psychiatric survivor

R. D. Laing, Thomas S. Szasz, and Mental Patients’ Liberation

Maverick psychiatrist Ronald David Laing once defined madness as follows: “Insanity — a perfectly rational adjustment to an insane world.” This speaks to the theoretical divide between R.D. Laing and his contemporary, fellow psychiatrist Thomas Stephen Szasz. His attitude towards Laing, from the beginning, was that of almost a visceral rejection, but on the grounds that Laing was, in his eyes, dissolute or lacking in moral fiber. This sort of symbolizes the distance between these two figures often falsely associated in the public mind.

Laing was a seminal thinker for the decade that came to be known as “the turbulent sixties”. Thoms Szasz was an emigre from a Hungary that fell under the soviet orbit following WWII, and thus reflected an older and more established world view, although similar claims could be made there, too. Szasz disputed the idea of mental illness, and approved, when it came to treatment, only of a therapist client sort of arrangement, an arrangement that jived with free trade. Laing wanted to throw off the divisions between patient and therapist in his unstructured and freer environment, the experimental therapeutic community, or residence.

What Szasz saw in Laing’s therapeutic setting, in his social experiment, was collectivism, of which, regardless of whether you are looking at communism or monasticism, he violently disapproved. Laing, on the other hand, recognized some of his clients “issues” as situational and social rather than imaginary and isolated. The theory is simple, you put some plants in one environment, and they are going to shrivel and die, however, if you transfer the same plants to another environment, they thrive. Animals, specifically the human animal, must be pretty much the same way.

There were other differences between the two, the stance of Szasz was moral. He was against forced treatment, and being against forced psychiatric treatment, he opposed the insanity defense as well. Laing, despite his social experiment, would never go so far as to oppose psychiatric force across the board. Power was something, for him, a psychiatrist might ruminate about, melodramatically, without relinquishing. He also was not beyond using the insanity defense, of which Szasz disapproved, in testimony before a court of law. Laing was operating under a mandate to live one’s life completely, and in so being, he would not be restricted by such moral constraints.

Another issue Szasz attacked Laing over was his use of psychiatric terminology, disease language, which he rejected. If “mental illness” was a myth, we shouldn’t speak of “problems in living”, as Szasz saw them, as “diseases”. Laing thought the disease theory, merely a theory, and not one that he necessarily subscribed to, but one he was not beyond utilizing in the interests of research and treatment. Basically it boils down to this. Laing served as an inspiration to those in favor of alternatives to forced and conventionally harmful treatments while Szasz served as an inspiration to those who would abolish forced treatment. Szasz’s approach to treatment focused more on accepting personal responsibility for one’s actions rather than evading that responsibility.

Thomas Szasz’s most famous book, in which he first expounded his views, The Myth of Mental Illness, was published in 1961, a year after he had published a landmark essay by the same title. R. D. Laing’s entrance into the published world began with The Divided Self, arguably his most famous book, in 1960. Kingley Hall, the first Laingian experiment, operated in London from 1965 – 1970. The mental patients’ liberation, or psychiatric survivor, movement began in 1969/1970 with the launch of the Lunatic Liberation Front in Portland, Oregon. The mental patients’ liberation movement, in so far as it existed, before becoming almost totally co-opted by federal financing, was against force and for “alternatives”, and thus, could be said to have been influenced and inspired by both figures.

Combating “Stigma” As A Selling Point

If you want more people claiming to be “mentally ill” in the world, there is a sure fired way to get them, and that way is to fight “stigma”, the “stigma” attached, by the way, to making that claim. This, at a time when currently the USA “mental illness” rate is estimated to range from somewhere just under 20 % to 25 % of the US population. We need, in other words, more mental patients like we need more Lyme’s disease to make Swiss cheese of more people’s brains.

What is the highest health care cost in the USA? The cost of mental health care. Why is this so? Because of campaigns to end “stigma”. “Mental illness” is a very popular “illness”. The state is paying for it to be so. What the state is not doing is getting people out of the mental health system (i.e. “mentally well”). This is because it is, in point of fact, not a mental health system at all, it is a “mental illness” system. You don’t push approaching a 1/4 of the population of the USA into treatment, for their “illnesses”, however illusory, if you want people to leave that system. “Mental illness” represents a cash cow to all sorts of people.

