Anti State, Anti Capital, Anti Psychiatry

-Michel Foucault

Anti-psychiatry is the belief that the psychiatric system is a system of social control masquerading behind made-up science. Protest against the mental health system is not a new phenomenon and in fact goes back hundreds of years to the 17th century, when inmates at Bethlem hospital began petitioning the House of Lords for more humane treatment. In the 19th Century, groups like the Alleged Lunatics' Friends Society campaigned against the assaults and abuse that were meted out routinely to inmates in the warehouse-style Victorian asylums. These groups were often self-organized, patient-led groups, but their ideology was essentially a liberal one — they campaigned for civil rights and the rule of law in the mental hospital, greater accountability of psychiatric power and reform of the psychiatric institutions. This tradition continued throughout the 20th century up to the present day. The National Association for Mental Health (now MIND) is one of several examples of reformist groups.

Anti-psychiatry was distinctive from this tradition because of its radicalism. Rather than seeking to modernize psychiatry, check its power or prevent abuse, the work of R. D. Laing, Thomas Szasz and others challenged the legitimacy of the whole psychiatric hierarchy. They argued not for a change in psychiatry but for an end to it. Anti-psychiatry was as political as it was medical; the movement flared up in the 1960s, a time of relative popularity for the revolutionary Left among the UK intelligentsia, and anti-psychiatry (with the neo-con Szasz as a notable exception) was very much a part of this progressive intellectual surge. Leftwing anti-psychiatry saw the psychiatric system as a coercive wing of the capitalist State, waging psychological warfare against the working class. Key thinkers fused Marxist materialism, philosophical libertarianism and revolutionary sentiment into a theory that called for the end of medical-capitalist hegemony and freedom for the proletariat from mental slavery.

Anti-psychiatry never made good on its promises. Despite making waves in intellectual circles, the theoretical movement never permeated to where it was most needed, in the asylums themselves. In 1965, Laing, Cooper and others formed a group called the Philadelphia Association and established an ‘anti-hospital’ or ‘community’ at Kingsley Hall in London. They lived and worked from within this separatist bubble, treating a handful of affluent patients and building their reputations through their written work whilst swapping struggle and revolution for anti-psychiatry lifestyle-ism. Without anchoring itself in real-world struggles, the movement drifted philosophically towards apolitical spiritualism, dying out at the end of the 70s with the rest of the hippie counterculture.

-R. D. Laing

Anti-psychiatry was never a homogenous movement. Apart from the Philadelphia Association, there was never an anti-psychiatry union or club, and as such there is no manifesto or definitive text that could serve as an introduction or overview of anti-psychiatry ideas. Many of the movement’s key thinkers rejected the term ‘anti-psychiatry’ altogether or rarely have their influence on the movement credited, and frequently disagreed with each other’s definitions of what anti-psychiatry actually is. Without clear practical applications, the reams and reams of text can seem nebulous, metaphysical and wilfully obscure. Trying to understand Szasz and Foucault’s works in particular can often feel like grasping at smoke.

To summarize every key text comprehensively would take a whole book in itself. For a quick overview, though, there are four basic arguments that make up what is usually called anti-psychiatry;
• That mental illnesses don’t literally exist, that the science behind psychiatry is not a real science[1], and that psychiatry is actually a branch of the legal system rather than a discipline of medicine. This is the argument put forward by Thomas Szasz in The Myth of Mental Illness.
• That mental illnesses are created by our environments, our society and our relationships with others, not by problems in our brains or bodies; this can be true on the level of abusive personal relationships (see R. D. Laing in, Sanity, Madness and the Family) or oppressive political and economic relationships (David Cooper most famously argued that capitalist exploitation caused mental breakdown in the working class; see his essay in The Dialectics of Liberation)
• That mental illnesses should be understood as ‘iatrogenic illnesses’- that is, that the psychiatric system actually creates most of the illnesses that it pretends to treat (see Ivan Illich’s book Medical Nemesis),
• That mental illnesses provide a pretext for the state or society to control people, and psychiatric power is a useful way of enforcing compliance to laws or norms. See Erving Goffman’s Asylums, David Cooper’s Psychiatry and Anti-Psychiatry or Murray Edelman’s Political Language, for more on this.

