Women, ECT, and Memory

As signaled in the title above, this article is about women, ECT, and memory. Despite the fact that the memory loss caused by ECT is greatly minimized by psychiatry to the point of downright denial, it is fairly common knowledge at this point, at least among people who have looked beyond the official ECT line, that one of the main and most devastating effects of ECT is the destruction of memory (for an example of a standard denial thereof, see, Abrams, 2002).  Innumerable shock survivors have testified to it (e.g., see https://coalitionagainstpsychiatricassault.wordpress.com/articles/); and it is conclusively established by credible research (see Sackeim et al., 2007 and Breggin, 1991). That noted, many of those who take in the reality of ECT-created memory loss are aware of it largely in an abstract manner.  As a statistic. As a fact supported by research. If our memory is relatively in tact, we can forget how very integral memory is to most every aspect of our daily lives. In this regard, I  am grateful to the many ECT survivors who have given testimony over the decades and whose words have made this destruction of memory real in the way that statistics never could. Note, in this regard, this sensitizing statement by survivor and author Linda Andre:

Imagine you wake up tomorrow with your past missing….You may not be able to recognize your home or know where your banks accounts are….You can’t remember your wedding or your college education. Eventually you realize that years of your life have been erased, never to return. Worse, you find that your daily memory and mental abilities aren’t what they were before. (Andre, 2009, p. 1)

Now generally the memory loss that besets ECT recipients is spoken of with little or no explicit reference made to gender. In this article as in certain of the literature (e.g., Burstow, 2006), on the other hand, gender is highlighted.  My intent in this article is to hone on gender per se, more specifically to shed light on how ECT, memory loss, and women’s lives come together.

That noted, I am aware that some folk may be wondering: But why are you writing about women specifically?  Is not ECT, comparatively speaking, a gender-neutral issue? To address that quickly, while both men and women are unconscionable harmed by this procedure—and I in no way wish to minimize what happens to men—as shown in Burstow (2015a and 2006), ECT and the lived reality of it is not even close to gender- neutral. Throughout the history of ECT, two to three times as many women as men have received electroshock. And as research has established, they have generally received it because of a man signing for it, often for behaviour seen as “inappropriate” for a woman, and this despite the fact that the women themselves do not want it—hence feminists such as myself theorizing it as a form of violence against women (Burstow, 2006). What is up and above this, there is a gender-specific differential impact that needs to be factored in.

The point is, yes, women are men both suffer devastating memory impairment because of ECT—but not equally. A short story to introduce you to this topic: When I was part of an organization that held public hearings into shock in the 1980s, the fact that such a difference existed was painfully apparent albeit no one commented on it. The point is, while men survivors too were often horrendously affected, overwhelmingly, it was women survivors who made reference to chunks of their lives as big as 5 to 20 years being totally wiped out. By the same token, it was overwhelmingly women who would make statements like, “That was fifteen years ago, and I still have to take notes all day long just to get through the day.”  Which led me at the time to conjecture a gender-specific impact differential. Decades later, the difference was confirmed by Sackeim et al. (2007)—the largest study in ECT history. This study established at a level of statistical significance that women’s memory is more impacted than men’s—a reality possibly related to women’s lower seizure threshold. A particularly perverse statistic, I would add, when you consider that it is the precisely the sex that is most adversely affected by the procedure that is being singled out for it!

That noted, the difference with respect to memory does not end here. The point is that we are all of us social beings, that both men and women lead gendered lives. And so to understand the real meaning of the destruction of people’s memory, whether the survivor be male or female, we need to understand it in the context of those gendered lives. By way of example—and this is just one among many different identities that could be drawn on, for women are also lesbians, teachers, seniors in nursing homes—with women commonly being in the role of wife and mother, to understand the meaning of that destruction of memory, one very helpful lens through which to view ECT is precisely the role of housewife and mother. Questions that we might ask in this regard include: What happens between a mother and child when the mother cannot recall a good part of the early years of her own child’s life?  When she is impaired in her ability to figure out how to be a mother? What happens to a woman expected to be a housewife when she cannot remember any of the everyday operations which allow her to navigate the very particular world in which she finds herself? 

With the intent of making this dimension more “real” for people, what follows is an excerpt from a novel of mine in-progress (currently under active consideration by a publisher) which delves into some of these issues, takes up a number of these questions, fleshes out a character whose post-ECT existence is deeply embedded in the social world of housewife and mother.  A few words by way of introduction: The novel is called “The Other Mrs. Smith” and it is the culmination of decades of research. The narrator is Naomi Smith (a totally fictional character). Once upon a time, Naomi was a budding young filmmaker but having fall prey to psychiatry shortly after giving birth, such avocations are no longer on her horizon. It is now late August of 1973—approximately five months since her last shock treatment. She is living with a husband named Earl (whom she has no memory of ever marrying him, nor any appreciable pre-ECT memory of) and a baby daughter named Ruth (of whom she has no pre-shock memory whatever). This is one and half years after the birth of her daughter.  For several years now, she has been estranged from her family of origin, though she has no idea why because she has no memory of the breakup. Her family of origin consists of her mother, her father, and her twin sister Rose. Naomi is now living in Toronto, has been ever since marrying, albeit she has no memory of ever having moved here and no pre-shock memory of Toronto. She is a Jew originally from Winnipeg (a city in Western Canada). Her husband Earl is an atheist Christian, originally from Newfoundland (one of Canada’s Atlantic provinces). St. Pukes, referred to in this excerpt, is the name the “patients” give to St. Patrick-St. Andrew’s Mental Health Center (the fictional psychiatric institution where Naomi received ECT). And Dominions is a local supermarket.

Excerpt From Novel “The Other Mrs. Smith”

Fear—that was the common thread that wove its way through my days, making them what they were.  I feared the growing frustration in Earl’s voice.  I feared that I would not be able to find my way into Ruthie’s heart.  I feared that my brain, my memory, my life were lying in tatters somewhere in a St. Puke’s garbage bin.  I feared that I would never again be in the loving arms of the sister and parents that I so adored.  I feared that all those years of hope and study had come to naught, for no celluloid world would ever issue forth from my shattered ship-wreck of a mind.  I feared the faces that I met—the ones that looked away embarrassed, the ones that snickered, the ones that whispered to their children as I walked by.  I feared myself for I knew not who I was nor what terrible thing I had done to deserve such a punishment.  But most of all, I feared existence itself—my very being in the world—for the unvarnished truth is, I did not have the wherewithal to be, to cope, to muddle through. 

