Anti-psychiatry
Anti-psychiatry, sometimes spelled antipsychiatry, is a movement based on the view that psychiatric treatment can often be more damaging than helpful to patients. The term anti-psychiatry was coined in 1912, and the movement emerged in the 1960s, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatric medications to demonstrate any deterministic treatments, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historical critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive therapy and insulin shock therapy. The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of whom 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 and psychoactive medication, 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. Anti-psychiatry considers psychiatry a coercive instrument of oppression due to an unequal power relationship between doctor, therapist, and patient or client, and a highly subjective diagnostic process. Involuntary commitment, which can be enforced legally through sectioning, is an important issue in the movement. When sectioned, involuntary treatment may also be legally enforced by the medical profession against the patient's will.
The decentralized movement has been active in various forms for two centuries. In the 1960s, there were many challenges to psychoanalysis and mainstream psychiatry, in which the very basis of psychiatric practice was characterized as repressive and controlling. Psychiatrists identified with the anti-psychiatry movement included Timothy Leary, R. D. Laing, Franco Basaglia, Theodore Lidz, Silvano Arieti, and David Cooper. Others involved were Michel Foucault, Gilles Deleuze, Félix Guattari, and Erving Goffman. 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 idea of mental illness being a myth in the book The Myth of Mental Illness. However, his literature actually very clearly states that he was directly undermined by the movement led by David Cooper and that Cooper sought to replace psychiatry with his own brand of it. Giorgio Antonucci, who advocated a non-psychiatric approach to psychological suffering, did not consider himself to be part of the antipsychiatric movement. His position is represented by "the non-psychiatric thinking, which considers psychiatry an ideology devoid of scientific content, a non-knowledge, whose aim is to annihilate people instead of trying to understand the difficulties of life, both individual and social, and then to defend people, change society, and create a truly new culture". Antonucci introduced the definition of psychiatry as a prejudice in the book I pregiudizi e la conoscenza critica alla psichiatria.
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 harmful, although they usually accept that there are issues that need addressing. Medical professionals often consider anti-psychiatry movements to be promoting mental illness denial, and some consider their claims to be comparable to conspiracy theories.
History
Precursors
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, a "moral treatment" movement challenged the harsh, pessimistic, somatic 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, there was a shift in the perception of madness, whereby it came to be seen as less about delusion, i.e. disturbed judgment about the truth, than about a disorder of regular, normal behavior 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. Another form of treatment involved nature's opposite, the theater, where the patient's madness was acted out for them 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. Foucault also argued that the increasing internment of the "mentally ill" 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.
The techniques and procedures of the asylums at this time included "isolation, private or public interrogations, punishment techniques such as cold showers, moral talks, 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 summarized 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.
Other analyses suggest that the rise of asylums was primarily driven by industrialization and capitalism, 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.
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 medicalization of "madness". Those critiques occurred at a time when physicians had not yet achieved hegemony 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, the author of Robinson Crusoe, 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 arose in England in the mid-19th century to challenge the system and campaign for rights and reforms. In the United States, Elizabeth Packard 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 nature of mental hospitals 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 19th century and developed allegedly more invasive treatments, opposition increased. In the Southern US, black slaves and abolitionists encountered drapetomania, 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, 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.