![Anti-psychiatry symbol](https://upload.wikimedia.org/wikipedia/commons/a/a4/Anti-psychiatry_symbol.png)
Anti-psychiatry is a movement based on the view that
psychiatric treatment
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
Initial psychi ...
is often more damaging than helpful to patients, highlighting
controversies about psychiatry
Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as some sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnos ...
. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historically critiques of psychiatry came to light after focus on the extreme harms associated with
electroconvulsive treatment
Electroconvulsive therapy (ECT) is a psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.Rudorfer, MV, Henry, ME, Sackeim, HA (2003)"Electroconvulsive the ...
or
insulin shock therapy
Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks.Neustatter WL (1948) ''Modern psychiatry ...
.
The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of who agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions.
Beyond concerns about effectiveness, anti-psychiatry might question the philosophical and ethical underpinnings of
psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
and
psychoactive medication
A psychoactive drug, psychopharmaceutical, psychoactive agent or psychotropic drug is a chemical substance, that changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behavior.
Th ...
, seeing them as shaped by social and political concerns rather than the autonomy and integrity of the individual mind. They may believe that "judgements on matters of sanity should be the prerogative of the philosophical mind", and that the mind should not be a medical concern. Some activists reject the psychiatric notion of
mental illness
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
.
Anti-psychiatry considers psychiatry a coercive instrument of oppression due to an unequal
power relationship between doctor and patient, and a highly subjective diagnostic process.
Wrongful involuntary commitment
Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hos ...
is an important issue in the movement.
The decentralized movement has been active in various forms for two centuries.
In the 1960s, there were many challenges to
psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
and mainstream psychiatry, where the very basis of psychiatric practice was characterized as repressive and controlling.
Psychiatrists identified with the movement included
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
,
Timothy Leary
Timothy Francis Leary (October 22, 1920 – May 31, 1996) was an American psychologist and author known for his strong advocacy of psychedelic drugs. Evaluations of Leary are polarized, ranging from bold oracle to publicity hound. He was "a her ...
,
Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
,
R. D. Laing
Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment o ...
,
Franco Basaglia
Franco Basaglia (; 11 March 1924 29 August 1980) was an Italian psychiatrist, neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, figurehead a ...
,
Theodore Lidz Theodore Lidz (1 April 1910 – 16 February 2001) was an American psychiatrist best known for his articles and books on the causes of schizophrenia and on psychotherapy with patients with schizophrenia. An advocate of research into environmental ca ...
,
Silvano Arieti
Silvano Arieti (June 28, 1914 in Pisa, Italy – August 7, 1981 in New York City) was a psychiatrist regarded as one of the world's foremost authorities on schizophrenia. He received his M.D. from the University of Pisa and left Italy soon after, d ...
, and
David Cooper. Others involved were
Michel Foucault
Paul-Michel Foucault (, ; ; 15 October 192625 June 1984) was a French philosopher, historian of ideas, writer, political activist, and literary critic. Foucault's theories primarily address the relationship between power and knowledge, and how ...
,
Gilles Deleuze
Gilles Louis René Deleuze ( , ; 18 January 1925 – 4 November 1995) was a French philosopher who, from the early 1950s until his death in 1995, wrote on philosophy, literature, film, and fine art. His most popular works were the two volu ...
,
Félix Guattari
Pierre-Félix Guattari ( , ; 30 April 1930 – 29 August 1992) was a French psychoanalyst, political philosopher, semiotician, social activist, and screenwriter. He co-founded schizoanalysis with Gilles Deleuze, and ecosophy with Arne Næss, ...
, and
Erving Goffman
Erving Goffman (11 June 1922 – 19 November 1982) was a Canadian-born sociology, sociologist, Social psychology (sociology), social psychologist, and writer, considered by some "the most influential American sociologist of the twentieth ...
. Cooper used the term "anti-psychiatry" in 1967, and wrote the book ''Psychiatry and Anti-psychiatry'' in 1971.
The word ''Antipsychiatrie'' was already used in Germany in 1904. Thomas Szasz introduced the definition of mental illness as a
myth
Myth is a folklore genre consisting of Narrative, narratives that play a fundamental role in a society, such as foundational tales or Origin myth, origin myths. Since "myth" is widely used to imply that a story is not Objectivity (philosophy), ...
in the book ''
The Myth of Mental Illness
''The Myth of Mental Illness: Foundations of a Theory of Personal Conduct'' is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, an ...
'' (1961), Giorgio Antonucci introduced the definition of psychiatry as a prejudice in the book ''I pregiudizi e la conoscenza critica alla psichiatria'' (1986).
The movement continues to influence thinking about psychiatry and psychology, both within and outside of those fields, particularly in terms of the relationship between providers of treatment and those receiving it.
Contemporary issues include freedom versus coercion, nature versus nurture, and the right to be different.
Critics of antipsychiatry from within psychiatry itself object to the underlying principle that psychiatry is by definition harmful. Most psychiatrists accept that issues exist that need addressing, but that the abolition of psychiatry is harmful.
Medical professionals often consider Anti-psychiatry movements to be promoting
mental illness denial
Mental illness denial or mental disorder denial is a form of denialism in which a person denies the existence of mental disorders. Both serious analysts and pseudoscientific movements question the existence of certain disorders.
In psychiatry, ...
, and has been compared with
conspiracy theories
A conspiracy theory is an explanation for an event or situation that invokes a conspiracy by sinister and powerful groups, often political in motivation, when other explanations are more probable.Additional sources:
*
*
*
* The term has a nega ...
.
History
Precursors
![Narrenturm Vienna June 2006 575](https://upload.wikimedia.org/wikipedia/commons/5/57/Narrenturm_Vienna_June_2006_575.jpg)
The first widespread challenge to the prevailing medical approach in Western countries occurred in the late 18th century.
Part of the progressive
Age of Enlightenment
The Age of Enlightenment or the Enlightenment; german: Aufklärung, "Enlightenment"; it, L'Illuminismo, "Enlightenment"; pl, Oświecenie, "Enlightenment"; pt, Iluminismo, "Enlightenment"; es, La Ilustración, "Enlightenment" was an intel ...
, a "
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 fr ...
" movement challenged the harsh, pessimistic,
somatic
Somatic may refer to:
* Somatic (biology), referring to the cells of the body in contrast to the germ line cells
** Somatic cell, a non-gametic cell in a multicellular organism
* Somatic nervous system, the portion of the vertebrate nervous sys ...
(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.
This "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.
As it became the establishment approach in the 19th century, opposition to its negative aspects also grew.
According to
Michel Foucault
Paul-Michel Foucault (, ; ; 15 October 192625 June 1984) was a French philosopher, historian of ideas, writer, political activist, and literary critic. Foucault's theories primarily address the relationship between power and knowledge, and how ...
, there was a shift in the perception of madness, whereby it came to be seen as less about
delusion
A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...
, i.e. disturbed judgment about the truth, than about a disorder of regular, normal behaviour or will. Foucault argued that, prior to this, doctors could often prescribe travel, rest, walking, retirement and generally engaging with nature, seen as the visible form of truth, as a means to break with artificialities of the world (and therefore delusions). Another form of treatment involved nature's opposite, the theatre, where the patient's madness was acted out for him or her in such a way that the delusion would reveal itself to the patient.
Thus the most prominent therapeutic technique became to confront patients with a healthy sound will and orthodox passions, ideally embodied by the physician . The "cure" 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
[''De la Folie''. Chapter 5: ''Traitement de la folie,'' pp 132-133: in Foucault (1997), p. 43]). Foucault also argued that the increasing
internment
Internment is the imprisonment of people, commonly in large groups, without charges or intent to file charges. The term is especially used for the confinement "of enemy citizens in wartime or of terrorism suspects". Thus, while it can simpl ...
of the "mentally ill" (the development of more and bigger asylums) had become necessary not just for diagnosis and classification but because an enclosed place became a requirement for a treatment that was now understood as primarily the contest of wills, a question of submission and victory.
![Kewwoodcut](https://upload.wikimedia.org/wikipedia/commons/8/80/Kewwoodcut.png)
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).
![Woodilee Asylum - geograph](https://upload.wikimedia.org/wikipedia/commons/0/02/Woodilee_Asylum_-_geograph.org.uk_-_441329.jpg)
Other analyses suggest that the rise of
asylums was primarily driven by
industrialization
Industrialisation ( alternatively spelled industrialization) is the period of social and economic change that transforms a human group from an agrarian society into an industrial society. This involves an extensive re-organisation of an econo ...
and
capitalism
Capitalism is an economic system based on the private ownership of the means of production and their operation for Profit (economics), profit. Central characteristics of capitalism include capital accumulation, competitive markets, pric ...
, including the breakdown of traditional family structures. By the end of the 19th century, psychiatrists often had little power in the overcrowded asylum system, acting mainly as administrators who rarely attended to patients in a system where therapeutic ideals had turned into 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, that played an important part in the development of the anti-psychiatry movement.
![Man in restraint chair; by H](https://upload.wikimedia.org/wikipedia/commons/e/e4/Man_in_restraint_chair%3B_by_H._Clarke%3B_1869_Wellcome_L0019069.jpg)
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
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evi ...
of "madness". Those critiques occurred at a time when physicians had not yet achieved
hegemony
Hegemony (, , ) is the political, economic, and military predominance of one State (polity), state over other states. In Ancient Greece (8th BC – AD 6th ), hegemony denoted the politico-military dominance of the ''hegemon'' city-state over oth ...
through psychiatry, however, so there was no single, unified force to oppose.
Nevertheless, there was increasing concern at the ease with which people could be confined, with frequent reports of abuse and illegal confinement. For example,
Daniel Defoe
Daniel Defoe (; born Daniel Foe; – 24 April 1731) was an English writer, trader, journalist, pamphleteer and spy. He is most famous for his novel ''Robinson Crusoe'', published in 1719, which is claimed to be second only to the Bible in its ...
, the author of ''
Robinson Crusoe
''Robinson Crusoe'' () is a novel by Daniel Defoe, first published on 25 April 1719. The first edition credited the work's protagonist Robinson Crusoe as its author, leading many readers to believe he was a real person and the book a tra ...
'', had previously argued for more government oversight of "madhouses" and for due process prior to involuntary internment. He later argued that husbands used asylum hospitals to incarcerate their disobedient wives, and in a subsequent pamphlet that wives even did the same to their husbands. It was also proposed that the role of asylum keeper be separated from doctor, to discourage exploitation of patients. There was general concern that physicians were undermining personhood by medicalizing problems, by claiming they alone had the expertise to judge, and by arguing that mental disorder was physical and hereditary. The
Alleged Lunatics' Friend Society
The Alleged Lunatics' Friend Society was an advocacy group started by former asylum patients and their supporters in 19th-century Britain. The Society campaigned for greater protection against wrongful confinement or cruel and improper treatment, ...
