Liberal “Mental Health” Reform: A “Fail-Proof” Way to Fail

Bonnie Burstow, PhD
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An ever-growing number of people are aware that something’s horrendously wrong with psychiatry — survivors, families, professionals, psychiatrists themselves. Of these a subsection has become actively involved in trying to bring about change. All of which is good. This notwithstanding, sincere and dedicated though almost everyone is — and it is clear that people are — only a tiny percentage of these are pressing for anything truly transformative (something beyond the humanistic correctives or additions typically called “reform”).

Without question, what people are advocating is of enormous importance. For example, for the most part reformers take seriously the deprivation of human liberty and the reductionism that characterizes psychiatry — and yet somehow they fall short of letting go of either the paradigm or the practice. What do people call for? They want less incarceration, but are not asking it be stopped. By the same token, people call for less drugging, while accepting that doctors will continue to prescribe psychiatric drugs. Most want to eliminate certain of the diagnoses, while holding tenaciously to others (e.g., Horwitz, 2002).

For obvious reasons — and who could argue with this? — the majority stipulate that there must be free and informed consent — but not for everyone and, even at that, there is little evidence that people are giving much thought to how such a thing would be possible with anything even vaguely resembling the institution as we know it. The vast majority favour a major expansion of humanistic services such as counseling and housing as well the introduction of voluntary outreach services wherein helpers turn up at people’s homes to assist with crises — good in itself, however, once again while leaving biological/institutional psychiatry relatively in tact.

What goes along with this, they want a team approach, with psychiatry only one member of that team. Albeit, of course, there are variations here and there, and some reformers go considerably further than others, here basically is the reformist position. Now I am in no way questioning the intentions or the soundness of many aspects of the position. There are a number of problems with it, however, not the least of which is the fact of leaving institutional psychiatry in tact — the elephant, as it were, in the room.

Underpinning the reformist stance, whether it is expressed or not, is the contention that psychiatry has something to offer, is worth retaining, moreover, that to do otherwise is reckless. Allen Frances (2014), by way of example, refers to antipsychiatry activists as “blind ideologues” and talks as if it were an indisputable fact that there is “good” and “bad” in psychiatry. His solution, correspondingly, is for the sensible people—the “moderates”—to join together to create the reforms needed (see Frances, 2014).

How is it that the situation gets viewed this way? Obviously there is no simple answer to this question for reformers differ from one another. Of survivors who are reformers, some are reluctant to phase out psychiatry because they feel that they themselves or people they know have benefited from the “services”. Many professionals are likewise so convinced. Professionals, including ones that courageously challenge their own profession, additionally, have vested interests that willy-nilly come into play. Then there is the more general problem: that we all us have difficulty thinking very far beyond what currently exists, never mind trusting anything substantially outside the current frame. The point here is, changes that are revolutionary inherently strike us as immoderate or to use Allen Frances’s word “extreme”. All understandable. Nonetheless, let me suggest that the reformist position begs the question.

The purpose of this article is to problematize the reformist stance and the beliefs and tendencies underpinning it. I begin by problematizing the biases surrounding the concept of moderation. I go on to theorize why something more substantial is called for. The article culminates in an investigation of some uncomfortable truths about the profession, the reality of the various industry interests, and what history has to teach us.

Thinking Beyond “Moderation” 

As a species, we have a tendency to think that moderation is always and inevitably best (hence the “middle way” in Buddhism, balance in Aboriginal thought, and the golden mean in Aristotle). Without question, this bias frequently serves us well. I put it to the reader that there are times, nonetheless, when the concept is inapplicable and/or where emancipatory principles dictate a pronouncedly different course of action.

For example, would we really want to embrace a middle way between murder or rape on one hand, and respecting the bodily integrity of others on the other? And more pointedly, what would have befallen the major liberatory advances in history had visionaries bowed to the imperative to be moderate? Take the institution of slavery. We would have far more people enslaved today if we automatically assumed that the ostensibly “extreme” position — actually abolishing slavery (as opposed to, say, “humanizing” it or resorting to it less often) — was a reckless and otherwise unwise thing to do. And note, abolition did indeed look reckless to the “moderates.”

