Reflections on the 2012 Radical Caucus Meeting

Bradley Lewis
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This year’s American Psychiatric Association (APA) convention was a charged affair owing to a number of factors, including the intense DSM V controversy, the recent high profile critiques of the profession (such as those by Robert Whitaker and Marcia Angell), the presence of documentary filmmakers shooting an expose on the APA’s role in an iatrogenic death from antipsychotics, and the new energy, participation, and strategies that Occupy Wall Street protesters brought to meetings. Out of all this, one of the most fascinating moments in the conference was when “APA Radical Caucus” invited psychiatric activists from Mindfreedom and the Icarus Project to their annual caucus meeting.

The invitation started with a protest meeting organized by Mindfreedom where Robert Whitaker, Jim Gottstein, and Keris Myrick spoke at the nearby Church of St Luke on “Imagining a Different Future in Mental Health.” This gathering attracted some members from the Radical Caucuswho then invited activists to come to the Caucus meeting later that evening.

The Radical Caucus meeting that followed turned out to be electric.

The Radical Caucus has existed for decades. Whatever radical or activist legacy it may have from the old days, for the last few years it has been more or less the same few psychiatrists meeting for presentations and discussions on political issues within and around psychiatry. A good conversation often occurs, then everyone goes out for dinner and drinks, and the conversation usually gets even better. But that is pretty much all that happens.

This year was already different because the protests and the controversies brought more psychiatrists, journalists, and filmmakers to the table than usual. Moreover, as already mentioned, this time there were representatives from the psychiatric activists groups at the table as well. The air was pregnant with energy and tension.

When the Radical Psychiatrists tried to conduct the meeting with a presentation and discussion followed by dinner and drinks the activists got angry. David Oaks, from Mindfreedom, led the way by refusing to sit quietly while the Radical Caucus proceeded with business as usual. He stood up, he got angry, he yelled, he sang a song, he put on his red nose, and he pounded on the table.

It was a dramatic and energizing performance.

Mr. Oaks was deeply concerned that the group lives up to its name, “Radical Caucus,” and that it take a serious stand on critical issues around psychiatric coercion and forced treatments. He was particularly concerned about forced electric shock treatments, which have been a longstanding Mindfreedom concern (for details see http://www.mindfreedom.org/campaign/electroshock-initiative ).

To my mind, what happened next was the most disappointing. The psychiatrists in the room attempted to normalize the conversation and they became defensive and self-justifying. They talked about how we should all get along and treat each other with respect and with proper decorum. They complained that they were being misunderstood because they are trying hard, they really care, they don’t want to hurt anybody, and they often feel they have no choice other than to use coercion and forced treatment, etc, etc. Some of the psychiatrists argued that there is scientific evidence to support forced treatment methods.

All of this made the activists even angrier and left the psychiatrists feeling more misunderstood and the meeting ended up in relative paralysis. That said, there was lots of back and forth, and everyone (psychiatrists, activists, journalists) did go out afterword for dinner and drinks. I had to catch a train, but I can only imagine that the conversation got even better!

What can be said constructive about such an event? First off, obviously it was a good try on everyone’s part. The key mantra of all medical activism—from Women’s Health, to ACT-UP, to Disability Rights, to Mad Pride—is NOTHING ABOUT US WITHOUT US!!! There’s a deep injustice built into the heart of healthcare where the primary stakeholders, the service users, are not included in creation of healthcare priorities, research, education, practice, and institutions. It’s so obvious a flaw that no one can seriously argue against it. Would women want men to decide “womens’ issues?” Of course not. It’s absurd. It wouldn’t help if the men said that they were trying their best and that they really cared. It also wouldn’t help if they said they were being “scientific” and therefore “objective, value free, and unbiased.” Trying hard and using science is not enough. The only solution to exclusion is inclusion.

So this meeting, for all its difficulty, was a move in the right direction. It brought key stakeholders to the table with at least marginal participants in psychiatric knowledge, practice, and institution building. Where it broke down, from my perspective, was that the marginal insiders, the Radical Caucus, did not think that the key stakeholders had the right agenda (I say key stakeholders because if any activists group has earned the right to speak it is Mindfreedom and the Icarus Project.)

