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

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

Saturday, July 12, 2014

On the Attrition Model of Psychiatry Abolition

In a recently released article I provided an overview of antipsychiatry, teasing out its features and both its overlaps with and differences from related movements and constituencies (Burstow, 2014; see http://bizomadness.blogspot.ca/2014/07/on-antipsychiatry.html). Necessarily, the commitment to psychiatry abolition emerged as definitional as well as pivotal. In this article, I will be attempting to shed further light by clarifying and probing a particular model of psychiatry abolition. The question being addressed here is: Okay, so you know what you want—but just how do you go about figuring out what to do? A question that has been plaguing the movement for some time.

A brief history: For the longest time, while antipsychiatry activists were clear about the abolitionist goal, virtually nothing was written on how to achieve it. No articulation, no models, not even, for that matter, debates—exactly. This much, nonetheless, was obvious to most: So powerful and so firmly entrenched in the state is institutional psychiatry, that it was not about to disappear any time soon, no matter how valid the reasons for discarding it, how many scandals come to light, or how astutely those who oppose it proceed. Here is a reality that left all abolitionists shaking their heads. What at once arose from and further contributed to the conundrum, antipsychiatry activists had difficulty prioritizing actions, also choosing when to actively support and when to “pass” on initiatives developed by other constituencies. It is not that there were not rationales given, sometimes cogent ones, for pursuing some paths and avoided others, but there was a lack of consistency and oftentimes choices were made on the sole basis that the action in question was one in which everyone had always engaged. As such, it gradually became clear that a decision-making model specifically geared to antipsychiatry was needed. It was in this context and with this understanding that in 2010, as a keynote at the international PsychOut Conference in Toronto, I introduced a model for prison abolition—what I call the “attrition model” (see Burstow, 2010--http://individual.utoronto.ca/psychout/papers/burstow_keynote.html). This model was subsequently adopted by Coalition Against Psychiatric Assault (CAPA). I articulate it in this article so that people can get a sense of it and assess its possible usefulness.

The model was inspired by and is loosely based on an attrition model developed in the 1970s for a neighbouring social justice movement—prison abolition. Significantly, that model to varying degrees underpins “penal abolition” to this day. The attrition model for prison abolition is predicated on two key premises: 1) that an entrenched institution like prison will not quickly disappear and so working at gradually wearing it away is the most judicious way to proceed; the issue then is to assess each potential move carefully to see if it is likely to advance things “in the right direction”; 2) one can easily be deceived over what constitutes “progress”; a change which looks like “a move in the right direction” may in fact only be further entrenching or indeed actually expanding the prison system (see Mathiesen, 1974 and Knopp, 1976). Substitute “institutional psychiatry” for “prisons”—and you can see the fit here—and an attrition model for psychiatry abolition begins to take shape.  

The attrition model for psychiatry abolition, as I have articulated it, centres on three “definitional” or “touchstone” questions which antipsychiatry activists are asked to keep firmly in mind when considering an action or direction:

1)    If successful, will the actions or campaigns that we are considering move us closer to the long-range goal of psychiatry abolition?
2)    Are they likely to avoid improving or giving added legitimacy to the current system?
3)    Do they avoid widening psychiatry’s net (creating conditions that allow psychiatry to scoop up, as it were, ever more people; see http://coalitionagainstpsychiatricassault.wordpress.com/attrition-model)?

Question one is the most fundamental of the questions asked. The purpose of asking it directly is to help activists stop themselves from getting sidetracked into focusing on otherwise benign actions and missions which in no way contribute to attrition (an example might be measures aimed at securing pocket money for people “on the inside”—a good thing in itself, but a questionable preoccupation for an abolitionist per se, given it brings us no closer to the ultimate goal.

With question two (are they likely to avoid improving or giving added legitimacy to the system?), psychiatry abolitionists more clearly part company with psychiatry reformers. The point underlying the question is that all sorts of actions, including many actively spearheaded by concerned people in related constituencies, serve to lend psychiatry legitimacy or in some way “improve psychiatry”. As such, however good the intention and whatever benefit certain people may derive (reasons why others might support them) they function to protect, support, and possibly expand psychiatry, and as such, should not be taken up by abolitionists. An example of the type of action that lends legitimacy to psychiatry is co-creating and mounting community/cultural events in concert with psychiatric institutions—festivals, theatre, celebrations. For examples of “improving psychiatry”, we need look no further than the long standing historic attempts of different players to exert a corrective influence on the DSM, arguing for the tweaking of some “diagnostic categories” or the removal of others. To be clear, I fully sympathize with people’s desire to intercede here, especially when it comes to groups uniquely oppressed by these categories. This notwithstanding, on a very basic level, even engaging in such advocacy has an unintended but unavoidable consequence: By the very act of everyone privileging the psychiatric text this way, such advocacy further ensconces the DSM as the go-to book—and as such, reinforces the centrality of psychiatry’s most formidable boss text (an institutional ethnography term; see Smith, 2005). Nor does the service to psychiatry stop here. Take the gutsy and very understandable fight to remove “homosexuality” from the DSM, which unfolded in the early 70s. While of course no one committed to social justice wants these highly oppressive definitions and categories, what in fact did this campaign succeed in doing? Making it look as if being lesbian or gay was no longer covered by “diagnoses”, when in fact new diagnoses which pathologized lesbians and gays such as “ego-dystonic homosexuality” were quickly and quietly introduced in place of the diagnosis removed (for a discussion of these diagnoses and this strategy, see Burstow, 1990); creating/recreating the classical “us-them” division, with activists involved in the campaign distinguishing between people who allegedly really were “mentally ill” and “gays” (see Teal, 1971). Moreover, it helped institutional psychiatry appear progressive—something to support. Ironically and sadly, it even proved to be a formidable factor in the ascendancy of biological psychiatry (for a discussion of how this happened, see Kirk and Kutchins, 1992 and 1997). In other words,, the consequences for the most part were decidedly negative. While it might not have been possible to predict the enormous boost this would give to biological psychiatry, the rest indeed could have been figured out—not something one can exactly expect of others, but herein lies the hard work of evaluating which abolitionists avoid at the cost of undermining their own goal. Hence the importance of taking care in assessing the likely long run impact of any action on psychiatric rule. And hence the significance of the second question.