What is clear, in other words, is that what seems like “sensible moderation” seems that way from a particular vantage point and what strikes the average person as moderation, as such, is hardly unassailable. That said, the question arises: Under what circumstances is abolition a more sensible course of action than reform? While this of course is a complex issue, let me suggest that viable indicators are: 1) when the practice in question overwhelmingly harms people, and 2) when it is inherently oppressive. Auxiliary indicators — and these too can legitimately enter in and in certain cases be pivotal — are when its foundational tenets have repeatedly been demonstrated to be fallacious; also, when it is backed by a massive industry that by hook or by crook is intent in maintaining the status quo or worse. Lest readers have not as yet noticed, all of the above pertains to psychiatry.

To begin with the first two, touching quickly on the incarceral and control mission (and it is a historical accident that psychiatry is in charge of this), it is clear that substantially depriving people of freedom and control is personally hurtful, however small the numbers and whatever the rationale. Nor is the alleged ‘dangerousness” an acceptable rationale, for there is no evidence that the “mentally ill” are any more dangerous than the average person. To be clear, it goes without saying that people should be stopped from harming others, whether or not the “transgressors” are deemed “mentally ill,” that actions must have consequences, that there are moments when figuring out how to enhance an individual’s safety is far from easy.

At the same time, as peacemaking criminologists (e.g., Pepinsky and Quinney, 1991), and critical disability theorists (e.g., Ben Moishe, Chapman, and Carey, 2014) have so cogently argued, a regimen of imprisonment and control is at once injurious, of dubious value in enhancing the safety of anyone, and is morally unacceptable. To turn to the “treatments” per se, as documented by critics like Breggin (1991), the “treatments” overwhelmingly damage people. That is, they give rise to actual brain damage, result in disorders such as tardive dyskinesia, and horrific conditions such as memory and cognitive impairment.

While reformers want to make exceptions for categories like schizophrenia, suggesting that in such cases “treatment” is necessary, I would add that studies clearly establish that mainstream convictions to the contrary, “schizophrenics” never, once on the drugs, fare better in the long run than any other group of “schizophrenics” (see Harrow, 2007 and Rappaport, 1978). In other words, even when it seems as if the opposite were transpiring, everyone is being harmed.

The inherent oppressiveness of psychiatry, additionally, is common knowledge among survivors and reformers alike, though one need only look at the classical signs of oppression to realize that it permeates the industry—the daily coercion, the incarceration, the surveillance and control, the targeting of the “genderized” and the “racialized”, the us-them division, the very use of concepts like “normal” (for details on how such ruling plays out, see Burstow, 2015). Nor would moderating this element eliminate the oppressiveness at the core.

To proceed to this next indicator — and I would suggest this is pivotal — we are blatantly dealing with faulty foundations. The point is that the basic psychiatric concepts and tenets have no validity either empirically or conceptually. In this regard, as researchers like Breggin (1991) and Colbert (2001) have repeatedly demonstrated, there is no proof whatever that any of the so-called “mental illnesses” are bone fide diseases. Nor do concepts like “mental illness” hold up to scrutiny. As Szasz (1961) so adroitly put it years ago, irrespective of whether or not people are floundering, it is a category confusion to call ways of thinking and acting per se a disease.

In essence, a medical overlay is but being slipped over distressed or distressing ways of thinking and acting. This being the case, it is no accident that the treatments profoundly harm. Treat people for non-existent diseases, “correct” imbalances that exist nowhere except in psychiatric credo, and you necessarily create real imbalances and in the process do untold harm. Herein the very nature of medicine — what it is and what it does — is all-important.  Note, in the vast majority of disciplines and professions, the invalidity of the basic tenets would not in and of itself necessitate abolition or even always make it desirable. It is precisely because invalidity and inevitable harm come together in psychiatry that abolition is critical.

Before I proceed to the other indicators, I would pause to touch on some of the objections likely to be posed to my points to date. The first is that there are “extreme cases” where psychiatry is needed. Let me suggest, the fact of people being in terrible straits in no way makes something medical when it otherwise is not.  If there is no disease, no matter how dire the problem, treating a person as if they had a disease and thereby harming them cannot be acceptable. Equally unacceptable, I would add, is the handling of misery and conflict by resorting to incarceration, surveillance, or control.

A second commonplace type of objection is predicated on the understandable belief that a plethora of services should be available — and so why not psychiatry? — especially seeing as so many people favour the drugs. A quick response is that the state should not be involved in injuring people, irrespective of whether or not doing so is called “services.” Moreover, it is blatantly unethical to present and/or promote something as is if it were a medical treatment in the total absence of medical validity. Nor is it the case that the elimination of psychiatry would narrow the options available. In point of fact, given the amount of money spent on psychiatry and the promotion thereof, eliminate psychiatry from the picture, and — presto — there would be ample resources to make a plethora of options available. Additionally, note, abolition does not require that people be denied access to psychopharmaceutical drugs — only that they not be approached as if medical, not promoted, and not prescribed by doctors.

