Psychiatry's Poor Image: Reflecting on Psychiatrists' "Apologias"

Those of us who critique psychiatry were recently treated to an interesting phenomenon—the publicly available part of the January 2015 issues of Acta Psychiatrica Scandinavica, which contains multiple articles devoted to the question of psychiatry’s “poor image”—how to understand it, how to assess it, what to do about it (see http://onlinelibrary.wiley.com/doi/10.1111/acps.2014.131.issue-1/issuetoc). The release of this issue is hardly the first occasion where articles have appeared in which psychiatrists have speculated on outsiders’ negative image of the profession. Indeed, more and more, we are seeing such articles together with other evidence that the professionals are concerned (e.g., Bhugra and Moran, 2014; and Oxtoby, 2008). What makes this issue special is that there is a sizable number of commentators; moreover, they include such leading figures as Gaebel, current President of the European Psychiatric Association, Wasserman, former President of the European Psychiatric Association, and Bhugra, President of the World Psychiatric Association. Could it be that the upper echelons of psychiatry, whether they admit or not, are becoming alarmed? Regardless, these psychiatric reflections are themselves a source of data—hence this article.

This article probes the collection in question for themes, positions, framing. Questions explored include: What positions are being taken? How valid are they? Insofar as constructions are never “innocent” but invariably have a function, what functions are being served? What do these articles tell us about psychiatrists? About the state of psychiatry?  How successful are the proffered solutions likely to be in resuscitating the “image of psychiatry”? And what should we be wary of here? 

The Special Issue in a Nutshell

The majority of the special issue is tightly focused on the image question. At the centre of the issue is a piece/study by Stuart et al. (2015). Counting the study and the two editorials, there are 10 pieces focused on this question in all.

The Stuart et al. article is in essence the write-up of a study conducted on non-psychiatric medical faculty’s opinions of psychiatry. 1057 faculty members were sampled. The major findings? The majority hold a very negative view of psychiatry, of psychiatrists, and as well as of their “patients”. Ninety per cent thought that psychiatrists were poor role models. One in five thought that psychiatrists have too much power over “their patients”.  Many questioned the efficacy of the treatments. Additionally, many saw psychiatrists as having poor medical skills and deemed psychiatrists to be illogical. Correspondingly, “the majority felt that students in their medical school were not interested in pursuing a psychiatric specialization” (p. 24), with over a third opining that “their colleagues generally do not speak well of psychiatry.” (p. 24). By way of commentary, the authors of the study note that there is no clear way to distinguish how much of the poor image may be attributed to being part of a “stigmatized group” and how much is attributable to accurate perception. Correspondingly, they link these perceptions to the low number of medical students choosing psychiatry as their specialty.

In the related pieces, authors comment not only on this article but more generally on psychiatry’s image— overall, whether it is indeed bad or not, and insofar as there is a problem, who is at fault and what to do about it.

The Most Important Question Never Emerges

Before I proceed further, I would point out that there is a conspicuous void in this collection. While all authors in their own different ways address what might be done to improve psychiatry’s image, significantly, not a single psychiatrist thinks to ask what by humanistic standards would appear to be the compulsory question: Insofar as any of the bad image is deserved, exactly how are the “patients” being ill served and what is owed them? With one exception only —and we will shortly see why he is an exception—nor does anyone seem to take in that in all likelihood, in dialoguing with each other, they are talking to the wrong people. The point is, insofar as this poor image in any way merited and in any way relates to practice—and it is arguably arrogant just to assume otherwise—it is not so much their colleagues with whom they most need to be in dialogue but the people whose situations they appear to badly misunderstand. What relates to this and is similarly worrisome, “patients” are discussed only insofar as psychiatrists speculate that part of the image problem arises from “stigma” against the “patients” being transferred to the psychiatrists. Nor is improving care per se a major theme. All of which suggest that advancing the profession is taking precedence over the welfare of the people “served”.

What the Focal Piece and the Introductions Set Up

There is somewhat more objectivity in the focal piece by Stuart et al. and in the two editorials than in most of the related psychiatric pieces. This notwithstanding, each constructs the inquiry and the issue in such a way that prejudice on the part of others appears as potentially the single most important factor in accounting for the poor image—and as such, they are hardly neutral. What is apropos here, the study itself was conceptualized in the context of trying to address “stigma” against psychiatrists—hardly a legitimate way to theorize critiques of a profession whose views are hegemonic and which is endowed with huge resources and massive power (not that I am ruling out the possibility of non-psychiatric doctors being unfair to psychiatrists). More particularly, it was “conducted as part of the scientific activities of the World Psychiatric Association’s Stigma and Mental Health Scientific Section.” (Stuart et al., p. 21) The bias inherent in this framing is reinforced by including in this study about negatives attitudes toward psychiatrists an investigation into negative attitudes toward “psychiatric patients”. Holding the two together in this way constructs the attitudes toward these very different constituencies as “of a piece”. The function served is that psychiatry appears as a victim, with all negative evaluations of it set up to be seen as examples of “stigma”. Other ways in which bias enters in? In the first editorial, the author states unequivocally (albeit without proof) that with the advent of molecular biology, the image of psychiatry is improving. Correspondingly, on a personal note, he writes, “This author represents the generation of young academics, with a background in psychiatric genetics. From my perspective, the view of our profession among medical students and doctors has improved significantly since I completed medical school.” (Tesli, 2015, p. 1) And the second editorial actually announces a victory right in the title—“Psychiatry Generating Comparative Respect”, thereby prompting us to view the forthcoming articles in a way favourable to psychiatry (see Munk-Jorgensen and Christiansen, 2015, p. 2-3).

The path is thereby set for evasion on the part of the other psychiatrists in this collection to appear as honest inquiry and for anything unfavourable to appear outdated. 

Emergent Themes/Claims

In this section, I am limiting myself to the pieces penned by the medical doctors (the vast majority of whom are psychiatrists). Most of these responses can be divided into several categories, and all entail some level of evasion. Emergent themes or claims in this regard include: 1) The evidence that psychiatry has a bad image is either not credible or is limited and as such, claims based on it are misleading; 2) Insofar as psychiatry and psychiatrists have a bad image, it is not primarily psychiatry’s fault but the fault of others; 3) The bad image is not exactly anyone’s fault—it goes with the territory; 4) While psychiatry is partially to blame, it is only one or two things psychiatry is doing wrong—none of which are substantive.

The “this is not credible or misleading” line of reasoning is evident to varying degrees in most of the commentators. The most cogent of these is Hartley (2015, pp. 10-11). He points out that the survey itself was conducted in a biased manner, for colleagues were asked to respond only to negative statements about psychiatry—a totally valid point. This notwithstanding, the critique is not as cogent as first appears for it ignores how dramatic the negativity was, also that there were other biases in the construction that pull in the opposite direction.  It likewise ignores the fact that the low enrollment in the psychiatric specialty in an abundance of medical schools itself serves as confirmation. That said, more obviously evasive are other variations on the theme. Note, in this regard, some, including Hartley, object that studies in Australia have had different results, thereby erroneously making it look as if outreach was limited, whereas in point of fact 15 different countries were surveyed. Likewise suggested is an “old-young” divide. The argument here (e.g., Kristiansen et al., 2015) is that being younger and so more keenly aware of how advanced psychiatry now is, medical students have a very positive image of it. It is only medical faculty that do not, and as the old are replaced by the young, the problem will disappear. What is wrong with this construction is that while psychiatry may well enjoy greater popularity among medical students in Australia and Denmark (there is a positive piece by medical students from Denmark in this collection), there is little indication of this other places; correspondingly, were young medical students really excited by psychiatry generally, the percentage of them signing up to study psychiatry would not be so low (for more representative figures, see, for example, Read 2015).

