Philosophy, Psychiatry, & Psychology

I am grateful for these comments on my paper, “The Dilemma of Compliance,” because they illuminate the limitations of the paper’s emphasis. The paper is, above all, meant to caution or warn providers of subtle but serious harm that can occur in institutional settings. I want to attune providers to the ways in which institutional coercion and violence occur in the ordinary process of following rules and filling of roles. Thus I write that the goal is “to become self-conscious observers of systems of compliance, rather than unconscious conformers.” Institutional coercion is a social process like any other and thus involves intersubjective dynamics. These dynamics do not appear as measurable, physical structures, but rather as invisible patterns in time, made visible only by being named and grasped experientially. I am offering language that can help make these invisible dynamics visible, so that providers can navigate institutions differently.

My desire to caution and attune other providers can be explained partly by the conditions in which I wrote the paper: making sense of my time in forensic mental health, where I worked with clients who were mandated mental health treatment upon avoiding or exiting incarceration. I was processing my own experience of submitting monthly “compliance reports” to various agencies. I was concerned with the experiential process of navigating coercive environments. Thus my commenter is correct to try and widen our consideration, as my paper is indeed limited by its focus on the lived experience of censorship, oppression, and institutional coercion.

This emphasis means that I am neglecting other dimensions, such as the positive role of rules in organizing communities, and the way in which some mental health institutions are working on creating safe and healing formal environments. I also believe, however, that the fields of psychology, psychiatry, and mental health broadly need to be careful about institutions, rules, and roles. We are not, in my estimation, in danger of providing too many safe spaces in which healing can occur. Quite the opposite, psychiatry and psychotherapy have, since their outset, been intertwined with troubling political motivations, and we continue to struggle with the manipulative tendencies of the field (Carr, 2018; Cabanas & Illouz, 2021).

I, therefore, would like to take this opportunity to restate the core argument of my paper, and to situate this argument within the context of my other publications and the overall project they belong to. There is likely some ambiguity about [End Page 385] the central thrust of my paper. When commenting on my discussion of schizophrenia, my commenter refers to it as “the seeming central topic of the paper.” This is understandable. Schizophrenia is the topic I discuss that has the most obvious clinical implications. Indeed, I am making an argument about the phenomenological intelligibility of schizophrenia. With both my discussions of schizophrenia and censorship, however, I am making both immanent arguments and transcendent arguments. In other words, although I am making arguments about both schizophrenia and censorship, those arguments need to be understood as an example of a broader problem of coercion within human relationships. My intent is to highlight general dynamics present within human relationships and communities that contribute to institutional violence and the excessive regulation of individuals. My concern is with rules, roles, and coercion in general; schizophrenia and censorship provide exaggerated examples of what is fundamentally an ordinary, daily experience. Mental health institutions are uniquely involved in coercive institutional processes, but almost all human environments carry some danger of coercion and oppression in terms of fitting, belonging, or conforming with rules and roles. My exploration of schizophrenia and censorship is certainly meant to illuminate those particular topics, but the broader point concerns all human experience.

The phenomenological or experiential thrust of the paper must be situated within my broader analysis that also includes institutional and epistemological dimensions. My reviewer is correct to point out that with schizophrenia, censorship, or trauma, the crucial dimension is communities in which people feel safe enough to learn, grow, and develop their capacities. In this vein, my reviewer points to Geel as an admirable model of communally driven care. I am largely in agreement with this line of thinking. In...