The Untenable Subjectivity of PTSD: A Foucauldian Analysis

Abstract

The field of problems that comprise Post-Traumatic Stress Disorder (PTSD) here in the early 21st Century may best be described as a maelstrom, one that implicates public health policy, the epistemological status of mental illness, and the way Western subjects constitute themselves in and through these discourses and practices. Juxtaposing discursive examples from each of these three domains reveals several conceptual irresolvabilities that permeate this tri-partite structure, such that it produces an untenable subjectivity of PTSD. Upon closer examination, this untenability reflects and exemplifies a much broader set of problems within our practices for studying, treating, and managing mental illness. By delving into the intellectual history of this maelstrom--using primarily Foucault's The Birth of the Clinic--I argue that many of its terms were determined by a similar scientific, institutional, and intrapsychic crisis roughly 200 years ago, at a time when pathological anatomy became the basis of medical experience in the West, irrevocably altering the meaning of death, the organization of space, and the philosophical relationship between universal and individual. This analysis of what Foucault would call “the historical a priori” of the PTSD crisis forms the basis for my argument that (a) the crisis is reaching fever pitch and thus cannot go on indefinitely (b) its fallout will not turn on finally discovering the “truth” of PTSD but rather on constructing a coherent pathological framework for psychiatric practice (in particular, vis-à-vis general medical practice), and (c) these new practices will have a profound, global impact on the social, the scientific, and the role of the state in managing the public (mental) health, and therefore, on the way all human subjects mediate their concrete existence in both public and private spaces. In brief, PTSD stands as both exemplar and catalyst for propelling the West across the philosophical threshold at which it now stands. While I do maintain the profound ethical importance of this historical moment, I do not offer the standard normative conclusion. Rather, I examine shame as an old philosophical nemesis that has transferred its potency to mental illness and follow Nietzsche in experimenting with ways of cutting off this artery, which feeds the storm.