A final objection that I would touch on is predicated precisely on faith of how far a reform agenda can transform psychiatry. The contention here would be that in the world brought about by a reform agenda, there would be no reason to get rid of psychiatry for it would just be one of many disciplines that converge on the territory. Additionally, psychiatry would itself be reformed, with psychiatrists for the most part providing counseling or other such supportive services.

Tackling the first part of this objection brings to the fore the whole issue of  power and of discourse. Hypothetically, we have a team approach now, but set foot in any hospital and it is clear that one player and one position dominates. Nor do words like “dialogue” alter the situation. The point is that even with benign intentions, dialogue can only go so far for the terms of the dialogue are already set/constrained by the psychiatric paradigm. To varying degrees, the same may be said of reform within psychiatry. What is equally fundamental, there are structural realities, vested interests, and contradictions at play that we gloss over to our peril.

A crucial factor being ignored here is that medicine is a bad fit, indeed a misfit insofar the direction sought is non-medical (nor are most medical people likely to excel at it). Correspondingly, there is a palpable danger involved in entrusting this direction, or indeed, any part of it, to psychiatry. Whatever might transpire in the short run—and of course there are individual psychiatrists who are trustworthy —why would we think that in the long run psychiatry (translation: institutional agents whose very profession is posited on emotional problems being medical) are likely to give up or even substantially qualify what, in essence, is the sole basis of their profession?

If the point being made seems confusing, look systemically at what we are dealing with here. Aside from the power attributed to it, this profession is distinguishable from others such as psychology by one sizable dimension only—the insistence on the medical. By the same token, look at what prepares psychiatrists for the tasks ahead. Psychiatrists in-the-making are people who take extensive training in medicine as if such problems in living were bone fide medical issues. Indeed, even at the residency stage, they rotate between the various medical specialties—biology, anatomy, and so forth—before they even approach “psychiatry” per se. Even were more counseling training added to the mix, the point is it remains part of the faculty of medicine, remains a “medical discipline”, and, indeed, is theorized and taught as such, with all the baggage which that entails.

That said, let us look more closely at this institution. Insupportable though the medical conceptualization is, psychiatry is “medicalized” through and through. Note, it is presided  over by “doctors”; it is assisted by “nurses”; and its pivotal work happens in places called “hospitals.” Correspondingly, it specializes in the use of substances defined as medical; and its discourse is medically framed (witness, in this regard, the prevalence of terms like “pathology,” “disorder,” “symptom”). Whatever psychosocial factors are added on, being “medical” — as it were — is its defining feature. Which brings us to some key structural issues: To whit: In the long run, how could be in the interests of a medical institution to support any substantial de-medicalization — given medicine is precisely the ground on which it stands? By the same token, in the long run how could it be in psychiatry’s interests to give up what the profession has spent centuries solidifying — their command over the “madness turf”? Which is not to say that individual psychiatrists are not sincere about demedicalizing, or the profession as a whole might not be willing to entertain such directions at a moment of crisis.

What happens in a crisis and what will be supported long term, however, is a different matter altogether. Bottom line: In the long run, it simply is not in psychiatry’s interests to demedicalize, decentre itself, or stop expanding. What adds to the conundrum, while all institutions to varying degrees pursue their own interest, history teaches us that discourses about care notwithstanding—medicalization, dominance, and expansion has been overwhelmingly what the institution of the psychiatry is about. This is the profession that historically drove out all competitors—the astrologers, the women healers, for example. This is the profession that sought and gained police powers. And this is the profession/industry that has been intent on declaring ever more people “mentally ill” (for details, see Conrad and Schneider, 1984).

What relates to this, from a business point of view (and psychiatry is nothing if not a series of interrelated businesses), it is obvious that what we are dealing with is a massive industry, all parts of which have self interests. Correspondingly — and again, we lose sight of this to our peril — all of these parts are not simply incompatible with but dramatically pull in the opposite direction than the reform agenda. By way of example, the interest of the psychiatric research industry is to continue expanding on one hand and satisfying its funders on the other (that is, producing ever more research studies and research results which in some way promote the prevalent treatments and agendas). By the same token, the interest of the shock industry is the continuation and spread of ECT.  Of these industries, of course, none is more formidable that the pharmaceutical industry.

