Thursday, January 29, 2009

Chuang Tzu, Foucault, and Deconstruction

The Diagnostic Statistical Manual is filled with pathologies.  Eating disorders.  Sleeping disorders.  Anxiety disorders.  Mood disorders.  The list runs on and on.  This is truly helpful in assessing and observing the phenomena of the intrapsychic functioning.  But an observation is an observation. It observes certain connections.  It observes certain causal relations.  It is a wonderful tool for people seeking to nurture souls.  But is it real? 

I once asked my therapist what he thinks of the DSM IV (Diagnostic Statistical Manual for psychological assessment). He replied, “A fiction, a necessary fiction.”  Chuang Tzu writes,

Now do you say that you are going to make Right your master and do away with Wrong, or make order your master and do away with Disorder?  If you do, then you have not understood the principle of heaven and earth or the nature of the ten thousand things.[i] 

James Hillman explains, “So long as the statistics of normalizing developmental psychology determine the standards against which the extraordinary complexities of a life are judged, deviations become deviants.  Diagnosis coupled with statistics is the disease.”[ii]  This is where, according to Dietrich Bonhoeffer, we have become the Creators.  The story of the fall is pretty clear.  Sin originated from Adam’s awareness of the knowledge of good and evil.  This is perhaps the sin of our society as well.  We create fashion models and make heavy people feel bad. We create social behaviors and make some feel out of place.  We create dependency and call others codependent.  We create civilization and name others uncivilized.  We create truth and see others in untruth.  The more creation, the more division.  The more pathologies, the more disorders.  If slim isn’t right and fat isn’t wrong then a conflict does not exist.  If dependency does not necessary mean emotionally healthy and codependency, unhealthy, then tension is dissolved. The problem is, we do not like what we have and hence we create right and wrong.  Reflecting on webbed toes Chuang Tzu writes:

 That which is ultimately correct does not lose the characteristics of its nature and destiny.  Therefore, joining is accomplished without a web, branching is accomplished without extraneousness, lengthening is accomplished without a surplus, shortening is accomplished without inadequacy.  Thus, although a duck’s legs are short, if we extend them it will come to grief; although a crane’s legs are long, if we cut them short, it will be tragic.  Therefore, if what by nature is long is not cut short, and if what by nature is short is not extended there will be no grief to dispense with.[iii] 

French philosopher Michael Foucault would have agreed with Chuang Tzu that webbed toes becomes marginalized only in relation to the society that pathologizes it.  Pathology, as we understand it today, is rooted in individual psyche.  Madness expresses itself in behavioral aberration that ultimately lands a person in social isolation and alienation.  Alienation, perpetuates madness itself and the cycle continues.  Foucault sees this whole process differently.  It is the reversal of the process, argues Foucault, that leads to mental illness.  Commenting on this argument Herbert Dreyfus, professor of philosophy, writes:

In Foucault’s account, social contradictions cause alienation, alienation causes defenses, defenses cause brain malfunction, and brain malfunction causes abnormal behavior.  In short: “It is not because one is ill that one is alienated, but in sofar as one is alienated that one is ill.”[iv]

To Foucault, social categories and norms create conflicts and conflicts, in turn, result in changes in brain chemistry causing various symptoms.  Social alienation is based on an assumption of truth and its deviation.  According to Foucault, the 19th century has brought along the concept of bio-power that aims at the betterment of human life.  Betterment is possible when one can grasp the true meaning of self through knowledge.  There is a self that one ought to be and through acquisition of knowledge and scientific methodologies, one can show the community what this ideal self ought to be.  In an attempt to move humanity toward its betterment, power seeks to classify, quantify, hierarchize, appraise, and label.[v]  With classification, evaluation, and label, we can now realize where people are and how to correct that.  Now there is the mad and the not-so-mad.  There is a neurotic and a psychotic.  There are subtypes of psychosis with numerical identification.  In his introduction to Mental Illness and Psychology Foucault points out, “The analyses of our psychologists and sociologists, which turn the patient into a deviant and which seek the origin of the morbid in the abnormal, are, therefore, above all a projection of cultural themes.”[vi]

 Hence there is a self that one ought to be and webbed toes do not belong in this category.  Webbed toes have to be unwebbed to belong.  But without the classification or quantification for the webbed or non-webbed, there is no alienation and therefore, no pain.  The problem according to Foucault is that we’ve allowed politics to defined and determined mental health and thus classified people accordingly. 


