Anti-psychiatry

Beginning in the 1960s, a movement called anti-psychiatry claimed that psychiatric patients do not necessarily have a "mental illness", but in fact are individuals who do not ascribe to the same conventional belief system, or consensus reality, shared by most people in their particular culture. Adherents of this movement sometimes refer to "the myth of mental illness", after Dr. Thomas Szasz's controversial book, The Myth of Mental Illness.

Origins of anti-psychiatry

The term "anti-psychiatry" was first used by David Cooper in 1967, though opposition to either psychiatry in general, or its practices, predates this coinage; surrealism's opposition to psychiatry predates it by decades. R. D. Laing, a psychiatrist, has been very influential; another psychiatrist, Thomas Szasz, is equally important, but both rejected the label "anti-psychiatry". Other critics of psychiatry often associated with the anti-psychiatry movement include Dr. Peter Breggin, Dr. Elliott Valenstein, Bruce Levine, Douglas C. Smith and Jeffrey Moussaieff Masson, a psychoanalyst who uncovered evidence Sigmund Freud had suppressed observations of child sexual abuse. Many anti-psychiatrists put terms such as "mental patient" in quotation marks to show their rejection of, or ambivalence toward, the terminology of conventional psychiatry. Also, some new religions, most notably Scientology, believe psychiatry is harmful to spirituality and have gone on vocal and influential campaigns against psychiatry. (Psychiatrists have said that Scientology only opposes psychiatry because their methods for treating mental illness, such as Dianetics, are ineffective.) Several fundamentalist Christian groups also oppose psychiatry as they view some or all mental illnesses as spiritual problems instead.

Some libertarians have opposed psychiatry or abuses of psychiatry on constitutional or other legal grounds. Among other popular movements against psychiatry are: the Psychiatric survivors movement (including such groups as MindFreedom and International Center for the Study of Psychiatry and Psychology); persons charged with abuse based on repressed memories; political prisoners of totalitarian regimes; believers in a range of anti-realist ideas including the theory of reality enforcement; and certain documenters of the Nazi Holocaust. The United States Libertarian Party can also be associated with anti-psychiatry as it has opposed involuntary commitment in its platform.[1] Anti-realists have argued that the definition of a "lack of capacity to recognize reality," both clinically and legally, constitutes or could constitute a direct attack on their ideas. Holocaust documenters point out that medicalization of social problems and systematic euthanasia of people in German mental institutions in the 1930s provided the institutional, procedural, and doctrinal origins of racial mass murder of the 1940s. The Nuremberg Trials convicted a number of physicians, mostly psychiatrists, who held key positions in both eras of Nazi murder, providing further overlap between psychiatry and oppression, according to Szasz and others. A sermon against the earlier practice by Bishop Clemens August Graf von Galen of Münster delivered on August 3, 1941, is credited with inspiring a group of young medical students to publish anti-Hitler pamphlets in 1942 and 1943, in the name of White Rose.

Although Cooper was a Marxist, and many Marxists oppose contemporary psychiatry, the anti-psychiatry movement is by no means homogenous ideologically. Szasz opposed Marxism, instead approaching what he saw as psychiatry's problems from a libertarian perspective, by arguing that any form of socialism would lead to more medicalization and the strengthening of psychiatry.

Most, if not all, antipsychiatrists oppose inhumane treatment of mental patients (or even their status as "mental patients" in the first place), either through the damaging effects of long-term institutionalization or the use of specific interventions given without informed consent. Electroconvulsive therapy, or ECT, has been used to sedate and punish difficult psychiatric patients rather than for therapeutic purposes (although how frequently and under what circumstances is debated), and some psychiatrists oppose ECT based on studies of its safety and effectiveness. Others, such as Szasz and Breggin, contend even accepted therapeutic practices remain instruments of social control. Punitive use of 'treatment', including ECT, isolation, and restraint has diminished somewhat, but anti-psychiatrists assert it still occurs regularly.

