Brief introductory post outlining what antipsychiatry is and the need for its renewal.
As part of their birthday celebrations Libcom decided to expand their blog section, so I decided I’d put my foot forward to do a bit of writing on mental health. While I know Ramona already writes on mental health, I figure it can’t hurt to have someone else contributing to promote the complexity of mental distress within the anarchist community. As such, I’m going to try not to let this blog become too theory-heavy or to use language that might alienate people who aren’t comfortable with the philosophy of mental health. At times this will mean sacrificing conceptual complexity for clarity of communication. I’ll be happy to address any theoretical points in discussion in the comments section. At the outset I should also disclose that I am a trained mental health nurse about to start working in the substance misuse field, in case people feel that this might be an important blinder to how I see thing. For now, I want to begin by emphasising why I want to write about mental health on an anarchist site at all.
There are countless analyses and arguments about the effects of capital and the state on human beings, the environment, and their ecological interdependence. They often focus on state power, authoritarianism, and the organisation of work, economic inequality and moral injustice. Too infrequently do we find considered and nuanced understandings of the relationship between the state, capitalism and mental distress. Often, it appears in a list of other negative consequences of life under late capitalism as a sort of footnote or, even more commonly, statistics on suicide rates will be deployed to bolster arguments about the human cost of capital. Those who seek to make the links and establish the mechanisms of the psychic fall-out of capitalism are rarely widely read and seem too often to be considered “anti-psychiatric” throwbacks to an earlier historical period. The argument is that we’ve matured beyond the point of being anti-psychiatric, and perhaps we have. Yet that doesn’t mean that the project and legacy of anti-psychiatry is any less important than it was at its height. Anti-psychiatry remains relevant for two reasons: it helped to establish contemporary psychiatric practice, and its critique remains unfinished.
Throughout the 1960s and 1970s a slew of psychiatrists and militant intellectuals began to critique the psychiatric establishment on the basis that its treatments were doing patients far more harm than good. The term itself was coined by the South African Marxist psychiatrist David Cooper. It was Cooper who helped put together the famous Congress on the Dialectic of Liberation that brought together Herbert Marcuse, RD Laing, Paul Goodman and Stokely Carmichael of the Black Panthers. Radical credentials verified, anti-psychiatry’s other celebrities included the aforementioned Laing but also figures as varied as American libertarian Thomas Szasz, French thinker Michel Foucault, and Italian psychoanalyst Felix Guattari. What united these diverse figures was their contention that psychiatry amounted to a form of violence and held that rather than seeking to heal or to cure the “therapeutic” function of psychiatry was really a thinly-veiled mode of social control.
To risk obliterating the very marked differences between some of these figures, we can summarise a general anti-psychiatric outlook or attitude. First, it rejected the idea that psychiatric illness was an exclusively biological phenomenon; it rejected the idea that psychiatric diagnoses were normatively neutral descriptions of illness states; it often rejected the use of neuroleptic medication; it saw the asylum/hospital/clinic as establishing a physical apartheid of the mad and the sane; it saw psychiatry as trying to regulate the behaviour and psychic life of whole populations along the lines of that apartheid through processes of “normalisation”; in doing so psychiatry was seen as depriving people of liberty and autonomy on spurious grounds; psychiatry’s history was revealed as one of constant brutality and violence grounded in pseudo-scientific discourses, infamously including the idea that homosexuality was a mental illness up until DSM-III was published in 1980. Specific critiques also outlined how psychiatric discourse actively constituted specific passive subjectivities (Foucault) or outlined how the psychiatric ward was more like a concentration camp than a genuinely therapeutic environment (Goffman). Crucial to almost all of these critiques was the notion that psychiatry is a pseudo-science.
These critiques all remain true today, so why haven’t we seen the emergence of an emancipatory and genuinely therapeutic approach to care for those suffering from mental distress? In part, I would say this is because the anti-psychiatric critiques- written off by the orthodox psychiatry of the day- was fully assimilated into the very structure of psychiatry itself. That is to say, the radicalism of the anti-psychiatrists was recuperated by the system it was attacking. This can be seen in the fact that psychiatry now prides itself on its emphasis on deinstitutionalisation and community care, its rhetorical embrace of the recovery movement, and its tokenistic inclusion of “service-users” into its hierarchy.
