The Antipsychiatry Movement: Dead, Diminishing, or Developing?

Kermit Cole
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An article in Psychiatric Services that asserts “a renewed yet amorphous critique of psychiatry is emerging, even though the tarnished name of antipsychiatry is studiously avoided by all. This critique may intensify, given the likely media and public interest surrounding the upcoming release of DSM-5.”

Abstract →

Whitley, R., The Antipsychiatry Movement: Dead, Diminishing, or Developing? Psychiatric Services 2012; doi: 10.1176/appi.ps.201100484

From the article:
(Opening Paragraphs)
The term “antipsychiatry” originated in the 1960s to describe a broad-based movement that questioned the legitimacy of standard psychiatric theory and practice. The movement specifically challenged the validity of psychiatric categories, diagnostic practices, and common forms of treat- ment.
The antipsychiatry movement was motivated by anger at the perceived arbitrariness of psychiatric diagnostic practice as well as outrage at the apparent inhumanity of certain treatments, such as electroconvulsive therapy and long-term involuntary hospitalization. Specific parts of the critique propelled reform, including rapid deinstitutionalization and attempts to improve the codification and reliability of psychiatric categories and diagnostic practices embodied in DSM-III and standardized clinical interviews.
Nevertheless, mainstream psychiatry — the body of accredited personnel working in psychiatry and the common practices, treatments, theories, and categorizations they employ — rejected the underlying critique that psychiatry was little more than a pseudoscientific agent of social control. Mainstream psychiatry perpetuated its theories and practices in officially endorsed training programs, educational curriculums, diagnostic manuals, and professional journals sanctioned by the American Psychiatric Association and other organizations.

(Conclusions)
Together, the various disparate activities depicted in this Open Forum characterize a surge in critical thinking regarding mainstream psychiatry. Critics express widespread concern at certain aspects of mainstream psychiatry, commonly demanding significant reform in several domains. Most notably, this concern focuses on psychiatry’s expansionist — some would say medicalizing or imperializing — tendencies as well as its heavy reliance on pharmacological interventions and the many adverse side effects associated with them.
The reliance on medications is also criticized because of the shadowy re- lationship that is perceived to exist between psychiatry and the phar- maceutical industry. This meta-observation has been shared by others outside the discipline, notably the physician Marcia Angell, a former editor of the New England Journal of Medicine, in supportive reviews of books by Whitaker, Carlat, and Kirsch.
The upcoming release of DSM-5 will garner much media exposure and popular interest in psychiatry. This attention may act as a clarion call for the consolidation of the disparate islands of activity that are variously critical of mainstream psychiatry. Though the tarnished name of anti- psychiatry is studiously avoided by all, a renewed yet amorphous critique of psychiatry may be developing that is quite distinct from its supposed successor, the patient-based consumer movement. Although not a resurrection of antipsychiatry per se, the critiques described earlier, while not yet a movement, share many of the original concerns raised by the antipsychiatry movement. Perhaps Rissmiller and Rissmiller were premature in announcing antipsychiatry’s transmogrification. Only time will tell.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

24 COMMENTS

  1. Greetings, all. I am a newbie here and trying to understand. There are so many things I’d like to say, but I’ll try to stay on topic 🙂

    I have been a consumer since the 80s. And before that my mother was a consumer in the 60s, when there were no “consumers,” only “patients.”

    Back in the 60s they only had tricyclics as medication for Major Depression. This article decries ECT, but my mom said she would rather have “shock” treatments than meds any day. She cited the quick relief of ECT as opposed to the trial-and-error waiting game of medications.

    As a consumer/patient, I am whole-heartedly grateful for both tricyclics and especially SSRIs. They have quite literally saved my life multiple times, and may save it yet again. I have a tough time understanding the anti-meds attitude I often see. Perhaps writers in these pages are referring to anti-psychotics, in which case I have little experience and perhaps I don’t belong here.

    Later…

    • Regarding “I don’t belong here”
      The issue of choice confuses people. If we all had the freedom to consume or NOT to consume drugs there would be no controversy.
      This goes to the title of patient/consumer.

      The ill do not want to be ill. To rename “patients” consumers implies that patients have some choice in the matter of illness.

