Vienna's Narrenturm—German for "fools' tower"—was one of the earliest buildings specifically designed as a "madhouse". It was built in 1784.
Anti-psychiatry is a movement
based on the view that psychiatric treatment is often more damaging
than helpful to patients. It considers psychiatry a coercive instrument
of oppression due to an unequal power relationship between doctor and patient and a highly subjective diagnostic process. It has been active in various forms for two centuries.
Anti-psychiatry originates in an objection to what some view as dangerous treatments. Examples include electroconvulsive therapy, insulin shock therapy, and brain lobotomy.
A more recent concern is the significant increase in prescribing
psychiatric drugs for children in the beginning of the 20th century. There were also concerns about mental health institutions. All modern societies permit involuntary treatment or involuntary commitment of mental patients.
In the 1960s, there were many challenges to psychoanalysis
and mainstream psychiatry, where the very basis of psychiatric practice
was characterized as repressive and controlling. Psychiatrists involved
in this challenge included Thomas Szasz, Giorgio Antonucci, R. D. Laing, Franco Basaglia, Theodore Lidz, Silvano Arieti, and David Cooper. Others involved were L. Ron Hubbard, Michel Foucault and Erving Goffman. Cooper coined the term "anti-psychiatry" in 1967, and wrote the book Psychiatry and Anti-psychiatry in 1971. Thomas Szasz introduced the definition of mental illness as a myth in the book The Myth of Mental Illness (1961), Giorgio Antonucci introduced the definition of psychiatry as a prejudice in the book I pregiudizi e la conoscenza critica alla psichiatria (1986).
Contemporary issues of anti-psychiatry include freedom versus coercion, racial and social justice, iatrogenic
effects of antipsychotic medications (unintentionally induced by
medical therapy), personal liberty, social stigma, and the right to be
different.
History
Precursors
The first widespread challenge to the prevailing medical approach in Western countries occurred in the late 18th century. Part of the progressive Age of Enlightenment, a "moral treatment" movement challenged the harsh, pessimistic, somatic
(body-based) and restraint-based approaches that prevailed in the
system of hospitals and "madhouses" for people considered mentally
disturbed, who were generally seen as wild animals without reason.
Alternatives were developed, led in different regions by ex-patient
staff, physicians themselves in some cases, and religious and lay
philanthropists.
The moral treatment was seen as pioneering more humane psychological
and social approaches, whether or not in medical settings; however, it
also involved some use of physical restraints, threats of punishment,
and personal and social methods of control. And as it became the establishment approach in the 19th century, opposition to its negative aspects also grew.
According to Michel Foucault, there was a shift in the perception of madness, whereby it came to be seen as less about delusion, i.e. disturbed judgment about the truth, than about a disorder of regular, normal behaviour or will.
Foucault argued that, prior to this, doctors could often prescribe
travel, rest, walking, retirement and generally engaging with nature,
seen as the visible form of truth, as a means to break with
artificialities of the world (and therefore delusions).
Another form of treatment involved nature's opposite, the theatre,
where the patient's madness was acted out for him or her in such a way
that the delusion would reveal itself to the patient.
According to Foucault, the most prominent therapeutic technique
instead became to confront patients with a healthy sound will and
orthodox passions, ideally embodied by the physician. The cure then
involved a process of opposition, of struggle and domination, of the
patient's troubled will by the healthy will of the physician. It was
thought the confrontation would lead not only to bring the illness into
broad daylight by its resistance, but also to the victory of the sound
will and the renunciation of the disturbed will. We must apply a
perturbing method, to break the spasm by means of the spasm.... We must
subjugate the whole character of some patients, subdue their transports,
break their pride, while we must stimulate and encourage the others (Esquirol, J.E.D., 1816). Foucault also argued that the increasing internment
of the "mentally ill" (the development of more and bigger asylums) had
become necessary not just for diagnosis and classification but because
an enclosed place became a requirement for a treatment that was now
understood as primarily the contest of wills, a question of submission
and victory.
Close up of the "Horrors of Kew Asylum" featured in Lee's Pictorial Weekly Budget Police News in 1876
The techniques and procedures of the asylums at this time included
"isolation, private or public interrogations, punishment techniques such
as cold showers, moral talks (encouragements or reprimands), strict
discipline, compulsory work, rewards, preferential relations between the
physician and his patients, relations of vassalage, of possession, of
domesticity, even of servitude between patient and physician at times". Foucault summarized these as "designed to make the medical personage the 'master of madness'"
through the power the physician's will exerts on the patient. The
effect of this shift then served to inflate the power of the physician
relative to the patient, correlated with the rapid rise of internment
(asylums and forced detention).
The Woodilee Hospital was opened in 1875 in Scotland
Other analyses suggest that the rise of asylums was primarily driven by industrialization and capitalism,
including the breakdown of the traditional family structures. And that
by the end of the 19th century, psychiatrists often had little power in
the overrun asylum system, acting mainly as administrators who rarely
attended to patients, in a system where therapeutic ideals had turned
into mindless institutional routines.
In general, critics point to negative aspects of the shift toward
so-called "moral treatments", and the concurrent widespread expansion of
asylums, medical power and involuntary hospitalization laws, in a way
that was to play an important conceptual part in the later
anti-psychiatry movement.
Internee being restrained in a bathtub
Internee in a restraint chair at the West Riding Pauper Lunatic Asylum
Various 19th-century critiques of the newly emerging field of
psychiatry overlap thematically with 20th-century anti-psychiatry, for
example in their questioning of the medicalization of "madness". Those critiques occurred at a time when physicians had not yet achieved hegemony through psychiatry, however, so there was no single, unified force to oppose.
Nevertheless, there was increasing concern at the ease with which
people could be confined, with frequent reports of abuse and illegal
confinement. For example, Daniel Defoe, the author of Robinson Crusoe, had previously argued for more government oversight of "madhouses" and for due process prior to involuntary internment. He later argued that husbands used asylum hospitals to incarcerate their disobedient wives, and in a subsequent pamphlet that wives even did the same to their husbands. It was also proposed that the role of asylum keeper be separated from doctor, to discourage exploitation of patients.
There was general concern that physicians were undermining personhood
by medicalizing problems, by claiming they alone had the expertise to
judge it, and by arguing that mental disorder was physical and
hereditary. The Alleged Lunatics' Friend Society arose in England in the mid-19th century to challenge the system and campaign for rights and reforms. In the United States, Elizabeth Packard
published a series of books and pamphlets describing her experiences in
the Illinois insane asylum to which her husband had had her committed.
Throughout, the class nature of mental hospitals,
and their role as agencies of control, were well recognized. And the
new psychiatry was partially challenged by two powerful social
institutions – the church and the legal system. These trends have been
thematically linked to the later 20th century anti-psychiatry movement.
As psychiatry became more professionally established during the
nineteenth century (the term itself was coined in 1808 in Germany, as
"Psychiatriein") and developed allegedly more invasive treatments,
opposition increased. In the Southern US, black slaves and abolitionists encountered Drapetomania, a pseudo-scientific diagnosis for why slaves ran away from their masters.
There was some organized challenge to psychiatry in the late 1870s from the new speciality of neurology.