There has been a resurgence of electroconvulsive therapy (ECT) research and treatment in the past 20 years, for treatment of a wide range of mental illnesses including severe depression, but many things about ECT are still poorly understood, including exactly how ECT works. Most scientific studies conclude that ECT as performed today is a relatively safe and humane practice, but opponents of the practice allege that ECT causes brain damage and has killed several patients on whom it was used, some without their consent. Some ECT patients report lasting harm from the controversial treatment, while others credit it for their recovery.

Observation of the abuses of psychiatry in the Soviet Union also led to questioning of the validity of the practice of psychiatry in the West. In particular, the diagnosis of political dissidents in the Russian Soviet Federated Socialist Republic with sluggishly progressing schizophrenia, led some to question either the existence of schizophrenia, its diagnostic criteria, its prevalence, or to allege that at least in some cases the diagnosis is used punitively against dissidents in the West. There is some evidence (and many would argue that there is more than some evidence) that psychiatry is used as a coercive arm of various groups in the United States against dissidents and whistleblowers today [2]; very few would argue that psychiatric diagnoses have never been used in an improper or politicised way.

Some, such as Szasz and Breggin, argue the body of information making up the discipline consists mostly of vague and non-falsifiable hypotheses, or, worse, hypotheses not testable without resorting to unconscionable and inhumane experiments on human beings. The indeterminacy of psychiatric diagnoses make it useful as a mechanism of social control, according to these authors.

During the 1970s, the anti-psychiatry movement acquired sufficient respectability to advocate and effect restraint from many of the worst psychiatric abuses. Jurists such as David Bazelon brought legal force and stature to anti-psychiatry sentiments. Still, in the modern therapeutic culture, often reliant upon pharmaceuticals as an important part of psychotherapy, those who question the ethics and efficacy of psychiatric practice in general remain outside the mainstream.

While the anti-psychiatric movement and in particular the Psychiatric Survivors Movement has in general operated nonviolently or even consciously based its activities on the principels of nonviolence, there have been examples of sabotage and violence that are arguably anti-psychiatric or directed against coercive psychiatry. For instance, in 1993 a man in downstate Michigan caused hundreds of thousands of dollars in damage to mental hospitals.

Arguments against anti-psychiatry

The scientific and medical communities view anti-psychiatry as a fringe movement that continues to lose credibility as more evidence is gathered that documents the neurobiological basis for serious mental illness. The discovery of evidence suggestive of biological and genetic basis for many serious mental illnesses, such as schizophrenia and bipolar disorder [3] has eroded support for the anti-psychiatric claim that mental illness is merely a social or political label.

Many people diagnosed with a mental illness or illnesses — and many of those who have family members or close friends who have been diagnosed with mental illness — find the views of the anti-psychiatry movement contrary to their own experience with mental illness. They believe the very real and terrible suffering produced by mental illnesses have been effectively relieved by psychiatry, medication, and social treatment programs. One of their strongest advocates is Dr. E. Fuller Torrey.

Another argument is that psychiatric disorders can be shown to have significant liabilities. An example is that children diagnosed with ADHD appear to be more prone to injuries. It is true that a highly active child is more likely to cause damage to physical things (including themselves) than a relatively inactive child. This point helps to illustrate a primary concern of anti-psychiatry: in a community that places a high degree of value on material possessions, a person that disregards this intensity of material value runs the risk of being diagnosed as mentally ill. Herein lies the considerable danger that an individuals degree of adherence to communally held values may be used to determine that persons level of mental health. Using this logic it could be argued that in a communal display of violence (as in a public Stoning) the person who abstains from violence could be diagnosed mentally ill and should, subsequently, be treated. This has, in fact, been the case in Iraq in recent years.

Finally, the effects of drugs used to treat psychiatric disorders appear to be consistent with proposed neurobiological models, particularly in regards to clinical depression, anxiety, bipolar disorder and ADHD.

