Anti-psychiatry
Encyclopedia
Construct (philosophy of science)
A construct in the philosophy of science is an ideal object, where the existence of the thing may be said to depend upon a subject's mind. This, as opposed to a "real" object, where existence does not seem to depend on the existence of a mind....
that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault
Michel Foucault
Michel Foucault , born Paul-Michel Foucault , was a French philosopher, social theorist and historian of ideas...
, R.D. Laing, and Thomas Szasz
Thomas Szasz
Thomas Stephen Szasz is a psychiatrist and academic. Since 1990 he has been Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He is a well-known social critic of the moral and scientific foundations of psychiatry, and of the social...
. The term was first used by the psychiatrist David Cooper
David Cooper (psychiatrist)
David Graham Cooper was a British psychiatrist, theorist and leader in the anti-psychiatry movement....
in 1967.
Two central contentions of the anti-psychiatry movement are that:
- The specific definitions of, or criteria for, hundreds of current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards.
- Prevailing psychiatric treatments are ultimately far more damaging than helpful to patients.
Other key criticisms of mainstream psychiatry include:
- Inappropriate and overuse of medical concepts and tools to understand the mind and society, including the miscategorization of normal reactions to extreme situations as psychiatric disorders;
- Scientifically and/or clinically ill-founded system of categorical diagnosesMedical diagnosisMedical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
(e.g., Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental DisordersThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
or DSM), which stigmatizes patients; - Unwillingness to develop and use objective tests (such as intelligence/cognitive tests) to determine patients' state (such as strong psychosis)
- Inappropriate (i.e. unvalidated) exclusion of other approaches to mental distress/disorder;
- Unexamined abuse or misuse of power over patients who are too often treated against their will;
- Relation of power between patients and psychiatrists, as well as the institutional environment, is too often experienced by patients as demeaning and controlling;
- Compromise to medical and ethical integrity because of financial and professional links with pharmaceutical companies and insurance companies in countries where these companies are a force.
- Forced use of government (both civilian and military) psychiatric treatment prevents the patient from choosing private psychiatric or alternative treatment thereby denying the patient of his or her basic rights.
Some mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
professionals and academics profess anti-psychiatry views, as do a number of former and current users of psychiatric services. Some critics focus their attention on what is known as biological psychiatry
Biological psychiatry
Biological psychiatry, or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics and...
. Proponents of some allegedly anti-psychiatric views seek to distance themselves from the term, both for its pejorative
Pejorative
Pejoratives , including name slurs, are words or grammatical forms that connote negativity and express contempt or distaste. A term can be regarded as pejorative in some social groups but not in others, e.g., hacker is a term used for computer criminals as well as quick and clever computer experts...
associations, and because they regard their theories and methods as evidence-based but not yet accepted by the mainstream psychiatric community.
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 EnlightenmentAge of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...
, a "moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
" movement challenged the harsh, pessimistic, somatic
Somatic
The term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...
(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
Michel Foucault
Michel Foucault , born Paul-Michel Foucault , was a French philosopher, social theorist and historian of ideas...
, there was a shift in the perception of madness, whereby it came to seen as less about delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
, i.e. disturbed judgement 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
Internment
Internment is the imprisonment or confinement of people, commonly in large groups, without trial. The Oxford English Dictionary gives the meaning as: "The action of 'interning'; confinement within the limits of a country or place." Most modern usage is about individuals, and there is a distinction...
of the "mentally ill" (the development of more and bigger asylums) 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. 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 summarised 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).
Other analyses suggest that the rise of asylums was primarily driven by industrialization and capitalism
Capitalism
Capitalism is an economic system that became dominant in the Western world following the demise of feudalism. There is no consensus on the precise definition nor on how the term should be used as a historical category...
, including the breakdown of the traditional family structures. And that by the end of the 19th century, psychiatrists often had little power in the over-run 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.
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 medicalisation of "madness". Those critiques occurred at a time when physicians had not yet achieved hegemony
Hegemony
Hegemony is an indirect form of imperial dominance in which the hegemon rules sub-ordinate states by the implied means of power rather than direct military force. In Ancient Greece , hegemony denoted the politico–military dominance of a city-state over other city-states...
through psychiatry, however, and so there was not such a single unified force to be "anti-". 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
Daniel Defoe
Daniel Defoe , born Daniel Foe, was an English trader, writer, journalist, and pamphleteer, who gained fame for his novel Robinson Crusoe. Defoe is notable for being one of the earliest proponents of the novel, as he helped to popularise the form in Britain and along with others such as Richardson,...
, the author of Robinson Crusoe
Robinson Crusoe
Robinson Crusoe is a novel by Daniel Defoe that was first published in 1719. Epistolary, confessional, and didactic in form, the book is a fictional autobiography of the title character—a castaway who spends 28 years on a remote tropical island near Trinidad, encountering cannibals, captives, and...
