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
http://bizomadnessevents.blogspot.ca/

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

Thursday, October 26, 2017

Ending ECT: From a Lawsuit to a Novel—The Moment is Now!

Eyes peer at me, then quickly look away.
Because they are afraid.
Because they sense the humiliation.
Because they know not what else to do.
Stretchers in front of me. Stretchers behind me.
Some poor soul being dragged where none of us want to go.

Who would have thought that a single shriek could fill the universe? (from Burstow, 2017—The Other Mrs. Smith; https://www.amazon.ca/Other-Mrs-Smith-Bonnie-Burstow/dp/1771334215/ref=sr_1_1?ie=UTF8&qid=1508451818&sr=8-1&keywords=the+other+mrs.+smith

In the midst of flagrant professional mispresentation of ECT, this article provides hard-hitting and accurate information about the “psychiatric treatment” known as electroshock (ECT).  What goes along with this, this article is a call to arms. Quite simply, the time has come for a frontal assault on the ECT industry and on the professionals associated with it.  The time has come to rid society of this barbaric “treatment” altogether. 

Naturally, it would make no sense to call for the end to a “treatment” unless clearly it was first and foremost profoundly injurious. So…

What are the Salient Facts about Electroshock?

There are so many horrific facts about ECT that it would take several articles to list them all. In a nutshell, however, some of the most pressing of these are:

·      ECT is a putative “treatment” involving the application of sufficient electricity to the brain to produce a grand mal (Whitaker, 2002, and Breggin, 1991). A relevant point here is that every other branch of medicine moves mountains to prevent grand mal seizures because of the damage which results. By contrast, psychiatry is purposely perpetrating grand male seizures, at the same time denying the damage in question.
·      ECT is inherently brain-damaging, with damage arising from both the seizure and the electricity (see Breggin, 1991).
·      ECT always causes memory loss, much of it extensive and permanent—both loss of memories from before the shock (retrograde amnesia) and inability to remember new facts (anterograde amnesia) (see Burstow, 2015),
·      Contrary to what the shock proponents claim, not a single form of ECT gets around the problems of brain-damage and memory loss. What does the largest study in electroshock history show—and this to a degree of statistic significance?  Despite the standard reference to new and improved, every single mode of ECT damages and creates memory loss (see Sackeim et. al, 2007).
·      As thousands of courageous ECT survivors have testified over the decades, most shock survivors are greatly impeded in their ability to navigate life as a result of this putative “benign treatment”. A typical day for a frighteningly large number is having to take notes all day long for otherwise, by the time the day has ended, they will have no way of knowing what has happened. More generally, an abundance of survivors routinely forget people in their lives, cannot remember facts, ways of proceeding, details, are stuck having to settle for a simplistic job despite having prepared for something very different, for gone are many of the skills that they have spent a lifetime acquiring (see ECT survivor testimony at https://coalitionagainstpsychiatricassault.wordpress.com/articles/personal-narratives/)
·      Electroshock is overwhelmingly an attack on women. In this regard: Two to three times as many women as men are subjected to electroshock. The psychiatric rationale for this difference is that electroshock helps with depression and women are more depressed than man. The truth, however, is, women are given electroshock two to three times as often as men irrespective of diagnosis. What is likewise significant, the very people who are targeted for shock (women) are the ones typically most damaged by it (see Burstow, 2006).
·      The rational for delivering this terrible blow to the mind and to the integrity of one’s being is that ECT allegedly prevents suicide.  The truth is that does not lower the suicide rate (Black et al.,1989).  In fact, a study by Munk-Olsen, et al., 2007, suggests instead that in the days after the “treatment”, it actually raises the risk of suicide.
·      Electroshock is not effective even by the psychiatry’s self-serving measures of effectiveness. As decades and decades of studies show, within six weeks electroshock is no more effective than placebo (for an extensive meta-analysis of the various effectiveness studies, see Ross, 2006).

In short, people are being permanently damaged —for nothing!  Virtually nothing! Hence the call to arms.

What Makes This a Good Time to Combat Shock?

A good time to mobilize on any issue is when you can detect movement on it—which is exactly where we are at this juncture. The point is, after decades of us activists largely spinning our wheels around shock, in the last half year, the attack on shock has been gaining real momentum. What are we seeing?—major law suits, legislative intervention, an uncompromising novel that truly lays bare the reality of shock: All reasons to seize the moment.

The Law Suit(s)

The leading legal action is in California. And it is a class action lawsuit against the manufacturers of shock machines. The filers of the motion are DK Law Group. The major defendants are the giant shock machine manufacturers MECTA Corporation and Somatics—and yes, these are giants! The allegations are: negligence, failure to warn, and loss of consortium. Anyone can join the class action who have sustained injury in California any time from May of 1982 onward as a result of the negligence of the shock manufacturers (for further details, including how to get involved, see David Karen, 2017). 

Significantly while this action is restricted to California, DK Law Group is committed to helping law firms in other states file similar cases. And interest is growing in having comparable suits world-wide. 

Herein lies a promising new direction and a momentum that we have not seen before.

I would just add: A Canadian law firm as well is actively considering launching a class action lawsuit, but unfortunately it would be open only to Canadians subjected to electroshock in the last 2 years (clearly an attempt to stay within the statute of limitations). What is promising, nonetheless, the conversation is happening.

The Pennsylvania Motion:

A promising development has likewise materialized in Pennsylvania. In short, a bill has been introduced by state representatives Stephen Kinsey and Tom Murt to prohibit the use of electroshock on children. A fortuitous initiative which could reverse the current targeting of children and youth.

Ways to Contribute to the Momentum Identified to Date:

Targeted ways to contribute to the current momentum, include a) taking part in or otherwise supporting the lawsuits and bills currently under way, and b) doing the footwork necessary to bring about similar suits and similar laws in additional jurisdictions. Obviously still other ways are speak-outs, demonstrations, and educationals.


