The mind managers
The field of psychiatry is one of the growth areas of the twentieth century. Today mental health forms a major branch of medicine, employing more than half a million people in the US alone. The field abounds with theories and schools of thought but is short on accepted fact.
One of the most influential schools of thought is behaviouralism. This holds that each person responds to their outer environment and their inner biological processes. It is more concerned with outward behaviour than inner processes - holding that people are a mass of reactions which can be manipulated or modified.
A major early practitioner was the Russian Pavlov, who taught dogs to respond to a system of bells. Its recent giant is the American B. F. Skinner.
Skinner has developed the theories of behaviour modification. He starts from the assumption that because people are effectively controlled by their environment and genetic make-up there is no such thing as freedom. People left to themselves may behave in a self destructive manner - so their behaviour should be modified to stop this.
Since there is no such thing as freedom none is lost - and people will be much better of having their foolish impulses restrained.
Behaviour is modified by means of ‘reinforcers’. Positive reinforcers reward types of behaviour, negative ones discourage it. The current haphazard organisation of society means that the wrong sort of behaviour is reinforced positively or occasion. Skinner wishes to reorder society so that desirable behaviour is positive, reinforced by rewards while the factors reinforcing undesirable behaviour are removed.
His theories of reinforcement operate on the same assumptions as classical economic theory with his ‘positive reinforcements having the same place as ‘incentive’ it capitalism as a reward for virtue. It has the same partial grasp on the real world as capitalist ideology - and a similar popularity with powerful groups.
The question of what constitutes unacceptable behaviour - normally known a: deviant behaviour - is essentially a social one, reflecting the balance of power ii society. The question of that definition vital for behaviouralism - which sees deviant behaviour as mental disorder.
In the nineteenth century ‘drapetomania’ was labelled as a form of deviance by American psychiatrists - the ‘insanity’ of slaves who ran away from their owners. That might seem a bizarre period piece - but homosexuality was listed as a mental disorder by the American Psychiatric Association until 1973. It was deleted, not as a result of any medical advance (nobody ever proved it had an organic base nor had treatments ever had any ‘success’) but because of political pressure from the increasingly powerful gay movement.
Deviant behaviour may be defined as anything which is considered a problem by a group powerful enough to do something about it. Many New Internationalist readers may consider ruthless self-made capitalists to be deviant, but they’ve little chance of getting something done about them.
Put together a theory which holds deviant behaviour to be the result of mental disorder with a definition of deviance which reflects the prejudices of the powerful and you have a formidable weapon for social control - made all the stronger by the fact that people under mental health treatment are having it ‘for their own good’.
The weapon’s scope is increased by our lack of knowledge. Psychiatry uses portmanteau terms such as ‘psychotic’ and ‘schizophrenic’, without being able to define precisely what they mean. A number of forms of schizophrenia are recognised - yet there is no certainty whether it is one disease, or many, or a disease at all. One observer has concluded that ‘the person is the disorder’.
The belief that behaviour may be altered or at least controlled by medical treatment is an effective means of dealing with people whose conduct is difficult, inconvenient or irritating for authority - if you can stop someone being a nuisance and furthermore claim it’s for their own good, what can be wrong in that’?
It’s a question of what is being defined as deviance. Political dissidents in capitalist systems such as British politicians Tony Benn and Tam Dalyell are well used to being accused of paranoia and other mental disorders by establishment supporters. BF Skinner accuses critics of ‘emotional instability’.
Deviance often takes the simple form of being a nuisance - and the answer to this is often drugs. In the US 240 million prescriptions are made out annually for psychotropic drugs - a quarter for the tranquilliser Valium. The powerful tranquilliser Thorazine is widely used in mental hospitals where it has reduced the need for physical restraints - but there is also evidence that doctors have ‘snowed’ patients with drugs to make them powerless and controllable.
Many problems are rooted in poverty, bad housing or education - a possibility the individualistic behaviouralists overlook. Statistics for New York covering 1841 to 1967 show an inverse relationship between the state of the economy and the number of admissions to mental hospitals.
Other studies have shown that the further down the social scale you are, the more likely you are either to be drugged or hospitalised. So are the poor and blacks in America crazier?
A New York woman shouted and screamed at being ignored in a housing office after she and her children had been made homeless following a fire. The police were called and she was taken to hospital where she was diagnosed as paranoid schizophrenic and kept in for several weeks. It didn’t cure her - but it stopped her disrupting that office!
A worker in Georgia was labelled ‘paranoid’ by the company doctor after filing seven complaints against his employer in 17 months. He was subsequently hospitalised for a week and sacked. An arbitrator got him his job back and most of his complaints were shown to be justified - but the potential of mental health as a control on inconvenient behaviour was well demonstrated.
Much treatment of deviant behaviour is intended as a pacifier and controller - one thing Skinner does recognise is the tendency of most societies to control through negative reinforcement rather than rewarding through positive reinforcement.
But for a full exposition of the possibilities of behaviouralist psychiatry as means of social and political control we have to look to the Soviet Union. The biologist Zhores Medvedev, a prominent dissident, was confined to a mental hospital. He was diagnosed as having ‘incipient schizophrenia accompanied by paranoid delusions of reforming society’! In any society which assumes total ideological uniformity to be ideologically different is without question deviant behaviour. Medvedev had influential friends in and out of the Soviet Union and was rapidly released. Many others have not been so lucky.
‘One waits in vain for psychologists to make it clear to the general public the actual limits of what is known’, philosopher Noam Chomsky said in a famous attack on Skinner. Medical labels have been fixed on to problems which are essentially social.
But the pressures of life in modern societies and the lack of alternative remedies means that the demand for psychiatric treatment will ensure a quieter life not only for sufferers but for the rulers of society. As American writer Peter Schragg points out:
‘Dependency, conformity, responsibility are abstractions: but the pain is immediate, the disturbance is real, the institution can’t function with the man out of control, his family is not safe. Thorazin for peace, Prelixin for safety, behaviour modification for institutional order. By the time the system changes, if indeed it ever does, he’ll have failed in school, lost his job, murdered his children. Every pill makes it less likely that the system ever will change’.
Huw Richards is a London-based writer.
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