, had previously argued that husbands used asylum hospitals to incarcerate their disobedient wives.) 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
Alleged Lunatics' Friend Society
The Alleged Lunatics' Friend Society was a pressure group started by ex-patients in 19th century Britain that campaigned for the human rights of people alleged to have mental disorders...
arose in England in the mid-19th century to challenge the system and campaign for rights and reforms. In the United States, Elizabeth Packard
Elizabeth Packard
Elizabeth Parsons Ware Packard was an advocate for the rights of women and people accused of insanity.-Life:...
published a series of books and pamphlets describing her experiences in the Illinois insane asylum to which her husband had had her committed
Committed
Committed may refer to:* Committed , a film starring Heather Graham and Luke Wilson* Committed , a comic strip by Michael Fry** Committed , an animated television series based on the strip...
.
Throughout, the class
Social class
Social classes are economic or cultural arrangements of groups in society. Class is an essential object of analysis for sociologists, political scientists, economists, anthropologists and social historians. In the social sciences, social class is often discussed in terms of 'social stratification'...
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
Drapetomania
Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity. Today, drapetomania is considered an example of pseudoscience, and part of the edifice of scientific racism...
, 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
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
. Practitioners criticized mental hospitals for failure to conduct scientific research and adopt the modern therapeutic methods such as nonrestraint. 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 openly confront the psychiatric establishment, 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 damned psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient involvement in the movement, he was influenced by Adolf MeyerAdolf Meyer
Adolf Meyer may refer to:*Adolf Bernard Meyer , German anthropologist and ornithologist*Adolf Meyer , Swiss psychiatrist*Adolf Meyer , German architect-See also:...
and the psychiatric establishment, and toned down his hostility as 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 meanwhile, the National Society for Lunacy Law Reform was established in 1920 by angry ex-patients sick of their experiences and complaints being patronisingly discounted by the authorities who were using medical "window dressing" for essentially custodial and punitive practices. 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
We Are Not Alone
-Personnel:Breaking Benjamin* Benjamin Burnley - Lead vocals, rhythm guitar* Aaron Fink - Lead guitar* Mark Klepaski - bass guitar* Jeremy Hummel - drumsAdditional musicians* David Bendeth - Additional keyboards...
(WANA) was founded by a group of patients at Rockland State Hospital in New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
, and continued to meet as an ex-patient group.
In the 1920s, controversial psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Henry Cotton
Henry Cotton (doctor)
Henry Andrews Cotton, MD was an American psychiatrist and the medical director of New Jersey State Hospital at Trenton in Trenton, New Jersey between 1907 and 1930...
at Trenton State Hospital in New Jersey became convinced that insanity
Insanity
Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity...
was fundamentally a toxic disorder and he surgically removed body parts to try to improve mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
. This often began with the removal of teeth and tonsils. Cotton's obsession with focal sepsis as the root cause of mental illness "persisted in spite of all evidence to the contrary and the frightening incidence of death and harm from the operations he initiated". Cotton's approach attracted some detractors, but the medical establishment of the day did not effectively renounce or discipline him.
In the 1920s extreme hostility to psychiatrists and psychiatry was expressed by the French playwright
Playwright
A playwright, also called a dramatist, is a person who writes plays.The term is not a variant spelling of "playwrite", but something quite distinct: the word wright is an archaic English term for a craftsman or builder...
and theater director Antonin Artaud
Antonin Artaud
Antoine Marie Joseph Artaud, more well-known as Antonin Artaud was a French playwright, poet, actor and theatre director...
, in particular, in his book on van Gogh. To Artaud, who was himself to spend a fair amount of time in a straitjacket
Straitjacket
A straitjacket is a garment shaped like a jacket with overlong sleeves and is typically used to restrain a person who may otherwise cause harm to themselves or others. Once the arms are inserted into the straitjacket's sleeves, they are then crossed across the chest...
, imagination was reality. Much influenced by the Dada
Dada
Dada or Dadaism is a cultural movement that began in Zurich, Switzerland, during World War I and peaked from 1916 to 1922. The movement primarily involved visual arts, literature—poetry, art manifestoes, art theory—theatre, and graphic design, and concentrated its anti-war politics through a...
and surrealist
Surrealism
Surrealism is a cultural movement that began in the early 1920s, and is best known for the visual artworks and writings of the group members....
enthusiasms of the day, he considered dream
Dream
Dreams are successions of images, ideas, emotions, and sensations that occur involuntarily in the mind during certain stages of sleep. The content and purpose of dreams are not definitively understood, though they have been a topic of scientific speculation, philosophical intrigue and religious...
s, 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 the 1930s several controversial medical practices were introduced, including inducing seizures (by electroshock, insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy
Lobotomy
Lobotomy "; τομή – tomē: "cut/slice") is a neurosurgical procedure, a form of psychosurgery, also known as a leukotomy or leucotomy . It consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain...
). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of morality, harmful effects, or misuse.
1940s and 1950s
The post-World War II decades saw an enormous growth in psychiatry; many Americans were persuaded that psychiatry and psychology, particularly psychoanalysisPsychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
, were a key to happiness. Meanwhile, most hospitalized mental patients received at best decent custodial care and at worst they were abused and neglected.
The psychoanalyst Lacan
Lacan
Lacan is surname of:* Jacques Lacan , French psychoanalyst and psychiatrist** The Seminars of Jacques Lacan** From Bakunin to Lacan: Anti-Authoritarianism and the Dislocation of Power, a book on political philosophy by Saul Newman** Lacan at the Scene* Judith Miller, née 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 rexamine its concepts and to appreciate psychosis as understandable. Other influences on Lacan included poetry
Poetry
Poetry is a form of literary art in which language is used for its aesthetic and evocative qualities in addition to, or in lieu of, its apparent meaning...
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
Erich Fromm
Erich Seligmann Fromm was a Jewish German-American social psychologist, psychoanalyst, sociologist, humanistic philosopher, and democratic socialist. He was associated with what became known as the Frankfurt School of critical theory.-Life:Erich Fromm was born on March 23, 1900, at Frankfurt am...
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"
In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...
, 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
Tardive dyskinesia
Tardive dyskinesia is a difficult-to-treat form of dyskinesia that can be tardive...
, and partly due their "chemical straightjacket" 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 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
Scientology
Scientology is a body of beliefs and related practices created by science fiction and fantasy author L. Ron Hubbard , starting in 1952, as a successor to his earlier self-help system, Dianetics...
movement.
The field of psychology
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...
sometimes came into opposition with psychiatry. Behaviorists argued that mental disorder was a matter of learning
Learning
Learning is acquiring new or modifying existing knowledge, behaviors, skills, values, or preferences and may involve synthesizing different types of information. The ability to learn is possessed by humans, animals and some machines. Progress over time tends to follow learning curves.Human learning...
not medicine; for example, Hans Eysenck
Hans Eysenck
Hans Jürgen Eysenck was a German-British psychologist who spent most of his career in Britain, best remembered for his work on intelligence and personality, though he worked in a wide range of areas...
argued that psychiatry "really has no role to play". The developing field of clinical psychology
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...
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 CooperDavid Cooper (psychiatrist)
David Graham Cooper was a British psychiatrist, theorist and leader in the anti-psychiatry movement....
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
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
. 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. It has been suggested that Cooper may have seen psychiatry as analogous to apartheid.
The psychiatrists R.D. Laing (from Scotland), Theodore Lidz
Theodore Lidz
Theodore Lidz was an American psychiatrist best known for his articles and books on the causes of schizophrenia and on psychotherapy with schizophrenic patients...
(from America), Silvano Arieti
Silvano Arieti
Silvano Arieti was a psychiatrist regarded in his time as one of the world’s foremost authorities on schizophrenia. He received his M.D. from the University of Pisa but left Italy soon after because of Benito Mussolini's increasingly racial policies...
(from Italy) and others, argued that "schizophrenia" and psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
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
The Politics of Experience
The Politics of Experience and the Bird of Paradise is a 1967 book by Scottish psychiatrist R.D. Laing. It presents psychosis as "a psychedelic voyage of discovery in which the boundaries of perception were widened, and consciousness expanded"...
) discussing mental distress in an interpersonal existential
Existentialism
Existentialism is a term applied to a school of 19th- and 20th-century philosophers who, despite profound doctrinal differences, shared the belief that philosophical thinking begins with the human subject—not merely the thinking subject, but the acting, feeling, living human individual...
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
Franco Basaglia
Franco Basaglia was an Italian psychiatrist and neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, charismatic leader in Italian psychiatry, figurehead and founder of Democratic...
promoted anti-psychiatry in Italy and secured reforms to mental health law there.
Laing, through the Philadelphia Association
Philadelphia Association
The Philadelphia Association is a UK "charity concerned with the understanding and relief of mental suffering." It was founded in 1965 by the psychiatrist and psychoanalyst R. D...
founded with Cooper in 1965, set up over 20 therapeutic communities including Kingsley Hall
Kingsley Hall
Kingsley Hall is a community centre in the East End of London. It dates back to the work of Doris Lester and Muriel Lester, who had a nursery school in nearby Bruce Road. Their brother, Kingsley Lester, died aged 26 in 1914, leaving money for work in the local area for "educational, social and...