A Different Kind Development: And a Special Opportunity: The Novel The Other Mrs. Smith

When we think of defeating shock, we quite rightly think of law suits and legislative interventions—all of which is necessary and all which is good. We also think of demonstrations and speak-outs—also good. Alas, though, we tend to overlook the enormous power of art. Art is magical, opens up a public space for understanding and transformation. Points can be made that otherwise allude. Art moves and educates, and can stir the public to protest. Correspondingly, if demonstrations or speak-outs sufficed to stir public indignation against shock, we would have won the battle against shock long ago. And has a development happened here as well—something that can add to the current momentum? In a word “yes”. Enter the new novel The Other Mrs. Smith—and in the interests of full disclosure, to be clear, I am the author.

 The blurb on the cover of The Other Mrs. Smith is as good an initial introduction to this novel as any. It reads:

This novel traces the life experiences of a once highly successful woman who falls prey to electroshock and subsequently struggles to piece back together her life. Naomi suffers enormous memory loss; additionally, an estrangement from her family of origin that she has no way to wrap her mind around. The novel begins with her wandering the corridor of St. Patricks-St Andrews Mental Health Centre (St. Pukes) faced with the seemingly impossible challenge of coming to terms with the damage done her, as well uncovering the hidden details of her life. It moves back and forth between a relatively happy childhood in the legendary north-end Winnipeg of the mid-1900s and post-ECT adulthood in Toronto. An exceptionally kind man named Ger who befriends Naomi comes to suspect that important pieces of the puzzle of what befell her lurk beneath the surface of writing in a binder of hers, which comes to be known as Black Binder Number Three. What Naomi progressively comes to do, often with Ger's help and just as often with the help of a very different and eerily similar sister named Rose, is find ways to do justice to her life and to the various people in it. Filled with a vast array of colourful and insightful characters from a variety of communities—Toronto¹s Kensington Market of the 1970s, the 1970's trans community, north-end Winnipeg Jewry, and the ingenious and frequently hilarious mad community—this novel sensitizes us to the horror of electroshock, takes us to new levels in our understanding of what it means to be human, and, in the process, leads us to question the very concept of normalcy. 

This is an engaging novel with broad appeal. At the same time, it drives home the horror of shock in a way not seen in fiction before. We see the effects of this “treatment” play out over the span of the heroine’s life. We see the effects on the next generation.  And we come to know the reality of shock from the inside—not just the outside—for the novel is narrated in the first person by a fictional shock survivor. Moreover, the sexist nature of this “treatment” is inescapable.

How I came to write this novel, I would add, is itself informative. I was part of the big 1980s push to abolish shock. Now there were moments back then when it looked as if us activists were on the verge of winning. Then I saw us totally lose the momentum. For the next several decades, like others in the struggle, I continued to push for the abolition of shock with very little promising materializing, when one day the idea of writing an ECT-centred novel narrated in the first person occurred to me. Now I knew that a first person narrative about someone badly harmed contravenes the inherited wisdom of what is possible to pull off in a work of fiction, but in short, I decided to do pursue this seemingly impossible project anyway. 

Soon after making this decision, I phoned Toronto shock survivor and long time activist Carla McKague and told her what I was doing. “For God’s sake, Bonnie, do it,” she insisted. “We have never had anything like this. What you are describing is a novel that the movement direly needs.”

Whereupon, I threw my heart and soul into this project for the next two years. However, problem after problem kept materializing. And I soon realized why a novel of this sort had been declared something that should not be tried. What emerged was often overwhelming and just as often confusing.

Anyway, the time came when I again called Carla to tell her that I was going to have to stop for it just wasn’t working.  Her answer was, “Bonnie, don’t stop. The movement, it absolutely needs this novel.” And understanding her point only to well, back to the drawing boards I went.

Two years later and after considerable work, again I felt the urgent need to stop—this time not so much because it was not working, though there were problems of this nature too, but because it was just too hard, just too agonizing.  What went along with this, there was an enigma at the very centre of the project: Namely, while I myself could tell Naomi’s story, the fictional narrator into whose head I had placed myself was often at a loss how to tell it precisely because of the memory impairment, precisely because of the damage done to her by shock. 

A related issue is that there were moments when I felt that I could not endure another second of being inside the head of someone whose memory was this impaired. To put this another way, I did not want to have to keep facing dead end after dead end. How wonderful it would be to get my life back!, I found myself thinking.  And to get it back, all I really had to do is give up writing this novel. Now for a brief moment there, that is precisely what I determined to do—when suddenly the realization struck me like a thunderbolt. 

Yes, of course, I could get my life back. But those of you who are shock survivors, you do not have the same option, do you? That is, you do not have the luxury to get your lives back. And if you can’t do it, then neither should I. Herein lay the moral imperative.

It took me almost ten years to complete this novel and to land a publisher, but the longer I worked at it, the better, the richer, more fulsome the novel became, what is particularly telling, with the very difficulties that had originally led to me declare the writing of this novel an impossibility being exactly what allowed this novel to become rich, multi-levelled, and potent.  In fact, soon it was evident not just to me but to everyone around me that what had emerged was nothing short of “dynamite”.

Fast forward. The novel is now out, and yes, my sense is that it genuinely has the power to motivate the public—it is that sensitizing, that powerful--but only if it is widely read. Hence my own current campaign.

