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.

References

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.