Poor Earl expected a wife and mother, the family, indeed, needed a wife and mother; and me, I simply could not function.  At night, I would tuck in my child and see her cringe and turn away, holding onto her doll for dear life.  Now if her daddy was not right there, she would scream blue murder.  And there I would stand—useless—knowing full well that a mother with her faculties in tact would have found a way in.  How come I am just fine with most vulnerable people on the ward and absolutely clueless when it comes to my baby daughter?, I would ask.  And Ruthie, if you are reading this, be assured that not a day went by when I did not ask, when I did not long to be the mother that you deserved.  Then, my heart heavy, I would crawl into bed with this stranger, even have sex with him, though neither of us were under any illusion about my feeling what he so desperately wanted me to feel.  The Mrs. Smith that I used to be, I would wonder, did she hunger for this man?  Was she able to lift the pain from his heart?

#

It was a weekday morning, not unlike the ones that came before, not unlike the ones to follow. 

“Brnng…brnng,” went the alarm.

“Time to get up,” urged Earl, reaching over and turning it off.

I rose, quickly closed the child’s gate, praying that Earl had not noticed.  I rustled up breakfast, saw Earl hovering over me. Gotenyu!  Had I left a burner on?

“Darling, don’t forget to mail the letters,” he called out minutes later.  Then with a hurried peck on my cheek, he rushed out the front door. 

Dreading the inevitable, I put off the chore a good half hour.  Then I gritted my teeth, lifted up Ruthie, started scouring the streets in search of the mail box.  Where could it have gone?  It was here yesterday.  At long last, I passed a little green house, a white picket fence at front. Shortly thereafter, I happened upon a rectangular box.  I dropped the letters into what appeared to be a slot.  Fine and good.  But how does one get home?  I whirled about, intent on retracing my steps.  Here was the little green house with the white picket fence on my right.  I passed it, scrupulously turned whenever the street turned—but back I find myself in front of the little green house. 

“Sir,” I call out to an older man in Bermuda shorts ambling by, “could you give me directions to 532?”

“No 532 here.  You must be looking for Palmerston Avenue.  This’s Palmerston Square.”

“So there’s two Palmerstons?”

“Three,” he corrects, chuckling.  Then a curious look comes over him. “Excuse me, but aren’t you the young woman who asked me this yesterday?” he queries, eyeing me ever more keenly.  “If this is a joke, young lady, it isn’t funny.” 

I apologize, back away mortified, eventually find my way home.  With Ruthie hollering that she is hungry again, and the word “vacuum” mysteriously coming to mind, I pull out what appears to be a Hoover.  Then suddenly, suddenly, I remember.  Groceries—God help me—I’m supposed to buy groceries.  Also, my daughter is hungry. 

I instantly stash the vacuum in the hall closet, hoping that’s where it came from, then feed Ruthie.  Then once again the two of us set out into the wilderness that is Toronto.  And once again, I search and search.  I pass a Victorian house.  Vaguely familiar.  I come to a corner.  A tall burly man in a police uniform is positioned in the middle of the street directing traffic.  Now somehow, his hand signals—if that’s what they are—do not compute, but this time, I know better than to draw attention to myself.  I stand at the very edge of the sidewalk, doing absolutely nothing as the policeman gazes my way.  Who could get in trouble just by doing nothing?  Suddenly, a horn begins honking.  Then another, and another.  The policeman stares right at me, while waving his hands progressively quicker.  And now he approaches, his expression very like Earl’s. 

“Lady, just whatchya expecting me to do?” he asks.  “Turn green?”

Eventually, I catch sight of the local Dominions, usher Ruthie safely through the door.  And while I cannot make head or tail of my grocery list, I recall that we are out of peas.  As luck will have it, I spot the right row, the right section of the right row.  With trepidation, I position myself smack in the middle of the peas section.  I reach out my hand.  Then I stand in front of those hundreds of tins of peas utterly stymied.  So many sizes, so many kinds—Libby’s, Aylmer’s—how is a person to choose?  Beads of perspiration forming on my brow, I take a deep breath, grab a tin at random, then hightail out of there as quickly as my legs will carry me.

Now I am half way out the door when it dawns on me that I have not paid.  Also, that there is one other item that I simply have to pick up.  Hoping that security is not on the way, I reenter, make my way to the meat counter—and brace myself. 

You see, pig, that turned out to be a staple in the Smith household, and it utterly flummoxed me.  Pork chops, ham, sausages, bacon, Newfoundland steak—hell, being Jewish and electroshocked to boot—they all seemed the same to me.  Now Earl would answer all my questions, would keep rattling off the different types, but try to hold onto to them though I did, every name, every description would come leaking out of my brain. 

“So lady, what’s it today?” asks the man in white behind the counter.

“A few pounds…a few pounds…a few pounds of…of…that,” I stammer, pointing at something reddish.

Meat in hand, I head over to the cashier, give the woman every ounce of lucre in my possession.  Her eyebrow raised, she hands me back most of my bills and several coins, together with what must be an itemized receipt.  I glance at it.  Another blur.  Then I pick up my daughter because she is clearly tiring, and scurry home.

“This’s just fine,” says Earl, hours later, gobbling up a poor imitation of a dinner.  But I can tell from his eyes that all of the meshugas is wearing him down. 

8:30 p.m., I tuck in Ruthie, hear her scream for her father.  Then Earl and I sit and sit and sit in that living room.  He tells me about his day, and I pretend to be following.  I tell him about mine, and he pretends to be listening.  “Missus, it’s about that time again,” he eventually announces.  I breathe a sigh of relief, take the pills, observe him watching me. 

At long last, the moment that I have been waiting for arrives—I get to crawl into bed—that nice, warm, comfortable bed—and call it a day.  I bury myself in the safety of the blankets, eager to fade into nothingness, eager to forget.  But now Earl, he’s crawling on top of me.  I instantly spread my legs.  Oh let him come quickly!, I pray.

Finally, finally, I close my eyes.  I drift off, glimpse a better place, a better time.  It is our fourth birthday, and attired in our new black tunics, Rose and I are blowing out the candles.  Now all four candles are out and the two of us are smiling at each other, nestling into the recesses of each other’s souls as only we can.  “Mazel tov,” chimes in my mother’s voice.  “Never mind with the mazel tov; Ida, give the girls cake,” pipes up dad.  Even as I savour the first tantalizing mouthful, a shrill sound shatters the stillness, and I awake with a start.  Frantic, I cast my eyes about.  I spot an alarm clock.  I see a bump in the covers next to me.  No!  No!  It can’t be!  Not here again! 

And so the days went.  How can we possibly keep this up?, I wondered.

(from novel-in-progress, Burstow, 2015b)

This particular passage, as you can see, focuses in on the abject terror of living in what is now an alien world. In the process, it probes Naomi’s inability to perform the everyday tasks integral to her life as housewife and mother, also the profound injury to Naomi’s relationship with her child and husband. 

I will comment no further on the passage—for better the reader make their own discoveries. However, I cannot leave the topic of the novel per se without commenting on the experience of writing it: As author, putting myself in the head of an electroshocked narrator struggling to tell a story, so much of which she simply cannot remember was one of the most frustrating and humbling tasks that I have ever taken on. Many a time I vowed to abandon the project once and for all because the journey ahead felt just too daunting. Whenever I was on the brink of “throwing in the towel,” however, I remembered that I always had the luxury to put aside the double binds and frustrations related to ECT and return to a life where memory is in tact—while shock survivors have no such option.