      Who creates or defines a consumer-patient? The psychiatrist. Without the psychiatrist the “consumer” would not exist.

      All you needed was access to drugs, but then what separates you from the street drug user? The cleanliness of the drugs.

      • I have always been uncomfortable with the label “consumer.” Now I understand why: the implication of choice. Thank you for that.

        I also despise the descriptor “behavioral health” that many agencies have adopted. As in “if these people would only ‘behave’ they would be fine.” I much prefer the old name “mental health.”

        I don’t know about the equivalency of street drugs and psychiatric drugs. But then I have been fortunate to have both a good doctor and the same doctor for years. It has not been such a trial-and-error effort for me. I’m sure that’s why I find it hard to understand anti-psychiatry.

        I know that most people aren’t as lucky as I have been. But I’m hear to learn.

  2. “They have quite literally saved my life multiple times, and may save it yet again. I have a tough time understanding the anti-meds attitude I often see.”

    To understand it you have to realize that not everybody has your experience on them. Most people are not helped at all, at least not in the long term, as the research on “antidepressants” clearly shows. Many are also harmed by them, some even irreversibly so.

    To understand negative attitudes toward drugs, you just have to understand that the drugs do hurt people and sometimes wreck lives.

    • Is some of the problem due to the fact that primary care docs hand out antidepressants to people who do no need them? Does phrma encourage this with their ads direct to the public?

      I do understand that these meds harm people, can do terrible, permanent harm. But I guess I had been under the impression that this was not such a frequent problem.

      Thanks for educating me about this.

  3. I would say its developing. The internet is exposing all the lies of the billion dollar psychopharmaceutical industrial complex.

    There old bag of marketting tricks doesnt work as well anymore.

    For examples

    The chemical imbalance lie is almost dead.

    Search the name of any psych-drug with the word lawsuit, they keep geting busted for lies and making people sick.

  4. The article does raise an interesting point I’ve been wondering about myself – what is the agenda of the anti-psychiatry movement today? Over the last few decades it has achieved many important reforms – deinstitutionalization, limiting criteria and lengths for involuntary hospitalizations, providing patients with rights to refuse medication, limiting use of seclusion and restraints.

    What is the focus of the movement now? The key difference between now and 20 years ago is that it is largely a voluntary system today. If one is in receiving psychiatric care today, it is overwhelmingly by choice (minus those of course in forensic facilities, on AOT outpatient court orders or on 72 hour holds).

    It seems that if one is truly anti-psychaitry, one should simply exercise the option not to utilize psychiatric services. However, if one is choosing to utilize them, coming in with the attitude of being ‘anti-psychiatry’ is not going to be particularly helpful. If one is not in agreement with the over-prescribing habits of a particular physician, one always has an option not to take the medication prescribed or to find a different physician who will prescribe more cautiously (or not at all).

    The failure of regulatory oversight of pharmaceuticals is not something unique to the psychiatry field of medicine(or to big business in general – look at what is happening today with regulators for Wall Street, the oil industry, etc.). We need to advocate for more responsible regulation and disclosure of medication effects by the FDA – but this is something that needs to be done by mobilizing all drug safety interest groups – it will not be achieved under a banner of being ‘anti-psychiatry.’

    Perhaps a more productive model would be a collaborative approach focusing on improving the inpatient experience, providing better education and choice, developing ombudsmen to resolve grievances and disputes on care, etc.

    The reform movement may have finally reached a point where we will now catch more flies with honey than with vinegar.

    • “What is the focus of the movement now? The key difference between now and 20 years ago is that it is largely a voluntary system today.”

      If I look to the fact less innocent people are being executed using the death penalty than decades ago, I still maintain my position against the death penalty.

      “It seems that if one is truly anti-psychaitry, one should simply exercise the option not to utilize psychiatric services. ”

      That option, is sadly not an option all the time. They will force this quackery on you.

      “a collaborative approach focusing on improving the inpatient experience”

      There is no way to improve the “experience” of having psychiatry forced onto you. None. Assault is assault.

