A Medical Anthropology of the “Global Psyche”
Stefan Ecks
Abstract
A medical anthropology of the “global psyche” may sound like an odd project. Is there one psyche that pervades the whole globe? In their introduction to this special issue, Dominique Béhague and Kenneth MacLeish dissuade any suggestion of either the global or the psyche as entities that could be examined like substances. Neither the psyche nor the globe are stable points of reference. They are not names of entities. Instead, the global psyche is “a concept, era, program, and episteme that rewards careful analysis” (this issue). There are “multitudinous labors” and “novel forces—political, technological, neurobiological, ecological” that are redefining what either the global or the psyche could be. For anthropology to describe the psyche as global, it needs to theorize what the psyche is and how it connects to its outside and to other psyches. But we struggle to do this; our conceptual language hardly allows it. There have been recent attempts in the social sciences at grasping psyche beyond individual brains. Elliott (2011) goes back to J. G. Herder's notion of “mood” (Stimmung) as both affect and environment. Cvetkovich (2012) gestures at depression as a “public feeling.” Rosa (2016) theorizes mental illness as a disturbed “resonance” between individuals and the world. The global psyche used to be a key idea in philosophy. In Greek thought, the universe was a living body with a single world psuche (ψυχή, as “soul,” “vital breath,” or “life”) extending through it. This global psyche maintained the shape of the cosmos by separating chaos from form. Plato's Timaeus describes the universe as a “Living Creature which is designed to embrace within itself all living creatures” (Plato 1952, 33). The shape of this living All is the sphere, “which of all shapes is the most perfect and the most self-similar” (p. 33). This cosmic being is “one visible animal comprehending within itself all other animals of a kindred nature” (p. 30). At its center, and “diffused throughout” (p. 33), is the global psyche. The psyche is “the best of things created” because it is composed of everlasting essence and “partakes of reason and harmony” (p. 37). The cosmic psyche is “global” as “reaching everywhere” and “being shaped like a rounded sphere.” The idea of a global psyche now feels like a premodern phantasy. To think of the world as if it was a maximally scaled-up cosmic animal seems madly unscientific. Gaston Bachelard (1967 [1934], 5) would have classed this “naive realism of spatial properties” as another example of an epistemic obstacle that scientific objectivity needed to overcome. Since the 17th century, scientists started describing the psyche as an emergent state located in individual human anatomies, specifically in that spherical mass of neural cells and blood vessels called the brain (Zimmer 2005). The brain became a closed system of nervous excitation that responds to sensory input only on its own terms. A psyche pervading matter beyond the individual body became an absurd proposition. The global psyche is now an entry in a Borgesian encyclopedia of impossible creatures. It produces a sense of alterity, “the stark impossibility of thinking that” (Foucault 2005 [1966], xvi). But rescuing the global psyche from the dustbin of discarded ideas has some advantages. One of them is that it reminds us of the historical contingency of thinking that the psyche can only be the property of separated individual brains. The Greek concept of a global psyche makes a surprise appearance in Jürgen Habermas's (1971) influential Knowledge and Human Interests. Habermas discusses Plato's global psyche as one of the foundations of the split between theory and practice. Plato, and most philosophers up to the 19th century, argued for a separation between perfect form on the one hand, and mutable and perishable materiality on the other. The really real is, for Plato, an abstract idea. The visible world is merely “that which is always becoming and never is” (Timaeus, 27). Habermas detects a continuity between modern scientific positivism and Greek ontology: “both are committed to a theoretical attitude that frees those who take it from dogmatic association with the natural interests of life and their irritating influence; and both share the cosmological intention of describing the universe theoretically in its lawlike order, just as it is” (1971, 303). This kind of positivism also permeates the social sciences, exemplified by the concept of value-–freedom. Social scientists are meant to describe the grammar of social action. They should not let their own interests cloud their analysis. For Habermas, value–freedom is a form of pseudo-objectivity that conceals “knowledge-constitutive interests” (1971, 308). In reality, all sciences value. Habermas distinguishes three major values that motivate scientific research: understanding, controlling, and emancipating. Understanding is directed toward other minds and is built on hermeneutics. Controlling the world is founded on deductive and empirical research. The intent to emancipate comes in a variety of