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.