Profit transparently drives the pharmaceutical industry. And significantly, reform of the type envisioned will willy-nilly hurt pharmaceutical profits, in other words, transparently conflicts with Big Pharma’s interest. (The fact that progressive psychiatrists would like to see less drugs used, I would add, is beside the point). A demedicalizing of the area doubly conflicts with psychiatry’s interest for, as demonstrated by researchers such as Whitaker (2002 and 2010), psychiatry itself is utterly dependent on pharmaceutical funding for their massive research projects, their publications, their educational endeavours. To put this another way, psychiatry needs the multinational pharmaceutical industry. Ergo, anything that hurts that industry hurts psychiatry. Indeed, at this juncture, the very existence of psychiatry is dependent on the pharmaceutical industry; and as such, as the professional elite are well aware, breaking with this industry in any substantial way would be the proverbial kiss of death. The upshot? Despite how individual psychiatrists may proceed, this is not now, and short of a new somaticizing benefactor materializing, cannot be the ultimate direction of the profession.

In short, besides that psychiatry is foundationless and by its nature harms, we cannot arrive at a better dispensation in the long run if psychiatry is included—not even a new and improved psychiatry. We cannot because it undermines the very raison d’etre of the profession. We cannot, ultimately, because it is not in psychiatry’s interest, not in the interests, that is, of the profession, the industry, or the myriad of industries surrounding it.  What likewise needs to be factored in, biological psychiatry has a long history of reasserting dominance, whatever seemingly benign turns are taken in the short run, for it does not for long lose sight of where its interests lie. In this respect, we have, as it were, “been there and done that” already—and the outcome was anything but reassuring. A lesson from history:

There was a moment in “modern” psychiatric history where the relentless push to medicalize and to dominate indeed appeared to be curtailed, and beyond that, substantially reversed. This was with the spread of psychoanalysis and the concomitant rise of the talk therapies. Freudian psychoanalysis was so successful as a movement (however one may judge its tenets and practice) that throughout North America it changed the face of psychiatry, bringing the psychological as opposed to the medical to the fore. What is additionally apropos, Freud opened up psychoanalysis to non-medical therapists — which itself helped give rise to the spread of a huge variety of talk therapies and this by “lay” practitioners of various types — psychologists, social workers.

Correspondingly, increasingly, despite obvious limitations, the agenda was humanist with various new and creative way of working with people imagined. The parallels with what is being sought today are obvious. Then a huge reversal set in. While the full story is too complicated to go into here, the salient point is that demedicalization was not in the interest of psychiatry, and beyond that, what became progressively obvious to the psychiatric elite is that their interest, on the contrary, lay in medicalizing to a point beyond anything heretofore imagined.

Hence the unprecedented surge of biological psychiatry and the advent of the highly medicalized DSM-III (transparently “medical” despite the claim to being etiology-free). Hence the declaration that “mental illnesses” were “brain diseases” (e.g., Andreason, 1984). And hence the alliance between psychiatry and the drug companies and the advent of what is euphemistically called “the drug revolution.”  All of which was possible, note, because institutional psychiatry had never in any way been dismantled.

Now to be clear, it is not just that the ground gained was lost. The situation which materialized was exponentially worse than what had preceded psychoanalysis, for everything became grist for biologizing agenda — even the psychoanalytical categories themselves. You can get a quick sense of how this transpired by looking at what happened with the “neurotic complaints” (originally spearheaded by the analysts). It is not that these were thrown out by biological psychiatry. Along with the various “psychoses” and the various other biological inventions, they were given a biological frame and added to the mix — with the result being an exponential growth in the number of “mental disorders” in DSM-III and, in essence, the pathologization of everyday life. (To trace this development, see Kirk and Kutchins, 1997)

Now it might be argued that what happened here arose from a unique concatenation of circumstances, and as such, liberal reform is not doomed to fail. While logically that is true, I would remind readers that a similar dynamic played out centuries earlier, after the rise of “moral management” — the one other time in history that a type of demedicalization had set in. Note, moral management involved approaching problems in living as spiritual issues. This, in essence, was the “reform” agenda of the 18th century. It being nonmedical in nature, not only the mad doctors but also lay people practiced it — the most notable being the Quakers (see Tuke, 1813/1996) — a phenomenon that was widely accepted.

What happened? The direction being pursued was hardly in psychiatry’s interest, and not coincidentally, the Quakers were considerably better at it. Accordingly, over time moral management gave way to the meteoric rise of biologically oriented psychiatry, the routing of lay people, and ultimately to the birth of the eugenics era.