More pronounced and more blatantly evasive is the response/claim, “While psychiatry has a bad image, others are to blame for this.” Herein we see the disingenuous claim of stigma discussed earlier. In this regard, Gaebel et al. (2015, p. 5 ff.) call their article “Overcoming Stigmatizing Attitudes toward Psychiatrists and Psychiatry”.  Correspondingly, they dismiss the critiques by the medical colleagues in question offhand with words like “bad mouthing” and “psychiatry-bashing”. All of this, note, without evidence or even a thought to what evidence in support of such a contention might entail. Ironically, what surprises most of us who are aware of psychiatry’s baselessness, is not how critical other doctors are of psychiatrists but how silent they are about the fraudulence of the medical claims—at least as a big a dynamic as the putative unfairness. The evasion evident here is in turn reinforced by linking the so-called “stigma against psychiatrists”  to the stigma against “mental patients”. Now indeed, it may well be, as these authors claim, that stigma against “mental patients” can impact negatively on people’s perceptions of psychiatrists. Nonetheless, trying to get around the problem like this begs the question. That is, it totally bypasses the central question of whether or not the critiques are accurate. Also it is hard to imagine how “transferred stigma” could translate into such critiques as “psychiatrists exercise too much power over their patients.” Since when do people operating out of “prejudice” against a population want less control—as opposed to more—exercised over said population? Correspondingly, this construction functions to create a false solidarity between psychiatrists and “patients” when psychiatry itself is one of the principle causes of stigma against “mental patients”.  

The primary purpose of the construction of course is to absolve psychiatry by transferring blame onto others. The various people blamed throughout this collection include: other medical teaching faculty; funders (who allegedly are not  providing sufficient resources to make psychiatry attractive to enter (see, for example Bhugra, 2015), and finally, the media.  Note in this last regard, Bhugra’s curious reference to the “antipsychiatry media coverage”. This of course is ironic given the enormous complicity of the press in furthering psychiatry (see Whitaker, 2002). Moreover, as those of who organize against psychiatry but receive negligible coverage are well aware, if there is antipsychiatry press out there, it is keeping itself well hidden. Which brings us to the next claim.

Mostly the people who take the position that the bad image comes with the territory are nonetheless likewise suggesting that stigma is an issue (see, for example Bhugra, 2015).  There is one author that does not and he is the one psychiatrist in this collection who appears to be thinking—and indeed, he can be credited with having a point. In this regard, Kapezinski and Passos (2015) distinguish between what they call “wet minds” (the science of the brain) and “dry minds” (our mental processes) and they state that psychiatry runs into trouble when it tries to simply ascribe “the issues of the mind to brain tissue.” (p.7) This is undoubtedly true and important. Where the authors err is not not going far enough. They recommend that psychiatrists focus their work on scientific explanations and leave it to others to develop explanatory models for human behavior.  The question remains: What about the issue of power?  And insofar as there is any science here that has both validity and relevance, would it not be better handled by credible scientists like neurologists?

Finally, comes the very common contention that while psychiatry is wonderful and amazingly successful (and all the psychiatrists more or less concur on this point), it is in fact doing but one or two things wrong, none of which are substantial, albeit they facilitate the “stigma”. Generally, the deficits identified relate to not having a game plan for fighting back and not properly communicating (e.g., what we are being asked to believe is that despite the enormity of the funds spent on promulgating its message—see this regard, Whitaker, 2002—psychiatry is failing to communicate how very scientific and advanced it is—hence the “misperceptions”—an example of this position being Wasserman’s piece, which largely assumes this is the case, then proceeds to offer suggestions). Given the decades of disaster and the enormity of the evidence that psychiatry’s basic tenets will not hold (see, for example, Whitaker, 2002 and Burstow, 2015), herein lies the ultimate evasion. Correspondingly, it is blatantly clear what purpose is served by such a construction. It is at once an evasion and an argument for pumping ever more resources into what is in essence medical model propaganda. That said, while there is a more general acknowledgement that psychiatrists need to learn how to communicate better, valid though that may be, that acknowledgment in no way touches the heart of the matter. As such, it is but another obfuscation.

The Lone Voice in the Wildness

The lone voice in the wilderness is critic John Read (2015). Read acknowledges the poor image, validating it with reference to statistics and narratives, and he lays the blame for the poor image squarely at the door of psychiatry. He identifies the underlying problem as a “rigid adherence to a narrow biogenetic ideology combined with arrogant dismissal of those with broader perspectives.” (p. 11) One need go no further than the various apologias in this issue to see what he is talking about—a source of confirmation in its own right. While I do not contend that no psychiatrist could have written this, I would add, it is hardly coincidental that what likewise distinguishes Read is that he is not a medical doctor, never mind a psychiatrist. Solutions which Read advocates include: Psychiatrists should start listening to their patients. They should not automatically head all “mental health” teams. And they should restrict themselves to providing scientific information, in the process, limiting themselves to what is “evidence-based”.

Read is a breath of fresh air, and much of what he recommends has validity. Who could argue against listening more to others—in particular, to the people whom one is hypothetically attempting to serve? And yes, something is very wrong with the assumption that psychiatrists should head all “mental health” teams. That said, there are a few questions that I would invite readers to ponder when looking at Read’s other solutions: Why do we need psychiatrists on these teams at all? Could not scientific data, insofar as relevant, be better provided by figures like neurologists? Why are we assuming that teams of professionals should be in charge of others’ emotional well being? Why should we be placing this degree of trust in evidence-based research? Was not the fetishization of evidence-based research part of what landed us in this current predicament (for a hard hitting critique of evidence-research, see Burstow, 2015; see also forthcoming articles). And finally, while Read is suggesting ways to “save psychiatry from itself”—is there in fact any cogent reason to save it?   

The Solutions Proffered by the Psychiatrists: A Further Reflection

The solutions offered by the psychiatrists, not surprisingly, match their positions as articulated above. Insofar as more or less everyone agrees that stigma against psychiatry is involved (again an all-too-convenient confabulation), anti-stigma campaigns are advocated, with one of the authors, Gaebel, additionally inviting his colleagues to address what he sees as the problem of “self stigma” (more commonly known as pangs of conscience). People are urged to come up with road maps. To facilitate the “needed communication”, correspondingly, the use of professional bodies is recommended as well as individual training in communications skills, with authors such as Wasserman (2015, p. 13), for example, writing, “To promote the destigmatization of psychiatry and change the negative attitudes toward psychiatrists, a road map of action is needed along side professional training in communication skills.”  And beyond that, there is encouragement and general agreement to proceed further and further along the road of biological psychiatry, for it here where psychiatry’s credibility allegedly lies.  In others words, a continuation and intensification of the status quo.

That these “solutions” will hardly get rid of psychiatry’s fundamental deficits is clear. How can you get rid of shortcomings by putting all your energy into attempting to persuade everyone that they don’t exist?  How can you deal with the problem of a faulty paradigm by further entrenching oneself in that paradigm? But, of course, addressing actual deficits is not the point of the exercise. Now whether or not increased efforts in the direction identified will help psychiatry improve its image—demonstrably, the overriding goal—is hard to say. This is exactly how psychiatry improved its image in the 70s, though, when its credibility was at an all-time low (for details, see Burstow, 2015), and, alas, it worked—and so there is always the possibility that it will work again. That is the “bad news”. The “good news”? At this point in time there is an unprecedented amount of evidence that the claims are untenable –even fraudulent—moreover, more and more people are aware of that—and as such, there is an excellent chance that it will backfire. 

