What is the BizOMadness Blog?

This blog is devoted to raising critical awareness of psychiatry generally. It is likewise devoted to the antipsychiatry research projects, publications, and related activities of Dr. Bonnie Burstow. Especially foregrounded are The Psychiatry Project, The Madness Project, and "Psychiatry and the Business of Madness". Related to one another, The Psychiatry Project and The Madness Project involve hundreds of interviews, a dozen focus groups, analysis of several hundred documents and their activation, and dedicated periods of institutional observation. The culmination of both as well as of decades of related interviews and activities is "Psychiatry and the Business of Madness" (timely updates on its publication will be provided)--a cutting edge book in which psychiatry is investigated from multiple angles and which begins to tackle the inevitable question: So if we get rid of psychiatry, where do we go from there?

For the Events page to find events related to this research or this book, see

To check out reviews of Psychiatry and the Business of Madness and related publications, see http://bizomadnessreviews.blogspot.ca/

Tuesday, July 22, 2014

Breaking News: Release of Anthology Psychiatry Disrupted

Breaking News:  I have just received my editor’s/author’s copy of Psychiatry Disrupted (one of the two dates used as official release dates). Accordingly, it is my pleasure to announce the much anticipated release of the international anthology Psychiatry Disrupted: Theorizing Resistance and Crafting the (R)evolution. (Eds. Bonnie Burstow, Brenda LeFrançois, and Shaindl Diamond).  McGill/Queen’s University Press. Preface by Kate Millet, Forward by Paula Caplan.

A wonderful new addition to the fields of antipsychiatry, critical psychiatry, and mad studies. Perspectives include antipsychiatry, critical disability, anti-colonialism, feminism, queer and trans theory, anti-racism, mad theory, Marxism, and anarchism.  While previous studies have critiqued psychiatry, Psychiatry Disrupted goes beyond theorizing what is wrong with psychiatry to concretely theorizing how we might stop it.
Scholars, activists, psychiatric survivors, and artists from across Canada, the U.K., and the U.S. have come together to make this unique book possible. Contributors include Simon Adam (University of Toronto), Rosemary Barnes (University of Toronto), Peter Beresford (Brunel University), Bonnie Burstow (University of Toronto), Chris Chapman (York University), Mark Cresswell (Durham University), Shaindl Diamond (York University), Chava Finkler (Memorial University), Ambrose Kirby (therapist in private practice), Brenda A. LeFrançois (Memorial University of Newfoundland), Mick McKeown (University of Central Lancashire), Robert Menzies (Simon Fraser University), China Mills (Oxford University), Tina Minkowitz (World Network of Users and Survivors of Psychiatry), Ian Parker (University of Leicester), Susan Schellenberg (artist), Helen Spandler (University of Central Lancashire), and AJ Withers (York University).
This is a timely and courageous book that asks compelling questions that no other book in the field touches.
Stay tuned for news about the book launch, to be happening in Toronto on Friday September 12.

Saturday, July 19, 2014

Consent and Psychiatry: Problematizing the Problematic

It is rare to get involved in a dialogue over psychiatry without sooner or later someone defending the use of such “treatments” as ECT “as long as they are consented to”, with the term “informed consent” periodically employed. Herein lies the context for this piece. The issue that I want to probe, to be clear, is not whether force should be used—for of course it shouldn’t—but the thorny issue of consent itself—what exactly constitutes consent and what other issues besides consent are critical to factor in when considering what it is and is not legitimate for a “medical” professional to offer.

Let me begin by suggesting that the standard framing of such issues is conceptually impoverished. Nor is the problem limited to the psychiatric arena. It is part and parcel of the dominant liberal, rationalist, individualistic notion of choice generally—which has little do with how “choice” concretely plays out in the world. The point is, despite the image that we all have of an independent person scrupulously sifting through information and carefully coming to the best position, even calmly made choices are seldom arrived at this way. Our choices and our thoughts about what is possible and best are increasingly managed by institutions, prepackaged by forces and processes outside of our view. While of course it is important to keep others in mind, we can be under considerable pressure from family or friends. And others beyond our ken have a frightening degree of “interest” in what we “decide”. Moreover, oftentimes we find ourselves forced to jump in one direction or another at moments so charged that we can barely breathe. Nowhere is this more obvious than with psychiatry.

We are at a strange moment in history. On one hand psychiatry places little value on the rights of others and is only too willing to run roughshod over them. Reinforcing this infringement way more than actually constraining it, we have a rights apparatus managed by the state which creates but the illusion of safeguarding rights—consent primarily (see Burstow, 2014). In the process of defending rights—in itself absolutely vital—meanwhile, so many of psychiatry’s critics themselves slip into acting as if consent were the only value of significance, and in the process invest themselves in this liberal conceptualization. 

The issue “in a nutshell”? It is commonplace for otherwise critical thinkers to take the position that as long as an individual “consents” to something called “a treatment”, then by definition, it is more or less unproblematic for a separate individual called “a doctor” to administer that treatment or an institution called “medical” to include it in its repertoire. Nor is it deemed relevant that the procedure being offered has no medical validity, exists only because it is in the interests of an industry, and beyond that, that it does profound damage—electroshock, for example (for literature demonstrating the lack of validity and the harm caused by ECT, see for instance, Breggin, 2007 and 1991). In some formulations (and admittedly not others), nor is it deemed significant who said what to a person just before she consented or what is likely to befall her afterward. What such a position does in essence is to at once hollow out and fetishize consent. It is as if we had substituted law for ethics and the technical for the meaningful. We have likewise conflated two very separate issues. While no one should be subjected to a “treatment” without consent, the giving of consent does not in and of itself make a “treatment” acceptable.