The radical caucus psychiatrists did not know how to recognize that the last century of exclusion of key stakeholders from psychiatric knowledge-making means that the people who have been talking need to let the other side control the agenda. The 100 year psychiatric monologue of experts talking about “patients” needs to become a dialogue. That starts with talkers being quiet for a while and listening to the other side of the conversation.

To be fair, many of the participants in the Radical Psychiatry Caucus are also members of the American Association of Community Psychiatrists (AACP). The Radical Caucus may be mostly a conversation and dinner group, but the AACP has tried hard for a long time to redress the “nothing without us about us” problem. The AACP, more than any other group in psychiatry, has tried to take seriously the idea of “recovery” for mental health services.

This recovery approach, as many people know, starts from within the activist community and it calls for much more active consumer participation, peer support, and alternative choices. It also calls for a much more hopeful approach to psychic difference and struggles that emphasizes the goals of well-being, spirituality, community, and justice over simple symptom reduction.

Part of the reason that the AACP members of the Radical Caucus were defensive is that they think they have been trying to live up to recovery concerns. There are two main problems with being too self-congratulatory here. The first is the way that recovery has been taken up is largely controlled by psychiatrists rather than consumers themselves. It is the psychiatrists, powerful budget administrators, and increasingly big pharma marketers who are having disproportionate influence on how consumers can participate and picking which consumers are appropriate. That means many activists are increasingly wary about the way that “recovery” is being adopted. Second, and more to the point of this meeting, the psychiatric activists at this meeting were not talking about recovery. They were talking about coercion and forced treatment.

For whatever reason, and I’m not sure I completely understand it (although of course I can weave a story around it if I have to), psychiatrists, even radicals and AACP members, were unable to hear these concerns. It wasn’t like the activists were hard to understand. They were being very clear, even willing to go to dramatics, to help people know that to their minds the most important issue for the meeting was forced treatment. And, in view of the 100 year monologue of experts, why shouldn’t the activists get to decide what is most important?

The other constructive thing to say is that the meeting was also a move in the right direction in terms of building a coalition. One of the reasons that the radical psychiatry caucus has mostly turned into a dinner group is that they feel so disempowered relative to the larger APA. It is unlikely that the APA is going to convert to a radical agenda soon, so the next step is to build a coalition to unleash additional sources of power. Psychiatric activists are key place to build affinity.

Also, another important person at the meeting was psychiatrist Duncan Double from the UK “critical psychiatry network” (http://www.criticalpsychiatry.co.uk/). Dr. Double added important perspective because unlike in the US, in the UK, critical psychiatry really does function as a “radical caucus.” The critical psychiatry network actively challenges the NHS on number of issues, including coercion, confinement, and forced treatment. Since Western psychiatry is rapidly globalizing, resistance and radical caucus type activity are emerging around the world. These can be sources of coalition power. There is a recent international offshoot of the UK group, the international critical psychiatry network,”which would be a good place for the Radical Caucus to build affinity (http://www.criticalpsychiatry.net/).

There’s also increasing opportunities to build coalitions with humanities and social science scholars and students who are rapidly developing work in madness studies (seeLiterature and Medicine2009 28.1: 152-171.) Also, there are radical social workers, psychologists, physicians, etc.

For better or for worse, all of this affinity building will require new participation in the Radical Caucus from within psychiatry. The well-meaning psychiatrists who have kept it alive all these years cannot do it. It needs a new generation of energy. Maybe, just maybe, new revolutionary times will be the stimulus.

Bradley Lewis MD, PhD is an associate professor at New York University’s Gallatin School of Individualized Study and a practicing psychiatrist. He has interdisciplinary training is in humanities and psychiatry and his recent books are Narrative Psychiatry: How Stories Shape Clinical Practice and Depression: Integrating Science, Culture, and Humanities.