Views on neurobiological basis

The finding that psychiatric disorders have a neurobiological basis is seen by some critics as largely uninformative and inconclusive. They point out that many behaviors considered normal-variant, such as homosexuality, left-handedness and giftedness, may similarly be shown to have a biological basis. For the argument to be persuasive, it would need to be shown that the neurobiological characteristics of all disorders are pathological in nature. Critics strongly suspect that such characteristics are in fact not pathological in many cases.

Psychiatric diagnoses interpret depression, obsession, anxiety, inattention, and other problems, when perceived to be chronic, as symptoms of a mental illness. In biology, illness is caused by pathogens, poisons, or injuries. In psychiatry, the balance of neurotransmitters in the brain is thought to be the biological basis for mental health. In this theory, personalities are damaged by disruptions of neurochemicals. According to this view, happiness and other positive emotions reflect a proper balance of neurochemicals, but depression and other negative emotions reflect an imbalance. Medications that regulate neurotransmitters are thought to heal damaged personalities in the way that antibiotics heal infected organs.

But there is no known biological mechanism for personality traits. The effects of certain chemicals on consciousness are well known, but different personalities may react differently to the same chemicals. Science has studied a relatively small sample of brains, and not a random sample. It may be that there is some correllation between specific personality types and specific chemical mixes or solutions in the brain, but that has not been proven. According to psychiatry critics, different balances of neurotransmitters may reflect natural variations of neurology and not pathologies. The autistic community calls this neurodiversity.

Views on behavioral genetics

Psychiatry proposes that certain genetic weaknesses or vulnerabilities may predispose people to mental illness. But genes do not code for weaknesses or vulnerabilities. Genes code for physical traits, like gender, hair color, skin color, or eye color. In contrast, no genes are known that code for personality traits. Some physical traits, such as height, body size, and organ size, are susceptible to environmental conditions, such as nutrition, exercise, or disease, but susceptibility is not a physical trait. Short stature, for example, is a trait which is generally not considered an illness unless it is the result of a tumor or an organ disease.

Genetic weaknesses depend on context, situation, and environment. For example, life on Earth may have a "weakness" to gravity, because few Earthlings can reach escape velocity from the planet's surface. This weakness could be exploited by space-faring aliens. But that would not make space invaders an illness. Human beings lack tails and claws, but that does not give us feline-deficit disorder or canine-deficit disorder. Sometimes symbiotic organisms take advantage of a host's genes, but symbiots are not illnesses.

According to psychiatry critics, personality has not been proven to have a biological source, and might instead have social or conceptual origins. Behaviors attributed to personality traits may not be transmitted by genetics, because there is no known genetic mechanism for personality traits. The traits interpreted by psychiatry symptoms of mental illness may only be disadvantages in certain contexts, but advantages in other contexts. Psychiatry presents one theory of personality. Other theories might be equally valid. For example, philosophical, spiritual, religious, information, or literary theories.

In fact, while twin studies do show that personality is heritable, they also show that it is far from being 100% heritable. The environmental factors involved in determining personality differences are unknown and there are no indications they are pathological in nature.

Anti-psychiatry allies

Many persons diagnosed with certain mental disorders do hold a view similar to that of anti-psychiatry. Notably, some people diagnosed with Asperger's Syndrome or autism appear to hold this position (see autism rights movement). While many parents of children diagnosed autistic oppose the efforts of autistic activists, there are some who say they value the uniqueness of their children and do not desire a cure for their autism. The autistic community has coined a number of terms that would appear to form the basis for a new branch of identity politics; terms such as "neurodiversity", "neurotypical", "neurodivergent", etc.

Views on the liabilities of mental illness

Proponents of anti-psychiatry generally do not dispute the notion that some people have emotional or psychological problems, skill deficits and self-defeating belief systems. They simply disagree on the appropriateness of characterizing these problems as illness and on what the proper management options are.

A common pro-illness argument is that persons diagnosed with a psychiatric disorder suffer from significant liabilities due to the disorder. To take an example, researchers have argued about "the side-effects of not treating ADHD" [4], which may include increased risk of accidental injury. To anti-psychiatry proponents, this is no different to persistent claims that homosexuality is a disorder due to increased risk of sexually-transmitted disease [5].