That noted, some questions to reflect on: If a way of being is not a “medical issue”, what happens when we call it medical? Irrespective of whether or not a “patient” consents, does a doctor have a right to offer an intervention as if it were medical when it is not? Or is it enough that his/her fellow doctors keep talking as if it were medical? Is it acceptable for what is not medical to be taken up as such, promoted, and popularized by a putative branch of  medicine? Does a doctor have a right to offer what substantially harms—and does little else? When a figure as esteemed in our society as a doctor offers a “bogus” product, is that the moral equivalent of a businessman offering it? Who benefits and who loses from that happening? Has anyone the inherent right to brain-damage another? If brain-damaging is not okay on the face of it, does “the recipient” signing on the dotted line make it okay? Is informed consent sufficient? When is “informed consent” not “informed”? Should the reason why one consents have a bearing? Or are reasons irrelevant? Should the context in which one consents have a bearing? Or are contexts irrelevant? Are we responsible only for what we force on others? Or are we also responsible for what we introduce, make available, recommend, offer?

As help in pondering such questions, correspondingly, I would introduce the following testimony by an ECT survivor (now deceased) named Chris:

I would like to speak briefly about electroshock and informed consent. Although they are inextricably linked, I will address them separately….I was hospitalized twice. I received ECT in both hospitalizations. The first hospitalization…was two courses of treatment….The second time I received one course of treatment….I was never given any information about potential risks, let alone any reliable information about the potential risks….What I was exposed to was the usual psychiatric propaganda. The sort of stuff you…hear in the media frequently. The idea that ECT saves lives. [That] ECT is now safe and effective. Is not damaging…is now safe and modern. It is as though beating someone with a plastic stick is much an improvement [over] the old wooden stick. I was shown a short video in the hospital. The video actually showed the person going through a course of being shocked....The video did not show the person awakening in the recovery room alone and disoriented….The very obvious and important thing is that blunt force trauma to the brain is not healing. Blunt force trauma to the brain is damaging….Finally on the topic of consent, I would like to say very clearly that when you are in a state of complete terror, absolute despair, and utter isolation…when you are in such great pain that suicide seems the only reasonable way to escape that pain, you cannot be said to give consent. (http://coalitionagainstpsychiatricassault.wordpress.com/articles/personal-narratives)

Implicit in this testimony is the position that giving “informed” consent to ECT is close to impossible for the “information” given is a “party-line” generated by the industry. More particularly, not only are key elements characteristically missing (e.g., that it damages the brain) but it is factually inaccurate and egregiously misleading. The same generalization, I would suggest, can be made about consent in psychiatry generally. I would quote in this regard from a comment by Mead (2014):

I for one consented to take the drugs because I was told all sorts of “facts” about biological illnesses, correction of chemical imbalance, “unmasking” etc. I was told that the drugs were “safe” and “effective” “medicine” and was rarely told about risks, particularly of permanent damage….The fact remains that I willingly embraced psychiatry because I believed it was the only rational choice — in essence, not a choice at all.

Of course one answer to the dilemma of “inadequate information” and egregious “misinformation” is that those of us with the knowledge and “fire in the belly” create and disseminate accurate information—and many are doing just that. As long as the current system prevails, it is mistake, however, to think what information we provide will be afforded the same credibility as the misinformation churned out by the system, or indeed will even be seen by the average person confronted with such a “choice”. 

What implication ought these and related conundrums hold for critics? The evolution of Dr. Peter Breggin’s position is significant in this regard. When I first started organizing against ECT, already his medical position was that there is a one-to-one ratio between the “therapeutic effect” of ECT and the damage done (see Breggin, 1979). Nonetheless, he did not take an abolitionist position. What he advocated instead is pushing psychiatry to provide better information, just as so many critics do today. This notwithstanding, he eventually shifted to an abolitionist stance on ECT. Why? The degree of damage done and his growing sense that there is little to to be gained by arguing for better information for psychiatrists are in the business of circulating misinformation among themselves (see Breggin, 1983). By the same token, with misinformation continuing and with ever more proof of the damaging effects of the various “treatments” having materialized, minimally, critics today should stop taking refuge in the concept of consent.

To be clear, I am not denying the possibility of official information materializing that is less egregiously wanting than what is provided now. Indeed, some hospitals’ consent forms are “less inadequate” than others. But the point is that no matter how improved the information became—and let’s be clear, it is going in the opposite direction—it is predictable that neither a consent form nor the verbal information provided would ever go far enough for anything resembling meaningful consent to be enacted. The point is the misinformation is being produced en masse, and it is hardly in the industry’s interest to substantially change.

I am reminded here of the article “A Model Consent Form for Psychiatric Drugs”, by Cohen and Jacobs (Cohen and Jacobs, 2000). Cohen and Jacobs did an admirable job designing a form for psychiatric drug consent, including such information as there is no proof of any mental illness, that if problems arose, the doctor would probably deny that they stemmed from the drug; moreover, they clarified the enormous likelihood of permanent impairment arising and specified the precise nature of the risk for each major class of drug. The “kicker” is, however, almost no “patient” would take a drug were it accompanied with this information, and accordingly, no such consent forms would ever figure in the official repertoire. The point is that psychiatry is built on lies and cover-ups and it has a huge vested interest in continuing both. Nor does the problem of “consent” stop here. 

Note, consent must not only be “informed”, it must be freely given. “Free and informed consent” is the precise discourse used. What we are assuming when we say that “free and informed consent” has been given is that the person has not been manipulated in any way and was able to say “no”, with no repercussion arising from this refusal other than those inherent in not taking the procedure in question. We hear these concepts in medicine proper so often that we tend not to question that they are being applied. While such an assumption misses the point in general, when this assumption is extended to psychiatry, what is left out is precisely the nature of the context. The point is that these are inherently coercive institutions, and so even if you got beyond the propaganda, and even if you are technically allowed to refuse, subtle and oftentimes not-so-subtle pressures are almost invariably and inevitably brought to bear. Take the many many women who over the years have been told that they never get well if they did not comply. Take being chided that you are being something less than a good wife to your husband if you reject “the treatment” (see Wendy’s story in Burstow, 2009). Take the change in tone, the condescending looks with which people are faced. And beyond pressure of this ilk is pressure by family and loved ones who themselves have been socialized to believe in the medical model. Such pressure may be imagined as existing on a continuum, with withdrawal of empathy and support on one end and further along, such phenomena as those experienced by Connie Neil, who accepted ECT out of a well-reasoned fear that if she did not, she might never get her baby back from her mother-in-law (see Burstow, 2006 and Phoenix Rising Collective, 1984). And then there is the pressure that comes from within, from having being told so often that you are mentally ill that you have internalized the message and in the process become your own enforcer.