Closing Thoughts

In ending, I would draw attention to our need as critics and activists to be ready to address what appears to be in the “offing”—a renewed propaganda push by psychiatry, whatever form that propaganda take (whether it be “explaining” alleged medical advances or laying claim to being uniquely holistic, whether it calls its model “biological” or “biopsychosocial”, whether it is presented as just providing “information” or as an “anti-stigma” campaign). I would also alert readers to attempts to lure survivors and their allies into taking a common stand against stigma (now being discussed almost as if it were shared). What is significant in this regard, besides that the very concept of stigma against psychiatry is a non sequitur, psychiatry’s constructions themselves are arguably the number one cause of the “stigma” faced by survivors. Also, while like everything else, psychiatry may at times be the object of unfair evaluations; overwhelmingly, it is given a high credibility that it in no way deserves. Correspondingly, given that psychiatrists stand in a relationship of oppressor to survivors, however it may appear or be made to appear, ultimately, neither structurally nor practically do psychiatric survivors have common cause with psychiatrists.

References

Bhugra, D. (2015). To be or not to be a psychiatrist-what is the question? Acta Psychiatrica Scandinavica, 131, 4-5.

Bhugra, D. and Moran, P. (2014). The alienation of the alienist: Psychiatry on the ropes? Journal of the Royal Society of Medicine, 107, 224-227.

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

Gaebel, W. et al. (2015). Overcoming stigmatizing attitudes toward psychiatrists and psychiatry. Acta Psychiatrica Scandinavica, 131, 5-6.

Hartley, L. P. (2015). The past is a foreign country: They do things differently there. Acta Psychiatrica Scandinavica, 131, 10-11.

Kapezinski and Passos (2015). Wet Minds, dry minds, and the future of psychiatry as a science. Acta Psychiatrica Scandinavica, 131, 8-9.

Kristiansen et al. (2015). Future perspectives on psychiatry. Acta Psychiatrica Scandinavica, 131, 8-9.

Munk-Jorgensen, P. and Christiansen, B. (2015). Psychiatry generating comparative respect. Acta Psychiatrica Scandinavica, 131, 2-3.

Oxtoby, K (2008). Psychiatry in crisis. BMJ Careers (http://careers.bmj.com/careers/advice/view-article.html?id=3050).

Read, J. (2015).  Saving psychiatry from itself. Acta Psychiatrica Scandinavica, 131, 11-12. 

Stuart, H. et al. (2015). Images of psychiatry and psychiatrists. Acta Psychiatrica Scandinavica, 131, 21-28.

Tesli, M. (2015). Acta Scandinavica—this issue. Acta Psychiatrica Scandinavica, 131, 1. 

Wasserman, D. (2015). Some thoughts on how to improve the image of psychiatry. Acta Psychiatrica Scandinavica, 131, 13-14.

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

A Response to a Query About the Standard Allen Frances Line

I have just been asked (via email) by someone at a conference that Allen Frances is attending what to do about Allen Frances's line that the antipsychiatry people are being ideological and that when someone is in crisis and so their judgment in impaired, forcing treatment may be the kindest thing to do. Also that better that they spend a week in a psychiatric institution than a far longer time in prison. As these are points that in one form or another are made again and again, I thought that I would post my response.  It went as follows:

Yes, that is the standard Frances line. Unfortunately, coercing what they consider as the odd person into receiving the treatment which they "need" is exactly the rationale that lies behind the system that we now have, exactly the discourse that underpins current mental health systems throughout the world; and so taking this line leaves us approximately where we are now. Frances is arguing that less people need to be coerced and then we just need to add safeguards. As reasonable as this seems, that is precise argument that led to the current state of affairs—and it resulted in no lasting changes for anyone—just more steps and more tic boxes, more types of governance as it were. Given the "treatments" that we currently administer overwhelmingly harm, moreover, it is an argument that minimally makes no sense at this point in time. Even before we factor what Frances would call "impaired judgment" (and how easily we apply this judgment to others) overwhelmingly the person with bad judgment is in the long run not making worse decisions for themselves than the system makes for them. "Crises", moreover, as the ancient Greeks knew, are "turning points". With support, people need to be allowed their space to work things out for themselves. As for making mistakes, even terrible ones in a crisis, that possibility is precisely our lot as human beings. We make our decisions, and if they don't kill us, we learn from them. 

Allen Frances, I would add, is quite rightly worried about the situation where distressed people transgress society's rules and end up in prison. His answer is to put them in a psychiatric institution instead. While I have no question but they are being horrifically mistreated in jail, it is not in the least clear to me that their week-long stint in a psychiatric institution will not hurt them more in the long run that a longer stint in prison, for they are fairly likely to end up on psych drugs for life. What this shows, is not that a little bit of psychiatry is the answer—but that neither the psychiatric system nor the prison system work—and we need to be tackling both institutions simultaneously. And here precisely is the folly of tackling the societal dilemmas that face us piecemeal. And indeed of accepting any kind of incarceral answer. 

That noted, it is not that Frances has no ideology. He does. It is the same ideology that all people have who think that they have "no ideology"—liberalism. The good thing about liberalism is it never goes to "excess". The bad thing about liberalism is that it gets to the roots of absolutely nothing, and as such, it cannot solve our problems.

The Burstow Video at the 2014 ISEPP Conference

I am happy to report that my video received an enthusiastic reception at the ISEPP Conference this Saturday.  A number of other presenters wrote, stating how sound they felt the vision was, how they wished more people had explored such dimensions, how they hoped to see me in Toronto soon.  To watch the video, see "Grounded Eutopianism:  Piece-ing/Peace-ing our Way Together: Toward a World Within Commons and Without Psychiatry"

Liberal “Mental Health” Reform: A “Fail-Proof” Way to Fail

An ever growing number of people are aware that something’s horrendously wrong with psychiatry—survivors, families, professionals, psychiatrists themselves. Of these a subsection has become actively involved in trying to bring about change. All of which is good. This notwithstanding, sincere and dedicated though almost everyone is—and it is clear that people are—only a tiny percentage of these are pressing for anything truly transformative (something beyond the humanistic correctives or additions typically called “reform”). Without question, what people are advocating is of enormous importance. For example, for the most part reformers take seriously the deprivation of human liberty and the reductionism that characterizes psychiatry—and yet somehow they fall short of letting go of either the paradigm or the practice. What do people call for? They want less incarceration, but are not asking it be stopped. By the same token, people call for less drugging, while accepting that doctors will continue to prescribe psychiatric drugs. Most want to eliminate certain of the diagnoses, while holding tenaciously to others (e.g., Horwitz, 2002). For obvious reasons—and who could argue with this?—the majority stipulate that there must be free and informed consent—but not for everyone, and even at that, there is little evidence that people are giving much thought to how such a thing would be possible with anything even vaguely resembling the institution as we know it. And the vast majority favour a major expansion of humanistic services such as counseling and housing as well the introduction of voluntary outreach services wherein helpers turn up at people’s homes to assist with crises—good in itself, however, once again while leaving biological/institutional psychiatry relatively in tact. What goes along with this, they want a team approach, with psychiatry only one member of that team. Albeit, of course, there are variations here and there, and some reformers go considerably further than others, here basically is the reformist position. Now I am in no way questioning the intentions or the soundness of many aspects of the position. There are a number of problems with it, however, not the least of which is the fact of leaving institutional psychiatry in tact—the elephant, as it were, in the room.