Then I would take a deep breath, pick up my pen, and resume writing.

Closing Remarks

I hope that this article has helped the reader gain a deeper sense of the reality of ECT as lived. More particularly, I hope people walk away better able to appreciate how the memory loss shatters lives and how that shattering invariably, indeed, inevitably transpires on a gendered level. In ending, let me express an even more ardently held wish—that some day soon we will be able to rid the world of this atrocity. That said, as long as ECT is being unleashed on people and as long as women and men survivors continue to have to navigate a world which has in essence been stolen from them, I would invite readers to factor gender into their understanding—for however poignant and sophisticated it may be, our grasp of the ECT phenomenon is lacking otherwise. 

References

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

Andre, L. (2009). Doctors of deception: What they don’t want you to know about shock treatment. New Brunswick, New Jersey: Rutgers University Press.

Breggin, P. (1991). Electroshock: Scientific, ethical, and political issues. International Journal of Risk and Safety in Medicine, 11, 5-40.

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

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

Burstow, B. (2015b). The Other Mrs. Smith (a novel in progress).

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.

The New York Booklaunch of Psychiatry and the Business of Madness

The New York book launch of Psychiatry and the Business of Madness was a smashing success. It took place at Bluestockings, on June 29 starting at 7:00 p.m. While I had been worried about not that many people showing, 54 people turned up, filling the bookstore to capacity. All speakers were terrific, with Lauren Tenney speaking first, followed by Paula Caplan, followed by me, followed by Celia Brown, following by others.  The audience was engaged, asked very poignant questions.  And on the heals of the question-and-answer period was a highly animated survivor speak-out where survivors shared courageously, talking about their ordeals at the hands of psychiatry, how they have dealt with it, and what can be learned from their experience. Emotions ranged from enthusiasm at the prospect of creating change, to anger at the infringement on human beings yet happening, to fellow feeling.  Additionally, what was very telling, we went over the time allotted; and many of the people who left gathered for hours later at a local pub to continue discussing psychiatry.  An indication in itself that interest had been sparked. All and all, a stellar event. Thank you, Lauren Tenney​, thank you, Paula Joan Caplan​, thank you Liam Walshe​, thank you Celia Brown​.

Upon the U.K. Launch of Psychiatry and the Business of Madness: A Reflection

This is a study of psychiatry. It is a study of an area officially a branch of medicine and overwhelmingly seen as legitimate, benign, progressive, and effective. That psychiatry is typically so viewed is readily apparent and may seem a “no-brainer”. Doctors specialize in it. It is covered by our health insurance, overseen by ministries of health. A high percentage of the population uses it treatments. People encourage their loved ones to consult a psychiatrist when encountering “personal problems”. And the media routinely report its “discoveries” and “improvements”, much as they report “breakthroughs” in the treatment of cancer. But what if society had it wrong? What if this were not legitimate medicine? (Burstow, 2015, p. 1)

So begins the book Psychiatry and the Business of Madness. And so began my speech on June 12^th.

Less than a week ago, in London, on June 12^th at 7:00 p.m., what I see as a historic event took place—the U.K. launch and indeed the very first launch of the book Psychiatry and the Business of Madness: A Ethical and Epistemological Accounting.” Was this my book?  It was.  And why, you may be wondering, do I think of the launch as historic?  In short, because an uncompromisingly psychiatry abolitionist book had not come out in decades. And yet here it was; and here were folk attending the launch, hailing from as far away as Cork Ireland. Against all odds—the event itself was in competition with a free showing of the film Asylum—between 31 and 40 determined souls had made their way to the well nigh impossible-to-find Palgrave headquarters—the location of the launch. And the evening was memorable, the speeches electrifying!

Dipping into the central tragedy in her life—the able m.c. Julie Wood set the tone for the evening by being deeply personal. She courageously revealed that the initial manuscripts used as an entry point into the investigation of psychiatry which forms the core of the book were documents associated with her psychiatrized son’s suicide. London ECT activist and psychiatric survivor Cheryl Prax spoke next; and she told the audience, “By page 5, I was crying with joy that such a book was written.” A consummate scholar, the third speaker, psychologist Ian Parker began by drawing attention to the subtitle and inviting people to see the careful tying together of epistemology, ethics, and accounting so integral to the book. He went on to highlight the significance of feminist and Marxist standpoint theory. Finally, as the author and the last speaker, I suggested that two things united all of us in the room—1) the knowledge that something was profoundly wrong with psychiatry, and 2) the commitment to do something about it. I went on to outline the major findings of my research, also, the core recommendation that the state sever its ties with psychiatry.

What followed was an animated and insightful question-and-answer period, with person after person coming up to the microphone to pose their question.  What do you think of the Soteria movement?” asked one.  Picking up on the discourse employed in the book, another asked, “wouldn’t you say that Open Dialogue is being colonized by psychiatry?” That the problem is that psychiatry can colonize anything?”

Then came the highlight of the evening—the survivor speak-out.  Survivors generously shared their stories, their analysis, their dreams, one survivor making it clear that the primary injury done her was the erosion of her self-confidence; another commenting that hearing the stories of other survivors is invariably a moment of learning. That the evening should have ended with survivors, I would add, is apt, for in the final analysis, whether we are antipsychiatry or critical psychiatry, whether we are professionals or survivors, the standpoint that we need to adopt is precisely the psychiatric survivor standpoint. By this I do not mean that whatever any survivor thinks is ipso facto correct.  Only that this location itself offers a privileged glimpse into the regime of ruling known as psychiatry, just as the standpoint of workers yields a privileged glimpse into capitalism. To use an institutional ethnography term (see Burstow, 2014a), it highlights the disjuncture which happens when psychiatry enters people’s lives—and, indeed, running with that juncture and mapping institutionally how it is created and recreated is integral to what this book is about, part of why I see it as important.

The strength of Psychiatry and the Business of Madness is precisely that it begins with the standpoint of the survivor, that it shows how various problems or “disjunctures” that occur in people’s every day life can be traced to the day-to-day working of the institution—whether it be its use of “treatments”, its activation of diagnoses, the filling out of forms. Its strength, to put this another way, is its holism—the fact that in the process of exploring the disjuncture, it shines a light on every single facet of the institution. Its strength on a whole different but related level is its no-holds-barred antipsychiatry perspective, together with the solidity of the research and the arguments.  This is significant.  Insofar as Psychiatry and the Business of Madness makes this case and does this mapping, it takes us where we need to go, provides ammunition needed for meaningful social change.