If after reading the novel, you too become convinced of the importance of ensuring that this novel is widely read, here are some ways that you can help:

1)    Write a review on Amazon.com or Amazon.ca and encourage others to do the same  (if over 100 of these materialize, the novel will indeed start to take off).
2)    Follow me on twitter and re-tweet the quotations from the novel that I post.
3)    Resend messages that I post about it on Facebook.
4)    Email information about the novel to friends, post it to listservs; write blurbs about it on Facebook, on your blogsite, on your personal webpage.
5)    Write a full scale review for a major publication.
6)    Give it as birthday and Christmas presents to your loved ones—and do remember, Christmas is just around the corner.
7)    If you are part of a book club, look into getting The Other Mrs. Smith on the agenda.
8)    Put in a request for your local library to purchase a copy; also hook up with women’s and trans centres in your area and encourage them to have copy on hand. 
9)    In any demos and other actions that you mount in support of the current move against electroshock—and I hope these will be legion—do consider reading a passage from the novel.
10) Get in touch with literary and media figures that you may know with the goal of interesting them.

In Ending

This article has provided a brief summary of what is wrong with electroshock and why it should be abolished. It has clarified what makes this an optimal moment to act while articulating the momentum that is building. And in the process, it is has introduced you to current actions to which you might contribute—a ground-breaking class action law suit, a legislative bill that could help to safeguard our children, and finally, a novel (The Other Mrs. Smith) that has the potential to do heavy lifting for us. 

That said, to end this article as it began, with a quotation from the novel, what follows are the opening words of the fictional heroine Naomi, ushering you into the world of what was I call the novel The Other Mrs. Smith and what she calls her “memoire”:

My name is Naomi, Nomi for short. Not two years ago I was at a public meeting in Toronto where an aged woman looked everyone straight in the eye and asked, “After all our years of service, is this what we have to look forward to?” Two months later, a far younger woman who is ever so precious to me called with an urgent request. “Write about everything,” she pleaded. “Do it for whoever—yourself, me, others at risk. Just do it.” Hence this curious journey on which we are embarking.    
Now in the sweep of literature, there have been many unusual, one might even say “oddball” narrators—corpses, the cross on which Jesus Christ hung, even—and I kid you not—a fish. By these standards, I am a fairly everyday narrator, for as best I can make out, I am neither the holy rood nor any kind of fish—well, leastways not since I last checked. What I am is a sixty-five-year-old activist with holes in my head and a whopper of a memory problem. And that is the crux of the matter. But enough said.
This is one of those stories, you see, best left to unfold on its own. Like a surprise autumn sunset. Like a murder at dawn. I would only point out that there are depths here to plumb, truths to probe. Step into my world, additionally, and you will quickly find yourself rubbing shoulders with a vast array of some of the most endearing and fascinating souls that a person could hope to meet—some housed like Gerald, some from the streets like my buddy Jack who could always roll the meanest cigarette in Turtle Island. Ah, but all in good time.
     Now I could begin almost anywhere—when I discovered the films of Ingmar Bergman, when I fuckin’ rediscovered the films of Ingmar Bergman—but if I am to trust in that old Spenser formula, “where it most concerneth me,” there is really only one place to begin: When I first started crawling out of the void. When those glimmers of consciousness first came upon me in the opening days of March 1973….

[For this article and other Burstow articles, see http://bizomadness.blogspot.ca/]

REFERENCES:

Black, D. et al (1989). Does electroshock influence mortality in depressives? Annals of Psychiatry, I, 165-173.
Breggin, P. (1991). Toxic psychiatry. New York: St. Martin’s Press.
Burstow, B (2006). Electroshock as a form of violence against women, Violence Against Women, Vol. 12, No. 4, 2006: pp. 372-392
Burstow, B. (2015) Psychiatry and the business of madness. New York: Palgrave.
Burstow, B. (2017). The other Mrs. Smith.  Toronto: Inanna Publications (https://www.inanna.ca/catalog/other-mrs-smith/).
Karen, David (2017). Electroshock Therapy Class Action Filed (see https://www.madinamerica.com/2017/10/electroconvulsive-therapy-class-action/).
Munk-Olsen, T., Laursen, T., Videbech, P., Mortensen, P., & Rosenberg, R. (2007). All-cause mortality among recipients of electroconvulsive therapy. British Journal of Psychiatry, 190, 435-439.
Ross, C. (2006). The sham ECT literature. Ethical Human Psychiatry and Psychology, 8, 17-26.
Sackeim, H. et al. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244-255.

Whitaker, R. (2002). Mad in America. New York: Perseus Books.

Sunday, July 2, 2017

A Landmark Victory against the “Oak Ridge Torturers”—Do We Cheer or Cry?


On June 1, a landmark decision was handed down by Justice Paul Perell of the Ontario Superior Court of Justice against the defendants the government of Ontario and two former Oak Ridge psychiatrists—Dr. Elliott Barker, who is hailed as the mastermind behind Oak Ridge’s therapy program, and Dr. Gary Maier—Barker’s successor. This suit (for damages) was launched by 31 of the men who had been “patients” (read: inmates) at Oak Ridge during the years 1966-1983. According to the ruling of the judge, three of the programs to which the “patients” were subjected constitute torture (see https://www.theglobeandmail.com/news/national/doctors-at-ontario-mental-health-facility-tortured-patients-court-finds/article35246519/), and as such, there was a violation of fiduciary responsibility.

 As one of the many activists who fought to get the horrors at Oakridge stopped over the years and indeed kept finding remnants of the horror persisting long after the 1983 date (see Burstow, 1986), I am relieved that at least a few of the victims have lived to see a modicum of justice —nonetheless, given the extent of what transpired, additionally, the possibility of appeal, I am caught between cheering and crying.

 So what is Oak Ridge? What is this judgment all about? And what are the lessons to be gleaned here?

Starting in 1933, for 81 years Oak Ridge was the maximum security forensic unit of Penetanguishene Mental Health Centre (Ontario)—a place where Ontario men were incarcerated who were found “criminally insane” or “unfit to stand trial”. What was wrong with this place was more than just the bad treatment and human rights violations typical in institutions of the ilk—not that the “usual” is remotely acceptable. Beginning in the early 1960s, largely at the direction of Barker, Oak Ridge introduced and developed what it called the STP (Social Therapy Program). And it is precisely the ingredients of this “therapy” that have been deemed torture—three central aspects of it specifically named so.