As mentioned above, anti-psychiatry is usually seen as ‘over’, outdated, irrelevant and a product of its time. This is partly true. Szasz’s apolitical anti-psychiatry quickly sold out its humanist potential to free market liberalism; and Laing’s reputation went up in smoke as he ditched credible psychopolitics in favour of LSD and spiritualism. The feminism implicit in Laing’s early work was undermined by his exclusively male colleagues' relationship with their predominantly female patients, particularly David Cooper’s nasty habit of prescribing ‘therapeutic sex’ to patients too ill to consent. Activists will struggle to find role-models among the original anti-psychiatrists, and there are few professionals now that would use the label for their own work.

-Ivan Illich

Despite claiming radicalism, Anti-psychiatry failed because it didn’t go far enough; whatever the name suggests, Anti-psychiatry was still, at its core, psychiatry. Its biggest stars (Laing, Cooper and Szasz) were all psychiatrists themselves, with little interest in working with existing service user groups or the emerging psychiatric survivor movement. Laing and co. perfected a kind of psychiatric Leninism. Their revolution was a top-down one, in which freeing patients didn’t involve actually listening to them.

The survivor movement had also been developing over the course of the century, and in Laing’s time there was a growing precedent for Marxist and Libertarian patient groups actively resisting state oppression in the asylums. These collectives were independent from the state and professionals, often based in squatted buildings, and typically organized democratically, from the bottom up, by the patients themselves. In lieu of formal therapeutic training, members of the collectives used their own experience to offer support to each other in a kind of therapeutic direct action.

As well as offering mutual support, survivor organizations were fighting forces in their own right. 1972 saw the birth of the Mental Patient’s Union in the UK; a self-organized patient movement with uncompromisingly communist politics. Whilst Kingsley Hall had become a countercultural myth, and Laing a household name, the MPU was stonewalled and ignored by the British media, and it’s legacy has been largely forgotten. In West Germany, the SPK (Socialist Patient Collective) therapeutic commune was facing brutal repression for its alleged involvement with political dissidence. Two doctors, Wolfgang and Ursula Huber, were jailed for their support of the movement. On both fronts, the anti-psychiatrists in the Philadelpia Association were silent. Laing and Cooper continued to practice at Kingsley Hall, taking patients and ‘treating’ them without ever stopping to question the validity of their own power. Anti-psychiatry, like conventional psychiatry, was something given by doctors and passively received by patients. Structurally speaking, and despite its ambitious rhetoric, it changed nothing.

-Thomas Szasz

The failings of the movement can’t entirely be blamed on the inertia of its leaders, though. The mid twentieth century saw a gradual process of deinstitutionalisation in mental health services across the UK, US and Europe. Successive governments committed themselves to health and welfare reform, and the vast asylums of the pre-war era were gradually phased out in favour of psychiatric wards and community care. Partly, this was driven by a liberal interest in desegregating patients and integrating them as citizens into society at large.

By the 1980s, though, when Peter Sedgwick released his seminal Psychopolitics, a critique of (and obituary for) the entire anti-psychiatry movement, it was clear that deinstitutionalisation had not led to psychiatric liberation. Why the patient liberation movement died out is not easy to explain. Naturally, some of the patient collectives disbanded and others were co-opted. Furthermore, governments who still paid lip service to the idea of ending segregation had made it undeniably clear that rights and freedoms were no longer on the agenda. The relative freedom promised by the shift in state healthcare policy in the 1960s and 1970s was compromised at the dawn of the 1980s, when the post-war drive for citizenship and democracy within the psychiatric system crashed headfirst into anti-welfare conservatism.