The point here is that reformism will not serve usAs I have argued elsewhere (see Burstow, 2014b), and as the history of psychiatry clearly shows, reform agendas have always culminated with a return of biological psychiatry with a vengeance, and far from ridding us the problems posed by the institution, have guaranteed the continuation of those problems. What we need to do rather is to acknowledge that psychiatry was a colossal misstep, and in essence to begin again. For this to happen, we need determination. We need to know when we are being led astray. We need vision. We also we need texts capable of making a truly convincing case for abolition. What I am referring to here is not just demonstrating that psychiatry does “more harm than good”—significant though this is—but demonstrating that psychiatry has no validity and, what goes along with this, that it is not a legitimate branch of medicine. That is precisely what Psychiatry and the Business of Madness sets out to do, and what I would suggest, it achieves.  To quote in this regard from the first review of the book, Philip Hickey (2015) states, “This book is a major milestone in the antipsychiatry effort and it stands as a monumental challenge to psychiatry’s continued existence as a branch of medicine.” And Don Weitz and Simon Adam, whose respective reviews will be coming out shortly, make similar points.

What are my hopes for this book?  To name a few, I hope that people threatened by family members with institutionalization—and we all know how psychiatry preys on families—give it to their family to read, and the family finds itself seriously entertaining second thoughts. That upon perusing Chapter Six, psychologists, nurses, and social workers take in the colonization of both their discipline and of themselves outlined here, reflect on their practice, get back in touch with why they entered a “helping profession” in the first place, and begin speaking up.  Having intricately traced not only the government backing and legitimation, but also the legal stranglehold that the state has created, I hope that government officials and our elected representatives are led to look more critically at what they are mandating, making possible—and in this regard, I am delighted that both member of the Ontario legislature Cheri DiNovo and renowned mental health lawyer Anita Szigeti will be speaking at the Toronto launch (September 18, 5:30, 12^th Floor, 252 Bloor St. West).

First and foremost, however, my hope for this book is quite simply that it be read—more particularly that it be read widely and carefully.  The point is, I believe that the book genuinely has the capacity to be a game-changer for it clarifies the territory, even I have found, for people who do not wish to see it.  “I just didn’t realize, I think maybe because I did not want to realize” said a friend to me, “but now that I see it, I can’t go back and not see it.” However, the book can do this heavy lifting only if it is widely read and discussed.

My invitation? Pick up a copy, read it, form your own judgment. And if your evaluation is similar to mine, call it to the attention of others. Perhaps give it to your mother for her birthday. Perhaps write a review for your local paper.  Maybe mention it to a coworker. 

My invitation to people more generally?: Whether or not you ever pick up this book or indeed, any book of its ilk:  Dare to imagine a world where helping is not professionalized, where caring is not commodified.  Where decisions do not come from on high, but where in the spirit of community, we go about the business of life together (the subject of the last chapter).

To end these reflections by focusing back in on the launch itself, albeit I was present via Skype only, I felt very much a part of the gathering in that room that evening. How wonderful to actually see folk with whom I had heretofore but exchanged emails! And we all of us walked away, knowing that together we had just pulled off an important piece of work. One small indicator of which is that the m.c. and her husband were up until the wee hours that night discussing psychiatry—exactly the kind of seriousness which one prays that a book launch will inspire.

References

Burstow, B. (2014a) Liberal mental health reform: A fail-proof way to fail.  Retrieved June 13, 2015 from http://www.madinamerica.com/2014/11/liberal-mental-health-reform-fail-proof-way-fail/.

Burstow, B. (2014b).  Taking an entry point. On investigating the psychiatric-psychopharmaceutical complex.  Retrieved June 13, 2015 from http://www.madinamerica.com/2014/08/taking-entry-point-investigating-psychiatric-pharmaceutical-complex/.

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

Hickey, P. (2015). Review: Psychiatry and the business of madness. Retrieved June 13, 2015 from http://www.madinamerica.com/2015/04/book-review-psychiatry-business-madness-ethical-epistemological-accounting/.

Getting Our Anti/Critical Psychiatry Authors Read: A Case for Book Activism

As a movement theorist, I have frequently written about ways of increasing our effectiveness as a movement (e.g., Burstow, 2014a and 2015a). While prioritizing strategic resistance, mostly, I have focused on practices so horrific that they scream out for redress—ECT, for example (Burstow, 2015b). The topic of this article, by contrast, is a far less heart-wrenching problem—the lack of mainstream attention to our publications—whether these be books by Breggin, Whitaker, Scull, or others. If this seems an issue that can safely be relegated to the “back burner” while we attend to the real horrors out there, I would point out that to an appreciable degree, our success as a movement depends on our ability to sway the general public—and if the mainstream press and media never afford our books their due—not even the blatantly cutting edge ones (and if anything, these are treated worse) and the general public, as a consequence, remains largely unaware of their existence, the likelihood of succeeding in our primary mission(s) is substantially reduced. The point is, secondary though this clearly is on a human level, it is a problem that we can ill afford to ignore.

That said, there are three related disjunctures underpinning this article. The first is the number of critical psychiatry or antipsychiatry authors who have confided in me of late that they have largely given up trying to get mainstream coverage and so are putting their energy elsewhere. While to be clear, this is a reasonable choice under the circumstances, the mainstream is a battleground that we can ill afford to cede. I would add that while I do not share the dim prognosis of many of my colleagues, nonetheless, as I ponder how to garner mainstream coverage for what should have been an easy book to get it for (Psychiatry and the Business of Madness, Burstow, 2015c), I too am aware that those of us who push the boundaries are up against a seemingly impenetrable obstacle. And herein lies the larger disjuncture. The point is, we make little sense to the mainstream press or media. Whatever role the financial cooptation of the media does or does not play here, our discourse is simply outside of their story line. Consequently, they provide negligible coverage of our books—ergo, the general public seldom hear of them, nor are primed to pick them up. And to be clear, the difference in treatment at issue here is not minor but palpable.

What is telling in this regard, when I emailed news editor Rob Wipond asking him his sense of the extent of the differential treatment—a phenomenon that he is uniquely positioned to assess—this was his response:

In my role as news editor for Mad in America, I go through reams of news alerts and notifications every day, and I can tell you that Jeffrey Lieberman's book celebrating the alleged successes of modern mainstream psychiatry has been getting an immense amount of coverage and reviews in the media. Conversely, since I started this job a year ago, I have not seen any book that takes even a slightly critical approach towards modern mainstream psychiatry get a tiny fraction of that amount of coverage.  (personal correspondence)

Not an easy truth for sure, but all the more reason that we need to face it head-on.

The third disjuncture (a smaller one) presented itself when I checked how Disability Incarcerated (Ben-Moshe, Chapman, and Carey, 2014) was faring on Amazon.ca, approximately one year after its release. This is a stellar anthology by American and Canadian authors which brings together prison abolition, critical disability, and antiracism. Having reviewed the book for the Canadian Journal of Disability Studies (see Burstow, 2014b), four weeks ago, as I was perusing books on Amazon.ca, I decided to see how that site’s readers were assessing the book (as reasonable an indicator as any of the interest being shown by the general public). To my disappointment, I found one review only. Not that most of our other books were faring any better. And to be clear, not that on some level that I was not painfully aware of what I would find.

