A clearing for social construction

"The idols and false notions which are now in possession of the human understanding, and have taken deep root therein, not only so beset men's minds that truth can hardly find entrance, but even after entrance obtained, they will again in the very instauration of the sciences meet and trouble us, unless men being forewarned of the danger fortify themselves as far as may be against their assaults." (76: Bacon, F., Novum organum, #38)

Hypocrisy residue

The history of support is that it is liable to become a competition for control(77: Madness network news) which exploits the precarious and frustrating client situation. A less hypocritical approach is for the professional/support person to engage the 'voicing deficit' of the client, the obscured potential for empowered and imaginative being, with restraint and constructed sensitivity. The client who presents as low-functioning is actually challenged by a kind of institutional perplexity and lives an eclipsed life largely concealed in the other of the perplexity system. The interpretation problematic thus properly turns upon the 'morbid sedimentation' of the logic of habituated accommodation in its historical givenness. (78: Cushman, P.)

Disempowerment manifests itself as a kind of personal power vacuum where we are excessively vulnerable to the deliberate or inadvertent intrusion of other people's business. Civil society intrudes upon the client with public bureaucratic interfaces and with private 'clinical' style interfaces, both of which are susceptible of being experienced as intrusions. These institutional manipulations are difficult to handle, 'foreign bodies' not readily assimilated in the service of building the sense of self, so they get introjected with attendant distortion of personality. Thus the social role of the client - whose self is other to the perplexity system and is hard to assert - will reflect the stress and madness dynamics themselves and be defined and reinforced by them.

The difficult social interface the client experiences recommends a self-conscious interpretive approach to involvement where the support person can attend to actual issues. Because the support person's way of involvement produces distortions, a premium is placed on management of the confusion produced by the distortion artifact. Such an involved, historically grounded self-awareness - identifying a kind of participatory 'counter- transference' - contradicts the tenet of 'value neutrality' (79: Haan, N., et al.) and defines a locus of moral problematics. When we promote our social values, as is unavoidable, we get enmeshed in a logic of accountability to the system's rationalities that favors and helps sustain its values, (80: Shotter, J., Social accountability and selfhood) a logic of compromise and hypocrisy.

In the contrast to the way the perplexity system induces a hypocritical ambience, the new paradigm invokes a problematic of blending in plausible accountings. Depending on skill and circumstance, either 'residual' hypocrisy may be effective in discrediting a new accounting, or our self-presentation may be managed so as to achieve acceptance. (81: Billig) The modality of 'blending' is a delicate, pivotal process at the precise point of stress and personal fragmentation where the client profoundly needs appropriate support structures in order to leverage the voice. Social constructionism is challenged to render resolvable these conflicting and inchoate interfaces, (82: Theo) to make ineffectual the elements of hypocrisy, and thus to make the alliance with the clients a viable possibility.

Unobservable subversion

The focus of this model of madness support work is examining the performance characteristics desirable for 'subverting' the perplexity system by 'reasonable' constructs. The most available approach to challenging the system is personal confrontation, based on anger and sporting a celebration of self that derives from an assertion of self-defining personality. While not absolutely counter-indicated in all circumstances, a reliance upon conflictuality tends to clash with the sensitivity needed for blending in the 'reasonable' constructs. The emphasis in designing such a blending is better not on unqualified opposition but rather on making 'pass' an identified radical difference which reflects perplexity's other.

Working the 'unobservable' other to the perplexity system (83: Shotter, J., CPEL) seems to require a disciplined and imaginative capacity precisely in locations that are opaque to the system's logic. The task then is to unmask (84: Grassi, E., The primordial metaphor) the deceptive characteristics natural to the catacomb of relations, based on non-standard truths, that are found in that other:

Francis Bacon (1561-1626) invented a philosophy and method for overcoming the universal speculations of medieval thought, by inducing reasonable argument based on practice. He described types of illusions ("idols") of speculative reason and identified their sources in the nature of thinking, personal idiosyncrasy, social interaction, and philosophical bias. (85: Bacon, F., Novum organum: #41-44) His work is well known as precedent and model for the techniques appropriate to decipher medieval notions and justify presentations of underlying realities as 'reasonable'. As a precursor to Descartes he offers us a standpoint for reworking the perplexity system based on its being, in effect, the unfinished resultant of Bacon's own contribution.

From this task requirement we see that an aggressive and intrusive involvement is liable to the effects of Bacon's 'illusion', unless carefully subordinated to a detached way of being. (86: Bhagavad gita.) Ideally, we expound our topics drawing them from the rhetoric of invention, subject to a requirement to discipline ourselves to interpret and transcend illusions of involvement.

While a construct may seem reasonable when presented and embellished outside of its context, the same construct may appear less plausible when located in its logical context. For example, in a classic study, Goldstein effectively deconstructs the idea of 'reflex', showing that isolated reflexes are an idealized abstraction of systems effects. (87: Goldstein, K., The organism) Thus, when we examine sensitively the notion of using conceptual 'atoms' consisting of isolated reflexes as the units of analysis of behavior, we find such an approach fatuous. The illusion that comes with reification can be strengthened out of its context, yet it breaks down under an analysis like that based on the mirror of Bacon's 'idols'.

The contrary to the reinforcing effect of individual and conceptual isolation is to put a partnership of clients and support persons on the level playing field of 'blending'. We can interweave the insufficient constructs from the clients and the induced forms of constructionist analysis into a tapestry of 'reasonable' forms. This defines a piecemeal, 'bottom-up' process for constructing engines of innovation within the tradition of invention envisioned by Bacon. If we can manage the 'rational visibility' (88: Billig) of novelty, keeping it low-profile or relatively so while it takes root, we can aspire to establish its institutional viability.