Practitioners criticized mental hospitals for failure to conduct
scientific research and adopt the modern therapeutic methods such as
non-restraint. Together with lay reformers and social workers,
neurologists formed the National Association for the Protection of the
Insane and the Prevention of Insanity. However, when the lay members
questioned the competence of asylum physicians to even provide proper
care at all, the neurologists withdrew their support and the association
floundered.
Early 1900s
It
has been noted that "the most persistent critics of psychiatry have
always been former mental hospital patients", but that very few were
able to tell their stories publicly or to confront the psychiatric
establishment openly, and those who did so were commonly considered so
extreme in their charges that they could seldom gain credibility. In the early 20th century, ex-patient Clifford W. Beers
campaigned to improve the plight of individuals receiving public
psychiatric care, particularly those committed to state institutions,
publicizing the issues in his book, A Mind that Found Itself (1908).
While Beers initially condemned psychiatrists for tolerating
mistreatment of patients, and envisioned more ex-patient involvement in
the movement, he was influenced by Adolf Meyer and the psychiatric establishment, and toned down his hostility since he needed their support for reforms.
His reliance on rich donors and his need for approval from
experts led him to hand over to psychiatrists the organization he helped
found, the National Committee for Mental Hygiene which eventually
became the National Mental Health Association.
In the UK, the National Society for Lunacy Law Reform was established
in 1920 by angry ex-patients who sought justice for abuses committed in
psychiatric custody, and were aggrieved that their complaints were
patronisingly discounted by the authorities, who were seen to value the
availability of medicalized internment as a 'whitewashed' extrajudicial
custodial and punitive process.
In 1922, ex-patient Rachel Grant-Smith added to calls for reform of the
system of neglect and abuse she had suffered by publishing "The
Experiences of an Asylum Patient". In the US, We Are Not Alone (WANA) was founded by a group of patients at Rockland State Hospital in New York, and continued to meet as an ex-patient group.
In the 1920s extreme hostility to psychiatrists and psychiatry was expressed by the French playwright and theater director Antonin Artaud, in particular, in his book on van Gogh. To Artaud, imagination was reality. Much influenced by the Dada and surrealist enthusiasms of the day, he considered dreams,
thoughts and visions no less real than the "outside" world. To Artaud,
reality appeared little more than a convenient consensus, the same kind
of consensus an audience accepts when they enter a theater and, for a
time, are happy to pretend what they're seeing is real.
In this era before penicillin was discovered, eugenics was popular. People believed diseases of the mind could be passed on so compulsory sterilization of the mentally ill was enacted in many countries.
Early 1930s
In the 1930s several controversial medical practices were introduced, including inducing seizures (by electroshock, insulin or other drugs) or cutting parts of the brain apart (lobotomy).
In the US, between 1939 and 1951, over 50,000 lobotomy operations were
performed in mental hospitals. But lobotomy was ultimately seen as too
invasive and brutal.
Holocaust historians argued that the medicalization of social programs and systematic euthanasia of people in German mental institutions in the 1930s provided the institutional, procedural, and doctrinal origins of the mass murder of the 1940s. The Nazi programs were called Action T4 and Action 14f13. The Nuremberg Trials
convicted a number of psychiatrists who held key positions in Nazi
regimes. For instance this idea of a Swiss psychiatrist: "A not so easy
question to be answered is whether it should be allowed to destroy lives
objectively 'unworthy of living' without the expressed request of its
bearers. (...) Even in incurable mentally ill ones suffering seriously
from hallucinations and melancholic depressions and not being able to
act, to a medical colleague I would ascript the right and in serious
cases the duty to shorten — often for many years — the suffering"
(Bleuler, Eugen, 1936: "Die naturwissenschaftliche Grundlage der Ethik".
Schweizer Archiv Neurologie und Psychiatrie, Band 38, Nr.2, S. 206).
1940s and 1950s
The
post-World War II decades saw an enormous growth in psychiatry; many
Americans were persuaded that psychiatry and psychology, particularly psychoanalysis,
were a key to happiness. Meanwhile, most hospitalized mental patients
received at best decent custodial care, and at worst, abuse and neglect.
The psychoanalyst Jacques Lacan
has been identified as an influence on later anti-psychiatry theory in
the UK, and as being the first, in the 1940s and 50s, to professionally
challenge psychoanalysis to reexamine its concepts and to appreciate
psychosis as understandable. Other influences on Lacan included poetry
and the surrealist movement, including the poetic power of patients'
experiences. Critics disputed this and questioned how his descriptions
linked to his practical work. The names that came to be associated with
the anti-psychiatry movement knew of Lacan and acknowledged his
contribution even if they did not entirely agree. The psychoanalyst Erich Fromm is also said to have articulated, in the 1950s, the secular humanistic concern of the coming anti-psychiatry movement. In The Sane Society
(1955), Fromm wrote ""An unhealthy society is one which creates mutual
hostility [and] distrust, which transforms man into an instrument of use
and exploitation for others, which deprives him of a sense of self,
except inasmuch as he submits to others or becomes an automaton"..."Yet
many psychiatrists and psychologists refuse to entertain the idea that
society as a whole may be lacking in sanity. They hold that the problem
of mental health in a society is only that of the number of 'unadjusted'
individuals, and not of a possible unadjustment of the culture itself".
Graveyard attached to the Church of St. Thomas in West Yorkshire, England, where thousands of internees from Storthes Hall rest in unmarked graves
In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine,
slowly came into use. Although often accepted as an advance in some
ways, there was opposition, partly due to serious adverse effects such
as tardive dyskinesia, and partly due their "chemical straitjacket" effect and their alleged use to control and intimidate patients. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control.
There was also increasing opposition to the large-scale use of
psychiatric hospitals and institutions, and attempts were made to
develop services in the community.
In 1950, Scientology was founded by L. Ron Hubbard who publicly stated a goal of "eradicating psychiatry from the face of this earth". Instead through his book Dianetics: The Modern Science of Mental Health the discredited use of introspection as treatment as well as auditing was promoted.
The Royal Earlswood Asylum for Idiots
was the first hospital for people with learning disabilities, led by
Lord Palmerston, Baron Rothschild and Lord Ashley in the 1850s
In the 1950s in the United States, a right-wing anti-mental health movement opposed psychiatry, seeing it as liberal, left-wing, subversive and anti-American
or pro-Communist. There were widespread fears that it threatened
individual rights and undermined moral responsibility. An early skirmish
was over the Alaska Mental Health Bill, where the right wing protestors were joined by the emerging Scientology movement.
The field of psychology sometimes came into opposition with psychiatry. Behaviorists argued that mental disorder was a matter of learning not medicine; for example, Hans Eysenck argued that psychiatry "really has no role to play". The developing field of clinical psychology in particular came into close contact with psychiatry, often in opposition to its methods, theories and territories.
1960s
Coming to the fore in the 1960s, "anti-psychiatry" (a term first used by David Cooper
in 1967) defined a movement that vocally challenged the fundamental
claims and practices of mainstream psychiatry. While most of its
elements had precedents in earlier decades and centuries, in the 1960s
it took on a national and international character, with access to the
mass media and incorporating a wide mixture of grassroots activist
organizations and prestigious professional bodies.
