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A look at the anti-psychiatry movement.

Are you Anti-Psychiatry?

Beginning in the 1960s, a movement called anti-psychiatry claimed that psychiatric patients are not ill but are individuals that are misfits in society, and therefore put into asylums. Adherents of this movement often refer to the myth of mental illness, after Dr. Thomas Szasz' 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. Leading lights of the anti-psychiatry movement included Thomas Szasz and R. D. Laing, both psychiatrists. Other critics of psychiatry often associated with the anti-psychiatry movement include Dr. Peter Breggin and Jeffrey Moussaieff Masson, a psychoanalyst who uncovered evidence that Sigmund Freud had suppressed observations of child sexual abuse. Civil libertarianism has opposed psychiatry or abuses of psychiatry on constitutional or other legal grounds. Among popular movements against psychiatry are the Psychiatric survivors movement, persons charged with abuse based on repressed memories, political prisoners of totalitarian regimes, and certain documenters of the Nazi holocaust. The latter point out that systematic euthanasia of people in German 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. A sermon against the earlier practice by Bishop August Clemens 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.

Cooper was a Marxist, and indeed there has been a great challenge to conventional theories of psychiatry from Western believers in Marxism, but the anti-psychiatry movement is by no means homogenous ideologically, and Szasz approached anti-psychiatry from a civil libertarian perspective and challenged Cooper's Marxist beliefs.

Many of their criticisms derived from the inhumane treatment of mental patients, either through the damaging effects of long-term institutionalisation 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. Others contend that even accepted therapeutic practices remain instruments of social control. Punitive use of "treatment", including ECT, isolation, and restraint has diminished, but is still widely documented to occur. (There has been a resurgence of ECT research and treatment in the past decade, 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, and opponents of the practice allege that ECT causes brain damage and has killed several patients on whom it was used, some without their consent.)

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 (RSFSR) with sluggishly progressing schizophrenia, when compared to four different types of schizophrenia recognized in the West, led some to question the existence of schizophrenia.) The alleged practice of the United States Secret Service, endorsed by the agency, of attempting to get involuntarily committed those it perceives (its critics would have it, perceives or claims it perceives) to be a danger to its protectees, rather than because of their mental illness, is claimed by some to come closest to these Soviet practices.

Others object to psychiatry not on these grounds, but on the grounds of the fact that 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. As Karl Popper noted, if it isn't falsifiable, it isn't empirically testable--and if it is not empirically testable, it is not science at all.

During the 1970s the anti-psychiatry movement acquired sufficient respectability to advocate restraint from the worst abuses prevalent in Psychiarty. Jurists such as David Bazelon brought legal force and stature to anti-psychiatry sentiments. Still, in the modern therapeutic culture with pharmaceuticals promising relief from all that ails, those who question the ethics and efficacy of psychiatric practice are far from mainstream.

Arguments against anti-psychiatry

The discovery of evidence suggestive of biological and genetic bases for some mental illnesses has eroded support for the more extreme claim among portions of the anti-psychiatric movement that mental illness is more a social label than a biological disorder, but such claims persist.

Anthropological studies have claimed that roughly equivalent percentages of people in a variety of cultures, some very different to modern Western culture, develop a disease recognised by that culture as such, with similar symptoms to schizophrenia, and subsequent medical examination of afflicted individuals show similar physical abnormalities as schizophrenics. However, the lower rates of diagnosis for the forms of schizophrenia accepted in the West in Western Europe than in the United States of America, has led some to question the criteria for diagnosis, and even that in some cases schizophrenia is deliberately misdiagnosed in the United States as a means of political or philosophical repression. 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 form of treatment also may vary according to suspect criteria; young black males in the United States are disproportionately prescribed high doses of "anti-psychotic" medication, and blacks are disproportionately subjected to involuntary commitment.

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 that mental illness produces real and terrible suffering which psychiatry and social treatment programs have been effective in relieving. One of their strongest advocates is Dr. E. Fuller Torrey. Torrey maintains that psychiatry diagnoses "normal" people. He also believes in the forcible medication and confinement of those he believes have genuine neurological problems.

Thomas Szasz points out that one of implications of the argument that mental illness does not exist must be that the insanity defense must be abolished. He insists that someone who has killed someone under the influence of psychosis should be fully criminally responsible for this 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.

Modern anti-psychiatric views

Some who are active in anti-psychiatry have not gone so far as to challenge the illness of psychiatric patients but 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 behind bars, that society is far too eager to lock up people with minor mental illnesses. The growing practice in the UK and elsewhere of "care in the community" was instituted partly in response to those 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.

A wide concern is of over-diagnosis. Again, advocates argue that while serious mental illness does exist, currently people are diagnosed as mentally ill, and sometimes detained 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 indeed in a few cases bounty hunters have even been used to take them to private psychiatric hospitals against their will. The treatment of patients in private psychiatric hospitals, chiefly teenagers, has been the subject of investigations by (U.S.) state attorneys general.

A few individuals have criticized some state statutes in the United States that provide for involuntary commitment, for being unconstitutional as they violate the First, Fourth or Fifth Amendments. They argue that in those cases in which the writing or behaviour of the individual examined by a psychiatrist who will possibly be certified as being in need of treatment forms the basis for the diagnosis, 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, in violation of the United States Constitution.

In 1998 Szasz and others staged the Foucault Tribunal on the State of Psychiatry in Berlin (named for the philosopher Michel Foucault who wrote books in 1954 and 1988 about the nature of madness and its treatment). 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.

One organization often confused 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. CCHR has used the considerable financial resources of Scientology to wage media campaigns against various psychiatrists, psychiatric organizations, and pharmaceutical companies (especially Eli Lilly). Dr. Breggin and other prominent figures and organizations in the anti-psychiatry movement have emphatically denounced efforts to associate them with Scientology, from which they are completely independent and, often as not, vehemently opposed. The prominence of Dr. Szasz - a co-founder of the CCHR - within the anti-psychiatry movement adds to this confusion.

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