Protesting Shock: A Moral/Existential Calling

After 14 months…I returned home to a family I had no memory of. I didn’t know how to be a mother to my young sons or a wife for my husband. I had to learn my name, how to speak, do up buttons, brush my teeth and so on. I didn’t even know my own parents, sisters, brothers. My social work career and law aspirations vanished. (public hearing testimony, ECT survivor Wendy Funk, from Coalition Against Psychiatric Assault, tape 1, 2005)

The context of this article is ECT. ECT is a medical procedure—correction, a procedure deemed medical. The point here is, despite the fact that it is administered in hospitals by people known as doctors, by any normal understanding of the term, it cannot justifiably be termed “medical” for such naming presupposes that something is medically wrong with the person—and yet there is no proof whatever that such is the case with prospective ECT recipients. That is, there is no edema, no cell deterioration, no irregular readings, no inflammation. Moreover, it presupposes that said medical problem is corrected by the “procedure”—when solid evidence establishes that on the contrary, medical problems are thereby created where none existed before (for details see Breggin, 1991).

That understood, what concretely is ECT? It is an experimental treatment which involves passing sufficient electricity through the brain to produce a grand mal seizure. How does it work? For most of the history of ECT, doctors who promote it have answered this question with the standard claim that they do not know how it works—only that it works. The latest claim is that they have at long last figured out the answer and that it works by stimulating the production of new brain cells, all of which are healthy (e.g., Abrams, 2002). Are new brains cells indeed produced? Indeed, they are. However, what professionals making such a claim fail to tell the public is that overwhelmingly, ECT annihilates brain cells, that the brain cells thereby annihilated were in fact perfectly healthy, and what new brain cells do appear (the phenomenon is called “neurogenesis”) are irregular, the product of brain damage, and are themselves accepted indicators of brain damage (see Zarubenko et al., 2005, and Greenberg, 2007).

That noted, ECT has been proven conclusively to cause extensive brain damage (see Zarubenko et al., 2005) and extensive and enduring cognitive impairment—memory loss in particular (see Breggin 1991 and Sackeim et al., 2007). Moreover, however the so-called therapeutic effect may be theorized, it has been demonstrated to be no more effective than placebo (see, for example, Ross, 2006). Now admittedly, there have been ample studies that report effectiveness. As clearly demonstrated by Read and Bentall (2010) though, such studies are inherently flawed, with, for example, no criterion of improvement provided or improvement being predicated solely on the subjective opinion of caregivers. Correspondingly, as research like Van Daalen-Smith’s (2011) suggests, there is a dramatic mismatch between the subjective assessment of care-givers and survivors’ self-assessment (what is apropos here, in the weeks following ECT, Van Daalen-Smith interviewed both shock survivors and the nurses caring for them. All of the shock survivors assessed their state as deteriorated, as opposed to all of their nurses, who to a person assessed the condition of these very same “patients” as improved). Additionally, and what is not surprising given what has been revealed to date, as Breggin (1991) and Burstow (2015) have demonstrated, there is a one-to-one ratio between the damage done and the so-called therapeutic effect. An added reality which helps one ferret out the truth of what is happening here is that ECT is overwhelmingly given to two particular constituencies—women and the elderly (for a strong feminist and anti-ageist analysis, see Burstow, 2006), albeit the largest and most extensive study in ECT history (Sackeim et al., 2007) conclusively establishes that these are the very groups that incur the greatest damage from the procedure. 

If the best conducted research invalidates the use of ECT—and as can be seen, it does—personal testimony is at least as damning. Indeed, the history of shock is a history of survivor after survivor testifying that their lives have been devastated, of survivors bearing witness to inability to remember, to massive cognitive impairment, to inability to carry down even the simplest of jobs (see Burstow, 2006). In short, the best scientific evidence and survivor testimony concur. What do they show? That ECT is not just slightly but profoundly damaging. That ECT is in essence a diminishment of the person. That, in short, ECT is anything but a valid medical procedure. Now while mounting evidence continues to pour in, these basic facts about ECT have long been known. And yet the treatment continues unabated. Hence the call for abolition. And hence the protests. 