Touted by its creators as the height of enlightenment and dubbed “Buber Behind Bars”, in a 1968 article of that same name published in The Canadian Psychiatric Association Journal (http://www.oakridgeclassaction.ca/document/vol%203/Vol%203%20%20sec%20%201.pdf), two of the program’s initial architects described and defended it as follows: “Psychopathology” is a disturbance in communication, and accordingly, forcing the “patient” into non-stop encounter with others (also called dialogue)—a central feature of STP—would force them to examine themselves, thereby cure them. Despite the Buberian overlay, seemingly recognizing some resemblance to Third Reich doctoring here, Barker and Mason went on to state, “If the process were one of eradicating a set of disapproved ideas . . . then we would be committing offences as grievous as those involved in The Third Reich . . . On the other hand, if our patients did not choose to deviate from society’s norms but rather were driven to such deviations by internal unresolved conflicts, then we should have them resolve such conflicts by every means at our disposal, including force, humiliation, and deprivation . . . And this force will not be lifted until he changes his behaviour.” A gut-wrenching bit of reasoning, to say the least, and yet the world welcomed this development with open arms!

So what were the primary components of “Social Therapy”? Besides solitary and sleep deprivation, which were pervasive (both of which the judge deemed tortuous), were three subprograms, all of which the justice ruled to be torture. While a detailed overview of the programs is beyond the scope of this article [for such detail, see my 1986 article “Oak Ridge before and after the Hucker Report”] (http://www.psychiatricsurvivorarchives.com/phoenix/phoenix_rising_v6_n2.pdf),  in short, the subprograms in question were: 1) Defence Disruptive Therapy (DDT); 2) Motivation, Attitude, Participation (MAPP), and 3) the capsule.

DDT consists of forcing hallucinatory drugs on “patients” to break down their defences and hypothetically force them to confront their unacceptable behaviour.  Patients subjected to this “treatment” for obvious reasons, walked around delirious.

Far more extensive, and arguably even more torturous was the Motivation Attitude and Participation Program, in which “patients” were kept for hours at a time one day after another generally for fourteen days on end, typically on the floor, not allowed to move a muscle, often chained to one another while being overseen by “patient teachers” who had authority over them, would punish them for the slightest movement, even force them to take drugs, all of this transpiring in a confine which McGuire describes as “three square feet” (see https://www.thestar.com/news/canada/2017/06/08/treatment-at-ontario-mental-health-facility-was-torture-judge-rules.html) This hyper-surveillance and disciplining by “patient-teachers”, I would add, continued on for some time after MAPP was officially cancelled.

Finally, nothing compares with the horror of the capsule, the part of “social treatment” ironically that seems to have inspired Barker to call STP “Buber behind Bars”. In a tiny room, patients were kept chained to one another, naked, forced to “encounter” each other for hours on end, day after day—and with the only food which they imbibed during the “treatment” being liquid, which was fed to them via straws emerging through tiny holes in the walls. Herein we appear to be witnessing Barker’s understanding of  “healing dialogue” and “total encounter”, though clearly what was happening was torture.

Is it any wonder that those subjected to this “treatment” were severely traumatized?

Now eventually, after decades of scandal, the most gruesome features of STP were discontinued. And recently, the Oak Ridge site itself was closed. Would that such torture had never been allowed in the first place! And would that at least some semblance of justice for the victims (the 31 litigants represent but a fraction of the victims) had been meted out decades ago! All of which brings me to ponder what has materialized here—and I invite readers to do the same.

There are of legions of questions that cry out to be answered: With reports of the horrid abuse at Oak Ridge surfacing frequently over the years, and with Barker’s own articles conveying a sense minimally of profound violation, how could this travesty have continued unabated for so long? What is wrong with the world and with the “therapeutic” community in particular that what happened here was hailed as a major advance? If STP was called “punishment” instead of “help”, could anything remotely this invasive have been practiced? And while what happened is an extreme, given that extremes “write large” the typical, and in so doing illuminate it, what does this tell us about the relationship between “mental health” practices and social control generally?

A few more questions, to bring the focus squarely into the here-and-now: Why is the current and laudable protest against the use of solitary in prisons not being coupled by an equally voracious protest against its use in “mental health facilities”? Can anyone really believe that solitary is “torture” for one population and “necessary treatment” for another? Correspondingly, in light of the flagrant abuse that went on in Oak Ridge for decades, how is it that the University of Toronto and Waypoint have recently mounted a digital commemorative archive of Oak Ridge, which is up for all to see on the internet now, moreover, which is more laudatory than not (called “Remembering Oak Ridge, see https://historyexhibit.waypointcentre.ca/).  Indeed the impression created is that what Barker introduced was good and the problems leading to the Ridge’s closure were simply created by his successor Maier, who, being hippy-like, overdid the use of psychedelic drugs! Contrast this with the tenor of the various archives dedicated to Third Reich atrocities—the reference point that the Barker himself introduced—and the problem with our response to our own human rights violations becomes crystal clear. 

That noted, there is indeed something to celebrate today—not only the Perell verdict per se, which is decidedly enlightened, but the wording accompanying it. Note in this regard, after stating that “torture is torture” irrespective of either intent or how it is seen at the time, Justice Perell went on to say, “It is a breach of a physician’s ethical duty to physically and mentally torture his patients even if the physician’s decisions are based on what the medical profession at the time counts for treatment for the mentally ill [my emphasis] (see https://www.theglobeandmail.com/news/national/doctors-at-ontario-mental-health-facility-tortured-patients-court-finds/article35246519/)
What in essence this means is that the fact that something is accepted “medical practice” does not legally absolve practitioners of wrong-doing. Herein we have ruling by a judge that can be cited as precedence. Moreover one that willy-nilly invites society to re-examine current practice.