[i] Chuang Tzu: Basic Writings, 102.  [ii] James Hilllman, The Soul’s Code: In Search of Character and Calling (New York: Warner Books, 1997), 30.  [iii] Victor Mair, trans., Wandering On the Way: Early Taoist Tales and Parables of Chuang Tzu (Honolulu: University of Hawaii Press, 1994), 76. [iv] Hubert Dreyfus, “Foreward to the California Edition,” Michael Foucault: Mental Illness and Psychology (California: University of California Press, 1976), xxvi. [v] Michael Foucault, The History of Sexuality, vol. 1, trans. Robert Hurley (New York: Vintage Books, 1980), 142-44. [vi] Michael Foucault, Mental Illness and Psychology, 63.



  1. A response to both readings...

    “So long as the statistics of normalizing developmental psychology determine the standards against which the extraordinary complexities of a life are judged, deviations become deviants.” Who gets to determine normal actions, behaviors, and thoughts? Who can truly decide what is real and what is not? I guess I thought until just recently that I could; that I knew what “abnormal” actions, behaviors and thoughts looked like. In the same breath I guess that I believed that I had the advantage of deciding if a client’s perception of reality was wrong or right, I had the privilege of writing my clinical note, making the diagnosis and determining the “realness” of their experience…but now my reality is different.

    Just last weekend I was called to visit my grandfather in Northern California; he had been hospitalized for a stroke and suffered a hospital induced psychosis shortly after arriving at the hospital. I sat for the last four days with a man I have always known so well, who no longer knows who I am and who does not adhere to my perception of reality. Does that make his reality less authentic? It seems exceptionally real to him. As I sat there, medical professionals much like me worked to make sense of his persecutory delusions and frightening hallucinations, increasing medication in an attempt to assist him in joining our reality. It has been determined at this point that his new found reality and perceptions may forever be different than mine. Clinically, this shift from ones previous reality to something far different is a transition that I would have previously pathologized and then moved on, and now my view has been blurred…I can’t determine what my truth might be…or if one even truly exists. ~ A'verria Sirkin ~

  2. As per Professor Herbert Dreyfus, in Foucault’s understanding, “It is not because one is ill that one is alienated, but in sofar as one is alienated that one is ill.” I think that this is a true statement. In the primary clinic where I interact with patients who mostly come in for physical illnesses, I can say that perhaps almost all have underlying psychological or emotional imbalances that could possibly have contributed to their physical symptoms. How many people can really say that they have “peaceful” or harmonious living? Some of us have conflicts between family members or at work or other aspects of our existence that lead us to feel alone or isolated. Conflicts in turn lead us to feelings of discontent, anxiety, loneliness, isolation and/or depression.
    I wonder how many of our conflicts stem from our tendency to label people. I think Chuang Tzu and Foucault is telling us that if we simplify our understanding of each other and accept other people without labeling them as “odd” or different from ourselves there would be less heartaches and unnecessary anguish in our daily lives. Our constructs or concepts that we live by have become so complicated that we begin to become destructive between each other. I sometimes wonder if our civilization really has gotten better than ages ago. We have become sophisticated in our ways yet have become so distant between each other, so much pain as evidenced by increased depression and other mental illnesses not to mention about wars within our localities and between countries. But then again are these all just a part of the natural evolution of mankind?
    Rose Sakamoto

  3. I can appeciate this article becasue it goes against the grain, I find it interesting. I tend to be someone who goes against the grain however, I still cannot bring myself to agree with this stance. What about the occasions where classification is helpful? Such as early intervention? What if cancer and HIV had no name? How would we treat it? I certainly recognize that the DSM can be stigmatizing which can worsen symptoms. But to suggest that categorizing is the root of all evil or is the root of all mentall illness seems extreme. I think that there can be cases of social isolation that have nothing to do with being classified. There was mentall illness long before a DSM existed. However, I anticipate that the author might respond by tracing things back to Genesis and talk about the detriment of labeling right and wrong. The author seems to be suggesting that euphoria exists within some nebulous place. Didn't John Lennon write a song about that? Sorry, I never did like the Beatles.

  4. My understanding of what Chuang Tzu is saying is that we have become "creators" ever since Adam and Eve sinned and received the knowledge of good and evil. We create labels for what's good and bad. Those that do "good" are perceived as bad and vice versa. I completely agree with him. As a society we have labels for everything and everyone and at times it becomes annoying. I personally don't think any of us are in a position to judge people or their situations. This is along the lines of what Foucault said that through politics people are classified by their mental illness.