Underpinning the reformist stance, whether it is expressed or not, is the contention that psychiatry has something to offer, is worth retaining, moreover, that to do otherwise is reckless. Allen Frances (2014), by way of example, refers to antipsychiatry activists as “blind ideologues” and talks as if it were an indisputable fact that there is “good” and “bad” in psychiatry. His solution, correspondingly, is for the sensible people—the “moderates”—to join together to create the reforms needed (see Frances, 2014).

How is it that the situation gets viewed this way? Obviously there is no simple answer to this question for reformers differ from one another. Of survivors who are reformers, some are reluctant to phase out psychiatry because they feel that they themselves or people they know have benefited from the “services”. Many professionals are likewise so convinced. Professionals, including ones that courageously challenge their own profession, additionally, have vested interests that willy-nilly come into play. Then there is the more general problem: that we all us have difficulty thinking very far beyond what currently exists, never mind trusting anything substantially outside the current frame. The point here is, changes that are revolutionary inherently strike us as immoderate or to use Allen Frances’s word “extreme”. All understandable. Nonetheless, let me suggest that the reformist position begs the question.

The purpose of this article is to problematize the reformist stance and the beliefs and tendencies underpinning it. I begin by problematizing the biases surrounding the concept of moderation. I go on to theorize why something more substantial is called for. The article culminates in an investigation of some uncomfortable truths about the profession, the reality of the various industry interests, and what history has to teach us.

Thinking Beyond “Moderation”

As a species, we have a tendency to think that moderation is always and inevitably best (hence the “middle way” in Buddhism, balance in Aboriginal thought, and the golden mean in Aristotle). Without question, this bias frequently serves us well. I put it to the reader that there are times, nonetheless, when the concept is inapplicable and/or where emancipatory principles dictate a pronouncedly different course of action. For example, would we really want to embrace a middle way between murder or rape on one hand, and respecting the bodily integrity of others on the other? And more pointedly, what would have befallen the major liberatory advances in history had visionaries bowed to the imperative to be moderate? Take the institution of slavery. We would have far more people enslaved today if we automatically assumed that the ostensibly “extreme” position—actually abolishing slavery (as opposed to, say, “humanizing” it or resorting to it less often)—was a reckless and otherwise unwise thing to do. And note, abolition did indeed look reckless to the “moderates”. What is clear, in other words, is that what seems like “sensible moderation” seems that way from a particular vantage point and what strikes the average person as moderation, as such, is hardly unassailable. That said, the question arises: Under what circumstances is abolition a more sensible course of action than reform? While this of course is a complex issue, let me suggest that viable indicators are: 1) when the practice in question overwhelmingly harms people and 2) when it is inherently oppressive. Auxiliary indicators—and these too can legitimately enter in and in certain cases be pivotal—are when its foundational tenets have repeatedly been demonstrated to be fallacious, also, when it is backed by a massive industry that by hook or by crook is intent in maintaining the status quo or worse. Lest readers have not as yet noticed, all of the above pertains to psychiatry.

To begin with the first two, touching quickly on the incarceral and control mission (and it is a historical accident that psychiatry is in charge of this), it is clear that substantially depriving people of freedom and control is personally hurtful, however small the numbers and whatever the rationale. Nor is the alleged ‘dangerousness” an acceptable rationale, for there is no evidence that the “mentally ill” are any more dangerous than the average person. To be clear, it goes without saying that people should be stopped from harming others, whether or not the “transgressors” are deemed “mentally ill”, that actions must have consequences, that there are moments when figuring out how to enhance an individual’s safety is far from easy. At the same time, as peacemaking criminologists (e.g., Pepinsky and Quinney, 1991), and critical disability theorists (e.g., Ben Moishe, Chapman, and Carey, 2014) have so cogently argued, a regimen of imprisonment and control is at once injurious, of dubious value in enhancing the safety of anyone, and is morally unacceptable. To turn to the “treatments” per se, as documented by critics like Breggin (1991), the “treatments” overwhelmingly damage people. That is, they give rise to actual brain damage, result in disorders such as tardive dyskinesia, horrific conditions such as memory and cognitive impairment. While reformers want to make exceptions for categories like schizophrenia, suggesting that in such cases “treatment” is necessary, I would add, studies clearly establish that mainstream convictions to the contrary, “schizophrenics” never once on the drugs fare better in the long run than any other group of “schizophrenics” (see Harrow, 2007 and Rappaport, 1978). In other words, even when it seems as if the opposite were transpiring, everyone is being harmed. The inherent oppressiveness of psychiatry, additionally, is common knowledge among survivors and reformers alike, though one need only look at the classical signs of oppression to realize that it permeates the industry—the daily coercion, the incarceration, the surveillance and control, the targeting of the “genderized” and the “racialized”, the us-them division, the very use of concepts like “normal” (for details on how such ruling plays out, see Burstow, 2015). Nor would moderating this element eliminate the oppressiveness at the core.

To proceed to this next indicator—and I would suggest this is pivotal—we are blatantly dealing with faulty foundations. The point is that the basic psychiatric concepts and tenets have no validity either empirically or conceptually. In this regard, as researchers like Breggin (1991) and Colbert (2001) have repeatedly demonstrated, there is no proof whatever that any of the so-called “mental illnesses” are bone fide diseases. Nor do concepts like “mental illness” hold up to scrutiny. As Szasz (1961) so adroitly put it years ago, irrespective of whether or not people are floundering, it is a category confusion to call ways of thinking and acting per se a disease. In essence, a medical overlay is but being slipped over distressed or distressing ways of thinking and acting. This being the case, it is no accident that the treatments profoundly harm. Treat people for non-existent diseases, “correct” imbalances that exist nowhere except in psychiatric credo, and you necessarily create real imbalances and in the process do untold harm. Herein the very nature of medicine—what it is and what it does—is all important.  Note, in the vast majority of disciplines and professions, the invalidity of the basic tenets would not in and of itself necessitate abolition or even always make it desirable. It is precisely because invalidity and inevitable harm come together in psychiatry that abolition is critical.

Before I proceed to the other indicators, I would pause to touch on some of the objections likely to be posed to my points to date. The first is that there are “extreme cases” where psychiatry is needed. Let me suggest, the fact of people being in terrible straits in no makes something medical when it otherwise is not.  If there is no disease, no matter how dire the problem, treating a person as if they had a disease and thereby harming them cannot be acceptable. Equally unacceptable, I would add, is the handling of misery and conflict by resorting to incarceration, surveillance, or control.

A second common place type of objection is predicated on the understandable belief that a plethora of services should be available—and so why not psychiatry?—especially seeing as so many people favour the drugs. A quick response is that the state should not be involved in injuring people, irrespective of whether or not doing so is called “services”. Moreover, it is blatantly unethical to present and/or promote something as is if it were a medical treatment in the total absence of medical validity. Nor is it the case that the elimination of psychiatry would narrow the options available. In point of fact, given the amount of money spent on psychiatry and the promotion thereof, eliminate psychiatry from the picture, and—presto—there would be ample resources to make a plethora of options available. Additionally, note, abolition does not require that people be denied access to psychopharmaceutical drugs—only that they not be approached as if medical, not promoted, and not prescribed by doctors.

A final objection that I would touch on is predicated precisely on faith of how far a reform agenda can transform psychiatry. The contention here would be that in the world brought about by a reform agenda, there would be no reason to get rid of psychiatry for it would just be one of many disciplines that converge on the territory. Additionally, psychiatry would itself be reformed, with psychiatrists for the most part providing counseling or other such supportive services.