Is not all seclusion torture—whether it happens in a prison or something called a “hospital”? What about involuntary treatment itself? Moreover, given that no less reputable an organization than the United Nations has declared that forced psychiatric treatment could be considered torture (see Minkowitz, 2014), and given that every state in the world is blithely ignoring such pronouncements, should these states not be held accountable, beginning with our own?

Correspondingly, if hallucinatory drugs can be ruled torture and a breach of fiduciary responsibility even though it was accepted at the time, how about the current use of “electroconvulsive therapy” or ECT, what with the grand mal seizures produced, the eradication of memory, the terror instilled, the profound interference with ability to navigate life? (for details on these ECT realities, see Burstow, 2006); alternatively, examine survivor testimony at  https://coalitionagainstpsychiatricassault.wordpress.com/articles/personal-narratives/).  

More generally still, are not both biological and institutional psychiatry to a degree at any rate inherently torturous?

Be that as it may, the bottom line is that not only is torture still happening, it remains rampant in the “mental health area”; and it has to stop. The good news is that we now have a verdict that can serve us.  Let’s start utilizing this ruling, this precedence to penalize and in the process begin putting an end to current abuse—tortuous practices, that is, that pass as acceptable largely because they constitute “standard” practice. Lawyers, survivors, advocates, let’s put our heads together on this.

Meanwhile, psychiatrists, be forewarned. And if for no other reason than self-protection, give some thought to what you yourself may be complicit in.

References

Burstow, B. (1986). Oak Ridge: Before and after the Hucker Report. Phoenix Rising, Fall, 1986: pp. 25-29.

Burstow, B. (2006). Electroshock as a form of violence against women, Violence Against Women, Vol. 12, No. 4: pp. 372-392. 

Minkowitz, T. (2014). Convention on the Rights of Persons with Disabilities and liberation from psychiatric oppression. In Bonnie Burstow, Brenda LeFrançois, and Shaindl Diamond, Psychiatry disrupted (pp. 129-144). Montreal: McGill-Queen’s University Press.

Thursday, June 15, 2017

Antipsychiatry—Say, What?: Once Again with Feeling


Over the last couple of years, I have written several articles intended to shed light on the term/phenomenon “antipsychiatry”—to name just a few, On Antipsychiatry (see http://bizomadness.blogspot.ca/2014/07/on-antipsychiatry.html), Antipsychiatry Revisited (see https://www.madinamerica.com/2014/10/antipsychiatry-revisited-toward-greater-clarity/), and On Fighting Institutional Psychiatry with the “Attrition Model” (see https://www.madinamerica.com/2014/07/attrition-model-psychiatry-abolition/). This is the next in the series. Questions addressed include: What exactly does “antipsychiatry” mean? And if there is more than one meaning or reference, how do you choose between them?  Is the term useful or hopelessly ambiguous? Can one be antipsychiatry without being abolitionist? Does antipsychiatry partake of degrees, such as being “very antipsychiatry” or “somewhat antipsychiatry”? And if one wants to end the use of psychiatric coercion only, does that position qualify as antipsychiatry? In the process of offering what clarification I can, I will be dipping in and out of history, for we cannot come to terms with this phenomenon or the tangle of confusions surrounding it without delving into historical developments. I would just add in passing that I am writing this article not only as an antipsychiatry theorist but as someone who has been actively involved in antipsychiatry activism non-stop for forty years. 

One further note in passing, throughout, I will be spelling “antipsychiatry” precisely as I have done so here.  For more on the question of spelling, see the end of this article.
    
To begin, the term “antipsychiatry” (spelled by him “anti-psychiatry”), was invented by a colleague of R.D. Laing’s, Dr. David Cooper in 1967 (see Cooper 1967). It was quickly picked up by the various people in the society that surrounded Laing. What the Laingian group were intending by the term is a different approach to “help”, with what had been called psychiatric problems being reframed as inherently social, political, and psychological rather than medical, with the existential philosophy of Jean-Paul Sartre figuring in critical ways in the mix (see Laing, 1963).  Laing and Cooper likewise explored and to varying degrees set up live-in therapeutic communities—where people were at least hypothetically given help as they went about their journey through madness, and with Cooper in the process introducing the concept “antihospital” just as he introduced the concept “antipsychiatry”. Now Cooper was far more activist than Laing and very much thought in terms of social movements. However, what is evident, even with Cooper, despite his legendary critique of “experts”, the movement that he was discussing was a professional movement—not a movement of the oppressed themselves. What is likewise relevant, despite how deeply he felt it, his opposition to psychiatry was in its own way muted, moreover (though admittedly, he did go back and forth), it became more muted over time, and indeed, eventually, became so “moderate” than he himself dropped the term antipsychiatry, as can be seen in Stephen Ticktin’s informative memoire “Brother Beast—A Personal Memoire of David Cooper” (see http://laingsociety.org/colloquia/inperson/davidcooper/brotherbeast2.htm), turning instead to the term “non-psychiatry” and alternatively, “non-medical psychiatry”. 

Now with regard to this latter term, I had an interesting conversation with Ticktin over it less than a month ago that proceeded roughly as follows:

Ticktin: Later David abandoned the word “antipsychiatry”, using instead the more political term “non-medical psychiatry”.
Burstow: That doesn’t sound more political to me. It sounds less political.
Ticktin: You think it’s less political?
Burstow: Look at the term. It is not announcing opposition to psychiatry or even to biological psychiatry, it is simply staking out a different form of practice. (personal conversation, CAPA meeting, June 3, 2017)

While I will be commenting on this curious shift later, for the time being, I leave readers themselves to reflect on how we might understand it.