There’s a slogan out there that goes, ‘It’s okay not to be okay’, which is kind of like saying, ‘It’s cool not to be cool’. Suddenly all these tinted shades have gone completely transparent. A contradiction is no longer a contradiction. A horse is a goose, a snake is a cow, a duck is a bear, your enemy is your friend, etc., etc., etc. Illogic is no longer illogic. Got it. You get these slogans because there’s money to be made in mental health treatment, and somebody is out to make it. When we talk about mental health treatment here, it is important to note, we are talking about treating people claiming to “have a mental illness”. There is no money to be made in treating people who claim to “have mental health”.

There is also, to provide a corollary, no known “stigma” attached to “mental health”, except in so far as there is a “stigma” attached to “mental illness”, giving the person who makes the claim of having a “mental illness” access to a steady funding stream denied to the person claiming to “have mental health”. We can’t manufacture “disability” payments without at the same time manufacturing “disabled” people to receive them. Manufacturing “able” people, enabling them, would be working in the opposite direction, that is, on getting more people back into the work force, and on lessening the numbers of people claiming to have a “mental illness”. This, unfortunately, is not the direction in which we are headed.

The World Health Organization has, if alarmingly, announced more than warned that depression is rapidly overtaking heart disease as the number one cause of disability throughout the world. A heck of a lot of people are unhappy. If we pay people to be unhappy, of course, that is not going to mean you’ve got less unhappy people in the world. If you keep people from being employed because of their unhappiness that is not going to make for less unhappy people in the world at large either. If you build a business around people’s unhappiness that is not going to make for any fewer unhappy people in the world as well.

Obviously, we are waiting on some kind sea change here that may be a long time indeed in arriving. Could we make a business out of facilitating happiness and contentment, in a material as well as spiritual sense, we might be getting somewhere. “Mental illness”, or rather it’s treatment, may be selling like hotcakes, all the same, were that it could be “mental health”, or non-treatment, that was selling instead; then the little pandemic of “mental disorder” that we are stuck in the middle of at present might show signs of letting up.

Food for thought then, for the decades ahead: how do we get people out of the mental health system and back into their communities rather than expand that system, and, thereby, manufacture more people who see themselves as being “in need” of treatment. I certainly don’t think we are going to get there by pretending to be combating a “stigma” attached to receiving treatment.

Unlearning Spurred On By Undiagnosis

Unlearning is very important to me. The school system I grew up with taught me I couldn’t do anything correctly. Unlearning this education meant I could do things correctly despite all I had been taught to the contrary. One wonders how many lives have been squandered at the alter of learned futility. Unlearning, in this case, was a matter of recognizing the value of utility instead.

Obviously, being taught that you are “incapable” of doing anything worthwhile is going to complicate the project of living one’s life severely. This complication translated, for yours truly, into a “serious mental disorder” diagnosis. Taught by the education system that I was “incapable”, there were all these doctors ready and willing to jump in with a “disease” diagnosis. My “incapacity”, in their eyes, was due to my having a “disease”, specifically, a “disease” of the brain.

If you read the literature on institutionalization, you will find mention of something they call “learned helplessness”. One could say, in a sense, that this diagnosis process merely represented an extension of the business of education. Here was, after all, confirmation that I was “incapable” of producing anything of value. Not only are people taught that they are “incapable”, but the suggestion is made that this “incapacity” is owing to having become “stricken” with “disease” rather than schooling.

If you succeed in failing at being educated, no wonder, for continued if lower education, we’ve got the mental health system. It can help if this unlearning process is accelerated by the shock of the mental health system. Through the mental health system, I learned to undiagnose fictitious disease. or rather because these “diseases” come to you through other people, pretty much the same thing, to unlearn them. The mental health system could be referred to as a form of radical unlearning.

If learning is a diagnosis, continued unlearning must, logically enough, encompass undiagnosis. Anyway, it makes sense to me. If nobody ever told you to be wary, if the mental health system doesn’t unteach you wariness, that wrong place must be the right place for you. Theoretically speaking, of course. There are some evil scoundrels in the world, and some of them are in positions of authority. Cardinal rule: You don’t attain positions of authority through unlearning.

More and more people it seems are discovering unlearning. The textbook may have black print on white paper, but transparent print on a transparent sheet of, say, plastic isn’t outside of the realm of possibility. One has to wonder, in most learning situations, where is the person in the classroom to tell the class to take everything said in front of it with a grain of salt? If there is such a person, it’s usually the person catching hell from the teacher. I would like to suggest that this may be because the teacher has a lot of unlearning to do yet.

