Over the last couple of years, I have written several articles intended to shed light on the term/phenomenon “antipsychiatry” (to name just a few, “On Antipsychiatry,” “Antipsychiatry Revisited,” and “On Fighting Institutional Psychiatry with the ‘Attrition Model’”). This is the next in the series. Questions addressed include: What exactly does “antipsychiatry” mean? And if there is more than one meaning or reference, how do you choose between them? Is the term useful or hopelessly ambiguous? Can one be antipsychiatry without being abolitionist? Does antipsychiatry partake of degrees, such as being “very antipsychiatry” or “somewhat antipsychiatry”? And if one wants to end the use of psychiatric coercion only, does that position qualify as antipsychiatry?
In the process of offering what clarification I can, I will be dipping in and out of history, for we cannot come to terms with this phenomenon or the tangle of confusions surrounding it without delving into historical developments. I would just add in passing that I am writing this article not only as an antipsychiatry theorist but as someone who has been actively involved in antipsychiatry activism non-stop for forty years.
One further note in passing: throughout, I will be spelling “antipsychiatry” precisely as I have done so here. For more on the question of spelling, see the end of this article.
To begin, the term “antipsychiatry” (spelled by him “anti-psychiatry”), was invented by a colleague of R.D. Laing’s, Dr. David Cooper, in 19671. It was quickly picked up by the various people in the society that surrounded Laing. What the Laingian group were intending by the term was a different approach to “help,” with what had been called psychiatric problems being reframed as inherently social, political, and psychological rather than medical, with the existential philosophy of Jean-Paul Sartre figuring into the mix in critical ways2. Laing and Cooper likewise explored (and to varying degrees set up) live-in therapeutic communities where people were at least hypothetically given help as they went about their journey through madness, and with Cooper in the process introducing the “antihospital” concept just as he introduced the concept of “antipsychiatry.”
Now, Cooper was far more activist than Laing and very much thought in terms of social movements. However, what is evident is that even with Cooper, despite his legendary critique of “experts,” the movement that he was discussing was a professional movement—not a movement of the oppressed themselves. What is likewise relevant is that despite how deeply he felt it, his opposition to psychiatry was in its own way muted; moreover, it became more muted over time (though admittedly he did go back and forth) and eventually became so “moderate” that he himself dropped the term antipsychiatry (as can be seen in Stephen Ticktin’s informative memoir “Brother Beast—A Personal Memoir of David Cooper”), turning instead to the term “non-psychiatry” and alternatively, “non-medical psychiatry.”
Now with regard to this latter term, I had an interesting conversation with Ticktin over it less than a month ago that proceeded roughly as follows:
Ticktin: Later David abandoned the word “antipsychiatry,” using instead the more political term “non-medical psychiatry.”
Burstow: That doesn’t sound more political to me. It sounds less political.
Ticktin: You think it’s less political?
Burstow: Look at the term. It is not announcing opposition to psychiatry or even to biological psychiatry, it is simply staking out a different form of practice. (personal conversation, CAPA meeting, June 3, 2017)
While I will be commenting on this curious shift later, for the time being, I leave readers themselves to reflect on how we might understand it.
Now in fairly short order, “antipsychiatry” (and yes, still spelled “anti-psychiatry”) made it into the lexicon of accepted scholarly terms. Nonetheless, instead of having a clear-cut meaning, it became somewhat of a “grab bag” category, with the term being applied to the positions of a large number of scholars who substantially critiqued psychiatry, albeit from very different perspectives. Examples are theorists as varied as Thomas Szasz in the US and Michel Foucault in France—the first a right wing libertarian psychiatrist who demonstrated that the very concept of “mental illness” was a myth, the second a French philosopher who approached the profession/practice as a paradigmal example of what he called “power-knowledge”3. Significantly, while almost all the theorists whose critiques of psychiatry figured heavily in the 1960s, 1970s, and the 1980s (e.g., Szasz, Foucault, Goffman, Becker) were lumped together under the umbrella term “antipsychiatry,” and while they all greatly influenced others who so identified, not a one of these theorists personally laid claim to the term antipsychiatry. In fact, quite the opposite: one of the very last books of Thomas Szasz (20094), specifically attacks what he saw as antipsychiatry, with Szasz not simply distancing himself from it, but soundly dismissing it as “quackery squared.”