  5. I think the less dogmatic members of modern anti-psychiatry have morphed into a kind of “consumer protection” movement. The science is still pretty crude. Many pharma abuses are showing up in court cases. We still have a psychiatric industry with old-school power hangups, plus a few notorious sinners. I am not anti-psychiatry but I expect honesty, respect and accountability — and I expect the same from social workers and others who work with vulnerable people.

    The original insight that these disorders are social constructs is still somewhat valid. Certainly the DSM is a classification system based on pattern recognition, committee work and little else, but right now there’s no better way to go after it.

    And as for the notion that not every eccentricity should be medicalized, that goes with the territory. These days more people get to have a say.

      • I love this comment edge! This could practically be a bumper sticker or something.

        There is a lot of truth is this statement.

        I’m proud to say that I am antipsychiatry, but I don’t bother to do that anywhere but here. I don’t have another place of interest and refuge to me. If I didn’t have MIA, I would not have developed an identity of opposing psychiatric interpretations and influence. Everything I know about being antipsychiatry I have learned from MIA!

        We’re lucky to have MIA. We’re lucky to be able to reply to such witticisms as “The Antipsychiatry Movement: Dead, Diminishing, or Developing?”.

  6. The term anti-psychiatry has been made laughable, in order to make its proponents laughable as well. One woman here in Finland told her psychiatrist of several of studies well known for MiA crowd, such as Harrow’s studies, the neuroleptic brain atrophy studies, etc, and he denied them all, he said that there are no such studies. Then he wen’t on to describe Scientology and how they oppose the meds. I can’t see any other reason for him bringing on the subject of Scientology except as an attempt to ridicule these people by inference and association.

    Maybe it’s generally wise to avoid the label anti-psychiatry because of its negative connotations. However, I personally don’t care – I don’t get my money from psychiatry or pharma and I don’t care if they think I’m a crackpot, and I’m not looking for a huge following. In some ways it’s an apt term, maybe it’s time to vindicate some of it.

    • This is why I believe legal action must be taken (here in the U.S., but anywhere else as well) because a doctor who is juggling the lives of patients, including ones against their will, should not be allowed to ignore scientific studies or have conflicts of interest.

      If you’re an ignorant auto mechanic who damages my car by not being up to date with information than I can sue you at the very least. When psychiatrists practice “medicine” while turning their head to important studies (this has been going on since at least the early 60’s) they should be held directly responsible for the harm that it causes.

      It is also not someone else’s responsibility to educate them. The information is out there, in books like Whitaker’s, and on the internet. They should have no excuse that because it wasn’t in this or that medical journal that they should be spared. When you’ve got peoples lives in your hands the very least you are expected to do is make sure that you’re not hurting or killing them.

  7. I got into anti-psychiatry what ever that means exactly after the standard “injectable form” threats to try and coerce me to take haldol and start taking trileptal… They were calling alcohol withdrawal reactions symptoms of BP.

    This “risperdal rape” depot injection thing is evil.

    I swore to myself if that “risperdal rape” was carried out I would kick that doctors teeth in outside the hospital when it was all over. Hurt him real bad and then do the jail time with a smile on my face.

    If you prick us, do we not bleed?
    If you tickle us, do we not laugh? If you poison us,
    do we not die? And if you wrong us, shall we not revenge?

    All this politics and philosophy is nice but lets not forget the violence and brutality thats called psychiatric “treatment”.

    Inpatient psychiatric treatment- Abuse of a type particularly gratifying to the abuser, in that it combines the pleasures of sadism with those of self-righteousness…

    Because they are called “treatment” not punishment, they seem to be criticized only by fellow-experts and on technical grounds, never by men as men and on grounds of justice…

  8. Many prefer civil and conformist ways of influencing issues, maybe with negotiations and suggestions things will be changed. I’m not always with them. Nietzsche, Feyerabend, Sex Pistols, did they do wrong with their non-conformist ways? I think not. Decry me as an anti-psychiatrist, and I’ll proudly take the title and spit on your face. I can’t stand idiotic pseudo-science for social control.

      • I prefer to label myself as militantly anti-Biological Psychiatry. Biological Psychiatry represents the wedding of those psychiatrists who promote genetic and biologically based theories of so-called “mental illness” with the pharmaceutical corporations and the major medical instituions of higher(actually lower)learning who train them.

