Damian Sendler: “Hypostatic abstraction,” which is central to the identity of contemporary medical specialties, such as psychiatric care, involves treating diseases or disorders as entities or conditions that individuals have. Psychiatry’s status as a medical speciality is challenged by mad activism, which opposes this idea. In this essay, the hypostatic abstraction is developed and used to medicine in order to better understand the difficulty of Mad activism. In order for psychiatry to remain a medical specialty while dealing with the challenges posed by Mad activism, it must establish a new understanding of the therapeutic interaction. This article poses two fundamental framing questions in an attempt to elaborate on this concept: To what end should the clinical encounter be directed? What is the overall goal of this encounter? Clinical encounters may satisfy the demands of Mad activism by including notions like as “secondary insight” (the goal of understanding) and “identity-making” (a therapeutic goal).
Damian Jacob Sendler: Psychiatry has a distinct identity that is shaped by a set of shared conceptions of what it is and what it is for. Psychiatry’s medical speciality distinguishes it from other fields of medicine. Medical physicians choose the specialization they wish to specialize in throughout their first few years of school. 1 Ophthalmology, cardiovascular, gynecological and pediatrics are among them. A number of commonalities exist across the many modern medical specialties: they all focus on the diagnosis and treatment of medical problems, illnesses, and diseases, and they all rely on basic sciences like physiology, anatomy, histology, and biochemistry as well as technology. Even as physicians are increasingly framing their work in ways that take into account the whole person, recognizing conflicting values and their implications for diagnosis and treatment, and acknowledging the role of the arts and humanities in medical education and practice, these features characterize modern medical specialties (see, e.g., McManus, 1995; Cox, Campbell, and Fulford, 2007; Cook, 2010; Fulford, van Staden, and Crisp, 2013).
Dr. Sendler: To separate itself from other medical specialities, psychiatry addresses mental health issues or disorders, as opposed to bodily illnesses or diseases. Mental illness and the consequences it has raises some difficult questions for psychiatry, which can lead some to question the specialty’s legitimacy. These questions include whether psychiatry can be considered a legitimate medical field, the explanatory limitations of its theories, and the classification errors that plague the field. In these three areas, there are continuing arguments that don’t seem to be reaching a conclusion at this time. 2 As a result of new methods to mental health advocacy, a fundamental challenge to psychiatry’s status as a medical speciality is now taking precedence over these previous discussions. 3 When it comes to mental disease and mental disorder, these methods, which I term to as Mad activism, do not believe that individuals have a problem that needs treatment. Insofar as psychiatry aspires to define itself as a branch of medicine, the concept that medicine treats illnesses, disorders, or diseases, lies at the core of medical practice and philosophy. It is via its rejection of the concept that individuals “have” a “condition” that it challenges the legitimacy of psychiatry as a medical field.
Damian Sendler
My purpose in writing this piece is to explore how psychiatry may meet the problem of Mad activism in a professional setting. In Section II, I elaborate on this issue and compare it to other mental health advocacy strategies. The “hypostatic abstraction,” a logical and semantic activity initially discovered by the philosopher Charles Sanders Peirce, is discussed in Section III of this paper. Hypostatic abstraction is at the very core of medical practice and philosophy, I argue, inasmuch as the illness is posed as something to be controlled and treated. The hypostatic abstraction is rejected by Mad activism as a threat to psychiatry. My answers to this problem are outlined in Section IV. There must be an extra notion of the clinical encounter in order to interact with both persons who believe they have a mental illness and those who don’t, so that the medical speciality may keep its medical identity while simultaneously coping with the problem of Mad activism. In order to better understand this notion, I’d want to ask two essential questions: To what end should the clinical encounter be directed? What is the overall goal of this encounter? Sections V and VI, respectively, address these concerns. When it comes to the clinical interaction, I believe that “secondary insight” and “identity-making” may be used to accommodate the challenges posed by Mad activism.
In spite of longstanding dissatisfaction about the treatment of those deemed to be mentally ill, the 1970s are seen as a turning point in a surge of activism that continues to this day.
4 Civil rights activities by black, homosexual, and women’s civil rights movements sparked other mental health groups to organize for the rights of psychiatric patients and to improve the mental health facilities they were in. While long-standing concerns about forceful treatments, lack of recovery engagement, restricted access to treatment, and societal stigma have long been a part of the c/s/x movement’s vocabulary and actions, some activists have also criticized the medicalization of lunacy. Here, I’ll refer to it as “Mad activism,” which includes features of Mad Pride and mad-positive activism.