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 Parsons Ware Packard (28 December 1816 – 25 July 1897), also known as E.P.W. Packard, was an American advocate for the rights of women and people accused of insanity. She was wrongfully confined by her husband who claimed that she ...
published a series of books and pamphlets describing her experiences in the Illinois insane asylum, to which she had been
committed at the request of her husband.
Throughout, the
class
Class or The Class may refer to:
Common uses not otherwise categorized
* Class (biology), a taxonomic rank
* Class (knowledge representation), a collection of individuals or objects
* Class (philosophy), an analytical concept used differentl ...
nature of
mental hospital
Psychiatric hospitals, also known as mental health hospitals, behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, such as schizophrenia, bipolar disorder, eating disorders, dissociati ...
s and their role as agencies of control were well recognized. 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
Events from the year 1808 in Germany.
Incumbents
Kingdoms
* Kingdom of Prussia
** Monarch – Frederick William III of Prussia (16 November 1797 – 7 June 1840)
* Kingdom of Bavaria
** Maximilian I (1 January 1806 – 13 October 1825)
* King ...
by
Johann Christian Reil
Johann Christian Reil (20 February 1759 – 22 November 1813) was a German physician, physiologist, anatomist, and psychiatrist. He coined the term psychiatry – ''Psychiatrie'' in German – in 1808.
Medical conditions and anatomical featur ...
, as "Psychiaterie") and developed allegedly more invasive treatments, opposition increased. In the Southern US,
black slaves
The Atlantic slave trade, transatlantic slave trade, or Euro-American slave trade involved the transportation by slave traders of enslaved African people, mainly to the Americas. The slave trade regularly used the triangular trade route and i ...
and
abolitionists
Abolitionism, or the abolitionist movement, is the movement to end slavery. In Western Europe and the Americas, abolitionism was a historic movement that sought to end the Atlantic slave trade and liberate the enslaved people.
The Britis ...
encountered
drapetomania
Drapetomania was a supposed mental illness that, in 1851, American physician Samuel A. Cartwright hypothesized as the cause of enslaved Africans fleeing captivity. This hypothesis centered around the belief that slavery was such an improvement up ...
, a pseudo-scientific diagnosis that presented the desire of slaves to run away from their masters as a symptom of pathology.
There was some organized challenge to psychiatry in the late 1870s from the new speciality of
neurology
Neurology (from el, wikt:νεῦρον, νεῦρον (neûron), "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine), medicine dealing with the diagnosis and treatment of all categories of co ...
, largely centered around control of state insane asylums in New York. 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 confront the psychiatric establishment openly, and those who did so were commonly considered so extreme in their charges that they could seldom gain credibility.
In the early 20th century, ex-patient
Clifford W. Beers
Clifford Whittingham Beers (March 30, 1876 – July 9, 1943) was the founder of the American mental hygiene movement.
Biography
Beers was born in New Haven, Connecticut, to Ida and Robert Beers on March 30, 1876. He was one of five children, all ...
campaigned to improve the plight of individuals receiving public psychiatric care, particularly those committed to state institutions, publicizing the issues in his book, ''A Mind that Found Itself'' (1908). While Beers initially condemned psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient involvement in the movement, he was influenced by
Adolf Meyer and the psychiatric establishment, and toned down his hostility since he needed their support for reforms. In Germany during this time were similar efforts which used the term "Antipsychiatrie".
Beers' reliance on rich donors and his need for approval from experts led him to hand over to psychiatrists the organization he helped found, the National Committee for Mental Hygiene, which eventually became the National Mental Health Association.
In the UK, the National Society for Lunacy Law Reform was established in 1920 by angry ex-patients who sought justice for abuses committed in psychiatric custody, and were aggrieved that their complaints were patronisingly discounted by the authorities, who were seen to value the availability of medicalized internment as a 'whitewashed' extrajudicial custodial and punitive process.
In 1922, ex-patient Rachel Grant-Smith added to calls for reform of the system of neglect and abuse she had suffered by publishing "The Experiences of an Asylum Patient". In the US,
We Are Not Alone (WANA) was founded by a group of patients at Rockland State Hospital in New York, and continued to meet as an ex-patient group.
In the 1920s extreme hostility to psychiatrists and psychiatry was expressed by the French playwright and theater director
Antonin Artaud
Antoine Marie Joseph Paul Artaud, better known as Antonin Artaud (; 4 September 1896 – 4 March 1948), was a French writer, poet, dramatist, visual artist, essayist, actor and theatre director. He is widely recognized as a major figure of the E ...
, in particular, in his book on
van Gogh
Vincent Willem van Gogh (; 30 March 185329 July 1890) was a Dutch Post-Impressionist painter who posthumously became one of the most famous and influential figures in Western art history. In a decade, he created about 2,100 artworks, inclu ...
. Much influenced by the
Dada
Dada () or Dadaism was an art movement of the European avant-garde in the early 20th century, with early centres in Zürich, Switzerland, at the Cabaret Voltaire (Zurich), Cabaret Voltaire (in 1916). New York Dada began c. 1915, and after 192 ...
and
surrealist
Surrealism is a cultural movement that developed in Europe in the aftermath of World War I in which artists depicted unnerving, illogical scenes and developed techniques to allow the unconscious mind to express itself. Its aim was, according to l ...
enthusiasms of the day, he considered
dream
A dream is a succession of images, ideas, emotions, and sensations that usually occur involuntarily in the mind during certain stages of sleep. Humans spend about two hours dreaming per night, and each dream lasts around 5 to 20 minutes, althou ...
s, thoughts and visions no less real than the "outside" world.
In this era before
penicillin
Penicillins (P, PCN or PEN) are a group of β-lactam antibiotics originally obtained from ''Penicillium'' moulds, principally '' P. chrysogenum'' and '' P. rubens''. Most penicillins in clinical use are synthesised by P. chrysogenum using ...
was discovered,
eugenics
Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior or ...
was popular. People believed
diseases of the mind could be passed on so
compulsory sterilization
Compulsory sterilization, also known as forced or coerced sterilization, is a government-mandated program to involuntarily sterilize a specific group of people. Sterilization removes a person's capacity to reproduce, and is usually done throug ...
of the
mentally ill was enacted in many countries.
1930s
In the 1930s several controversial medical practices were introduced and framed as "treatments" for mental disorders, including inducing seizures (by
electroshock
Electroconvulsive therapy (ECT) is a psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.Rudorfer, MV, Henry, ME, Sackeim, HA (2003)"Electroconvulsive the ...
,
insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism o ...
or other drugs) or psychosurgery (
lobotomy
A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections to ...
). In the US, beginning in 1939 through 1951, over 50,000 lobotomy operations were performed in mental hospitals, a procedure ultimately seen as inhumane.
Holocaust
The Holocaust, also known as the Shoah, was the genocide of European Jews during World War II. Between 1941 and 1945, Nazi Germany and its collaborators systematically murdered some six million Jews across German-occupied Europe; a ...
historians argued that the
medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evid ...
of social programs and systematic
euthanasia
Euthanasia (from el, εὐθανασία 'good death': εὖ, ''eu'' 'well, good' + θάνατος, ''thanatos'' 'death') is the practice of intentionally ending life to eliminate pain and suffering.
Different countries have different eut ...
of people in German
mental institution
Psychiatric hospitals, also known as mental health hospitals, behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, such as schizophrenia, bipolar disorder, eating disorders, dissociative ...
s in the 1930s provided the institutional, procedural, and doctrinal origins of the
mass murder
Mass murder is the act of murdering a number of people, typically simultaneously or over a relatively short period of time and in close geographic proximity. The United States Congress defines mass killings as the killings of three or more pe ...
of the 1940s. The Nazi programs were called
Action T4
(German, ) was a campaign of mass murder by involuntary euthanasia in Nazi Germany. The term was first used in post-war trials against doctors who had been involved in the killings. The name T4 is an abbreviation of 4, a street address of ...
and
Action 14f13
Action 14f13, also called ''Sonderbehandlung'' (special treatment) 14f13 and Aktion 14f13, was a campaign by Nazi Germany to murder Nazi concentration camp prisoners. Also called ''invalid'' or ''prisoner euthanasia'', the sick, the elderly and t ...
.
The
Nuremberg Trials
The Nuremberg trials were held by the Allies of World War II, Allies against representatives of the defeated Nazi Germany, for plotting and carrying out invasions of other countries, and other crimes, in World War II.
Between 1939 and 1945 ...
convicted a number of psychiatrists who held key positions in Nazi regimes. As one Swiss psychiatrist stated: "A not so easy question to be answered is whether it should be allowed to destroy lives objectively 'unworthy of living' without the expressed request of its bearers. (...) Even in incurable mentally ill ones suffering seriously from hallucinations and melancholic depressions and not being able to act, to a medical colleague I would ascript the right and in serious cases the duty to shorten — often for many years — the suffering" (Bleuler, Eugen, 1936: "Die naturwissenschaftliche Grundlage der Ethik". Schweizer Archiv Neurologie und Psychiatrie, Band 38, Nr.2, S. 206).
1940s and 1950s
The post-World War II decades saw an enormous growth in psychiatry; many Americans were persuaded that psychiatry and psychology, particularly
psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
, were a key to happiness. Meanwhile, most hospitalized mental patients received at best decent custodial care, and at worst, abuse and neglect.
The psychoanalyst
Jacques Lacan
Jacques Marie Émile Lacan (, , ; 13 April 1901 – 9 September 1981) was a French psychoanalyst and psychiatrist. Described as "the most controversial psycho-analyst since Freud", Lacan gave yearly seminars in Paris from 1953 to 1981, and pu ...
has been identified as an influence on later anti-psychiatry theory in the UK, and as being the first, in the 1940s and 50s, to professionally challenge psychoanalysis to reexamine its concepts and to appreciate psychosis as understandable. Other influences on Lacan included poetry and the surrealist movement, including the poetic power of patients' experiences. Critics disputed this and questioned how his descriptions linked to his practical work. The names that came to be associated with the anti-psychiatry movement knew of Lacan and acknowledged his contribution even if they did not entirely agree.
The psychoanalyst
Erich Fromm
Erich Seligmann Fromm (; ; March 23, 1900 – March 18, 1980) was a German social psychologist, psychoanalyst, sociologist, humanistic philosopher, and democratic socialist. He was a German Jew who fled the Nazi regime and settled in the U ...
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
nddistrust, 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".
![St Thomas Thurstonland 014](https://upload.wikimedia.org/wikipedia/commons/a/a8/St_Thomas_Thurstonland_014.jpg)
In the 1950s new psychiatric drugs, notably the antipsychotic
chlorpromazine
Chlorpromazine (CPZ), marketed under the brand names Thorazine and Largactil among others, is an antipsychotic medication. It is primarily used to treat psychotic disorders such as schizophrenia. Other uses include the treatment of bipolar dis ...
