Power must be analyzed as something which circulates, or rather as something which only functions in the form of a chain. It is never localized here or there, never in anybody's hands, never appropriated as a commodity or piece of wealth. Power is employed and exercised through a net-like organization. And not only do individuals circulate between its threads; they are always in the position of simultaneously undergoing and exercising this power. They are not only its inert and consenting target; they are always also the elements of its articulation. In other words, individuals are the vehicles of power, not its points of application.... One needs to investigate historically, and beginning from the lowest level, how mechanisms of power have been able to function. - Michel Foucault
This book developed out of the experience of moving back and forth between worlds, both literally and symbolically. For several years, I spent part of my time teaching philosophy and psychology at Sonoma State University in California and part of my time studying psychoanalysis and seeing clients in connection with a training program at the C.G. Jung Institute in Zürich, Switzerland. I also returned to the United States during this time to work intensively with schizophrenic patients in a mental hospital. Throughout the same period, I maintained a long-term involvement with human rights movements in Latin America and the United States. Traveling in connection with this work over the years, I met liberation theologists, revolutionaries, and neighborhood organizers; and I sometimes found myself in communities with a shared the belief that their healers could communicate with ancestors, encounter spirits, or turn themselves into animals or birds to serve as guides. If, as I shall claim in these pages, there is an autonomous human need to integrate disparate experience, my work on this manuscript is concrete evidence of its existence.
At the Jung Institute in Zürich, I attended lectures by psychotherapists and medical doctors from various countries discussing experiences with psychological healing that were off the map of the known world in terms of what is considered "normal" subject matter in most university psychology departments in the United States. Meanwhile, in many American bookstores, books about what is called psychology in Zürich or healing in Latin America were being shelved in the "Occult" section. In my own work with clients in Zürich and at the mental hospital, I began to experience phenomena connected with dreams and creativity that were inexplicable in terms of the canon of contemporary Western philosophy. As a result, I became particularly interested in the subject of synchronicity which is central to Jungian thought, and which, until recently, had no basis in either Western science or philosophy. Synchronicity is the experience of meaningful connections in space and time which cannot be explained causally. Precognitive dreams, divination, parapsychology, out-of-body experiences, shape-shifting, spontaneous healing, spiritual awakening, unexplained coincidence, and many other phenomena which have been held to be "supernatural" or "unreal" by modern science are based in the phenomenon of synchronicity.
As I traveled back and forth across the Atlantic during these years, several parts of my own psyche carried on a cultural war. There was that part of me which had been trained in Western philosophy and science and was logical and rational. From another perspective, I could see very well that the ecological and cultural disasters of the modern world clearly indicated an irrational shadow side to this way of thinking. My own experience of the irrational in dreams and synchronicities also demanded a place in theory. To make matters more complicated, both the academic world and the Jungian community were involved in profound inner conflicts over the direction and meaning of their disciplines. At the mental hospital where I worked, and where this book begins, the cultural war I had encountered in my own experience was enacted around me in a reflecting parallel world. In trying to rethink and heal its ruptures, I have also been knitting together my own. A new paradigm was surely needed to integrate these diverse worlds.
Until recently, most academic psychologists and philosophers in the West assumed that the "normal person" is an autonomous, self-determining, self-sufficient adult with a controlling "mind" at the center. Child development is often theorized as a series of universal fixed stages leading to the development of critical thinking, and failure to achieve a certain type of abstract, logical thinking has been presented as evidence of moral and cultural inferiority or mental illness. Mostly outside of these discourses, however, a chorus of contemporary writers have suggested that this conception is far from universal or desirable, and, in fact, is part of the invisible cultural baggage of modern urban life. It may belong more to men than to women, more to developed than developing countries, more to those in power than to those oppressed by power. A new wave of critique from feminists, people-of-color, ecologists, cultural theorists, and political activists has challenged this view of personal identity, making a place for alternative views by digging up the soil for new growth.