That said, there is yet another constituency—and I would suggest, a more important one— that is associated with the word “antipsychiatry.” It is comprised of psychiatric survivors and their allies, people who see themselves as part of a social movement, the overriding goal of which is to abolish psychiatry. What distinguishes these activists (and to be clear, I count myself among them) from the individuals and groups discussed to date are:
- They invariably combine a medical position (a position on what science does and does not show and on what is wrong with the allegedly medical claims being advanced) with an epistemological position (a position on how we know and on the very nature of the claims to knowledge) and an ethical position (what, in light of what has been revealed, society is called upon to do).
- They identify as part of a liberatory social movement.
- The experience and the standpoint of survivors—not that of professionals—is considered the primary one.
- Psychiatry is theorized as a bogus branch of medicine and an oppression.
- The overarching commitment is to rid of the world of this oppression—that is, to rid the world of psychiatry—just as feminists are committed to ridding the world of sexism.
- Antipsychiatry is not simply a label stuck on members of this constituency by others. It is at once a form of self-identity and a calling that is actively embraced.
This position and this identity found expression in various movement magazines from the early 1980s onward (see, for example, the various issues of the totally antipsychiatry Toronto-based magazine Phoenix Rising, aptly subtitled “the voice of the Psychiatrized”), which featured, among other things, the voices of iconic survivors like Don Weitz. While drawing heavily on the theoretic foundations provided by writers like Szasz—and while drawing at least as significantly on the lived experience as well as the theorizing of psychiatric survivors everywhere, under the banner of antipsychiatry—what all such activists have done and have continued to do over the years is fundamentally to critique psychiatry and fight for its abolition. It was likewise a major ingredient in survivor magazines that combined both antipsychiatry and other critical voices, e.g., Madness Network News.
Some salient points and distinctions: While hardly being identical to the psychiatric survivor movement, antipsychiatry as practiced by the people discussed above profoundly connects with the survivor movement. At the same time, it is also distinct. As discussed by Shaindl Lin Diamond in her groundbreaking thesis5, some members of the survivor movement are antipsychiatry while others are not. Correspondingly, while psychiatric survivors make up a major part of the antipsychiatry movement, the movement is not restricted to them.
What is by far the largest and longest standing antipsychiatry organization and network in the world, Coalition Against Psychiatric Assault (CAPA), is instructive in this regard. Committed to psychiatry abolition, and guided by a survivor standpoint, it is open to everyone who takes an abolitionist position, irrespective of social location. Note in this regard these words in its very inclusive mandate statement: “CAPA is a coalition of people committed to dismantling the psychiatric system and building a better world. Radical and visionary, we are comprised of activists, psychiatric survivors, dramatists, academics and professionals.” Herein antipsychiatry organizations mirror the operations of social movement groups like Marxist organizations, for example, in which the basis of unity is the set of common principles and commitments and not the social location. And herein this movement differs from both the survivor movement and the mad movement (to which, once again, it is intrinsically connected).
One further bit of context: Contrasting with, while to varying degrees interacting with the various groups discussed to date—that is, both those who self-identify as antipsychiatry and those whom third parties simply label antipsychiatry—are still others whom no one sees as antipsychiatry but who nonetheless argue/fight for something better than what exists, with many but not all of these at the same time seeing themselves as part of a social movement. I do not locate the survivor movement in this category, for the survivor movement is its very own special entity and spans most of the other movements. Pivotal here are movements of professionals, although survivors often identify with them and very commonly work with them. An example is “the movement for a democratic psychiatry,” which originated with Basaglia in Italy and is exemplified currently by the work of Asylum Magazine in England. A more formidable example is the far larger network of theorists, survivors, and activists who identify as “critical psychiatry,” with the “democratic psychiatry” folk now largely being subsumed under the umbrella term “critical psychiatry.” The primary mandate of such groups may roughly be described as “mental health reform” or “psychiatric reform.”