Cooper was a South African psychiatrist working in Britain. A
trained Marxist revolutionary, he argued that the political context of
psychiatry and its patients had to be highlighted and radically
challenged, and warned that the fog of individualized therapeutic
language could take away people's ability to see and challenge the
bigger social picture. He spoke of having a goal of "non-psychiatry" as
well as anti-psychiatry.
"In the 1960s fresh voices mounted a new challenge to the pretensions of psychiatry as a science and the mental health system as a successful humanitarian enterprise. These voices included: Ernest Becker, Erving Goffman, R.D. Laing; Laing and Aaron Esterson, Thomas Scheff, and Thomas Szasz. Their writings, along with others such as articles in the journal The Radical Therapist, were given the umbrella label "antipsychiatry" despite wide divergences in philosophy. This critical literature, in concert with an activist movement, emphasized the hegemony of medical model psychiatry, its spurious sources of authority, its mystification of human problems, and the more oppressive practices of the mental health system, such as involuntary hospitalisation, drugging, and electroshock".
The psychiatrists R D Laing (from Scotland), Theodore Lidz (from America), Silvano Arieti (from Italy) and others, argued that "schizophrenia" and psychosis
were understandable, and resulted from injuries to the inner
self-inflicted by psychologically invasive "schizophrenogenic" parents
or others. It was sometimes seen as a transformative state involving an
attempt to cope with a sick society. Laing, however, partially
dissociated himself from his colleague Cooper's term "anti-psychiatry".
Laing had already become a media icon through bestselling books (such as
The Divided Self and The Politics of Experience) discussing mental distress in an interpersonal existential
context; Laing was somewhat less focused than his colleague Cooper on
wider social structures and radical left wing politics, and went on to
develop more romanticized or mystical views (as well as equivocating
over the use of diagnosis, drugs and commitment). Although the movement
originally described as anti-psychiatry became associated with the
general counter-culture movement of the 1960s, Lidz and Arieti never became involved in the latter. Franco Basaglia promoted anti-psychiatry in Italy and secured reforms to mental health law there.
Laing, through the Philadelphia Association founded with Cooper in 1965, set up over 20 therapeutic communities including Kingsley Hall, where staff and residents theoretically assumed equal status and any medication used was voluntary. Non-psychiatric Soteria houses, starting in the United States, were also developed as were various ex-patient-led services.
Psychiatrist Thomas Szasz argued that "mental illness"
is an inherently incoherent combination of a medical and a
psychological concept. He opposed the use of psychiatry to forcibly
detain, treat, or excuse what he saw as mere deviance from societal
norms or moral conduct. As a libertarian,
Szasz was concerned that such usage undermined personal rights and
moral responsibility. Adherents of his views referred to "the myth of
mental illness", after Szasz's controversial 1961 book of that name
(based on a paper of the same name that Szasz had written in 1957 that,
following repeated rejections from psychiatric journals, had been
published in the American Psychologist in 1960).
Although widely described as part of the main anti-psychiatry movement,
Szasz actively rejected the term and its adherents; instead, in 1969,
he collaborated with Scientology to form the Citizens Commission on Human Rights.
It was later noted that the view that insanity was not in most or even
in any instances a "medical" entity, but a moral issue, was also held by
Christian Scientists and certain Protestant fundamentalists, as well as Szasz.
Szasz was not a Scientologist himself and was non-religious; he
commented frequently on the parallels between religion and psychiatry.
Erving Goffman, Gilles Deleuze, Félix Guattari and others criticized the power and role of psychiatry in society, including the use of "total institutions" and the use of models and terms that were seen as stigmatizing. The French sociologist and philosopher Foucault, in his 1961 publication Madness and Civilization: A History of Insanity in the Age of Reason,
analyzed how attitudes towards those deemed "insane" had changed as a
result of changes in social values. He argued that psychiatry was
primarily a tool of social control, based historically on a "great
confinement" of the insane and physical punishment and chains, later
exchanged in the moral treatment era for psychological oppression and
internalized restraint. American sociologist Thomas Scheff applied labeling theory
to psychiatry in 1966 in "Being Mentally Ill". Scheff argued that
society views certain actions as deviant and, in order to come to terms
with and understand these actions, often places the label of mental
illness on those who exhibit them. Certain expectations are then placed
on these individuals and, over time, they unconsciously change their
behavior to fulfill them.
Observation of the abuses of psychiatry in the Soviet Union in the so-called Psikhushka hospitals also led to questioning the validity of the practice of psychiatry in the West. In particular, the diagnosis of many political dissidents with schizophrenia led some to question the general diagnosis and punitive usage of the label schizophrenia.
This raised questions as to whether the schizophrenia label and
resulting involuntary psychiatric treatment could not have been
similarly used in the West to subdue rebellious young people during
family conflicts.
Since 1970
Scientologists on an anti-psychiatry demonstration.
New professional approaches were developed as an alternative or reformist complement to psychiatry. The Radical Therapist,
a journal begun in 1971 in North Dakota by Michael Glenn, David Bryan,
Linda Bryan, Michael Galan and Sara Glenn, challenged the psychotherapy
establishment in a number of ways, raising the slogan "Therapy means
change, not adjustment." It contained articles that challenged the
professional mediator approach, advocating instead revolutionary
politics and authentic community making. Social work, humanistic or existentialist therapies, family therapy, counseling and self-help and clinical psychology developed and sometimes opposed psychiatry.
Psychoanalysis was increasingly criticized as unscientific or harmful. Contrary to the popular view, critics and biographers of Freud, such as Alice Miller, Jeffrey Masson and Louis Breger,
argued that Freud did not grasp the nature of psychological trauma.
Non-medical collaborative services were developed, for example
therapeutic communities or Soteria houses.
The psychoanalytically trained psychiatrist Szasz, although
professing fundamental opposition to what he perceives as medicalization
and oppressive or excuse-giving "diagnosis" and forced "treatment", was
not opposed to other aspects of psychiatry (for example attempts to
"cure-heal souls", although he also characterizes this as non-medical).
Although generally considered anti-psychiatry by others, he sought to
dissociate himself politically from a movement and term associated with
the radical left-wing. In a 1976 publication "Anti-psychiatry: The
paradigm of a plundered mind", which has been described as an overtly
political condemnation of a wide sweep of people, Szasz claimed Laing,
Cooper and all of anti-psychiatry consisted of "self-declared socialists, communists, or at least anti-capitalists and collectivists".
While saying he shared some of their critique of the psychiatric
system, Szasz compared their views on the social causes of
distress/deviance to those of anti-capitalist anti-colonialists who claimed that Chilean poverty was due to plundering by American companies, a comment Szasz made not long after a CIA-backed coup had deposed the democratically elected Chilean president and replaced him with Pinochet. Szasz argued instead that distress/deviance is due to the flaws or failures of individuals in their struggles in life.
The anti-psychiatry movement was also being driven by individuals
with adverse experiences of psychiatric services. This included those
who felt they had been harmed by psychiatry or who felt that they could
have been helped more by other approaches, including those compulsorily
(including via physical force) admitted to psychiatric institutions and
subjected to compulsory medication or procedures. During the 1970s, the
anti-psychiatry movement was involved in promoting restraint from many
practices seen as psychiatric abuses.