In this as in a microscope, we can see the problem with non-foundational reform. It is not that there are no good tenets or good people involved. Indeed there are. Correspondingly, it is not that progressive psychiatrists have no role to play in the initial stages of a transformational process, for again, they do. However, in refusing to take seriously both the nature and the self-interestedness of the profession, reform (as opposed to revolution) leaves in tact an inherently problematic institution, legitimizes rule by “expert,” and paves the way for a return of biologism and of oppression with a vengeance.

And as such, liberal conceptualizations like “mental health reform” do not and cannot serve us well.

Concluding Remarks 

In ending, I would reiterate that we are currently at one of those crossroads in history. To varying degrees, people are aware that our “solutions” are backfiring. Survivors are vocal about wanting something different. The general public minimally suspects that something is horrendously wrong. “Helpers” from other disciplines are commonly in dismay. And progressively, psychiatrists are sensing that the institution is in a crisis. Indeed, with the rampant spread of iatrogenic diseases, society itself is in crisis. A terrible reality on one hand, for it bespeaks the harm being done, but a rare opportunity on the other, for crises are precisely the time when real change is possible. As a society, this is the time to be absolutely clear what we are about, for the opportunity for fundamental change does not come often; and it would be a shame to squander the moment. Do we tinker with the “mental health system”, adding more humane services, while retaining psychiatry?  Or do we adopt an abolitionist agenda — that is, slowly break with psychiatry and co-construct a whole new approach to problems in living and, indeed, how we-are-with-one-another?

As you ponder this, I would invite readers to consider: What kind of world would you like to bequeath to future generations? — To your great grandchildren? To people seven generations hence? Ultimately, who should be in charge of society’s needs — the community as a whole (that is, each of us together) or stated-sanctioned “experts” and mega-industries? Who wins and who loses if psychiatric rule continues? And finally, if tempted to speak of “paradigm shift” and psychiatry in one breath, in the words of Black feminist Audre Lorde, (1984), when in social change history have we ever known the “master’s tools” to “dismantle the master’s house”?

* * * * *

For this and other articles on this issue, see: http://www.bizomadness.blogspot.ca. For detailed elaboration of dimensions touched on in the article, including a visioning of services in a transformed society, see Burstow, 2015.

References:

Andreasen, N. (1984). The Broken Brain. New York: Harper and Row.

Breggin, P (1991). Toxic Psychiatry. New York: Springer.

Ben-Moshe, L., Chapman, D, and Carey, A (Eds.). (2014). Disability Incarcerated: Imprisonment and Disability in the United States and Canada. New York: Palgrave Macmillan,

Burstow, Bonnie (2015). Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting. New York: Palgrave Macmillan.

Colbert, T. (2001). Rape of the Soul. Tiscam: Kevco.

Conrad, P. & Schneider, J. (1980). Deviance and Medicalization: From Badness to Sickness. St. Louis: The C.V. Mosby Company

Frances, A. (2014). Finding a Middle Ground Between Psychiatry and Anti-psychiatry.  Retrieved from .

Harrow, M. (2007). Factors in outcome and recovery in schizophrenic patients not on antipsychotic medications. The Journal of Mental and Nervous Disease, 195, 406-414.

Horwitz, A. (2002). Creating Mental iIllness. Chicago: University of Chicago Press.

Kirk, S. & Kutchins, H. (1997). Making Us Crazy: DSM, The Psychiatric Bible and the Creation of Mental Disorders. New York: The Free Press.

Lorde, A. (1984). Sister Outsider. New York: Crossing Press.

Pepinsky, H. & Quinney, R. (1991) (Eds.). Criminology as Peacemaking. Bloomington: Indiana University Press.

Rappaport, M. (1978). Are There Schizophrenics for Whom Drugs may be Unnecessary or Contraindicated? International Pharmacopsychiatry, 13, 100-111.

Szasz, T. (1961). The Myth of Mental Illness. New York: Paul B. Hoeber.

Tuke, S. (1813/1996). Description of the Retreat. New York: Process Press.

Whitaker, R. (2002). Mad in America. New York: Perseus Books.

Whitaker, R. (2010). Anatomy of an Epidemic. New York: Broadway Paperbacks.

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47 COMMENTS

  1. Thank you, Bonnie, for yet another good analysis of why people who believe in freedom should not imagine that tinkering with the edges of psychiatry will bring about any real change. That idea, in fact, is exactly what Allen Frances, whom I consider the most clever of psychiatry’s apologists right now, is advocating.