forms: to make conscious of inequalities, or to free from bonds and constraints. Critical theory aims at emancipation. Habermas's three types of values are mirrored in major streams of medical anthropology: understanding is the goal of hermeneutic approaches; control is the goal of applied and policy-oriented research; and emancipation motivates critical medical anthropology. These are the interests of the researchers. When anthropologists look over the shoulders of other experts, another layer of interests emerges. Do the experts value understanding, or control, or emancipation? Habermas's interests help us see many connections between the contributions to this special issue. All of the articles try to understand what drives other people's actions. In all the articles, these people are some kind of psy expert. These experts either try to control the world or they seek emancipation, either for themselves or for others. The psy sciences veer between control and emancipation: “Psychiatric labels and discourses are employed as tools of governance in the face of violence and disorder but also as means of grievance and redress for social and political movements” (Béhague and MacLeish, this issue). The articles most clearly focused on control—and the limits of control—are by Margaret Lock, Junko Kitanaka, Jocelyn Chua, and Hanna Kienzler. Lock shows, with a hefty range of medical, biological, and ecological research, how bad the state of planetary health has become. The survival of humanity itself is at stake. All the toxins and pollutants spread in the water, the air, and the earth refuse to stay outside living bodies. They seep inward and destroy health on all scales. Since the discovery of epigenetics, environmental stresses become measurable on the genetic level. Environmental toxins become neurotoxins. Lock further argues that socioeconomic inequality presents the “most pernicious form of toxic environment” (this issue). She finds that the technocratic desire for control has led to a loss of control. In its desire to make life better, technocapitalism has overreached. The dark dialectics of science-based control are the total loss of control. Dementia is a condition characterized by a loss of control over one's own thinking, feeling, and moving. The suffering self loses control over itself, and carers lose control over the sufferer. People become “incommensurable” to themselves and others. Junko Kitanaka's contribution traces current experiences of dementia in Japan. She finds a strong shift toward a “neurobiologization” of dementia since the 2000s, making the Japanese “engaged in a new level of neurobiological/neuropsychological intervention in everyday life that covers the whole lifecycle” (Kitanaka, this issue). This drive to gain control over dementia is not confined to biomedical practitioners: Both the people living with dementia, as well as their carers, find some relief in neuropsychiatric diagnostics and labelling. Brain scans became the foundation of new self-understandings. Kitanaka riffs on Socrates, saying that “the unexamined life is not worth living” (Plato, Apology, 38). In Japan, life is now “unexamined” as long as it is unexamined by the neurosciences: “brain scans become a prerequiste for living ‘an examined life’” (Kitanaka, this issue). But all attempts at controlling the degeneration of the brain and its functions are limited. At some point, it seems better to “own the label” of dementia sufferer than to fight it (Kitanaka, this issue). Jocelyn Chua also studies how attempts at control get frustrated. Her ethnography of the U.S. military's changing positions toward soldiers’ psychopharmaceutical consumption shows that so-called total institutions struggle to exert control, both over what goes on within them and what goes on beyond their boundaries. The U.S. military wants to control what kind of psychotropic substances their troops are taking. Ideally, all troops would be in excellent mental condition, without any of the “vices of civilians and civilian culture: mental weakness, intolerance to pain and suffering, self-indulgence, and desires for immediate gratification” (Chua, this issue). However, the military has to acknowledge that a large number of soldiers get medicated in the civilian sector and carry these medications with them into the military; that soldiers get (over)medicated by army doctors who are not meant to do this; or that soldiers obtain psychotropics through informal market exchanges with other soldiers. “Pharmaceutical creep” happens through many vectors, and Chua chronicles changing attempts by the military to keep the creep at bay. The seepage of substances is motivated by a desire to enhance battle fitness. Ironically, both the top brass of the military and the individual soldiers pursue the same value: to enhance combat fitness through controlled medication use. Luis, one of the soldiers quoted by Chua, explains how his sergeant is supplying him with regular doses of the stimulant Adderall. The transaction breaks the rules, but the sergeant is doing this to augment combat fitness. Luis agrees that his superior is “saving my life with