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20 COMMENTS

  1. some time ago, Another blogger on this site wrote about the lack of critical thinking in psychiatry. If I understood her, it seemed as though critical thinking, or the willingness to question assumptions, is actively discouraged in the profession. I have seen this operate in my own organization. I have no doubt that the “radicals” are well intentioned, work hard, and so on. They cannot see the parameters of their own schema, and so cant understand the anomolous, outside the box perceptions. these are simply too contrary to what they have been required to believe. If they were to begin questioning assumptions, even very basic ones, they would all have little choice but to join our Dr Keyes on sabatical.
    I am proud to have been with you all in philadelphia last weekend. Robert Whitakers book changed my life.

  2. Having attended this meeting I agree with much that Brad Lewis had to say about it, although I think that there were many psychiatrists in the room who were not defensive and who were really interested in listening to the folks from Mind Freedom and Occupy Psychiatry. While Brad did accurately describe the tensions that arose from the meetings structure and the comments made by some of psychiatrists who chose to speak, I think it is inaccurate and simplistic to paint all the psychiatrists in the room with the same brush, just as it would be to believe that all of the survivors in the room have the same beliefs and feelings as the ones who were most vocal.

    Part of the problem was that there was an attempt to stick to an agenda that did not really serve the occasion. As Brad suggested, what we really need to have is a dialogue that allows an airing and examination of the stereotypes that entrap all of us, the power inequalities that poison our relationships, and the mistrust that arises from past experiences. It is only through these interactions that we will achieve a true reconciliation and a foundation for new relationships that would permit a partnership for a successful activist agenda.

  3. Among the unconscious elements in righteous reformism is primitive destructiveness.Thus Lenin ordered the execution of the Tsar’s innocent wife and children along with hundreds more without trial,while no left-wing liberal,except Bertrand Russell,labelled him a monster then or since.After all,did the Tsar forbid the execution of Lenin’s youthful brother? I myself have been a reformer,not only of psychiatry-with papers 60 or more years ago urging the abolition of insulin coma therapy and of mental hospitals yet I’m suspicious about the inner workings of todays radical psychiatrists and advanced thinking reformers as well as of my own.

  4. Thanks for this report. Very interesting to know there is a “Radical” Caucus. How many people are the core of this group?

    I’m wondering also what the tone was within the APA convention. Is there any sense that psychiatry is embattled? Is anyone questioning the APA leadership and direction?

    Also, I want to stand up for a group of psychiatric victims that are all but unseen, although they are the vast majority of psychiatric patients. Those are the people prescribed antidepressants, often for years and for no good reason.

    They constitute 90% of psychiatric patients.

    Their issue is not forced treatment but stupid treatment. Their lives are endangered by unnecessary, ineffective psychiatric drugs just as surely as those treated with antipsychotics.

    It is from this vast number of people — about 30 million in the US — that many cases of iatrogenic diabetes will arise, as well as other serious health problems, to swamp our lousy health system.

    I would have gone to Philadelphia myself to speak up for these people, but I have been unable to travel for 3 years due to neurological damage from Paxil withdrawal.

    • Not 100% sure about the situation in the U.S. (would be surprised, though, to hear it was much different), but if there’s a group of people in Europe whose iatrogenic suffering is unseen, overlooked, and silenced to a far greater extent than any other, it’s those who are (force-)fed neuroleptics. There hardly goes one single day these days where there’s not an article in one or the other newspaper, a debate on TV, or some other public attention on the risks of antidepressants, stimulants, and benzos, on the lack of evidence for their efficacy, on the influence of the pharmaceutical industry, on personal tragedies, etc. etc.. I wouldn’t call that “unseen”.

      The narrative in the public these days goes like this: “There are all these people who’ve been subjected to harmful treatments when some talk therapy, exercise, and nutritional advice could have helped them, and who maybe aren’t even brain diseased, many of them. Isn’t it time to start and rethink the approach to these people’s problems? But, hey, that of course doesn’t mean that we should rethink our approach to the real loonies! God forbid that we get a critical debate about our approach to these non-people, and they toss out their necessary meds!” Us and them.

        • Marian is right though. Those who are force-fed antipsychotics are the forgotten ones and who have lost their human rights. I rang around looking for doctors and clinics to help my son off antipsychotics and the answer I got was every time: “We help people off benzodiazepines, sleeping tablets, anti depressants and pain-killers. We don’t get people off antipsychotics” So we had to go it alone and it was jolly hard.

