Commencing a Dialogue

Every year come May, an overwhelmingly medical model phenomenon comes upon us--tellingly known as “Mental Health Awareness Week”. Benign statements about the importance of tolerance and compassion are made, and as such, on the surface, this initiative looks like a good thing to support. That noted, the essence and point of the week is transparently to further promulgate the medical model. In line with this, during this period, you can expect to repeatedly encounter such claims as: “mental illness” is a “disease like any other”.  That mental illnesses are bone fide diseases, caused by chemical imbalances. That psychiatric treatments are “safe and effective” and “correct” said chemical imbalances. Correspondingly, every year without fail, vast amounts of industry money fund what is in essence a huge advertisement for the medical model, with the psychopharmaceutical industry and psychiatry receiving the overwhelming benefit.  Herein lies the status quo.

Of course none of this would be problematic if the medical model indeed had substance.  The question arises: Are the claims being made supported by good evidence? Is psychiatry on a solid footing? And does it in point of fact tend to help people? While a “yes” answer to these questions may seem obvious, evidence overwhelmingly suggests otherwise.

As Colbert (2001) has written, despite repeated claims to the contrary, there is no proof whatever of a biological basis or even a physical indicator for a single so-called “mental illness”.  And as Szasz (1961 and 1988) so astutely pointed out decades ago, without a biological basis, something cannot be deemed an illness, for illness by definition pertains to the body. Now if you treat a fictional disease and “correct” a fictional imbalance, expectably, you will not end up with “effective” resolution of a problem but rather with damage. In line with this, Peter Breggin (2008) has established that there is a one-to-one correlation between the alleged effectiveness of psychiatric treatments and the brain damage thereby incurred. By the same token, researchers like Moncrieff (2009) demonstrate that the drug trials correctly read in no way support claims of effectiveness. Correspondingly, as shown by Healey (2012) Whitaker (2010), and Colbert (2001), and Burstow (2015), among others, psychiatric treatments culminate in real disorders and the profound and often irreversible lessening of the quality of life. That noted, you might ask, insofar as this is so, why is society continuing on this path? 

Society’s desire to control people whom they deem mad is one answer—and clearly the fear of the “other” is involved here, (see Burstow, 2015). Another and inevitable answer is that the continuing growth of biological psychiatry is in the interests of the psychiatric and the psychopharmaceutical industry itself. Correspondingly, psychiatry enjoys the power that comes from being an agent of the state and its views, as such, are hegemonic. On top of this, and indeed, what is enabled by this, the industry has excelled in the widespread deception of the public, something only too easy to do when an industry is allied to a profession whose word is law. This includes the burying of negative results, the fudging of statistics, the standard proclamation of findings that not only have not been established but have been disproven (see Breggin, 2008, Healey 2012, Moncreiff, 2009 and Burstow, 2015).

Given all this, progressively there are widespread critiques of psychiatry—by scholars, by psychiatric survivors, by activists, by disgruntled practitioners, all of them exposing, all of them clamoring for change. Correspondingly, more and more scholars are calling for a social dialogue, out of which a new social consensus and a sounder direction might be forged. Most of these meticulously analyze one or two highly problematic aspects of  psychiatry—the drugs, for example (Moncrieff), or the corrupt nature of one of the players (Whitaker and Cosgrove), or the fact that racism, ableism, classism, or sexism are so often inherently implicated (Ben-Moshe, Chapman, and Carey, 2014), leveraging their analysis to make a case for psychiatric reform. And then there are books like mine—Psychiatry and the Business of Madness—which, in their own way, take the discourse to a whole different level.

To zero in on that book, for I belief its message is critical, what most distinguishes Psychiatry and the Business of Madness is that the critique is multifaceted, holistic, and abolitionist—all of them qualities, I would suggest, that are urgently needed in this dialogue. Embedded in extensive research, including hundreds of interviews and dedicated periods of observation, it is an institutional ethnography which illustrates how psychiatry rules through texts, which highlights the centrality of the state, which uncovers the power relations and the violence at the heart of the psychiatric endeavor, and which meticulously demonstrates the circularity of psychiatry’s claims. In the process, the book in essence “makes a case”. Facet by facet, chapter by chapter, it purports to do nothing less than demonstrate extensively, conclusively, and in a variety of different ways that psychiatry is untenable and unacceptable. Beyond that, it demonstrates that the problems inherent in this institution run so deep that what might be construed as “improvement” is not and cannot be sufficient. Additionally, it provides concrete guidance for how we might change society so that people became less alienated, better able to cope.  And it fleshes out what services might look like in such a transformed society while exploring what could be introduced into the nooks and crannies of current society.

As this book is embedded in the notion of community, it ends with a call for a societal dialogue. So, I would add, does the Whitaker and Cosgrove book (2015).

