Translator: Ting Cheung Reviewer: Genesis Quijije
I'm a psychiatrist
and my profession is probably
the most imperfect one that exists.
Psychiatry, if we think about it,
was created as an instrument of power,
arguably scientific,
that tries to define the place
between "normal" and "abnormal."
And as psychiatrists, we're nothing more than experts
who decide where that place is.
But let's think about this a little.
What are the consequences for crossing that line?
Well, not more than 4 decades ago,
the distinction between "normal" and "abnormal"
caused the institutionalization of people who were "sick."
It was that terrible era of insane asylums.
Now, a few years later,
that has changed in most of the world.
But the distinction between "normal" and "abnormal"
still exists.
It's much more subtle,
if I may, it's conceptual.
It's a linguistic distinction.
That distinction is formed by a diagnosis.
Namely, the people who aren't "normal"
have a psychiatric diagnosis,
and we psychiatrists are responsible for this.
With the diagnosis, what happens is very similar
to what happened in institutions years ago,
which is, on one hand,
that the crazy identify themselves as sick,
and on the other,
that society has a reason, an excuse,
to justify isolating them.
Thus, 4 years ago
a group of young mental health professionals
that had joined together
in the old Doctor Villacián Healthcare Center,
thought that all professionals
involved in the mental health "movement"
should think a little about this.
Generally, everyone in society,
but above all, young professionals.
Thus began the Delirious Revolution.
Behind this big name,
is a movement whose only objective
is to adopt a lot of the ideals and the ideas
that influenced our teachers
when mental hospitals closed during the Psychiatric Reform,
and to apply them to today's so-called psychology.
But of course, we could not stop there.
We couldn't just talk about it in theory,
because those are just words,
the intriguing part was to bring it to healthcare,
to clinical practices,
which was up to us.
I may have shocked some of you
because I constantly use the word "insane" or "crazy."
Perhaps it's a word that can sound bad to some,
but some of us prefer to use it
instead of "mental illness,"
which seems more politically correct.
When we talk about "mental illness," we're talking about illness.
We're positioning the person
in a passive place concerning him,
with something that has nothing to do with him.
However, when we talk about insanity,
we call that difference,
that imperfection, possibly,
that brilliance,
the way the person can create
a different way to exist in the world,
or not create.
And it's because you can define insanity in many ways.
One of them, is that insanity
is a way of living in the world.
It's a way that could be imperfect,
distressing,
it may imply a lot of suffering,
this we see in our work everyday.
However, sometimes,
it's the only way the person has
to be himself and to be with others.
Everyday we see things
like how loneliness, the cause of loneliness,
is a much more important factor
in the formation of a crisis,
in forming psychiatric clinics,
than supposed biochemical imbalances
or neurotransmitters,
or genetic disorders,
which they want us to think is always the cause,
and that loneliness is much more important than those.
Our own patients tell us that,
in statements like, sometimes it's better to feel followed,
to feel watched, to be paranoid, you could say,
than to be alone.
Or those thoughts that stay stuck in your head,
like sometimes it's better to believe in God than to know anyone.
Well if it's like that,
the professionals, instead of being those in society
who make the diagnosis,
what we should do
to be useful to the patient
is to find the place where that person
can create a new way of living in the world
that doesn't involve being crazy,
but is unique to him.
Some of us are lucky
to be able to work with this way of thinking
with these ideas,
in some places in public health.
That's the idea that I want to share with you today.
We're working in a center, in a pilot project,
we've spent a year and 9 months
in the Río Hortega University Hospital in Valladolid,
it's called the Community Intervention Center
and it's a place where we work with people
who've been told by psychiatrists that they have a serious mental disorder.
Meaning people with psychotic disorders
or people with serious personality disorders.
But we always try to work by doing some of what I've said,
blurring the diagnosis and getting to know that one person
who can create something new.
And we do that, sometimes,
simply by changing the way we relate.
For example, changing the question
with which we approach that person.
Doctors use questions like,
What are your symptoms?
When did they start, how bad are they,
and why do you think you have them?
If psychiatrists use those questions,
in fact, they use them often,
we would confuse the terms, in my opinion.
Medication addresses the body,
while psychiatrists deal with something much broader.
It may be too philosophical,
but I think that the field of psychiatry
is the field of the soul.
Therefore, the question that professionals should ask a patient
is what he needs,
and in every case, what he suffers from,
because here we're engaging in
the individuality of that person.
Although it may be a little controversial,
we the psychopharmacological treatment,
the psychiatric drugs,
we use them, but we believe they're only a means,
not an end, not a solution for anything.
Therefore, we always have to be in agreement with the patient.
Now that we're in a time where
some defend involuntary outpatient treatments,
and this is becoming a debate.
In the end, what we want
is that we professionals adapt to the person's needs,
and not that the person has to adapt
to what we think we know he needs.
It's a very subtle nuance,
but it completely changes the therapeutic relationship.
In the year and 9 months we've spent,
we've seen that sometimes it's more useful
when a person is sick, to go for a walk together,
or to a cafe to drink coffee,
than to make an appointment within a month.
We've also seen that it's more efficient,
since now everything is about efficiency,
to visit the patient at home
than to wait until he's admitted to start treatment.
Or, sometimes, when a person is sick,
providing something for him, like a radio program, for example,
or helping him move
is much better than giving him medication.
In fact, this could be summarized in one short sentence:
we try to substitute the treatment with treatment.
And we should use that treatment with the community, in society,
which is where the problem lies, as we said earlier.
This is a difficult task, it's hard work,
above all, it's a task that's difficult to understand
for the most orthodox psychiatrists,
for other medical workers, and for society itself.
But it's a job in which you don't stop learning.
And perhaps the most important thing to learn,
what I want to share with you today,
is that professionals namely, those in mental health,
we don't know anything.
It's the knowledge from insanity that should guide us.
The power-knowledge dichotomy inversion,
which founded psychiatry in the early 14th century,
is what we need to enact to be useful to the patient,
because we shouldn't forget that we work for them.
Therefore, even though I'm a professional,
today I'll try to open the bars of the cell a little
that psychiatrists have built since science was born,
and I'm going to surrender what is most important, knowledge,
which is the word given to those assumed to be crazy.
I'm going to reverse it, I'll give up the time,
and I'll leave insanity as insanity
and go outside the cell.
Thank you.
(Applause)