Gaze and involvement

We reflect on the impact of the attitude that a support person takes when participating in the drama of involvement with the mental health client environment. This posture, or 'gaze', typically shows up in the current paradigm in the form of clinical and/or 'value-free observer' attitudes which are not informed by intersubjectivity. Of course, the case of the gaze which reflects involvement with personal confrontation and identity challenges is a hardened one, distorted by the violent and disorderly character of interactions. Yet even the hermeneutic or interpretive gaze itself is also problematized by attitude and demands a clear divination of its own institutionally based intrusiveness to produce an optimal relatedness. (89: Shotter, J., Social construction as social poetics)

Consider the cogito, the ground of the rationalist gaze, as just one kind of involvement, rather than as that exceptional ground that derives from 'first principles'. At the fringes of the confines of that 'rationality', the interpretive gaze is yet socially accountable for the attitude it presents in engaging madness at the point of inspiration/affliction. One accounting is to deconstruct the privileging of the clinical gaze by rendering the diagnostic view of madness as 'bizarre' behavior over into a way that is more philosophically comprehensible. (90: DSM IV; 91: Valla, L, Disquisitiones dialecticae) Sass, for instance, following Wittgenstein, has already presented us such a theory - of the inspired, cryptic, incomplete realization or 'apophany' of mad Being. (92: Sass, L.A., Madness and modernism)

In the contrary case, where attitude serves as obstruction and fails as touchstone for balanced conversation, the unwieldiness of the gaze muddles the intersubjectivity. When this fails consistently - and this outcome is hard to avoid from time to time - it produces the quality of 'beating up' the client or even outright character assault:

The prejudice that is at the core of habituation to tradition (93: Stern, D.) magnifies the 'professional' gaze and turns it into an opportunity for psychological domination. The social relatedness of their involvement renders the institutionally privileged party liable to stereotype the vulnerable party and thus lends a free hand for insult and abuse. Interpreting this relatedness is thus central to maintenance of balance, with the risk being a fall into a kind of habituated counter-transference that demeans the character of the client. Gadamer offers us a process puzzle where in some undetermined but unavoidably creative way it is necessary to ask 'open questions' in order to 'disconfirm prejudice'. (94: Stern, D.)

The hazard for the client here is developing an irrational interface with hermeneutic blundering; the imperative is to show attentiveness to prejudice and complexity of response. The support person on the other hand wields a privileged social situation and must show accessibility and detachment as well as imagination and discipline of understanding.

The clinical approaches coming from the old paradigm, and even many current hermeneutic and constructionist approaches, reflect an individualist practicum. When we network and blend constructions with the new 'reasonableness' we provide what is essentially a social construction with social implications. This scheme of involved interpretation networks around the logic of the perplexity system and erodes prevailing rules, standards, and norms. Such a program challenges marginally valuable habits in the prevailing social relations, (95: Hooks, B.) unsettles the gaze, and weakens the bindings of the traditions underpinning the perplexity.

Originary authorship

Since the social clearing available does not provide robust opportunities for client Vision, it provides by default a broad opportunity for unscrupulous exploitations. There is a fundamental choice of whether to minister to dysfunction to the point of collaborating with it, as against making advocacy for and growing new insights and values. The vulnerable 'new shoots' are readily demeaned by blunt hypocrisy that emanates from the irrationality of the rationalist representations of the perplexity system. (96: Lenin, V.I., A great beginning) And any effort to resist this blaming invokes calumnious rhetoric and aggressive, domineering behavior, attacks that batter sensitivity and dull the tool of imagination.

The alternative advocated here is empowerment through partnership with enlightened support persons who help shoulder the burden of being beaten up. History provides multiple examples of alliances between psychiatrists and client activists which are 'gaze-driven' and adversarially impacted by personal agendas of the professionals. (97: Torrey) Dependent solutions of this sort impede the available social clearing and divert the clients from any program of freely asserting their creativity. My experience is that the best connection with support persons is when they're near to the being of madness, interface socially with the clients, and jointly author innovations. (98: Phelps, A., Making sense)

An agenda of advocacy for the 'paradigm shift' offers the clients room to be imaginative; it also provides openings for institutional support for projects oriented away from the clinical paradigm. One sort of such openings might involve construction of new and sensitive approaches to patients rights and innovative support modalities for people facing stress. Another might extend the notion of self-help and peer counseling to the development of alternative provider institutions and the training of qualified support persons. We have to brainstorm and identify the social value we can produce and how to construct thereby the financial basis for a new style of system seamlessly integrated into the community.

Especially in this century, the agenda of psychiatry and allied disciplines of building the clinical system has resulted in a hegemonic practice that sets the standards. This system is deeply flawed, is now in fact institutionally challenged, and is being restructured into economics-based practices such as managed care. As things proceed, mental health service provision has depended and will increasingly on client/community control and advocacy of humane outcomes. By providing theoretical support and social advocacy and letting go of selfish agendas, we can promote a client-driven 'madness' program that competes for provider status/funding in the public (and private) helping arenas. (99: Shotter, J., {management})

RECAP. The reader needs to recognize that this article presents the problematic of psychiatric reform as a deficiency (or even delusory activity) when initiated from the provider perspective. The ontology of 'organic intellectuals' who challenge reductionism is insufficient grounding in itself for the successful deconstruction of the system. (100: Basaglia; 101: Mollica) The challenge of a partnership program, as Psichiatrica Democratica found in Italy, is to develop a self-discipline of increasingly rendering the forum for expression as a clearing available to the clients. There should be no thought however of the intent of this prescription being derogation of the providers, however, as the soft, illusory quality of this activity is as inescapable as it is helpful.

Visionary directions