I have called this article “Protesting ECT”. If ECT is the ultimate context of this article, the more immediate context is indeed a protest. On May 16 2015—an international day of protest against ECT is being held. In this respect, several months ago, a call was issued by three survivors—Ted Chabasinski in California, Mary Maddock in Ireland, and Debra Schwartzkopff in Oregon—inviting survivors and their allies throughout the world to take part in an international day of protest against electroshock (for details, see Chabasinski, 2015). This article is leveraging the occasion of that protest to focus in on shock protest more generally —its nature, why we should engage in it, what we get from it, and in the process, it probes the still larger question of protest. Questions taken up include: What exactly happens when people protest? What is a protest? Why is it important to protest shock? In itself? In the context of psychiatry as a whole?  And what makes the action currently being planned significant?

To begin with the obvious, it is important to protest ECT precisely because, however it may be theorized or intended, ECT is in its very essence injurious—that is, it is not simply incidentally but is inherently injurious (the fact that it is being done in the name of help, I would add, in no way alters the equation). What is called ECT “working”, to put this another way, as can be seen, is precisely the effects of damage. Correspondingly, not just the short but the long term effects are devastating. When people are being subjected to brain damage, when people are being seriously impeded in their ongoing ability to navigate their lives, when, as so often happens, the memory of even those nearest and dearest is obliterated, when decades later people still have to write notes incessantly to get through the day because of a “procedure” to which they have been subjected, however commonplace or cosmeticized what is happening may be, we are witnessing something violent, something objectionable—that is, something that calls out for protest. In saying this, note, I am making a moral claim. At the same time, I am making an existential claim that goes to the heart of what protest is about. 

What is protest? If images of marching in the streets come to mind—and for sure, these are examples of protest—and you are tempted to say that it is a formal political challenge, let me suggest, that at its core, it is far more basic than that. It is a fundamental dimension of our being-in-the-world and of our being-with-others.  In this respect, protest is a deeply existential phenomenon. It is a way of saying “no”, of saying that “I won’t tolerate this.” And note, from our earliest years, even as infants, we have a human need to say “no” when something does not sit right. And indeed, saying “no” at such times is part and parcel of our authentic being-with one another, as it were, of our moral contract.

I am reminded here of the film The Wild Child by François Truffaut (see http://en.wikipedia.org/wiki/The_Wild_Child). In this film, as a test, the scientist at one point punishes the human creature/child that he had brought in from the wild, albeit well aware that the child had done nothing wrong. What then happened? The child protested. The scientist was reassured at seeing the protest. Leaving aside the inevitable question of the morality of forcing “civilization” upon the child in the first place or even of conducting such tests, why was the scientist reassured? Precisely because such protest signified that the child grasped the basic human covenant which we have with one another, knew that protest was called for, and responded accordingly.

Organized public protest such as the one being planned for May 16 is a variant of this existential dynamic, while turning protest into a collective action which binds people together while reaching more concretely into the public. It is a way of asserting that “we” (whoever the “we” may be) see what is happening as unacceptable; beyond this, that we are joined together in asserting loud and clear that it is unacceptable; moreover, we are appealing to others around us and/or those who may happen upon our protest to see it similarly, to bear witness to something that it outside the realm of what is tolerable, and we are demanding action. Given this latter dimension especially, I would add, there is a clear moral appeal and moral demand at the core of public protest.

I am aware of course that there are people (and no, not movement people) who cannot imagine protesting against those deemed helpers. I would suggest, though, if anything, the fact of the designation just adds to the injury for it means that betrayal of trust is involved. Correspondingly, when damage of such proportions is being done and, indeed, done with no upside, when it is accompanied by systemic deception, moreover, unleashed on vulnerable populations, irrespective of whether or not those engaged in these actions are called helpers or are convinced that they are doing good, why would one not protest?

To clear, I am in no way suggesting that public protest is invariably the best strategy. This notwithstanding, there is an upside to such action even in those instances when in the short run, it appears to bring us no closer to our goals. And that upside is precisely the witnessing engendered, together with the existential and moral factors highlighted above. All of which makes anti-ECT protest intrinsically meaningful.

Now the fact that I am taking this at least seemingly non-strategic position, I am aware, may surprise some, for I am a staunch advocate of strategic activism (see, for example, Burstow, 2014a) and the direction being highlighted here appears to conflict with the call for strategic activism. That noted, let me suggest that the strategic and the existential/relational are not mutually exclusive. In this regard, one may sometimes emphasize one dimension, sometimes the other, and at times one may be able to bring them together. Correspondingly, what is more basic here, while tailoring one’s activities strategically so that they serve our goals (read: morally called-for goals) is an important value, so is standing up and being counted. What is likewise relevant, even when it comes to the question of effectiveness itself, straight line thinking does not always serve us, for we never know when a mode of resistance that appears to have no impact will suddenly become a “game-changer”—such is the power of the existential.

