“Doing” Antipsychiatry on all Cylinders: Possibilities, Enigmas, Challenges

Year after year, we confront, we explain. Maybe we get minor concessions. Then presto, something happens, and even those handouts are gone. (S. R., activist and interviewee)

On several occasions I have written about the complexities of antipsychiatry politics, exploring more specifically, how to “do our politics” in a way that moves society squarely in the direction of the abolitionist goal (e.g., Burstow, 2014). In this article, I am once again theorizing the “how” of activism—for understanding this territory is critical to maximizing effectiveness. However, this time round, I am approaching it from an angle at once more general and more practical. That is, I am investigating the tools or approaches at our disposal as activists. What relates to this, I will be discussing the genus of politic—that is, the manner of politics being engaged.  

Pivotal questions grappled with in this article include: What fundamental approaches might be taken to end/rein in psychiatry? What are the strengths and shortcomings of each? What dangers do they present? To what larger genus of politic do they belong?  How are we to understand these in themselves? In relation to psychiatry? What are some of the enigmas, or challenges facing us? And how might they be met?

Now obviously, very different approaches might be adopted depending on the intended target of our change efforts—psychiatrists, survivors whom we hope to influence, our selves, the general public, the state. For the purpose of this article, I will largely be limiting the focal target to those with power in this area on one hand and the general public on the other.

That said, let me suggest that there are two overarching or umbrella approaches available to us as activists—persuasion on one hand and the application of political pressure on the other (for an articulation of these principles in relation a neighbouring movement, see Rosenthal, 1996).

To begin with persuasion, persuasion is predicated on the supposition that if we make our points well enough, say, by assembling cogent evidence, by making it assessable, by personalizing this with sensitizing stories and other emotional persuaders, people will become convinced that action of the type suggested is called for—for example, that ECT should be abolished. Correspondingly, it is assumed that there is an extremely close relationship between people being persuaded and change happening. Now whatever the limitation of this perspective and this approach, without question, persuasion is a key element in most change processes. Moreover, it is part of our existential nature to try to persuade and to move. Understandably, correspondingly, efforts at persuasion abound in our movement, whether we call what we are doing providing information, exposing, sensitizing, telling our story, or educating. Examples are: almost all the articles in Mad in America, the books that we pen, fact sheets that we produce, dialogues that we invite.

That said, I would agree that this is a necessary, even pivotal dimension. Why, for example, would the public support banning ECT short of becoming convinced that it is inherently damaging? Our tools here—and it is important to master them—include: sound scientific evidence, latest findings, cogent analysis, people’s stories, with ones with which public can identify being particular important, for they heighten empathy, lead to “aha” movements, and motivate. And with all of this, painstaking accuracy is critical. Note, the establishment can get away with lying, twisting, and exaggerating—we cannot.

That granted, a number of questions arise. First, are there risks involved in heavily relying on persuasion? Let me suggest that indeed, there are, with the risks different for different types of persuasion. To begin with the simplest of these, when trying to persuade, especially when using personal stories as persuaders, we can readily fall into what has been called “the politics of compassion” (in the politics of compassion, we are in essence leveraging the compassion that people feel or can be induced to feel to effect the changes sought; for an articulation of this concept, see Rosenthal, 1996). To be clear, I am in no way trying to minimize the importance of compassion. Nonetheless, the politics of compassion is at best a tenuous base from which to proceed. Why? For one, the presence of compassion does not in and of itself mean that the shift that materializes will be benign, despite our best efforts. In this regard, strange though this may seem, most people who support forced drugging are convinced that there are thereby being compassionate to the objects of the force. Additionally, even good changes made on such a basis tend to be less than reliable. Why? Because people whose political decisions stem overwhelmingly from compassion seldom have a solid grasp of the territory. Correspondingly, the object of their compassion can shift—and as a result, such changes can be very short-lived. 

One way that this happens is by the establishment likewise appealing to compassion. In this regard, in the early 1980s ECT survivors frequently got on tv and moved the public with chilling stories of how the treatment ruined their lives—seemingly, real progress. Within short order, though, psychiatrists were bringing their own patients onto shows with them, with the patients testifying how ECT had saved their lives. The audience was still compassionate but compassion now culminated in support for the status quo.