, where staff and residents theoretically assumed equal status and any medication used was voluntary. Non-psychiatric Soteria
Soteria
Soteria is a community service that provides a space for people experiencing mental distress or crisis. Based on a recovery model, common elements of the Soteria approach include primarily non-medical staffing; preserving resident's personal power, social networks, and communal responsibilities;...
houses, starting in the United States, were also developed as were various ex-patient-led services.
Psychiatrist Thomas Szasz
Thomas Szasz
Thomas Stephen Szasz is a psychiatrist and academic. Since 1990 he has been Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He is a well-known social critic of the moral and scientific foundations of psychiatry, and of the social...
argued that "mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
" 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
Libertarianism
Libertarianism, in the strictest sense, is the political philosophy that holds individual liberty as the basic moral principle of society. In the broadest sense, it is any political philosophy which approximates this view...
, 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
Citizens Commission on Human Rights
The Citizens Commission on Human Rights is an advocacy group established in 1969 by the Church of Scientology and psychiatrist Thomas Szasz. The group promotes several video campaigns which support views against psychiatry...
. 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.
Erving Goffman
Erving Goffman
Erving Goffman was a Canadian-born sociologist and writer.The 73rd president of American Sociological Association, Goffman's greatest contribution to social theory is his study of symbolic interaction in the form of dramaturgical perspective that began with his 1959 book The Presentation of Self...
, Deleuze and Guattari
Félix Guattari
Pierre-Félix Guattari was a French militant, an institutional psychotherapist, philosopher, and semiotician; he founded both schizoanalysis and ecosophy...
, and others criticized the power and role of psychiatry in society, including the use of "total institution
Total institution
A total institution is place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life...
s," and stigmatizing
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...
. The French sociologist and philosopher Foucault, in his 1961 publication Madness and Civilization
Madness and Civilization
Madness and Civilization: A History of Insanity in the Age of Reason by Michel Foucault, is the English edition of Histoire de la folie à l'âge classique, a 1964 abridged edition of the 1961 Folie et déraison: Histoire de la folie à l'âge classique. An English translation of the complete 1961...
: 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
Labeling theory
Labeling theory is closely related to interactionist and social construction theories. Labeling theory was developed by sociologists during the 1960's. Howard Saul Becker's book entitled Outsiders was extremely influential in the development of this theory and its rise to popularity...
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.
The novel One Flew Over the Cuckoo's Nest
One Flew Over the Cuckoo's Nest (novel)
One Flew Over the Cuckoo's Nest is a novel written by Ken Kesey. Set in an Oregon asylum, the narrative serves as a study of the institutional process and the human mind, as well as a critique of Behaviorism and a celebration of humanistic principles. Written in 1959, the novel was adapted into a...
became a bestseller, resonating with public concern about involuntary medication
Involuntary treatment
Involuntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...
, lobotomy and electroshock procedures used to control patients. In addition, Holocaust documenters argued that the medicalization
Medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...
of social problems and systematic euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
of people in German
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
mental institutions in the 1930s provided the institutional, procedural, and doctrinal origins of the mass murder
Mass murder
Mass murder is the act of murdering a large number of people , typically at the same time or over a relatively short period of time. According to the FBI, mass murder is defined as four or more murders occurring during a particular event with no cooling-off period between the murders...
of the 1940s. The Nuremberg Trials
Nuremberg Trials
The Nuremberg Trials were a series of military tribunals, held by the victorious Allied forces of World War II, most notable for the prosecution of prominent members of the political, military, and economic leadership of the defeated Nazi Germany....
convicted a number of psychiatrists who held key positions in Nazi regimes. Observation of the abuses of psychiatry in the Soviet Union
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
in the so-called Psikhushka
Psikhushka
In the Soviet Union, systematic political abuse of psychiatry took place. Soviet psychiatric hospitals were used by the authorities as prisons in order to isolate hundreds or thousands of political prisoners from the rest of society, discredit their ideas, and break them physically and mentally...
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
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
. 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.
1970s & onward
New professional approaches were developed as an alternative or reformist complement to psychiatry. The Radical TherapistThe Radical Therapist
The Radical Therapist was a journal that emerged in the early 1970s in the context of the counter-culture and the radical U.S. antiwar movement. The “Movement,” inspired and galvanized by organizations such as the Students for a Democratic Society, was highly critical of the “Establishment” and all...
, 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
Social work
Social Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
, humanistic or existentialist therapies, family therapy
Family therapy
Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...
, counseling and self-help
Self-help
Self-help, or self-improvement, is a self-guided improvement—economically, intellectually, or emotionally—often with a substantial psychological basis. There are many different self-help movements and each has its own focus, techniques, associated beliefs, proponents and in some cases, leaders...
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
Alice Miller (psychologist)
Alice Miller née Rostovski was a psychologist and world renowned author, who is noted for her books on child abuse by their own parents, translated in several languages...