What does this boil down to? It is important to protest shock whether or not such protest can be reasonably judged as likely to be effective. What relates to this, social protest with respect to recurring injury has a special significance in that it is a means of keeping faith with people across time. In the case of shock, it keeps faith with those who have been injured in the past. It keeps faith with those currently being beset. And it keeps faith with the prospective victims of the future— herein lies a commitment, however hard it may be to bring it to fruition, to such concepts as “never again”.

To turn to the action at hand, if protesting shock in general is important, this particular ECT initiative is particularly important. Why? Because it was initiated by and to a large extent is being organized by shock survivors themselves—and as such, is first order protest (that is, protest by those centrally affected). Because survivors and their allies are standing up together. Because it is part of the insurrection of subjugated knowledge (“subjugated” knowledge is the disallowed knowledge of the oppressed; see Foucault, 1980). Because it announces to the world that survivors are a constituency that can no longer be ruled/overruled. Because of the sheer size of it. It is significant in this regard that the action being planned is by far the largest international protest against shock in history. Note, twenty-eight cities had signed on when last I checked, and in no past international protest has there been more than five (achieved in the Mother’s Day Protest organized by Coalition Against Psychiatric Assault in 2011). What the sheer size, together with the survivor and the global quality signifies is that there is massive dissatisfaction with this this “treatment”, and there is a growing commitment to resist. Correspondingly, it delivers a tangible message to the public. What does it tell the public? No, ECT was not stopped years ago. No, it is not the “improved”  and benign procedure of psychiatry’s messaging. No, it is not true that most people greatly benefit from shock—in fact, quite the opposite. No, we will not be quiet about it.  And yes, there is an onus on you to do something about it.

That said, while these are primary reasons to protest ECT and while they are existential in nature, there are also formidable non-existential reasons. Whether directly or indirectly, some of these link up with the psychiatry abolitionist agenda. And it is here where the question of strategy enters in.

The point is, while it is important to protest regardless, strategic considerations themselves call for a targeting of ECT. To concretize this, insofar as we want to make inroads in reining in psychiatry, prioritizing a procedure that most psychiatrists themselves refrain from employing and which the public to varying degrees fear makes sense. Why? Because people know on some level that it is woefully misguided, even if they do not admit to themselves that they know. Correspondingly, as something that the general public inherently recognizes as violent, ECT can serve as a symbol of the violent nature of psychiatry overall. That is, it can be employed as a sensitizer, as an aid in making manifest what is now covert, and as such, unrecognized. What relates to this and is likewise significant, insofar as an attrition model of psychiatry abolition is followed, the abolition of ECT is an obvious place to begin (for a discussion of psychiatry abolition and the attrition model, see Burstow, 2014a and 2014b) Why? Again, precisely because the violence is more obvious, precisely because most psychiatrists do not practice it, moreover, because of all the fights facing our movement, arguably, it is the fight that can be most readily won.

A different but likewise strategic reason to prioritize anti-ECT protests relates back to the existential point made earlier about the nature of public protests, more pointedly, about how such processes existentially unite us as a “we” (for further elucidation on the concept, see Sartre. 1946/1953). Whatever we call this movement against psychiatry, whether it be “critical psychiatry”, “antipsychiatry”, “the mad movement”, “the disability rights movement”, or “the survivor movement”, like every other movement, it is beset by differences that pull its members apart. What is of strategic significance about ECT is that our attitude toward ECT for the most part draws us together. How so? Because overwhelmingly, movement people recognize how utterly beyond the pale ECT is. Correspondingly, insofar as this is the case, a focus on shock intensifies the cohesion inherent in protest generally, and as such, shock protest can be a potent force for movement building.