That noted, the immediate problem that we are facing is this: Despite the transparently superior quality of our authors’ publications—and compare any of our leading books to, say, Lieberman’s (2015) book, and you will quickly see what I mean—and despite our authors’ best efforts to break into the mainstream, our books receive comparatively few reviews in the mainstream press; they are not picked up by the mainstream media; correspondingly, they are not shown the same interest by the casual reader.

Such is the dilemma and the challenge. 

For revealing accounts of why this is happening, see Whitaker (2010), Wipond (2013), and Burstow (2015c). That noted, “why” is not the focus of this article. The question being posed here, rather, is: Practically speaking, what can we as a movement do to turn this situation around? That is, how might we help increase the number of reviews which our authors receive in the mainstream press? How do we pry open the door to the mainstream media? And what can we do about the fact that a comparatively low number of people post comments about our books in the comments sections of sites like Amazon?

A good beginning, let me suggest, is taking the issue seriously. Also—and this may be a stretch for some—acknowledging that the movement as a whole has a huge vested interest in the success of our books, and as such, we have a role to play here. The point is: Yes, we can say that this is not our problem, that it is the problem rather of the authors and their publishers (without question, true to point), but if we do that, what is, after all, our cause suffers. A very different choice—and I am inviting fellow activists to consider it—is going in the opposite direction, that is, taking up what might be called “book activism,” whether in groups or at an individual level, whether systematically (developing concrete goals and a plan) or more sporadically. What I am suggesting? That individually and collectively, we concretely take this problem on as a movement. 

For those interested, there are many different ways to go about this—and we will be but scratching the surface in this article. However, let me begin with a global suggestion that has an immediate payoff even were we not explicitly thinking about getting these books into others’ hands. As educators and activists, among the most valuable tools at our disposal are precisely these books and articles—they provide evidence; they give details; they make vivid; they explain. So why not conscientiously put them to work? Toward this end, activists who are taking up this challenge and who have not already done so might begin by truly immersing themselves in the literature, turning themselves into authorities in their own right (common mistakes to avoid here are: 1) restricting oneself to one’s favourite author and assuming that “he” has “said it all”; and 2), failing to appreciate the significant differences between the books—the very specific perspective, the unique contribution, who is being spoken to, what it teaches or could be used to teach).   

With this expertise under one’s belt, one can readily go into “high gear”—and such is my recommendation. That is, as the occasion arises, use the familiarity gleaned to make effective selections to assist you in whatever task be at hand. If speaking with a person who is claiming that ECT does not cause brain damage, for example, you might cite specific passages in Breggin (2008). Alternatively, if calling the APA into question, Whitaker and Cosgrave (2015) could come in handy. And from the perspective of movement building, if trying to interest anti-colonial activists in our cause, you might draw on Mills (2013). Such an approach, note, has the obvious advantage of immediately serving your purpose while at the same time promoting the book(s) in question.

Those who want to approach the challenge more modestly, by contrast, can draw on methods already known to them. Some examples are: recommending specific books to friends. Lending out books. Correspondingly, those of us who are academics integrating such books into courses and  reference lists. 

Now, to be clear, none of foregoing in itself results in mainstream coverage. This notwithstanding, if enough of us do it, it increases the exposure of these books, additionally, in so doing, creates an atmosphere more conducive to mainstream coverage.

For those wanting to go further, on other hand, those, moreover, intent on proceeding methodically, one way of beginning would be developing criteria which could be used to judge which books to devote most of one’s energy to.  Examples of possible criteria are: a) the extent to which the book undermines psychiatry (the “attrition model” criterion); b) the coverage afforded sexism, racism, ableism, classism, etc. (the anti-oppression criterion); c) the degree to which the book hooks into issues currently in the news (the relevance criterion). A possible next step would be choosing a few books on which to focus. The pivotal steps of course are executing actions which create a stir about them.

That noted, the question arises: What actions? And where? One obvious venue is the social media—a revue, I would add, that a goodly number of survivors and their allies are already putting to good use. Individuals or groups might systematically use Facebook and/or Twitter to inform people about “pivotal books”. Other related and possible activities include: Sensitizing our “friends” and “followers” to a book by posting quotations; alerting them to news about the book; making a point of retweeting and reposting (thereby extending the work of other activists). Additionally, where a book is assessed as especially critical and you and/or our group are so inclined, more extensive internet-related book activism might be considered, including:

·      creating YouTube pieces about why it is important and/or what it reveals.

·      interviewing the author and mounting the interview.

·      creating pages and/or blog sites dedicated to it.

·      generating discussion about the book on Reddit (see http://www.reddit.com).

·      creating pointer pages for book-related events.

·      writing your own reviews, then tweeting about these.

Now the reader may well be thinking: Fair enough, but social media coverage hardly equates with mainstream coverage. True.  Nonetheless, the point is, if done skillfully, what you post can attract the interest of the general public—which is, after all, the ultimate goal.  For example, if one your tweets goes viral or if enough people put your messages on their timeline, a stir is created which takes the message far beyond the your original network. Correspondingly, if there is a big enough social media stir around any of these books, at that point the mainstream press and mainstream media themselves “sit up and take notice”. What is critical here, is not just posting occasionally (which many of us already do) but keeping the pressure up, retaining the focus.

That said, book activism can of course also include directly approaching the mainstream media and press. In this regard, if you know any reporters who write reviews in the areas of health or social change, you might approach them—and if you do this, where possible align your proposal in some way with a storyline that they have already used (a clear hook). Additionally or  alternatively, you might send individualized proposals involving a book to select programs. Watching previous shows makes sense as preparatory work for the familiarity so gleaned will help you choose judiciously and shape the proposal in ways that increase the likelihood of it gaining traction. Keeping an eye on current items in the news and linking with one of them is likewise an asset. And note, coordinating with others who subsequently submit overlapping proposals to the same program greatly enhances the chance of a proposal of this ilk being taken up. 

In this regard, numbers are all-important (as is independent status). If both author and the publisher try to pitch a book to the producers of a mainstream program, short of having a solid relationship with them, vital though it be that they make such pitches, in most instances, they stand little chance of being successful. By contrast, if say, over a three month stretch ten different people make similar but separate pitches, the producer is primed to surmise a growing interest in the area and respond accordingly.

Examples of Canadian programs that might be approached in this regard include: The Current, The Agenda, the Fifth Estate, The Passionate Eye, W-5. I leave it to readers from other parts of the world to generate comparable lists.

This sheds a bit of light on the first two questions. Which bringsn us to the issue of the paucity of comments afforded our books on online sites like Amazon and Indigo.