  5. This comment has been removed by a blog administrator.

  6. I find this posting both refreshing and upsetting at the same time. I disagree that labeling is what creates psychical discord - people create that due to a lack of understanding. For example, Jung discusses the perceptions of the "archiac man" and equates those perceptions and behaviors to more "civilized man." What is gleamed from this is not that either perception or understanding is wrong, but that the same processes of rational thought are used in order to come up with a different conclusion. So why does this happen? This happens because of differing degrees of self acquired information. With regards to this post, science has not produced a label but simply brought our attention to the fact that there are behaviors/actions/occurences that are rare or not part of every day life. These can be given labels, but the classification of the value/worth/moral content of those labels is entirely self driven. According to the reading by Jung, the subsequent behaviors and value assessment of a certain occurence is completely determined by preexisting beliefs and superstitions of the world. This leads me to the conclusion that the method of discovery or understanding needs not to be questions but our own value system in how value to an occurence is assigned.

  7. I also agree that having tools for assessment such as the DSM are important for accurate diagnosis and effective treatment for diagnoses. But I'm not sure that I agree with Foucault's account that "social contradictions cause alienation, alienation causes defences, defence causes brain malfunction, and brain malfunction causes abnormal behavior." If that were true, how would we explain diseases like Alzheimer's? I think that in the case of Aleheimer's, the cause & effect chain would be a little different, perhaps brain malfunction causing abnormal behavior would be the first link in the chain rather than social contradictions.
    Either way, I think that the important thing to remember when using assessment tools is to not rely on the diagnosis or "label" to tell you about the person, but rather seeing the person as an individual who also has ____ diagnosis.
    -Sarah Jaggers

  8. I agree with Sarah on the relevance of the DSM in adding in making more accurate diagnosis. While I view it as a guideline for providing information on how to better, ore direct, you8r therapeutic frame. However, with the understanding that the DMS also places people within groups and “labels” them we must be cognizant to keep the best interests of the client in mind, that every person should remain as individual and the DSM should solely be used as one of many tools in your therapeutic tool box. I enjoyed this quote: "Pathology, as we understand it today, is rooted in individual psyche. Madness expresses itself in behavioral aberration that ultimately lands a person in social isolation and alienation. Alienation, perpetuates madness itself and the cycle continues." While Foucault argues that the process should be view in the reversal, I hold to the understanding that both paths can lead to mental illness. Individuals process and integrate aspects of life differently and we as clinicians must be aware of this and use the tools we have to effectively guide us in our work.

  9. "We create fashion models and make heavy people feel bad. We create social behaviors and make some feel out of place. We create dependency and call others codependent. We create civilization and name others uncivilized. We create truth and see others in untruth."

    I agree that it is the people themselves who try to create what is normal and not normal. We label others and create an environment that only suits our lifestyle or personalities. Instead of helping others, we often drive them to insantiy or create situtaions of pain, etc. However, I do understand that these norms must be created in order for a society to function as peacefully and productively as possible. We are made to be biased and encouraged to be skeptical in life.

    When it comes to the DSM, I think it's important to keep in mind that our ultimate goal is to help one another, not to label and stigmatize a certain group or disorder. I think the best way to achieve this is to have knowledge of other cultures and sociology as well.
    -Nikita Mistry

  10. I agree with this last post that Sarah made. The DSM has its value when used properly. It is not intended to be something we use to label and categorize people; it can be a valuable tool to aide in diagnoses that bring help and healing to those we seek to treat accurately and responsibly. The key in all of this is balance and moderation. Problems arise when we get into the black/white (either/or) mentality. Even basic biology teaches us the need for balance, for homeostasis. This is as true in the individual organism as it is in society. Tolerance is key.

  11. I find a few fairly disturbing assumptions at play here. First the statement that sin came in to existence with Adam and evils knowledge of good and evil. This is taken as an assumption there is no argument for it. Good and evil still existed. God gave Adam and eave commandments about what they can and can’t eat. The fall was a result of Adam and Eaves disobedience not of their knowledge. We must remember the knowledge was a side effect of the act.

    Secondly the DSM is not based simple on our imaginations. Statistics aren’t just some creation of mans imagination they are descriptive of existing reality.

    Finally, I would like to draw attention to the fact that most DSM diagnosis included a requirement that the symptoms be causing serious distress or impairment in to that individual. Many of these poor stigmatized individuals refer themselves to treatment because they want to change.

    Just because we may not agree on what the ideal way to be or live is does not mean that there are not situations that are far less than ideal.