As opposed to treatment-focused efforts, mad activism views the issue as one of respect and acknowledgement. Public representation and worth of people’s identities is at risk, with the mainstream view of lunacy as a mental condition being perceived as an attack on a positive identity. This is the issue at hand.” Reforming psychiatry is only one part of the plan; a broader objective includes influencing public perceptions of mental illness. campaigners “have moved beyond treatment-centered activism to articulate a wider culture of madness,” write Schrader, Jones, and Shattell (2013, 64). When it comes to organizing around concerns of identification and recognition, Mad activism shares goals with other social movements. For example, in the area of sexual orientation and gender, homosexual rights and trans rights are not only concerned with preventing discrimination in the workplace, but also obtaining symbolic and cultural restitution in society.
Damian Jacob Markiewicz Sendler: Many issues are raised by the claims and demands of Mad activism. Activists, for example, contend that mental illness is a valid basis for a person’s identity. Even if a positive view of mental illness is maintained, how is it possible to acknowledge the suffering and limitations that come along with these conditions? What moral and political arguments may sustain the demands of Mad activism, and what are the proper social and political responses? All of these are issues that I’m currently addressing elsewhere (Rashed, 2019b, 2019a).
The activists’ denial that they have a medical ailment that need treatment is the primary topic of this article. The question is whether or not psychiatry can accept this assertion. To what extent does this issue extend beyond the realm of activism? Psychiatrists regularly find themselves in the position of diagnosing people who don’t believe they have a medical ailment that warrants treatment. Regardless of what a patient believes, there is precedent for involuntary custody in cases when the patient has mental illness, lacks awareness of his condition, and meets the legal conditions for detention, which may include a danger to oneself or others. However, given that this is the usual course of events, I’d want to know how things may continue forward if we take the individual’s rejection of the premise that they have a condition as the starting point for any future discussions. How well prepared is the clinical (psychiatric) encounter to handle this situation? 6 Although individual clinicians may have the expertise and insight to address this predicament, I argue in what follows that psychiatry as a body of knowledge and as a set of institutional procedures does not have the conceptual resources to do so. “Hypostatic abstraction” is an important explanation for this, and it may be summarized in the concept of physicians treating things that individuals have, or “things they have,” as opposed to “things they don’t have.” As a result, psychiatry is dedicated to the notion that is rejected by the patient in the therapeutic encounter. Psychiatry’s status as a medical speciality is challenged by the focus on encounters between patients and their doctors. The hypostatic abstraction is an important concept to understand before looking at alternative remedies to this difficulty (Section IV).
Taking anything apart from its relationships or qualities is known as abstraction.
7 The act of abstracting a property from its examples, such as in the following propositions: the ball is round, honey is delicious, and Ahmad is courageous, is a kind of this. As a result of this, philosopher Charles Peirce has coined the term “precisive abstraction.” 8 Instead of saying honey has sweetness, we say honey is sweet; instead of saying the guy is shy, we say the man suffers from shyness. He differentiates between precisive abstraction and hypostatic abstraction in these statements. An individual’s essence or “substance” is referred to as a “hypostasis” by the word.
When we do a hypostatic abstraction we produce an object of thought, but Peirce makes it clear that this object is only ever actual when we do so; the difference between precise and hypostatic abstraction is a logical and semantic one, not an ontological one. How may hypostatic abstraction be of use to anyone? It is possible for us to interrogate essentiality by allowing us to think of the ball and its roundness or Ahmad’s shyness as two separate subjects via the use of hypostatic abstraction, which also allows for the reification of the abstracted property t. 10
Hypostatic abstraction may be used in medicine to describe illnesses, syndromes, and diseases as “things” a person “possesses.” So we may examine if such “things” are part of the person’s basic essence or just their external attributes (the first affordance noted above). 11 An individual’s sorrow is transformed into a human being and suffering when a clinical diagnosis is made. It is more accurate to state that Mahmoud suffers from depression, rather than that Lisandra is schizophrenic, and vice versa. 12 Hypostatic abstraction allows medicine to function in a logical and semantic domain. It is assumed that the ailment is not part of the person’s fundamental essence when it is brought up in the therapeutic interaction. At this early stage, the goal is to get the patient back to where he was before the commencement of the illness. There must be a clear distinction between this current state and one’s pre-condition state in order to recover from it. Many therapeutic interactions are characterized by the promise and optimism that the hypostatic abstraction offers. If you’ve ever been in a situation like this: In the event that you believe your symptoms are medically related (e.g., pain in a limb, emotional states), you should see a doctor. There is a history taken, a physical examination, and a few tests. Then she may make a diagnosis, explain your problem, and give you an estimate of how long it will take you to get well. Both the doctor’s promise and the patient’s hope are implicit in this contact, which is aimed at restoring the patient to his or her pre-conditional state, if feasible.