          • Please send me the contact information for those doctors and clinics who will taper people off psychiatric drugs at survivingads at comcast dot net. I’m looking for doctors anywhere in the world who do this.

  5. Brad,

    I’ve heard you interviewed on Madness Radio and am excited to see you here at MiA. Welcome!

    Thank you very much for this piece and all I can say is please tell us more! My spouse and I were at the the APA protest and mini-conference you describe. I only saw one person there with APA ID on (Steve Balt, who told me he was unaware of other psychiatrists who had come. Thank you for coming, Steve!) Of course there may have been others I didn’t see, or who came without their badges. My spouse and I thought it was amazing that in a city hosting 10,000 psychiatrists a church a few blocks away from the convention center couldn’t attract more psychiatrists to hear Robert Whitaker. We thought that intellectual curiosity, if not outright solidarity, would have drawn in at least a couple dozen. (Actually only my husband, a leftist academic who has only experienced the mental health system vicariously, thought this. My own estimate was more realistic.)

    How many came to hear Bob, Jim, and Keris from the radical caucus? How many members does the radical caucus have? What are some examples of presentations and discussion topics from past years? Have minutes or other records been kept from these meetings? I’m eager to learn more.

  6. Thanks, Dr. Lewis, for sharing your description of the meeting. I think we’ve had other fruitful on-line communications before. I appreciate any psychiatrists getting more involved with this web-site and hopefully blogging (if you have thick skin). Please consider becoming a regular blogger, Dr. Lewis (and Dr. Sowers). Carl Cohen has been the leader of the caucus, so his input is needed in this discussion.

    I’ve come to the Radical Caucus on and off over the years, but could not this year. What I heard from some other psychiatrists who were there is disappointment that the meeting was not more fruitful. It reminded of some of what happens to blogs posted by psychiatrists here; there are attempts to shout us down and get rid of us. That won’t get us very far if we need to work together in any way.

    Yes, psychiatrists have by far more power than consumers, but much less than is often thought. That is why I see very well-meaning psychiatrists leaving the field completely. The “system” has by far the most power. Can we find ways to join together to improve things, and do so respectfully?

    • Steve,

      Thank you for inviting Brad to join the conversation! I, too, hope more psychiatrists will participate.

      Since you express the hope that a broader and more diverse conversation take place at MiA, I am curious as to your opinion on the “healthcare professionals” only comment policy at the Psychiatric Times. I know you blog for PT so this affects you, as well as those of us who are not allowed to comment there. Do you support this policy? Is there talk of changing it?

      These are not rhetorical questions and I hope you will respond.

    • Just wanted to say again, it is virtual shouting and, while it can be off-putting, is not an actual threat.

      The participants here are not bound by any kind of professional etiquette or inclination to reasonableness. Some are expressing anger after what they consider to be unconscionable abuse. They also attack non-doctors.

      There are others who want to have a discussion.

      Not every comment requires a response.

      I also hope we hear more from Bradley Lewis and the Radical Caucus.

  7. I think by attacking an idea you end up in the position where you end up in a worse position than the people who support the idea.

    I have just picked up a book that says on it’s inside cover:

    “Writings on madness fill entire libraries but until now nobody has thought to engage exclusively with the idea of sanity; we define it simply as that bland and nebulous state of not being mentally ill. But what is sanity? How broad, how eccentric is it’s range of behaviour? And how do we go about crafting a creative and fluid definition of a sane existence, One we can guide ourselves by.”

    I think if we devoted some time to define “sane” rather than take the attack to “their” battlefield where they use DSM to define madness.

    We should set up our battlefield for them to prove People like Ewen Cameron, who ran the MK-Ultra program for the CIA and guided psychiatrists along the theoretical path where people believe mental illness is biological, was not MAD but was actually. I believe he was an egomaniacal madman.

  8. Sorry I got so mad thinking about Ewen Cameron I sent off that comment without thinking. As you can read in Wikipedia Ewen Cameron Dr. Ewen Cameron who Was at the Allen Memorial in Montreal in the 1950’s Attached to McGill University, which could be considered the Canadian equivalent of Harvard or Yale. When he was at the Allen Memorial there were 70 psychiatrists in Canada. 40 of them were in Montreal.

