Existential psychoanalysis and the nature of mental disorder: Between the medical model and antipsychiatry
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This dissertation develops a Sartrean framework for understanding mental disorders. Sartre set the basic framework for existential psychoanalysis in his Being and Nothingness. While this framework offers only the basic tenets of existential psychoanalysis, Sartre’s existential biographies of Baudelaire, Genet and Flaubert are elaborate illustrations and developments of it. My goal is to explain how we can use Sartre’s philosophy in order to better understand mental disorders and to bridge the gap between the anti-psychiatrists on the one hand and the medical model on the other. My analysis of Sartre’s philosophy and his existential psychoanalysis in brief shows the following: first, that psychiatry should focus on the person as a whole, thus incorporating both the objective and the subjective dimension; second, that definitions of mental disorder should start with defining mental health; and third, that phenomenology is indispensable in determining which structures underlie our experience of the world. These three points are developed throughout the chapters of the dissertation, and express Sartre’s central concept of the individual as a “universal singular”, emphasizing both the lived experience of the disorder as well as its objective dimension. This means that an individual is a personal response to her objective—historical and social—circumstances. Chapter I develops and explains the tenets of Sartre’s account on mental illness. I here show that, according to Sartre, we need an elaboration of both subjective and objective dimensions of a condition—pain and illness on the subjective side, and the disease/disorder on the objective one. This is a consequence of Sartre’s understanding of an individual as being a being-for-self but also having a being-for-others, or alternatively as a singular universal. I also examine anti-psychiatric criticisms in order to further develop Sartrean account of mental disorder. In particular, the two anti-psychiatric views that I examine posit the following claims: that for the concept of mental disorder to be applicable, the behavior of the person has to be unintelligible (Laing), and that there is no mental disorder without physical lesions present in the brain (Szasz). The analysis of both positions provides an argument in support of Sartrean account of mental disorders and the argument that psychiatry should focus on the individual as a whole. Argument against Szasz’s view is given in Chapter II, which also critiques the strong medical model that treats mental disorder as a disorder of the brain. Chapter III deals with definitions of mental disorder. I argue that the four most influential definitions are each lacking in different respects. In light of this critique, my proposal, following Sartre’s analysis of Flaubert, is that we first need to know what constitutes mental health. I proceed to provide a definition that involves an understanding of a human being not simply in terms of biology, but also in terms of the abilities a human being needs to lead a fulfilling life. I develop this understanding through a phenomenological analysis of several cases of mental disorder, which further supports the arguments given in Chapters I and II. The main issue developed in Chapter IV is the problem of demarcating between mental disorder and normal human suffering—a widely recognized problem of contemporary psychiatry. This issue is an important one not simply because the medicalizing of human suffering results in undesirable side-effects, but also because it entirely devalues suffering in general, and construes issues of social injustice and oppression as mental disorders on the part of the victim. I here give additional argument for my claim that psychiatry needs to consider the person in her situation, rather than atomically and in isolation from her circumstances. Given the fact that Sartre’s understanding of mental disorder is psychoanalytic, in Chapter V I examine Sartre’s method further by contrasting it with Freud’s psychoanalysis. I start by explaining Sartre’s critique of Freud, but my main analysis rests on a comparison of Freud’s and Sartre's analyses of the Schreber case. The final chapter provides a developed understanding of delusions in order to illustrate in detail how phenomenology can illuminate our understanding of concrete symptoms. The explanation of delusions given in DSM IV and 5 is in terms of false or fixed belief. The problem is that it is far from obvious that delusions are beliefs. This is because delusions are typically not acted on, and are resistant to counterevidence, unlike beliefs. I argue in favor of considering Sartre’s phenomenological perspective, which reveals that the delusional content is experienced on the plane of the imaginary. This is what explains why delusions are not manifested in behavior and their resistance to counterevidence. This concludes my argument that phenomenology is indispensable to psychiatry.