In the psychology of C.G. Jung, which has not been generally accepted in the academic milieu, each human individual is considered an embodied psyche, a many-layered, lived world. The embodied psyche is known within an organized field of conscious awareness, a subset of the larger whole called "ego," where there is only limited voluntary control of the rest of the embodied psyche. The ego opens toward the world through its work, intentionality, and perceptual and cognitive experience, toward community or "collective consciousness" through language, habitat, custom, and values, and toward its originating matrix of bodily life in fatigue, moods, feelings, symbols, dreams, and creativity. Psychoanalytic theory refers to this matrix as the "unconscious," and assumes that one can learn about the relationship of a particular ego to its matrix by analyzing various dream series, fantasy images, and expressive artistic productions of the individual involved. Jung also claimed that one could discern behind the outpouring of images from the unconscious a kind of self-organizing, meaning-creating function he called the "Self," which attempts to integrate and synthesize personal experience.
As a result of the emergent quality of ego consciousness in this Jungian view of the "person," authentically knowing oneself, the world, and the "other" become related problematics to be approached again and again without closure and with humility. Both the "inner" and "outer" world happen to the ego, arising within the embodied psyche as self-organized systems largely outside the ego's awareness of the process. People in different cultures and classes experience, name, and understand various aspects of the process in different ways. Every theory and schematic image arises from a particular psyche in a particular place, and shows as much about its origin as its destination.
Though classification systems are "constructed" or "projected" models in this approach, they are not entirely consciously invented. We need to avoid two extremes in theory on this topic: one, typical of modern science, which sees the world spread out before an impartial observer waiting to be discovered, and the other, typical of some literary theories, which sees each individual world as an invented personal narrative. The lived situation of the embodied psyche is far more complex and ambiguous, with bodily experience, human community, objects, ideas, memories, metaphors, images, symbols, language, and values appearing spontaneously from an unconscious matrix we can know little about because it is more complex and dense than the ego which attempts to know it. The historical development of all of these elements in personal experience forms a kind of lens or focusing device which organizes the background of our thoughts into a slowly evolving reality-binding paradigm that provides a somewhat reliable interface with the environment. Within this paradigm, consciousness of self, other, and world are involved in "mutual arising," to borrow a term from Buddhist philosophy. Conscious ideas can then feed back into the paradigm and alter its evolution, but they do not control its evolution. We can wish we felt powerful or were interested in something, but quite often we cannot force the issue. Philosopher Daniel Dennett has put the problem this way:
I envisage the mind to work rather like the Reagan presidency - lots of sub-agencies and coalitions and competitive functionaries working simultaneously to create the illusion that one Boss agent is in control.
It is all of these agencies and functionaries that we need to take into account in understanding the human psyche. If the embodied psyche involves multiple agencies, what we need to explain is not how its unity can fall apart, but rather how it can be maintained. This has been called the binding problem in information theory. In a constantly changing physical, economic, and social world, the psyche must perform a continual activity of reintegration in order for the ego to think of the world and the self as unified and historically continuous entities. Where there are social structures of domination and control, public activities of reintegration become difficult. Health, for both a community and the individuals in it, means that a binding process is going on successfully and mysteriously. People seek out mental health practitioners when the process begins to fail. Two or more psyches then enter a dialogue of which only a small part can be conscious. Mental health practitioners need to know something about the unconscious as well as the environmental background of integration in order to support the process. We need to avoid the reification of the practitioner's diagnostic system, and at the same time, avoid attributing to the patient an idealized authenticity of personal voice not shared by the practitioner. Both partners enter the dialogue with evolving symbolic modeling systems in a constantly changing social environment; both have an ongoing capacity to rethink their lives.
A health practitioner who attempts to deal with human suffering, whether medical doctor, shaman, priest, therapist, or folk healer, begins the work of healing in a specific cultural and social setting, embedded in personal history and experience. In order to diagnose or categorize the symptoms of patients, practitioners must have theoretical assumptions on the basis of which they can sort differences. According to medical anthropologist Arthur Kleinman:
Disease ... is what the practitioner creates in the recasting of illness in terms of theories of disorder. Disease is what the practitioners have been trained to see through the theoretical lens of their particular form of practice. That is to say, the practitioner reconfigures the patient and family's illness problems as narrow technical issues, disease problems.
Every theory emerges from a frame of reference that defines which elements to include and which to exclude in making a diagnosis. We have to decide what is to be diagnosed and what signs to take as indicators. Such decisions are the first principles of any discipline, and unconscious cultural assumptions necessarily seep into them. First principles are value decisions that can never be judged according to any principle of truth or falsity, but rather according to how well the resultant classification system helps us to understand regularities, think about research, or predict behavior.