        I believe there is a very small minority of progressive to radical psychiatrists who can be united with and become important allies in our struggle to totally dismantle modern psychiatry’s oppressive bio-medical model. This group can play a vital role inside the belly of the beast by disrupting “business as usual” and helping to plant our pole of militant opposition, including giving a voice to our most powerful and articulate survivors of their crimes.

        If all NEW prescriptions for psychiatric drugs were completely stopped today, there would still be a valuable role for “properly” trained doctors, over the next few decades, to help the current victims of this medication holocost to safely taper off or reduce their dependence on these toxic substances. A major scientific effort could be launched to study tapering protocols and find the ways to help strengthen people’s coping mechanisms and overall resilience. In the absence of psych med prescriptions perhaps more emphasis could also be placed on prescribing appropriate placebos.

        As to whether or not our current concept of psychiatry will still exist or be something completely different at the conclusion of this revolution, I don’t think we can answer that now. Hopefully those psychiatrists willing to play a role in this coming battle have the courage and moral fortitude to risk their careers to do what is historically just and correct.

        Richard

  9. “Antipsychiatry” is an ad hominem attack on a person whom the psychiatric authority (or authorities) don’t want to respond to. It’s a perfectly legitimate observation to state that the DSM diagnostic criteria are observably, objectively, undeniably subjective. They are clearly based on social criteria, such as “interferes with normal functioning,” or “creates clinically significant distress.” They are also based on the assumption that “clinically significant distress” is in itself the problem, rather than being a possibly appropriate response to a stressful environment.

    It’s one of those things like being “pro-life” vs. “pro-choice.” It’s really an ethical/philosophical issue, not a scientific one. We’re all operating here on the idea that psychiatric diagnostic labels should be objectively distinguishable and should suggest interventions that lead to positive outcomes. The “true believers” in the Church of Psychiatry don’t subscribe to those same values. So when confronted with the scientific reality of their failed treatments, they sink to ad hominem attacks, having no rational arguments to fall back on.

    As to this movement, I agree that a civil rights framework is the most encompassing and most difficult to argue with. People have the right to good information and have the right to decide for themselves what is and is not helpful. This is held to be true in every other area of medicine – the right to refuse treatment or a particular treatment is so fundamental, it’s been argued in front of the Supreme Court. Why should the same not apply to “mental health treatments,” which are based on a much more subjective and often outright spurious basis in comparison with objectively observable disease?

    We also need a comeback for the accusation that everyone opposed to psychiatry is a “Scientologist” that doesn’t buy into the idea that being a Scientologist would make someone’s argument automatically weaker. Mine would be, “What on earth does a person’s religion have to do with the lack of a scientific basis for your claims? Either they have a scientific basis or they don’t. I don’t care if your detractors are Catholic or Muslim or Zoroastrians or followers of the Reverend Sun Myung Moon – I want to hear what the scientific basis of these DSM diagnoses are, or proof of your proposed ‘chemical imbalances.’ If you don’t have it, admit it and stop trying to distract us from the hard facts of the situation by bringing in irrelevant factors.” That ought to stop them in their tracks.

    —- Steve

  10. What annoys one is when they go around talking as if there were an antipsychiatry movement, one single homogenous group which one can gain membership to, all members united by adherence to the same manifesto! It’s preposterous, yet these are the same people who set themselves up as supremely rational and sane, as being in touch with this elusive entity that we call reality. People get sectioned for what is essentially the same thing; distorted, delusional thinking.

    In an article I read by Rael Jean Isaac yesterday, she talks of an “anti-treatment movement”, as if there is a movement where people are opposed to getting real treatment for real diseases! This would be similar to myself claiming that people like her are part of an “anti-Bill of rights movement”, or “anti-Hippocratic Oath movement”.

    • You rock, Cledwyn! I’m a big fan. As a side note, I did a 7 year tour of duty with Effexor so I can relate to the anguish of going off. I hope things are going better these days.

      I myself have no clue what being “antipsychiatry” actually entails and certainly don’t yet see it as much of an actual, credible movement, but I definitely identify with it. It gives me great consolation to join my experience of psychiatry to that of Ted Chabasinski, Laura Delano, and others here on MIA.

      Again, I love reading your stuff,
      Emily