Owen Whooley is Associate Professor of Sociology at the University of New Mexico. His research uses historical and qualitative research methods to explore questions related to medical knowledge and professional power.

Interview by Timothy O’Brien

Q. The subtitle of the book is the “politics of not knowing.” What do you mean by the “politics of not knowing” and how might sociologists benefit from closer attention to ignorance?

Ignorance poses problems for professionals who are accorded privileges and authority on the basis of their perceived possession of knowledge.  People don’t expect professionals to be all-knowing, but they do expect professionals to possess enough expert knowledge so as to act effectively.  My book explores what happens when ignorance becomes glaring and evident, when it starts to threaten the legitimacy of the profession. Given its longstanding gaps in its knowledge, psychiatry is a good case to explore this.

Essentially, the “politics of not knowing” refers to how actors seek to mitigate and minimize the problems ignorance poses to their legitimacy.  For psychiatrists, these politics have focused on framing their ignorance as “knowable unknowns” rather than “unknowable”. In the book, I argue, these politics of not knowing have driven the history of American psychiatry. The profession has evolved less in response developments in its knowledge base and more by the strategies it has adopted to mitigate the consequences of its ignorance.

I should say that these dynamics are not unique to psychiatry. All professions must engage in the politics of not knowing to some extent.

Q. You write that psychiatry has remade itself several times as a profession. Where is the field at today in terms of its relationship to knowledge and ignorance?

Looking at the board sweep of the history of American psychiatry, I’d say that the field is headed toward another reckoning regarding its ignorance. In the book, I talk about psychiatry’s recurrent cycle of reinvention and crisis, hype and disappointment.  In short, when faced with a crisis of ignorance, generation after generation of psychiatric reformers have reinvented the profession in sweeping and fundamental ways.

Psychiatry today, I’d argue, is entering the disappointment stage of this process.  Psychiatry’s current incarnation emerged in the early 1980s as a reinvention in response to a widespread anti-psychiatry movement. Reformers of the time sought to recommit psychiatry to a biomedical model. They pursued this course primarily through diagnostic reforms to the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III).  Reliable, standardized diagnoses were seen as the means by which to build the requisite biomedical research base and uncover the underlying mechanisms of mental disorder.

DSM-III was quite a professional and cultural success. However, the research built upon DSM-III has been less successful. Psychiatry’s two main research programs – genetic science and neuroscience – have yielded more questions than answers.  Ignorance, once again, is rearing its head, and many psychiatrists are getting restless.

Where psychiatry goes from here is unclear.  It has really boxed itself in.  Psychiatry has ceded psychotherapy to its competitors, the hegemony of the DSM is being challenged by alternative classification systems, and the main psychiatric treatment – psychopharmaceutical medication – is being questioned as little more than a placebo.

To be clear, I’m not predicting the coming death of psychiatry. Many a prognosticator has been made a fool predicting psychiatry’s demise only to watch it resurrect itself. Plus, we sociologists are notoriously bad fortune tellers.

Q. On the Heels of Ignorance provides a detailed historical analysis of psychiatry as it developed over a span of nearly two centuries. Is there any advice you can offer to young scholars who are interested in using historical methods to study science, knowledge, and technology?

I’ll let others more eloquent than me wax poetic on the allure of the archive.  Instead I’ll offer more mundane advice.

First, touch the documents.  It is important to go into the archives with a plan, but you want to also allow for serendipitous discovery. Prior to beginning your systematic research, spend some time with the documents, flip through them, get a good feel for them.  Reference entries in a library database only convey so much of the texture of the documents.

Second, when working with historical scientific documents, pay close attention to the jargon of the day.  Scientific concepts evolve and change meaning over time. Highly technical language comprehensible to one generation of scientists might be nonsensical to the next. This is bewildering at first. In my first book, I had a hell of a time just deciphering the language used to describe disease pre-germ theory.  So keep a running list of antiquated jargon, and as you plod on, try to pin down how these terms were understood in the day.

Finally, lean on historians.  My books are greatly indebted to historians who came before me.  This secondary source material was invaluable in helping me contextualize what I was seeing in the archive.  Beyond the obvious secondary sources related directly to your topic, read broadly about your era of study.  Cultural, social and political histories that may seem tangential can be instrumental in making sense of your case.

Q. You are a two-time Merton award winner. Your earlier book Knowledge in the Time of Cholera: The Struggle over American Medicine in the Nineteenth Century was winner of the 2015 award. Are there overarching lessons that stand out when you think about the two projects side-by-side, especially in terms of the relationship between knowledge and ignorance?

I wrote a book on knowledge and a book on ignorance.  I could have easily swapped the focus — ignorance was certainly rampant in 19^th century cholera epidemics, epistemic contests abound in the history of psychiatry – and ended up in a similar analytical place. This speaks to the ways in which the political dynamics surrounding knowing and not-knowing are related.  Ultimately both books explore what professionals do to create and maintain cultural authority in light of the fact that their knowledge will always be incomplete and imperfect.

With that said, I don’t want to suggest that the politics of knowledge and the politics of ignorance are mirror images of each other.  They have key differences.  For this reason, I’d advocate for a greater focus on, and intentional theorizing of, ignorance on the part of SKAT researchers, building on the exciting research out there.

Q. On the Heels of Ignorance concludes that psychiatric knowledge has developed in fits and starts rather than as a linear accumulation. To what extent do you think practitioners and policy makers are aware of this intellectual history? If they aren’t, how might they benefit from a better understanding of how psychiatric knowledge developed?

Psychiatry displays a curious contradiction when it comes to remembering and forgetting.  On one hand, distinct among other medical professionals, psychiatrists talk a lot and write a lot about their own history. On the other hand, they continue to separate the contemporary psychiatry from this history, treating it as a progressive reform set apart from an ignorant past.  For example, psychiatrists will critically interrogate the hype surrounding a past treatment fad, something like lobotomy, and recognize it as disastrous, but not consider whether there might be similar dynamics at work surrounding the current mode of treatment.

While I’d like to believe that those who know their history aren’t doomed to repeat it, I don’t think the failures of psychiatry can be chalked up to a lack of knowing its history.  It’s more a matter of owning this history and situating the present in it. Perhaps if psychiatry did this, it would pursue its course with less hubris and more humility.

Q. What comes after On the Heels of Ignorance? Could you give us some insight into your current research?

The short and honest answer to what I’m doing currently is trying to survive a global pandemic.  Like many scholars, the stress of living through this time, combined with the daily challenges it presents, has wrought havoc on my research agenda.

The longer answer is that prior to the novel coronavirus’s arrival in the US, I was researching community mental health workers. This is a departure for me. I got a little tired of reading about psychiatric elites, whose rhetoric can feel far removed from the on-the-ground reality of psychiatric treatment.  So I decided to turn my attention to our fractured and broken community mental health system. The goal is to identify and trace the dysfunctions of this system by illuminating the struggles and experiences of those toiling in it.  I’ve been spending my time with folks in Albuquerque who are tasked with addressing the mental health crisis – mental health workers, law enforcement, and government officials. When COVID struck I was neck deep in data collection, so I’m not clear what the central thrust of the project is yet.