    I would emphasize also that the strong attacks that Frances and other psychiatric leaders make on the idea of “anti-psychiatry” should tell us something. What they tell me is that psychiatry is terrified of the idea that the concept of “anti-psychiatry” may take hold among the public as a legitimate point of view. And what that also tells me is that those who hold an anti-psychiatry position should announce it loud and clear.

    In the next weeks there will be more public discussion of an anti-psychiatry conference, or several of them, and I urge the readers of this fine and useful article to stay tuned and be ready to participate.

  2. First of all, I’d like to thank you for laying out your case in a clear and logical way. I wish I had your breadth of knowledge about all the different harms of psychiatry, and I’ll bookmark your article so as to read further among the sources you cite.

    If I have one reservation about the current state of affairs with people who’ve chosen to speak up about psychiatry, it’s that there’s an awful lot of consciousness raising and yet a curious lack of proposals for what we can do about it on a systemic level. Maybe that’s just my ignorance showing, but that’s what I see when I look around. I wish I saw more articles like yours.

    So, when I offer some words of criticism, it is not intended to defeat positive action, but simply to point out some problems which you may very well have anticipated but simply neglected to go into here.

    My belief is that psychiatry cannot be effectively abolished. I don’t know what steps you would take to abolish it, but if there is one thing we should all know from both evolution and economics, it is that when a profitable niche opens up, something will come along to fill it. You may abolish psychiatry, but it will crop up again under another name, just as slavery did when it turned itself into Jim Crow, where you may not actually have one person legally owning another but where you have a system of laws that deprives people of their freedom to move around or to choose their terms of employment or to vote their own interests, etc. With psychiatry, you may succeed in eliminating it as a specialty practice in medicine, but soon you will have new specialists cropping up to take their place — neuroscientists, nutrition experts, etc., etc. — all of whom will soon unite to protest the “stifling effect on science and medicine” that prohibiting any of their practices would entail. It will be only too easy for them to claim that the barbaric practices of the past have been left behind, even as they revive them in new forms, just as insulin shock gave way to electroshock, which gave way to lobotomies, which gave way to medications, and whose purpose was always the same: to incapacitate, pacify and silence all those unruly defectives. The other day I was talking to a friend, the mother of a woman with some psychological issues, about why I was mostly opposed to medication. She would hear absolutely none of it, except to tell me that I should “think of the families” and that it was important to have a range of options, a “balance” (just as you mentioned in your article), and I realized that what she was really saying, as much by the nature of her resistance as by anything she said, was that she was simply afraid. Her daughter has suffered, she has suffered, and she is afraid that without medication her daughter will suffer even more, and I think this is what people are mostly afraid of: that without medication, without psychiatry to hold their hands and assure them that this is the best possible treatment, that no one knows what will happen. They have a very real and very legitimate fear of chaos and suffering, and the pseudo-medical charlatans of the future will exploit that fear in the unlikely even that you should ever succeed in getting rid of the charlatans we have now.

    My other belief is that abolishing psychiatry is irresponsible. Someone in the medical profession has to know how the brain works and how chemicals affect it, if only to reverse their current role of perpetrating harm to one where they protect us from harm in the future. If there were some way to liberate psychiatry from the malign influence of the pharmaceutical industry and from practicing on patients, if they simply did research about the brain and so forth, we might actually benefit from what they find out. In fact, by removing their motives to turn a blind eye to what is really going on with psychopharmacology, we might get them to turn out some honest results that have value. I have no idea how this change would come about, except through the continued efforts of people like yourself to learn the facts of psychiatry, think about the whole picture, and publish your conclusions so that the public can see what is going on and hopefully force the profession into meaningful reform by stripping away its abusive powers where possible and setting up a system of meaningful regulation to create transparency and accountability with their use of any powers that remain. As they say, sunlight is the best disinfectant.

    I am not in favor of the current system and I would like to see it changed. But I don’t see how simply abolishing psychiatry is going to solve a problem that seems intrinsic to human nature, with its propensity toward greed, opportunism, and fear.

    • It’s generally straightforward to define the boundaries of medicine. When there is a blood or imaging test, or a biopsy that distinguishes “normal” from not normal, then that pertains to medicine. If a specific technique is required to affect a certifiably physiological condition, like highly toxic drugs for cancer, that pertains to medicine. If the state of consciousness needs to be altered to facilitate a physical intervention, like anesthesia for surgery, that pertains to medicine. The boundaries are less clear when using anesthetics like morphine to manage acute physical pain or tranquilizers like haldol to manage a mental crisis. The short term benefits are as clear as the long term harm. Where to draw the line?