, Jeffrey Masson and Louis Breger
Louis Breger
Louis Breger is an American psychologist, psychotherapist and scholar who was born and grew up in Los Angeles, California. He received his undergraduate education at Cornell University and U.C.L.A., following which he obtained his Ph.D. in Clinical Psychology at The Ohio State University in 1961...
, 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 Chile
Chile
Chile ,officially the Republic of Chile , is a country in South America occupying a long, narrow coastal strip between the Andes mountains to the east and the Pacific Ocean to the west. It borders Peru to the north, Bolivia to the northeast, Argentina to the east, and the Drake Passage in the far...
an 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
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
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
DSM
-Business:* DSM , an international life science and performance materials company from the Netherlands* Delhi school of music, a music school in India...
, replacing it with a category of "sexual orientation disturbance" and then "ego-dystonic homosexuality," which was deleted in 1987, although "gender identity disorder
Gender identity disorder
Gender identity disorder is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria . It describes the symptoms related to transsexualism, as well as less severe manifestations of 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].
Increased legal and professional protections, and a merging with human rights
Human rights
Human rights are "commonly understood as inalienable fundamental rights to which a person is inherently entitled simply because she or he is a human being." Human rights are thus conceived as universal and egalitarian . These rights may exist as natural rights or as legal rights, in both national...
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
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
, neurochemical
Neurochemical
A neurochemical is an organic molecule, such as serotonin, dopamine, or nerve growth factor, that participates in neural activity. The science of neurochemistry studies the functions of neurochemicals.-Prominent neurochemicals:...
s and pharmaceutic
Pharmacology
Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
drugs
DRUGS
Destroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...
). 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
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
often argues for full recovery
Recovery model
The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasizes and supports each individual's potential for recovery...
, empowerment
Empowerment
Empowerment refers to increasing the spiritual, political, social, racial, educational, gender or economic strength of individuals and communities...
, self-management and even full liberation
Liberty
Liberty is a moral and political principle, or Right, that identifies the condition in which human beings are able to govern themselves, to behave according to their own free will, and take responsibility for their actions...
. Schemes were developed to challenge stigma
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...
and discrimination, often based on a social model of disability
Social model of disability
The social model of disability is a reaction to the dominant medical model of disability which in itself is a Cartesian functional analysis of the body as machine to be fixed in order to conform with normative values...
; 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.
Civilization as a cause of distress
In recent years, David SmailDavid Smail (psychologist)
David Smail is a clinical psychologist who is a proponent of a social materialist explanation of psychological distress. Born in Putney, London, on 23 April 1938, he grew up in Epsom and Wimbledon....
, a psychotherapist considered part of the anti-psychiatry movement, has 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 interest in modern Western society. He argues that feelings and emotions are not, as is commonly supposed, features of the individual, but rather responses of the individual to his situation in society. Even psychotherapy, he suggests, can only change feelings inasmuch as it helps a person to change the "proximal" and "distal" influences on his life, which range from family and friends, to politics and work.
R.D. Laing notoriously emphasized family nexus
Family nexus
The term family nexus was used by the psychiatrist R D Laing to describe a common viewpoint held and reinforced by the majority of family members regarding events in the family and relationships with the world...
as a mechanism whereby individuals become victimized by those around them, and spoke about a dysfunctional society.
Normality and illness judgments
One remarkable example of psychiatric diagnosis being used to reinforce cultural bias and oppress dissidence is the diagnosis of drapetomania. In the USA prior to the American Civil War, psychiatrists 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 unhealth. This example indicates the probability for not only cultural bias
Cultural bias
Cultural bias is the phenomenon of interpreting and judging phenomena by standards inherent to one's own culture. The phenomenon is sometimes considered a problem central to social and human sciences, such as economics, psychology, anthropology, and sociology...
but also confirmation bias
Confirmation bias
Confirmation bias is a tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true.David Perkins, a geneticist, coined the term "myside bias" referring to a preference for "my" side of an issue...
and bias blind spot
Bias blind spot
The bias blind spot is the cognitive bias of failing to compensate for one's own cognitive biases. The term was created by Emily Pronin, a social psychologist from Princeton University's Department of Psychology, with colleagues Daniel Lin and Lee Ross...
in psychiatric diagnosis and psychiatric beliefs.