The point is that consent in this arena is neither “free” nor “informed”. Nor would amassing an even larger army to oversee the consent process make it so. Ironically, indeed, in the long run all that expanding this sphere of operations would succeed in accomplishing would be augmenting the size and credibility of the institution. While it beyond the scope of this article to cover this dimension, I would add, nor do the prepackaged alternatives with which people are presented even roughly equate with what, in our deeper moments, we actually intend by the word “choice”.

Moreover, putting all this aside—which we can do only hypothetically—even were consent free and informed, and even were we convinced that real choice was involved, the question remains: Is what is happening ethical? In this regard, Chris points out quite correctly that “blunt force trauma to the brain” (inherent in ECT) is not healing and is always damaging. That said, bracket off for a moment the lack of real consent and ask yourself this: Is it ever acceptable for a medical institution to unleash such unmitigated damage on a person? Violence, however cosmeticized? To be clear, I am not suggesting that individuals do not have the right to harm themselves. Indeed we all of us do. However, doctors per se have no right to do harm—never mind to advocate for it or to call it “medicine”.  

The issue at hand, I would add, becomes still more confused when people contend that we would be interfering with someone’s right to choose by eliminating a treatment. Treatments in “real medicine” are discarded all the time as a result of an assessment of the harm caused. If it is valid as opposed to an interference with personal liberty to stop offering a  treatment because of the enormity of the harm caused when the treatment is actually medical, how much clearer this issue should be when “the treatment” is not medical. Nor is okay to pass off the non-medical as medical, regardless. Bottom line: doctors should not be in the business of introducing bogus treatments and passing them off as medical. It is likewise confused, I would add, to defend such abuse on the grounds that people need choices.

Still other dimensions come to light in Chris’s testimony—some transparently present, some lurking just beneath the surface. He states, “I would like to say very clearly that when you are in a state of complete terror, absolute despair, and utter isolation…when you are in such great pain that suicide seems the only reasonable way to escape that pain, you cannot be said to give consent.” In essence, what Chris is telling us is that he was so terrified and so alone he would have agreed to anything. Comments like this, minimally, should give us pause. As we are all painfully aware, being in such a horrible state that one would hazard anything is hardly uncommon for people in “psychiatric institutions” and/or in crisis. But does that mean that “anything” is fair game for a psychiatrist or anyone else to “offer”? Or rather, as Chris suggests, should this very vulnerability put a greater onus on others to take care in what they offer?

Chris himself states very clearly that agreement under conditions such as this cannot be called “consent”. Finally, he hints at something that I will only briefly allude to here for it is not central to my argument, albeit it is a dimension that we forget to our peril —that accepting such a treatment may be part of a suicidal wish, born precisely out of agony and despair. Again something to bear in mind.

At the very end of his testimony, Chris makes one final point. To whit:

Support and compassion do not cause brain damage. And as far as I know, no one has ever died from oversleeping.

If Chris’s main point is that consent to psychiatric “treatment” is inherently compromised, his secondary point is that it unacceptable for a doctor to perpetrate harm. This is so, I would suggest, irrespective of consent. I would remind readers here of the ancient Greek medical principle “primum non necere”—first do not harm. Also, the Hippocratic Oath, which obliges the physician to use medicine to approach disease and in the process “to do no harm” (see http://en.wikipedia.org/wiki/Primum_non_nocere). How is it that we have so strayed from the basis of the profession that we are defending the right of doctors to approach non-disease as if it were disease and to do so in a way that harms? How is it that we are conflating individual choice with what “medical practitioners” should or should not be providing?

Which brings us back to where we began.

To sum up, our prevailing conceptualizations of choice are out of keeping with our experiences as human beings. With regard to psychiatry more particularly, we have fetishized consent to such an extent that we have lost sight of ethics in a more expansive sense and the nature of consent per se. Moreover, we have trivialized hegemony and the fact of institutional rule. The point is, a liberal and individualistic notion of consent is wanting at the best of times. Beyond that, it is seriously at odds with the truth about psychiatry. When it comes to psychiatry, typically, consent is not even close to informed, is not even close to “free”. Additionally, what is far more basic, “doctors” should not be offering bogus medical “treatments, nor interventions that essentially harm—and yet such is the nature of psychiatric “choice”.

(for research, articles, and interview excerpts on these and related topics, see  other posting on http://bizomadness.blogspot.ca or follow author on twitter @BizOMadness)


Breggin, P. (1979). Electroshock: Its brain-disabling effects. New York: Springer.

Breggin, P. (1983). ECT ban controversy (www.breggin.com/ECT/ECTBanControversy.pdf).

Breggin, P. (1991). Electroshock: Scientific, ethical, and political issues. International Journal of Risk and Safety in Medicine, 11, 5-40.

Breggin, P. (2007). ECT damages the brain. Ethical Human Psychology and Psychiatry, 9, 83 ff.

Burstow, B. (2006). Electroshock as a form of violence against women. Violence Against Women, 12, 372-392.

Burstow, B. (2009). Electroshock: The gentleman’s way to batter women. Domestic Violence Report, 1 ff.

Burstow, B. (2014). The Consent and Capacity Board: Justice enacted (http://www.bizomadness.blogspot.ca/2014/07/as-researcher-investigating-psychiatry.html).

Cohen, D. and Jacobs, D. (2000). A model consent form for psychiatric drugs (http://laingsociety.org/colloquia/polofdiagnosis/modelconsent.htm).

Mead, E. (2014). Comment. http://www.madinamerica.com/2014/07/attrition-model-psychiatry-abolition/#comment-46145.