The context now clear, and to return to the questions with which this article began: so what does “antipsychiatry” mean? And is the term useful?
From one very limited perspective, it surely does seem ambiguous, for the term has blatantly been used in different ways by different players. That said, I would like to pursue a different line of reasoning here. On one hand, the word has evolved, and when a word evolves we don’t compare it to the original meaning and on the basis of the difference between them claim ambiguity. Doing so here would be a bit like saying that the meaning of the word “typewriter” is ambiguous for it initially referred to the person operating the machine. What is likewise significant, the original inventor and promulgator of the word does not get to determine what it means.
More generally, words can have meaning and relevance on a number of different bases. One—and an important one it is—is a practical basis. Questions to ask, in this regard, include: Does a given usage of the word sharply distinguish the phenomenon in question from separate albeit related phenomena? And does it establish a direction? And what is clear is that activists who proclaim themselves antipsychiatry are using the term in a way that establishes a direction—abolition—and in the process, we have created a niche that distinguishes antipsychiatry very sharply from critical psychiatry. As such, antipsychiatry has an “evolved meaning” which is both unambiguous and useful. What is likewise relevant, of all usages of the term that have surfaced over the years, this is the one—and this the only one—that stands out as “linguistically correct.” How so?
Closely examine the word “antipsychiatry.” It is a complex term composed of two parts, the first of which defines the orientation to be taken to the second. So there is “anti,” which means “against,” and there is “psychiatry,” the meaning of which, alas, we all know only too well. “Anti” identifies the orientation toward psychiatry. Ergo, to be antipsychiatry, by the very logic of how language works, means to be against psychiatry. To be “against,” note, is blatantly different than “reforming psychiatry,” or “modifying it” or “coming up with a new version thereof,” which in essence is what critical psychiatry stands for. Two conclusions follow. The first is that the activists who are using the term “antipsychiatry” to designate an abolitionist position, which is what the vast majority of self-proclaimed antipsychiatry activists are doing today, are using it correctly. The second, and we have already touched on this, is that it is not an ambiguous word, but one with a clear and precise meaning. To be antipsychiatry, in a nutshell, is to be “against psychiatry”—is to be committed to getting rid of it.
How does one square this reality with the early historical use of the term? By acknowledging that words change meaning. Beyond this, however, by taking in the fact that when Cooper invented the term “antipsychiatry,” what he did, in effect, is come up with a “misnomer”—for, while he had issues with psychiatry, strictly speaking he was not “against psychiatry.” The term was quickly accepted without anyone commenting on or seeming to notice the misnomer. What resulted from this acceptance of the term is that for a very long time everyone with a substantial critique of psychiatry got lumped together under this word. Come the modern activists—and survivors were absolutely pivotal to this change—slowly but surely a huge turnabout happened. For the first time, the linguistic meaning of the word and what it was being used to designate actually came together! The upshot? Though the term “antipsychiatry” entered into our political vocabulary as a misnomer, what materialized in the fullness of time is a useful word associated with a clear position and a very important agenda. Correspondingly, there is no question whose meaning of the word is accurate.
Herein lie answers to most of the questions posed at this beginning of this article. Yes, the term is useful. No, it is not ambiguous. Yes, it is clear which usage to follow. No, it is not subject to degrees. In this last regard, to be clear, one may of course have a strong critique of psychiatry without wanting to get rid of it—but in that case one is “critical psychiatry,” not “antipsychiatry.” The same is true of people who call themselves antipsychiatry while taking the position, for example, that they only want to get rid of nonconsensual psychiatry, as vitally important as such an advance would be. To fathom why I am saying this, look at comparable political terms in other areas—terms such as “antiracism” and “anti-sexism.” No one, for example, would say that they are avidly antiracist but that being so does not imply that they want to stop all racism, just “non-consensual racism.” Nor would anyone say they are “anti-ableist” while meaning it is okay if people are ableist privately—that they are only against ableism that is institutionally organized, that they have no objection to other types.
