Contradictions in the social production of clinical knowledge: The case of schizophrenia

This paper is divided into two parts. In Part I, I contend that the current thrust to synthesize clinical and critical medical anthropology is misdirected and may serve to further fragment, rather than unify their concerns. I then suggest that instead of focusing on their differences, either in levels of analysis ('micro-' versus 'macro-') or in objects for analysis, we should emphasize instead the perspective that they share--one drawn from the common task their work assumes as a critical, emancipatory science of mankind. In Part II, keeping in mind this short prolegomenon, I utilize data regarding the National Alliance for the Mentally Ill (NAMI) to illustrate that medical knowledge is reducible to neither natural nor social forces; it is instead produced by living actors who are constrained by their social and historical conditions and the exigencies of the mode of production in which these actors produce. I show how NAMI members have succeeded in changing 'blame-the-family' ideologies about schizophrenia etiology and treatment, but I also explain how the medicalized alternative they produced in redefining schizophrenia as a disease of the brain is itself limited and fraught with contradictions (e.g. reinforcing a depersonalizing mind/body separation that inhibits healing). These contradictions highlight the difficulty of transcending the assumptions implicit in medical categories since they are tied to the dominant epistemology of the mode of production in which they are produced--one that binds our world views and limits the options we can generate. Anthropologists must draw attention to these constraints as an initial step to transcending them.