That noted, why is the societal dialogue that so many of the critics are inviting so important? Read my book, read the books of authors like Whitaker, Read, Breggin, and the answer will become clear. However, to name a few reasons at this juncture:  It is critical because human beings are being damaged, moreover, damaged in the name of help. It is critical because we have allowed something with no validity in the first place to assume more and more control over more and more people. It is critical because the system is such that it is almost impossible for people to refuse such “help.” It is critical because as a community, we are not only permitting but are funding such damage. It is critical because what is happening is at once inhumane and a violation of human rights.  It is critical because we owe more to everyone, but especially to vulnerable populations. It is critical because we are now facing a virtual epidemic of iatrogenic (doctor-created) illnesses. Moreover, with the new push to psychiatrize children, we are putting in jeopardy not only ourselves and our neighbors, but indeed, the next generation, which in essence means the future of human kind.

In light of this state of affairs, how apt it would be if we could make this year’s “Mental Health Awareness Week” a moment of reversal—a moment when the eyes of the world are not primarily on the objects of psychiatry but on psychiatry itself! Whether we can achieve such a reversal or not, more generally, my hope is that that many many people will be inspired to rethink, re-envision, and act. In this regard, my invitation to folk perusing this article is to the read the critics, to think critically, to be open to problematizing concepts like “schizophrenia” that you may long have taken for granted. Also, talk to psychiatric survivors. And ask yourself: Do these concepts and approaches really make sense? Does ceding our power to these “experts” make sense? What could be done differently?  What can I, my neighbors, my community do about what is happening here?

I would add here that the temptation when starting to dip one’s toes into these critical waters is to ally oneself with those critical voices which are comparatively “moderate”. To put this structurally, it is to gravitate toward a reform rather than an abolitionist stance. Why is this is so? Let me suggest, one very prominent reason is that our default mode as a species is to think that the more moderate position is inherently the more reasonable—hence the golden mean in Aristotle, the middle way in Buddhism, and balance in Aboriginal thought. Now to be clear, I am not arguing here that we should be abandoning this default mode. Such a predisposition serves us tolerably well much of the time. Nonetheless, clearly, there are things that do not permit of the golden mean. For example, we would not want to strike a mean between raping women and treating women respectfully. Nor is the concept of mean applicable when we are referring to oppression—and with psychiatry, which deprives human being of their rights and damages them in the process, we transparently are. By the same token and what relates to this, when a paradigm is untenable—and I am arguing precisely that this one is—concepts like reform and balance are not applicable. Note, we do not want the “right” among of “error”, but rather, we should be trying to rid ourselves of error to the extent possible. Accordingly, I encourage readers to think more structurally and to have the courage to follow where your thinking takes you.

In ending: A closing observation for those who would argue that reform is at least “better than nothing”. While that is possibly so, it also possibly not. The point here is that in the absence of an abolitionist agenda, historically, reform has not been successful in tempering what most people might think of as the “excesses” of psychiatry—leastwise, not in the long run. And in fact, its biggest legacy is the very opposite. In this regard, there have been two major historical attempts to “reform” psychiatry—the advent of what was called “moral management” in the eighteenth century and psychoanalysis in the twentieth. Each came at time when psychiatry was perceived to be in crisis, much as it is today. Both did indeed temper psychiatry for a while. Under moral management, wholesome activities like walks in the country became commonplace, as, to a degree, did dialogue. And with psychoanalysis, to a degree, at any rate, the human beings being “treated” were be listened to. This said, each culminated in the return of biological psychiatry with a vengeance. That is, moral management was followed by the birth of eugenics movement. And for all intents and purposes, psychoanalysis was succeeded by the “drug revolution” (see Burstow, 2015). To put this another way, each major time that reformism was chosen, this very choice, in essence, “saved psychiatry” at a time when the institution was in crisis and truly fundamental change might have been possible. In the process, the reformist agenda itself, as it were, squandered the moment and paved the way for the return of and, indeed, the growth and the intensification of biological psychiatry.

Question: What reason have we to believe that a reformist agenda would serve us better this time around?

References

Ben-Moshe, L.,  Chapman, C., and Carey, C. (2014). Disability incarcerated. New York: Palgrave Macmillan.

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

Burstow, B. (2015). Psychiatry and the business of madness: An ethical and epistemological accounting. New York: Palgrave Macmillan.

Colbert, T. (2001). Rape of the soul. Tiscam: Kevco.

Healy, D. (2012). Pharmageddon. Berkeley: University of California Press.

Moncreiff, J. (2009). The myth of the chemical cure: A critique of psychiatric drug treatment. London: Palgrave Macmillan.

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.

Whitaker, R. (2010). Anatomy of an epidemic. New York: Broadway Paperback.

Whitaker, R. and Cosgrove, L. (2015). Psychiatry under the influence. New York: Palgrave Macmillan.