The gay rights
movement continued to challenge the classification of homosexuality as a
mental illness and in 1974, in a climate of controversy and activism,
the American Psychiatric Association
membership (following a unanimous vote by the trustees in 1973) voted
by a small majority (58%) to remove it as an illness category from the DSM,
replacing it with a category of "sexual orientation disturbance" and
then "ego-dystonic homosexuality," which was deleted in 1987, although
"gender identity disorder" (a widely used term for gender dysphoria) and a wide variety of "paraphilias"
remain. It has been noted that gay activists at the time adopted many
of Szasz's arguments against the psychiatric system, but also that Szasz
had written in 1965 that: "I believe it is very likely that
homosexuality is, indeed, a disease in the second sense [expression of
psychosexual immaturity] and perhaps sometimes even in the stricter
sense [a condition somewhat similar to ordinary organic maladies perhaps
caused by genetic error or endocrine imbalance. Nevertheless, if we
believe that by categorising homosexuality as a disease we have
succeeded in removing it from the realm of moral judgement, we are in
error."
Increased legal and professional protections, and a merging with human rights and disability rights movements, added to anti-psychiatry theory and action.
Anti-psychiatry came to challenge a "biomedical" focus of psychiatry (defined to mean genetics, neurochemicals and pharmaceutic drugs). There was also opposition to the increasing links between psychiatry and pharmaceutical companies,
which were becoming more powerful and were increasingly claimed to have
excessive, unjustified and underhand influence on psychiatric research
and practice. There was also opposition to the codification of, and
alleged misuse of, psychiatric diagnoses into manuals, in particular the
American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders.
Anti-psychiatry increasingly challenged alleged psychiatric
pessimism and institutionalized alienation regarding those categorized
as mentally ill. An emerging consumer/survivor movement often argues for full recovery, empowerment, self-management and even full liberation. Schemes were developed to challenge stigma and discrimination, often based on a social model of disability; to assist or encourage people with mental health issues to engage more fully in work and society (for example through social firms),
and to involve service users in the delivery and evaluation of mental
health services. However, those actively and openly challenging the
fundamental ethics and efficacy of mainstream psychiatric practice
remained marginalized within psychiatry, and to a lesser extent within
the wider mental health community.
Three authors came to personify the movement against psychiatry,
and two of these were practicising psychiatrists. The initial and most
influential of these was Thomas Szasz who rose to fame with his book The Myth of Mental Illness, although Szasz himself did not identify as an anti-psychiatrist. The well-respected R D Laing wrote a series of best-selling books, including The Divided Self. Intellectual philosopher Michel Foucault
challenged the very basis of psychiatric practice and cast it as
repressive and controlling. The term "anti-psychiatry" was coined by David Cooper in 1967. In parallel with the theoretical production of the mentioned authors, the Italian physician Giorgio Antonucci questioned the basis themselves of psychiatry through the dismantling of the psychiatric hospitals Osservanza and Luigi Lolli and the liberation – and restitution to life – of the people there secluded.
Challenges to psychiatry
Civilization as a cause of distress
In recent years, psychotherapists David Smail and Bruce E. Levine,
considered part of the anti-psychiatry movement, have written widely on
how society, culture, politics and psychology intersect. They have
written extensively of the "embodied nature" of the individual in
society, and the unwillingness of even therapists to acknowledge the
obvious part played by power and financial interest in modern Western
society. They argue that feelings and emotions are not, as is commonly
supposed, features of the individual, but rather responses of the
individual to their situation in society. Even psychotherapy, they
suggest, can only change feelings in as much as it helps a person to
change the "proximal" and "distal" influences on their life, which range
from family and friends, to the workplace, socio-economics, politics
and culture.
R. D. Laing emphasized family nexus as a mechanism whereby individuals become victimized by those around them, and spoke about a dysfunctional society.
Inadequacy of clinical interviews used to diagnose 'diseases'
An
etiology common to bipolar spectrum disorders has not been identified.
Patients cannot be identified just by clinical interviews [citation
needed]. A neurobiological basis of bipolar disorder has not been
discovered [citation needed]. In making a bipolar spectrum disorder
diagnosis based solely on a clinical interview, a false positive cannot
be avoided [citation needed].
Psychiatrists have been trying to differentiate mental disorders
based on clinical interviews since the era of Kraepelin, but now realize
that their diagnostic criteria are imperfect. Tadafumi Kato writes, "We
psychiatrists should be aware that we cannot identify 'diseases' only
by interviews. What we are doing now is just like trying to diagnose
diabetes mellitus without measuring blood sugar."
Normality and illness judgments
A
madness of civilization: the American physician Samuel A. Cartwright
identified what he called drapetomania, an ailment that caused slaves to
be possessed by a desire for freedom and a want to escape
In 2013, psychiatrist Allen Frances
said that "psychiatric diagnosis still relies exclusively on fallible
subjective judgments rather than objective biological tests".
Reasons have been put forward to doubt the ontic status of mental disorders. Mental disorders engender ontological skepticism on three levels:
- Mental disorders are abstract entities that cannot be directly appreciated with the human senses or indirectly, as one might with macro- or microscopic objects.
- Mental disorders are not clearly natural processes whose detection is untarnished by the imposition of values, or human interpretation.
- It is unclear whether they should be conceived as abstractions that exist in the world apart from the individual persons who experience them, and thus instantiate them.
In the scientific and academic literature on the definition or
classification of mental disorder, one extreme argues that it is
entirely a matter of value judgements (including of what is normal) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms). Common hybrid views argue that the concept of mental disorder is objective but a "fuzzy prototype"
that can never be precisely defined, or alternatively that it
inevitably involves a mix of scientific facts and subjective value
judgments.
One remarkable example of psychiatric diagnosis being used to
reinforce cultural bias and oppress dissidence is the diagnosis of drapetomania. In the US prior to the American Civil War, physicians such as Samuel A. Cartwright
diagnosed some slaves with drapetomania, a mental illness in which the
slave possessed an irrational desire for freedom and a tendency to try
to escape.
By classifying such a dissident mental trait as abnormal and a disease,
psychiatry promoted cultural bias about normality, abnormality, health,
and illness. This example indicates the probability for not only cultural bias but also confirmation bias and bias blind spot in psychiatric diagnosis and psychiatric beliefs.
It has been argued by philosophers like Foucault that characterizations of "mental illness" are indeterminate
and reflect the hierarchical structures of the societies from which
they emerge rather than any precisely defined qualities that distinguish
a "healthy" mind from a "sick" one. Furthermore, if a tendency toward
self-harm is taken as an elementary symptom of mental illness, then
humans, as a species, are arguably insane in that they have
tended throughout recorded history to destroy their own environments, to
make war with one another, etc.
Psychiatric labeling
"Psychiater
Europas! Wahret Eure heiligsten Diagnosen!" ("Psychiatrists of Europe!
Protect your sanctified diagnoses!"), says the inscription on the
cartoon by Emil Kraepelin, who introduced the schizophrenia concept, "Bierzeitung", Heidelberg, 1896
Mental disorders were first included in the sixth revision of the International Classification of Diseases (ICD-6) in 1949. Three years later, the American Psychiatric Association created its own classification system, DSM-I. The definitions of most psychiatric diagnoses consist of combinations of phenomenological criteria, such as symptoms and signs and their course over time.
Expert committees combined them in variable ways into categories of
mental disorders, defined and redefined them again and again over the
last half century.
