Session 6: The ‘Fluid’ and Complex Territory of Judgement and Diagnosis

Session 6: The ‘Fluid’ and Complex Territory of Judgment and Diagnosis
Chair: Abel Franco
They Wouldn’t Make Good Ophelias – Reality of Experience in Women’s Madness Narratives
Katarzyna Szmigiero

20th century human sciences criticised bio-medical psychiatry for its reductionist attitudes. Psychiatric diagnosing is based on culturally and historically dependant factors. It is also guilty of gender bias. Moreover, diagnostic criteria and procedures used worldwide vary, which suggests the inability of contemporary medicine to pinpoint the legitimate psychiatric complaint. That is why, anti-psychiatry thinkers have denied the existence of mental illness, regarding it as a social construct, an attempt to stigmatize unorthodox members of the society. They frequently idealised madness. Ironically, such an attitude was more often expressed by scholars than the patients themselves. Those who suffer from a mental disorder might reject pharmacological treatment or patronising medical establishment; yet, they would seldom go as far as to question the existence of the illness itself or view it as beneficial. Mental disorder, for the sufferer, is a painful, desolating reality, threatening one’s sense of integrity. This paper analyses the experience of mental illness and its consequences as expressed in women’s madness narratives. Contrary to anti-psychiatrists’ beliefs, the characters in these texts do not perceive themselves as scapegoats punished by psychiatric machinery for various transgressions but as individuals who, due to their mental agony, are unable to cope with everyday life.

Download Draft Conference Paper –

In New Zealand a person who has committed a serious offence may be found not guilty by reason of insanity if when committing the act, they were labouring under a ‘disease of the mind’. In such cases, the defence has to illustrate that the accused was affected to such an extent as to render them incapable of knowing that the act was morally wrong in regard to commonly accepted standards of right or wrong. As part of this process, the defence and prosecution each employ a psychiatrist to act as an expert witness who will give opinion as to whether the defendant meets this criteria.
The term ‘disease of the mind’ is a legal term; the psychiatric expert witness may offer opinion as to what constitutes a ‘disease of the mind’ but the final decision is a matter for the judge to decide. Common law stipulates that a ‘disease of the mind’ must be lengthy in duration and an effect of internal rather than external causes. It must also be so severe in nature as to render the accused incapable of knowing the moral wrongfulness of their actions.  Drawing on information generated from qualitative research, this presentation will consider the implications of illicit drug use and non-use of prescribed medication for determining diseases of mind and moral wrongfulness. The presentation will consider the implications of cases that involve the accused refraining from taking their medication, with the knowledge that they may become psychotically unwell and violent.  On the flip side, it will also consider the rise in the use of methamphetamine in New Zealand and the problems the use of this drug have created for determinations of insanity. In both instances, the difficulties associated with delineating transitory from permanent disorders and internal from external causes in light of personal choice and responsibility will be critically explored.

Ian Hacking, in his book Mad Travelers, proposes that new psychiatric diagnoses that “catch on” do so because they fit an “ecological niche” in the psychic life of a society. The book’s main example is hysterical fugue, which was briefly prevalent in Europe in the late 19th century. Hacking offers a list of “vectors” that successful diagnoses align with, and less successful ones do not. This paper will analyse the absence of Stendhal syndrome sufferers outside Florence, Italy as a function of the condition’s failure to line up with two of Hacking’s vectors: cultural polarity and release.
Stendhal syndrome is a psychiatric condition in which museum-goers, confronted with art of overwhelming beauty, suffer symptoms such as panic, hallucinations, palpitations and fainting spells. The term was coined by psychiatrist Graziella Magherini of Florence, Italy. Named after the French novelist, who described similar symptoms on a visit to Florence in 1817, the syndrome has only been diagnosed and clinically studied in that city, where Magherini claims to see dozens of cases annually. It is one of a number of conditions, sometimes called “tourist-specific psychopathologies,” in which unfamiliar surroundings trigger mental breakdowns. What makes it unique is that it is defined as an overwhelming aesthetic response; the victim overdoses on art. This idea has a powerful imaginative appeal, and since the term “Stendhal syndrome” was coined it has surfaced regularly in writing on art and culture. Outside Florence, however, actual diagnoses have failed to materialize. This paper will argue that this is because there is no urgent, inchoate tension in current Western society that is likely to seek expression through art-induced madness. The enduring fascination with the syndrome, however, speaks to a yearning for a world in which such madness exists.

Download Conference Paper (PDF)

Last year’s highly publicized “Virginia Tech Massacre” brought the discussion of Asian Americans and mental health to national attention.  When Cho Seung-Hui murdered thirty-two people before committing suicide there was intense debate surrounding his cultural background and its relation to his violent act.  As a group largely defined by “model minority” status, Asian Americans have rarely been considered in national discussions of mental health, and indeed “underutilize” services.  Yet through a more critical lens: what grounds the definitions of Asian Americans, model-minority status, and madness in the Virginia Tech media coverage?  This paper will consider the production of Cho Seung-Hui as a raced and “crazy,” subject and its relation to the expansion of mental health screenings in several sectors of American society.
In 2001 the USDHHS released a supplement to the Surgeon General’s mental health report, entitled “Mental Health: Culture. Race, and Ethnicity.” The document addressed issues of mental health care disparity and cultural competency in treatment, and was heralded as a major event in the world of cross-cultural psychiatry and psychotherapy. Yet through a Foucaultian perspective the report can be read as an attempt to extend mechanisms of psychiatric disciplinary power, as well as pharmaceutical profits, into previously un-tapped populations.  Screening processes ranging from the Bush Administration’s New Freedom Commission on Mental Health to college mental health tests have taken a new interest in communities of color.  Without dismissing the need for more equitable health care, a question remains as to what that care consists of.  An evaluation of both the public reaction to the Virginia Tech Massacre and the ongoing efforts to “open” ethnic groups to psychiatric care provides rich insight into American notions of health, race, and normalcy.  Critical interventions in this discussion, from both the Asian American community and alternative mental health groups like the Icarus Project, will also be considered.

Download Conference Paper (PDF)