Tuesday, November 4, 2014

"Hypermodern times" by Gilles Lipovetsky and psychiatry

In his 2005 book Hypermodern Times, the French philosopher Gilles Lipovetsky refers to the new millennium as “hypermodernity,” that is, something as paradoxical as a “modernist renaissance” characterized by hyperconsumerism, new individualism, narcissism, and a desperate need for control that remains impossible to satisfy in the absence of a belief system.

Lipovetsky puts the new era in the context of modernism and postmodernism, and elegantly describes its many paradoxes. The hypermodern times actually began when the description of postmodernism became common knowledge in the last decades of the 20th century. The predominant emotional chord is described like this:

“The ambience of this civilization of ephemerality has changed the prevailing emotional tone. A sense of insecurity has invaded all minds; health has imposed itself as a mass obsession; terrorism, catastrophes and epidemics are regularly front-page news. /…/ The only real question now is that of protection, security and defense of social benefits, of urgent humanitarian aid and safeguarding the planet.” (p 39)

And about future: “The less one has a teleological vision of the future, the more that future lends itself to being manufactured in a hyperrealist way: science and technology in combination aspire to explore the infinitely great and the infinitely small, to reshape life, to manufacture mutants, to offer a semblance of immortality, to resurrect vanished species, to programme the genetic future.” (p 43)

Psychiatry is, and always has been, medicine's—and perhaps the modern era's—most daring enterprise. Here, man uses natural science to try to explain that thoughts, feelings—even consciousness—have material causes that are subject to the laws of nature and, therefore, are possible to manipulate and predict. Even the name is edgy: the Greek word “psyche” (which few psychologists or psychiatrists can define off the cuff) is the New Testament's word for life, the soul, that which previously was seen as the immortal, God-like, free essence of being human, which, through psychiatry, becomes a part of physiology and pathology.

Mental suffering has been referred to widely divergent conceptions of causes, such as sexual experiences in infancy, capitalist alienation from work, and the “schizococcus,” but from Freud's psychoanalysis to Marxist-influenced social psychiatry, to neuropsychiatry, the same modernist insistence that psychological phenomena can be traced back to sufficient causes has characterized the different schools of thought.

In the hypermodern culture, psychiatric knowledge and tools are suddenly indispensable for people who struggle to use their minds just as their bodies. The spell of the 1970ies anti-psychiatry is broken. As the body has taken on new iconic meaning as a provider of status and bliss, the same perspective is taken on our inner selves, with identity-shaping schemes to create the “dream-me”. Anxiety is controlled with the help of computer programs, visualization techniques, meditation, and other forms of “training.” We even map our genetic predispositions using saliva DNA kits purchased online, and use inventories and websites to match our procreation, love, relationship, friendship, and existential ideals to other people's.

Young people are increasingly seeking out psychopharmacological treatments, not only for impairing conditions but also as “enhancers” of everything from attention span to love or moral judgment. The lust for self-experimentation is striking. Forty years ago, treatment with psychopharmacological agents was widely considered nightmarish. Now, it is clearly mainstream.

With structural and functional imaging methods, epidemiological and molecular genetics, national databases, and broad psychopharmacology, does psychiatry finally have the technology to realize the 1930's modernist ideals of “healthier, clearer, cooler?”

Yet the need for security and predictability is ever-increasing. Instrument-based risk assessments are increasingly used to certify people in order to point out individuals who present some sort of risk. New hospitals use cutting-edge technologies to supervise patients. Do we see the beginning of a new culture wherein neuroscience truly can influence mankind's big questions of peace, happiness, financial security, and global health?

Or will there be a huge disappointment in hypermodernist solutions on the scale of that in the late 1960-early 1970ies? After all, there is very little evidence that psychiatry is improving either general mental health, well-being or the outcome for patients. On the contrary, mental health is getting steadily worse in the hypermodern culture, treatment results have not improved in any general sense and psychiatry itself is getting more repressive, with more involuntary care, forced pharmacotherapies and long-term monitoring. Is this an early sign that hypermodernism is not really all there is to our future?

In 2014, the confidence in the progress of psychiatry seems to have started to dwindle. Funding from the pharmacoceutical industry is drying up, and molecular genetic studies implicate extremes of normal variation rather than identifiable mutations in a large majority of research subjects with common conditions such as depression or even autism spectrum disorders. If mental health problems arise along a spectrum ranging from the normal variation into out-lying pathologies without clear demarcations between disorder-health or between different diagonses, easy technical solutions will be difficult to deliver. 

(Partly excerpted from this paper, available in full text, where changes in psychiatry from modernism to postmodern and hypermodern times are described)

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