An obvious answer—and I will stick with one—is that we rectify such problems by posting in the comments sections ourselves. The good news is: Here our power as readers is considerable, and here we can make a major impact with very little effort. The point is that whether the target book (the book we are trying to promote) be Disability Incarcerated (Ben-Moshe, Chapman, and Carey, 2014), Psychiatry and the Business of Madness (Burstow, 2015c) Psychiatry Under the Influence (Whitaker and Cosgrove, 2015), Mad Matters (LeFrançois, Menzies, and Reaume, 2013), Decolonizing Global Mental Health (Mills, 2013), or one of Breggin’s works, the more of us who post comments about the book, the more significant the book looks; what goes along with this, by sharing what we ourselves think of the work, we are concretely suggesting to people who are specifically looking to be interested, why they should consider this book. Correspondingly, comments, as it were, themselves beget more comments. The point is, after reading several comments about a book which they themselves have read, people are tempted to “add their two cents”. And while there is hardly a one-to-one relationship, the more comments, the more readers for the book—all of which translates into more people potentially being “persuaded”.  By the same token, the more comments, the more that the mainstream media will take note, which further translates into broader coverage, and by extension, a broader readership. 

What, in a nutshell, is the process?

1.     Go to one of the online sites where the book is sold.

2.     Find and click on the book about which you would like to comment.

3.     Scroll down to the “Customer Reviews” section.

4.     Click on the box which reads “Create your own review” or a variant thereof.

5.     Rate the book (usually a 1-5 rating), and enter your comments.

6.     Then hit post or publish.

Do you need to have purchased the book from the outlet in question to post a comment? In the case of some sites, yes. With others, no.   

.

That said, we all have multiple demands on our time and so while I have outlined some fairly extensive actions, I am aware that most people’s contributions will be on the modest side. All good. Should you choose to get involved in this dimension of our struggle, just do what you are comfortable doing. Have fun in the process—you may find yourself discovering skills that you never knew that you had. However large or small your individual contributions, each contribution adds up. Correspondingly, be assured that if we as a community have a mind to do this—and such is my hope—together we can turn ourselves into a force to be reckoned with.

Concluding Remarks

This article has put forward the case that pivotal to the success of our movement is getting our authors read by the public at large; it has noted the paucity of coverage by the mainstream press and media (a highly related issue); and it has recommended that we include book activism within our activist repertoire. The bulk of article focuses in on ways to go about such activism. Ways explored include: assiduously referencing our books when making points; use of social media; directly pitching a story to the mainstream media; and posting comments on online sites where the books are sold.

In ending, let me invite readers with experience in this or related areas to share their own suggestions about how best to do book activism. What have you yourself done?  What have you seen work? Not work? What do you know about the media in your area that it would be helpful for the rest of us to know?

An observation in closing: While for sure there are exceptions, generally, all coverage, including psychiatry “panning” our books works to our advantage. So do not worry if your postings culminate in psychiatry going on the offensive, that is, devoting their energy to attacking the target book—don’t even become alarmed it they start making spurious claims about it (to some extent, inevitable). The fact that they bother is itself an indicator that they are losing ground. Correspondingly, their doing so, spells controversy. And the value of controversy especially when handled skillfully may be gleaned from the PsychOut experience:

To wit, PsychOut was an activist University of Toronto conference on organizing against psychiatry. It received highly negative and indeed demeaning press—presenters being portrayed as “flakes”, the entire operation portrayed as a waste of the public purse—hence the controversy. A war of words ensued—which the knowledgeable activists won handily. The long and short? The bad press, together with activists’ able response to it, culminated in the most extensive and the best press that we activists/antipsychiatry scholars had received in decades (see Burstow and Diamond, 2011).

(For related articles, see http://bizomadness.blogspot.ca/).

References

Ben-Moshe, L., Chapman, C., & Carey, A. (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. (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). A prison by any other name: A review of Disability Incarcerated. Canadian Journal of Disability Studies, 2014, Volume 3. No. 3, pp. 137-143. 

Burstow, B. (2015a) “Doing” antipsychiatry on all cylinders: Possibilities, enigmas, challenges. Retrieved April 15 2015 from http://www.madinamerica.com/2015/04/antipsychiatry-cylinders-possibilities-enigmas-challenges/.

Burstow, B. (2015b). Protesting ECT: A moral/existential calling. Retrieved April 17 2015 from http://www.madinamerica.com/2015/03/protesting-ect-moralexistential-calling/

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

Burstow, B. & Diamond, S. (2011). Building a global network of activists. Asylum, Vol. 18, No. 4,  pp. 21-22.

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

Lieberman, J. (2015). Shrinks: The untold story. New York: Little, Brown and Company.

Mills, C. (2013). Decolonizing global mental health: The psychiatrization of the majority world. London: Routledge.

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

Whitaker, R. & Cosgrove, L. (2015). Psychiatry under the influence: Institutional corruption, social injury, and prescriptions for reform. New York: Palgrave Macmillan.

Wipond, R. (2103). Pitching mad: News media and the psychiatric survivor perspective. In B. LeFrançois, R. Menzies, and G. Reaume. Mad matters: A critical reader in mad studies (pp. 253-264). Toronto: Canadian Scholars Press.

First Review of Psychiatry and the Business of Madness is Out---and It's a Ringing Endorsement

Writes psychologist and theorist Philip Hickey, "This book is a major milestone in the antipsychiatry effort, and stands as a monumental challenge to psychiatry's continued existence as a branch of medicine."

What every author holds their breath for--the first review of Psychiatry and the Business of Madness is out--and it's a ringing endorsment.

Another memorable statements from Hickey?   Normally when I write a book review, I include some quotes from the work to enable readers to judge for themselves the quality and content of the material.  With Psychiatry and the Business of Madness, however, this presented a problem, in that virtually every one of the 264 pages of text contains eminently quotable material.

For Hickey's full review of the book, see his review in Mad in America

“Doing” Antipsychiatry on all Cylinders: Possibilities, Enigmas, Challenges

Year after year, we confront, we explain. Maybe we get minor concessions. Then presto, something happens, and even those handouts are gone. (S. R., activist and interviewee)

On several occasions I have written about the complexities of antipsychiatry politics, exploring more specifically, how to “do our politics” in a way that moves society squarely in the direction of the abolitionist goal (e.g., Burstow, 2014). In this article, I am once again theorizing the “how” of activism—for understanding this territory is critical to maximizing effectiveness. However, this time round, I am approaching it from an angle at once more general and more practical. That is, I am investigating the tools or approaches at our disposal as activists. What relates to this, I will be discussing the genus of politic—that is, the manner of politics being engaged.  

Pivotal questions grappled with in this article include: What fundamental approaches might be taken to end/rein in psychiatry? What are the strengths and shortcomings of each? What dangers do they present? To what larger genus of politic do they belong?  How are we to understand these in themselves? In relation to psychiatry? What are some of the enigmas, or challenges facing us? And how might they be met?

Now obviously, very different approaches might be adopted depending on the intended target of our change efforts—psychiatrists, survivors whom we hope to influence, our selves, the general public, the state. For the purpose of this article, I will largely be limiting the focal target to those with power in this area on one hand and the general public on the other.