The operating procedure at most mental hospitals is that the diagnosis is made by a psychiatrist through an interview or series of interviews with the patient, perhaps assisted by a battery of psychological tests given by a staff psychologist, and a short discussion in a team meeting on the patient's ward. In most hospitals, the doctor's training, cultural point of view, attitude, and classification system are taken as a literal and unquestioned given. The cultural biases and subjectivity of the staff are not assumed to have importance. The patient is viewed as an object to be studied by neutral observers. This is what Kleinman refers to as reconfiguring illness as narrow technical issues.
I want to diagnose the illness and healing I saw at the mental hospital where I worked by including and excluding different elements than those in the current medical model being used there; and I want to analyze the functioning of the medical model by including and excluding different elements than those used currently in the Western academic world. For the most part, the academic world in the United States is organized according to disciplines, or schools within disciplines, which attempt to reduce theoretical questions to separate and mostly non-overlapping fields of research. Medical education, for example, focuses primarily on the physical body of the individual. Although many important discoveries result from these choices, there has been an unfortunate side effect over time. Western academic thought is now divided into separate disciplines with competing and contradictory findings. In many cases, this has resulted in either a chaos of relativism or a retreat into disciplinary closure, with too little attempt to cross disciplinary boundaries in order to form a coherent picture.
A corrective is needed in the form of an intercultural and interdisciplinary exploration of human consciousness, illness, and healing, searching out both general patterns and exceptional states from various perspectives. The goals of this exploration must include cultural reflexivity, because alternative cultures and disciplines add things up in different ways.
Reflexivity is the attempt to locate the effects of the observer in the activity of observation. It means thinking critically about one's own cultural biases while speaking a particular language and using current classifying systems. Accepting the limitations of all cultural perspectives relativizes every cultural location. Every human view is partial. Reflexivity requires that we struggle with the changing background of our social, physical, and ideological embeddedness and try to make the projections or constructions of our personal and social history more conscious. Cultural and theoretical differences are viewed as dialogic from the perspective of reflexivity. Many plausible and useful formulations can frame the same set of variables, yielding alternative perspectives. The differences between them can then be negotiated through dialogue only to some level of agreement. None have a direct access to fact unmediated by culture. Each allows us to know some things, and prevents us from knowing others. This type of reflexivity, which always considers knowing as an interactive process between subject and object, observer and observed, has been called constructivist or postmodern thought, although I am not at all sure it is a recent invention. I believe it is the central idea both in Jung's notion of "individuation," and in the experience of "enlightenment" sought after in some schools of Buddhist meditation, which involve protracted efforts of reflexivity.
In these pages, I do not want to frame my diagnosis of mental illness as a narrow technical issue but as a broad, interdisciplinary exploration, using both a series of reflexive questions and the application of classification systems, both a hermeneutic and a descriptive approach. I am particularly interested in connecting recent cultural studies and cultural anthropology with new work in mathematics and computer science called complexity theory. Computer programs which enact evolution have modeled new ways of understanding how life forms are organized. Biologists have suggested that biological life evolves "at the edge of chaos" where change and conservation of form reach a delicate balance in each ecosystem. Those organisms which survive find ways to maintain this balance. They are self-organized "complex adaptive systems." Linking cultural studies with evolutionary science involves deconstructing environments of knowing at the same time that we study what is known within them. Obviously, this new paradigm for postmodern psychology will include a much more complex analysis than the current diagnostic system.
As a result of this analysis, I also want to question the uses to which the entire project of diagnosis has been applied in the Western mental hospital setting. It is not the case that every healing system begins the encounter between patient and practitioner with an attempt at diagnosis. Particularly in dealing with the type of discomfort labeled "mental illness" in most modern Western medical systems, it is not at all clear that the patient is best served by being told in which fixed category the practitioner places him or her. If the experience of the patient is one of disorientation or loss of meaning, then the problem for that patient is to reclaim his or her own capacity to find meaning and orientation, to balance at a psychological edge of chaos between too much change and too little. Being told that a condition is already understood by experts who know more about it than the patient does, or worse, that it has been judged incurable, will not facilitate the patient's sense of integrity and empowerment.