, 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 (TD) is a disorder that results in involuntary repetitive body movements, which may include grimacing, sticking out the tongue or smacking the lips. Additionally, there may be rapid jerking movements or slow writhing movemen ...
, and partly due their "chemical straitjacket" effect and their alleged use to control and intimidate patients.
Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control.
There was also increasing opposition to the large-scale use of psychiatric hospitals and institutions, and attempts were made to develop
services in the community.
![Royal Earlswood Park - geograph](https://upload.wikimedia.org/wikipedia/commons/f/f6/Royal_Earlswood_Park_-_geograph.org.uk_-_1214701.jpg)
According to the Encyclopedia of Theory and Practice in Psychotherapy and Counseling, "In the 1950s in the United States, a
right-wing
Right-wing politics describes the range of political ideologies that view certain social orders and hierarchies as inevitable, natural, normal, or desirable, typically supporting this position on the basis of natural law, economics, authorit ...
anti-mental health movement opposed psychiatry, seeing it as
liberal
Liberal or liberalism may refer to:
Politics
* a supporter of liberalism
** Liberalism by country
* an adherent of a Liberal Party
* Liberalism (international relations)
* Sexually liberal feminism
* Social liberalism
Arts, entertainment and m ...
,
left-wing
Left-wing politics describes the range of political ideologies that support and seek to achieve social equality and egalitarianism, often in opposition to social hierarchy. Left-wing politics typically involve a concern for those in soci ...
, subversive and
anti-American
Anti-Americanism (also called anti-American sentiment) is prejudice, fear, or hatred of the United States, its government, its foreign policy, or Americans in general.
Political scientist Brendon O'Connor at the United States Studies Centr ...
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
The Alaska Mental Health Enabling Act of 1956 (Public Law 84-830) was an Act of Congress passed to improve mental health care in the United States territory of Alaska. It became the focus of a major political controversy after opponents nickname ...
, where the right wing protestors were joined by the emerging
Scientology
Scientology is a set of beliefs and practices invented by American author L. Ron Hubbard, and an associated movement. It has been variously defined as a cult, a business, or a new religious movement. The most recent published census data indi ...
movement."
The field of
psychology
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries betwe ...
sometimes came into opposition with psychiatry.
Behaviorists
Behaviorism is a systematic approach to understanding the behavior of humans and animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual' ...
argued that mental disorder was a matter of
learning
Learning is the process of acquiring new understanding, knowledge, behaviors, skills, value (personal and cultural), values, attitudes, and preferences. The ability to learn is possessed by humans, animals, and some machine learning, machines ...
not medicine; for example,
Hans Eysenck
Hans Jürgen Eysenck (; 4 March 1916 – 4 September 1997) was a German-born British psychologist who spent his professional career in Great Britain. He is best remembered for his work on intelligence and personality, although he worked on other ...
argued that psychiatry "really has no role to play". The developing field of
clinical psychology
Clinical psychology is an integration of social 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 persona ...
in particular came into close contact with psychiatry, often in opposition to its methods, theories and territories.
1960s
Coming to the fore in the 1960s, "anti-psychiatry" (a term first used by
David Cooper in 1967) defined a movement that vocally challenged the fundamental claims and practices of mainstream psychiatry. While most of its elements had precedents in earlier decades and centuries, in the 1960s it took on a national and international character, with access to the mass media and incorporating a wide mixture of grassroots activist organizations and prestigious professional bodies.
Cooper was a South African psychiatrist working in Britain. A trained Marxist revolutionary, he argued that the political context of psychiatry and its patients had to be highlighted and radically challenged, and warned that the fog of individualized therapeutic language could take away people's ability to see and challenge the bigger social picture. He spoke of having a goal of "non-psychiatry" as well as anti-psychiatry.
::In the 1960s fresh voices mounted a new challenge to the pretensions of psychiatry as a science and the mental health system as a successful humanitarian enterprise. These voices included: Ernest Becker, Erving Goffman, R.D. Laing; Laing and Aaron Esterson, Thomas Scheff, and Thomas Szasz. Their writings, along with others such as articles in the journal ''
The Radical Therapist
''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. It was an "alternative journal" in the mental health field that published 12 issues between 1970 ...
'', were given the umbrella label "antipsychiatry" despite wide divergences in philosophy. This critical literature, in concert with an activist movement, emphasized the hegemony of medical model psychiatry, its spurious sources of authority, its mystification of human problems, and the more oppressive practices of the mental health system, such as involuntary hospitalisation, drugging, and electroshock.
The psychiatrists
R D Laing
Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment ...
(from Scotland),
Theodore Lidz Theodore Lidz (1 April 1910 – 16 February 2001) was an American psychiatrist best known for his articles and books on the causes of schizophrenia and on psychotherapy with patients with schizophrenia. An advocate of research into environmental ca ...
(from America),
Silvano Arieti
Silvano Arieti (June 28, 1914 in Pisa, Italy – August 7, 1981 in New York City) was a psychiatrist regarded as one of the world's foremost authorities on schizophrenia. He received his M.D. from the University of Pisa and left Italy soon after, d ...
(from Italy) and others, argued that "schizophrenia" and
psychosis
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
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 and The Bird of Paradise'' is a 1967 book by the Scottish psychiatrist R. D. Laing. The book comprises two parts - the first a collection of seven articles previously published between 1962 and 1965; the second a free ...
'') discussing mental distress in an interpersonal
existential
Existentialism ( ) is a form of philosophical inquiry that explores the problem of human existence and centers on human thinking, feeling, and acting. Existentialist thinkers frequently explore issues related to the meaning, purpose, and value ...
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
A counterculture is a culture whose values and norms of behavior differ substantially from those of mainstream society, sometimes diametrically opposed to mainstream cultural mores.Eric Donald Hirsch. ''The Dictionary of Cultural Literacy''. Hou ...
movement of the 1960s, Lidz and Arieti never became involved in the latter.
Franco Basaglia
Franco Basaglia (; 11 March 1924 29 August 1980) was an Italian psychiatrist, neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, figurehead a ...
promoted anti-psychiatry in Italy and secured reforms to mental health law there.
Laing, through the
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 radical psychiatrist and psychoanalyst R. D. Laing along with fellow psychiatrists David Cooper, Joseph B ...
founded with Cooper in 1965, set up over 20
therapeutic communities Therapeutic community is a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. The approach was usually residential, with the clients and therapists living together, but increasingly residential ...
including
Kingsley Hall
Kingsley Hall is a community centre, in Powis Road, Bromley-by-Bow in the London Borough of Tower Hamlets, East End of London. It dates back to the work of Doris and Muriel Lester, who had a nursery school in nearby Bruce Road. Their brother, ...
, where staff and residents theoretically assumed equal status and any medication used was voluntary. Non-psychiatric
Soteria houses, starting in the United States, were also developed as were various ex-patient-led services.
Psychiatrist
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
argued that "
mental illness
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
" 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 (from french: libertaire, "libertarian"; from la, libertas, "freedom") is a political philosophy that upholds liberty as a core value. Libertarians seek to maximize autonomy and political freedom, and minimize the state's e ...
, 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
Scientology is a set of beliefs and practices invented by American author L. Ron Hubbard, and an associated movement. It has been variously defined as a cult, a business, or a new religious movement. The most recent published census data indi ...
to form the
Citizens Commission on Human Rights
The Citizens Commission on Human Rights International (CCHR) is a nonprofit organization established in 1969 by the Church of Scientology and psychiatrist Thomas Szasz, headquartered in Los Angeles, California. Its stated mission is to "eradicate ...
.
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
Christians () are people who follow or adhere to Christianity, a monotheistic Abrahamic religion based on the life and teachings of Jesus Christ. The words ''Christ'' and ''Christian'' derive from the Koine Greek title ''Christós'' (Χρι ...
and certain
Protestant
Protestantism is a Christian denomination, branch of Christianity that follows the theological tenets of the Reformation, Protestant Reformation, a movement that began seeking to reform the Catholic Church from within in the 16th century agai ...
fundamentalists
Fundamentalism is a tendency among certain groups and individuals that is characterized by the application of a strict literal interpretation to scriptures, dogmas, or ideologies, along with a strong belief in the importance of distinguishing ...
, as well as Szasz.
Szasz was not a Scientologist himself and was non-religious; he commented frequently on the parallels between religion and psychiatry.
Erving Goffman
Erving Goffman (11 June 1922 – 19 November 1982) was a Canadian-born sociology, sociologist, Social psychology (sociology), social psychologist, and writer, considered by some "the most influential American sociologist of the twentieth ...
,
Gilles Deleuze
Gilles Louis René Deleuze ( , ; 18 January 1925 – 4 November 1995) was a French philosopher who, from the early 1950s until his death in 1995, wrote on philosophy, literature, film, and fine art. His most popular works were the two volu ...
,
Félix Guattari
Pierre-Félix Guattari ( , ; 30 April 1930 – 29 August 1992) was a French psychoanalyst, political philosopher, semiotician, social activist, and screenwriter. He co-founded schizoanalysis with Gilles Deleuze, and ecosophy with Arne Næss, ...
and others criticized the power and role of psychiatry in society, including the use of "
total institution
A total institution is a 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. Privacy is limited in ...
s" and the use of models and terms that were seen as
stigmatizing. The French
sociologist and philosopher Foucault, in his 1961 publication ''
Madness and Civilization
''Madness and Civilization: A History of Insanity in the Age of Reason'' (French: ''Folie et Déraison: Histoire de la folie à l'âge classique'', 1961) is an examination by Michel Foucault of the evolution of the meaning of madness in the cultu ...
: 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 posits that self-identity and the behavior of individuals may be determined or influenced by the terms used to describe or classify them. It is associated with the concepts of self-fulfilling prophecy and stereotyping. Labeling th ...
to psychiatry in 1966 in "Being Mentally Ill". Scheff argued that society views certain actions as deviant and, in order to come to terms with and understand these actions, often places the label of mental illness on those who exhibit them. Certain expectations are then placed on these individuals and, over time, they unconsciously change their behavior to fulfill them.
Observation of the abuses of psychiatry in the
Soviet Union
The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, it was nominally a federal union of fifteen national ...
in the so-called
Psikhushka
Psikhushka (russian: психу́шка; ) is a Russian ironic diminutive for psychiatric hospital. In Russia, the word entered everyday vocabulary. This word has been occasionally used in English, since the Soviet dissident movement and diaspora ...
hospitals also led to questioning the validity of the practice of psychiatry in the West. In particular, the diagnosis of many
political dissident
A dissident is a person who actively challenges an established political or religious system, doctrine, belief, policy, or institution. In a religious context, the word has been used since the 18th century, and in the political sense since the 20t ...
s with schizophrenia led some to question the general diagnosis and punitive usage of the label
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
. This raised questions as to whether the schizophrenia label and resulting involuntary psychiatric treatment could not have been similarly used in the West to subdue rebellious young people during family conflicts.