That said, let me suggest that there are two overarching or umbrella approaches available to us as activists—persuasion on one hand and the application of political pressure on the other (for an articulation of these principles in relation a neighbouring movement, see Rosenthal, 1996).

To begin with persuasion, persuasion is predicated on the supposition that if we make our points well enough, say, by assembling cogent evidence, by making it assessable, by personalizing this with sensitizing stories and other emotional persuaders, people will become convinced that action of the type suggested is called for—for example, that ECT should be abolished. Correspondingly, it is assumed that there is an extremely close relationship between people being persuaded and change happening. Now whatever the limitation of this perspective and this approach, without question, persuasion is a key element in most change processes. Moreover, it is part of our existential nature to try to persuade and to move. Understandably, correspondingly, efforts at persuasion abound in our movement, whether we call what we are doing providing information, exposing, sensitizing, telling our story, or educating. Examples are: almost all the articles in Mad in America, the books that we pen, fact sheets that we produce, dialogues that we invite.

That said, I would agree that this is a necessary, even pivotal dimension. Why, for example, would the public support banning ECT short of becoming convinced that it is inherently damaging? Our tools here—and it is important to master them—include: sound scientific evidence, latest findings, cogent analysis, people’s stories, with ones with which public can identify being particular important, for they heighten empathy, lead to “aha” movements, and motivate. And with all of this, painstaking accuracy is critical. Note, the establishment can get away with lying, twisting, and exaggerating—we cannot.

That granted, a number of questions arise. First, are there risks involved in heavily relying on persuasion? Let me suggest that indeed, there are, with the risks different for different types of persuasion. To begin with the simplest of these, when trying to persuade, especially when using personal stories as persuaders, we can readily fall into what has been called “the politics of compassion” (in the politics of compassion, we are in essence leveraging the compassion that people feel or can be induced to feel to effect the changes sought; for an articulation of this concept, see Rosenthal, 1996). To be clear, I am in no way trying to minimize the importance of compassion. Nonetheless, the politics of compassion is at best a tenuous base from which to proceed. Why? For one, the presence of compassion does not in and of itself mean that the shift that materializes will be benign, despite our best efforts. In this regard, strange though this may seem, most people who support forced drugging are convinced that there are thereby being compassionate to the objects of the force. Additionally, even good changes made on such a basis tend to be less than reliable. Why? Because people whose political decisions stem overwhelmingly from compassion seldom have a solid grasp of the territory. Correspondingly, the object of their compassion can shift—and as a result, such changes can be very short-lived. 

One way that this happens is by the establishment likewise appealing to compassion. In this regard, in the early 1980s ECT survivors frequently got on tv and moved the public with chilling stories of how the treatment ruined their lives—seemingly, real progress. Within short order, though, psychiatrists were bringing their own patients onto shows with them, with the patients testifying how ECT had saved their lives. The audience was still compassionate but compassion now culminated in support for the status quo.

Indeed, even when substantial (and benign) changes have materialized, in the absence of a more solid base, they can quickly be reversed. Consider, in this regard, the great strides made with respect to psychiatric survivor rights in the 1980s. In Ontario Canada, for instance, education on the impossible plight of psychiatric survivors led to legal changes predicated on the notion that the default mode should be survivors making their own decisions. Shortly thereafter, however, a man called Brian was killed by someone identified as  “disordered” and the incident was seized upon by institutional psychiatry, its supporters, and the media. Whereupon, the public’s compassion shifted from survivors per se to what was seen as their potential victims. The result was the passing of Brian’s Law—a piece of legislation which dramatically lowered the bar on what suffices to incarcerate involuntarily (for details, see Burstow, 2015a).

For changes to be benign, solid, and enduring, in other words, additional education is needed that goes beyond the education typically associated with the politics of compassion. Examples are: education debunking the myth of the dangerous mental patient, education around the inefficacy of and the harm done by the “treatments,” and education on psychiatry’s lack of foundation. More fundamentally, if substantial and enduring change is to be achieved, the politics of entitlement has to take precedence over the politics of compassion. To hone in on consent, for example, the message that needs to be delivered is: Irrespective of how others may feel, it is everyone’s right to be free.

This being the case, public education on people’s rights is important. And of particular importance are initiatives like Tina Minkowitz’s, which culminated in the U.N. declaring involuntary treatment torture (see Minkowitz, 2014). And here we move from liberal to radical education, and, indeed, consciousness-raising. 

At this point the question arises: If education is both more thorough and more radical, will it then suffice? At risk of frustrating the reader, let me suggest, for the most part, no. And here, we come up against the limitations of persuasion, also the inadequacy of what passes as common sense. In this regard, it is commonly believed that if provided with good evidence and ways to relate, people can be persuaded to see things differently; correspondingly, once enough people or the right people are so persuaded, social change, ipso facto, will occur. The very fact that for decades now an abundance of  scholars, activists, and survivors have masterfully provided such education (e.g., Szasz, Breggin, Frank) and yet psychiatry continues to command respect and to grow is itself an indicator that such an understanding is too simplistic. While of course, on some level or other, persuasion is generally at work when change happens, what such a perspective ignores is the very fact of power and how it works.

The point is that there are structures and there is a profession here endowed with authority. And there are huge vested interests at play—the multinational pharmaceutical companies, for example, armies of  “professional helpers”, indeed the entire psychiatric/psychopharmaceutical industrial complex. These yield enormous power, including the power to determine who and what is credible. Correspondingly, they can be counted on to use that power to further their own interests, including their own bottom line. On top of which the public is wary of people whom they see as mad— and so want such structures in place. Moreover, the industry has vast sums of money and other capital at their disposal, and whenever it has seen public sentiment shift against it, it has invariably responded by drawing on its extensive resources to wage a new campaign (for details, see Burstow, 2015a). All formidable reasons why persuasion does not suffice.

If the combination of logic, facticity, and fellow feeling, while essential, do not suffice—and I am suggesting that they do not—what else is needed? At this point in history at any rate, force. The point is, insofar as an oppressor wields power, and insofar as we are trying to overturn a system that is inherently oppressive and all-encompassing, we too need to wield power. To be clear, I am in no way suggesting physical force, but non-violent action such as that waged by visionaries like Gandhi (see Sharp, 1973).

Now indeed, albeit it is underutilized, to varying degrees nonviolent resistance too has always figured in our repertoire. Note, in this regard, the Highlander work, wherein survivors  pointedly modeled themselves on the civil rights movement. Note the demonstrations in the UK (see Mckeown, Creswell, and Spandler, 2014). Correspondingly, witness MindFreedom’s 2002 hunger strike (for details, see http://www.mindfreedom.org/kb/act/2003/mf-hunger-strike/hunger-strike-news?searchterm=hunger+ ).