A further flaw of the argument is that the proposed solution does not necessarily address the problem at hand. That is, there is no sound cost-benefit analysis done in prescribing medication. While Ritalin may result in a modest decrease in the risk of accidental injury, its long-term side-effects - which may or may not include personality alteration, an increased risk of cancer and heart problems - are not well understood, despite the fact that Ritalin is prescribed to about 6 million children every year in the United States.

In the case of ADHD, it is unclear if the risk of injury actually results in decreased life expectancy. Taking autism as a possible reference, that would appear unlikely.

A complaint often leveled against psychiatrists is that they tend to focus only on the negative aspects of disorder phenotypes, and seldom document any positive aspects, with some of them actively arguing and denying that positive aspects exist at all. For instance, there is no mention of hyperfocus in the scientific literature even though persons diagnosed with ADHD and Asperger's syndrome have reported it time and again. In fairness, this is not true of the entire research community. For example, studies that link increased creativity to bipolar disorder exist [6]. Autism researchers, such as Uta Frith, speak of "cognitive style" rather than "cognitive impairment" and have shown that the autistic phenotype really does include information processing advantages in certain areas [7]. The relatively high prevalence of savant skills among autistics is undisputed [8]. Others, such as Simon Baron-Cohen, have started to speculate that autism may lead to 'difference' rather than 'disability' [9]. In general, there appears to be increasing recognition that eccentricity can be both a gift and a curse.

Variations in prevalence

Anthropological studies have been interpreted as suggesting roughly equivalent percentages of people in a variety of cultures, some very different to modern Western culture, develop behaviors recognized by that culture as deviant, with symptoms similar to schizophrenia.

However, the lower rates of diagnosis for the forms of schizophrenia accepted in Western Europe than in the United States have led some to question the criteria for diagnosis, and even speculate that in some cases schizophrenia is deliberately misdiagnosed in the United States as a means of political or philosophical repression or as the result of increasing pharmaceutical industry marketing influence upon mental health professionals. DSM-IV-TR also notes that there is "a far higher incidence [of schizophrenia] for second generation African Caribbeans living in the United Kingdom."

The unexplained increases in the incidence of autism and ADHD have also raised questions about the subjectivity involved in diagnosing psychiatric disorders. Some critics attribute the increase in prevalence to nothing but mass hysteria.

The form of treatment also may vary according to criteria that some find suspect; young African American males in the United States are disproportionately prescribed high doses of "anti-psychotic" medication, and African Americans are disproportionately subjected to involuntary commitment.

Arguments from precedent

Psychiatrists have changed their mind in the past about the pathological nature of certain atypical behaviors.

Homosexuality is the most cited example, given that it was listed in the DSM. Homosexuality was dropped from the DSM in 1973 mostly due to political activism and controversy, not so much due to new scientific findings. Today, attempts to "cure" homosexuality by means of behavioral intervention have been left to a few religious organizations and some hold-out psychiatrists.

Left-handedness has also been the subject of some controversy. Even though it has been linked to certain neurological deficits and other disadvantages, it is generally not considered pathological. Incidentally, there appears to be a prevalence correlation between left-handedness and homosexuality, as well as prevalence correlations between left-handedness and various psychiatric disorders.

Giftedness is another example of a behavior that is generally considered to be normal-variant, despite some recognized liabilities, such as higher propensity to myopia, depression, introversion, etc. Giftedness has also been shown to have a neurobiological basis [10]. The prevalence of giftedness is significantly lower than that of certain psychiatric disorders, such as ADHD, so it could be said to be more "abnormal". It is therefore not surprising to some critics that psychiatrists have started to label gifted children as mentally disordered [11][12].

Some psychiatry critics point out that many disorders are not natural in an evolutionary sense. For example, dyslexia would not exist if not for the invention of writing systems, a relatively recent event in evolutionary terms. It follows from this that in the future new disorders could be invented to describe deficits in the ability to use new technology.