Tackling the first part of this objection brings to the fore the whole issue of  power and of discourse. Hypothetically, we have a team approach now, but set foot in any hospital and it is clear that one player and one position dominates. Nor do words like “dialogue” alter the situation. The point is that even with benign intentions, dialogue can only go so far for the terms of the dialogue are already set/constrained by the psychiatric paradigm. To varying degrees, the same may be said of reform within psychiatry. What is equally fundamental, there are structural realities, vested interests, and contradictions at play that we gloss over to our peril.  

A crucial factor being ignored here is that medicine is a bad fit, indeed a misfit insofar the direction sought is non-medical (nor are most medical people likely to excel at it). Correspondingly, there is a palpable danger involved in entrusting this direction, or indeed, any part of it, to psychiatry. Whatever might transpire in the short run—and of course there are individual psychiatrists who are trustworthy —why would we think that in the long run psychiatry (translation: institutional agents whose very profession is posited on emotional problems being medical) are likely to give up or even substantially qualify what, in essence, is the sole basis of their profession?  If the point being made seems confusing, look systemically at what we are dealing with here. Aside from the power attributed to it, this profession is distinguishable from others such as psychology by one sizable dimension only—the insistence on the medical. By the same token, look at what prepares psychiatrists for the tasks ahead. Psychiatrists in-the-making are people who take extensive training in medicine as if such problems in living were bone fide medical issues. Indeed, even at the residency stage, they rotate between the various medical specialties—biology, anatomy, and so forth—before they even approach “psychiatry” per se. Even were more counseling training added to the mix, the point is it remains part of the faculty of medicine, remains a “medical discipline”, and, indeed, is theorized and taught as such, with all the baggage which that entails.

That said, let us look more closely at this institution. Insupportable though the medical conceptualization is, psychiatry is “medicalized” through and through. Note, it is presided  over by “doctors”; it is assisted by “nurses”; and its pivotal work happens in places called “hospitals”. Correspondingly, it specializes in the use of substances defined as medical; and its discourse is medically framed (witness, in this regard, the prevalence of terms like “pathology”, “disorder”, “symptom”). Whatever psychosocial factors are added on, being “medical”—as it were—is its defining feature. Which brings us to some key structural issues: To whit: In the long run, how could be in the interests of a medical institution to support any substantial de-medicalization—given medicine is precisely the ground on which it stands? By the same token, in the long run how could it be in psychiatry’s interests to give up what the profession has spent centuries solidifying—their command over the “madness turf”? Which is not to say that individual psychiatrists are not sincere about demedicalizing, or the profession as a whole might not be willing to entertain such directions at a moment of crisis. What happens in a crisis and what will be supported long term, however, is a different matter altogether. Bottom line: In the long run, it simply is not in psychiatry’s interests to demedicalize, decentre itself, or stop expanding. What adds to the conundrum, while all institutions to varying degrees pursue their own interest, history teaches us that discourses about care notwithstanding—medicalization, dominance, and expansion has been overwhelmingly what the institution of the psychiatry is about. This is the profession that historically drove out all competitors—the astrologers, the women healers, for example. This is the profession that sought and gained police powers. And this is the profession/industry that has been intent on declaring ever more people “mentally ill” (for details, see Conrad and Schneider, 1984).

What relates to this, from a business point of view (and psychiatry is nothing if not a series of interrelated businesses), it is obvious that what we are dealing with is a massive industry, all parts of which have self interests. Correspondingly—and again, we lose sight of this to our peril—all of these parts are not simply incompatible with but dramatically pull in the opposite direction than the reform agenda. By way of example, the interest of the psychiatric research industry is to continue expanding on one hand and satisfying its funders on the other (that is, producing ever more research studies and research results which in some way promote the prevalent treatments and agendas). By the same token, the interest of the shock industry is the continuation and spread of ECT.  Of these industries, of course, none is more formidable that the pharmaceutical industry.

Profit transparently drives the pharmaceutical industry. And significantly, reform of the type envisioned will willy-nilly hurt pharmaceutical profits, in other words, transparently conflicts with Big Pharma’s interest. (The fact that progressive psychiatrists would like to see less drugs used, I would add, is beside the point). A demedicalizing of the area doubly conflicts with psychiatry’s interest for, as demonstrated by researchers such as Whitaker (2002 and 2010), psychiatry itself is utterly dependent on pharmaceutical funding for their massive research projects, their publications, their educational endeavours. To put this another way, psychiatry needs the multinational pharmaceutical industry. Ergo, anything that hurts that industry hurts psychiatry. Indeed, at this juncture, the very existence of psychiatry is dependent on the pharmaceutical industry; and as such, as the professional elite are well aware, breaking with this industry in any substantial way would be the proverbial kiss of death. The upshot? Despite how individual psychiatrists may proceed, this is not now, and short of a new somaticizing benefactor materializing, cannot be the ultimate direction of the profession.  

In short, besides that psychiatry is foundationless and by its nature harms, we cannot arrive at a better dispensation in the long run if psychiatry is included—not even a new and improved psychiatry. We cannot because it undermines the very raison d’etre of the profession. We cannot, ultimately, because it is not in psychiatry’s interest, not in the interests, that is, of the profession, the industry, or the myriad of industries surrounding it.  What likewise needs to be factored in, biological psychiatry has a long history of reasserting dominance, whatever seemingly benign turns are taken in the short run, for it does not for long lose sight of where its interests lie. In this respect, we have, as it were, “been there and done that” already—and the outcome was anything but reassuring. A lesson from history:

There was a moment in “modern” psychiatric history where the relentless push to medicalize and to dominate indeed appeared to be curtailed, and beyond that, substantially reversed. This was with the spread of psychoanalysis and the concomitant rise of the talk therapies. Freudian psychoanalysis was so successful as a movement (however one may judge its tenets and practice) that throughout North America it changed the face of psychiatry, bringing the psychological as opposed to the medical to the fore. What is additionally apropos, Freud opened up psychoanalysis to non-medical therapists—which itself helped give rise to the spread of a huge variety of talk therapies and this by “lay” practitioners of various types—psychologists, social workers. Corresponding, increasingly, despite obvious limitations, the agenda was humanist with various new and creative way of working with people imagined. The parallels with what is being sought today are obvious. Then a huge reversal set in. While the full story is too complicated to go into here, the salient point is that demedicalization was not in the interest of psychiatry, and beyond that, what became progressively obvious to the psychiatric elite is that their interest, on the contrary, lay in medicalizing to a point beyond anything heretofore imagined. Hence the unprecedented surge of biological psychiatry and the advent of the highly medicalized DSM-III (transparently “medical” despite the claim to being etiology-free). Hence the declaration that “mental illnesses” were “brain diseases” (e.g., Andreason, 1984). And hence the alliance between psychiatry and the drug companies and the advent of what is euphemistically called “the drug revolution”. All of which was possible, note, because institutional psychiatry had never in any way been dismantled. Now to be clear, it is not just that the ground gained was lost. The situation which materialized was exponentially worse than what had preceded psychoanalysis, for everything became grist for biologizing agenda—even the psychoanalytical categories themselves. You can get a quick sense of how this transpired by looking at what happened with the “neurotic complaints” (originally spearheaded by the analysts). It is not that these were thrown out by biological psychiatry. Along with the various “psychoses” and the various other biological inventions, they were given a biological frame and added to the mix—with the result being an exponential growth in the number of “mental disorders” in DSM-III, and, in essence, the pathologization of every day life (to trace this development, see Kirk and Kutchins, 1997).