Since 1970
![Narodowa antypsychiatria](https://upload.wikimedia.org/wikipedia/commons/d/d2/Narodowa_antypsychiatria.jpg)
New professional approaches were developed as an alternative or reformist complement to psychiatry. ''
The 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. It was an "alternative journal" in the mental health field that published 12 issues between 1970 ...
'', 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 is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...
,
humanistic
Humanism is a philosophical stance that emphasizes the individual and social potential and agency of human beings. It considers human beings the starting point for serious moral and philosophical inquiry.
The meaning of the term "humani ...
or
existentialist
Existentialism ( ) is a form of philosophical inquiry that explores the problem of human existence and centers on human thinking, feeling, and acting. Existentialist thinkers frequently explore issues related to the meaning, purpose, and value ...
therapies,
family therapy
Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology and clinical social work that works with families and couples in intimate relationsh ...
,
counseling
Counseling is the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes.
This is a list of co ...
and
self-help
Self-help or self-improvement is a self-guided improvement''APA Dictionary of Physicology'', 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007.—economically, intellectually, or emotionally—often with a subst ...
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
Jeffrey Moussaieff Masson (born March 28, 1941 as Jeffrey Lloyd Masson) is an American author. Masson is best known for his conclusions about Sigmund Freud and psychoanalysis. In his ''The Assault on Truth'' (1984), Masson argues that Freud may ha ...
and
Louis Breger
Louis Breger (November 20, 1935 – June 26, 2020) was an American psychologist, psychotherapist and scholar. He was Emeritus Professor of Psychoanalytic Studies at the California Institute of Technology
Life
Breger was born and grew up in Los Ang ...
, 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
Socialism is a left-wing economic philosophy and movement encompassing a range of economic systems characterized by the dominance of social ownership of the means of production as opposed to private ownership. As a term, it describes the eco ...
,
communists
Communism (from Latin la, communis, lit=common, universal, label=none) is a far-left sociopolitical, philosophical, and economic ideology and current within the socialist movement whose goal is the establishment of a communist society, a so ...
,
anarchists
Anarchism is a political philosophy and movement that is skeptical of all justifications for authority and seeks to abolish the institutions it claims maintain unnecessary coercion and hierarchy, typically including, though not necessari ...
or at least anti-
capitalists
Capitalism is an economic system based on the private ownership of the means of production and their operation for profit. Central characteristics of capitalism include capital accumulation, competitive markets, price system, private pr ...
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
Colonialism is a practice or policy of control by one people or power over other people or areas, often by establishing colonies and generally with the aim of economic dominance. In the process of colonisation, colonisers may impose their relig ...
who claimed that
Chile
Chile, officially the Republic of Chile, is a country in the western part of South America. It is the southernmost country in the world, and the closest to Antarctica, occupying a long and narrow strip of land between the Andes to the east a ...
an poverty was due to plundering by American companies, a comment Szasz made not long after a
CIA
The Central Intelligence Agency (CIA ), known informally as the Agency and historically as the Company, is a civilian intelligence agency, foreign intelligence service of the federal government of the United States, officially tasked with gat ...
-backed coup had deposed the democratically elected Chilean president and replaced him with
Pinochet
Augusto José Ramón Pinochet Ugarte (, , , ; 25 November 1915 – 10 December 2006) was a Chilean Captain general#Chile, general who ruled Military dictatorship of Chile (1973–1990), Chile from 1973 to 1990, first as the leader of the Gover ...
. 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
Rights affecting lesbian, gay, bisexual, and transgender (LGBT) people vary greatly by country or jurisdiction—encompassing everything from the legal recognition of same-sex marriage to the death penalty for homosexuality.
Notably, , 3 ...
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
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
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 or dsm may refer to:
Science and technology
* Deep space maneuver
* Design structure matrix or dependency structure matrix, a representation of a system or project
* Diagnostic and Statistical Manual of Mental Disorders
** DSM-5, the fifth ed ...
, replacing it with a category of "sexual orientation disturbance" and then "ego-dystonic homosexuality," which was deleted in 1986, although a wide variety of "
paraphilias
Paraphilia (previously known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. It has also been defined as sexual interest in anything ot ...
" remain. It has been noted that gay activists in the 1970s and 1980s 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
xpression of psychosexual immaturityand perhaps sometimes even in the stricter sense
condition somewhat similar to ordinary organic maladies perhaps caused by genetic error or endocrine imbalance Nevertheless, if we believe that by categorising homosexuality as a disease we have succeeded in removing it from the realm of moral judgement, we are in error."
The diagnostic label
gender identity disorder
Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used until ...
(GID) was used by the
DSM
DSM or dsm may refer to:
Science and technology
* Deep space maneuver
* Design structure matrix or dependency structure matrix, a representation of a system or project
* Diagnostic and Statistical Manual of Mental Disorders
** DSM-5, the fifth ed ...
until its reclassification as ''gender dysphoria'' in 2013, with the release of the
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
. The diagnosis was reclassified to better align it with medical understanding of the condition and to remove the
stigma associated with the term ''disorder''.
The American Psychiatric Association, publisher of the DSM-5, stated that
gender nonconformity
Gender variance or gender nonconformity is behavior or gender expression by an individual that does not match masculine or feminine gender norms. A gender-nonconforming person may be variant in their gender identity, being transgender or non-bina ...
is not the same thing as gender dysphoria,
and that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."
Some transgender people and researchers support declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the
binary model of gender.
Szasz also publicly endorsed the transmisogynist work of
Janice Raymond
Janice G. Raymond (born January 24, 1943) is an American lesbian radical feminist and professor emerita of women's studies and medical ethics at the University of Massachusetts Amherst. She is known for her work against violence, sexual explo ...
. In a 1979 ''
New York Times
''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid d ...
'' book review of Raymond's ''
The Transsexual Empire
''The Transsexual Empire: The Making of the She-Male'' is a 1979 book critical of transgender people by American radical feminist author and activist Janice Raymond. The book is derived from Raymond's dissertation, which was produced under the sup ...
'', Szasz drew connections between his ongoing critique of psychiatric diagnosis and Raymond's feminist critique of trans women.
Increased legal and professional protections, and a merging with
human rights
Human rights are Morality, moral principles or Social norm, normsJames Nickel, with assistance from Thomas Pogge, M.B.E. Smith, and Leif Wenar, 13 December 2013, Stanford Encyclopedia of PhilosophyHuman Rights Retrieved 14 August 2014 for ce ...
and
disability rights
The disability rights movement is a global social movement that seeks to secure equal opportunities and equal rights for all people with disabilities.
It is made up of organizations of disability activists, also known as disability advocat ...
movements, added to anti-psychiatry theory and action.
Anti-psychiatry came to challenge a "
biomedical
Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine) " focus of psychiatry (defined to mean
genetics
Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar wor ...
,
neurochemical A neurochemical is a small organic molecule or peptide that participates in neural activity. The science of neurochemistry studies the functions of neurochemicals.
Prominent neurochemicals
Neurotransmitters and neuromodulators
*Glutamate is the ...
s and
pharmaceutic
Pharmaceutics is the discipline of pharmacy that deals with the process of turning a new chemical entity (NCE) or old drugs into a medication to be used safely and effectively by patients. It is also called the science of dosage form design. The ...
drugs). There was also opposition to the increasing links between psychiatry and
pharmaceutical companies
The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...
, 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
Recovery or Recover may refer to:
Arts and entertainment Books
* ''Recovery'' (novel), a Star Wars e-book
* Recovery Version, a translation of the Bible with footnotes published by Living Stream Ministry
Film and television
* ''Recovery'' (fil ...
,
empowerment
Empowerment is the degree of autonomy and self-determination in people and in communities. This enables them to represent their interests in a responsible and self-determined way, acting on their own authority. It is the process of becoming strong ...
, self-management and even full liberation. Schemes were developed to challenge
stigma and discrimination, often based on a
social model of disability
The social model of disability identifies systemic barriers, derogatory attitudes, and social exclusion (intentional or inadvertent), which make it difficult or impossible for disabled people to attain their valued functionings. The social mode ...
; to assist or encourage people with mental health issues to engage more fully in work and society (for example through
social firms
Social firm is the British term for a work integration social enterprise (WISE), a business created to employ people who have a disability or are otherwise disadvantaged in the labour market. Its commercial and production activities are undertaken ...
), and to involve service users in the delivery and evaluation of mental health services. However, those actively and openly challenging the fundamental ethics and efficacy of mainstream psychiatric practice remained marginalized within psychiatry, and to a lesser extent within the wider mental health community.
Three authors came to personify the movement against psychiatry, and two of these were practising psychiatrists. The initial and most influential of these was
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
who rose to fame with his book ''
The Myth of Mental Illness
''The Myth of Mental Illness: Foundations of a Theory of Personal Conduct'' is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, an ...
'', although Szasz himself did not identify as an anti-psychiatrist. The well-respected
R D Laing
Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment ...
wrote a series of best-selling books, including ''
The Divided Self
Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment of ...
''. Intellectual philosopher
Michel Foucault
Paul-Michel Foucault (, ; ; 15 October 192625 June 1984) was a French philosopher, historian of ideas, writer, political activist, and literary critic. Foucault's theories primarily address the relationship between power and knowledge, and how ...
challenged the very basis of psychiatric practice and cast it as repressive and controlling. The term "anti-psychiatry" was coined by
David Cooper in 1967.
[ In parallel with the theoretical production of the mentioned authors, the Italian physician ]Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
questioned the basis themselves of psychiatry through the dismantling of the psychiatric hospitals'' Osservanza'' and ''Luigi Lolli'' and the liberation – and restitution to life – of the people there secluded.
Challenges to psychiatry
Civilization as a cause of distress
In recent years, psychotherapists David Smail and Bruce E. Levine
Bruce E. Levine is an American clinical psychologist, often at odds with the mainstream of his profession (see critical psychology), in private practice in Cincinnati, Ohio. He has been in practice for more than three decades. Levine writes and sp ...
, considered part of the anti-psychiatry movement, have written widely on how society, culture, politics and psychology intersect. They have written extensively of the "embodied nature" of the individual in society, and the unwillingness of even therapists to acknowledge the obvious part played by power and financial interest in modern Western society. They argue that feelings and emotions are not, as is commonly supposed, features of the individual, but rather responses of the individual to their situation in society. Even psychotherapy, they suggest, can only change feelings in as much as it helps a person to change the "proximal" and "distal" influences on their life, which range from family and friends, to the workplace, socio-economics, politics and culture.[ at ]AlterNet
AlterNet is a left-leaning online news outlet. It was launched in 1997 by the Independent Media Institute. In 2018, the website was acquired by owners of ''Raw Story''.
Coverage
Coverage is divided into several special sections related to progre ...