The majority of these diagnostic categories are called
"disorders" and are not validated by biological criteria, as most
medical diseases are; although they purport to represent medical
diseases and take the form of medical diagnoses.
These diagnostic categories are actually embedded in top-down
classifications, similar to the early botanic classifications of plants
in the 17th and 18th centuries, when experts decided a priori about
which classification criterion to use, for instance, whether the shape
of leaves or fruiting bodies were the main criterion for classifying
plants. Since the era of Kraepelin, psychiatrists have been trying to differentiate mental disorders by using clinical interviews.
Experiments admitting "healthy" individuals into psychiatric care
In 1972, psychologist David Rosenhan published the Rosenhan experiment, a study questioning the validity of psychiatric diagnoses.
The study arranged for eight individuals with no history of
psychopathology to attempt admission into psychiatric hospitals. The
individuals included a graduate student, psychologists, an artist, a
housewife, and two physicians, including one psychiatrist. All eight
individuals were admitted with a diagnosis of schizophrenia or bipolar
disorder. Psychiatrists then attempted to treat the individuals using
psychiatric medication. All eight were discharged within 7 to 52 days.
In a later part of the study,
psychiatric staff were warned that pseudo-patients might be sent to
their institutions, but none were actually sent. Nevertheless, a total
of 83 patients out of 193 were believed by at least one staff member to
be actors. The study concluded that individuals without mental disorders
were indistinguishable from those suffering from mental disorders.
Critics such as Robert Spitzer
placed doubt on the validity and credibility of the study, but did
concede that the consistency of psychiatric diagnoses needed
improvement.
It is now realized that the psychiatric diagnostic criteria are not
perfect. To further refine psychiatric diagnosis, according to Tadafumi
Kato, the only way is to create a new classification of diseases based
on the neurobiological features of each mental disorder.
On the other hand, according to Heinz Katsching, neurologists are
advising psychiatrists just to replace the term "mental illness" by
"brain illness."
There are recognized problems regarding the diagnostic
reliability and validity of mainstream psychiatric diagnoses, both in
ideal and controlled circumstances and even more so in routine clinical practice (McGorry et al.. 1995). Criteria in the principal diagnostic manuals, the DSM and ICD, are inconsistent. Some psychiatrists who criticize their own profession say that comorbidity,
when an individual meets criteria for two or more disorders, is the
rule rather than the exception. There is much overlap and vaguely
defined or changeable boundaries between what psychiatrists claim are
distinct illness states.
There are also problems with using standard diagnostic criteria
in different countries, cultures, genders or ethnic groups. Critics
often allege that Westernized, white, male-dominated psychiatric
practices and diagnoses disadvantage and misunderstand those from other
groups. For example, several studies have shown that African Americans are more often diagnosed with schizophrenia than Caucasians, and men more than women. Some within the anti-psychiatry movement are critical of the use of diagnosis as it conforms with the biomedical model.
Tool of social control
Whitchurch Hospital.
According to Franco Basaglia, Giorgio Antonucci, Bruce E. Levine and Edmund Schönenberger whose approach pointed out the role of psychiatric institutions in the control and medicalization of deviant behaviors
and social problems, psychiatry is used as the provider of scientific
support for social control to the existing establishment, and the
ensuing standards of deviance and normality brought about repressive
views of discrete social groups.
According to Mike Fitzpatrick, resistance to medicalization was a
common theme of the gay liberation, anti-psychiatry, and feminist
movements of the 1970s, but now there is actually no resistance to the
advance of government intrusion in lifestyle if it is thought to be
justified in terms of public health.
In the opinion of Mike Fitzpatrick, the pressure for
medicalization also comes from society itself. As one example,
Fitzpatrick claims that feminists who once opposed state intervention as
oppressive and patriarchal, now demand more coercive and intrusive
measures to deal with child abuse and domestic violence.
According to Richard Gosden, the use of psychiatry as a tool of social
control is becoming obvious in preventive medicine programs for
various mental diseases.
These programs are intended to identify children and young people
with divergent behavioral patterns and thinking and send them to
treatment before their supposed mental diseases develop.
Clinical guidelines for best practice in Australia include the risk
factors and signs which can be used to detect young people who are in
need of prophylactic drug treatment to prevent the development of
schizophrenia and other psychotic conditions.
Psychiatry and the pharmaceutical industry
Critics
of psychiatry commonly express a concern that the path of diagnosis and
treatment in contemporary society is primarily or overwhelmingly shaped
by profit prerogatives, echoing a common criticism of general medical
practice in the United States, where many of the largest
psychopharmaceutical producers are based.
Psychiatric research has demonstrated varying degrees of efficacy
for improving or managing a number of mental health disorders through
either medications, psychotherapy, or a combination of the two. Typical
psychiatric medications include stimulants, antidepressants, anxiolytics, and antipsychotics (neuroleptics).
On the other hand, organizations such as MindFreedom International and World Network of Users and Survivors of Psychiatry maintain that psychiatrists exaggerate the evidence of medication and minimize the evidence of adverse drug reaction. They and other activists
believe individuals are not given balanced information, and that
current psychiatric medications do not appear to be specific to
particular disorders in the way mainstream psychiatry asserts;
and psychiatric drugs not only fail to correct measurable chemical
imbalances in the brain, but rather induce undesirable side effects. For
example, though children on Ritalin and other psycho-stimulants become more obedient to parents and teachers, critics have noted that they can also develop abnormal movements such as tics, spasms and other involuntary movements. This has not been shown to be directly related to the therapeutic use of stimulants, but to neuroleptics. The diagnosis of attention deficit hyperactivity disorder
on the basis of inattention to compulsory schooling also raises
critics' concerns regarding the use of psychoactive drugs as a means of
unjust social control of children.
The influence of pharmaceutical companies is another major issue
for the anti-psychiatry movement. As many critics from within and
outside of psychiatry have argued, there are many financial and
professional links between psychiatry, regulators, and pharmaceutical
companies. Drug companies routinely fund much of the research conducted
by psychiatrists, advertise medication in psychiatric journals and
conferences, fund psychiatric and healthcare organizations and health
promotion campaigns, and send representatives to lobby general
physicians and politicians. Peter Breggin,
Sharkey, and other investigators of the psycho-pharmaceutical industry
maintain that many psychiatrists are members, shareholders or special
advisors to pharmaceutical or associated regulatory organizations.
There is evidence that research findings and the prescribing of drugs are influenced as a result. A United Kingdom cross-party parliamentary inquiry
into the influence of the pharmaceutical industry in 2005 concludes:
"The influence of the pharmaceutical industry is such that it dominates
clinical practice"
and that there are serious regulatory failings resulting in "the unsafe
use of drugs; and the increasing medicalization of society". The campaign organization No Free Lunch
details the prevalent acceptance by medical professionals of free gifts
from pharmaceutical companies and the effect on psychiatric practice.
The ghostwriting of articles by pharmaceutical company officials, which
are then presented by esteemed psychiatrists, has also been
highlighted.
Systematic reviews have found that trials of psychiatric drugs that are
conducted with pharmaceutical funding are several times more likely to
report positive findings than studies without such funding.
The number of psychiatric drug prescriptions have been increasing
at an extremely high rate since the 1950s and show no sign of abating.