Now if people opt to take a critical psychiatry position, they are, of course, free to do so. What would be helpful, however, is that they not confuse their own position with antipsychiatry, that they not turn an unambiguous term into a vague term, that they not conflate antipsychiatry with critical psychiatry—that they not, as it were, send us retreating back into the “grab bag category” era.
I am aware, of course, that there are people who straddle the divide between antipsychiatry and critical psychiatry, or to put this another way, between abolition and reform. And of course, I respect people’s right to use words as they choose. In the interest of clarity, nonetheless, what I would encourage people who straddle these positions to do is try to articulate their stance without calling it antipsychiatry, for despite the best of intentions—and I in no way doubt that people’s intentions are honourable—doing otherwise does “muddy the waters.” And while I realize I am “stretching” here, I would encourage them more generally to ask themselves: What is stopping them from taking an abolition position? And are there perhaps better ways of dealing with what worries them without taking a position which, for all intents and purposes, involves propping up a bogus and destructive system, lending it both power and legitimacy? (For an article that illustrates that despite the best intentions, history shows again and again that this is where non-abolitionist reform leads, see “Liberal ‘Mental Health’ Reform: A ‘Fail-Proof’ Way to Fail.”)
By way of example, if they are worried that people need help—and who among us is not?—then how about working to establish participatory help networks which are voluntary and do not empower psychiatry? Correspondingly, if you are worried that people will be deprived of their way of coping if psychiatry is phased out—will be robbed of the drugs that get them through the day, for instance (obviously a totally legitimate concern)—please note that there is nothing in the abolitionist agenda which implies “leaving people in the lurch.” Herein, let me suggest, lies the difference between thoughtful and thoughtless abolitionist work.
Now I will not be mounting a case for antipsychiatry in this article, for I have often done so in the past and such is not the purpose of this article. Suffice it to say, at this point, that it has been demonstrated repeatedly by hundreds of solid theorists (both of the antipsychiatry and the critical psychiatry variety) that psychiatry lacks foundations, that it is a bogus branch of medicine, and that it overwhelmingly harms (see, for example Breggin 19916, Whitaker, 20107, Burstow, 20158, and Gøtzsche, 20139). As such, however one imagines this happening, does it not make sense to bring it to an end? Nor is the issue of respecting people’s choices relevant, though understandably, this issue almost invariably pops up when people explain why they are not antipsychiatry. Of course people’s wishes need to be respected! That is absolutely non-negotiable. And of course, people need choices! As I have argued in detail elsewhere, that is a totally separate issue from stopping bogus medicine from passing as real medicine, stopping the public funding of psychiatry and the industries surrounding it, stopping giving them power and legitimacy—which, not coincidentally, is a good part of what most of us mean by psychiatry abolition. Moreover, as likewise shown in the article referenced above, psychiatry overwhelmingly drives out choice; that is, it actually curtails the plethora of services that many want, while co-opting whatever else exists.
As for those who are uncomfortable with the notion of abolition itself, while abolition may seem extreme to people, and I totally understand the impulse toward “moderation,” albeit commonly a wise position, “moderation” is not an answer to everything. If a practice or institution is fundamentally unacceptable (take murder, take slavery) should we not be getting rid of it rather than just looking to develop a less horrific version?
By the same token, while some are afraid of the concept because it seems tumultuous, note that there is nothing in the commitment to abolition that in any way involves a commitment to instantaneous overthrow. I would remind readers here of the painstakingly careful attrition model of psychiatry abolition, where bit by bit, you unravel psychiatry, supporting only those reforms which lead in the direction of abolition (for details on how to implement a strategy such as this, see Burstow, 201310). More generally, pursuing abolition intelligently, kindly, sensitively and in ways that take seriously the plight and the rights of everyone is precisely what good abolitionist work is about.
To summarize, in short, the term “antipsychiatry” has a very clear meaning, a very clear goal. It carves out a totally distinct space. And its agenda is defensible, one might even say necessary. More generally, the arguments against it do not hold. At most they apply to careless abolition work, which is in no way implied in the commitment to abolition.
