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.
References
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.
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