Phoenix Rising Collective (Ed.) (1984). Testimony on electroshock. Phoenix Rising 4 (3&4), 16A-22A.

Saturday, July 12, 2014

On the Attrition Model of Psychiatry Abolition

In a recently released article I provided an overview of antipsychiatry, teasing out its features and both its overlaps with and differences from related movements and constituencies (Burstow, 2014; see http://bizomadness.blogspot.ca/2014/07/on-antipsychiatry.html). Necessarily, the commitment to psychiatry abolition emerged as definitional as well as pivotal. In this article, I will be attempting to shed further light by clarifying and probing a particular model of psychiatry abolition. The question being addressed here is: Okay, so you know what you want—but just how do you go about figuring out what to do? A question that has been plaguing the movement for some time.

A brief history: For the longest time, while antipsychiatry activists were clear about the abolitionist goal, virtually nothing was written on how to achieve it. No articulation, no models, not even, for that matter, debates—exactly. This much, nonetheless, was obvious to most: So powerful and so firmly entrenched in the state is institutional psychiatry, that it was not about to disappear any time soon, no matter how valid the reasons for discarding it, how many scandals come to light, or how astutely those who oppose it proceed. Here is a reality that left all abolitionists shaking their heads. What at once arose from and further contributed to the conundrum, antipsychiatry activists had difficulty prioritizing actions, also choosing when to actively support and when to “pass” on initiatives developed by other constituencies. It is not that there were not rationales given, sometimes cogent ones, for pursuing some paths and avoided others, but there was a lack of consistency and oftentimes choices were made on the sole basis that the action in question was one in which everyone had always engaged. As such, it gradually became clear that a decision-making model specifically geared to antipsychiatry was needed. It was in this context and with this understanding that in 2010, as a keynote at the international PsychOut Conference in Toronto, I introduced a model for prison abolition—what I call the “attrition model” (see Burstow, 2010--http://individual.utoronto.ca/psychout/papers/burstow_keynote.html). This model was subsequently adopted by Coalition Against Psychiatric Assault (CAPA). I articulate it in this article so that people can get a sense of it and assess its possible usefulness.

The model was inspired by and is loosely based on an attrition model developed in the 1970s for a neighbouring social justice movement—prison abolition. Significantly, that model to varying degrees underpins “penal abolition” to this day. The attrition model for prison abolition is predicated on two key premises: 1) that an entrenched institution like prison will not quickly disappear and so working at gradually wearing it away is the most judicious way to proceed; the issue then is to assess each potential move carefully to see if it is likely to advance things “in the right direction”; 2) one can easily be deceived over what constitutes “progress”; a change which looks like “a move in the right direction” may in fact only be further entrenching or indeed actually expanding the prison system (see Mathiesen, 1974 and Knopp, 1976). Substitute “institutional psychiatry” for “prisons”—and you can see the fit here—and an attrition model for psychiatry abolition begins to take shape.  

The attrition model for psychiatry abolition, as I have articulated it, centres on three “definitional” or “touchstone” questions which antipsychiatry activists are asked to keep firmly in mind when considering an action or direction:

1)    If successful, will the actions or campaigns that we are considering move us closer to the long-range goal of psychiatry abolition?
2)    Are they likely to avoid improving or giving added legitimacy to the current system?
3)    Do they avoid widening psychiatry’s net (creating conditions that allow psychiatry to scoop up, as it were, ever more people; see http://coalitionagainstpsychiatricassault.wordpress.com/attrition-model)?

Question one is the most fundamental of the questions asked. The purpose of asking it directly is to help activists stop themselves from getting sidetracked into focusing on otherwise benign actions and missions which in no way contribute to attrition (an example might be measures aimed at securing pocket money for people “on the inside”—a good thing in itself, but a questionable preoccupation for an abolitionist per se, given it brings us no closer to the ultimate goal.

With question two (are they likely to avoid improving or giving added legitimacy to the system?), psychiatry abolitionists more clearly part company with psychiatry reformers. The point underlying the question is that all sorts of actions, including many actively spearheaded by concerned people in related constituencies, serve to lend psychiatry legitimacy or in some way “improve psychiatry”. As such, however good the intention and whatever benefit certain people may derive (reasons why others might support them) they function to protect, support, and possibly expand psychiatry, and as such, should not be taken up by abolitionists. An example of the type of action that lends legitimacy to psychiatry is co-creating and mounting community/cultural events in concert with psychiatric institutions—festivals, theatre, celebrations. For examples of “improving psychiatry”, we need look no further than the long standing historic attempts of different players to exert a corrective influence on the DSM, arguing for the tweaking of some “diagnostic categories” or the removal of others. To be clear, I fully sympathize with people’s desire to intercede here, especially when it comes to groups uniquely oppressed by these categories. This notwithstanding, on a very basic level, even engaging in such advocacy has an unintended but unavoidable consequence: By the very act of everyone privileging the psychiatric text this way, such advocacy further ensconces the DSM as the go-to book—and as such, reinforces the centrality of psychiatry’s most formidable boss text (an institutional ethnography term; see Smith, 2005). Nor does the service to psychiatry stop here. Take the gutsy and very understandable fight to remove “homosexuality” from the DSM, which unfolded in the early 70s. While of course no one committed to social justice wants these highly oppressive definitions and categories, what in fact did this campaign succeed in doing? Making it look as if being lesbian or gay was no longer covered by “diagnoses”, when in fact new diagnoses which pathologized lesbians and gays such as “ego-dystonic homosexuality” were quickly and quietly introduced in place of the diagnosis removed (for a discussion of these diagnoses and this strategy, see Burstow, 1990); creating/recreating the classical “us-them” division, with activists involved in the campaign distinguishing between people who allegedly really were “mentally ill” and “gays” (see Teal, 1971). Moreover, it helped institutional psychiatry appear progressive—something to support. Ironically and sadly, it even proved to be a formidable factor in the ascendancy of biological psychiatry (for a discussion of how this happened, see Kirk and Kutchins, 1992 and 1997). In other words,, the consequences for the most part were decidedly negative. While it might not have been possible to predict the enormous boost this would give to biological psychiatry, the rest indeed could have been figured out—not something one can exactly expect of others, but herein lies the hard work of evaluating which abolitionists avoid at the cost of undermining their own goal. Hence the importance of taking care in assessing the likely long run impact of any action on psychiatric rule. And hence the significance of the second question.

