, ironically, in part because of them – an implicit part of the old critiques is haunting many of those currently invested in the field of mental health, whether they be therapists, researchers, activists, or, frequently now, patients – namely that mental illness, in addition to whatever else it may be, is a problem of knowledge. Put simply, it is now more often assumed or suspected that we can no longer simply describe what is ‘out there’ in terms of the ‘problem of mental illness,’ nor what is ‘in there’ with respect to ‘aberrant’ subjectivities and behaviors, without considering epistemological issues. Therefore, the recent expansion of the biomedical revolution has, partly through its own force alone, placed matters of context and legitimacy at the center of scientific claims. Whether ‘for’ or ‘against’ psychiatry (and unqualified, immutable positions seem harder to assume), the problem of knowledge obligates us to consider on what basis we make claims to truth, with what authority, and with what consequences. It also requires a new critical reflexivity about the ‘truth’ of our own suffering. Now often radically invested in our own mental states, we cannot escape the unsettling question of how far the discourses of disorder practically extend. In hyper-mediated and increasingly medicalized social worlds, can we even trust our own pain?

    New historical, epistemological, and, indeed, bodily struggles, of course, require new accountings of the empirical conditions that seem to be behind them. While sections of the book locate institutional changes and track shifts in expert knowledges, many of the chapters present explicit or implicit strategies for change – in theory, method, and research. Some of the authors also address potential ways to reconfigure persons as historical subjects within the changes we are only beginning to understand. Beyond theoretical debates about the status of ‘the subject,’ the concern here is about working toward more creative and critical engagements with an environment characterized by expanding and increasingly refined systems of psychotherapeutic expertise, ongoing reconstruction of the boundaries of the pathological (and therefore the ‘normal’), and more stark, often market-driven, efforts to codify and colonize the intrapsychic realm – all movements with durable histories that now forge on, relatively unimpeded. But again, this book is a product of its time: an era that affords the opportunity to realize the full significance and possibility that comes with aggressively positioning the knowledges that were once virtually positionless within the guise of an innocuous, free-floating objectivity that guaranteed relative immunity from both ‘internal’ or ‘external’ inquests. The only certainty, of course, is that this is a portentous moment, and it requires new and sometimes unpopular commitments.

    I would like to thank the many people who offered assistance and encouragement throughout the duration of this project. The editorial staff at Sage, London, have my sincere appreciation for their efforts and flexibility throughout. Ziyad Marar provided early encouragement at the proposal stage, and was chiefly responsible for giving this project a chance. I can imagine no better publishing editor than Naomi Meredith, whose practical help and patience made the process a smooth one for me, a first-time editor with lots of questions. I would also like to thank Rosemary Campbell and Kate Scott for their help in the latter stages of the manuscript preparation, and to Lucy Robinson, my first contact with Sage, for her editorial assistance as well.

    In preparing the manuscript, my assistant Christy E. Gell provided invaluable assistance with proofreading, but her insights also helped me to consider larger editorial and conceptual issues about the project as a whole. The assistantship was partially funded by a small grant from the Faculty Professional Development Fund at Middlebury College. More generally, the College quickly provided the support and facilities necessary to finish the project during my recent move to Vermont.

    I would like to acknowledge the influence of David D. Franks, Thomas J. Scheff, Jackie Orr, and, more recently, Gerald C. Davison, for his comments on the Introduction and for his overall encouragement. Thank you to Houghton Mifflin for permission to reproduce extracts from Prozac Nation.Kenneth J. Gergen has been an intellectual inspiration, and his support helped the book to find this fortunate place in the Inquiries in Social Construction Series. I would also like to thank students in my ‘sociology of mental illness’ courses over the past several years who have pushed my thinking and helped me to originally formulate this project. My friends at Vassar, Andrew Davison and William Hoynes, offered regular incentives and motivation, as did my family. My greatest appreciation goes to Eve H. Davison for her uncompromising assurance and loving support, to which I am continually indebted. Finally, I would like to express my appreciation to the authors themselves for their creative efforts, but also for their patience and conscientiousness throughout the course of the project.


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