Owen Whooley, On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing (Chicago, IL: University of Chicago Press, 2019), ISBN: 9780226616384
Ahlam Rahal, McGill University, Montreal
Positioning himself in psychiatric knowledge as a researcher, Owen Whooley starts On the Heels of Ignorance by describing memories from his childhood, which planted the seeds that grew into his writing about psychiatric ignorance. As the son of a man with a mental illness, young Whooley had daily experienced questions related to his father’s mental health problems. His attempts to understand his father’s depression and drug addiction had always been surrounded by ignorance, uncertainty, and inscrutability. As the author explains, both he and mental health professionals failed to grasp his father’s inner world or to define clearly the characteristics of his mental illness. This experience impacted Whooley’s thoughts and provided the impetus to study historical ignorance within psychiatric knowledge.
Unlike earlier scholars, who critically investigated the profession of psychiatry and the sociopolitical interests that underlie health professions (e.g., Foucault, 1976; Fromm, 1955), Whooley investigates both challenges in psychiatric knowledge and power interests that proliferate within the psychiatric field. The biggest challenge, according to Whooley, is ignorance, which hampers our grasp of mental illness.
Ignorance, Whooley argues, is related to two self-reinforcing dimensions: ontology and epistemology. The ontological dimension refers to descriptions, causes, and the nature of “insanity”; whereas epistemology involves the assumptions, investigations, and inquiry approaches that grasp the essence of the mental illness. Whooley argues that the multiple definitions of the nature of the mental illness that psychiatry has offered throughout history have influenced the investigation of mental illness, and therefore, created incoherent psychiatric knowledge. Explaining these attempts to redefine and reinvent psychiatric identity, Whooley suggests that psychiatry has aimed to maintain its prestigious position, professional authority, and social control over the population and other health fields through the recreation of its discourse. Through writing this book, the author attempts to answer the following question: How has psychiatry dealt with its knowledge’s challenges, securing itself as a prestigious profession, and restoring professional power?
To answer these questions, Whooley traces the historical development of psychiatric discourses. The author uses qualitative methods of inquiry, collects data from multiple sources, including the American Journal of Psychiatry over its entire run, professional journal articles such as the American Journal of Psychoanalysis, institutional documents, and interviews with thirty mental health professionals. Through this data, Whooley reconstructs the knowledge of psychiatry, illuminating both crises that have emerged within its body of knowledge and the strategies psychiatry has used to deal with unknown fields (i.e., ignorance).
The book is divided into five chapters. In each chapter, the author discusses the reinvention of psychiatric knowledge in a specific period, ontological assumptions regarding mental illness, dominant therapeutic modes, and psychiatric institutional infrastructure. Each chapter ends with a remaining unknown field in psychiatry, which threatens psychiatric authority, and therefore motivates policymakers and practitioners to reinvent the body of psychiatric knowledge.
Considering the multiple transformations that psychiatry has undergone and the wide range of literature the book embraces, readers might get frustrated by seeing the incohesive forms of knowledge and different tactics that psychiatry has used in an attempt to overcome ignorance. After reading about psychiatric knowledge in each period, I pause for a breath, thinking of the varied tactics that policymakers, directors and regulators in psychiatry have used to restore psychiatric authority in each era. As the book details, these tactics mainly include cultural and institutional strategies. Culturally, officials have redefined the nature of the mental illness, starting with adopting religious morals in early times, continuing through embracing biological and psychoanalytical principles, and ending with borrowing knowledge from medicine and neuroscience. Institutionally, psychiatry has concealed its ignorance by attaching itself to a secured and prestigious doctrine that dominates the science of each period. In current times, psychiatry has attached itself to the fields of medicine and neuroscience.
This book not only provides mental health professionals with rich information about the historical development of psychiatric knowledge, but also stimulates readers’ thoughts about psychiatrists’ interests in changing their professional knowledge. Readers who might have been diagnosed with mental illnesses might also benefit from reading this book to rethink the appropriateness of the treatments they receive. Do those treatments meet their needs? Do psychologists understand their clients’ inner worlds? Should clients be hesitant to trust mental health professionals?
Whooley devotes a great deal of effort to exploring challenges and debates within psychiatry but pays less attention to external social events that played a role in reshaping psychiatric knowledge. An example of that is the economy. In the last chapter, Whooley shows that, when psychiatry has turned to diagnosis and medications, pharmacological companies have benefited from this transformation. But it remains unclear how the financial benefits of such companies have motivated changes in psychiatric knowledge, supporting its scientific power in turn. But incomplete answers in this book might provide readers with opportunities to study the political-economic forces that have reshaped psychiatric discourse. Such studies might grasp the understanding of how psychiatry has dealt with its ignorance in light of internal and external power relations.