  12. Would it seem contradictory if I agreed with the notion on the DSM and expressed reservations about total deconstruction at the same time? If these represent a continuum of beliefs, I am not sure mine fully land on the scale. I believe in God. I believe he is a God of order. I do not believe he could be the author of so much confusion. Confusion, which in many ways, I think, stems from the precepts of man mixed in with a divine set of truths. Combine the two – variations of chaos. In essence, while I think the deconstruction of many fabricated stigmas and traditions would benefit humanity, I would still be left anticipating a reconstruction of undefiled principles leading toward a rightful and designated outcome.

    Adam Anderson

  13. I really resonated with this discussion. It reminds me of something we had discussed in a previous class. In this country, if one had auditory hallucinations and paranoia, they most likely will be diagnosed with schizophrenia. However, elsewhere in the world, this person would be revered in their community and looked to as a healer or a spiritual guide. It is also similar to what Jung discusses in Archiac Man. Assumptions alone are what sets us apart.
    However when working with clients, I often forgot about all the assumptions that have gone into the creation of the DSM. I often become too focused on figuring out what category they fit into instead of questioning what assumptions I am making while doing this. It got me thinking about the population that I am currently working with, eating disorders. Many assumptions are made about this population, it is just dieting gone bad, it only happens in “rich, white girls.”, etc. These are assumptions I encountered everyday. However, it is interesting to think about how these symptoms are conceptualized by other cultures all over the world. I do know that starvation and fasting are a major part of most world religions and there have been famous religious leaders who would meet criteria for an eating disorder, Gandhi and St. Catherine to name a few. Is starvation a pious exercise or a dangerous mental disorder?

    Jessica Wertz

  14. Like we are always told, mental health providers work in a world a grey. We have these categories that we place ourself in, but nothing is absolute and definite. This is a perfect example of the DSM. We have categories in which we attempt to label individuals with certain pathologies, but often times these criterias do not fit everybody. This shos how complex human nature is.

    I think this similar thought can be applied in other realms of our lives. What is right to one person does doesn't necessary have the same meaning to another. I think this is what is so great about the world we live in. It is okay to have different views, whether is spirituality/religion or etc. The most important aspect is to be open-minded and tolerant.

  15. A DSM diagnosis is necessary to provide for common understanding and quality care.

    I am confused as to what is meant by stigmatization. Many of this posts make it seem as if making a diagnosis entails taking out an ad in a newspaper. Unless an individual chooses to share their diagnosis with others, that diagnosis is typically known only to the therapist, client, and possibility an insurance company. Therefore any stigmatization that occurs is probably that which the client has already internalized about mental illness, since it should not come from the therapist and will not come from the insurance company, which doesn't care about much outside of what it must pay for.

    This problem can be diffused or redirected within the context of therapy. In fact, for some individuals it may be helpful to be able to put a name to their problem, separating it from the core of their personality, and making it seem treatable.

    I would like to second what Ms. Jaggers said; we must see out clients as "so-and-so who happens to have been diagnosed as bipolar," rather than "my bipolar client so-and-so."

  16. I appreciate comments, perspectives, ideas, and suggestions made regarding this post. It sure does help me to become more aware of the multiple issues related to this conversation and thus the need to rethink and clarify for my own understanding. Regarding the question of DSM, I do acknowledge the benefits it brings as tool for our understanding and for the possibility for treatments and intervention. I believe often knowing what one has can help to normalize the process. A related perspective is what Jessica raised in her post that is interesting. If a person's symptoms fit DSM category, it is still possible to view this patient with other lens, other possibilities. Averria made reference to this as well in terms of how we now view reality. Even if symptoms fit, is it possible to assign different meaning to this mental process? How about a guru who rolled himself up the mountain and became well respected by his community? And there are numerous examples...many saints we can think of. So the question that I struggle with is, is it the symptoms or the meaning assigned to them that create distress? And if a schizophrenia comes up with a religious system (e.g. incarnation etc.)that works really well for them how should we deal with this 'reality' that we think is not really there? Thanks for your perspectives.