Likewise crucial and likewise complicated is the third question: Do they [the actions being considered] avoid widening psychiatry’s net? What this guideline is inviting activists to do is avoid any action, which if successful, is likely to increase the number of people subjected to psychiatric rule. Again this is irrespective of whether or not the action is otherwise benign. Examples of initiatives, however seemingly benign, which would in point of fact “widen the net” are new services which are either performed by psychiatry or have a demonstrable tie-in with psychiatry. Think about how direly certain services are needed—services for battered women in isolated northern Canadian communities, say, or services for trans youth who have become homeless—and you can see how easy it would be to overlook or rationalize the hook-in with psychiatry which accompanies them. What this model is inviting us to look at and take seriously is this: If we make such a deal and we accept the expansion of psychiatry into some area as a necessary tradeoff in order to get “services”, whatever may or may not happen in the short run, our primary long term achievement is precisely the expansion of psychiatry, that, paradoxically, together with eventual endangerment of the very population that we were endeavouring to assist. While the expansion of psychiatry may seem like a minor hiccup or “side effect”, the point is, as with the psychiatric drugs, the “side effect” is the major effect.

Tricky though it may be at times—and you can see that it is—the long term benefits of such a model are obvious. As is evident from the examples, it would help abolitionists avoid seemingly benign actions that would preserve the status quo—or worse—that might otherwise be very easy to slip into. Moreover, the model would readily facilitate prioritization. While it is beyond the scope of this piece to spell out the various prioritizing that might emerge, for example, it could be argued that the disappearance of various noxious “treatments” has the potential to erode psychiatry, and as such, use of the model would lead to the prioritization of campaigns such as those against ECT. Other priorities that I can see emerging are the rescinding of key pieces of legislation (e.g., out-patient committal laws and involuntary “hospitalization”); the launching of law suits against “hospitals”, individual doctors, the pharmaceutical companies, moreover, the state; the curtailing of psychiatry’s “right” to “treat” without consent; and the creation of “befriending” networks independent of government and professionals (for a fuller articulation, see Burstow, 2010 and Burstow, “Psychiatry and the Business of Madness”). 

Here then is the model as I have developed it and its possible usefulness. I leave it to antipsychiatry organizations to determine for themselves if and how it might serve them. An observation: The Coalition Against Psychiatric Assault adopted this model at its 2005 retreat. It was contentious at the time and so was taken up on a trial basis only, to be reassessed in one year’s time. Come the 2006 retreat, every member to a person endorsed making its adoption permanent—so helpful had it proved in establishing direction, settling disagreements, and getting our bearings. Not that it was consulted as a matter of course, but now and again in the midst of a heated disagreement or a decision that initially seemed simple, a light would go on in someone’s eye and the person would ask, “But what about our model?”—and a unique space for thinking and planning materialized.

That noted, a few questions in ending: While the attrition model has obvious relevance to antipsychiatry activists, would this model or a modified version thereof be of any use to other constituencies who organize against psychiatry? Has it the potential, for instance, to illuminate the path of mad theorists or critical psychiatry theorists who are not abolitionists per se? Possibly, yes, though not in any easy or straight forward way. The point is that it is likely to “complexify” decisions or directions that now seem simple or obvious—in itself, a good thing—but people would need to want to take that on.  

Finally: Is attrition per se the only major factor that an abolitionist need consider? At the risk of further complicating an already complicated issue, my answer would be no. Besides that the future, while crucial to keep sight of, can never be our only concern, it is not enough to rid ourselves of psychiatry. If that is all we accomplished, psychiatry could easily be replaced by a new form of ruling that is just as powerful, that is just as all-encompassing, also—dare we imagine it?—that is every bit as damaging. Moreover, if we as a society want something better, we need to sow the seeds now.

But that is a topic for a different article.


Burstow, B. (1990). A history of psychiatric homophobia. Phoenix Rising, 8, S38-S39.

Burstow (2010).  The withering away of psychiatry: An attrition model for antipsychiatry (http://individual.utoronto.ca/psychout/papers/burstow_keynote.html).

Burstow, B. (2014). On antipsychiatry. http://bizomadness.blogspot.ca/2014/07/on-antipsychiatry.html).

Kirk, S. and Kutchins, H. (1992). The selling of the DSM. New Brunswick, New Jersey: Transaction Publishers.

Kirk, S. and Kutchins, H. (1997). Making us crazy. New York: The Free Press.

Knopp, F. (1976). Instead of prisons: A handbook for prison abolitionists. New York: Prison Research Educational Project.

Mathiesen, T. (1974).The politics of abolition. New York: Halstead Press.

Smith, D. (2005). Institutional ethnography: A sociology for people. Toronto: University of Toronto Press.

Tiel, D. (1971). The gay militants. New York: Stein and Day.

Sunday, July 6, 2014

Tribute to a Prison Abolitionist and a Friend of the Antipsychiatry Movement--Liz Elliott

A couple of weeks ago I was on the sociology department website of Simon Fraser University trying to look up an old student and colleague I had lost touch with decades ago. I found  her listed as faculty under the special category "In Memoriam". After the initial shock, I made inquiries and discovered that Liz had died approximately three years ago--after a heroic battle with cancer--and that she remained active fighting the injustices of the penal system right to the end. A fitting recognition of the rent that happens in our communities when someone dies that SFU afforded her a special place in their list of faculty. Which leads me to a Liz Elliott story, which I would like to tell as my own tribute to this remarkable activist.