R. D. Laing emphasized family nexus
In psychology, a family nexus is a common viewpoint held and reinforced by the majority of family members regarding events in the family and relationships with the world. The term was coined by R. D. Laing, who believed that this nexus "exists on ...
as a mechanism by which individuals become victimized by those around them, and spoke about a dysfunctional society.
Inadequacy of clinical interviews used to diagnose 'diseases'
Psychiatrists have been trying to differentiate mental disorders based on clinical interviews since the era of Kraepelin, but now realize that their diagnostic criteria are imperfect. Tadafumi Kato writes, "We psychiatrists should be aware that we cannot identify 'diseases' only by interviews. What we are doing now is just like trying to diagnose diabetes mellitus without measuring blood sugar."
Normality and illness judgments
In 2013, psychiatrist Allen Frances
Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as cha ...
said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".
Reasons have been put forward to doubt the ontic
In ontology, ontic (from the Greek , genitive : "of that which is") is physical, real, or factual existence.
In more nuance, it means that which concerns particular, individuated beings rather than their modes of being; the present, actual thing i ...
status of mental disorders. Mental disorders engender ontological
In metaphysics, ontology is the philosophical study of being, as well as related concepts such as existence, becoming, and reality.
Ontology addresses questions like how entities are grouped into categories and which of these entities exis ...
skepticism on three levels:
# Mental disorders are abstract entities that cannot be directly appreciated with the human senses or indirectly, as one might with macro- or microscopic objects.
# Mental disorders are not clearly natural processes whose detection is untarnished by the imposition of values, or human interpretation.
# It is unclear whether they should be conceived as abstractions that exist in the world apart from the individual persons who experience them, and thus instantiate them.
In the scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is normal Normal(s) or The Normal(s) may refer to:
Film and television
* ''Normal'' (2003 film), starring Jessica Lange and Tom Wilkinson
* ''Normal'' (2007 film), starring Carrie-Anne Moss, Kevin Zegers, Callum Keith Rennie, and Andrew Airlie
* ''Norma ...
) while another proposes that it is or could be entirely objective
Objective may refer to:
* Objective (optics), an element in a camera or microscope
* ''The Objective'', a 2008 science fiction horror film
* Objective pronoun, a personal pronoun that is used as a grammatical object
* Objective Productions, a Brit ...
and scientific
Science is a systematic endeavor that builds and organizes knowledge in the form of testable explanations and predictions about the universe.
Science may be as old as the human species, and some of the earliest archeological evidence for ...
(including by reference to statistical norms). Common hybrid views argue that the concept of mental disorder is objective but a "fuzzy prototype
A prototype is an early sample, model, or release of a product built to test a concept or process. It is a term used in a variety of contexts, including semantics, design, electronics, and Software prototyping, software programming. A prototyp ...
" that can never be precisely defined, or alternatively that it inevitably involves a mix of scientific facts and subjective value judgments.
One remarkable example of psychiatric diagnosis being used to reinforce cultural bias and oppress dissidence is the diagnosis of drapetomania
Drapetomania was a supposed mental illness that, in 1851, American physician Samuel A. Cartwright hypothesized as the cause of enslaved Africans fleeing captivity. This hypothesis centered around the belief that slavery was such an improvement up ...
. In the US prior to the American Civil War, physicians such as Samuel A. Cartwright
Samuel Adolphus Cartwright (November 3, 1793 – May 2, 1863) was an American physician who practiced in Mississippi and Louisiana in the antebellum United States. Cartwright is best known as the inventor of the 'mental illness' of drapetomania ...
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 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, ...
but also confirmation bias
Confirmation bias is the tendency to search for, interpret, favor, and recall information in a way that confirms or supports one's prior beliefs or values. People display this bias when they select information that supports their views, ignoring ...
and bias blind spot
The bias blind spot is the cognitive bias of recognizing the impact of biases on the judgment of others, while failing to see the impact of biases on one's own judgment. The term was created by Emily Pronin, a social psychologist from Princeton Uni ...
in psychiatric diagnosis and psychiatric beliefs.
It has been argued by philosophers like Foucault that characterizations of "mental illness" are indeterminate and reflect the hierarchical structures of the societies from which they emerge rather than any precisely defined qualities that distinguish a "healthy" mind from a "sick" one. Furthermore, if a tendency toward self-harm is taken as an elementary symptom of mental illness, then humans, ''as a species'', are arguably insane in that they have tended throughout recorded history to destroy their own environments, to make war with one another, etc.
Psychiatric labeling
Mental disorders were first included in the sixth revision of the International Classification of Diseases
The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
(ICD-6) in 1949. Three years later, the American Psychiatric Association created its own classification system, DSM-I. The definitions of most psychiatric diagnoses consist of combinations of phenomenological criteria, such as symptoms and signs and their course over time. Expert committees combined them in variable ways into categories of mental disorders, defined and redefined them again and again over the last half century.
The majority of these diagnostic categories are called ''disorders'' and are not validated by biological criteria, as most medical diseases are; although they purport to represent medical diseases and take the form of medical diagnoses. These diagnostic categories are actually embedded in top-down classifications, similar to the early botanic classifications of plants in the 17th and 18th centuries, when experts decided a priori about which classification criterion to use, for instance, whether the shape of leaves or fruiting bodies were the main criterion for classifying plants. Since the era of Kraepelin, psychiatrists have been trying to differentiate mental disorders by using clinical interviews.
Experiments admitting "healthy" individuals into psychiatric care
In 1972, psychologist David Rosenhan
David L. Rosenhan (; November 22, 1929 – February 6, 2012) was an American psychologist. He is best known for the Rosenhan experiment, a study challenging the validity of psychiatry diagnoses.
Biography
Rosenhan received his Bachelor of Arts d ...
published the Rosenhan experiment
The Rosenhan experiment or Thud experiment was an experiment conducted to determine the validity of psychiatric diagnosis. The participants feigned hallucinations to enter psychiatric hospitals but acted normally afterwards. They were diagnosed w ...
, a study questioning the validity of psychiatric diagnoses.[ ] The study arranged for eight individuals with no history of psychopathology to attempt admission into psychiatric hospitals. The individuals included a graduate student, psychologists, an artist, a housewife, and two physicians, including one psychiatrist. All eight individuals were admitted with a diagnosis of schizophrenia or bipolar disorder. Psychiatrists then attempted to treat the individuals using psychiatric medication. All eight were discharged within 7 to 52 days. In a later part of the study, psychiatric staff were warned that pseudo-patients might be sent to their institutions, but none were actually sent. Nevertheless, a total of 83 patients out of 193 were believed by at least one staff member to be actors. The study concluded that individuals without mental disorders were indistinguishable from those with mental disorders.
Critics such as Robert Spitzer cast doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement. The challenge of the validity versus the reliability of diagnostic categories continues to plague diagnostic systems. Neuroscientist Tadafumi Kato advocates for a new classification of diseases based on the neurobiological features of each mental disorder. while Austrian psychiatrist Heinz Katsching advises psychiatrists to replace the term "mental illness" by "brain illness."
There are recognized problems regarding the diagnostic reliability and validity of mainstream psychiatric diagnoses, both in ideal and controlled circumstances and even more so in routine clinical practice (McGorry ''et al.''. 1995). Criteria in the principal diagnostic manuals, the DSM and ICD
The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
, are not consistent between the two manuals. Some psychiatrists in critiquing diagnostic criteria point out that comorbidity
In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often wikt:co-occur#Verb, co-occurring (that is, wikt:concomitant#Adjecti ...
, when an individual meets criteria for two or more disorders, is the rule rather than the exception, casting doubt on the distinctness of the categories, with overlap and vaguely defined or changeable boundaries between what are asserted to be distinct disorders.
Other concerns raised include using standard diagnostic criteria in different countries, cultures, genders or ethnic groups. Critics contend 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
African Americans (also referred to as Black Americans and Afro-Americans) are an ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American" generally denotes descendants of ens ...
are more often diagnosed with schizophrenia than white people, and men more than women. Some within the anti-psychiatry movement are critical of the use of diagnosis at all as it conforms with the biomedical model The biomedical model of medicine is the current dominating model of illness used in most Western healthcare settings, and is built from the perception that a state of health is defined purely in the absence of illness. The biomedical model contrasts ...
, seen as illegitimate.
Tool of social control
According to Franco Basaglia, Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
, and Bruce E. Levine
Bruce E. Levine is an American clinical psychologist, often at odds with the mainstream of his profession (see critical psychology), in private practice in Cincinnati, Ohio. He has been in practice for more than three decades. Levine writes and sp ...
, whose approach pointed out the role of psychiatric institutions in the control and medicalization of deviant behaviors and social problems, psychiatry is used as the provider of scientific support for social control to the existing establishment, and the ensuing standards of deviance and normality brought about repressive views of discrete social groups. According to Mike Fitzpatrick, resistance to medicalization was a common theme of the gay liberation, anti-psychiatry, and feminist movements of the 1970s, but now there is actually no resistance to the advance of government intrusion in lifestyle if it is thought to be justified in terms of public health.
In the opinion of Mike Fitzpatrick, the pressure for medicalization also comes from society itself. As one example, Fitzpatrick claims that feminists who once opposed state intervention as oppressive and patriarchal, now demand more coercive and intrusive measures to deal with child abuse and domestic violence. According to Richard Gosden, the use of psychiatry as a tool of social control is becoming obvious in preventive medicine programmes for various mental diseases.[ ] These programmes are intended to identify children and young people with divergent behavioral patterns and thinking and send them to treatment before their supposed mental diseases develop. Clinical guidelines for best practice in Australia include the risk factors and signs which can be used to detect young people who are in need of prophylactic drug treatment to prevent the development of schizophrenia and other psychotic conditions.
Psychiatry and the pharmaceutical industry
Critics of psychiatry commonly express a concern that the path of diagnosis and treatment in contemporary society is primarily or overwhelmingly shaped by profit prerogatives, echoing a common criticism of general medical practice in the United States, where many of the largest psychopharmaceutical producers are based.
Psychiatric research has demonstrated varying degrees of efficacy
Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as ''effectiveness'', and it has often been used synonymously, although in pharmacology a pragmatic clinical trial#Efficacy versu ...
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
Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...
s, antidepressant
Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
s, anxiolytic
An anxiolytic (; also antipanic or antianxiety agent) is a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety. Anxiolytic medications are used for the treatment of anxi ...
s, and antipsychotic
Antipsychotics, also known as neuroleptics, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but ...
s (neuroleptics).
On the other hand, organizations such as MindFreedom International
MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. Based in the United States, it was founded in 1990 to advocate against Involuntary treatment, ...
and World Network of Users and Survivors of Psychiatry The World Network of Users and Survivors of Psychiatry (WNUSP) is an international organisation representing, and led by what it terms " survivors of psychiatry". As of 2003, over 70 national organizations were members of WNUSP, based in 30 countrie ...
maintain that psychiatrists exaggerate the evidence of medication and minimize the evidence of adverse drug reaction
An adverse drug reaction (ADR) is a harmful, unintended result caused by taking medication. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs. The meaning of this term ...