  17. I believe we categorize groups as a part of our natural learning. These mental heuristics allow for us to process mass quantities of information and make quick judgements that are often helpful but can be inaccurate. If a guy is mumbling to himself on the side of the road and gesturing madly I will likely not interact with him based on my heuristic; he's probably in the middle of a psychotic episode. These categories are a survival/instictive skill rather than something we create out of dissatisfaction. I think human beings also then place themselves within or outside of these groups as another classification technique. These acts are not independently unhealthy or harmful. I think the big issue again arises with our tendancy to be egocentric and believe 'I am always right' that causes us to demonize the outliers.
    Again, I don't believe the act of creating heuristics is the problem. Labels, as the post states, are helpful in discovering where people are in relation to one another. The Bible even does this. Some are called to be teachers, some apostles, prophets, etc. This is a method to categorize and allow people to choose where to go once they know where they are. It is also true that abnormality is a projection of cultural norms. However I do not believe this leads to the conclusion that mental illness is ficticious, nor do I believe we create mental illness through our lableing. Mental illness simply means that a person is suffering and what he/she is doing is not working to make that suffering dissipate. We all suffer on a spectrum of mental illness, so to speak. The 'outliers' are those that are suffering to the degree that their symptoms interfere with their ability to lead their lives functionally. If someone has unusual customs that do not interfere with his/her functioning that is not mental illness. The categories are there as a tool of organization, and the DSM uses this system with a goal of providing care to people who are suffering. Therefore it is dangerous to suggest mental illness is simply born out of or a reaction against a categorical heuristic. This belief could lead to the belittlement of the suffering of those who are living with mental illness. -Jameson

  18. Jameson, I do agree with most of what you said. And also recognizing the importance of 'categories' as tools for assessing someone. Beyond this, my question is whether the way community gives meaning to symptoms can affect the person either positively or negatively. For example, feminist literature often assigns a lot of power to the community in how much it can really affect a person's mental health. My question is, how do you see the possible influence of community on mental health? Foucault did a thorough study on the history of how mental health institutions, historically, defined and categorized mental illness. His showed that how mental illness was defined and categorized had such a tremendous impact on a certain population. I guess my question is,is there a sociological implication?

  19. I have often thought of the DSM as "a necessary fiction" for working with HMOs and for working in a world where most people have the need to categorize and quantify everything. With this said, I do see the DSM as a valuable tool in guiding my treatment decisions, yet I am always cognizant of its limitations. I am often candid with my clients, telling them that the DSM is currently our 'best guess'/best way to describe what is going on with them (and to develop a treatment approach). Sometimes I also share with clients my view that pathology and health are on different ends of a continuum. I see people as being quite variable. Some are very representative of DSM criteria while others are not at all or only have some features of a disorder and seem not to really fit with a label/diagnosis. The idea of continuum does not bother me, as I dislike labels for many things, which others are eager to classify (e.g. racial/ethnic group, gender roles, sexuality). For me, it is only natural to see haelth/pathology as a continuum and not a dichotomy. While I do not dismiss the DSM as useless, I make sure to use it with caution.
    Angela H.

  20. The individual self. The autonomous, objective, isolated, conflicted, empty, self-deprecating, individual self. A construct of Western philosophy and religion. Western thought has given us for which to be thankful. In many ways, it has advanced civilization farther than other philosophies. We should be thankful for Western thought. We should be just as cautious. Western thought – like every form of human thought – has its faults and blind spots. In its efforts to understand, quantify, objectify, and improve the human condition it has become blind or, relatively blind, to the communal, social, invisible, subjective, and existential ways of thinking and being.

    As those raised within the prickly and sometime perilous self-contained habitat of Western thought we are responsible to hold fast to one thing that the history of Western thought should have taught us well. There will always be new facts, new ways of analyzing, and understanding, new and previously unforeseen vistas of understanding. Our ways are not sacred and will not last forever. There are new, “bigger” truths beyond what we know and believe, and someday they will overtake our own.

    So, what should we do? We need to learn where our ways of thinking have come from. We need to understand how these ways of thinking have shaped us and our worldview. We need to try to understand how our ways of thinking limit what we see, think, feel, and believe is possible. We see and understand a lot. We should be thankful. We need to be just as open and humble that there are – probably – whole worlds beyond the ones that our Western eyes can see.Preston Peterson

  21. Categories and classifications serve an important purpose. It allows us to process information in an efficient manner. We ultimately become very nervous or disoriented when we cannot put something in a nice category or box. It also seems that in an effort to create order we also create disorder. But how can we truly get around this dilemma. Furthermore, the lines that are created differ across cultures so we are still left behind in trying to fully understand what is normal. Just as side note, the measure of normal is in relation to what is abnormal. What might helpful in working with illnes is to assess functionality of behaviors within their social context. Perhaps understanding the function of the behaviour and it role in coping in the immediate social environment. This might allow for more flexibility and less isolation in societies at large.

  22. Тhіs post will help the internet people for setting up new web
    site or еven a blog from stаrt to еnd.

    Feel free to νisit mу ωebpage bad credit loans

  23. can you treat a fatty liver can you treat a fatty liver can you treat a
    fatty liver

    My website; natural treatment of fatty liver