Psychiatry, Critical Psychiatry, and AntiPsychiatry

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I don’t know that I had ever encountered two words critical and psychiatry coupled together until I encountered it in book form with a copy of Critical Psychiatry: The Politics of Mental Health, edited by David Ingleby. This Critical Psychiatry was published in 1980, almost two decades before the network and website of the same name were established in 1990s UK. Critical Psychiatry, curiously enough, is also referenced in Anti-psychiatry: Quackery Squared (2009) by Thomas Szasz. Critical Psychiatry, as it is delineated in the book here, sets out to distance itself from the anti-psychiatry it associates with the 1960s.

The idea that psychiatry is a political issue is, of course, one which was first brought into public view by the ‘anti-psychiatrists’ who gained prominence during the late 1960s — Laing, Cooper, Basaglia, Szasz and others. Each of these figures stood for a different approach, and all have therefore disowned the umbrella label of ‘anti-psychiatry; Laing’s work led him into a therapeutic concern with fundamental existential issues, while for Cooper ‘anti-psychiatry’ was replaced by ‘non-psychiatry’, as the questions resolved themselves into more purely political ones. Basaglia sent his staff out of the hospital into the community at large; while Szasz denounced all these varieties of ‘creeping socialism’, and insisted that psychiatrists should return to a contractual relationship with the patient, aimed simply at promoting individual liberty. Yet despite their differences, all these figures were united in seeing the scientific image of psychiatry as a smokescreen; the real questions were: whose side is the psychiatrist on? what kind of society does he serve, and do we want it?

Critical Psychiatry (1980), Introduction, Ingleby, pg. 8

Nonsense to a degree, but baring a residue of truth.

Later, in this same introduction, Ingleby channels us into the real distinction between their antipsychiatry and his critical psychiatry.

A word about the title: why ‘Critical Psychiatry’?
‘Psychiatry’ because, unlike David Cooper’s ‘non-psychiatrists’, the contributors to this volume all feel that mental illnesses — whatever their correct interpretation and their political significance may be — do exist, and furthermore call for specialized understanding and help…

Critical Psychiatry (1980), Introduction, Ingleby, pg. 18

The contributors to Ingleby’s book felt such to be true because they couldn’t know such to be true. That “mental illnesses” exist isn’t knowledge, really, so much as it is supposition. and, in the case of most people so diagnosed, presumption. Minds aren’t subject to disease, and diseased brains are the proper sphere of study for neurologists, not psychiatrists.

Critical Psychiatry versus Psychiatry

  • The predominate mode in psychiatry today is bio-medical psychiatry.
  • Bio-medical psychiatry sees mental disorder as largely biological.
  • Critical psychiatry questions, if not the biological basis for mental disorder, the extent of that basis.
  • Critical psychiatry then sees social, psychological, and environmental factors as no less important to the formation of mental disorder than biology.

The Bio In Biological Psychiatry

  • While some mainstream psychiatrists have cautioned against a bio-bio-bio approach to psychiatry,
  • Calling it extreme and claiming to be bio-psycho-social in approach.
  • The difference is in how much emphasis is placed on the biological.
  • It is much more permissible for a critical psychiatrist to envision a mental disorder without a basis in biology while it is practically considered heresy for a biological psychiatrist to do so.

Antipsychiatry versus Critical Psychiatry

  •  At the heart of the matter is the validity of psychiatric diagnosis.
  •  Critical psychiatry supports the notion of mental disorder.
  • Antipsychiatry dismisses the notion of mental disorder as a popular fiction.

Abolition versus Reform

  • Reformism = more or less forced treatment.
  • Reformism when it comes to force is a matter of degree: law and order reformers want more, socially progressive reformers want less.
  • Abolition = NO non-consensual coercive psychiatric treatment.
  • It is only through mental health law that you get non-consensual coercive treatment.
  • Repeal mental health law, and non-consensual coercive treatment is what it is everywhere else, that is, criminal assault.

The issue of abolition of forced treatment is pivotal. I find it very hard to consider anybody who doesn’t support the abolition of forced treatment antipsychiatry. Critical psychiatry, in the main, remains reformist, that is, critical psychiatry would opt for less force. More mainstream psychiatrists, also reformist, could go either way, for more or for less, on the force issue. Abolitionists would have mental health law repealed, or the UN CRPD, which could potentially outlaw forced treatment through international law, endorsed. Should psychiatry itself be abolished? First things first. Some might not think so, but as for myself, I’m not setting myself up to be the psychiatrist’s friend on this matter.

Antipsychiatry Redux

  • Antipsychiatry is not a throw-back to the sixties and seventies.
  • Antipsychiatry has not disappeared. If antipsychiatry has gone underground, due to the success of the failure of psychiatry, antipsychiatry has also managed to remain above ground. Antipsychiatry can’t entirely be forced underground until all the governments in the world have been replaced by a world psychiatric institution. Just because such hasn’t happened yet doesn’t mean that it is outside of the realm of possibility.
  • Antipsychiatry has merely progressed beyond the antipsychiatry of psychiatrists, and even the antipsychiatry of the mental health profession.
  • Psychiatrists are hardly the only people in the world capable of promoting non-psychiatry.
  • Psychiatry being bigger than ever before, and also being a bigger failure at recovering people to non-psychiatry from its diagnoses and treatments than ever before, justifies the existence of its nemesis, that is, antipsychiatry.
  • The problem, in other words, is not that people have “mind sicknesses”, the real problem is the profession of psychiatry that identifies, and lives off of, its postulated “mind sickness”. The solution to this problem is more tolerance for human difference (i.e. an end to the profession of psychiatry).
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