    He was trained in the 1930’s when training similar to that given to psychiatrists in Germany. And we know where their training led. After the German psychiatrists had proved how efficiently they could deal with people who had mental illness the NAZI’s carried on with the Jews, the Gays and anyone else they did not feel was “normal”.

    I would like anyone who thinks they can change a person’s personality simply by administering a chemical compound prove to me that they are sane.

    I would also like a bunch of RICH PRIVILEGED OLDER, MOSTLY
    MALE people who stay in Expensive Hotels on an expense account to hold meetings to discuss what they think is normal human behaviour explain to me how sane it is. Except for a few who had to work their way through school they have absolutely no concept of what most people have to go through to work for a living. They have probably spent all their life in an academic cocoon and have absolutely no idea of the stresses most people go through in daily living.

    Oh, by the way, the book is called “Going Sane” and the Author is Adam Phillips.

  9. The more we can enhance wellness and “sanity”, as well as prevent what is called mental disorders, the better.

    As to Psychiatric Times, I have advocated for the comments to be open to those who are not professionals. I have been turned down so far, in part because of the vitiolic comments that we often see on Mad in American. Sure, the internet allows such vitiol and anonymity, but words still can hurt. I realize such way of commenting is common to many, many other internet sites. Maybe if this site becomes more respectful and others feel comfortable to participate, then Psychiatric Times will become more open.

    • Venting and vitriol are common across the Internet. It’s normal human behavior when individuals are not held responsible for their posts via anonymous posting or unmonitored posting.

      Bad behavior is not restricted to any particular group, patient or otherwise. Many people have axes to grind and, given an opportunity, they will.

      Unfortunately, injured patients have so few avenues to vent, they may overstep boundaries of civility on MIA. Being injured by doctors is a highly emotional issue that does not easily resolve.

      Physicians don’t have the time or interest to read attacks and rants. Yet, doctors need to hear about bad outcomes, too, as they tend to avoid that information.

      How can patients communicate the failure in care in a way that enables the doctors to hear it?

    • Words can still hurt? Not anywhere near as much as feeling like you are breaking your own neck because you have just taken stelazine, not as much as being raped with chemicals.

      Maybe people will start being more ‘civil’ when you start being more ‘civil’ in your treatment of the ‘mentally ill’. My civility is contingent upon a restoration of patient’s rights and dignity.

      There is little ‘civil’ about what you advocate, or am I not being ‘civil’ enough, in speaking the truth?

      Asking a psychiatric slave and rape-victim to be ‘civil’ towards his aggressors is like asking a a Jewish person to be civil towards a Nazi, a legally designated slave to his master. I will not waste honeyed words on an adversary. The man thinks anything is admissable in the attainment of his paradoxically dystopian utopia, as do all totalitarian-utopians.

      Mr Moffic is no better at judging what is ‘civil’ than he is at judging what is in the best interests of the ‘mentally ill’. Most of what he probably considers uncivil is simply what he doesn’t like to hear said about his own profession. A lot of the time I think it is the truth he deems erroneously or maybe even strategically to be uncivil.

      What next, banning anyone who utters the unvarnished truth on the grounds that it has been misconstrued as uncivil?

  10. I really don’t understand what people think they are accomplishing by meeting with groups of mainstream psychiatrists. They don’t need to be “educated.” They know perfectly well what they are doing, and they do it because (1) they don’t see us as human and couldn’t care less what happens to us and (2) because they can. As long as they have the almost unlimited power they have, and as long as the general public sees us as non-persons, just as slaves were perceived in the nineteenth century, all the abuses we experience will continue.

    I think our job is to delegitimize psychiatry by getting the general public to see how the way it is practiced is damaging a greater and greater proportion of the population. We need also to try to get the public to see that almost anyone, not just the stereotypical “crazy on the street,” is at risk of being labeled and forcibly “treated.” The APA is helping us with this with the new DSM, and we should take advantage of that.

    Please, those who want to put energy into meeting with mainstream psychiatrists, tell us what you hope to accomplish. Don’t just talk about “dialogue.” Dialogue is not an end in itself. Tell us what you think that dialogue will lead to.