Insanity defense

As Thomas Szasz points out, one of implications of the argument that mental illness does not exist is the insanity defense would thus be abolished. He insists someone who has killed someone under the influence of psychosis should be fully criminally responsible for his actions. This position is regarded as inhumane by many people. However, despite perceptions caused by sensationalist news stories, most people with psychiatric labels suffer violence by others more than they commit violence.

Some anti-psychiatry activists point out that the "insanity defence" is almost invariably of no advantage to criminal defendants. Rather than serving their sentences in jail, psychiatric prisoners serve them in hospitals where they are subjected to forced drugging and forced electroshock. In many cases, defendants actually serve longer sentences in psychiatric hospitals and, in all cases, terms are indefinite and are essentially at the discretion of the director of the psychiatric facility.

Institutionalization and coercive treatment

Some who are active in anti-psychiatry have not challenged the illness of psychiatric patients, but have instead merely challenged the practice of involuntary commitment from a legal or civil liberties perspective. Many people argue that, even if it is sometimes necessary to detain a few people with extreme mental illnesses, society is far too eager to utilize psychotropic medication treatments, often coercively (see Sally Satel), or lock up people with minor mental illnesses (see New Freedom Commission on Mental Health). The growing practice in the U.K., and elsewhere, of "care in the community" was instituted partly in response to such concerns. On June 22, 1999, the United States Supreme Court ruled in Olmstead v. L.C., against unnecessary confinement of people with disabilities, including the mentally ill, in institutions. However, in the United States, 42 States have now passed legislation allowing court-ordered involuntary treatment of outpatients with psychiatric drugs (see outpatient commitment).

A number of individuals and advocacy groups have criticized certain State statutes in the U.S. providing for involuntary commitment, as unconstitutional violations of the First, Fourth or Fifth Amendments (however, there have been court rulings that the Fifth Amendment is not applicable to these cases, being only applicable to criminal cases). They argue that, in those cases in which the statements or writings of the individual examined by a psychiatrist — who will possibly be certified as being in need of treatment — forms the basis for the diagnosis, then the deprivation of liberty which will result (if the individual is so found) will actually be a result of his speech or writing, and testimony taken while in custody, would therefore be in violation of the United States Constitution.

Fifth Amendment concerns have been somewhat ameliorated in some jurisdictions, which have provided statutory equivalents of Fifth-Amendment rights in involuntary commitment cases.

State of modern-day psychiatry

A major area of concern to critics of modern psychiatry is that of over-diagnosis, facilitated by the escalating use of medical algorithms and evidence-based medicine (see Texas Medication Algorithm Project). Again, while some advocates argue that, while serious mental illness does exist, currently far too many people are diagnosed as mentally ill — and sometimes detained involuntarily in mental hospitals — when they are (or their speech or behaviour is) merely different (or said to be different) from the prevailing attitudes of their society. There have been allegations that teenagers are particularly susceptible to improper involuntary commitment, and bounty hunters have even been used to take them to private psychiatric hospitals against their will (see Joe Sharkey). The treatment of patients in private psychiatric hospitals, chiefly teenagers, has been the subject of investigations by State attorneys general in the U.S.

In 1998 Szasz and others staged the Foucault Tribunal on the State of Psychiatry in Berlin (named for the philosopher Michel Foucault, who conceptualized madness in the History of Madness in the Classical Age (1961), and other works, as a social construction enforcing a definition of normality eminently useful to the functioning of power over bodies). This tribunal reached what could be said to be a preordained verdict — that, among other things, "We demand the abolition of the mental patients laws as a first step toward making psychiatry accountable to society."

Many of the premises of anti-psychiatry have been adopted by psychologists working to treat mental disorders without medication, including sexual addiction counselor, Joe Zychik and David Keirsey, a clinical therapist and author of several books on temperament traits.

