The radicalness of the anti-psychiatry movement has unfortunately become one of its greatest hurdles to overcome. Even in otherwise radical spaces like prison abolition, neurodiversity, or intersectional feminism, the most common reaction to anti-psychiatry ideas is to dismiss them as so intuitively ridiculous they need not be engaged with. Sanism, behaviorism, drugs and force have permeated our culture to the point many people literally can’t imagine life without them.
On a good day, our leaders pontificate about “reforms” that would somehow fix a system whose deepest foundation is a bed of violence, oppression, and at best pseudoscience. They ask for cultural awareness training, yoga classes, art therapy, and healthier food options in psychiatric facilities, without ever questioning the confinement that made those things unavailable in the first place (let alone the coercion involved when participation in such activities becomes a condition of obtaining release).
Reform is a jail cell with pretty wallpaper. We don’t need mental health reform, we need total abolition of force and coercion. The system doesn’t just have problems, it IS the problem. So if we really fixed everything that’s wrong with the mental health system, there would be no more mental health system.
We have to be careful, of course, about rebranding. We’ve seen this happen with institutions for disabled people, renaming themselves to talk about independence, while still keeping people locked in and forcing drugs on them. Changing the name to something other than “mental health” means nothing if whatever name we replace it with offers all the same abuses. If we truly eliminated all the horrid practices that are currently committed by the mental health system, what would the world look like? What would it take to go about abolishing psychiatry and the mental health system?
What follows are 15 ways our society would need to change before we could be confident that we are free from the tyranny of the mental health system.
1. No one would be deemed incompetent.
No person would ever be declared unqualified to make decisions about their own life. Not because of a mental illness, disorder, diagnosis, health condition, disability, nor any other title. There would simply be no system in place to allow such a thing. The idea of meeting legal requirements to be conserved, confined, or made a ward of the state would become as anachronistic as the idea of meeting legal requirements to be enslaved. Everyone would be the ultimate authority on their own bodies.
“Mentally ill” is a legal term which translates into plain language as “unable to make decisions.” Not biologically, but legally. Unable to decide where to live, whether to live, who to live with, what food to eat, and what drugs to take or not take. Efforts to attack the term “mentally ill” as an offensive slur haven’t done anything to combat this legal designation. All that’s changed is that people with “mental health challenges” or “psychiatric diagnoses” are deemed unable to make decisions.
The fact that such a designation exists within the law — in letter, spirit, and execution — makes the mental health system, and by extension our whole society, intrinsically unjust and oppressive, because someone will always be designated by it. Truly overthrowing the mental health system, as opposed to just forcing it to get more subtle or rebrand, would mean that any remaining systems fully support cognitive liberty: the principle that everyone can do whatever the hell they want, with restrictions only ever placed on actions that harm other people.
2. All psychiatry programs in all schools would be replaced with Mad studies and neurodivergent studies programs.
As part of a total abolition of the mental health system, it would be necessary to put a complete halt on any influx of new mental health practitioners. For students in the middle of their training, it would be unfair to pigeonhole them into finishing, with a degree in a field that no longer exists. Instead, those students would be given transfer credits and an opportunity to change programs with full scholarship.
Mad studies and neurodivergent studies would open up as new programs that these students would have the option to transfer into. These areas of study already exist in a small number of universities, but by freeing up funding from psychiatry programs, they would have the opportunity to expand.
The meaning of the prefix “psychiatric” is undefined in all fields, so the only difference between a medical drug and a psychiatric drug is that one is called a psychiatric drug. The study of these drugs would be taken up by medical doctors, who are already required to learn about drugs.
3. Mad and neurodivergent people would be managers, not “peer specialists.”
The creation of various “peer” positions has accomplished very little besides handing out a few minimum wage jobs to disabled people. A requirement of “lived experience” rather than a degree makes a vaguely defined identity group into the primary qualification.
The essential function of a “peer specialist” is to appear non-threatening, earn people’s trust, and convince them to stay on their meds. Hiring managers know that these positions only exist because others don’t, that there are far more job-seekers than jobs to fill, and thus that anyone they hire is easily replaceable. “Peer specialists” are grunt laborers with no real power to meaningfully affect the establishment that brought them in. If a radical abolitionist gets the job and conscientiously objects to their assigned duties, they just get fired like in any other job.