. They and other activists
Activism (or Advocacy) consists of efforts to promote, impede, direct or intervene in social, political, economic or environmental reform with the desire to make changes in society toward a perceived greater good. Forms of activism range fro ...
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
Methylphenidate, sold under the brand names Ritalin and Concerta among others, is the most widely prescribed central nervous system (CNS) stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) and, to a lesser extent ...
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
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inap ...
on the basis of inattention to compulsory schooling also raises critics' concerns regarding the use of psychoactive drugs as a means of unjust social control of children.
The influence of pharmaceutical companies is another major issue for the anti-psychiatry movement. As many critics from within and outside of psychiatry have argued, there are many financial and professional links between psychiatry, regulators, and pharmaceutical companies. Drug companies routinely fund much of the research conducted by psychiatrists, advertise medication in psychiatric journals and conferences, fund psychiatric and healthcare organizations and health promotion campaigns, and send representatives to lobby general physicians and politicians. Peter Breggin
Peter Roger Breggin (born May 11, 1936) is an American psychiatrist and critic of shock treatment and psychiatric medication and Covid-19 response. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with ...
, 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
In parliamentary procedure, requests and inquiries are motions used by members of a deliberative assembly to obtain information or to do or have something done that requires permission of the assembly. Except for a request to be excused from a duty ...
into the influence of the pharmaceutical industry in 2005 concludes: "The influence of the pharmaceutical industry is such that it dominates clinical practice" and that there are serious regulatory failings resulting in "the unsafe use of drugs; and the increasing medicalization of society". The campaign organization ''No Free Lunch'' details the prevalent acceptance by medical professionals of free gifts from pharmaceutical companies and the effect on psychiatric practice. The ghostwriting of articles by pharmaceutical company officials, which are then presented by esteemed psychiatrists, has also been highlighted. Systematic reviews have found that trials of psychiatric drugs that are conducted with pharmaceutical funding are several times more likely to report positive findings than studies without such funding.
The number of psychiatric drug prescriptions have been increasing at an extremely high rate since the 1950s and show no sign of abating. In the United States antidepressants and tranquilizers are now the top selling class of prescription drugs, and neuroleptics and other psychiatric drugs also rank near the top, all with expanding sales. As a solution to the apparent conflict of interests, critics propose legislation to separate the pharmaceutical industry from the psychiatric profession.
John Read and Bruce E. Levine
Bruce E. Levine is an American clinical psychologist, often at odds with the mainstream of his profession (see critical psychology), in private practice in Cincinnati, Ohio. He has been in practice for more than three decades. Levine writes and sp ...
have advanced the idea of socioeconomic status as a significant factor in the development and prevention of mental disorders such as schizophrenia and have noted the reach of pharmaceutical companies through industry sponsored websites as promoting a more biological approach to mental disorders, rather than a comprehensive biological, psychological and social model.
Electroconvulsive therapy
Psychiatrists may advocate psychiatric drugs, psychotherapy or more controversial interventions such as electroshock or psychosurgery
Psychosurgery, also called neurosurgery for mental disorder (NMD), 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 th ...
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 (July 15, 1932 – January 15, 2015,) was an American human rights activist, psychiatric survivor, editor, writer, aphorist, and lecturer.
Frank lived in San Francisco from 1959 until his death, where he managed an art gallery b ...
writes that estimates of ECT-related death rates vary widely. The lower estimates include:
*2–4 in 100,000 (from Kramer's 1994 study of 28,437 patients)
*1 in 10,000 (Boodman's first entry in 1996)
*1 in 1,000 (Impastato's first entry in 1957)
*1 in 200, among the elderly, over 60 (Impastato's in 1957)
Higher estimates include:
*1 in 102 (Martin's entry in 1949)
*1 in 95 (Boodman's first entry in 1996)
*1 in 92 (Freeman and Kendell's entry in 1976)
*1 in 89 (Sagebiel's in 1961)
*1 in 69 (Gralnick's in 1946)
*1 in 63, among a group undergoing intensive ECT (Perry's in 1963–1979)
*1 in 38 (Ehrenberg's in 1955)
*1 in 30 (Kurland's in 1959)
*1 in 9, among a group undergoing intensive ECT (Weil's in 1949)
*1 in 4, among the very elderly, over 80 (Kroessler and Fogel's in 1974–1986).
Political abuse of psychiatry
Psychiatrists around the world have been involved in the suppression of individual rights by states in which the definitions of mental disease have been expanded to include political disobedience. Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions. Psychiatry possesses a built-in capacity for abuse which is greater than in other areas of medicine. The diagnosis of mental disease can serve as proxy for the designation of social dissidents, allowing the state to hold persons against their will and to insist upon therapies that work in favour of ideological conformity and in the broader interests of society. In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.
Under the Nazi regime
Nazi Germany (lit. "National Socialist State"), ' (lit. "Nazi State") for short; also ' (lit. "National Socialist Germany") (officially known as the German Reich from 1933 until 1943, and the Greater German Reich from 1943 to 1945) was ...
in the 1940s, the "duty to care" was violated on an enormous scale. In Germany alone 300,000 individuals that had been deemed mentally ill, work-shy or feeble-minded were sterilized. An additional 200,000 were euthanized. These practices continued in territories occupied by the Nazis further afield (mainly in eastern Europe
Eastern Europe is a subregion of the Europe, European continent. As a largely ambiguous term, it has a wide range of geopolitical, geographical, ethnic, cultural, and socio-economic connotations. The vast majority of the region is covered by Russ ...
), affecting thousands more. From the 1960s up to 1986, political abuse of psychiatry
Political abuse of psychiatry, also commonly referred to as punitive psychiatry, is the misuse of psychiatry, including diagnosis, detention, and treatment, for the purposes of obstructing the human rights of individuals and/or groups in a society ...
was reported to be systematic in the Soviet Union, and to surface on occasion in other Eastern European countries such as Romania
Romania ( ; ro, România ) is a country located at the crossroads of Central Europe, Central, Eastern Europe, Eastern, and Southeast Europe, Southeastern Europe. It borders Bulgaria to the south, Ukraine to the north, Hungary to the west, S ...
, Hungary
Hungary ( hu, Magyarország ) is a landlocked country in Central Europe. Spanning of the Carpathian Basin, it is bordered by Slovakia to the north, Ukraine to the northeast, Romania to the east and southeast, Serbia to the south, Croatia a ...
, Czechoslovakia
, rue, Чеськословеньско, , yi, טשעכאסלאוואקיי,
, common_name = Czechoslovakia
, life_span = 1918–19391945–1992
, p1 = Austria-Hungary
, image_p1 ...
, and Yugoslavia
Yugoslavia (; sh-Latn-Cyrl, separator=" / ", Jugoslavija, Југославија ; sl, Jugoslavija ; mk, Југославија ;; rup, Iugoslavia; hu, Jugoszlávia; rue, label=Pannonian Rusyn, Югославия, translit=Juhoslavija ...
, as well as in Western European countries, such as Italy. An example of the use of psychiatry in the political field is the "case Sabattini", described by Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
in his book Il pregiudizio psichiatrico. A "mental health genocide" reminiscent of the Nazi aberrations has been located in the history of South African oppression during the apartheid era. A continued misappropriation of the discipline was later attributed to the People's Republic of China.
K. Fulford, A. Smirnov, and E. Snow state: "An important vulnerability factor, therefore, for the abuse of psychiatry, is the subjective nature of the observations on which psychiatric diagnosis currently depends." In an article published in 1994 by the ''Journal of Medical Ethics
The ''Journal of Medical Ethics'' is a monthly peer-reviewed academic journal covering the field of bioethics that was established in 1975. According to the ''Journal Citation Reports'', the journal has a 2019 impact factor of 2.021, ranking it fou ...
'', American psychiatrist Thomas Szasz stated that "the classification by slave owners and slave traders of certain individuals as Negroes was scientific, in the sense that whites were rarely classified as blacks. But that did not prevent the 'abuse' of such racial classification, because (what we call) its abuse was, in fact, its use." Szasz argued that the spectacle of the Western psychiatrists loudly condemning Soviet colleagues for their abuse of professional standards was largely an exercise in hypocrisy. Szasz states that K. Fulford, A. Smirnov, and E. Snow, who correctly emphasize the value-laden nature of psychiatric diagnoses and the subjective character of psychiatric classifications, fail to accept the role of psychiatric power. He stated that psychiatric abuse, such as people usually associated with practices in the former USSR, was connected not with the misuse of psychiatric diagnoses, but with the political power built into the social role of the psychiatrist in democratic and totalitarian societies alike. Musicologists, drama critics, art historians, and many other scholars also create their own subjective classifications; however, lacking state-legitimated power over persons, their classifications do not lead to anyone's being deprived of property, liberty, or life. For instance, a plastic surgeon's classification of beauty is subjective, but the plastic surgeon cannot treat his or her patient without the patient's consent, so there cannot be any political abuse of plastic surgery.
The bedrock of political medicine is coercion masquerading as medical treatment. In this process, physicians diagnose a disapproved condition as an "illness" and declare the intervention they impose on the victim a "treatment," and legislators and judges legitimate these categorizations. In the same way, physician-eugenicists
Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior or ...
advocated killing certain disabled or ill persons as a form of treatment for both society and patient long before the Nazis came to power.
From the commencement of his political career, Hitler put his struggle against "enemies of the state" in medical rhetoric. In 1934, addressing the Reichstag, he declared, "I gave the order… to burn out down to the raw flesh the ulcers of our internal well-poisoning." The entire German nation and its National Socialist politicians learned to think and speak in such terms. Werner Best
Karl Rudolf Werner Best (10 July 1903 – 23 June 1989) was a German jurist, police chief, SS-''Obergruppenführer'', Nazi Party leader, and theoretician from Darmstadt. He was the first chief of Department 1 of the Gestapo, Nazi Germany's secret ...
, Reinhard Heydrich
Reinhard Tristan Eugen Heydrich ( ; ; 7 March 1904 – 4 June 1942) was a high-ranking German SS and police official during the Nazi era and a principal architect of the Holocaust.
He was chief of the Reich Security Main Office (inclu ...
's deputy, stated that the task of the police was "to root out all symptoms of disease and germs of destruction that threatened the political health of the nation… n addition to Jews,most f the germswere weak, unpopular and marginalized groups, such as gypsies, homosexuals, beggars, 'antisocials', 'work-shy', and 'habitual criminals'."
In spite of all the evidence, people ignore or underappreciate the political implications of the pseudotherapeutic character of Nazism and of the use of medical metaphors in modern democracies. Dismissed as an " abuse of psychiatry", this practice is a controversial subject not because the story makes psychiatrists in Nazi Germany look bad, but because it highlights the dramatic similarities between pharmacratic controls in Germany under Nazism and those that have emerged in the US under the free market
In economics, a free market is an economic system in which the prices of goods and services are determined by supply and demand expressed by sellers and buyers. Such markets, as modeled, operate without the intervention of government or any o ...
economy.