In the United States antidepressants and tranquilizers are now the top
selling class of prescription drugs, and neuroleptics and other
psychiatric drugs also rank near the top, all with expanding sales.
As a solution to the apparent conflict of interests, critics propose
legislation to separate the pharmaceutical industry from the psychiatric
profession.
John Read and Bruce E. Levine
have advanced the idea of socioeconomic status as a significant factor
in the development and prevention of mental disorders such as
schizophrenia and have noted the reach of pharmaceutical companies
through industry sponsored websites as promoting a more biological
approach to mental disorders, rather than a comprehensive biological,
psychological and social model.
Electroconvulsive therapy
A
Bergonic chair "for giving general electric treatment for psychological
effect, in psycho-neurotic cases", according to original photo
description. World War I era.
Psychiatrists may advocate psychiatric drugs, psychotherapy or more controversial interventions such as electroshock or psychosurgery
to treat mental illness. Electroconvulsive therapy (ECT) is
administered worldwide typically for severe mental disorders. Across the
globe it has been estimated that approximately 1 million patients
receive ECT per year.
Exact numbers of how many persons per year have ECT in the United
States are unknown due to the variability of settings and treatment.
Researchers' estimates generally range from 100,000 to 200,000 persons
per year.
Some persons receiving ECT die during the procedure (ECT is
performed under a general anaesthetic, which always carries a risk). Leonard Roy Frank
writes that estimates of ECT-related death rates vary widely. The lower
estimates include: 2-4 in 100,000 (from Kramer's 1994 study of 28,437
patients), 1 in 10,000 (Boodman's first entry in 1996), 1 in 1,000
(Impastato's first entry in 1957), 1 in 200, among the elderly, over
60 (Impastato's in 1957) Higher estimates include: 1 in 102 (Martin's
entry in 1949), 1 in 95 (Boodman's first entry in 1996), 1 in 92
(Freeman and Kendell's entry in 1976), 1 in 89 (Sagebiel's in 1961), 1
in 69 (Gralnick's in 1946), 1 in 63, among a group undergoing
intensive ECT (Perry's in 1963–1979), 1 in 38 (Ehrenberg's in 1955), 1
in 30 (Kurland's in 1959), 1 in 9 among a group undergoing intensive
ECT (Weil's in 1949), 1 in 4, among the very elderly, over 80
(Kroessler and Fogel's in 1974–1986).
Political abuse of psychiatry
The psychiatric ward at Guantanamo Bay.
Psychiatrists around the world have been involved in the suppression
of individual rights by states wherein the definitions of mental disease
had been expanded to include political disobedience. Nowadays, in many countries, political prisoners are sometimes confined to mental institutions and abused therein. Psychiatry possesses a built-in capacity for abuse which is greater than in other areas of medicine.
The diagnosis of mental disease can serve as proxy for the designation
of social dissidents, allowing the state to hold persons against their
will and to insist upon therapies that work in favour of ideological
conformity and in the broader interests of society.
In a monolithic state, psychiatry can be used to bypass standard legal
procedures for establishing guilt or innocence and allow political
incarceration without the ordinary odium attaching to such political
trials.
Under the Nazi regime in the 1940s, the 'duty to care' was violated on an enormous scale. In Germany alone 300,000 individuals that had been deemed mentally ill, work-shy or feeble-minded were sterilized. An additional 200,000 were euthanized. These practices continued in territories occupied by the Nazis further afield (mainly in eastern Europe), affecting thousands more. From the 1960s up to 1986, political abuse of psychiatry was reported to be systematic in the Soviet Union, and to surface on occasion in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia.
A "mental health genocide" reminiscent of the Nazi aberrations has been
located in the history of South African oppression during the apartheid
era. A continued misappropriation of the discipline was subsequently attributed to the People's Republic of China.
K. Fulford, A. Smirnov, and E. Snow state: "An important
vulnerability factor, therefore, for the abuse of psychiatry, is the
subjective nature of the observations on which psychiatric diagnosis
currently depends." In an article published in 1994 by American psychiatrist Thomas Szasz on the Journal of Medical Ethics
he stated that "the classification by slave owners and slave traders of
certain individuals as Negroes was scientific, in the sense that whites
were rarely classified as blacks. But that did not prevent the 'abuse'
of such racial classification, because (what we call) its abuse was, in
fact, its use."
Szasz argued that the spectacle of the Western psychiatrists loudly
condemning Soviet colleagues for their abuse of professional standards
was largely an exercise in hypocrisy.
Szasz states that K. Fulford, A. Smirnov, and E. Snow, who correctly
emphasize the value-laden nature of psychiatric diagnoses and the
subjective character of psychiatric classifications, fail to accept the
role of psychiatric power.
He stated that psychiatric abuse, such as people usually associated
with practices in the former USSR, was connected not with the misuse of
psychiatric diagnoses, but with the political power built into the
social role of the psychiatrist in democratic and totalitarian societies
alike.
Musicologists, drama critics, art historians, and many other scholars
also create their own subjective classifications; however, lacking
state-legitimated power over persons, their classifications do not lead
to anyone's being deprived of property, liberty, or life.
For instance, plastic surgeon's classification of beauty is subjective,
but the plastic surgeon cannot treat his or her patient without the
patient's consent, therefore, there cannot be any political abuse of plastic surgery.
The bedrock of political medicine is coercion masquerading as medical treatment. What transforms coercion into therapy are physicians diagnosing the person's condition an "illness," declaring the intervention they impose on the victim a "treatment," and legislators and judges legitimating these categorizations as "illnesses" and "treatments." In the same way, physician-eugenicists
advocated killing certain disabled or ill persons as a form of
treatment for both society and patient long before the Nazis came to
power.
From the commencement of his political career, Hitler put his struggle against "enemies of the state" in medical rhetoric.
In 1934, addressing the Reichstag, Hitler declared, "I gave the order…
to burn out down to the raw flesh the ulcers of our internal
well-poisoning." The entire German nation and its National Socialist politicians learned to think and speak in such terms. Werner Best, Reinhard Heydrich’s
deputy, stated that the task of the police was "to root out all
symptoms of disease and germs of destruction that threatened the
political health of the nation… [In addition to Jews,] most [of the
germs] were weak, unpopular and marginalized groups, such as gypsies,
homosexuals, beggars, 'antisocials', 'work-shy', and 'habitual
criminals'."
In spite of all the evidence, people underappreciate or, more
often, ignore the political implications of the therapeutic character of
Nazism and of the use of medical metaphors in modern democracies. Dismissed as an "abuse of psychiatry",
this practice is a touchy subject not because the story makes
psychiatrists in Nazi Germany look bad, but because it highlights the
dramatic similarities between pharmacratic controls in Germany under
Nazism and those that have emerged in the US under the free market economy.
The Swiss lawyer Edmund Schönenberger claims that the strongholds
of psychiatry have absolutely nothing to do with “care”, the law or
justice – instead, they are nothing other than instruments of
domination.
"Therapeutic state"
The "therapeutic state" is a phrase coined by Szasz in 1963.
The collaboration between psychiatry and government leads to what Szasz
calls the "therapeutic state", a system in which disapproved actions,
thoughts, and emotions are repressed ("cured") through pseudomedical
interventions.