It was decades ago and Liz and I were co-directors of a halfway house in Toronto (called "My Brother's Place", which was abolitionist in philosophy and which catered only to men who had spent the majority of their adult lives going between regular jails and psychiatric prisons). One day in our second year of operations, we encountered a perplexing problem. Dissension had set in in the household. The men kept denouncing each other as "rats" (translation: people who squealed to authorities and the lowest of the low according to the prison code). Day in and day out, one or other would start yelling that so-and-so was a rat, and no one should talk to him. Now we had gatherings with the men three mornings out of seven, at which we would discuss whatever the men wished--whether it be psychiatric labeling or the ways in which measures that look benign typically extend institutional control.  While Liz almost never came to these meetings, on this occasion, she did. And lo and behold, she brought with her a giant round of cheese. "What's the cheese for?" everyone asked, knowing that there is never food at these morning meetings. "In a moment," she answered. Eventually all eyes were on her. She looked from one to other, and at long last answered, "I have been watching you all for months now, and as far as I can make out, every single one of you is 'a rat'. And so let's just acknowledge that we are all rats, and let's all eat the cheese together." There was a difficult moment, as a few of the men turned pale. Liz had just uttered the worst insult anyone could give another--and if it could be believed--she had accused every single one. One guy looked like he did just before he punched a wall and another guy, muscular and over 6 foot 4, just like he did before attacking someone--moments, alas, with which we were all too familiar. I could see additionally that one of the shorter guys--Z--was holding his breath. Then suddenly one of the men began to laugh. Soon everyone was laughing. And now H, a quiet chap, who tended to keep to himself, nodded, looked around, and proceeded to do the unthinkable--cut a piece of cheese and begin eating it. Another moment's hesitation. Then another man followed suit and then another. Soon everyone was enjoying the cheese and laughing with each other. And this was the last time that people at My Brother's Place ever heard that "so-and-so" was a "fucking rat".

Make of the story what you will. Meanwhile I tender it as my own belated tribute to the remarkable penal abolitionist Liz Elliott.

Saturday, July 5, 2014

On Antipsychiatry

There is a considerable confusion among scholars, activists, and indeed, the general public over what it means to be antipsychiatry, much of generated or exacerbated by what is in print. One result of that confusion is people keep being surprised by antipsychiatry thinkers/actors, for example, imagining that we can easily change our minds on what may understandably seem to others like minor issues. What particularly astounds allies and sometimes confuses them is our very particular use of language (which can easily strike them as counter-intuitive and unnecessarily confrontational), also our rejection of actions that seem to them benign. Still others assume that antipsychiatry folk are all “Laingians”—and while I personally value R.D. Laing, and while Laing and his followers gave birth to a U.K. movement which called itself “anti-psychiatry” (for details, see Crossly, 1998), he is barely known by most current antipsychiatry thinkers and actors; nor would most see themselves as aligned with his analysis. Adding to the confusion, most people, including in related movements, assume that antipsychiatry, mad, critical psychiatry, and the psychiatric survivor movements more or less connote the same thing. They reason, quite rightly, that all of these groups challenge the violation of human rights that is endemic to psychiatry, the extensive use of “treatment” as a form of control, and the pervasive medicalization of human problems (all correct). Correspondingly, they note that all critique the DSM, expose psychiatric illogic, buy into the proposition that the treatments overwhelmingly harm (also correct). And they take from this that “antipsychiatry” is a difference, as it were, without a distinction (incorrect).

The purpose of this post is to make some distinctions, however imperfect, and in the process shed light.

The Nature of Antipsychiatry and its Relationship to Other Constituencies

Some initial clarification: Like most movements that critique/combat psychiatry, antipsychiatry arises out a horror at what is happening to human beings, out of a critique of psychiatry, and out of a history of opposition. Like the survivor and the mad movement, it counts psychiatric inmates who rose up in resistance (e.g., Elizabeth Packard), as pivotal figures. Moreover, antipsychiatry activists see themselves as part of a larger “community” composed of people who individually and jointly challenge psychiatry (for the original articulation of the “community” concept, see Diamond, 2011). And in this spirit, antipsychiatry activists frequently, in some cases, routinely act in concert with other constituencies, with it be in protesting specific human rights violations, mounting consciousness-raising education, or lobbying for the creation of the kind of services seen as needed. What is additionally important to take in, many players belong to more than one constituency. For example, many people are part of at once the mad movement, the psychiatric survivor movement, and the antipsychiatry movement. That said, there is a specificity that is integral to antipsychiatry—a specificity that it is critical to take in, or the territory will continue to allude.

So what is antipsychiatry? It is at once a philosophic position, a movement, and a long term objective. Unlike the mad movement, it is not based on identity politics. Albeit psychiatric survivors are in the majority and seen as pivotal, it is based on a particular analysis and commitment.

Antipsychiatry in its current incarnation begins with a discursive argument—that “mental illness” per se is “a literalized metaphor” (Szasz, 1961). To put this another way, while people can find themselves in dire emotional distress and/or may alarm others, that does not in any way equate with “having an illness”. Nor does receiving a diagnosis. For a phenomenon to be an illness, it might fit the criteria for an illness. The gold standard in this regard is the Virchow criterion (the standard in medicine proper since the nineteenth century). According to this, pain or discomfort is neither a necessary nor a sufficient condition for something to qualify as a illness; it must be characterized by real lesion, by real cellular pathology (for discussion of the Virchow criteria, see Szasz, 1987). Significantly not only do none of the “illnesses” claimed by psychiatry meet such a standard, they do not meet substantially lower standards. What is apropos here, while psychiatry has been claiming for a very long time that people who are “disordered” have chemical imbalances and frequently reiterate that imbalances have been found, the reality is that no imbalances have ever been established for a single “mental illness”. By contrast, the various treatments of psychiatry (e.g., the drugs, electroshock) have been demonstrated to create illness. It is this reality that is the bedrock of antipsychiatry.