Likewise crucial and likewise complicated is the third question: Do they [the actions being considered] avoid widening psychiatry’s net? What this guideline is inviting activists to do is avoid any action, which if successful, is likely to increase the number of people subjected to psychiatric rule. Again this is irrespective of whether or not the action is otherwise benign. Examples of initiatives, however seemingly benign, which would in point of fact “widen the net” are new services which are either performed by psychiatry or have a demonstrable tie-in with psychiatry. Think about how direly certain services are needed—services for battered women in isolated northern Canadian communities, say, or services for trans youth who have become homeless—and you can see how easy it would be to overlook or rationalize the hook-in with psychiatry which accompanies them. What this model is inviting us to look at and take seriously is this: If we make such a deal and we accept the expansion of psychiatry into some area as a necessary tradeoff in order to get “services”, whatever may or may not happen in the short run, our primary long term achievement is precisely the expansion of psychiatry, that, paradoxically, together with eventual endangerment of the very population that we were endeavouring to assist. While the expansion of psychiatry may seem like a minor hiccup or “side effect”, the point is, as with the psychiatric drugs, the “side effect” is the major effect.

Tricky though it may be at times—and you can see that it is—the long term benefits of such a model are obvious. As is evident from the examples, it would help abolitionists avoid seemingly benign actions that would preserve the status quo—or worse—that might otherwise be very easy to slip into. Moreover, the model would readily facilitate prioritization. While it is beyond the scope of this piece to spell out the various prioritizing that might emerge, for example, it could be argued that the disappearance of various noxious “treatments” has the potential to erode psychiatry, and as such, use of the model would lead to the prioritization of campaigns such as those against ECT. Other priorities that I can see emerging are the rescinding of key pieces of legislation (e.g., out-patient committal laws and involuntary “hospitalization”); the launching of law suits against “hospitals”, individual doctors, the pharmaceutical companies, moreover, the state; the curtailing of psychiatry’s “right” to “treat” without consent; and the creation of “befriending” networks independent of government and professionals (for a fuller articulation, see Burstow, 2010 and Burstow, “Psychiatry and the Business of Madness”). 

Here then is the model as I have developed it and its possible usefulness. I leave it to antipsychiatry organizations to determine for themselves if and how it might serve them. An observation: The Coalition Against Psychiatric Assault adopted this model at its 2005 retreat. It was contentious at the time and so was taken up on a trial basis only, to be reassessed in one year’s time. Come the 2006 retreat, every member to a person endorsed making its adoption permanent—so helpful had it proved in establishing direction, settling disagreements, and getting our bearings. Not that it was consulted as a matter of course, but now and again in the midst of a heated disagreement or a decision that initially seemed simple, a light would go on in someone’s eye and the person would ask, “But what about our model?”—and a unique space for thinking and planning materialized.

That noted, a few questions in ending: While the attrition model has obvious relevance to antipsychiatry activists, would this model or a modified version thereof be of any use to other constituencies who organize against psychiatry? Has it the potential, for instance, to illuminate the path of mad theorists or critical psychiatry theorists who are not abolitionists per se? Possibly, yes, though not in any easy or straight forward way. The point is that it is likely to “complexify” decisions or directions that now seem simple or obvious—in itself, a good thing—but people would need to want to take that on.  

Finally: Is attrition per se the only major factor that an abolitionist need consider? At the risk of further complicating an already complicated issue, my answer would be no. Besides that the future, while crucial to keep sight of, can never be our only concern, it is not enough to rid ourselves of psychiatry. If that is all we accomplished, psychiatry could easily be replaced by a new form of ruling that is just as powerful, that is just as all-encompassing, also—dare we imagine it?—that is every bit as damaging. Moreover, if we as a society want something better, we need to sow the seeds now.

But that is a topic for a different article.


Burstow, B. (1990). A history of psychiatric homophobia. Phoenix Rising, 8, S38-S39.

Burstow (2010).  The withering away of psychiatry: An attrition model for antipsychiatry (http://individual.utoronto.ca/psychout/papers/burstow_keynote.html).

Burstow, B. (2014). On antipsychiatry. http://bizomadness.blogspot.ca/2014/07/on-antipsychiatry.html).

Kirk, S. and Kutchins, H. (1992). The selling of the DSM. New Brunswick, New Jersey: Transaction Publishers.

Kirk, S. and Kutchins, H. (1997). Making us crazy. New York: The Free Press.

Knopp, F. (1976). Instead of prisons: A handbook for prison abolitionists. New York: Prison Research Educational Project.

Mathiesen, T. (1974).The politics of abolition. New York: Halstead Press.

Smith, D. (2005). Institutional ethnography: A sociology for people. Toronto: University of Toronto Press.

Tiel, D. (1971). The gay militants. New York: Stein and Day.

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