Thus suicide, unconventional religious beliefs, racial bigotry,
unhappiness, anxiety, shyness, sexual promiscuity, shoplifting,
gambling, overeating, smoking, and illegal drug use are all considered
symptoms or illnesses that need to be cured.
When faced with demands for measures to curtail smoking in public,
binge-drinking, gambling or obesity, ministers say that "we must guard
against charges of nanny statism". The "nanny state" has turned into the "therapeutic state" where nanny has given way to counselor. Nanny just told people what to do; counselors also tell them what to think and what to feel.
The "nanny state" was punitive, austere, and authoritarian, the
therapeutic state is touchy-feely, supportive—and even more
authoritarian.
According to Szasz, "the therapeutic state swallows up everything human
on the seemingly rational ground that nothing falls outside the
province of health and medicine, just as the theological state had
swallowed up everything human on the perfectly rational ground that
nothing falls outside the province of God and religion".
Faced with the problem of "madness", Western individualism proved
to be ill-prepared to defend the rights of the individual: modern man
has no more right to be a madman than medieval man had a right to be a
heretic because if once people agree that they have identified the one
true God, or Good, it brings about that they have to guard members and
nonmembers of the group from the temptation to worship false gods or
goods.
A secularization of God and the medicalization of good resulted in the
post-Enlightenment version of this view: once people agree that they
have identified the one true reason, it brings about that they have to
guard against the temptation to worship unreason—that is, madness.
Civil libertarians warn that the marriage of the State with psychiatry could have catastrophic consequences for civilization. In the same vein as the separation of church and state, Szasz believes that a solid wall must exist between psychiatry and the State.
"Total institution"
In his book Asylums, Erving Goffman coined the term 'total institution' for mental hospitals and similar places which took over and confined a person's whole life.
Goffman placed psychiatric hospitals in the same category as
concentration camps, prisons, military organizations, orphanages, and
monasteries. In Asylums
Goffman describes how the institutionalization process socializes
people into the role of a good patient, someone 'dull, harmless and
inconspicuous'; it in turn reinforces notions of chronicity in severe
mental illness.
Law
While the insanity defense is the subject of controversy as a viable
excuse for wrongdoing, Szasz and other critics contend that being
committed in a psychiatric hospital
can be worse than criminal imprisonment, since it involves the risk of
compulsory medication with neuroleptics or the use of electroshock
treatment.
Moreover, while a criminal imprisonment has a predetermined and known
time of duration, patients are typically committed to psychiatric
hospitals for indefinite durations, an unjust and arguably outrageous
imposition of fundamental uncertainty.
It has been argued that such uncertainty risks aggravating mental
instability, and that it substantially encourages a lapse into
hopelessness and acceptance that precludes recovery.
Involuntary hospitalization
Critics see the use of legally sanctioned force in involuntary
commitment as a violation of the fundamental principles of free or open
societies. The political philosopher John Stuart Mill
and others have argued that society has no right to use coercion to
subdue an individual as long as he or she does not harm others. Mentally
ill people are essentially no more prone to violence than sane
individuals, despite Hollywood and other media portrayals to the
contrary. The growing practice, in the United Kingdom and elsewhere, of Care in the Community
was instituted partly in response to such concerns. Alternatives to
involuntary hospitalization include the development of non-medical
crisis care in the community.
In the case of people suffering from severe psychotic crises, the American Soteria
project used to provide what was argued to be a more humane and
compassionate alternative to coercive psychiatry. The Soteria houses
closed in 1983 in the United States due to lack of financial support.
However, similar establishments are presently flourishing in Europe,
especially in Sweden and other North European countries.
The physician Giorgio Antonucci, during his activity as a director of the Ospedale Psichiatrico Osservanza
of Imola, refused any form of coercion and any violation of the
fundamental principles of freedom, questioning the basis of psychiatry
itself.
Psychiatry as pseudoscience and failed enterprise
Many of the above issues lead to the claim that psychiatry is a pseudoscience.
According to some philosophers of science, for a theory to qualify as
science it needs to exhibit the following characteristics:
- parsimony, as straightforward as the phenomena to be explained allow;
- empirically testable and falsifiable;
- changeable, i.e. if necessary, changes may be made to the theory as new data are discovered;
- progressive, encompasses previous successful descriptions and explains and adds more;
- provisional, i.e. tentative; the theory does not attempt to assert that it is a final description or explanation.
Psychiatrist Colin A. Ross and Alvin Pam maintain that biopsychiatry does not qualify as a science on many counts.
Psychiatric researcher have been criticised on the basis of the replication crisis and textbook errors. Questionable research practices are known to bias key sources of evidence.
Stuart A. Kirk
has argued that psychiatry is a failed enterprise, as mental illness
has grown, not shrunk, with about 20% of American adults diagnosable as
mentally ill in 2013.
According to a 2014 meta-analysis, psychiatric treatment is no
less effective for psychiatric illnesses in terms of treatment effects
than treatments by practitioners of other medical specialties for
physical health conditions. The analysis found that the effect sizes for
psychiatric interventions are, on average, on par with other fields of
medicine.
Diverse paths
Szasz
has since (2008) re-emphasized his disdain for the term
anti-psychiatry, arguing that its legacy has simply been a "catchall
term used to delegitimize and dismiss critics of psychiatric fraud and
force by labeling them 'antipsychiatrists'". He points out that the term
originated in a meeting of four psychiatrists (Cooper, Laing, Berke and Redler)
who never defined it yet "counter-label[ed] their discipline as
anti-psychiatry", and that he considers Laing most responsible for
popularizing it despite also personally distancing himself. Szasz
describes the deceased (1989) Laing in vitriolic terms, accusing him of being irresponsible and equivocal
on psychiatric diagnosis and use of force, and detailing his past
"public behavior" as "a fit subject for moral judgment" which he gives
as "a bad person and a fraud as a professional".
Daniel Burston, however, has argued that overall the published
works of Szasz and Laing demonstrate far more points of convergence and
intellectual kinship than Szasz admits, despite the divergence on a
number of issues related to Szasz being a libertarian and Laing an
existentialist; that Szasz employs a good deal of exaggeration and
distortion in his criticism of Laing's personal character, and unfairly
uses Laing's personal failings and family woes to discredit his work and
ideas; and that Szasz's "clear-cut, crystalline ethical principles are
designed to spare us the agonizing and often inconclusive reflections
that many clinicians face frequently in the course of their work". Szasz has indicated that his own views came from libertarian politics held since his teens,
rather than through experience in psychiatry; that in his "rare"
contacts with involuntary mental patients in the past he either sought
to discharge them (if they were not charged with a crime) or "assisted
the prosecution in securing [their] conviction" (if they were charged
with a crime and appeared to be prima facie
guilty); that he is not opposed to consensual psychiatry and "does not
interfere with the practice of the conventional psychiatrist", and that
he provided "listening-and-talking ("psychotherapy")" for voluntary
fee-paying clients from 1948 until 1996, a practice he characterizes as
non-medical and not associated with his being a psychoanalytically
trained psychiatrist.