On the basis of arguing that the medical overlay is both mistaken and runs counter to the interests of those subjected to it, antipsychiatry thinkers and activists uncategorically oppose the medicalization. This means rejection of all putatively medical “treatments”. More fundamentally still, it means the rejection of all medical model language/conceptualizations (e.g., “mental illness”, “mental disorder”, “mental health” ,“symptom”, “syndrome”, “psychiatric treatment”, “schizophrenia”, “borderline personality disorder”). What goes along with this, on the basis of it having no defensible medical grounding, antipsychiatry theorists dispute the legitimacy of psychiatry as an area of medicine. The point is, if what is happening is not medical, the problems in living now theorized as “psychiatric problems” are not “psychiatric” or “medical” except by imposition and should not be the province of medicine.

Just as antipsychiatry fundamentally disputes the medical foundation, it identifies institutional psychiatry as an incarceral project and rejects it as such.  This includes not only what is euphemistically termed “hospitalization” but also the use of “treatments” like drugs, which serve as a form of invisible restraint (see, for example, Fabris, 2011). Correspondingly, in the spirit of thinkers like Foucault, antipsychiatry holds that psychiatry is intrinsically about power-over, the bodily surveillance and control of “othered” populations (especially women, the racialized, the poor, gay and transgender, the very young, the very old)—what Foucault (1995 and 1961/1988)  terms “bio-power” . Given the intrinsically flawed foundations, the profound harm done, the inherent violation of human rights, and the nature of the political agenda, moreover, antipsychiatry sees no place for psychiatry. Accordingly, not the “improvement of psychiatry” but psychiatry abolition is the long run goal (for an articulation of how this might be approached, see Burstow, 2014). But why not try to improve it?, you may ask.  Because you only seek to improve something you judge as having some legitimacy—not something which you contend has none.

The contrast with the positions of others in “the community” is poignant, albeit not always straight forward. Others to varying degrees employ the language of psychiatry, albeit there is an interesting development with the mad movement, for just as antipsychiatry theorists/activists use terms like “drugging” in lieu of “medicating”, mad theorists use words like “mad” (for a discussion of the various languages used, see Burstow, 2013). Except for certain critical disability theorists, who also view “mental illness” as a social construct, there is a fairly profound different in conceptualization. There is likewise a difference in mandate. Note, the explicit mandate of critical psychiatry is to reform psychiatry (or “the mental health system”). What goes along with this, few (except those who are also antipsychiatry) call for total decarceration, though they object to the current level of incarceration. Additionally—and herein lies a huge difference—thinkers in the critical psychiatry network and most of the other networks argue that some people are helped by psychiatric treatments and so while there should be way less of it (the classical “over-drugging” position), approaches of this ilk have a legitimate place in the medical repertoire. An example of an outlier in this regard is psychiatrist Dr. Peter Breggin—a long time ally of all the movements.  His position is a pivotal one, moreover, one largely adopted by antipsychiatry—namely, that the so-called “therapeutic effect” of any given “psychiatric treatment” has a one-to-one ratio with the damage which it causes. In other words, it is precisely the damage which is experienced as helpful (Breggin, 2008). While this position is identical to the antipsychiatry one, I would add, Breggin does not call for the end to psychopharmaceutical prescribing, nor an end to the profession per se, and in this regard, he is on the radical edge of what might loosely be defined as “the reformist camp”.   

In short, antipsychiatry differs in manifold, significant, and complex ways from the positions of other constituencies. To conclude in a way that simplifies this (and toward that end, leaving Breggin out of the mix), the pivotal difference between the antipsychiatry position and other positions comes down to paradigm. In line with arguing that a) the paradigm is irredeemably flawed and b) damage is inevitable because there is a one-to-one ratio between the “therapeutic” effect and the damage done, antipsychiatry activists conclude that psychiatry “has to go”—and as such, end up in a radical abolitionist camp. Other constituencies critique the paradigm while falling short of concluding that it has no validity, and as such, call for “reform” (in the odd case, even while hoping that the system will “transform” itself such that psychiatry, as it were, disappears).

In the end, hardly a difference without a distinction. At the same time, the overlaps are considerable.


Breggin, P. (2008). Brain-disabling treatments in psychiatry: Drugs, electroshock, and the psychopharmaceutical complex. New York: Springer.

Burstow, B. (2013). A Rose by Any Other Name:  Naming and the Battle Against Psychiatry”. In Mad Matters: A Critical Reader in Mad Matters, ed. Brenda Lefrançois, Robert and Geoffrey Reaume. Toronto: Canadian Scholars Press, pp. 79-93.

Burstow, B. (2014). The withering of psychiatry: An attrition model for Antipsychiatry. In Bonnie Burstow, Brenda LeFrançois, and Shaindl Diamond (Eds.). Psychiatry disrupted: Theorizing resistance and crafting the revolution. Montreal: McGill-Queen’s University Press.

Crossley, N. (1998). R. D. Laing and the British antipsychiatry movement. Social Science and Medicine. Vol. 47, pp. 877-889.

Diamond, S. (2011). Imagining possibilities outside the medicalization of humanity: A critical ethnography of a community trying to build a world free of sanism and psychiatric oppression. Doctoral thesis: University of Toronto.

Fabris, E. (2011). Tranquil prisons. Toronto: University of Toronto Press.

Foucault, M. (1961/1988). Madness and civilization. New York: Random House.

Foucault, M. (1995). Discipline and punish: The birth of the prison. New York: Vintage.

Szasz, T. (1961). The myth of mental illness. New York: Paul B. Hoeber.

Szasz T. (1987). Insanity: The idea and its consequences. New York: John Wiley and Sons.