Now in fairly short order “antipsychiatry” (and yes, still spelt “anti-psychiatry) made it into the lexicon of accepted scholarly terms. Nonetheless, instead of having a clear-cut meaning, it became somewhat of a “grab bag” category, with the term being applied to the positions of a large number of scholars who substantially critiqued psychiatry, albeit from very different perspectives. Examples are theorists as varied as Thomas Szasz in the US and Michel Foucault in France—the first, a right wing libertarian psychiatrist who demonstrated that the very concept of “mental illness” was a myth, the second a French philosopher who approached the profession/practice as a paradigmal example of what he called “power-knowledge” (see Foucault, 1980). Significantly, while almost all the theorists whose critiques of psychiatry figured heavily in the 1960s, 1970s, and the 1980s—e.g., Szasz, Foucault, Goffman, Becker—were lumped together under the umbrella term “antipsychiatry”, and while they all greatly influenced others who so identified, not a one of these theorists personally laid claim to the term antipsychiatry. In fact, quite the opposite, one of the very last books of Thomas Szasz (2009), specifically attacks what he saw as antipsychiatry, with Szasz not simply distancing himself from it, but soundly dismissing it as “quackery squared”.

That said, there is yet another constituency—and I would suggest, a more important one— that is associated with the word “antipsychiatry”. It is comprised of psychiatric survivors and their allies, people who see themselves as part of a social movement—the overriding goal of which is to abolish psychiatry. What distinguishes these activists—and to be clear, I count myself among them—from the individuals and groups discussed to date are:

1)    They invariably combine a medical position (a position on what science does and does not show and on what is wrong with the allegedly medical claims being advanced), with an epistemological position (a position on how we know and on the very nature of the claims to knowledge), with an ethical position (what, in light of what has been revealed, society is called upon to do).
2)    They identify as part of a liberatory social movement.
3)    The experience and the standpoint of survivors—not that of professionals--is considered the primary one.
4)    Psychiatry is theorized as a bogus branch of medicine and an oppression.
5)    The overarching commitment is to rid of the world of this oppression—that is, to rid of the world of psychiatry—just as feminists are committed to ridding the world of sexism.
6)    Antipsychiatry is not simply a label stuck on members of this constituency by others. It is at once a form of self-identity and a calling that is actively embraced.

This position and this identity found expression in various movement magazines from the early 1980s onward (see, for example, the various issues of the totally antipsychiatry Toronto-based magazine Phoenix Rising, aptly subtitled “the voice of the Psychiatrized” at http://www.psychiatricsurvivorarchives.com/phoenix.html), which featured among other things, the voices of iconic survivors like Don Weitz. While drawing heavily on the theoretic foundations provided by writers like Szasz, while drawing at least as significantly on the lived experience as well as the theorizing of psychiatric survivors everywhere, under the banner of antipsychiatry, what all such activists have done and have continued to do over the years is fundamentally critique psychiatry and fight for its abolition. It was likewise a major ingredient in survivor magazines that combined both antipsychiatry and other critical voices, e.g., Madness Network News (see http://www.madnessnetworknews.com/).

Some salient points and distinctions: While hardly being identical to the psychiatric survivor movement, antipsychiatry as practiced by the people discussed above, profoundly connects with the survivor movement. At the same time, it is also distinct. As discussed by Diamond (2012) in her ground-breaking thesis, some members of the survivor movement are antipsychiatry, while others are not. Correspondingly, while psychiatric survivors make up a major part of the antipsychiatry movement, the movement is not restricted to them. 

What is by far the largest and longest standing antipsychiatry organization and network in the world—Coalition Against Psychiatric Assault or CAPA (see https://coalitionagainstpsychiatricassault.wordpress.com/)–is instructive in this regard.  Committed to psychiatry abolition, and guided by a survivor standpoint, it is open to everyone who takes an abolitionist position, irrespective of social location. Note in this regard these words in its very inclusive mandate statement, “CAPA is a coalition of people committed to dismantling the psychiatric system and building a better world. Radical and visionary, we are comprised of activists, psychiatric survivors, dramatists, academic and professionals.” Herein antipsychiatry organizations mirror the operations of social movement groups like Marxist organizations, for example, in which the basis of unity is the set of common principles and commitments and not the social location. And herein this movement differs from both the survivor movement and the mad movement (to which, once again, it is intrinsically connected).

One further bit of context: Contrasting with, while to varying degrees interacting with the various groups discussed to date—that is, both those who self-identify as antipsychiatry and those whom third parties simply label antipsychiatry—are still others whom no one sees as antipsychiatry but who nonetheless argue/fight for something better than what exists, with many but not all of these at the same time seeing themselves as part of a social movement. I do not locate the survivor movement in this category, for the survivor movement is its very own special entity and spans most of the other movements. Pivotal here are movements of professionals, albeit survivors often identify with them and very commonly work with them. An example is “the movement for a democratic psychiatry”, which originated with Basaglia in Italy (see https://en.wikipedia.org/wiki/Franco_Basaglia) and is exemplified currently by the work of Asylum Magazine in England (see http://www.pccs-books.co.uk/asylum-magazine). A more formidable example is the far larger network of theorists, survivors, and activists who identify as “critical psychiatry”, with the “democratic psychiatry” folk now largely being subsumed under the umbrella term “critical psychiatry”. The primary mandate of such groups may roughly be described as  “mental health reform” or “psychiatric reform”.

The context now clear, to return to the questions with which this article began, so what does “antipsychiatry” mean? And is the term useful? From one very limited perspective, it surely does seem ambiguous for the term has blatantly been used in different ways by different players. That said, I would like to pursue a different line of reasoning here. On one hand, the word has evolved and when a word evolves, we don’t compare it to the original meaning and on the basis of the difference between them claim ambiguity. Doing so here would be a bit like saying that the meaning of the word “typewriter” is ambiguous for it initially referred to the person operating the machine. What is likewise significant, the original inventor and promulgator of the word does not get to determine what it means. 

