“It’s purely social”: On the creation of a social/psychiatric dualism in the social sciences and in the everyday work of psychiatry

By Céline Borelle

Many studies of psychiatry share the same methodological and theoretical assumption: namely, to show that the reality of mental illness—both its definition and treatment—is social, always involves challenging the construction of its subject through psychiatry, and that to focus on one dimension of this reality, psychiatric or social, inevitably leads to neglect of the other. The establishment of this mutually exclusive relationship between social and psychiatric issues produces a “dualist” approach, in which the role of social sciences is to distinguish between what psychiatry claims to do—identify and treat mental health problems—and what it actually does—social control, normalizing deviance, moralizing a social class, or serving as an instrument of power over the education system. This article aims to distance itself from these dualistic approaches by challenging the mutually exclusive relationship between the social and the psychiatric, as well as the competitive relationship between the social sciences and psychiatry that it produces. This challenge is based on an approach that highlights tensions internal to the activity as a point of entry to the study of psychiatry. It attempts to describe a specific type of tension: ontological tension. This refers to the way in which professionals respond, in practice and under given circumstances, to the issue of the ontological indeterminacy of the problems they face. This article aims to reveal the ontological tension between psychiatric and social issues that is at work in the practices of diagnosing and treating problematic behaviors and individuals. It seeks to show that the question of the ontology of the problem, and specifically the ontological problem of the border between the psychiatric and the social, is faced by psychiatry professionals themselves and that this question, aligned with institutionalized professions, raises key issues regarding the practical division of labor and shared responsibility for a situation.

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