If a patient is prisoner to the medical facility, while their counselor has never been imprisoned and is free to leave at the end of their shift, then the counselor does not have the same lived experience and is not a peer to their client. They are just another generic white coat whose income stream depends on keeping others locked up and coercively medicated.
If the “peer specialist” has more power than the patient, then they’re not a peer, and if they have the same or less power, then they’re not needed.
Advisory committees made up of “peer advocates” are not effective either. They are a token position with no actual power. They can tell the managers what to do, but the managers have no obligation to follow their advice. In many cases all that’s accomplished is to create the appearance of listening, placating any protesters while creating no real policy change.
What reformists say would be fixed by additional “peer specialists” would actually be fixed by having Mad and neurodivergent people in management positions, with actual decision-making power. This situation could be achieved legislatively, through diversity quotas, or culturally, through the understanding that Mad and neurodivergent people not only have instant added value in their wide range of lived experiences, but also can be just as skilled or more than any neurotypical.
The hierarchal structure of business means that putting good people at the top would eventually improve the immediate service at the bottom, because we understand our own needs better than someone who just needed a job.
4. Crisis hotlines would be prohibited from tracking callers or dialing law enforcement without the caller’s consent.
In today’s cultural landscape, crisis hotlines are being pushed as a way to access the mental health system quickly and without insurance. Currently, all hotlines train their staff as mandated reporters, to listen for key phrases and if the caller utters one of them, secretly send people with guns and a history of recklessly using them, directly to the caller’s location. The sole exception is Trans Lifeline, which is of course exclusively for trans people, only a fraction of everyone who might want to call a crisis hotline.
Rather than fixing these serious safety hazards, reforms to crisis hotlines include expanding hours of operation, adding text options, and starting new hotlines for identity groups like teens or LGBT. All that gets accomplished here is increasing the number of people who get tricked into putting themselves in danger, while thinking they’re getting an emotional support or referral service.
Crisis hotlines are undoubtedly part of the mental health system as long as they behave this way. So in order to overthrow the system, the hotlines would need to be more regulated. Specifically, the regulations would give hotline callers the same confidentiality rights they have with a doctor or therapist, which under this new paradigm would of course include the right not to be locked up for hearing voices or being a danger to yourself.
5. Compliance with Olmstead “community living” would mean Housing First with no strings attached.
The supreme court decision of Olmstead vs L.C. declares the right of disabled people, including those disabled by psychiatry, to live “in the community” instead of in institutions.
Unfortunately, the implementation has been a lot more fuzzy than the decision itself. Prisoners of institutions wishing to leave must first establish a place to go ahead of time, which means they must have either the money to leave on their own or a solid support network. Obviously people who have been disabled and stigmatized are not always going to have those things.
A few public supports exist, such as transitional housing for homeless people, but these all come with a heaping spoon of coercion. They may require residents to regularly see a psychiatrist, comply with drug prescriptions, eliminate their use of non-prescribed drugs, get chummy with their neighbors or attend a minimum number of religious cult meetings each week.
Some cities have implemented Housing First programs, meaning that homeless people are taken off the street and given free permanent homes, in some cases with no strings attached. These programs have been a huge success, even by dogmatic standards like increases in employment and decreased use of non-prescription illegal drugs (because they’re not so stressed by being homeless).
If you truly want to free people from institutions and homelessness, just give them homes.
6. Service providers would be trained to consider doing nothing as a valid option.
An emotional crisis or spiritual emergency doesn’t always require an intervention of any kind. Sometimes the interventions we’re told are “best practice” only make the situation worse. Sometimes the person experiencing the situation already knows their best coping strategies, and will do a much better job at implementing them than someone they have to be explained to. Sometimes their friends are already familiar with the best ways to support them. An emergency psychiatrist necessarily isn’t, and neither is a so-called peer counselor.
In a post-psychiatry world, both would be regularly, sternly reminded of their humility. Moreover, they would be taught when not to intervene, and they would not need to have basic respect packaged as just another proprietary methodology, with a sexy name like “Open Dialogue,” “Intentional Peer Support,” “Emotional CPR,” or even “Alternatives to Suicide.”
Suicide attempts aren’t always a “heat of the moment” thing. We all die. Some of us would like to decide how, and some of us would also like to decide when. Sometimes a deeply introspective, thoroughly logical contemplation reveals that suicide is the mode of death most consistent with one’s beliefs and values. An immense degree of arrogance is needed to say that this person should be required to live against their will, in a facility where all their freedoms are taken away, which could only make a reasonable person more certain that they would rather die. An even greater arrogance is needed to say that stripping a person of everything they have, emotionally and literally, would improve their health.