That said, to quickly return to the early history with which this article began—learning that I was penning an article of this ilk, several days ago, one of my friends asked me this: Had Cooper lived long enough to see what both psychiatry and antipsychiatry were to become, do I think he himself would have endorsed an honest-to-God antipsychiatry vision? While it is hard to know for certain, my guess is probably not, or he would never have abandoned the term in the first place. My guess is that, in part, Cooper abandoned the term precisely because it began to dawn on him just how out-of-the-box it was. On the other hand, who is to say where he would have gone had he stayed in the field and found himself contending with the mega growth of biological psychiatry?
Let me suggest, however, that even if he would not have endorsed antipsychiatry, besides the fact that his endorsement is hardly needed, that would not make the term an iota less clear or the antipsychiatry agenda an iota less pressing. What it would do, rather, is stand as yet another indicator of the limitations of social movement initiatives that originate from professionals as opposed to originating with the oppressed. In this regard, professionals can be important, even invaluable allies, and beyond that, brothers and sisters in struggle—and thankfully, we all know ones who are. Except under certain circumstances, however, professionals are simply not the oppressed. This notwithstanding, hats off to David Cooper for coming up with a term which was gutsier and even wiser than he knew!
Finally, in conclusion, and to return to the enigma surrounding spelling which I hinted at early on: regardless of how you spell “antipsychiatry,” linguistically speaking, it means the same thing. Correspondingly, like Shakespeare who spelled the word “spear” in three different ways throughout his portfolios, I have always considered society’s preoccupation with “standard spelling” as at best pedantic. Nonetheless, a curious difference surfaces in the spelling of the term “antipsychiatry.” While the word that Cooper invented was hyphenated, and while the vast majority of others who went on to employ it or reference it followed suit, there are generations of activists who have consistently spelled the word differently, in some cases even consciously intending a break with Cooper. In this regard, all thirty-two issues of the historical antipsychiatry magazine Phoenix Rising consistently used the non-hyphenated version, as have legions of antipsychiatry activists and their organizations (e.g., Resistance Against Psychiatry and Coalition Against Psychiatric Assault). I personally have published seven books consistently employing the unhyphenated version and literally hundreds of articles. And all the writings of the iconic survivor author Don Weitz (and his writings in this area date back to the 1970s) similarly uphold the spelling “antipsychiatry.”
Of course, spelling is “just spelling” and the vast majority of folks who come across your writing are unlikely to even notice the difference. So “no sweat” if you choose to retain whatever spelling you have been employing. This notwithstanding, if you want to stand in an almost forty year old tradition of people who have used “antipsychiatry” consistently to mean “abolition” (note, “antipsychiatry” without the hyphen has never been used in any other way), if you want to line up with the activists and radicals as distinct from the professionals, if you want to stand your ground as an abolitionist visionary, do consider joining us and bidding the hyphen “adieu.”
- Cooper, D. (1967). (Ed.). Psychiatry and antipsychiatry. London: Paladin. ↩
- Laing, R. D. (1965). The divided self. London: Pelican Books. ↩
- Foucault, M. (1980). Power/Knowledge (C. Gordon, Trans.). New York: Pantheon. ↩
- Szasz, T. (2009). Antipsychiatry: Quackery squared. Syracuse, New York: Syracuse University Press. ↩
- Diamond. S. (2012). Against the medicalization of humanity. Doctoral Thesis. Toronto: University of Toronto. ↩
- Breggin, P. (1991). Toxic psychiatry. New York: St. Martins Press. ↩
- Whitaker, R. (2010). Anatomy of an epidemic. New York: Broadway Paperbacks. ↩
- Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave. ↩
- Gøtzsche, P. (2013). Deadly medicine and organized crime. New York: Radcliffe. ↩
- Burstow, B. (2013). The withering of psychiatry: An attrition model for antipsychiatry. In B. Burstow, B. LeFrançois, and S. Diamond (Eds.). Psychiatry disrupted (pp. 34-51). Montreal: McGill-Queen’s University Press. ↩