Now it might be argued that what happened here arose from a unique concatenation of circumstances, and as such, liberal reform is not doomed to fail. While logically that is true, I would remind readers that a similar dynamic played out centuries earlier, after the rise of “moral management”—the one other time in history that a type of demedicalization had set in. Note, moral management involved approaching problems in living as spiritual issues. This, in essence, was the “reform” agenda of the 18^th century. It being nonmedical in nature, not only the mad doctors but also lay people practiced it—the most notable being the Quakers (see Tuke, 1813/1996)—a phenomenon that was widely accepted. What happened? The direction being pursued was hardly in psychiatry’s interest, and not coincidentally, the Quakers were considerably better at it. Accordingly, over time moral management gave way to the meteoric rise of biologically oriented psychiatry, the routing of lay people, and ultimately to the birth of the eugenics era.  

In this as in a microscope, we can see the problem with non-foundational reform. It is not that there are no good tenets or good people involved. Indeed there are. Correspondingly, it is not that progressive psychiatrists have no role to play in the initial stages of a transformational process, for again, they do. However, in refusing to take seriously both the nature and the self-interestedness of the profession, reform (as opposed to revolution) leaves in tact an inherently problematic institution, legitimizes rule by “expert”, and paves the way for a return of biologism and of oppression with a vengeance. 

And as such, liberal conceptualizations like “mental health reform” do not and cannot serve us well.

Concluding Remarks

In ending, I would reiterate that we are currently at one of those crossroads in history. To varying degrees, people are aware that our “solutions” are backfiring. Survivors are vocal about wanting something different. The general public minimally suspects that something is horrendously wrong. “Helpers” from other disciplines are commonly in dismay. And progressively, psychiatrists are sensing that the institution is in a crisis. Indeed, with the rampant spread of iatrogenic diseases, society itself is in crisis. A terrible reality on one hand, for it bespeaks the harm being done, but a rare opportunity on the other, for crises are precisely the time when real change is possible. As a society, this is the time to be absolutely clear what we are about, for the opportunity for fundamental change does not come often; and it would be a shame to squander the moment. Do we tinker with the “mental health system”, adding more humane services, while retaining psychiatry?  Or do we adopt an abolitionist agenda—that is, slowly break with psychiatry and co-construct a whole new approach to problems in living and, indeed, how we-are-with-one-another?

As you ponder this, I would invite readers to consider: What kind of world would you like to bequeath to future generations?—To your great grandchildren? To people seven generations hence? Ultimately, who should be in charge of society’s needs—the community as a whole (that is, each of us together) or stated-sanctioned “experts” and mega-industries? Who wins and who loses if psychiatric rule continues? And finally, if tempted to speak of “paradigm shift” and psychiatry in one breath, in the words of Black feminist Audre Lorde, (1984), when in social change history have we ever known the “master’s tools” to “dismantle the master’s house”?

 (For this and other articles on this issue, see: http://www.bizomadness.blogspot.ca. For detailed elaboration of dimensions touched on in the article, including a visioning of services in a transformed society, see Burstow, 2015).

References

Andreasen, N. (1984). The broken brain. New York: Harper and Row.

Breggin, P (1991). Toxic psychiatry. New York: Springer.

Ben-Moshe, L., Chapman, D, and Carey, A (Eds.). (2014). Disability Incarcerated: Imprisonment and Disability in the United States and Canada. New York: Palgrave Macmillan,

Burstow, Bonnie (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.

Conrad, P. & Schneider, J. (1980). Deviance and medicalization: From badness to sickness. St. Louis: The C.V. Mosby Company

Frances, A. (2014). Finding a middle ground between psychiatry and anti-psychiatry.  Retrieved from http://www.madinamerica.com/2014/10/between-psychiatry-and-anti-psychiatry-mad-in-america-opens-a-dialogue/.

Harrow, M. (2007). Factors in outcome and recovery in schizophrenic patients not on antipsychotic medications. The Journal of Mental and Nervous Disease, 195, 406-414.

Horwitz, A. (2002). Creating mental illness. Chicago: University of Chicago Press.

Kirk, S. & Kutchins, H. (1997). Making us crazy: DSM: The psychiatric bible and the creation of mental disorders. New York: The Free Press.

Lorde, A. (1984). Sister outsider. New York: Crossing Press.

Pepinsky, H. & Quinney, R. (1991) (Eds.). Criminology as peacemaking. Bloomington: Indiana University Press.

Rappaport, M. (1978). Are there schizophrenics for whom drugs may be unnecessary or contradindicated? International Pharmacopsychiatry, 13, 100-111.

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

Tuke, S. (1813/1996). Description of the retreat. New York: Process Press.

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

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

Antipsychiatry Revisited: Toward Greater Clarity

A friend reported to me the other day that she was at a conference with other “progressive professionals” in which her colleagues kept passing questionable judgments on antipsychiatry positions and theorists, this on the basis of fallacious beliefs. Indeed, one of the colleagues in question stated as if it were a matter of fact that all antipsychiatry activists were right wing, then proceeded to cite as an example thereof an activist who is neither right wing nor antipsychiatry. By the same token, over the last decade, people have commonly made statements to me of the ilk, “What bugs me about antipsychiatry people is they only care about tearing down; there is no commitment to actually helping people.” All of which suggests that there is a serious dearth of awareness about antipsychiatry, the range of its adherents, and what they stand for. This is minimally unfortunate. It impedes our working together. What is likewise relevant, with psychiatry’s power and capacity to harm continuing to grow by leaps and bounds, the antipsychiatry message has never been so important as it is today. This being the case, over the last few years, I have taken upon myself the task of attempting to dispel confusions and to promote clarity.

In other publications, I have focused broadly, providing overall accounts of antipsychiatry (see Burstow 2014a and b). My intent in this piece is considerably more modest. It is to respond in abbreviated form to some very specific confusions/misconceptions surrounding antipsychiatry. I am drawing in this regard on the myth/fact distinction—a helpful heuristic, despite its obvious shortcomings.

Myths/Facts

Myth: Antipsychiatry theorists deny or minimize the enormity of the personal/emotional distress into which people can sink.

Fact: While no doubt some so minimize, they are decidedly in the minority. It goes without saying that people can end up in truly abysmal states, and like many who coalesce on this territory, antipsychiatry folk are deeply concerned about the welfare of people in distress. What is being maintained, rather, is that emotional difficulties and confusion are not in themselves “diseases” and hence should not be approached as such.  In this regard, antipsychiatry theorists oppose the medicalization of problems in living. Additionally, they draw a sharp distinction between two phenomena that are routinely conflated—being distressed oneself (which may or may not be something for which services are needed/wanted) and being found distressing by others (which can often be traced to societal intolerance or unawareness).

Myth: Antipsychiatry activists have no interest in people receiving the help which they need.

Fact: As people who care deeply about those in distress, antipsychiatry activists commonly lobby for increased services, albeit the commodification of help which is part and parcel of the concept services is something they challenge. More broadly speaking, we strive to co-create a society which is less “distressing” in the first place, wherein everyone has ready access to an abundance of help, moreover, where people in distress are reached out to. What we oppose is “psychiatric treatment” (pseudo-medicine, which is inherently harmful) on the one hand and coercion and manipulation on the other—as distinguished from genuine help which people are truly free to accept or refuse.

Myth: Antipsychiatry activists are anti-drug.

Fact: While some of us have a critique of medicine overall, antipsychiatry activists see a legitimate place for the medical use of drugs (drugs which address bone fide medical conditions). Many of us would additionally decriminalize street drugs. Moreover, we recognize and respect that since time immemorial people have coped with the use of substances which, as it were, “take the edge off”, that allow people who are floundering for any number of reasons to get through the day. What we are against is the “medical” pushing and the prescribing of pseudo-medicine on one hand, and the government support for and legitimation of such substances and practices on the other.