The attack on psychiatry’s pseudo-scientific nature led to the aggressive adoption of the biological model of mental illness at the same time that training programmes for psychiatrists, nurses and other service-workers began to talk about a “biopsychosocial model”- talk that has yet to manifest in any real practical upheavals of psychiatric care.
Alongside this is the adoption as orthodoxy of one of RD Laing’s most controversial ideas. In the 1970s Laing conducted studies on the language patterns and communicative interactions of people diagnosed with schizophrenia and their families. His startling conclusion was that these linguistic interactions could actually make the schizophrenic experience worse, causing relapses into psychoses and prolonging their frequency and duration (chronicity). At the time, Laing was accused of blaming families for causing schizophrenia and was cemented as a dangerous and callous man. However, that very same idea has been integrated into the heart of “evidence-based” psychiatry in the form of the concept “high-expressed emotion”. One of the most radical challenges to biopsychiatry was dismissed, destroyed and then recuperated. In practice this has cashed out in terms of some people being offered systems family therapy, but the radical idea that experience has a social rather than purely biological basis has been dropped.
None of which is to claim that the experience of mental distress isn’t biologically mediated. We are bodies and our experience is embodied- there is no “mind” floating independently of our physiology. At the same time though, psychiatry remains unwilling to accept that our embodiment exists in complex ecological relationships that includes our sociality.
Similarly, none of this is to claim that the original critiques of the anti-psychiatrists were unproblematic. For instance, Szasz’s critique was motivated by his right-wing libertarian philosophy and included the desire to see people stand trial for acts they committed while experiencing distress, acts they may not otherwise have performed.
Foucault’s position in some of his work seems to embrace a kind of romanticism of mental distress, while Laing expressed some dubious ideas about “schizophrenia” as a shamanic journey of self-discovery. Many of the anti-psychiatrists also rejected the benefits of therapy and medication as if these were evil in-itself, in a move that would remind many anarchists of primitivism’s rejection of technology.
Too few of those involved in the original anti-psychiatry movement were revolutionaries, most of them being radicals or hyper-liberals who can offer us a lot of helpful work but themselves didn’t situate that work as part of the supersession of capitalism and the state (Guattari is the only one that really seems to have had this as a goal and he is, ironically, the one anti-psychiatrist most often neglected from histories of the "movement").
As we begin to see a raft of reports on increasing suicide rates, depression, anxiety and eating disorders, along with the related rise in prescriptions for psychiatric medications, and more and more fears about the “pathologisation of everyday life”, I think it is time for anarchists to become more involved in the return to anti-psychiatry. Clinical psychologist Richard Bentall has (not unproblematically) heralded the need for a new ‘rational anti-psychiatry’ while people like Pat Bracken are spear heading a ‘critical psychiatry’. Yet without linking this to thorough analyses of the relationship of mental health and psychiatry to corrosive powers of capitalism and the state such a renewed anti-psychiatry is pointless. The critique has been swallowed whole by the system and turned into the justification for today’s aggressive colonisation of our lives by that very system.
It seems to me that the “mentally ill” have always been among those subjects to be proletarianised. Today, this proletarianisation has always gone hand in hand with social exclusion, impoverishment and the social death that economic proletarians face. In conditions such as our own, these two versions of proletarianisation are united into a common face.
If the original anti-psychiatry helped to shape the current form of psychiatry then it is clear it can’t simply be reactivated, but it is also clear that it must be repeated in a new way to challenge its violence and its psycho-political management of populations. Part of the purpose of this blog will be to discuss this renewed critical stance to psychiatry and to do so from an anarcho-communist perspective.
Initially, I will be posting critical short introductions to key figures, events and ideas from antipsychiatry's history and its afterlives. I aim to do this with a fairly regular schedule, as well as submitting sporadic posts in response to current events that touch on relevant issues. I’d welcome feedback and any requests for topics to be covered.