Anti-Psychiatry In The 21st Century

I just finished reading David Cooper’s The Language of Madness (1978), his last book. I’d been been talking to some folks about the views of various psychiatrists who had some issues with their own profession. I don’t think Anti-psychiatry: Quackery Squared (2009) was a very wise maneuver on the part of Thomas Szasz. Szasz, in his book, attacks the psychiatric left wing, anti-psychiatry. This puts Szasz in the very uncomfortable position of providing a defense to the very people he opposes, proponents of forced psychiatry. It also alienates him from potential allies, regarding psychiatry and force, because of political differences. The result of this publication was to provide even more fodder for opponents of abolition of forced treatment, and to weaken the position of proponents of abolition, that is to say, now you’ve got establishment psychiatrists claiming Szasz as one of their own at the very moment they are bashing him.

R.D. Laing and David Cooper I would call anti-establishment psychiatrists. Thomas Szasz was an anti-psychiatric-establishment, considering that the psychiatric establishment is all about force, psychiatrist. Thomas Szasz was not otherwise anti-establishment. He was no friend of the new left, nor of what was then known as the counter-culture, both of which both Laing and Cooper could claim to have a stake in. Laing eventually saw in madness religious experiences. For Cooper madness embodied political action. I would fault Laing, Cooper, and associates (especially Laing) for not going all the way, and clearly opposing coercive psychiatry. I don’t think everybody was necessarily on the same page about this matter. I would have thought that the guru of Kingsley Hall would have “got it”, to a greater degree anyway, but apparently he stopped short. Laing, to a certain extent, is being “rehabilitated”, “resuscitated” perhaps, by the media. David Cooper, unfortunately, in the process becomes more or less a footnote on stories regarding Laing.

I love the clarity found in the thought of Thomas Szasz. David Cooper’s thought is more fuzzy, but there is some, perhaps much, good to be found in it as well. The problem is how do you separate the sense from, if you will pardon the pun, the anti-sense in Cooper. One thing he does is quote Karl Marx, in relation to his followers, saying he was not a Marxist. He then makes a similar claim about anti-psychiatry, that nobody can be one. I might have agreed if he’d said he wasn’t Cooperian or a Cooperist, and especially as that means little more than a footnote anymore. Cooper eventually talks about a non-psychiatry movement as if it were the successor to his anti-psychiatry movement. My conception though of anti-psychiatry is as a promoter of non-psychiatry. He titled the final chapter, The Invention of Non-Psychiatry.

Non-psychiatry is coming into being. Its birth has been a difficult affair. Modern psychiatry, as the pseudo-medical action of detecting faulty ways of living lives and the technique of their categorization and their correction, began in the eighteenth century and developed through the nineteenth to its consummation in the twentieth century.

Etc., etc., etc.

The thing is, you don’t have to invent non-psychiatry as it existed long before psychiatry was ever ‘invented’. It exists, even with what Cooper calls psycho-technology, in the same world that psychiatry exists in. The government control and surveillance aspect of psychiatry may be a big thing, but it certainly isn’t everything. There is also the matter of what we mean when we say psychiatry. Psychiatry wasn’t even a word until the nineteenth century.

I see a lot of good in Cooper. He and Szasz might have even agreed about force. We will never know. Szasz thought of anti-communist as a “good” word. Cooper was laying his cards on world revolution. Cooper was a supporter of worker co-operatives and social experimentation. Szasz thought the only way to go with counseling/therapy was as a contractual matter between professional and client. The issue I have with David Cooper is that if he had looked maybe he could have seen that anti-psychiatry doesn’t have to exist within psychiatry (or the mental health system). I see him talking about anti-psychiatry changing psychiatry from within. I don’t think there is a big likelihood of its doing so. I think there is a much greater potential for anti-psychiatry to overtake psychiatry from outside of psychiatry. When the taxpayer becomes anti-psychiatry, well, there you go. Why would anybody be paying for something they don’t have to pay for, and especially when that something is torture, slavery, physical harm, and imprisonment?

Enough is enough when it comes to the anti-psychiatry of psychiatrists. If we’re going to have an anti-psychiatry movement, let it be dominated by people who aren’t psychiatrists. In other words, a few more survivors, a few more blacks, a few more women, etc. We will even consider a psychologist here or there. As people never tire of saying in the disability rights movement, “Nothing about us without us!” The monopoly by psychiatrists on the development of the theory and practice of anti-psychiatry is something pretty easy to remedy. I think, in fact, we are getting there, if we are not already there. Nobody needs a degree in psychiatry to oppose psychiatry. There is something to be said for non-psychiatrists, in fact, there is something to be said for non-Ivy League professionals, or even non-Wall Street speculators, opposing psychiatry. There is something to be said for people taking charge of their own lives, and with those lives, their bodies, and the health of those bodies.

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).