In Summation

To return to the question with which this query began, why should we be protesting ECT? To summarize, because of what both shock and human protest are, as it were, “all about”; because shock is so damaging as to be unacceptable; because in so protesting, we are expressed our own humanity in the deepest sense of the term; because it involves bearing witness to what screams out to be witnessed; because shock protest is something owed those violated, whether the people violated be ourselves or others; because it allows us to join together, to stand up together and be counted; because it is a way of keeping faith with people have already been or might yet be subjected to ECT; because such protest is part and parcel of the insurrection of subjugated knowledge. These are reasons of relevance to everyone, that place some degree of demand on everyone, and while no one can actively (capital “p”) Protest every injustice, besides that this one is especially egregious, people can always do something, however minimal, to register protest. Additionally, it makes sense for adherents of antipsychiatry/critical psychiatry to both actively protest and to prioritize shock protest not only for the moral/existential reasons listed above and not only because this is our community (meaningful in itself), but because doing so is strategic in that ECT acts as a symbol, because such protest lays bare the covert nature of psychiatry generally, because it fits with an abolition agenda, because it contributes to movement building.

That said, to return to the context which occasioned this article: On May 16^th  2015, at the instigation of shock survivors, people across the world—from the US, to Canada, to Ireland, to Brazil, to Uruguay—will be joined together in protest. I applaud all those who have taken up this task—who are planning, making posters, blogging, talking to the press. I wish everyone the best in their various efforts that day and, indeed, in all subsequent ECT protests; and I encourage folk outside the antipsychiatry and critical psychiatry fold to consider joining in. Note, if is it is a moral/existential calling, it is also a mitzvah to stand up for justice, or to use feminist Kate Millet’s descriptor for protests of this ilk (personal correspondence), to stand up for the mind. Hopefully, the article has added a new dimension of understanding, and, in the process, however modestly, contributed to the action and the cause. Correspondingly, in the spirit of solidarity, in ending, as one human being to another (read: one protestor to another), I leave you with a modified version of the Anti-Shock Proclamation, which I penned in 2011.

Please feel free to draw on it should you find it of any assistance to you, whether in this or in subsequent protests:

The Anti-Shock Proclamation

We who care,

We who are committed to decency,

We who behold with horror the disrespect for human life around us,   

We who shudder at the knowledge

Of women whose memory has been turned into ember and ashes, 

Of families brutally torn asunder by pulse waves or sine waves,

Of the elderly, whose final life reward is electrocution,  

We who hold this fearful knowledge can be silent no longer.

LEGISLATORS, on this day of international protest, May 16 2015, we hold you directly accountable and call on you to withdraw your authorization for electroshock.   

FELLOW CITIZENS who think this “practice” stopped decades ago, on this day of protest, May 16, 2015,

We tell you that the carnage continues and that you too are responsible. 

On this day of protest, May 16^th 2015, as survivors and allies, we come together to raise our voices in protest,

And we vow to return,

To return,

And return again 

Until this abomination

Is no more.  

(For more extensive analyses, see Burstow, 2015, Chapter Eight).

References

Abrams, R. (2002). Electroconvulsive therapy (4th. ed.). New York: Oxford University Press.

Breggin, P. (1991). Toxic psychiatry. New York: St. Martins Press.

Burstow, B. (2006). Electroshock as a form of violence against women. Violence Against Women, 12 (4), 372-392.

Burstow, B. (2014a). 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. (2014b). On the attrition model of psychiatry abolition. Retrieved on March 27, 2015 from http://www.bizomadness.blogspot.ca/2014/07/in-recently-released-article-i-provided.html.

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

Chabasinski, T. (2015). May 16, 2015: The international day of protest. Retrieved on March 27, 2015 from http://www.madinamerica.com/2015/03/may-16-2015-international-day-protest-shock-treatment/

Coalition Against Psychiatric Assault (2005). Narratives from Inquiry into Psychiatry. Retrieved on April 6, 2013 from http://coalitionagainstpsychiatricassault.wordpress.com/articles/personal-narratives.

Foucault, M. (1980). Power knowledge. New York: Pantheon.

Greenberg, D. (2007). Neurogenesis and stroke. CNS and neurological disorders-drug target, 6, 231-325.

Read, J. & Bentall, R. (2010). The effectiveness of electroconvulsive therapy: A literature review. Epidemiologia e Psichiatria Sociale, 19, 333 ff.

Ross, C. (2006). The sham ECT literature: Implications for consent to ECT. Ethical Human Psychology and Psychiatry, 8, 17-28.

Sackeim, H., Prudic, J., Fuller, R., Kielp, J., Lavori, P., & Olfson, M. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244-255.