More generally, words can have meaning and relevance on a number of different bases. One—and an important one it is—is a practical basis. Questions to ask, in this regard, include: does a given usage of the word sharply distinguish the phenomenon in question from separate albeit related phenomena? And does it establish a direction?  And what is clear is that activists who proclaim themselves antipsychiatry are using the term in a way that establishes a direction—abolition—and in the process, we have created a niche that distinguishes antipsychiatry very sharply from critical psychiatry. As such, antipsychiatry has an “evolved meaning” which is both unambiguous and useful. What is likewise relevant, of all of usages of the term that have surfaced over the years, this is the one—and this the only one—that stands out as “linguistically correct”. How so?

Closely examine the word “antipsychiatry”. It is a complex term composed of two parts, the first of which defines the orientation to be taken to the second. So there is “anti”, which means “against” and there is “psychiatry”, the meaning of which, alas, we all of know only too well.  “Anti” identifies the orientation toward psychiatry. Ergo, to be antipsychiatry, by the very logic of how language works, means to be against psychiatry. To be “against”, note, is blatantly different than “coming up with a new version thereof”, “reforming psychiatry”, or “modifying it” –which in essence is what critical psychiatry stands for. Two conclusions follow. The first is that the activists who are using the term “antipsychiatry” to designate an abolitionist position, which is what the vast majority of self-proclaimed antipsychiatry activists are doing today, are using it correctly.  The second—and we have already touched on this—is that it is not an ambiguous word, but one with a clear and precise meaning. To be antipsychiatry, in a nut shell, is to be “against psychiatry”, is to be committed to getting rid of it.

How does one square this reality with the early historical use of the term?  By acknowledging that words change meaning. Beyond this, however, by taking in that when Cooper invented the term “antipsychiatry”, what he did in effect is come up with a “misnomer”, for, while for sure he had issues with psychiatry, strictly speaking, he was not “against psychiatry”. The term was quickly accepted without anyone commenting on or seeming to notice the misnomer. What resulted from this acceptance of the term is that for a very long time everyone with a substantial critique of psychiatry got lumped together under this word. Come the modern activists—and survivors were absolutely pivotal to this change—slowly but surely, a huge turnabout happened. For the first time, the linguistic meaning of the word and what it was being used to designate actually came together! The upshot? Though the term “antipsychiatry” entered into our political vocabulary as a misnomer, what materialized in the fullness of time is a useful word associated with a clear position and a very important agenda. Correspondingly, there is no question whose meaning of the word is accurate.

Herein lie answers to most of the questions posed at this beginning of this article. Yes, the term is useful. No, it is not ambiguous. Yes, it is clear which usage to follow. No, it is not subject to degrees. In this last regard, to be clear, one may of course have a strong critique of psychiatry without wanting to get rid of it—but in that case one is “critical psychiatry”, not “antipsychiatry”. The same is true of people who call themselves antipsychiatry while taking the position, for example, that they only want to get rid of nonconsensual psychiatry, as vitally important as such an advance would be.

To fathom why I am saying this, look at comparable political terms in other areas—terms such as “antiracism” and “anti-sexism”. No one, for example, would say that they are avidly antiracist, but that being so does not imply that they want to stop all racism—just “non-consensual racism”. Nor would anyone say they are anti-ableist”, while meaning it is okay if people are ableist privately—that they are only against ableism that is institutionally organized—that they have no objection to other types.

Now if people opt to take a critical psychiatry position, they are, of course, free to do so. What would be helpful, however, is that they not confuse their own position with antipsychiatry, that they not turn an unambiguous term into a vague term, that they not conflate antipsychiatry with critical psychiatry, that they not, as it were, send us retreating back into the “grab bag category” era.

I am aware, of course, that there are people who straddle the divide between antipsychiatry and critical psychiatry, or to put this another way, between abolition and reform.  And of course, I respect people’s right to use words as they choose. In the interest of clarity, nonetheless, what I would encourage people who straddle these positions to do is try to articulate their stance without calling it antipsychiatry for despite the best of intentions—and I no way doubt the people’s intentions are honourable—doing otherwise does “muddy the waters”. And while I realize I am “stretching” here, I would encourage them more generally to ask themselves what is stopping them from taking an abolition position? And are there perhaps better ways of dealing with what worries them without taking a position which, for all intents and purposes, involves propping up a bogus and destructive system, lending it both power and legitimacy (for an article that illustrates that despite the best intentions, history shows again and again that this is where non-abolitionist reform leads, see https://www.madinamerica.com/2014/11/liberal-mental-health-reform-fail-proof-way-fail/)

By way of example, if they are worried that people need help—and who among us is not?—then how about working to establish participatory help networks which as well as being voluntary, do not empower psychiatry?  Correspondingly, if you are worried that people will be deprived of their way of coping if psychiatry is phased out—will be robbed of the drugs that get them through the day, for instance (obviously, a totally legitimate concern)—please note that there is nothing in the abolitionist agenda which implies “leaving people in the lurch”. Herein, let me suggest, lies the difference between thoughtful and thoughtless abolitionist work.

Now I will not be mounting a case for antipsychiatry in this article, for I have done so often in the past and such is not the purpose of this article. Suffice it to say at this point, that it has been demonstrated repeatedly by hundreds of solid theorists (both of the antipsychiatry and the critical psychiatry variety) that psychiatry lacks foundations, that it is a bogus branch of medicine, and that it overwhelmingly harms (see, for example Breggin 1992, Whitaker, 2010, and Burstow, 2015, and Gøtzsche, 2013). As such, however one imagines that happening, does it not make sense bringing it to an end? Nor is the issue of respecting people’s choices relevant, though understandably, this issue almost invariably pops up when people explain why they are not antipsychiatry. Of course people’s wishes need to be respected! That is absolutely non-negotiable. And of course, people need choices! As I have argued in detail elsewhere (see https://www.madinamerica.com/2014/07/consent-psychiatry-problematizing-problematic/), that is a totally separate issue from stopping bogus medicine from passing as real medicine, stopping the public funding of psychiatry and the industries surrounding it, stopping giving them power and legitimacy—which, not coincidentally, is a good part of what most of us mean by psychiatry abolition. Moreover, as likewise shown in the article referenced above, psychiatry overwhelmingly drives out choice; that is, it actually curtails the plethora of services that many want, while coopting whatever else exists.