Indeed, even when substantial (and benign) changes have materialized, in the absence of a more solid base, they can quickly be reversed. Consider, in this regard, the great strides made with respect to psychiatric survivor rights in the 1980s. In Ontario Canada, for instance, education on the impossible plight of psychiatric survivors led to legal changes predicated on the notion that the default mode should be survivors making their own decisions. Shortly thereafter, however, a man called Brian was killed by someone identified as  “disordered” and the incident was seized upon by institutional psychiatry, its supporters, and the media. Whereupon, the public’s compassion shifted from survivors per se to what was seen as their potential victims. The result was the passing of Brian’s Law—a piece of legislation which dramatically lowered the bar on what suffices to incarcerate involuntarily (for details, see Burstow, 2015a).

For changes to be benign, solid, and enduring, in other words, additional education is needed that goes beyond the education typically associated with the politics of compassion. Examples are: education debunking the myth of the dangerous mental patient, education around the inefficacy of and the harm done by the “treatments,” and education on psychiatry’s lack of foundation. More fundamentally, if substantial and enduring change is to be achieved, the politics of entitlement has to take precedence over the politics of compassion. To hone in on consent, for example, the message that needs to be delivered is: Irrespective of how others may feel, it is everyone’s right to be free.

This being the case, public education on people’s rights is important. And of particular importance are initiatives like Tina Minkowitz’s, which culminated in the U.N. declaring involuntary treatment torture (see Minkowitz, 2014). And here we move from liberal to radical education, and, indeed, consciousness-raising. 

At this point the question arises: If education is both more thorough and more radical, will it then suffice? At risk of frustrating the reader, let me suggest, for the most part, no. And here, we come up against the limitations of persuasion, also the inadequacy of what passes as common sense. In this regard, it is commonly believed that if provided with good evidence and ways to relate, people can be persuaded to see things differently; correspondingly, once enough people or the right people are so persuaded, social change, ipso facto, will occur. The very fact that for decades now an abundance of  scholars, activists, and survivors have masterfully provided such education (e.g., Szasz, Breggin, Frank) and yet psychiatry continues to command respect and to grow is itself an indicator that such an understanding is too simplistic. While of course, on some level or other, persuasion is generally at work when change happens, what such a perspective ignores is the very fact of power and how it works.

The point is that there are structures and there is a profession here endowed with authority. And there are huge vested interests at play—the multinational pharmaceutical companies, for example, armies of  “professional helpers”, indeed the entire psychiatric/psychopharmaceutical industrial complex. These yield enormous power, including the power to determine who and what is credible. Correspondingly, they can be counted on to use that power to further their own interests, including their own bottom line. On top of which the public is wary of people whom they see as mad— and so want such structures in place. Moreover, the industry has vast sums of money and other capital at their disposal, and whenever it has seen public sentiment shift against it, it has invariably responded by drawing on its extensive resources to wage a new campaign (for details, see Burstow, 2015a). All formidable reasons why persuasion does not suffice.

If the combination of logic, facticity, and fellow feeling, while essential, do not suffice—and I am suggesting that they do not—what else is needed? At this point in history at any rate, force. The point is, insofar as an oppressor wields power, and insofar as we are trying to overturn a system that is inherently oppressive and all-encompassing, we too need to wield power. To be clear, I am in no way suggesting physical force, but non-violent action such as that waged by visionaries like Gandhi (see Sharp, 1973).

Now indeed, albeit it is underutilized, to varying degrees nonviolent resistance too has always figured in our repertoire. Note, in this regard, the Highlander work, wherein survivors  pointedly modeled themselves on the civil rights movement. Note the demonstrations in the UK (see Mckeown, Creswell, and Spandler, 2014). Correspondingly, witness MindFreedom’s 2002 hunger strike (for details, see http://www.mindfreedom.org/kb/act/2003/mf-hunger-strike/hunger-strike-news?searchterm=hunger+ ).