Therapeutic state
The "therapeutic state" is a phrase coined by Szasz in 1963. The collaboration between psychiatry and government leads to what Szasz calls the "therapeutic state", a system in which disapproved actions, thoughts, and emotions are repressed ("cured") through pseudomedical interventions. Thus suicide, unconventional religious beliefs, racial bigotry, unhappiness, anxiety, shyness, sexual promiscuity, shoplifting, gambling, overeating, smoking, and illegal drug use are all considered symptoms or illnesses that need to be cured. When faced with demands for measures to curtail smoking in public, binge-drinking, gambling or obesity, ministers say that "we must guard against charges of nanny statism". The "nanny state" has turned into the "therapeutic state" where nanny has given way to counselor. Nanny just told people what to do; counselors also tell them what to think and what to feel. The "nanny state" was punitive, austere, and authoritarian, the therapeutic state is touchy-feely, supportive—and even more authoritarian. According to Szasz, "the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion".
Faced with the problem of "madness", Western individualism proved to be ill-prepared to defend the rights of the individual: modern man has no more right to be a madman than medieval man had a right to be a heretic because if once people agree that they have identified the one true God, or Good, it brings about that they have to guard members and nonmembers of the group from the temptation to worship false gods or goods. A secularization of God and the medicalization of good resulted in the post-Enlightenment version of this view: once people agree that they have identified the one true reason, it brings about that they have to guard against the temptation to worship unreason—that is, madness.
Civil libertarians warn that the marriage of the State with psychiatry could have catastrophic consequences for civilization
A civilization (or civilisation) is any complex society characterized by the development of a state, social stratification, urbanization, and symbolic systems of communication beyond natural spoken language (namely, a writing system).
Ci ...
. In the same vein as the separation of church and state
The separation of church and state is a philosophical and jurisprudential concept for defining political distance in the relationship between religious organizations and the state. Conceptually, the term refers to the creation of a secular sta ...
, Szasz believes that a solid wall must exist between psychiatry and the State.
"Total institution"
In his book '' Asylums'', Erving Goffman coined the term 'total institution
A total institution is a 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. Privacy is limited in ...
' 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.
Law
In the US, critics of psychiatry contend that the intersection of the law and psychiatry create extra-legal entities. For example, the insanity defense
The insanity defense, also known as the mental disorder defense, is an affirmative defense by excuse in a criminal case, arguing that the defendant is not responsible for their actions due to an episodic psychiatric disease at the time of the cr ...
, leading to detainment in a psychiatric institution versus a prison, can be worse than criminal imprisonment according to some critics, as it involves the risk of compulsory medication with neuroleptics or the use of electroshock treatment.. While a criminal imprisonment has a predetermined and known time of duration, patients are typically committed to psychiatric hospitals for indefinite durations, an arguably outrageous imposition of fundamental uncertainty. It has been argued that such uncertainty risks aggravating mental instability, and that it substantially encourages a lapse into hopelessness and acceptance that precludes recovery.
Involuntary hospitalization
Critics see the use of legally sanctioned force in involuntary commitment as a violation of the fundamental principles of free or open societies. The political philosopher John Stuart Mill
John Stuart Mill (20 May 1806 – 7 May 1873) was an English philosopher, political economist, Member of Parliament (MP) and civil servant. One of the most influential thinkers in the history of classical liberalism, he contributed widely to ...
and others have argued that society has no right to use coercion to subdue an individual as long as they do not harm others. Research evidence regarding violent behavior by people with mental illness does not support a direct connection in most studies. The growing practice, in the United Kingdom and elsewhere, of Care in the Community
Care in the Community (also called "Community Care" or "Domiciliary Care") is a British policy of deinstitutionalisation, treating and caring for physically and mentally disabled people in their homes rather than in an institution. Institutional ca ...
was instituted partly in response to such concerns. Alternatives to involuntary hospitalization include the development of non-medical crisis care in the community.
The American Soteria project was developed by psychiatrist Loren Mosher
Loren Richard Mosher (September 3, 1933, Monterey, California – July 10, 2004, Berlin) was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the Nation ...
as an alternative model of care in a residential setting to support those experiencing psychiatric symptoms or extreme states. The Soteria houses closed in 1983 in the United States due to lack of financial support . Similar programs were established in Europe, including in Sweden and other North European countries. More recently, a Soteria House opened in Vermont, USA
The physician Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
, during his activity as a director of the ''Ospedale Psichiatrico Osservanza'' of Imola in Italy from 1979 to 1996, refused any form of coercion and any violation of the fundamental principles of freedom, questioning the basis of psychiatry itself.
Psychiatry as pseudoscience and failed enterprise
Many of the above issues lead to the claim that psychiatry is a pseudoscience
Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or falsifiability, unfa ...
. According to some philosophers of science, for a theory to qualify as science it needs to exhibit the following characteristics:
* ''parsimony'', as straightforward as the phenomena to be explained allow (see Occam's razor
Occam's razor, Ockham's razor, or Ocham's razor ( la, novacula Occami), also known as the principle of parsimony or the law of parsimony ( la, lex parsimoniae), is the problem-solving principle that "entities should not be multiplied beyond neces ...
);
* ''empirically testable and falsifiable'' (see Falsifiability
Falsifiability is a standard of evaluation of scientific theories and hypotheses that was introduced by the philosopher of science Karl Popper in his book ''The Logic of Scientific Discovery'' (1934). He proposed it as the cornerstone of a sol ...
);
* ''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 (July 14, 1950) is a Canadian psychiatrist and former president of the International Society for the Study of Trauma and Dissociation from 1993 to 1994. There is controversy about his methods and claims, which include recovering me ...
and Alvin Pam
Alvin Pam is an American psychologist and author who was formerly the director of psychiatry at the Bronx Psychiatric Center in the Bronx, New York City, New York. He also formerly served as a clinical professor at the Albert Einstein College of Me ...
maintain that biopsychiatry does not qualify as a science on many counts.
Psychiatric researchers have been criticised on the basis of the replication crisis
The replication crisis (also called the replicability crisis and the reproducibility crisis) is an ongoing methodological crisis in which the results of many scientific studies are difficult or impossible to reproduce. Because the reproducibili ...
and textbook errors. Questionable research practices are known to bias key sources of evidence.
Stuart A. Kirk has argued that psychiatry is a failed enterprise, as mental illness has grown, not shrunk, with about 20% of American adults diagnosable as mentally ill in 2013.
According to a 2014 meta-analysis, psychiatric treatment is no less effective for psychiatric illnesses in terms of treatment effects than treatments by practitioners of other medical specialties for physical health conditions. The analysis found that the effect sizes for psychiatric interventions are, on average, on par with other fields of medicine.
Diverse paths
Szasz has since (2008) re-emphasized his disdain for the term anti-psychiatry, arguing that its legacy has simply been a "catchall term used to delegitimize and dismiss critics of psychiatric fraud and force by labeling them ''antipsychiatrists''". He points out that the term originated in a meeting of four psychiatrists (Cooper, Laing, Berke
Berke Khan (died 1266) (also Birkai; , tt-Cyrl, Бәркә хан) was a grandson of Genghis Khan and a Mongol military commander and ruler of the Golden Horde ( division of the Mongol Empire) who effectively consolidated the power of the Blue ...
and Redler) who never defined it yet "counter-label dtheir 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
Sulfuric acid (American spelling and the preferred IUPAC name) or sulphuric acid ( Commonwealth spelling), known in antiquity as oil of vitriol, is a mineral acid composed of the elements sulfur, oxygen and hydrogen, with the molecular formu ...
terms, accusing him of being irresponsible and equivocal on psychiatric diagnosis and use of force, and detailing his past "public behavior" as "a fit subject for moral judgment" which he gives as "a bad person and a fraud as a professional".
Daniel Burston, however, has argued that overall the published works of Szasz and Laing demonstrate far more points of convergence and intellectual kinship than Szasz admits, despite the divergence on a number of issues related to Szasz being a libertarian and Laing an existentialist; that Szasz employs a good deal of exaggeration and distortion in his criticism of Laing's personal character, and unfairly uses Laing's personal failings and family woes to discredit his work and ideas; and that Szasz's "clear-cut, crystalline ethical principles are designed to spare us the agonizing and often inconclusive reflections that many clinicians face frequently in the course of their work". Szasz has indicated that his own views came from libertarian politics held since his teens
Adolescence () is a transitional stage of physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated with the ...
, 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 heir
Inheritance is the practice of receiving private property, titles, debts, entitlements, privileges, rights, and obligations upon the death of an individual. The rules of inheritance differ among societies and have changed over time. Officiall ...
conviction" (if they were charged with a crime and appeared to be prima facie
''Prima facie'' (; ) is a Latin expression meaning ''at first sight'' or ''based on first impression''. The literal translation would be 'at first face' or 'at first appearance', from the feminine forms of ''primus'' ('first') and ''facies'' (' ...
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
Rights affecting lesbian, gay, bisexual, and transgender (LGBT) people vary greatly by country or jurisdiction—encompassing everything from the legal recognition of same-sex marriage to the death penalty for homosexuality.
Notably, , 3 ...
or gay liberation
The gay liberation movement was a social and political movement of the late 1960s through the mid-1980s that urged lesbians and gay men to engage in radical direct action, and to counter societal shame with gay pride.Hoffman, 2007, pp.xi-xiii. ...
movement is often thought to have been part of anti-psychiatry in its efforts to challenge oppression and stigma and, specifically, to get homosexuality
Homosexuality is romantic attraction, sexual attraction, or sexual behavior between members of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to peop ...
removed from the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders. However, a psychiatric member of APA's Gay, Lesbian, and Bisexual Issues Committee has recently sought to distance the two, arguing that they were separate in the early 70s protests at APA conventions and that APA's decision to remove homosexuality was scientific and happened to coincide with the political pressure. Reviewers have responded, however, that the founders and movements were closely aligned; that they shared core texts, proponents and slogans; and that others have stated that, for example, the gay liberation critique was "made possible by (and indeed often explicitly grounded in) traditions of antipsychiatry".
