Protesting Shock: A Moral/Existential Calling

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In Summation

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

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

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

The Anti-Shock Proclamation

We who care,

We who are committed to decency,

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

We who shudder at the knowledge

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

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

Of the elderly, whose final life reward is electrocution,  

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

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

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

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

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

And we vow to return,

To return,

And return again 

Until this abomination

Is no more.  

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

References

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

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

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

Burstow, B. (2014a). The withering of psychiatry: An attrition model for antipsychiatry. In B. Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted: Theorizing resistance and crafting the revolution (pp. 34-51). Montreal: McGill-Queen’s University Press.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For link to publisher and purchase information, see

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

Commencing a Dialogue

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

Tribute to Leonard Roy Frank

This is a very sad day for the survivor movement, the antipsychiatry movement, and for all those who organize against psychiatry—for one of our pillars of our community and indeed, one of our guiding lights has just passed—Leonard Roy Frank.  Awful for us all who are facing this loss, though it is good that we are pulling together—and indeed Leonard would have liked that.

As I reflect on this day, I am taken back to the moment when I first came face-to-face with Leonard. It was 1982—and Leonard, like Don Weitz, like so many other people were testifying at Toronto City Hall Council Chambers. There was a hushed moment just before Leonard got up to speak; and I had an eerie sense that something remarkable was about to transpire. Then Leonard with his legendary long magnificent beard which made him look ever so like an Old Testament prophet, and his keen penetrating eyes rose to speak. At first, Leonard’s voice was exceptionally gentle, almost as if he were soothing a child. And so your first impression is that this is a very soft-spoken guy.  Gradually, however, with every word that he spoke as he was elaborating on the appalling legacy of psychiatry, his voice grew louder and louder—as if a divine fury were overtaking the man. By the middle of his speech, his voice was thundering, his eyes grabbing you, so that there was no way that you would miss a syllable or fail to take in the seriousness of what was happening.  It is as if his righteous anger itself were a way of knowing, of way of seeing that guided him and the rest of us infallibly.

Over the years, the pattern that I witnessed that day was repeated again and again. Whenever clarity was needed, whenever someone was needed to spell out the profound violation of human rights or to cut through the tangle of psychobabble, there was Leonard, warrior that he was, uttering forbidden truths, articulating them loud and clear, never pulling his punches, never retreating an inch. Such was the strength and the certainty of the man. At once a friend, a team member, a social justice activist, a seer, and a voice in the wildness that willy-nilly spoke truth to power. 

Leonard’s legacy is gargantuan and is unquestionable—his stellar contributions to Madness Network News, his organizing, his various Quotationaries, his exceptionally well researched and at once scholarly and accessible book on the history of shock, which we all of us reference to this day. And there was his quiet behind-the-scenes support of so much that his comrades-in-arms were doing—e.g., his solid support of those of us who were penning a feminist critique of ECT, for example, for which I will always be grateful. I would also like to point out and add Leonard’s unwavering ability to keep his sights on what is important and not to get sidetracked.  Albeit there have at times been fractious divisions in our movement, as there have been, indeed, with all movements, Leonard was never part of it.  What goes along with this, he was interested in working with anyone who was making a genuine contribution. And he was good at recognizing an ally when he saw one.

Leonard, we remember and cherish you for all the work you did both publicly and behind the scenes.  We remember you for your wisdom, your good sense, and your generosity. We remember you for how you lived, who you were, what you cared about, what you made of your life.

What privilege it has been working with you all these decades!  And what mitzvah to have had you as a friend!

Enjoy a well earned rest, comrade ours. And may your memory be as a blessing.

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.