Anti-psychiatry  

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Anti-psychiatry refers to a collection of movements that challenge the fundamental theories and practices of (mainstream) psychiatry. Common criticisms include: that psychiatry applies medical concepts and tools inappropriately to the mind and society; that it too often treats patients against their will; that it inappropriately excludes other approaches to mental distress/disorder; that its medical and ethical integrity is compromised by financial and professional links with pharmaceutical companies and insurance companies; that it uses a system of categorical diagnoses (e.g., Diagnostic and Statistical Manual of Mental Disorders) that they claim stigmatizes patients and to be ill-founded scientifically or clinically; and that the psychiatric system is experienced by too many of its patients as demeaning and controlling.

History

History of anti-psychiatry

A number of deviant phenomena, such as alcoholism, drug addiction, and mental illness have been examined by Kittrie who demonstrated how such phenomena were originally considered as moral, then legal, and now medical problems. As a result of these perceptions, peculiar deviants were subjected to moral, then legal, and now medical modes of social control. Similarly, Conrad and Schneider concluded their review of the medicalization of deviance by supposing that three major paradigms may be identified that have reigned over deviance designations in different historical periods: deviance as sin; deviance as crime; and deviance as sickness.

The word psychiatry was invented by Johann Christian Reil in 1808. What much later became known as the anti-psychiatry movement had its origin in concern over alleged misuse of psychiatric procedures for purposes of social control. Daniel Defoe, best known as the author of Robinson Crusoe, reported as far back as the eighteenth century that some husbands were using madhouses to incarcerate their disobedient—though sane—wives.

Psychiatry became more professionally established in the nineteenth century. As more invasive forms of treatment evolved, so too did opposition to the profession. Some disputes concerned custodial rights over those seen as mad, particularly if unfortunate enough to end up in one of the multiplying lunatic asylums.

In the 1800s the American physician Samuel A. Cartwright had stumbled upon drapetomania, the explanation for why slaves would on occasion display an alarming tendency to run away from their masters. A further disorder afflicting slaves and, by extension, their owners was dysaethesia aethiopica, a disease "affecting both mind and body". This explained the apparent lack of a proper work ethic among slaves. Found exclusively among blacks, dysaethesia aethiopica—"called by overseers 'rascality' "—was characterized by partial insensitivity of the skin and "so great a hebetude of the intellectual faculties, as to be like a person half asleep."

In the latter part of the nineteenth century Emil Kraepelin became an eminent deviser of novel categories of mental illness, which duly entered psychiatric usage despite their origin in extrapolation from observed behavior, rather than in clinical pathology or etiology in any strict sense. The Soviet state in the twentieth century devised suitable psychiatric diagnoses for any who opposed its will with sufficiently persistent vigor but who, whether by dint of ingenuity or mere social eminence, proved difficult to criminalize. They were duly hospitalized instead.

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, who was himself to spend a fair amount of time in a straitjacket, 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 the 1930s several controversial medical practices were introduced, including inducing seizures (by electroshock, insulin or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of morality, harmful effects, or misuse. In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use.

Although often accepted as an advance in some ways, there was some opposition, partly due to serious adverse effects such as tardive dyskinesia. 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 base services in the community.

Coming to the fore in the 1960s, anti-psychiatry [a term first used by David Cooper in 1962 and who never made clear whether anti-psychiatry was a genuine alternative to psychiatry or whether traditional psychiatry was indeed "anti-psychiatric", in the sense that, as practiced, it was anti-soul healing (to use the etymologic meaning of the word)] defined a movement that vocally challenged the fundamental claims and practices of mainstream psychiatry.

Both Cooper and his better-known colleague R.D. Laing were much influenced by Madness and Civilization by the French philosopher and social theorist Michel Foucault, the English translation of an abridged edition of Foucault's 1961 Folie et déraison. Histoire de la folie à l'âge classique. The work argues that conceptions of madness are not discoveries but cultural (legal, political, philosophical and medical) constructions of a given time and place, that vary from civilization to civilization and time to time.

Foucault begins his history in the Middle Ages, noting the social and physical exclusion of lepers. He argues that with the gradual disappearance of leprosy, madness came to occupy this excluded position. The ship of fools in the 15th century is a literary version of one such exclusionary practice, namely that of sending mad people away in ships. In 17th century Europe, in a movement that Foucault famously describes as the Great Confinement, "unreasonable" members of the population were locked away and institutionalized. In the eighteenth century, madness came to be seen as the reverse of Reason, and, finally, in the nineteenth century as mental illness.

Foucault also argues that madness was silenced by Reason, losing its power to signify the limits of social order and to point to the truth. He examines the rise of scientific and "humanitarian" treatments of the insane, notably at the hands of Philippe Pinel and Samuel Tuke. He claims that these new treatments were in fact no less controlling than previous methods. Pinel's treatment of the mad amounted to an extended aversion therapy, including such treatments as freezing showers and use of a straitjacket. In Foucault's view, this treatment amounted to repeated brutality until the pattern of judgment and punishment was internalized by the patient.

Laing, Cooper, Theodore Lidz, Silvano Arieti and others went on to argue that schizophrenia could be understood as an injury to the inner self inflicted by psychologically invasive "schizophrenogenic" parents, or as a healthy attempt to cope with a sick society. Psychiatrist Thomas Szasz argues that "mental illness" is an inherently incoherent combination of a medical and a psychological concept, but popular because it legitimizes the use of psychiatric force to control and limit deviance from societal norms.

Adherents of this view referred to "the myth of mental illness" after Szasz's controversial book of that name. (Even though the movement originally described as anti-psychiatry became associated with the general counter-culture movement of the 1960s, Szasz, Lidz and Arieti never became involved in that movement.) Michel Foucault, Erving Goffman, Deleuze and Guattari, and others criticized the power and role of psychiatry in society, including the use of "total institutions", "labelling" and stigmatizing.

Foucault argued that the concepts of sanity and insanity were social constructs that did not reflect quantifiable patterns of human behavior, and that, rather, were indicative only of the power of the "sane" over the "insane". The novel One Flew Over the Cuckoo's Nest by counterculture icon Ken Kesey became a bestseller, resonating with public concern about involuntary medication, lobotomy and electroshock procedures used to control patients.

In addition, Holocaust documenters argued that Nazi eugenics and the medicalization of social problems and Action T4, the 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 Nuremberg Trials convicted a number of psychiatrists who held key positions in Nazi regimes.

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.

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 anti-psychiatry movement was also being driven by individuals with adverse experiences of psychiatric services. This included those who 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 challenged the classification of homosexuality as a mental illness and, in a climate of controversy and activism, in 1974 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" and a wide variety of "paraphilias" remain. Increased legal and professional protections, and merging with human rights and disability rights movements, added to anti-psychiatry theory and action. The Yogyakarta Principles on the application of international human rights law in ralation to sexual orientation and gender identity affirm that "notwithstanding any classifications to the contray, a person's sexual orientation and gender identity are not, in and of themselves, medical conditions and are not to be treated, cured or suppressed. Further, "An Activist's Guide" to the Yogyakarta Principles in Action condemn medicalization of transsexuality stating that "it is important to note that while "sexual orientation" has been declassified as a mental illness in many countries, "gender identity" or "gender identity disorder" often remains under consideration."

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.

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