Sartre, J.-P. (1943/1956). Being and nothingness (Hazel Barnes, Trans.) New York: Pocket Books.

Van Daalen-Smith, C. (2011). Waiting for oblivion: Women’s experiences with electroshock. Journal of Mental Health Nursing, 32, 457-472.

Zarubenko, I., Yakolev, A., Stepanichev, M., & Gulyaeva, N. (2005). Electroconvulsive shock induces neuron death in the hippocampus: Correlation of neurodegeneration with convulsive activity. Neuroscience and Behavioral Science, 35, 715-721.

Timeline for Upcoming Events Surrounding Bonnie Burstow’s Grounding-breaking New Book: Psychiatry and the Business of Madness

First week of April: Psychiatry and the Business of Madness is released by Palgrave Macmillan.

April/May: The book is highlighted by publisher re “Mental Health Awareness” Week.

June 12th, 7:00 p.m.: The kickoff book launch, The London England Book Launch (Place: Palgrave Macmillan, the Stables Building, 2 Trematron Walk, London, England. Speakers: author Dr. Bonnie Burstow, critical practitioner Dr. Ian Parker, survivor/activist Cheryl Prax, and researcher Julie Wood. If intending to come, rsvp lauren8spring@gmail.com)

June 17^th, 4:00-5:00 eastern time: guest on The Dr. Peter Breggin Hour (to listen to show live, go to http://www.prn.fm By the following day the show will be permanently available at this link). 

June 27th, 8 p.m.-10:00 p.m. eastern time: guest on Talk with Tenney: Pre-Launch of Bonnie Burstow’s Psychiatry and the Business of Madness. Blog radio (for information, see http://www.blogtalkradio.com/talkwithtenney/2015/06/28/talk-with-tenney-pre-launch-burstows-psychiatry-and-the-business-of-madness

June 29^th,  7:00 p.m.: The North American Debut: The New York Book Launch (Place, Bluestockings, 172 Allen St., New York, NY. Speakers: author Dr. Bonnie Burstow, radical psychiatrist Dr. Peter Breggin, feminist psychologist Dr. Paula J. Caplan, and survivor/activist/scholar Dr. Lauren Tenney. Survivor speak-out at end facilitated by leading survivor activists Lauren Tenney and Celia Brown).

September 18^th, 3:30 p.m.: The Press Conference (Place, 7^th floor, room 162, Ontario Institute for Studies in Education, 252 Bloor St. West, Toronto, M5S 1V6. Speakers: author Dr. Bonnie Burstow, MPP Cheri DiNovo, lawyer Anita Szigeti, and survivor/activist/MSW student Rebecca Ballen).

September 18th, 5:30 p.m.: The Canadian Debut, the book launch to end all launches, the huge Toronto Book Launch. Place: The Nexus Lounge, 12^th Floor, Ontario Institute for Studies in Education, 252 Bloor St. West, Toronto, M5S 1V6. Speakers: author Dr. Bonnie Burstow, award-winning journalist Robert Whitaker, scholar Dr. David Cohen, MPP Cheri DiNovo, and lawyer Anita Szigeti).

About the book: Psychiatry and the Business of Madness deconstructs psychiatric discourse and practice, exposes the self-interest at the core of the psychiatric/psychopharmacological enterprise, and demonstrates that psychiatry is epistemologically and ethically irredeemable. Burstow's medical and historical research and in-depth interviews demonstrate that the paradigm is untenable, that psychiatry is pseudo-medicine, that the "treatments" do not "correct" disorders but cause them. Burstow fundamentally challenges our right to incarcerate or otherwise subdue those we find distressing. She invites the reader to rethink how society addresses these problems, and gives concrete suggestions for societal transformation, with "services" grounded in the community. A compelling piece of scholarship, impeccable in its logic, unwavering in its moral commitment, and revolutionary in its implications.

For more information & updates, see @BizOMadness and http://bizomadness.blogspot.ca/

For link to publisher and purchase information, see

https://drive.google.com/file/d/0B39eB1GoDYuQbkZGWUd3SmZURHc/view?usp=sharing

Commencing a Dialogue

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

Szasz, T. (1961) The myth of mental illness. New York: Paul B. Hoeber.

Szasz T. (1987). Insanity: The idea and its consequences. New York: John Wiley and Sons.

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

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