In the clinical setting, the two strands of anti-psychiatry—criticism of psychiatric knowledge and reform of its practices—were never entirely distinct. In addition, in a sense, anti-psychiatry was not so much a demand for the end of psychiatry, as it was an often self-directed demand for psychiatrists and allied professionals to question their own judgements, assumptions and practices. In some cases, the suspicion of non-psychiatric medical professionals towards the validity of psychiatry was described as anti-psychiatry, as well the criticism of "hard-headed" psychiatrists towards "soft-headed" psychiatrists. Most leading figures of anti-psychiatry were themselves psychiatrists, and equivocated over whether they were really "against psychiatry", or parts thereof. Outside the field of psychiatry, however—e.g. for activists and non-medical mental health professionals such as social workers and psychologists—'anti-psychiatry' tended to mean something more radical. The ambiguous term "anti-psychiatry" came to be associated with these more radical trends, but there was debate over whether it was a new phenomenon, whom it best described, and whether it constituted a genuinely singular movement. In order to avoid any ambiguity intrinsic to the term anti-psychiatry, a current of thought that can be defined as critique of the basis of psychiatry, radical and unambiguous, aims for the complete elimination of psychiatry. The main representative of the critique of the basis of psychiatry is an Italian physician, Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
, the founder of the non-psychiatric approach to psychological suffering, who posited that the "essence of psychiatry lies in an ideology of discrimination".
In the 1990s, a tendency was noted among psychiatrists to characterize and to regard the anti-psychiatric movement as part of the past, and to view its ideological history as flirtation with the polemics of radical politics at the expense of scientific thought and enquiry. It was also argued, however, that the movement contributed towards generating demand for grassroots involvement in guidelines and advocacy groups, and to the shift from large mental institutions to community services. Additionally, community centers have tended in practice to distance themselves from the psychiatric/medical model and have continued to see themselves as representing a culture of resistance or opposition to psychiatry's authority. Overall, while antipsychiatry as a movement may have become an anachronism by this period and was no longer led by eminent psychiatrists, it has been argued that it became incorporated into the mainstream practice of mental health disciplines. On the other hand, mainstream psychiatry became more biomedical, increasing the gap between professionals.
Henry Nasrallah claims that while he believes anti-psychiatry consists of many historical exaggerations based on events and primitive conditions from a century ago, "antipsychiatry helps keep us honest and rigorous about what we do, motivating us to relentlessly seek better diagnostic models and treatment paradigms. Psychiatry is far more scientific today than it was a century ago, but misperceptions about psychiatry continue to be driven by abuses of the past. The best antidote for antipsychiatry allegations is a combination of personal integrity, scientific progress, and sound evidence-based clinical care".
A criticism was made in the 1990s that three decades of anti-psychiatry had produced a large literature critical of psychiatry, but little discussion of the deteriorating situation of the mentally troubled in American society. Anti-psychiatry crusades have thus been charged with failing to put suffering individuals first, and therefore being similarly guilty of what they blame psychiatrists for. The rise of anti-psychiatry in Italy was described by one observer as simply "a transfer of psychiatric control from those with medical knowledge to those who possessed socio-political power".
Critics of this view, however, from an anti-psychiatry perspective, are quick to point to the industrial aspects of psychiatric treatment itself as a primary causal factor in this situation that is described as "deteriorating". The numbers of people labeled "mentally ill", and in treatment, together with the severity of their conditions, have been going up primarily due to the direct efforts of the mental health movement, and mental health professionals, including psychiatrists, and not their detractors. Envisioning "mental health treatment" as violence prevention has been a big part of the problem, especially as you are dealing with a population that is not significantly more violent than any other group and, in fact, are less so than many.
On October 7, 2016, the Ontario Institute for Studies in Education
The Ontario Institute for Studies in Education of the University of Toronto (OISE/UT) is Canada's only all-graduate institute of teaching, learning and research, located in Toronto, Ontario. It is located directly above the St. George subway sta ...
(OISE) at the University of Toronto announced that they had established a scholarship for students doing theses in the area of antipsychiatry. Called "The Bonnie Burstow
Bonnie Burstow (March 6, 1945 – January 4, 2020) was a Canadian psychotherapist, author, and anti-psychiatry scholar. She was a professor in the Ontario Institute for Studies in Education (OISE) at the University of Toronto.
Burstow argued th ...
Scholarship in Antipsychiatry", it is to be awarded annually to an OISE thesis student. An unprecedented step, the scholarship should further the cause of freedom of thought and the exchange of ideas in academia. The scholarship is named in honor of Bonnie Burstow, a faculty member at the University of Toronto, a radical feminist, and an antipsychiatry activist. She is also the author of ''Psychiatry and the Business of Madness'' (2015).
Some components of antipsychiatric theory have in recent decades been reformulated into a critique of "corporate psychiatry", heavily influenced by the pharmaceutical industry
The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...
. A recent editorial about this was published in the ''British Journal of Psychiatry'' by Moncrieff, arguing that modern psychiatry has become a handmaiden to conservative political commitments. David Healy is a psychiatrist and professor in psychological medicine at Cardiff University School of Medicine
The Cardiff University School of Medicine ( cy, Ysgol Feddygaeth Prifysgol Caerdydd) is the medical school of Cardiff University and is located in Cardiff, Wales, UK. Founded in 1893 as part of the University College of South Wales and Monmouth ...
, Wales
Wales ( cy, Cymru ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by England to the Wales–England border, east, the Irish Sea to the north and west, the Celtic Sea to the south west and the ...
. He has a special interest in the influence of the pharmaceutical industry on medicine and academia
An academy (Attic Greek: Ἀκαδήμεια; Koine Greek Ἀκαδημία) is an institution of secondary education, secondary or tertiary education, tertiary higher education, higher learning (and generally also research or honorary membershi ...
.
In the meantime, members of the psychiatric consumer/survivor movement continued to campaign for reform, empowerment and alternatives, with an increasingly diverse representation of views. Groups often have been opposed and undermined, especially when they proclaim to be, or when they are labelled as being, "anti-psychiatry". However, as of the 1990s, more than 60 percent of ex-patient groups reportedly support anti-psychiatry beliefs and consider themselves to be "psychiatric survivors". Although anti-psychiatry is often attributed to a few famous figures in psychiatry or academia, it has been pointed out that consumer/survivor/ex-patient individuals and groups preceded it, drove it and carried on through it.
Criticism
A schism exists among those critical of conventional psychiatry between radical abolitionists and more moderate reformists. Laing, Cooper and others associated with the initial anti-psychiatry movement stopped short of actually advocating for the abolition of coercive psychiatry. Thomas Szasz, from near the beginning of his career, crusaded for the abolition of forced psychiatry. Today, believing that coercive psychiatry marginalizes and oppresses people with its harmful, controlling, and abusive practices, many who identify as anti-psychiatry activists are proponents of the complete abolition of non-consensual and coercive psychiatry.
Critics of antipsychiatry from within psychiatry itself object to the underlying principle that psychiatry is by definition harmful. Most psychiatrists accept that issues exist that need addressing, but that the abolition of psychiatry is harmful. Nimesh Desai concludes: "To be a believer and a practitioner of multidisciplinary mental health, it is not necessary to reject the medical model as one of the basics of psychiatry." and admits "Some of the challenges and dangers to psychiatry are not so much from the avowed antipsychiatrists, but from the misplaced and misguided individuals and groups in related fields."
See also
* ''Against Therapy
''Against Therapy: Emotional Tyranny and the Myth of Psychological Healing'' is a 1988 book by author Jeffrey Moussaieff Masson, in which the author argues against the practice of psychotherapy. The work was criticized by reviewers.
Summary
Ma ...
''
* Bioconservatism
* Biopsychiatry controversy
The biopsychiatry controversy is a dispute over which viewpoint should predominate and form a basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics include dis ...
* Brazilian anti-asylum movement
* Conversion therapy
Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation, gender identity, or gender expression to align with heterosexual and cisgender norms. In contrast to evidence-based medicine and cli ...
* Drapetomania
Drapetomania was a supposed mental illness that, in 1851, American physician Samuel A. Cartwright hypothesized as the cause of enslaved Africans fleeing captivity. This hypothesis centered around the belief that slavery was such an improvement up ...
* Duplessis Orphans
The Duplessis Orphans (french: link=no, les Orphelins de Duplessis) were a population of Canadian children wrongly certified as mentally ill by the provincial government of Quebec and confined to psychiatric institutions in the 1940s and 1950s ...
, children diagnosed mentally ill for financial benefit
* Flexner Report
The ''Flexner Report'' is a book-length landmark report of medical education in the United States and Canada, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Many aspects of the present-day American me ...
* History of mental disorders
Historically, mental disorders have had three major explanations, namely, the supernatural, Biology, biological and Psychology, psychological models. For much of recorded history, deviant behavior has been considered supernatural and a reflectio ...
* Icarus Project
The Icarus Project (2002-2020) was a network of peer-support groups and media projects with the stated aim of changing the language and culture of what gets called mental health and mental illness. The name is derived from Icarus, a hero in Greek ...
* ''Interpretation of Schizophrenia
''Interpretation of Schizophrenia'' (first edition, 1955) is a book by Italy-born American psychiatrist Silvano Arieti in which the author sets forth demonstrative evidence of a psychological etiology for schizophrenia.
Arieti expanded the book v ...
''
* Ivar Lovaas
Ole Ivar Løvaas (8 May 1927 – 2 August 2010) was a Norwegian-American clinical psychologist and professor at the University of California, Los Angeles. He is most well known for his research on what is now called applied behavior analysis (A ...
* Joanna Moncrieff
Joanna Moncrieff is a British psychiatrist and academic. She is Professor of Critical and Social Psychiatry at University College London and a leading figure in the Critical Psychiatry Network. She is a prominent critic of the modern 'psychophar ...
, psychiatrist
* Law of the instrument
The law of the instrument, law of the hammer, Maslow's hammer (or gavel), or golden hammer is a cognitive bias that involves an over-reliance on a familiar tool. Abraham Maslow wrote in 1966, "If the only tool you have is a hammer, it is tempting ...
* ''Liberation by Oppression: A Comparative Study of Slavery and Psychiatry''
* Mad Pride
* Memento mori
* Mental illness denial
* Mind Freedom
* Neurodiversity
* Political abuse of psychiatry
* Positive disintegration
* Psychiatric survivors movement
* Psychoanalytic theory
* Radical Psychology Network
* Rosenhan experiment
The Rosenhan experiment or Thud experiment was an experiment conducted to determine the validity of psychiatric diagnosis. The participants feigned hallucinations to enter psychiatric hospitals but acted normally afterwards. They were diagnosed w ...
* Self-help groups for mental health
* Therapeutic nihilism
* World Network of Users and Survivors of Psychiatry The World Network of Users and Survivors of Psychiatry (WNUSP) is an international organisation representing, and led by what it terms " survivors of psychiatry". As of 2003, over 70 national organizations were members of WNUSP, based in 30 countrie ...
* Wrongful involuntary commitment
Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hos ...
* ''Anatomy of an Epidemic'', book by author Robert Whitaker (author), Robert Whitaker
* List of long term side effects of antipsychotics
References
Works cited
*
Further reading
*
*
*
*
*
* (Original edition: Tavistock Publications, 1960)
*
*
*
*
*
External links
* 12–13 February 2013
{{DEFAULTSORT:Anti-Psychiatry
Anti-psychiatry,
Psychiatry controversies
Ethics in psychiatry