The gay rights or gay liberation
movement is often thought to have been part of anti-psychiatry in its
efforts to challenge oppression and stigma and, specifically, to get homosexuality
removed from the American Psychiatric Association's (APA) Diagnostic
and Statistical Manual of Mental Disorders. However, a psychiatric
member of APA's Gay, Lesbian, and Bisexual Issues Committee has recently
sought to distance the two, arguing that they were separate in the
early 70s protests at APA conventions and that APA's decision to remove
homosexuality was scientific and happened to coincide with the political
pressure. Reviewers have responded, however, that the founders and
movements were closely aligned; that they shared core texts, proponents
and slogans; and that others have stated that, for example, the gay
liberation critique was "made possible by (and indeed often explicitly
grounded in) traditions of antipsychiatry".
In the clinical setting, the two strands of
anti-psychiatry—criticism of psychiatric knowledge and reform of its
practices—were never entirely distinct. In addition, in a sense,
anti-psychiatry was not so much a demand for the end of psychiatry, as
it was an often self-directed demand for psychiatrists and allied
professionals to question their own judgements, assumptions and
practices. In some cases, the suspicion of non-psychiatric medical
professionals towards the validity of psychiatry was described as
anti-psychiatry, as well the criticism of "hard-headed" psychiatrists
towards "soft-headed" psychiatrists. Most leading figures of
anti-psychiatry were themselves psychiatrists, and equivocated over
whether they were really "against psychiatry", or parts thereof. Outside
the field of psychiatry, however—e.g. for activists and non-medical
mental health professionals such as social workers and
psychologists—'anti-psychiatry' tended to mean something more radical.
The ambiguous term "anti-psychiatry" came to be associated with these
more radical trends, but there was debate over whether it was a new
phenomenon, whom it best described, and whether it constituted a
genuinely singular movement.
In order to avoid any ambiguity intrinsic to the term anti-psychiatry, a
current of thought that can be defined as critique of the basis of
psychiatry, radical and unambiguous, aims for the complete elimination
of psychiatry. The main representative of the critique of the basis of
psychiatry is an Italian physician, Giorgio Antonucci.
In the 1990s, a tendency was noted among psychiatrists to
characterize and to regard the anti-psychiatric movement as part of the
past, and to view its ideological history as flirtation with the
polemics of radical politics at the expense of scientific thought and
enquiry. It was also argued, however, that the movement contributed
towards generating demand for grassroots involvement in guidelines and
advocacy groups, and to the shift from large mental institutions to
community services. Additionally, community centers have tended in
practice to distance themselves from the psychiatric/medical model and
have continued to see themselves as representing a culture of resistance
or opposition to psychiatry's authority. Overall, while antipsychiatry
as a movement may have become an anachronism by this period and was no
longer led by eminent psychiatrists, it has been argued that it became
incorporated into the mainstream practice of mental health disciplines. On the other hand, mainstream psychiatry became more biomedical, increasing the gap between professionals.
Henry Nasrallah claims that while he believes anti-psychiatry
consists of many historical exaggerations based on events and primitive
conditions from a century ago, "antipsychiatry helps keep us honest and
rigorous about what we do, motivating us to relentlessly seek better
diagnostic models and treatment paradigms. Psychiatry is far more
scientific today than it was a century ago, but misperceptions about
psychiatry continue to be driven by abuses of the past. The best
antidote for antipsychiatry allegations is a combination of personal
integrity, scientific progress, and sound evidence-based clinical care".
A criticism was made in the 1990s that three decades of
anti-psychiatry had produced a large literature critical of psychiatry,
but little discussion of the deteriorating situation of the mentally
troubled in American society. Anti-psychiatry crusades have thus been
charged with failing to put suffering individuals first, and therefore
being similarly guilty of what they blame psychiatrists for. The rise of
anti-psychiatry in Italy was described by one observer as simply "a
transfer of psychiatric control from those with medical knowledge to
those who possessed socio-political power".
Critics of this view, however, from an anti-psychiatry
perspective, are quick to point to the industrial aspects of psychiatric
treatment itself as a primary causal factor in this situation that is
described as "deteriorating". The numbers of people labeled "mentally
ill", and in treatment, together with the severity of their conditions,
have been going up primarily due to the direct efforts of the mental
health movement, and mental health professionals, including
psychiatrists, and not their detractors. Envisioning "mental health
treatment" as violence prevention has been a big part of the problem,
especially as you are dealing with a population that is not
significantly more violent than any other group and, in fact, are less
so than many.
On October 7, 2016, the Ontario Institute for Studies in Education
(OISE) at the University of Toronto announced that they had established
a scholarship for students doing theses in the area of antipsychiatry.
Called “The Bonnie Burstow Scholarship in Antipsychiatry,” it is to be
awarded annually to an OISE thesis student. An unprecedented step, the
scholarship should further the cause of freedom of thought and the
exchange of ideas in academia. The scholarship is named in honor of
Bonnie Burstow, a faculty member at the University of Toronto, a radical
feminist, and an antipsychiatry activist. She is also the author of Psychiatry and the Business of Madness (2015).
Some components of antipsychiatric theory have in recent decades
been reformulated into a critique of "corporate psychiatry", heavily
influenced by the pharmaceutical industry. A recent editorial about this was published in the British Journal of Psychiatry by Moncrieff, arguing that modern psychiatry has become a handmaiden to conservative political commitments. David Healy is a psychiatrist and professor in psychological medicine at Cardiff University School of Medicine, Wales. He has a special interest in the influence of the pharmaceutical industry on medicine and academia.
With the decline of industrial age psychiatric hospitals, efforts to rehabilitate them have begun, like the Traverse City State Hospital becoming the Village at Grand Traverse Commons, complete with homes, offices, and businesses, including a wine bar
In the meantime, members of the psychiatric consumer/survivor
movement continued to campaign for reform, empowerment and alternatives,
with an increasingly diverse representation of views. Groups often have
been opposed and undermined, especially when they proclaim to be, or
when they are labelled as being, "anti-psychiatry".
However, as of the 1990s, more than 60 percent of ex-patient groups
reportedly support anti-psychiatry beliefs and consider themselves to be
"psychiatric survivors".
Although anti-psychiatry is often attributed to a few famous figures in
psychiatry or academia, it has been pointed out that
consumer/survivor/ex-patient individuals and groups preceded it, drove
it and carried on through it.
Criticism
A
schism exists among those critical of conventional psychiatry between
radical abolitionists and more moderate reformists. Laing, Cooper and
others associated with the initial anti-psychiatry movement stopped
short of actually advocating for the abolition of coercive psychiatry.
Thomas Szasz, from near the beginning of his career, crusaded for the
abolition of forced psychiatry. Today, believing that coercive
psychiatry marginalizes and oppresses people with its harmful,
controlling, and abusive practices, many who identify as anti-psychiatry
activists are proponents of the complete abolition of non-consensual
and coercive psychiatry.
Criticism of antipsychiatry from within psychiatry itself object
to the underlying principle that psychiatry is by definition harmful.
Most psychiatrists accept that issues exist that need addressing, but
that the abolition of psychiatry is harmful. Nimesh Desai concludes:
"To be a believer and a practitioner of multidisciplinary mental health, it is not necessary to reject the medical model as one of the basics of psychiatry." and admits "Some of the challenges and dangers to psychiatry are not so much from the avowed antipsychiatrists, but from the misplaced and misguided individuals and groups in related fields."