Whether you place the highest importance on health or liberty, using force and coercion makes no sense because doing so improves neither. It makes much more sense to think of counseling a suicidal person as end-of-life care: the professional listens, acknowledges feelings, reflects on them, and doesn’t send someone with a gun to make sure their client dies faster or goes to prison. It’s not assisted suicide; it’s just respecting another person’s beliefs and values, even if you disagree with them. You may even find that when people have the freedom to talk about their feelings without having violence committed against them, they might be more inclined to keep on living.
Knowing when not to intervene is just as important as knowing a good methodology. In many situations doing nothing is the best strategy available. To overthrow the mental health system, we must train professionals, as well as the general public, to regularly and seriously consider the option of letting people make their own decisions without trying to threaten them out of it.
7. Short-term and long-term housing would be unlocked 24/7.
Peer respites, emotional wellness centers, urban safety retreats — whatever we wind up calling the former “mental health” facilities — they are all unlocked both ways, allowing the people who stay there to come and go as they please. Common areas like kitchens and TV rooms would remain open and powered as well. Strongly worded legislation would be passed to shut down any facility that resembles an institution, such as ones that don’t pass the burrito test.
Confinement is always violence. Involuntary homelessness is always violence. Lock-ins, lock-outs and curfews cannot ever be therapeutic because they violate a person’s safety and autonomy.
Furthermore, consent is not possible any time the consenting party needs someone else’s permission to leave. Even when people technically have the legal right to refuse drugs, or not choose the “healthy” food, or abscond from group therapy, they can be coerced into doing those things because it influences someone’s opinion of how long they need to be held. Therefore, the overthrow of the mental health system is incompatible with the continued operation of locked facilities.
8. Every care unit would be funded in a way that decreases the length of stay and gives visitors the drugs they want.
It’s bad enough that anyone with a badge, a degree, or a child can create a 72-hour imprisonment with no crime, no victim, no due process, not even a charge. 72 hours can cost you your job, your home, or even your life. Yet for many, those 72 hours are only the beginning.
Most psychiatric facilities try to keep people for even more absurd lengths such as weeks or months. One reason they want people to stay longer is because medical insurance companies are willing to pay for psychiatric services. The longer the stay, the more money the facility gets. Ironically, what is otherwise considered “good insurance” paints a target on the heads of false commitment victims, whereas “bad insurance” may end up saving a person’s life.
In these environments, it’s very easy to get a forced injection of tranquilizers by acting non-compliant, yet it’s challenging to impossible to get the drugs you actually want and need, or even to continue them based on existing prescriptions.
Although we should have already banned outright cages at this point, it’s difficult to completely eliminate all coercion. Doctors and psychiatrists can be persuasive pressurers who espouse the importance of their snake oil, or they can refuse to administer legitimate life-saving services until after an arbitrary screening period.
To fix all of these problems, the end of the mental health system would have to include a revision of how care facilities are funded. Rather than getting a flat rate for each day a visitor stays, they would get a variable rate that diminishes according to the amount of time the person stays in the facility, instead of moving back into community living with proper supports.
This way, care facilities have a financial incentive to give visitors the services they asked for quickly, including drugs if desired, so that those people are satisfied enough to leave earlier.
9. All drugs would be legalized, including prescription drugs.
As said by Thomas Szasz, considered by many to be the father of anti-psychiatry, prescription drugs are illegal. You cannot waltz into a drug store and buy a prescription drug without a prescription. Prescribing to yourself is a crime. Prescribing to your friends or family is a crime. It is a crime to give someone else a drug that was prescribed to you, and it is a crime for you to take a drug that was prescribed to someone else. No other form of property is treated this way, except for illegal drugs.
Criminalization and prescription are two sides of the same coercive coin. Together, they mean that people who need or want a drug either can’t get it at all, or can only get it if they are wealthy enough, normative enough, and socially savvy enough to convince an arbitrary authority to grant permission. Restricting your choices is not on the same level as forcing a substance into your body, but it is one of the many ways the mental health system oppresses us.