Myth: Antipsychiatry theorists oppose professional services.

Fact. While antipsychiatry theorists reject psychiatry and commonly critique other disciplines, there is no uniform rejection of other disciplines (except in insofar as they have become colonized by psychiatry). More concretely, besides that antipsychiatry advocates have often joined forces with others in lobbying for more non-medical services (e.g., supportive house, drop-ins, befriending services), there are antipsychiatry activists who are themselves practicing social workers and practicing psychologists. This notwithstanding, as people with a vision of a very different kind of society, the vast majority of antipsychiatry theorists oppose the wholesale transferring of human help into the hands of experts, whatever those experts may be called, and would prioritize instead more organic and more community-based services.  Correspondingly, many hold a Foucauldian analysis of disciplinary regimes.

Myth: Antipsychiatry theorists are all right-wingers.

Fact: Class analysis is not one of the bases of unity among antipsychiatry advocates. As a consequence, there are antipsychiatry advocates on the left (e.g., Don Weitz), and antipsychiatry advocates on the right (e.g., Thomas Szasz). Who predominates? The left, the anarchistic, the feminist, the gay and trans positivist, and the anti-racist. 

Myth: Antipsychiatry theorists are all followers of R. D. Laing.

Fact: The name “antipsychiatry” originated with Laing’s colleague Cooper (1967). This notwithstanding, the meaning of antipsychiatry has shifted over the years to one of psychiatry abolition. Of these abolitionists, some are influenced by Laing, while others are not, with the latter in the majority. Nonetheless, while rejecting his use of terms like “schizophrenia”, all would agree that society is deeply implicated in the seemingly individual angst that people feel. And by the same token, all would agree that the current  targeting of individuals as “the problem” is woefully off base.

Myth: If I am critical of psychiatry, then I am antipsychiatry.

Fact: While all antipsychiatry theorists are critical of psychiatry, not all such critics are antipsychiatry. The difference is that in the absence of an abolitionist stance, one is not antipsychiatry.

Myth: Antipsychiatry folk look down on people who take psychiatric drugs. 

Fact: Antipsychiatry folk take a position on the drugs and their “pushers”, in essence on the institution—not on the people who use these substances. It is generally understood and accepted that people cope as best they can, often very heroically, under less than ideal circumstances.

Myth: Antipsychiatry activists only work with activists and thinkers who are likewise antipsychiatry.

Fact: Most actively participate in broad-based coalitions. Correspondingly, they put on conferences with others in the community. And they routinely include non-abolitionists in their publications and themselves contribute to publications theorized from alternate perspectives (in this last regard, note the large number of antipsychiatry contributors—e.g., Weitz, Burstow, Diamond, and Starkman—to the mad politics book Mad Matters, edited by LeFrançois, Menzies, and Reaume, 2013).

Myth: Antipsychiatry theorists are hyper-critical of families.

Fact: This misconception stems largely from the ongoing conflation between antipsychiatry and R. D. Laing (who again is at most peripheral in current antipsychiatry). Laing saw family dynamics as pivotal to the emotional distress in which people find themselves, much as psychoanalysts do. In the process, while some of his analyses were highly insightful, he could without question also be blatantly unfair to family members—mothers in particular (see, for example, Laing and Esterson, 1970)—none of which, note, has any bearing on antipsychiatry. The point is, while individuals vary, antipsychiatry per se has no position on the family. That said, where one or more family member has been subjected to psychiatry, insofar as there is a tendency among theorists, it would be to see the family as a whole as a victim of psychiatry, however that psychiatrization came about and whether or not cooptation was involved. What is likewise relevant, in the world for which antipsychiatry activists strive, there would be far more support (read: noncompulsory and non-pathologizing support) available to families in distress. 

Myth: To be antipsychiatry is to be a follower of Thomas Szasz.

Fact: At this juncture, it would be hard, if not impossible, to be an antipsychiatry theorist without being substantially influenced by Szasz. And indeed, to date Szasz remains the most pivotal figure. Obvious influences include rejecting the notion of mental illness and seeing the psychiatrist as an agent of state control. Being a “follower”, however, is a separate matter altogether. Besides that the very idea of being a follower runs counter to how most antipsychiatry activists operate, while respecting the foundational works of Thomas Szasz, most antipsychiatry activists have substantial differences with him. Difference include: Unlike Szasz, few are right wing. Unlike Szasz, more or less none see prisons as any kind of solution (in this regard, we are more influenced by Foucault, 1995 than Szasz). Unlike Szasz, most have a strong commitment to transformative justice. And what is absolutely pivotal, all by definition are abolitionists, whereas despite his foundational critique, strictly speaking, Szasz himself was not an abolitionist (see in this regard, Szasz, 1961 and Szasz, 2009).

Myth: Antipsychiatry folk are all ivory tower intellectuals.

Fact: This is at once factually and interpretively incorrect. While academics for sure figure in antipsychiatry circles, it is survivors, whether academic or otherwise, who constitute the majority and indeed the core. Correspondingly, few of the academics could be depicted as “ivory tower”. More generally, people from all walks of life gravitate toward and find a base and a home in the antipsychiatry community. These include: survivors, activists, professionals, academics, artists, family members—and a subsection that is getting larger by the moment—every day people who began with no such politic but found themselves on a steep learning curve having lost family members and/or loved ones to psychiatry.

Myth: To be antipsychiatry is to be unreasonable and impractical.

Fact: On an individual basis, antipsychiatry folk, like everyone else, can be reasonable or unreasonable, practical or impractical. The antipsychiatry mandate, on the other hand, (working to phase out an institution that is serving us poorly and constitutes a threat to everyone), on the face of it, is eminently reasonable. By contrast, positions predicated on continuing to tinker with psychiatry, when, arguably, such positions have themselves contributed to the current state of affairs, are minimally questionable.

Myth: Antipsychiatry folk think that all psychiatrists are bad and deny that some people are helped by their psychiatrists.

Fact: Antipsychiatry theorizing operates on a very different level. It is a position on an institution—not a position on individuals. Advocates in no way deny that some people may be helped by their psychiatrist, just as some are helped by their priests. What antipsychiatry is maintaining rather is that psychiatry’s fundamental tenets and practices are insupportable—both epistemologically and morally.

Myth: Antipsychiatry theorists oppose all psychiatric reform.

Fact: Antipsychiatry theorists hold that reform can never be sufficient for the paradigms and tenets of psychiatry are faulty. What goes along with this, they see reform as having a tendency, irrespective of intent, to reinforce the status quo. As such, it would be fair to say antipsychiatry does not focus on reform and in no way can be seen as reformist. This notwithstanding, as with most revolutionary movements, being antipsychiatry inevitably also involves supporting more limited agendas, this, while keeping an eye on the larger goal. Which? And how are such choices made? Here once again there is no unanimity. Some antipsychiatry organizations support only those initiatives related to increased rights for psychiatric survivors. Some would prioritize support for initiatives around homelessness, others, safety. Correspondingly, those who employ the attrition model as a guide (see Burstow, 2014c) make decisions based on the answer to the question: If successful, will the actions or campaigns that we are considering move us closer to the long range goal of psychiatry abolition? What is likewise significant, a distinction must be made between “not actively supporting” and “opposing”. Antipsychiatry activists seldom oppose reforms that on the surface seem benign. The point is, as with everyone else, our assessment can be wrong, and regardless, we are not in the business of undermining our allies. However, we may or may not endorse or support such initiatives, and where we do not, once again, generally it because we see them in the long run as running counter to the abolitionist agenda, as re-entrenching psychiatry, or more worrisome still, helping it expand.