The latter, I would add, is a particularly instructive action to probe. The protestors’ ultimate demand was the provision of choice in “services”; and in the process of making this demand, they challenged the American Psychiatric Association and the National Institute of Mental Health to point to a single study showing that “mental illness” is biological—which, of course, they could not. This action was nothing short of remarkable; it included among its team no less a figure than the former head of “schizophrenia studies” at National Institute of Mental Health; it brought together survivors and radical professionals, drawing on the knowledge of each; it garnered press; it brought goals, methods, and means of measurement into alignment with each other, as is critical in strategic activism; correspondingly, it constituted a formidable education in its own right. At the same time, even this stellar piece of activism fell short of achieving its objective. Nor did it exactly create a base from which to proceed. And here is the rub.

Now to be clear, as I have stated elsewhere (Burstow, 2015b), standing up and being counted is important irrespective of effectiveness. And so is raising awareness even when nothing concrete materializes. Nonetheless, insofar as our goal is social change, effectiveness in the strictest sense of the term matters. So the question is: what kind of pressure can we bring to bear that might actually materialize in change? In short, there are two types of pressure involved in non-violent action. The first is moral force, also known as the force of truth (and the personal stories alluded to earlier are a part of this). Such is arguably achievable in our movement, for the cause is just and the harm demonstrable.

That said, while moral force is absolutely critical—and for sure it was being wielded in that hunger strike—it similarly does not suffice. In this regard, history teaches us—and we ignore this to our peril—that moral pressure needs to be combined with pressure of a more material kind. Note, in India when Gandhi mobilized against the British colonizers, or to add a second example, when the Black community in Nashville sought to desegregate the commercial centre of their city, they were successful because not only had they moral force, they used and leveraged the power of numbers to obstruct. In this regard, the oppressed inhabitants of India greatly outnumbered the British occupiers, did all the work utilized by the regime, and so by the very act of striking, they were able to bring production to a halt and in the process, undermine the British. By the same token, the Black community in Nashville was sufficiently large that once the overwhelming majority of Black residents (plus allies) had joined the ongoing boycott of stores practicing segregation (more or less all stores in central Nashville) and had engaged in it long enough, the seemingly intransigent merchants of Nashville were, in essence, brought to their knees (for a blow-by-blow of this very extensive campaign, see York, 2000).

To put this simply, the question facing any movement intent on change is leverage. Having large enough numbers that you can stop the work of industry constitutes leverage. Being able to wield sufficient economic power that simply by refusing to purchase you can materially affect companies’ bottom line constitutes leverage. Now generally, the leverage in question is of an economic nature, but there is no obvious reason why this must be so. That noted, the question facing our movement is this: Besides the morality of our cause, exactly what is our leverage? And if we haven’t sufficient leverage now—which I am suggesting is the case—what kind of leverage can we get and how do we acquire more?

The answer to this question is anything but obvious. A course which I teach (Creative Empowerment Work with the Disenfanchized) is instructive in this regard. Year after year, I have engaged students in an exercise—and it invariably ends with the same impasse: The class having been divided into three, each group is tasked with brainstorming a strategic piece of resistance that would stand a reasonable chance of being successful—group one, in regard to homelessness, group two with respect to prisons, group three with regards to psychiatry. While all three encounter difficulties, almost invariably, it is the students in the antipsychiatry group that flounder. Why? Precisely because, try though they might, they cannot locate a point of leverage.

This said, arguably, the single biggest task confronting us as a movement is finding or generating leverage. Boycotting the drugs, clearly, would not get the unity needed and would otherwise backfire. And in the end, even at its best, the only pressure of use to us that would arise from a hunger strike is moral pressure, which short of having a person with the reputation of Gandhi at the helm, is not going to advance the movement far. 

I do not have a clear answer to the dilemma posed here, though I can hazard some guesses about direction. Insofar as lack of numbers presents a formidable obstacle to any strategy, let me suggest that coalition politics appears to be called for. Note, if even a modest percentage of the people poorly served by society banded together, we would greatly outnumber the establishment, and as such, arguably, the necessary critical mass could be forged. Though to accomplish this, obviously, ongoing work reaching out and co-visioning would be critical.