In addition, many feel that they are being pathologized for simply being different. Some people diagnosed with Asperger syndrome
Asperger syndrome
Asperger's syndrome that is characterized by significant difficulties in social interaction, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development...
or autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
hold this position, particularly those involved in the autism rights movement
Autism rights movement
The autism rights movement is a social movement that encourages autistic people, their caregivers and society to adopt a position of neurodiversity, accepting autism as a variation in functioning rather than a mental disorder to be cured...
or the autistic pride movement. While many parents of children diagnosed as autistic support the efforts of autistic activists, there are some who say they value the uniqueness of their children and do not desire a "cure" for their autism. The autistic community has coined a number of terms that would appear to form the basis for a new branch of identity politics
Identity politics
Identity politics are political arguments that focus upon the self interest and perspectives of self-identified social interest groups and ways in which people's politics may be shaped by aspects of their identity through race, class, religion, sexual orientation or traditional dominance...
; terms such as "neurodiversity
Neurodiversity
Neurodiversity is a "controversial concept [that] ... regards atypical neurologicaldevelopment as a normal human difference". According to Jaarsma and Welin , the "neurodiversity movement was developed in the 1990s by online groups of autistic persons...
" and "neurotypical
Neurotypical
Neurotypical is a term that was coined in the autistic community as a label for people who are not on the autism spectrum: specifically, neurotypical people have neurological development and states that are consistent with what most people would perceive as normal, particularly with respect to...
". However, an anti-psychiatric viewpoint is not found in nearly all of those advocating acceptance for autists or other "outsiders".
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
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 ICDICD
The International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...
, are inconsistent. Some psychiatrists who criticize their own profession say that comorbidity
Comorbidity
In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...
, 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 women more than men. Some within the anti-psychiatry movement are critical of the use of diagnosis as it conforms with the biomedical model
Biomedical model
The biomedical model of medicine has been around since the mid-nineteenth century as the predominant model used by physicians in diagnosing diseases.It has four core elements....
.
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
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
for improving or managing a number of mental health disorders through either medications, psychotherapy, or a combination of the two. Typical psychiatric medications include stimulant
Stimulant
Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
s, antidepressants, hypnotic minor tranquilizers and neuroleptics (antipsychotics).
On the other hand, organizations such as MindFreedom International
MindFreedom International
MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. It was founded in 1990 to advocate against forced medication, medical restraints, and involuntary electroconvulsive therapy. Its stated mission is...
and World Network of Users and Survivors of Psychiatry
World Network of Users and Survivors of Psychiatry
The World Network of Users and Survivors of Psychiatry is an international organisation representing, and led by "survivors of psychiatry". As of 2003, over 70 national organizations were members of WNUSP, based in 30 countries...
maintain that psychiatrists exaggerate the evidence of medication and minimize the evidence of adverse drug reaction
Adverse drug reaction
An adverse drug reaction is an expression that describes harm associated with the use of given medications at a normal dosage. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs...
. They and other activists
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
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
Social control
Social control refers generally to societal and political mechanisms or processes that regulate individual and group behavior, leading to conformity and compliance to the rules of a given society, state, or social group. Many mechanisms of social control are cross-cultural, if only in the 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
Peter Breggin
Peter Roger Breggin is an American psychiatrist and critic of biological psychiatry and psychiatric medication. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with humanistic approaches, such as psychotherapy, education, and broader human...
, 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
Parliamentary inquiry
A parliamentary inquiry is a question directed to the presiding officer of a deliberative assembly to obtain information on a matter of parliamentary law or the rules of the organization bearing on the business at hand...
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.
Electroconvulsive therapy
Psychiatrists may advocate psychiatric drugs, psychotherapy or more controversial interventions such as electroshock or psychosurgeryPsychosurgery
Psychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...
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
Leonard Roy Frank
Leonard Roy Frank is an American human rights activist, electroconvulsive therapy survivor and writer from New York. Since 1959 he has lived in San Francisco, where he managed an art gallery before he began collecting great quotations.Leonard Roy Frank (born July 15, 1932) is an American human...
cites approximately 400 deaths mentioned in psychiatric journals.
Law
While the insanity defense is the subject of controversy as a viable excuse for wrong-doing, Szasz and other critics contend that being committed in a psychiatric hospitalPsychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
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 time of end that could be anticipated, patients are typically committed to psychiatric hospitals for indefinite durations.
Involuntary hospitalization
Critics see involuntary committal's use of legally sanctioned force as counter to one of the pillars of open or free societies: John Stuart MillJohn Stuart Mill
John Stuart Mill was a British philosopher, economist and civil servant. An influential contributor to social theory, political theory, and political economy, his conception of liberty justified the freedom of the individual in opposition to unlimited state control. He was a proponent of...
's principles. Mill argues that society should never use coercion to subdue an individual as long as he or she does not harm others. In contrast to the Hollywood portrait of schizophrenics, mentally ill people are essentially no more prone to violence than sane individuals. The growing practice, in the United Kingdom and elsewhere, of care in the community
Care in the Community
Care in the Community is the British policy of deinstitutionalization, treating and caring for physically and mentally disabled people in their homes rather than in an institution...
