Mental Health Let's Talk Crazy

What Gets Lost In Translation

If we look at the process of diagnosing mental illness, we can see how in their interactions with patients, psychiatrists try to fit an actual human with abstract experiences in one of the made-up categories in the DSM

What Gets Lost In Translation

In his critique of psychiatry, Foucault talks about the absence of the body and medical crisis, which makes diagnosing mental illness challenging. Unlike physical illnesses, mental health challenges exist as subjective experiences and cannot be measured with objective tests (like body temperature or blood tests).

Moreover, Foucault insists that the industry of psychiatry is interested in the absolute diagnosis, in contrast to the differential diagnosis that is present in medicine. With a physical illness, when your symptoms match more than one condition, your doctor will follow up with additional tests before making a diagnosis. Tests will narrow down potential conditions on your healthcare provider’s differential diagnosis list. With mental distress, on the other hand, multiple conditions share similar symptoms, and your diagnosis will depend on your psychiatrist's interpretation of your subjective experiences.

Even though Foucault is more interested in the structure than in the personal motifs of doctors, and it would be unfair to claim that every specialist in the field acts strictly in accordance to the model proposed by Foucault, the traits of methods and approaches he describes can be recognized in practices today.

If we look at the process of diagnosing mental illness through the lens that Foucault provides us with, we can see how in their interactions with patients, psychiatrists do not try to approach every individual situation and learn more about person’s experiences. Instead, using lists of concrete symptoms provided in the diagnostic manual, they try to fit an actual human with abstract experiences in one (or more) of the made-up categories.

An illustration showing hands gently holding the globe over to three geometrically-shaped slots: a triangle, a diamond, and a star. The text on top of it reads, "Translating experiences into symptoms," with an arrow pointing from the globe to the geometrically shaped slots.s
Practically, translating experiences into symptoms feels like trying to push something through an opening it won't fit into without some serious adjustments

The Language of Mental Illness

To fit into a mental patient frame, a person needs to translate their experiences into symptoms.

Instead of saying, for instance, “I feel sad when people I love are far away,” a patient should word their experience according to the rules of psychiatry, “I have dependency issues.”

The details and nuances of every individual situation get lost in translation, however.

The goal of evaluation is not to discover the particular circumstances of a specific person but to make sure every symptom points back at the person as a source of all of their problems.

A doctor needs to prove that a patient’s behavior is abnormal so that the doctor can classify the patient. If, as Harp says in “Schizo-Culture: On Prisons and Psychiatry” chapter, if we view the patient’s problem as “a normal reaction to abnormal conditions” (p.169), the doctor becomes irrelevant.

Therefore, the process of evaluation needs to culminate in the confession and the acceptance of the psychiatric discourse: “In short, whether in the form of confession or in the form of actualization of the central symptoms, the subject must be forced into a sort of tight corner, a point of extreme contradiction at which he is constrained to say “I am mad” and really play out his madness” (Psychiatric Power p.274).

A psychiatrist needs a patient to confess their madness. In this scene from "One Flew Over The Cuckoo's Nest", we see the psychiatrist and Randle McMurphy struggle to agree on whether Randle's subjective experiences can be framed as symptoms of a mental illness or whether they are normal.

“Give me some symptoms; I will remove the fault”

Acceptance of mental illness removes the responsibility from the patient and grants the doctor their authority.

Though a lot has changed in the industry, and, for example, involuntary commitment and the power of psychiatrists are more strictly regulated now, the approach to evaluation and treatment can still be misleading.

Doctors offer symptoms for patients’ consideration—actually planting an unequivocal way of thinking about their own experiences into their heads. The industry is still fascinated with classification and labeling, and individual experiences often get lost in the attempt to separate “normal” from “crazy.” Instead of providing a patient with means of belonging in society again, the industry promotes a feeling of inadequacy and further isolation.

Ultimately, what gets lost in translation is the significance of individual experiences and subjective realities, which cannot be classified and reduced to a list of symptoms.

Evaluating mental health requires compassion and empathy, as well as willingness to understand patients' experiences rather than expecting them to conform to the diagnostic categories.

Thus, healthcare providers should apply their knowledge of modern psychiatry while keeping in mind the dangers of its power to pathologize, dominate and erase the human experience through the instrument of diagnosis.

As always with Let's Talk Crazy blog posts, I would like to finish with a mood song. Today, it's a classic from Radiohead, "I don't care if it hurts / I wanna have control / I want a perfect body / I want a perfect soul"