Not an easy or a quick answer, I agree, but one with the added advantage of being holistic and truly leading in the direction of a better society.

In summation, there are very serviceable tools at our disposal as antipsychiatry activists—and these include various kinds of persuasion and force. Correspondingly, it is critical that we know them, select and use them skillfully. At the same time, major challenges confront us.  Getting past our conviction that persuasion suffices is one of them—and then there are the material problems, together with issues like power and leverage. Hopefully, this article has shed a little more clarity on all of such aspects. And hopefully, the reflections and dialogue started here can continue.

Indeed, as you go about your work, I invite the reader to continue pondering the distinctions, queries, and challenges raised. In particular, I invite you to ask yourself: What power do we wield? Could we wield? Who historically have our allies been? (e.g., homelessness activists, prison abolitionists, Quakers) And who might new allies be? As an addendum, correspondingly, I leave you with the following consideration:

No campaign is successful without images. And if chosen judiciously, symbols can be of considerable help in generating leverage.

One possibility in this regard is using the violence of ECT as a symbol for psychiatry overall (see Burstow, 2015b). What might be at least as potent—and I think that we would do well to seriously entertain this possibility—is to focus in on the psychiatrization of children. By this I do not mean what happened to current adult survivors when young (important though this dimension is), but the rampant targeting of children going on now (see Whitaker, 2010). Children being placed on Ritalin. Children being labeled ADHD. Children being controlled/subdued chemically in classrooms around the world. Herein lies a powerful symbol. Question: If we leverage it properly, might not the public at large be moved to rally in protection of its children? And were that possible, in the long run, might not such a focus deliver the numbers needed for strategic action? 

What is significant here, irrespective of espoused belief, understandably (given that the young in particular are entrusted to our care), people are readily outraged by what happens to children, and more pointedly, what happens or could happen to their child. And significantly, the vast majority of the human population are parents, grandparents, and the like. Now for sure, a frightening number of parents, moreover, the vast majority of ones publicly weighing on these issues are in the opposite camp, have become, in essence, an extension of psychiatry. By the same token, a particularly formidable weapon in psychiatry’s current arsenal are pro-medical model family organizations like NAMI, tutored, funded, and otherwise resourced by the psychopharmaceuticals. This notwithstanding, those of us who organize in this area have witnessed first hand the enormous power that can be unleashed when parents suddenly realize that they have been, as it were, “sold a bill of goods”. As such, arguably, if we put our minds to reaching and leveraging the power of this very considerable constituency (of which we, after all, are a part), for the first time in history, we might be able to create the leverage needed—indeed, potentially, leverage beyond our wildest dreams—a good beginning.

Insofar as this is the case, I would add, the greed of the psychiatric/psychopharmaceutical industry in relentlessly pursuing this erstwhile “untapped market”—the real reason that our children have been targeted—could prove to be its own undoing.

References

Burstow, B. (2014). The withering of psychiatry: An attrition model for antipsychiatry. In B. Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted: Theorizing resistance and crafting the revolution (pp. 34-51). Montreal: McGill-Queen’s University Press.

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

Burstow, B. (2015b). Protesting ECT. Retrieved on April 3 2015 from http://www.madinamerica.com/2015/03/protesting-ect-moralexistential-calling/.

Mckeown, M., Creswell, M., and Spandler, H. (2014). Deeply engaged relationships. In B. Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted: Theorizing resistance and crafting the revolution (pp. 145-162). Montreal: McGill-Queen’s University Press.

Minkowitz, T. (2014). Convention on the rights of persons with disabilities and liberation from psychiatric oppression. In B. Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted: Theorizing resistance and crafting the revolution (pp. 129-144). Montreal: McGill-Queen’s University Press.

Rosenthal, R. (1996). Dilemmas of local antihomelessness movements. In J. Baumohl (Ed.). Homelessness in America (pp. 201-232). Phoenix, Arizona: Oryx Press.

Sharp, G. (1973). The politics of nonviolent action. Boston: Porter Sargent Publications.

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

York, S. (2000). A force more powerful (PBS). New York: United States Institute of Peace.