Steve Fuller is an American philosopher and sociologist, and an expert in the field of science and technology studies. Born in New York City, Fuller has written over 18 books, including the highly acclaimed Kuhn vs. Popper and Science vs. Religion? Since 2011, Fuller has been the holder of the Auguste Comte Chair in Social Epistemology at the University of Warwick.

We spoke to him about the power of psychiatry.


How can sociology help us understand psychiatry?

Sociology can provide insight into the source and nature of the authority that psychiatry exerts, despite the highly contested character of its knowledge claims. This character is periodically in open display with each new edition of the Diagnostic and Statistical Manual of Mental Disorders, as happened in May of this year, when the fifth edition was published. The DSM is often dubbed the Bible of psychiatry, which is apt not because its knowledge claims are inviolate but because, as the "sacred text", many interested parties seek legitimacy in its pages.

Are psychiatrists ignoring social causes of mental illness?

Not really. Given the hybrid nature of their profession (part scientist, part practitioner), psychiatrists are fairly open-minded in terms of diagnosing mental disorders, so they are unlikely to neglect social causes. The real question is how they translate those causes into a prescription for the patient. After all, a psychiatrist may correctly realise that the patient’s suffering is a result of social deprivation related to her class position. But many different prescriptions remain possible: (a) take a drug; (b) remain in therapy; (c) engage in politics; (d) try harder to reform your life.

How does the shape of psychiatry relate to societal norms and ideals?

Psychiatry is problematic because of the enormous discretionary power it has over people’s lives. At the risk of sounding cynical, it should be obvious that psychiatrists would have very little to do if we did not think that many of us are on the verge of mental disorder. (Put another way, if we placed more trust in the legal system, we might just let people be as they are and when they break the law, they are simply tried for their specific offence.) Freud may be credited (or blamed?) with having created this indefinitely extensive market for psychiatry by speaking of "normalcy" as an idealised absence of neurosis.

Another Freudian neologism, "coping", captures the prospect that a mental disorder is never properly cured but one learns somehow to live with it. The most recent edition of the DSM, though hardly Freudian in content, deepens this death grip of psychiatry over patients by stressing the potential genetic bases for mental disorders that have yet to be manifested. I can easily imagine some psychiatry zealot calling for people’s genomes to be scanned so that their mental disorders can be pre-empted, as in the "pre-crime" policy of the Steven Spielberg film, Minority Report.

What is the power balance between psychiatrists and their clients and what ought it to be?

First of all, we should take the idea of the client seriously! In the 1960s, Carl Rogers popularised the idea of "client-centred therapy", in which the term "client" – as opposed to "patient" – signified a level playing field with the therapist, who was dealt with face-to-face as a notional equal (i.e. not in the oblique manner of Freudian therapy, where the patient did most of the talking in a dark room, lying down, with minimal input from the therapist, who in the end delivered a diagnosis). A client pays for therapy just as long as it makes sense for her, no more and no less. Moreover, while the client is paying for advice from the therapist, she is under no obligation to accept that advice. Of course, "clients" may end up making more mistakes than "patients" who might have acted more cautiously as self-understood "mentally disordered" people. But if we claim to live in a truly "modern" society that values Enlightenment ideals of autonomy, then we should afford to live with such mistakes.

But despite ideals of autonomy, isn’t an asymmetry of power reasonable between the psychiatrist and his client, if the client is suffering from severe mental illness?