One organization often tied with the anti-psychiatry movement is the Citizens Commission on Human Rights (CCHR), founded in 1969 by the Church of Scientology and Dr. Thomas Szasz, who has continued to support this group over the years, though not associated with Scientology. Scientology has used its considerable financial resources, funneled through CCHR, to wage media campaigns against various psychiatrists, psychiatric organizations, and pharmaceutical companies (especially Eli Lilly).

According to Time magazine, Dr. Breggin admits that he was once an ally of Scientology and that his wife was a member.[13] The prominence of Dr. Szasz — a co-founder of the CCHR — within the anti-psychiatry movement adds to this confusion.

The antipsychiatry movement is much larger than Scientology and is primarily made up of psychiatric survivors, civil libertarians and dissident mental health professionals such as Dr. Peter Breggin.

One controversial offshoot of the anti-Psychiatry movement is the Pro-ana movement, whose members argue anorexia nervosa is an alternative lifestyle rather than a disorder.

Parodies

Although not specifically connected to the anti-psychiatry movement, a parody by autistic rights activists titled Institute for the Study of the Neurologically Typical includes a page with diagnostic criteria for what it calls Psychiatry disorder. It describes psychiatrists as persons suffering from delusions, who believe they must rescue others from themselves, and who believe they are able to tell not only what is going through the minds of others, but also what should be going through the minds of others.

See also

• Autism rights movement
• Bruce Levine
• Chemical imbalance theory
• Douglas C. Smith
• Elliott Valenstein
• Evolutionary neuroscience
• ICSPP
• Joe Sharkey
• Laura's Law
• Peter Breggin
• Psychopathology
• Sanity
• Social constructionism
• Tom Cruise

External links

Psychiatry media reports and opinion

• BBC.co.uk 'The Century of the Self', BBC documentary (explores Freud family role in fostering the "rise of the self", from Sigmund Freud, to Anna Freud, to Edward Bernays and to Matthew Freud)
• AntiPsychiatry.org 'Schizophrenia: a nonexistent disease', Lawrence Stevens, JD
• Mother Jones Medicating Aliah, 'When state mental health officials fall under the influence of Big Pharma, the burden falls on captive patients. Like this 13-year-old girl.'
• Oikos.org - The Dark Side of Psychiatry
• ZMagSite.org - 'Eli Lilly, Zyprexa, and the Bush Family: The diseasing of our malaise', Bruce Levine (May, 2004)
• Tripod.com - 'The Myth of Mental Illness', Dr. Sam Vaknin
• UEA.ac.uk - 'What was Anti-Psychiatry?' (article critical of psychiatry)
• UKY.edu - Philosophy of Psychiatry Bibliography
• findarticles.com 'The quandary over mental illnes', an archived copy of the article in USA Today, with a focus on disagreement between psychiatrists and its critics; by Richard E. Vatz, Associate Psychology Editor of USA Today.

Sites dedicated to prominent figures

• Breggin.com - Homepage of Peter Breggin
• Claudio Ajmone - official Home Page
• LaingSociety.org - The Society for Laingian Studies
• Mosher Soteria - Loren Mosher, MD, (1933-2004)
• PsychLaws.org - E. Fuller Torrey, MD (biographical summary)
• Szasz.com - The Thomas S. Szasz, MD, Cybercenter for Liberty and Responsivility

Organizations critical of psychiatry

• AdBusters.org - Prozac Spotlight
• AHRP.org - Alliance for Human Research Protection
• AntiPsychiatry.org - The Antipsychiatry Coalition
• CCHR.org - Citizens Commission on Human Rights, website of the Church of Scientology off-shoot
• GIDReform.org - Gender Identity Disorder Reform Advocates (opposes psychiatric classifications of transgendered people)
• IAAPA.ch - International Association Against Psychiatric Assault
• ICSPP.org - International Center for the Study of Psychiatry and Psychology
• OISM - Italian Observatory on Mental Health
• MindFreedom.org - Support Coalition International (a coalition of groups supporting "United Action for Human Rights in Mental Health")
• PsychRights.org - Law Project for Psychiatric Rights
• Psychosurgery.org - Lobotomy victims remembered