If the motive at the start of the asylum closures was a liberal one, the motive at the end was decidedly profit-driven. In the state of California, the first community mental health facilities were opened under the Reagan governorship, and in the UK, the first Minister of Health to implement deinstitutionalisation was Enoch Powell. The new community care facilities were left cash-strapped and dangerously under-staffed, and the current mental health system, where the housing of patients is routinely palmed off onto emergency housing, homeless shelters, police cells and for-profit landlords, was born. In the present day, groups like MIND have found themselves tasked with meeting statutory requirements, patching up the holes in the welfare state and trying to confront the relentless demands for frontline care left behind in the wake of vanished public spending. This leaves little time for political organizing.

-Mental Patient's Union

The 60s are long gone, and to academics, Laing’s work has grown boring. Why should anyone care now? What does anti-psychiatry have to offer, to the workfare and PFI generation?

Psychiatry is big at the moment. Adverts promoting ‘better mental health’ seem to be everywhere. These so-called ‘anti-stigma’ campaigns, like mental health awareness week and ‘#mandictionary’, are state-funded, presented without context, and frustratingly apolitical. Psychiatric reform has also resurfaced in the agenda of the parliamentary Left. In his first week as Labour leader, Jeremy Corbyn, created the office of the Shadow Minister for Mental Health and appointed Luciana Berger MP to the role. This was largely a response to pressure from the anti-cuts movement which propelled his ascendancy. Several anti-cuts organizations have identified that cuts to welfare would trigger mental health problems among the working class, whilst cuts to the social care sector would leave it unable to cope with the new influx. The recent spate of suicides among disabled people following work capability assessments is just one statistic of many that seems to prove their point.

Significantly, though, the anti-cuts movement has seen self-organized patient/service user groups come to the fore. Disabled People Against Cuts are the among the most militant of these. Members of DPAC chained their wheelchairs to the railings in front of the 2015 Tory party conference, and a group of DPAC activists were responsible for triggering a UN Human Rights investigation into the DWP’s murderous welfare policies.

Clearly, there is dissatisfaction with the status quo. However, whilst the anti-cuts movement makes all the right noises, it is essentially a short-sighted, legalistic and reformist campaign. The clear links between class, poverty, mental illness and suicide were well-documented long before the beginning of the last government’s austerity experiment. Psychiatric oppression is inherent in all capitalist systems. It is not just a product of the current brand of Thatcherism that it is being hawked from above. It will not be ended simply by replacing one top-down system, with another.

The anti-cuts movement will inevitably sell out or fail, and when this happens there will be disaffected patients and healthcare workers left behind looking for a new cause to rally behind. For meaningful change to occur, it is important that a radical, abolitionist movement is ready to rise up in the place of failed legalism.

The Tory government has already begun to install therapists in jobcentres and jobcentre staff in GP surgeries. The collaboration between psychiatry, capitalism and the state has never been more blatant. To resist effectively, a new movement would have to see the bigger picture behind the cuts to services and the rise in mental illness, to recognise the now undeniable links between the invention of mental illness and the control of the working class by the capitalist state. Patient-led groups like Hearing Voices Network have already started to look beyond narrow questions of policy and funding. In a recent statement in response to the release of the DSM-V diagnostic manual, HVN openly challenged the scientific validity of the entire psychiatric system and called for greater patient control over mental health policy and the de-medicalising of patient care. For groups like HVN and DPAC, direct action seems like the obvious next step from protests and petitions. A self-organized patient’s union with a clear anti-state, anti-capitalist agenda could be the organizational tool from which direct action is launched. Anti-psychiatry, for all its flaws, provides the theoretical basis for such an organization.

[1] This is not to say that mental suffering doesn’t exist or that patients are in any way ‘making up’ their illnesses, since things like hallucinations, eating disorders and feelings of suicide are undeniably real to those undergoing them. Rather, the argument is that the experiences suffered by mental patients are not measurable, predictable or scientifically observable, and do not have a clear biological, chemical or physiological cause, therefore mental ‘illnesses’ aren’t actually illnesses. Simply put, you can see a broken leg on an x-ray but you can’t see a depression or a schizophrenia. Mental illnesses can’t be understood in purely scientific terms.