      An over-simplistic way to abolish psychiatry is just to eliminate the license. Let psychiatrists switch to either neurology or anesthesiology, or both, and become “real” doctors. OK, I don’t believe that’s going to happen anytime soon, no matter how successful the abolitionists are. But just because a concept is not realistic, doesn’t mean it’s not valuable. As Eric points out the abolition of slavery did not eliminate racial discrimination, and the Civil Rights Act did not eliminate the ethnic component of social injustice. Those landmarks, however, did fundamentally improve the situation of the oppressed. The underlying forces that changes society for the better are always those same immutable principles, that all humans have equal rights and that injustice in all its institutionalized forms must be eliminated. I believe the abolitionism Bonnie is talking about falls in that category.

    • “Someone in the medical profession has to know how the brain works and how chemicals affect it, if only to reverse their current role of perpetrating harm to one where they protect us from harm in the future.”
      Toxicologists, neurologists, virologists – if the problem is indeed in the brain there are professions dealing with it already which actually have some scientific basis to them at times.

  3. So much of psychiatry is, as you say, giving a medical response to what is expressly not a medical problem, and so much of it is seeing biology where there is no biology, no abnormal biology anyway, in the interrelations of, and between, people. Telling the truth here is revolutionary act as there is just so very much lying going on.

    The allusions to biology usually stem from the damage done by psychiatric drugs rather than any good achieved through them, and now psychiatrists are talking about collaborating with other physicians in dealing with the injury that they themselves have caused through these drugs. How absurd is that? I think it’s pretty absurd anyway. Heap injury on insult, and then call it medicine. Now you can collaborate with physicians in what amounts to a massive cover up. The mysterious mythical “disease” did it. Sure, and they will keep saying that. It sells drugs.

    Psychiatry supports the status quo, and the status quo is a world run, and essentially wrecked (think pollution, poverty, and war), by a small corporate elite. We can do better, surely, but you won’t arrive at that better through reform. Reform, in the long run only, means more of the same old same old. (In historical terms consider the asylum building boom that moral management spawned, and the mental patient population boom that came of it.) Abolition means looking at the real reasons. Abolition means power, freedom, and health, not to mention responsibility. Who could object to that? Well, you know, the few who hold power now. We must tell them its time to move aside.

    Thank you, Bonnie. Great post. Keep ’em coming.

  4. Obvious – brilliant – useful…..So writes the Bard of Reading.

    One question?

    What role of psyche drugs and who would dispense them if psychiatry is abolished?

    I know this seems a contradiction, there are no psychiatric illnesses but the deadening of psychic pain by drugs is sometimes useful (sleeping pills for example) and liked by many (alcohol – or major tranqulisers seem to have thier advocates).

    Me, I like expensive cake from quality cafe’s and flirting with handsome young men when moderately distressed. In extreme distress I’ll settle for loving conversation with good friends and no moderating influence of any drug or anything else – it’s a dangerous and innefective route for me and I suspect for most others.

  5. Hi Bonnie, great article.

    I had a conversation with a psychiatrist a few weeks back about Islam and ISIS. She was interested in understanding the situation in Iraq and Syria. It was after this conversation that I realised that she has a lot in common with the mujahadeen. They both have a belief system that they know what is good for people, and that in some instances it needs to be shoved down their throats at the barrel of a gun. Coercion and force are what will bring people to their notion of ‘good’. Where does this leave a Muslim psychiatrist?

    Oh, and just in case Mr Obama is reading, if the beheadings by ISIS are “ungodly” and “barbaric”, might be best you avoid ‘chop square’ next time you visit the troops in Saudi. They are cutting peoples heads off for such crimes as “witchcraft”. Still, their our guys eh?

  6. Bonnie:

    Thanks for the medicine of honesty and clarity. I can definitely envision the kind of world I want my grandchildren to inherit: a society in which struggling individuals and families will not have to be afraid any longer. Afraid of the stigma of being emotionally disturbed and afraid to seek services for emotional or mental distress because well intentioned ‘professionals’ viewing the answers on a two page checklist of ‘symptoms’ will make false assumptions, exercise abusive power and make matters much worse. A new paradigm of mental wellness that eliminates the power of the state to harm and abuse people by diagnosing them after thirty minute ‘screenings’ and making false judgements and assumptions because they see clients only through the lens of ‘disease’ and genetic disposition.