Damian Jacob Sendler
As both physicians and patients are well aware, medical promises and expectations are routinely let down. It’s possible that the individual’s pre-condition state is under jeopardy, or that the condition is chronic and the person must learn to deal with it on a day-to-day basis. In these circumstances, the hypostatic abstraction is not always abandoned—we continue to refer to a cancer patient and a chronic pain patient.. Many cancer patients speak of “fighting” cancer and “triumphing” over chronic pain, which suggests a distinct distinction between the illness and its victims, as well as a constant desire for a life free of suffering. As a last resort, palliation may be called for when it becomes clear that the patient’s condition is terminal and they will never recover. As soon as the patient’s pre-condition state is acknowledged as irrecoverable, the promise and optimism that usually permeate therapeutic encounters are gone, as is the need for hypostatic abstraction.
For the second opportunity mentioned, the hypostatic abstraction enables both a patient and a clinician to have a distinct moral attitude toward the condition as something that has to be treated and fixed. Doctors are able to have certain attitudes toward their patients because of this. The individual may now assume the role of the ill person, and attempts to remedy the ailment can be made without the interference of moral judgment. It is the sickness that is labeled “terrible” in the hypostatic abstraction, rather than the individual, which is deemed “disagreeable.” People’s character is not something that modern medicine considers to be a part of its job description. Schizophrenia is not seen as a character flaw, but rather a disease that affects a person’s mental health. 13 However, despite the fact that individuals might be held responsible for their lifestyles that lead to the sickness, once they have it, they can be held responsible for the illness itself and not for themselves.
One of the hypostatic abstraction’s benefits is to allow the person’s pre-condition state to be regained (at least until it is clear that it cannot be recovered), and the other is to deflect moral censure onto their disease rather than away from them.
For psychiatry’s institutional identity as a medical speciality that deals with illnesses, disorders, or diseases that affect people, the hypostatic abstraction is critical.
14 As a result, psychiatry is able to stand out from other methods to treating human suffering because to the aforementioned affordances. Consider the discrepancy between the hypostatic abstraction and the precisive abstraction, i.e., propositions consisting of a subject and a predicate rather than a relation between two subjects, to show this. We return to x is y instead of x [has/possesses/is impacted by] y. Assuming that x and y are the same thing is to assert an identity rather than a relationship between two topics. People who want to assist me will work on my y-ness, which is my identity, if my pain is linked to my y-ness. To the extent that I am characterized in part by y, every judgment that y incurs is a judgment that I incur as well. It is because of this that we lose the safety from moral judgment offered by hypostatic abstraction: If x is wicked or good, so am I. Certain non-medical approaches to human suffering are characterized by precise abstraction. According to certain religious traditions, the symptoms of mental illness such as sadness and anxiety are signs that a person has departed from the appropriate path of spiritual growth (see Rashed, 2015). As a result, these symptoms might be interpreted as a call for spiritual rejuvenation. People with these symptoms are not believed to be influenced by them in a manner that does not alter their identity, but rather to be defined by these symptoms. ‘ Due to the fact that they are in a state of depression, people are subject to moral criticism. Such approaches to human suffering cannot be compared to the hypostatic abstraction in psychiatry. Psychiatry’s unique approach cannot be understood if the hypostatic abstraction is not included in the explanation of that method.
Damien Sendler: When it comes to mental health, the hypostatic abstraction allows for certain potentially helpful benefits, but it also eliminates the prospect of another kind of language emerging. Through a precise abstraction, the language of identity-making, self-creation, and the good and terrible ways of existence is accessible to us. Even though the uncritical application of such normative notions to pass judgment on other people’s lives can be problematic, it can give people the resources they need to better understand their own suffering and experiences than is possible through the linguistic affordances of hypostatic abstraction. They can. The hypostatic abstraction, which is important to psychiatry’s identity at the institutional level, has been outlined in this section, but I’ve already gotten ahead of myself.
When discussing psychiatry, it is vital to differentiate between the institutional definition of psychiatry and the day-to-day knowledge that certain psychiatrists have of what they perform in practice. That hypostatic abstraction is not a major part of the project may be made clear, and that they do not see it as a “condition” that is distinct from the individual. For them, it may be said, their job is to assist those who have been traumatized by life to reclaim their independence and social involvement. Even if they do provide a diagnosis for insurance and other bureaucratic reasons, they do not really use it in their practice or recommend it to the patient. These are significant endeavors, and they do seem to provide a (possibly) accommodating solution to the issue posed by Mad activism. When it comes to diagnosing, if the aforementioned psychiatrists don’t have a diagnostic knowledge, what do they look for in the clinical encounter? Now that they’ve given up on the hypostatic abstraction, how do they see this encounter? What kind of non-standard lingua franca do they use? What are the clinic’s therapeutic aims for the patient? As a result, it is possible that the answers to these questions will be unique to each individual psychiatrist because of their knowledge and experience. That’s obviously not going to work. As a result, we can’t rely just on chance to choose who a patient sees in the clinic, and we can’t be satisfied with arbitrary criteria. The notions that underlie each psychiatrists’ work must be openly articulated, something that certain Mad activists could demand if they operate routinely outside the sphere of hypostatic abstraction. Thus, we face the problem of Mad activity in the same way as before.