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, critics of psychiatry contend, 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, Soteria-like houses are presently flourishing in Europe, especially in Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
and other North European countries.
"Therapeutic State"
The "Therapeutic State" is a phrase coined by American psychiatrist Thomas Szasz in 1963.Civil libertarians warn that the marriage of the State with psychiatry could have catastrophic consequences for civilization
Civilization
Civilization is a sometimes controversial term that has been used in several related ways. Primarily, the term has been used to refer to the material and instrumental side of human cultures that are complex in terms of technology, science, and division of labor. Such civilizations are generally...
. In the same vein as the separation of church and state
Separation of church and state
The concept of the separation of church and state refers to the distance in the relationship between organized religion and the nation state....
, Szasz believes that a solid wall must exist between psychiatry and the State.
"Total Institution"
In his book AsylumsAsylums (book)
Asylums: Essays on the Social Situation of Mental Patients and Other Inmates is a book written by sociologist Erving Goffman in 1961. Asylums was a key text in the development of deinstitutionalisation. The book is one of the first sociological examinations of the social situation of mental...
, Erving Goffman coined the term 'Total Institution
Total institution
A total institution is place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life...
' 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 institutionalisation process socialises people into the role of a good patient, someone ‘dull, harmless and inconspicuous’; it in turn reinforces notions of chronicity in severe mental illness.
Psychiatry as a pseudo-science
Many of the above issues lead to the claim that psychiatry is a pseudo-science. According to some philosophers of science (especially Karl PopperKarl Popper
Sir Karl Raimund Popper, CH FRS FBA was an Austro-British philosopher and a professor at the London School of Economics...
), for a theory to qualify as hard science it needs to exhibit the following characteristics:
- parsimony, as straightforward as the phenomena to be explained allow (see Occam's RazorOccam's razorOccam's razor, also known as Ockham's razor, and sometimes expressed in Latin as lex parsimoniae , is a principle that generally recommends from among competing hypotheses selecting the one that makes the fewest new assumptions.-Overview:The principle is often summarized as "simpler explanations...
); - empirically testable and falsifiable (see FalsifiabilityFalsifiabilityFalsifiability or refutability of an assertion, hypothesis or theory is the logical possibility that it can be contradicted by an observation or the outcome of a physical experiment...
); - 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
Colin A. Ross
Colin A. Ross is a psychiatrist of Canadian origin and professional training. Ross attended medical school at the University of Alberta, Edmonton, Canada and completed his training in psychiatry at the University of Manitoba, Winnipeg, Canada...
and Alvin Pam maintain that biopsychiatry does not qualify as a science on many counts.
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, BerkeJoseph Berke
-Early years:He studied at Columbia College of Columbia University and graduated from the Albert Einstein College of Medicine in New York. He moved to London in 1965 where Berke worked with R. D...
and Redler
Leon Redler
Leon Redler is a doctor of medicine, a psychiatrist, a psychotherapist, and teacher of the Alexander Technique.He was a part of the experiment in radical psychiatry at Kingsley Hall between 1965 and 1970, along with other members of the Philadelphia Association including R. D...
) 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 assassinating the character of Laing, with an overarching agenda of using 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
Prima facie
Prima facie is a Latin expression meaning on its first encounter, first blush, or at first sight. The literal translation would be "at first face", from the feminine form of primus and facies , both in the ablative case. It is used in modern legal English to signify that on first examination, a...
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
Gay Liberation
Gay liberation is the name used to describe the lesbian, gay, bisexual and transgender movement of the late 1960s and early to mid 1970s in North America, Western Europe, and Australia and New Zealand...
movement is often thought to have been part of anti-psychiatry in its efforts to challenge oppression
Oppression
Oppression is the exercise of authority or power in a burdensome, cruel, or unjust manner. It can also be defined as an act or instance of oppressing, the state of being oppressed, and the feeling of being heavily burdened, mentally or physically, by troubles, adverse conditions, and...
and stigma
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...
and, specifically, to get homosexuality
Homosexuality
Homosexuality is romantic or sexual attraction or behavior between members of the same sex or gender. As a sexual orientation, homosexuality refers to "an enduring pattern of or disposition to experience sexual, affectional, or romantic attractions" primarily or exclusively to people of the same...
removed from the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification 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 psychiatrists and allied professionals questioning their own judgements 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 "tough headed" psychiatrists towards "soft head" psychiatrists. Even the leading figures of anti-psychiatry were within psychiatry and equivocated over whether they were really against psychiatry, or which parts. Outside psychiatry however - for example student and lay activists and other mental health professionals such as social workers and psychologists - anti-psychiatry tended to mean something more uniformly radical. And the ambiguous term "anti-psychiatry" came to be associated with these stronger forms, but there was debate over whether it was a new phenomena, who "owned" it, and whether it even constituted a genuinely singular movement.
