Psychiatric Hospitals and Instrumental Rationality

Abstract

Therapists in psychiatric hospitals often overuse a model borrowed from natural science, with the patient becoming an object to be examined, assessed, and altered, and underuse an interpretive psychotherapeutic approach, or misuse it to control patients. And while expressing an interest in the meaning of what patients say, they exclude most of the traditional sources of meaning, in ethics, religion, literature, art, and political thought. The author argues that therapists do these things for two ideological reasons: to maintain their position in the authoritarian structure of the hospital and to maintain the hospital as an agent of class domination. Along with other groups, therapists bring instrumental rationality, such as that of natural science, to bear on political, cultural, and personal questions for which this type of rationality is often destructive. In the long run, political participation and social integration decrease, culture traditions provide less meaning, and personality formation is disrupted. Thus the end result of the overuse of instrumental rationality is not only domination by one class of others, but a decrease in the stability of the society as a whole. Hospital therapists participate in these trends, but they could do otherwise, by working to create a more democratic form of therapy.