As for those who are uncomfortable with the notion of abolition itself, while abolition may seem extreme to people, and I totally understand the impulse toward “moderation”, as I have argued elsewhere (see https://www.madinamerica.com/2014/11/liberal-mental-health-reform-fail-proof-way-fail, albeit commonly a wise position, “moderation” is not an answer to everything. If a practice or institution is fundamentally unacceptable (take “murder, take “slavery”) should we not be getting rid of it rather than just looking to develop a less horrific version? By the same token, while some are afraid of the concept because it seems tumultuous, note that there is nothing in the commitment to abolition that in any way involves a commitment to instantaneous overthrow. I would remind readers here of the painstakingly careful attrition model of psychiatry abolition, where bit by bit, you unravel psychiatry, supporting only those reforms which lead in the direction of abolition (for details on how to implement a strategy such as this, see Burstow, 2013). More generally, pursuing abolition intelligently, kindly, sensitively, in ways that take seriously the plight and the rights of everyone, that is precisely what good abolitionist work is about. 

To summarize, in short, the term “antipsychiatry” has a very clear meaning, a very clear goal. It carves out a totally distinct space. And its agenda is defensible, one might even say, necessary. More generally, the arguments against it do not hold. At most they apply to careless abolition work, which is in no way implied in the commitment to abolition.

That said, to quickly return to the early history with which this article began, learning that I was penning an article of this ilk, several days ago, one of my friends asked me this: Had Cooper lived long enough to see what both psychiatry and antipsychiatry were to become, do I think he himself would have endorsed an honest-to-God antipsychiatry vision? To share my answer with the reader, while it is hard to know for certain, my guess is probably not—or he would never have abandoned the term in the first place. My guess is that in part Cooper abandoned the term precisely because it began to dawn on him just how out-the-box it was. On the other hand, who is to say where he would have gone had he stayed in the field and found himself contending with the mega growth of biological psychiatry? Let me suggest, however, that even if he would not have endorsed antipsychiatry, besides that his endorsement is hardly needed, that would not make the term an iota less clear, or the antipsychiatry agenda an iota less pressing. What it would do rather is stand as yet another indicator of the limitations of social movement initiatives that originate from professionals as opposed to originating with the oppressed. In this regard, professionals can be important, even invaluable allies, and beyond that, brothers and sisters in struggle—and thankfully, we all know ones who are. Except under certain circumstances, however, professionals are simply not the oppressed. This notwithstanding, hats out to David Cooper for coming up with a term which was gutsier and even wiser than he knew!

Finally, in ending, to return to the enigma surrounding spelling which I hinted at early on, regardless of how you spell “antipsychiatry”, linguistically speaking, it means the same thing. Correspondingly, like Shakespeare who spelled the word “spear” in three different ways throughout his portfolios, I have always considered society’s preoccupation with “standard spelling” as at best pedantic. Nonetheless, a curious difference surfaces in the spelling of the term “antipsychiatry”. While the word that Cooper invented was hyphenated (as in “anti-psychiatry”) and while the vast majority of others who went on to employ it or reference it followed suit, there are generations of activists who have consistently spelt the word differently, in some cases even consciously intending a break with Cooper. In this regard, all thirty-two issues of the historical antipsychiatry magazine Phoenix Rising consistently used the non-hyphenated version, as have legions of antipsychiatry activists and their organizations (e.g., Resistance Against Psychiatry and Coalition Against Psychiatric Assault). I personally have published 7 books consistently employing the unhyphenated version and literally hundreds of articles. And all the writings of the iconic survivor author Don Weitz  (and his writings in this area date back to the 1970s) similarly uphold the spelling “antipsychiatry”.

Of course, spelling is “just spelling” and the vast majority of folks who come across your writing are unlikely to even notice the difference. So “no sweat” if you choose to retain whatever spelling you have been employing. This notwithstanding, if you want to stand in an almost forty year old tradition of people who have used “antipsychiatry” consistently to mean “abolition” (note, “antipsychiatry” without the hyphen has never been used in any other way), if you want to line up with the activists and radicals as distinct from the professionals, if you want to stand your ground as an abolitionist visionary, do consider joining us and bidding the hyphen “adieu”.

References

Breggin, P. (1991). Toxic psychiatry. New York: St. Martins Press.
Burstow, B. (2013). The withering of psychiatry: An attrition model for antipsychiatry. In B. Burstow, B. LeFrançois, and S. Diamond (Eds.). Psychiatry disrupted (pp. 34-51). Montreal: McGill-Queen’s University Press.       
Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave.
Diamond. S. (2012). Against the medicalization of humanity. Doctoral Thesis. Toronto: University of Toronto.
Cooper, D. (1967). (Ed.). Psychiatry and antipsychiatry. London: Paladin.
Foucault, M. (1980). Power/Knowledge (C. Gordon, Trans.). New York: Pantheon.
Laing, R. D. (1965). The divided self. London: Pelican Books.
Gøtzsche, P. (2013). Deadly medicine and organized crime. New York: Radcliffe.
Szasz, T. (1961). The myth of mental illness. New York: Paul B. Hoeber.
Szasz, T. (2009). Antipsychiatry: Quackery squared. Syracuse, New York: Syracuse University Press.
Whitaker, R. (2010). Anatomy of an epidemic. New York: Broadway Paperbacks.