If we are to achieve the much-needed paradigm shift in the way we respond to human suffering, it is imperative that the various strands of the anti-psychiatry movement unite. Given the powerful vested interests sustaining the dominant bio-medical model, a fragmented opposition will possess insufficient power to transform the current mental health system. Indeed, the adage, ‘united we stand, divided we fall’, has never been more apt.
As a vocal critic of Western psychiatry I actively engage in a variety of social media and, like many others on this side of the debate, often find myself embroiled in arguments regarding the most appropriate ways to help people who are experiencing emotional distress and overwhelm. Predictably, many of these spats are with biological psychiatrists and others wedded to ‘broken brain’ explanations. But – perhaps more surprisingly – I’ve witnessed a growing number of passionately expressed differences between people who each identify with the anti-psychiatry movement.
What are the sources of these conflicting ideas?
I suspect that tensions within the diverse range of voices striving for radical change in our approach to emotional distress originate from three major sources.
1. Abolitionists versus reformers?
One important line of division seems to be around whether the ultimate goal of our efforts should be total eradication of psychiatry or its radical reform.
Many argue that the inherent inadequacies of Western psychiatry are so deeply engrained as to render the current system beyond repair. It is reasoned that the ‘illness like any’ approach to human suffering, justifying the gross overuse of psychotropic drugs and a perverse approach to risk, is now so energetically defended by vested interests – the pharmaceutical industry and a psychiatry profession desperate to retain its status as a bona fide medical speciality – that the prospect of meaningful change in our mental health services is remote.
The abolitionists often highlight the human-rights violations, and the mental health legislation that legitimises them, as justification enough for calling for an end to psychiatry. They claim that the collusion between the state and medicine, enabling doctors to incarcerate law-abiding people and enforce ‘treatments’ without their consent, propels a psychiatrist into the role of enforcer of the government’s desire to control those who they deem to be troublesome. These discriminatory practices, it is argued, can only be halted by the total dismantling of the institution of psychiatry.
In contrast, the reformers draw attention to pockets of good practice within the existing mental health service, where innovators are striving to change the system from within. Promising initiatives, such as Open Dialogue, are held up as evidence that radical change can be realised within the existing psychiatric service. They propose that critical voices need to focus on incremental, evolutionary improvements rather than demanding a revolution.
2. Service-user versus professional perspectives
The relative weights given to the views of service users and mental health professionals is another major source of tension within the anti-psychiatry movement.
At one end of the continuum are those people who have – understandably – been alienated by their direct experience of receiving ‘treatments’ from psychiatry, and often feel traumatised by their time spent in the services, who assert that anyone who has worked as a mental health professional (medical or otherwise) is automatically rendered incapable of being an ally in the struggle for psychiatric reform. Making a living from collusion with psychiatry’s human rights abuses, the argument goes, is unforgiveable and strips the person of any credibility as an opponent of the current system.
On the other side of the spectrum are those critics of psychiatry who assert that the vast majority of mental health professionals entered into these careers expecting to learn skills that would help reduce human suffering, rather than for the opportunity to control, dominate and abuse. Furthermore, from a pragmatic point of view they argue that, if radical change is going to be realised, agents of change need to be operating within the psychiatric system as well as outside it. And given that psychiatric professionals typically possess much more power than the people they are paid to serve, it would be foolish and self-defeating to disqualify this potentially influential ally.
3. Societal influences versus individual responsibility
Critical voices pushing for alternatives to biological psychiatry all recognise that societal ills (such as homelessness, poverty, discrimination and inequality) contribute in a significant way to the level of mental health problems within our communities. Nonetheless, there seems to be diverse views about the magnitude of societal change that is necessary to achieve a radical shift in the way we approach human suffering.
Many people within the anti-psychiatry movement argue that a marked improvement in the emotional wellbeing of our citizens cannot be achieved within the political systems that currently dominate the Western world. They claim that globalisation, and the capitalist philosophy that underpins it, are engine rooms for the divisions and inequalities that fuel mental distress and that the total rejection of these political systems is an essential prerequisite for radical change to the way we prevent, and respond to, human suffering.
Activists who support this revolutionary stance typically emanate from the left of the political spectrum and champion socialist ideologies. Within this frame, mental health problems are viewed as inevitable consequences of a sick society with the individual sufferers having little or no power to improve their plights.
In contrast, others arguing for alternatives to biological psychiatry put greater emphasis on personal responsibility as a vehicle for recovery. Espousing the virtues of choice and free will, those on this side of the debate typically seek to minimise state involvement – via policies or laws – preferring to allow individuals to navigate their own routes to wellbeing, unfettered by government interference. In a more extreme form of this philosophy, it is assumed that each of us, irrespective of the environmental context, possess the inherent capability to steer our escape from emotional pain via a sequence of rational decisions – in effect, to think our way out of our problems.
The above describes my personal musings on the sources of divisions within those opposed to the traditional psychiatric system. I would be keen to hear the views of others in the comments section (below).
In the second part of this blogpost I will suggest that there may be common goals around which the various strands of the anti-psychiatry movement can collaborate, thereby enabling a collective effort to radically change the damaging and relatively ineffective bio-medical paradigm that continues to dominate our approach to human suffering.
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