these drugs” (this issue). While Chua studies the psyche in active military service, Hanna Kienzler looks at post-conflict psychotherapies for civilians. The psy-scientific logic of “Global Mental Health” looks deceptively simple: conflict creates psychological problems. These problems are perfectly described by standard diagnostics and can all be treated through pharmacological and nonpharmacological interventions. Interventions developed by Euro American psy sciences are ready to be “scaled up” across the globe. Anyone's psyche can be brought back under control. However, as Kienzler shows in her ethnography of different psychotherapeutic practitioners in the Kosovo, there are limits to this logic. Psychosocial interventions cannot be scaled up quite so easily in a place without solid infrastructures in medicine and social welfare. Kienzler's Kosovar therapists get stuck in a double bind: On the one hand, they are meant to treat their patients; on the other, they realize that patients’ living conditions are so troubled as to render simple intervention useless. The therapists try to regain control by reducing all problems to some kind of conflict-related psychological trauma. This reduction allows them to resort to “handing out of placebos, giving more or less helpful life advice, and referring women to often dysfunctional social services (Kienzler, this issue). How a refusal of control can become an act of emancipation is the topic of Cristiana Giordano's study of asylum seekers in the south of Italy. The refugee situation is the confluence of multiple crises. There are military and economic crises in the countries where the asylum seekers are from. In turn, the influx of immigrants presents a crisis to the countries where they arrive. Due to its long Mediterranean coast and proximity to North Africa and the Middle East, Italy is one of the countries that receives a huge number of asylum seekers. These crises are all forms of losing control. The usual response to these crises is an attempt to regain control. Giordano finds that there is another way of dealing with the crises: a refusal to acknowledge them. Giordano tells the story of an asylum seeker called Victor, who refuses to make drawings of his “refugee experience.” The reasons for Victor's refusal never become transparent: he “prefers not to.” Victor reminds Giordano of Melville's character Bartleby the scribe, who vexes everyone by gently refusing to do what he is meant to do. Victor does not rewrite the grammar of crisis, but he interrupts it for a short moment. Not acknowledging the crisis is (perhaps) an act of emancipation. The quest for emancipation is clearest in Sean Brotherton's contribution on Lacanian psychoanalysis in Argentina. This South American country is, in his description, an exemplar of chronic political and economic crises. Brotherton's interlocutors seek solace from the crises in psychoanalysis. Freudian psychoanalysis has deep roots in Argentina. The Lacanian version has been gaining traction since the 1970s, perhaps because it intersects with Marxian theory and lends itself better to a critical analysis than Freudianism (Stavrakakis 2002). However, psychoanalysis on its own is ill-suited to grasp sociopolitical crises. Further, the costly fees preserve psychoanalysis as a practice by an economic elite for an economic elite. And yet, Brotherton's Argentinian interlocutors find in it a language of emancipation. Lacanian analysis provides a “grammar” that allows people to articulate their suffering and their “desire to live a better life” (Brotherton, this issue). Brotherton shows that psychoanalysis has the same duality of control and emancipation that also appears in biomedical psychiatry: It purports to make the inner self “legible” and amenable to intervention, and at the same time it wants to give insight, relief, and emancipation. Yet, just like in biopsychiatry, the emancipation remains apolitical: The “self-knowledge” (autoconocimiento) gained through Lacanian analysis is confined to helping the inner psyche respond in a more relaxed way to outside crises. All the articles speak to the global dissemination of psy-science expertise. Diagnoses such as dementia, depression, or post-traumatic stress have traveled the globe. Treatments, both pharmacological and nonpharmacological, are available in all parts of the world. Diagnoses and treatments have been cut loose from the control of the psy sciences (Ecks 2013). In turn, there is a global connection between different causes of mental suffering. War, violence, economic breakdown, and environmental destruction have all reached global proportions. Regaining control over this situation seems impossible. The psyche cannot find an easy path to emancipation because there is no sane outside to turn to. Habermas picked on Plato's global psyche as a forerunner of value-free positivism in the sciences. But there is another side to Plato's idea, which is that it questions the psy sciences’ individualization and materialist reductionism. The Greek notion of a global psyche was an epistemic obstacle to technoscientific overreach—but not obstacle enough.