The latter, I would add, is a particularly instructive action to probe. The protestors’ ultimate demand was the provision of choice in “services”; and in the process of making this demand, they challenged the American Psychiatric Association and the National Institute of Mental Health to point to a single study showing that “mental illness” is biological—which, of course, they could not. This action was nothing short of remarkable; it included among its team no less a figure than the former head of “schizophrenia studies” at National Institute of Mental Health; it brought together survivors and radical professionals, drawing on the knowledge of each; it garnered press; it brought goals, methods, and means of measurement into alignment with each other, as is critical in strategic activism; correspondingly, it constituted a formidable education in its own right. At the same time, even this stellar piece of activism fell short of achieving its objective. Nor did it exactly create a base from which to proceed. And here is the rub.

Now to be clear, as I have stated elsewhere (Burstow, 2015b), standing up and being counted is important irrespective of effectiveness. And so is raising awareness even when nothing concrete materializes. Nonetheless, insofar as our goal is social change, effectiveness in the strictest sense of the term matters. So the question is: what kind of pressure can we bring to bear that might actually materialize in change? In short, there are two types of pressure involved in non-violent action. The first is moral force, also known as the force of truth (and the personal stories alluded to earlier are a part of this). Such is arguably achievable in our movement, for the cause is just and the harm demonstrable.

That said, while moral force is absolutely critical—and for sure it was being wielded in that hunger strike—it similarly does not suffice. In this regard, history teaches us—and we ignore this to our peril—that moral pressure needs to be combined with pressure of a more material kind. Note, in India when Gandhi mobilized against the British colonizers, or to add a second example, when the Black community in Nashville sought to desegregate the commercial centre of their city, they were successful because not only had they moral force, they used and leveraged the power of numbers to obstruct. In this regard, the oppressed inhabitants of India greatly outnumbered the British occupiers, did all the work utilized by the regime, and so by the very act of striking, they were able to bring production to a halt and in the process, undermine the British. By the same token, the Black community in Nashville was sufficiently large that once the overwhelming majority of Black residents (plus allies) had joined the ongoing boycott of stores practicing segregation (more or less all stores in central Nashville) and had engaged in it long enough, the seemingly intransigent merchants of Nashville were, in essence, brought to their knees (for a blow-by-blow of this very extensive campaign, see York, 2000).

To put this simply, the question facing any movement intent on change is leverage. Having large enough numbers that you can stop the work of industry constitutes leverage. Being able to wield sufficient economic power that simply by refusing to purchase you can materially affect companies’ bottom line constitutes leverage. Now generally, the leverage in question is of an economic nature, but there is no obvious reason why this must be so. That noted, the question facing our movement is this: Besides the morality of our cause, exactly what is our leverage? And if we haven’t sufficient leverage now—which I am suggesting is the case—what kind of leverage can we get and how do we acquire more?

The answer to this question is anything but obvious. A course which I teach (Creative Empowerment Work with the Disenfanchized) is instructive in this regard. Year after year, I have engaged students in an exercise—and it invariably ends with the same impasse: The class having been divided into three, each group is tasked with brainstorming a strategic piece of resistance that would stand a reasonable chance of being successful—group one, in regard to homelessness, group two with respect to prisons, group three with regards to psychiatry. While all three encounter difficulties, almost invariably, it is the students in the antipsychiatry group that flounder. Why? Precisely because, try though they might, they cannot locate a point of leverage.

This said, arguably, the single biggest task confronting us as a movement is finding or generating leverage. Boycotting the drugs, clearly, would not get the unity needed and would otherwise backfire. And in the end, even at its best, the only pressure of use to us that would arise from a hunger strike is moral pressure, which short of having a person with the reputation of Gandhi at the helm, is not going to advance the movement far. 

I do not have a clear answer to the dilemma posed here, though I can hazard some guesses about direction. Insofar as lack of numbers presents a formidable obstacle to any strategy, let me suggest that coalition politics appears to be called for. Note, if even a modest percentage of the people poorly served by society banded together, we would greatly outnumber the establishment, and as such, arguably, the necessary critical mass could be forged. Though to accomplish this, obviously, ongoing work reaching out and co-visioning would be critical.

Not an easy or a quick answer, I agree, but one with the added advantage of being holistic and truly leading in the direction of a better society.

In summation, there are very serviceable tools at our disposal as antipsychiatry activists—and these include various kinds of persuasion and force. Correspondingly, it is critical that we know them, select and use them skillfully. At the same time, major challenges confront us.  Getting past our conviction that persuasion suffices is one of them—and then there are the material problems, together with issues like power and leverage. Hopefully, this article has shed a little more clarity on all of such aspects. And hopefully, the reflections and dialogue started here can continue.

Indeed, as you go about your work, I invite the reader to continue pondering the distinctions, queries, and challenges raised. In particular, I invite you to ask yourself: What power do we wield? Could we wield? Who historically have our allies been? (e.g., homelessness activists, prison abolitionists, Quakers) And who might new allies be? As an addendum, correspondingly, I leave you with the following consideration:

No campaign is successful without images. And if chosen judiciously, symbols can be of considerable help in generating leverage.

One possibility in this regard is using the violence of ECT as a symbol for psychiatry overall (see Burstow, 2015b). What might be at least as potent—and I think that we would do well to seriously entertain this possibility—is to focus in on the psychiatrization of children. By this I do not mean what happened to current adult survivors when young (important though this dimension is), but the rampant targeting of children going on now (see Whitaker, 2010). Children being placed on Ritalin. Children being labeled ADHD. Children being controlled/subdued chemically in classrooms around the world. Herein lies a powerful symbol. Question: If we leverage it properly, might not the public at large be moved to rally in protection of its children? And were that possible, in the long run, might not such a focus deliver the numbers needed for strategic action? 

What is significant here, irrespective of espoused belief, understandably (given that the young in particular are entrusted to our care), people are readily outraged by what happens to children, and more pointedly, what happens or could happen to their child. And significantly, the vast majority of the human population are parents, grandparents, and the like. Now for sure, a frightening number of parents, moreover, the vast majority of ones publicly weighing on these issues are in the opposite camp, have become, in essence, an extension of psychiatry. By the same token, a particularly formidable weapon in psychiatry’s current arsenal are pro-medical model family organizations like NAMI, tutored, funded, and otherwise resourced by the psychopharmaceuticals. This notwithstanding, those of us who organize in this area have witnessed first hand the enormous power that can be unleashed when parents suddenly realize that they have been, as it were, “sold a bill of goods”. As such, arguably, if we put our minds to reaching and leveraging the power of this very considerable constituency (of which we, after all, are a part), for the first time in history, we might be able to create the leverage needed—indeed, potentially, leverage beyond our wildest dreams—a good beginning.

Insofar as this is the case, I would add, the greed of the psychiatric/psychopharmaceutical industry in relentlessly pursuing this erstwhile “untapped market”—the real reason that our children have been targeted—could prove to be its own undoing.

References

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