    The new system will give people choices and alternatives and present them with a veritable buffet of healthy choices in times of distress, conflict, and crisis. Those choices should reflect the diversity and richness of the communities in which we were raised, even despite
    the fact that some of the richness and diversity of our communities has been diminished and even in some cases destroyed by a homogenous, corporate controlled political and economic system.

    Unless psychiatry can disentangle itself from the power and authority of the state to which is had made an unholy alliance, we should definitely call for abolition of psychiatry, as long as we are willing to admit that this abolition should extend to the other disease industries, as well. End of life decisions and family planning, warehousing of the elderly in geriatric facilities, obesity and the processed food industry, there are many other intersections between medicine and public health policy other than psychiatry.

  7. Bonnie

    This was good beginning analysis of the severe limitations of a reformist strategy attempting to guide a movement to end psychiatric oppression within today’s world.

    To say that Biological Psychiatry can (or should) be reformed is like saying that the monopoly capitalist system can be reformed. It would be the equivalent of asking Dracula to suck water instead of blood. The true nature of the economic and political system that gave rise to, and sustains, modern psychiatry was “the elephant in the room” not directly addressed in this blog.

    These two institutions have become completely interconnected and mutually dependent on one another. In my blog titled, “What is Biological Psychiatry Part 2: Anatomy of Power and Control,” I made the following statement:

    “Today’s Biological Psychiatry has become such an essential part of the economic and political fabric holding together our present day society, including its ability and need to maintain control over the more volatile sections of the population, that its future existence may be totally interdependent on the rise and fall of the entire system itself.”

    This interdependence is also fundamentally related to just how profitable the sale of psychiatric drugs are today, and how vitally important their genetically based theories and the expansive nature of the pharmaceutical industry is to the future health of the capitalist economy.

    Modern psychiatry will not leave history’s stage and/or be “abolished” until the masses of people have enough power and control (within an entirely new type of society) to actually pass the necessary laws that outlaw ALL of the forms of oppressive power and control this institution wields within today’s society.

    When these conditions finally come into being (through great struggle and upheaval throughout society) and when the masses of people are fundamentally educated about the false science that underpins the psychiatric profession, formal “abolishment” will not be necessary (or necessarily the best option to advocate for). This institution will simply “wither away.” People will have far more liberating options to choose from within such a revolutionary new society.

    All this will require FAR more advanced organization and forms of direct mass action than currently exists today. We all have much work to do in order to bring these conditions into being.

    Richard

  8. I don’t know. I think it is possible that continued exposure of the lack of proof for the brain diseases and the ineffective and damaging treatments for said diseases could eventually lead psychiatry as a profession to be seen akin to something like chiropracty.

    I guess it also depends which way governments go, do they support psychiatry to get more authority over the populace or do they look at the rising costs to society as a whole from psychiatry, maybe in the end they might not have a choice. It really depends how unpopular psychiatry might become.

  9. There is no question that psychiatry has gone too far and harmed many people. And it makes no sense to advocate a “moderate” position somewhere between coercion and personal autonomy. Bonnie may be 100% correct that no state sanctioned experts, including psychiatrists, can ever be legitimate but as a practical matter many people in extreme states are not able to look after their basic needs and personal safety, for whatever reason. And many of them have nobody available to help. It may be a utopian dream that some day communities will organize to correct this . It just is not likely.
    It may or may not be possible for psychiatry to reform to offer a valid service to those in need but it is also dangerous to compromise by insisting that psychologists, social workers and others should play a role. The danger is that the army of state-sanctioned “experts”, many with no knowledge of physiology, will jump on the current bandwagon (where mental illness is defined by pharma marketing departments) and we will mistake this for progress.

    Before we do anything, “mental illness” needs to be better understood. 90% of what passes for mental illness may be social in origin but what if social factors cannot explain 100%? And this is what the evidence appears to show. Who should investigate and try to solve that other 10%?

    • “Who should investigate and try to solve that other 10%?”
      Neurologists (brain tumours or trauma can explain certain behavioural and cognitive problems).
      Toxicologists (drugs and environmental toxins cause many “psychiatric symptoms”)
      Virologists (untreated HIV infection can cause psychotic experiences)
      Dieticians (vitamin and micro-element deficiency e.g. of iron can lead to decreased mood and other problems)
      etc.
      Still no psychiatry required.