In the 1990s, a tendency was noted among psychiatrists to regard the anti-psychiatric movement as having entered the annals of history, and to look back on its ideology as an attempt to flirt with polemics at the expense of scientific thought and enquiry. It was 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. In addition, in reality, community centers tended to distance themselves from the psychiatric medical model and continued to see themselves as representing a culture of resistance or opposition to psychiatry's power. Overall, while antipsychiatry may have fallen from grace and was no longer be led by eminent psychiatrists, it was argued that it had in fact only been handed over to the team. On the other hand, mainstream psychiatry became more biomedical, increasing the gap between professionals.
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 of thus being guilty of what they accuse psychiatrists. 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".
In the meantime, members of the psychiatric consumer/survivor movement carried on campaigning for reform, empowerment and alternatives, with an increasingly diverse representation of views. Groups have often 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.
Scientology
Scientology has also challenged psychiatric theory and practice. L. Ron HubbardL. Ron Hubbard
Lafayette Ronald Hubbard , better known as L. Ron Hubbard , was an American pulp fiction author and religious leader who founded the Church of Scientology...
, the founder of Scientology, who claimed the cause of insanity is always an undiagnosed or untreated distressing physical illness, became increasingly at odds with psychiatry and in 1969 cofounded the Citizens Commission on Human Rights
Citizens Commission on Human Rights
The Citizens Commission on Human Rights is an advocacy group established in 1969 by the Church of Scientology and psychiatrist Thomas Szasz. The group promotes several video campaigns which support views against psychiatry...
(CCHR), with Thomas Szasz. CCHR was formed as an advocacy group focused on what it calls psychiatry's "human rights crimes". In the keynote address at the 25th anniversary of CCHR, Szasz stated: "We should all honor CCHR because it is really the organization that for the first time in human history has organized a politically, socially, internationally significant voice to combat psychiatry. This has never been done in human history before." Although Szasz appears in some of CCHR's keynote addresses, he has never been a Scientologist, instead self-identifying as a secular humanist.
Despite sharing notable anti-psychiatrists' views on some issues, Scientology doctrine differs in some respects. Scientology doctrine holds that psychiatrists caused the decline in this universe billions of years ago, and Scientologists are committed to never taking psychiatric drugs and reject psychology
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...
outright.
See also
|
Positive Disintegration The Theory of Positive Disintegration by Kazimierz Dąbrowski describes a theory of personality development.Unlike mainstream psychology, Dąbrowski's theoretical framework views psychological tension and anxiety as necessary for growth... Psychiatric survivors movement The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services... Psychoanalytic theory Psychoanalytic theory refers to the definition and dynamics of personality development which underlie and guide psychoanalytic and psychodynamic psychotherapy. First laid out by Sigmund Freud, psychoanalytic theory has undergone many refinements since his work... Radical Psychology Network The Radical Psychology Network began in Toronto in 1993 when two dozen people attended a discussion at the American Psychological Association convention entitled "Will Psychology Pay Attention to its Own Radical Critics?"... Rosenhan experiment The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973. It was published in the journal Science under the title "On being sane in insane places." The study is considered an important and influential criticism of... Self-help groups for mental health Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. There are several international mental health self-help organizations including Emotions Anonymous, the... World Network of Users and Survivors of Psychiatry The World Network of Users and Survivors of Psychiatry is an international organisation representing, and led by "survivors of psychiatry". As of 2003, over 70 national organizations were members of WNUSP, based in 30 countries... Loren Mosher Loren Richard Mosher was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the National Institute of Mental Health... |
Further reading
- Laing, R.D., The Divided Self, Penguin Books, 1976, ISBN 978-0140207347
- Laing, R.D., The Politics of Experience, Pantheon, 1983, ISBN 978-0394714752
- Szasz, Thomas, The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement, Syracuse University PressSyracuse University PressSyracuse University Press, founded in 1943, is a university press that is part of Syracuse University. The areas of focus for the Press include Middle East Studies, Native American Studies, Peace and Conflict Resolution, Irish Studies and Jewish Studies, among others. The Press has an international...
, 1997, ISBN 978-0815604617
External links
- The Antipsychiatry Coalition
- International Center for Humane Psychiatry and Dan L. Edmunds,Ed.D.
- National Mental Health Consumers' Self-Help Clearinghouse
- Commercial influence and the content of medical journals British Medical Journal.
- ICSPP.org — International Center for the Study of Psychiatry and Psychology
- PsychRights.org — Law Project for Psychiatric Rights
- IAAPA International Association Against Psychiatric Assault
- PSAT Psychiatric Survivor Archives of Toronto
- Critical Psychiatry Website (UK) Network of Psychiatrists Critical to Psychiatry Working in the UK.