Myth: Antipsychiatry would deny people the right to protect themselves against “violent others”.

Fact: An antipsychiaty position in no way involves denying that people can be violent or opposing protective measures. Rather, it involves opposing measures based on the assumption that the people deemed “mad” tend to be violent—for statistics show that the “mad” are no more violent than anyone one else. Correspondingly, it involves opposing solutions that are inherently incarceral, controlling, individualizing, pathologizing, harmful, and otherwise oppressive.

Myth: To be antipsychiatry is to be anti-choice.

Fact: Herein lies an ever recurring and profound confusion. The confusion is not limited to antipsychiatry. It also extends to psychiatry and to the nature of choice itself. From a radical vantage point, it is institutional psychiatry that is in the business of depriving people of choice—not antipsychiatry. What goes along with this, to theorize choice in the context of harm, of underlying intrusion, of artificial options, of rampant misinformation, and of ruling institutional agendas, is to fall into a liberal notion of choice (for elaboration, see Burstow 2014d). What is likewise relevant, antipsychiatry activists are working toward the creation of a society wherein people have considerably more choices, correspondingly, where services arise organically from felt needs and desires—not from the vicissitudes of industry profit.

Myth: If antipsychiatry activists had their way, everyone who uses psychiatric drugs would soon find themselves robbed of their life line.

Fact: No abolitionist would find it acceptable for anyone to be put in such straits—irrespective of their position on these substances.

Myth: Antipsychiatry theorists ignore what history teaches us—that if we rid ourselves of psychiatry, some other tyranny would take its place.

Fact: Antipsychiatry theorists are well aware of the history of madness—and of how one type of oppressor succeeded another. We focus on psychiatry because for centuries now, it has been in charge of the “madness turf, moreover because it has expanded that terrain in unprecedented ways. At the same time, as people who do not see any form of tyranny as acceptable, nor tyranny itself as inevitable, we work toward the creation of a more egalitarian and caring society (in particular, see Burstow, 2015, Chapter Nine—in press).

Myth: Antipsychiatry activists are stuck in the past.

Fact: Besides that a case could be made that antipsychiatry has never been so relevant and so pressing as it is today, paradoxically, the problem is in in some ways the opposite of what is expressed above. That is, while antipsychiatry is rooted in a vision for the future, to varying degrees, when thinking about change (and I in no way am denying that some of our allies here are highly progressive), most folk have difficulty thinking very far beyond the present—hence the paradigmatic reformist position. As a result, they keep falling into what institutional ethnographers like Smith (2005 and 2006) call “institutional capture”. What antipsychiatry activists are doing, in essence, is inviting people to think further, to see beyond the structures and conceptions that are now taken as “givens”, and dare to entertain a radically different, more humane, more accepting, more respectful, and more relational way of operating. 

* * * * *

(For elaboration on many of these points, see: http://www.bizomadness.blogspot.ca.)

References

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

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

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

Burstow, B. (2014c). 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. (2014 d). Consent and psychiatry: Problematizing the problematic. Retrieved from http://www.madinamerica.com/2014/07/consent-psychiatry-problematizing-problematic/.

Cooper, D. (1967) (Ed.). Psychiatry and antipsychiatry. London: Paladin.

Laing, R. D. and Esterson, A. (1970). Sanity, madness, and the family. London: Pelican.

Foucault, M. (1995). Discipline and punish: The birth of the prison. New York: Vintage.

LeFrançois, B., Menzies, R. & Reaume, G. (Eds.) (2013). Mad matters: A critical reader in Canadian mad studies. Toronto: Canadian Scholars Press.

Smith, D. (2005). Institutional ethnography: A sociology for the people. Landham: Altamira Press.

Smith, D. (2006). Institutional ethnography as practice. Landham: Rowman and Littlefield.

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

Szasz, T. (2009). Antipsychiatry: Quakery squared. Syracuse, New York: Syracuse University Press.

Book Launch for Psychiatry Disrupted a Smashing Success

On Friday, September 12, the much anticipated book launch for Psychiatry Disrupted (Eds. Burstow, LeFrançois, and Diamond) happened.  The launch was nothing short of magnificent.  A wonderful community event, with the reality and the presence of community palpable. Approximately 120 people were in attendance--the editors, contributors, activists, artists, academics, radical professionals.  The air was filled with excitement. Indeed, you could feel a certain something in the room.  Something that uplifted and joined us to one another.  Also a sense that those of us who oppose psychiatry had inherited the moment and were unstoppable.

Tables included material from all participating activist organizations. All eight speakers were inspiring, thoughtful, and reflective.  While the entire event was uplifting, moments that particularly stand out for me were:  Ambrose Kirby as he told those assembled that the worst thing about psychiatry for the trans community is "not what you think", is not the diagnoses or the bias, but the invitation not to trust one's own body and mind.  Susan Schellenberg as she reasserted the significance of art to resistance. My keen awareness of people behind the scenes like Liam, who had risen early in the morning, and equipped with his cart, stopped in at shops around the city, making sure that there would be sufficient there for everyone to eat. Don Weitz, now his 80s, present and presiding over the CAPA table and Rebecca Ballen, going to the microphone and explaining CAPA. The card for ailing Carla MacKague that so many people signed. Brenda arriving all way from Newfoundland. A. J Withers as they carefully and brilliantly articulated a radical disability critique.

All and all, a rare event.  Thank you to the hosts--CWSE, CAPA, and McGill-Queen's University Press.  Thank you everyone who participated, and otherwise made it possible.  And thank you those who thoughtfully sent us good wishes (and yes of course, we felt you there with us in spirit)

Breaking News about Psychiatry and the Business of Madness

An important victory has just been achieved in my attempt--or more accurately, determination--to have my magnum opus--Psychiatry and the Business of Madness--make its debut to the reading public in the best way possible. What I wanted was a first rate international publisher, moreover a paperback release.  More generally,  I wanted something that would put antipsychiatry on the map in the way it has not been for years, such that it would engender a much needed societal wide conversation. And what goes along with this,  I needed it affordable (which it would not be if released in hardcover only). Given what I felt to be the importance of this book, how could I settle for less?

I turned to  Palgrave Macmillan--an excellent international publisher with outreach throughout the world.  Palgrave Macmillan was very enthusiastic, as were the researchers to whom they sent the book. The snag is, they have a policy about initially releasing scholarly books in hardcover only--a monetary issue. The long and the short is that while they offered me a contract, it was for hardcover only.  I imagined the book quickly buried.  And I was well aware that few people can afford a book such an expense--never mind the audience of psych survivors and students.  I took a deep breath. And albeit it was hard to do so, with my heart in my mouth, I  rejected the offer.   Months of negotiations followed, all of it in good faith. There were moments there where the suspense was almost unbearable. Today, the payoff came. Palgrave Macmillan wrote offering me a contract for a simultaneous paperback and hardcover release.

Within six months to a year, expect to see this book in your local bookstore, on Amazon, discussed in the press.  And do come to the book launch when it happens.

How do I understand what played out here? Let me say that to a degree I was just plain lucky for I had a highly receptive editor and in a way, the timing could not have been better.  Nonetheless, if there is a lesson to be learned here--and I suspect there is--it is to is to know the quality of your work, know the needs of your readers, and when push comes to shove, be willing to stand up for both.