The kinds of suffering that have been labeled "mental illness" can be more complex than the ones we know as "physical illness." There seem to be multiple conditions in which they originate. The symptoms through which they are identified are often found in people who are supposedly "normal." Their course can rarely be predicted with accuracy, and there are many cases of spontaneous healing. Furthermore, there is strong disagreement among psychiatrists and psychologists of different schools over types of therapy that can be effective for each diagnosis. When we add to these problems within Western medical disciplines the immense variety of diagnostic systems, healing practices, and outcomes that have been studied in other cultures, it seems to me that we arrive at a postmodern situation where diagnostic categories for mental illnesses must be seen as relative, culturally constructed, and only locally useful shorthand conventions. There is no one overarching theory against which different diagnostic systems could be measured, though there are many interesting ways we can look at similarity and difference among them.
Jungian psychology traditionally avoids diagnosis as part of therapy, though practitioners study both non-Western healing practice and Western psychiatric diagnosis and are aware of how they might be applied. Jung stated the problem with diagnosis in 1945:
It is generally assumed in medical circles that the examination of the patient should lead to the diagnosis of his illness, so far as this is possible at all, and that with the establishment of the diagnosis an important decision has been arrived at as regards prognosis and therapy. Psychotherapy forms a startling exception to this rule: the diagnosis is a highly irrelevant affair since, apart from affixing a more or less lucky label to a neurotic condition, nothing is gained by it, least of all as regards prognosis and therapy. In flagrant contrast to the rest of medicine, where a diagnosis is often, as it were, logically followed by a specific therapy and a more or less certain prognosis, the diagnosis of any particular psychoneurosis means, at most, that some form of psychotherapy is indicated. As to the prognosis, this is in the highest degree independent of the diagnosis.
Western psychiatric care is based on the notion of diagnosis which distances the practitioner from the patient. The psychiatrist becomes the knowing subject who classifies; the patient becomes the passive object of classification. Yet, there is good evidence that the experience of psychological healing is promoted exactly by the empathetic sharing of the more distressing elements of the human condition. Unfortunately, one of the most distressing elements for all biological organisms is the constant transformation in our inner and outer environments that prevents us from ever arriving at a permanent and unchanging understanding of our situation. We all have to suffer ambiguity in our day-to-day encounters. Health for biological life forms might be defined by their capacity to continue to reorganize and reproduce order as "autopoietic systems," or self-organizing unities, according to biologists Humberto Maturana and Francisco Varela. If we diminish the capacity of mentally ill people to do this by refusing to accompany them in their efforts, or by doing it for them with a diagnostic system, we may be taking away their ability to heal themselves. In the act of diagnosis, the practitioner privileges his or her complex autopoietic point of view, while simplifying that of the patient. This is a power relationship, masking a political system that determines whose voice is important. These dynamics become more questionable when we take into account the fact that most psychiatrists in the United States and Europe have been men, while most patients with serious mental illnesses are women, many of whom are uneducated and from impoverished families.
Diagnosis in psychological relationships, if seen as a purely "objective" activity, allows the practitioner to retreat to a point of observation supposedly not compromised by cultural assumptions or subjective bias. It edits out the complexity of the personal encounter between therapist and patient. On the other hand, when viewed as a model, each diagnostic system is a schema that captures some regular features of experience and can help us in our quest to understand the many diverse ways in which our world has been constructed. According to Jung,
All knowledge is the result of imposing some kind of order upon the reactions of the psychic system as they flow into our consciousness. ... It is not a question of asserting anything, but of constructing a model which opens up a promising and useful field of inquiry. A model does not assert that something is so, it simply illustrates a particular mode of observation.
In my analysis of what is problematic in mental illness and healing, it will not be assumed that phenomena to be studied are primarily in the brains or subjective experiences of the patients or the medical staff. Instead, there will be a focus on how the entire environment - including geography, economics, social conventions, culture, history, perceptual and cognitive structures, and personal experience - creates organized systems of affiliation and information exchange that each individual, whether patient or staff member, has to negotiate. Information systems can have different ecostructures. If there are many linkages, news can be passed rapidly among many individuals. If information is hierarchically managed, the spread of information can be uneven and slow. Some people can be "in the loop" and others not. Through complexity theory, we now know that different informational ecostructures can produce surprisingly different self-organized effects.