Tuesday, July 1, 2014

The Consent and Capacity Board: Justice "Enacted"

As a researcher investigating psychiatry (The Psychiatry Project), in preparation for writing the 5th chapter of “Psychiatry and the Business of Madness” I attended and conducted careful observations of many meetings of the Consent and Capacity Board of Ontario. The Consent and Capacity Board of Ontario—and there are similar processes in other jurisdictions—is a quasi-judicial review tribunal to which psychiatric “detainees” can appeal various determinations made with respect to them. Most commonly, what inmates appeal is their involuntary status (being committed involuntarily) or having been declared “incapable” of making their own decisions about treatments (for details on mandate etc., see http://www.ccboard.on.ca/scripts/english/index.asp).The existence of these avenues of appeal is touted as the epitome of a system with rights, presented as proof that the necessary safeguards are in place. Besides that that idea of “involuntary treatment” is morally unacceptable, and besides that the “treatments” given are inherently harmful, with these processes, it is the appearance of rights far more than rights itself that is enacted. The point is that inmates stand very little chance of prevailing. To provide you with an example of one statistic by way of demonstration, in 2011, in only 5% of the incapacity appeals in Ontario did the inmate win (statistic provided in personal email from CCB registrar, October 24, 2012). How, you might ask, could this be? My observation of these hearings serve to illustrate. More generally every such observation acted as a window onto a system which functions in a circular fashion, and where the proverbial cards are stacked against the inmate. I report here on one such hearing for purposes of illustration. As it is highly common for the hearings to be “aborted”, I choose as an example one in which, indeed, rebooking occurred.

It is 10:00 a.m. on October 25 2012 at a central “mental hospital” in Ontario. As an observer, I am sitting at one of the chairs toward the back of a medium sized room, waiting for the hearing to begin. Seated at front, the panel was already present when I entered, and it is complete with the mandatory community member, lawyer (chair), and psychiatrist. Slightly ahead of me is the lawyer for the hospital. To my side is the lawyer for the “patient”, who for the purposes of this example, I shall call “R”. The chair makes a few remarks and looks toward R, well aware the “patient” is conspicuous by his absence. R carefully explains that there has been what he calls “an incident”, that it happened a few hours ago, and that the “incident” obliged the doctor to medicate his patient. R refers to the doctor’s response to “the incident’ as a “treatment decision”. Correspondingly, he points out that while he is no way questioning that “treatment decision”, he fears that his client may now be too sedated to appear. We are just going to have to wait and see if he sufficiently recovers for the hearing to proceed, he states.

At this stage in my research journey, I have already been to enough hearings that essentially “did not happen” that I am painfully aware that little may materialize today. Time passes, with members of the panel schmoozing, catching each other up on events in their life, exchanging pleasantries, as in “And how is your daughter these days?” Clearly no one is thinking that anything out of the ordinary has happened. Finally around 10:30, the eagerly awaited appearance actually happens. A young Black man ( the “detainee”) appears. Wheeled in by guards, he is blatantly unable to walk. He is deposited in a chair, where he keeps drifting in and out of consciousness. Barely able to hold himself up, almost of the verge of falling, he sits there slumped over. Never once does he open his eyes. We continue to wait, presumably in the hope that the “detainee” will “recover” sufficiently to proceed. Still the “detainee” does not open his eyes. Eventually R asks that the hearing be adjured and a new hearing called. And the chair obliges.

What does this episode point to? Lest anyone thinks that the answer is “bad lawyering”, let me begin by pointing out that R was a highly experienced and capable lawyer with a track record far superior to most.

The use of the word “incident” and the easy acceptance of it by everyone present is an early indication that it is accepted that one of these parties (the detainee) is given to “inappropriate behaviour” and that the other (the psychiatrist) is the correct determiner of that. More fundamentally, what we can see right from the start is the whole operation is predicated on a belief that the psychiatrist is an authority who knows what he is doing and the inmate is problematic, moreover, that the psychiatrist’s assuming power over the inmate is not only acceptable but necessary. By the same token, the use of the concept “treatment” to describe so tranquilizing the person that they cannot stay conscious and the fact that the lawyer for the detainee knows not to bother challenging this tells us that short of making a mistake out of the ordinary, in the end, the psychiatrist is sure to prevail, for what is being assumed is precisely what should have been had to be proved. What is assumed, to be clear, are the soundness of the interventions and the correctness of the power dynamic.

Recall that this is a quasi-judicial proceeding and the contradictory nature of what has unfolded here becomes evident. In what other area of jurisprudence is one of the parties to a legal dispute entitled to drug the other to oblivion or almost to oblivion just before the hearing commences? Now this particular inmate was drugged more than most, which, in itself, raises the question of systemic racism. Be that as it may, in every single hearing that I attended, the inmate had blatantly been administered far more drugs than usual shortly before the hearing began. Correspondingly, overwhelmingly, they entered the room, slurring their words and stumbling. To quote one of my survivor interviewees in this regard, “I was totally drugged. They sat me down. I put my head on the table, and I didn’t hear a thing. I just cried and cried and cried.” Witness additionally this exchange with Dan Brodsky, a Toronto lawyer who routinely represents clients at such tribunals:

Burstow: So as a lawyer who represents clients at such hearings, you are telling me that they actually do it? That they actually increase the medication before the hearing? 

Brodsky: Over and over again.

This is hardly a fair or “normal” hearing. What adds to the travesty, a person so drugged will indeed look “incapable” when s/he arrives at the hearing—and the setup is complete. Here they are on display—capable psychiatrist whose decision must be upheld and the confused incoherent inmate. And so it is that that justice is “enacted” and “accomplished”.

To zero in one final time on this particular case: What if the detainee “revived” sufficiently that the functionaries could deem him acceptably present—presumably, what all the other parties present were waiting for? In this highly “drugged out” state, would he have truly understood what was happening? Could he have in any way been able to make a case for himself? More to the point (since he was well represented legally), how would he have appeared to the people in whose hands his fate lay? Would he have looked “capable” of making his own “treatment” decisions? Of being “voluntary”? Of getting out?

What is apparent is that we have here is not a test of capacity but a show in which everything is orchestrated to demonstrate incapacity. What we have, to put this another way, is not a check on the system but the activation and reaffirmation of the system.

All things considered, it is hardly surprising that inmates seldom prevail. What is surprising is that they ever win at all. That, however, is another story altogether (for insight into that particular dilemma and related issues, see Burstow, Psychiatry and the Business of Madness, Chapter Five).