Summary Of Decentralization Efforts By Paul Smoke

In Paul Smoke’s article, which analyzes the use of subnational revenue for decentralization efforts, he claims that generating subnational revenue often fails even when normative instruction has been followed. In an attempt to shed light to this oddity, he posses the question, “are the principles inappropriate, or are they just poorly applied?” He later goes on to demonstrate how both elements hinder decentralization efforts (Smoke 2013). This notion of principle versus practice echoes an issue psychiatry faces as an instrument for social control. While theoretically, using psychiatry to implement order and structure positively impacts society’s wellbeing, it is apparent in practice that this notion is naïve and unrealistic. As a result, social control seems to mostly function as a hindrance to
psychiatric therapy. In an attempt to explain this incongruity between theory and practice, we explore social control and psychiatry through the lens of academic commentary provided by Foucault, Goffman, Burns, and Rosenhan. In the process, we observe how social control impedes the therapeutic benefit of psychiatry by limiting who can receive treatment because of differences in socioeconomic, as well as limiting who seeks out therapy because of stigmatization behind being labeled “mental”.
While the exact moment as to when psychiatry became an agent of social control is unclear, one could argue that the movement’s origins are rooted in the 17th century. Shortly before this time, the belief was that madness is linked to the truth of knowledge. Although stigma before the 17th century surrounding madness seemed to have been quelled, this peace was soon replaced with negativity. One way in which this negative shift occurred was through the popularization of confinement homes. Though psychiatry did not directly influence these establishments per se, the homes did have an administrative structure and were influenced by powerful entities, all of which allude to social control. France’s Hôpital-Général, for instance, has been describe as, “a strange power that the King established between the police and the courts, at the limits of the law.” (Foucault 40)
In actuality, these institutions were formulated to contain social deviants of various assortments.
While this label did include mentally ill patients, other imprisoned deviants included vagabonds, the poor, criminals, and the unemployed. Also important is to note that this undertaking occurred in conjunction with a change in attitude towards idleness and moral obligation. Society believed that forcing “deviants” to partake in manual labor could figuratively mold them back into healthy and productive members of society. This approach did help re-integrate certain patients back into society; mainly the poor and the criminals that lacked adequate professional skills to thrive as productive members of society. It did absolutely nothing, however, to the patients that truly experienced mental illness. In creating an over encompassing label and refusing to address the medical symptoms experienced by the mentally sick, 17th century society inadvertently used autocratic control to hinder therapy. Although there were clearly ulterior motives, this offbeat approach to therapy seems like it could theoretically be helpful. In practice, however, the results proved
unfavorable.
For the next one hundred years, social control continued to mislabel the mad alongside criminals. During the 18th century, it seemed as though improvements were forthcoming, but a look beyond superficial analysis would reveal that the plight of the mad remained unchanged. 18th century society wanted to separate the mentally ill from the criminals, but not in order to protect the mental. The prisoners raised absurd complaints against their mental inmates, making comments like, “the workshop is disturbed by the cries and the confusion of the insane; their frenzy is a perpetual danger, and it would be better to send them back to the cells, or to keep them in chains.” (Foucault 223) In essence, the prisoners protested that confinement amongst the mad was a form of punishment. Only at the start of the 19th century did psychiatry truly begin to support the mentally ill, claiming it was the mentally ill patients who needed protection, not the criminals. At first the main reason for the newfound interest was most probably linked to the economic benefit. Foucault claimed that starting in the 18th century poverty became less linked to immorality and more a concern of economics. In order for society to develop its industry, it needed cheap labor. Additionally, using money to finance confinement of the poor actually increased poverty. As a result, the necessity for all confinements soon dissolved away and madness was freed from the influence of unreason.
Psychiatry, as an instrument for social control, began to genuinely affect the mentally ill when Philippe Pinel liberated the insane from Bicetre and Tuke's asylum. The Tuke asylum appears to have been better than the treatment options offered previously, but its therapy style still raises concern. The main issue with William Tuke’s establishment is that he used religion to control and confine madness. This sort of “cure” created an air of constant anxiety, making the patients feel morally responsible for disturbing society. In effect he replaced carefree panic with agonized obligation. Work was also considered critical for treatment, as Tuke believed it rescued the worker from dangerous liberty.