Without the mental health system, there would be no such thing as a psychiatric prescription because all drugs would be legal. Supporters of the status quo often ask “how would you get the medication you need without a doctor prescribing it?” The answer is right there in the question: without a doctor prescribing it. In other words, the same way you get any other product: you go to a store and buy it.
To overthrow the mental health system, we must abolish the prescription system, and replace it with a system of informed consent. Psychiatrists would no longer be the gatekeepers who decide whether you will be allowed to take the drugs you actually want. Instead, the role of a psychiatrist would be to give recommendations and safety warnings. The paper you leave with would simply be a reminder note of what name and dosage to grab off the shelf.
Also, it would be nice if we released, pardoned, and compensated everyone who is currently in jail (including the jails that are called hospitals) on a non-violent drug charge.
10. Adverse drug effects would be independently studied, listed on the box, and discussed without taboo.
Informed consent is the only true consent. The reason is simple: if a person was not made aware of the risks and downsides, then that person did not consent to them. Abolishing prescriptions would be a major victory, but that alone would not guarantee a system of informed consent. Although banning untested drugs altogether is yet another act of paternalism, to protect you from yourself, it is nevertheless the obligation of a responsible society to protect individuals from predatory companies.
There are two parts to this change: Studying and labeling.
Trials for new drugs would be conducted by independent parties. “Independent” must mean sufficiently divorced from the manufacturer such that the people collecting data do not know the name of the drug or the company that made it. Double-blind, placebo-controlled is a good foundation for a standard, but we must also add the full human spectrum to the subject pool, including people of diverse ages, people of size, disabled people, and people who have a uterus (currently biomedical research often excludes anyone with a uterus because it would be inconvenient if they got pregnant).
As a precaution against residual paternalism from the mental health system, the results of these studies would have to be made freely accessible and open source. Once a drug goes mass market, the people who take it would be able to submit anonymous complaints (petition for redress of grievances) to an open-source government site, and a certain number of people submitting the same complaint would automatically prompt a re-investigation.
Once the drug effects are known to the elite few who understand, care about, and have time to comb through data, that knowledge must be disseminated. The most effective method is to require warning labels directly on the product. PSAs on TV, in newspapers or online all have a selection bias, word of mouth clearly hasn’t overpowered marketing money yet, and warnings in doctor’s offices would be a moot point after abolishing the prescription system. A mandatory warning on the package in the store ensures that everyone who receives the product receives the warning. Voila, informed consent.
The warning label method does have one weakness though: Many people don’t bother reading them, not because they don’t care, but because it’s so unheard of that these drugs might not be perfect. For this reason and many others, the overthrow of the mental health system would have to be not only a series of legislative victories, but a cultural shift too. Feeling like there must be something wrong with the individual, rather than the drug, is one of the insidious ways the mental health system prevents survivors from coming out, which prevents conversations about adverse effects from being normalized. More psychiatric survivors must open up about their experiences, and it must be safe for us to do so.
11. Every program that recommends drugs would also offer support for quitting drugs.
Even after the prescription system is replaced by a system of informed consent, psychiatric drug withdrawal is very real. Those who were informed and consented to the drugs may still decide to stop taking them later. Any withdrawal is a difficult process and requires support.
The lack of support for people who want to stop taking their drugs makes it difficult to have free choice over the use of mind-altering substances. Expecting people to suffer alone while they taper off the drugs or go cold turkey is essentially pressuring them to stay on the drugs. It’s a form of coercion, and thus part of the mental health system.
In a world free from the mental health system, everyone who is trained to recommend drugs would also be trained in how to help people taper off, and drug dealer facilities would also have a withdrawal unit, both for safe tapering and for maintaining a relative amount of safety while quitting all at once.
12. All psychiatric diagnoses would be recognized as bunk and removed from medical records.
Despite all the “biological brain disease” rhetoric justifying the pseudoscience of psychiatry, no so-called “diagnosis” in DSM 5 has ever been demonstrated by a biological test. In the few cases where we have discovered a biological cause, such as trisomy 21 for Down syndrome, that classification has ceased to be the domain of psychiatry.
Because these “diagnoses” are little more than pseudoscience, made up by psychiatrists to oppress people and gain money, the end of the mental health system would mean the end of the DSM. Every DSM classification would cease to be a disorder in public or professional consciousness, and they would become obsolete from medical records, because they are not medical information.
What about legitimate identities that happen to be falsely pathologized? How would they get services?
Firstly, there is no logical dependency between a group existing and that same group being classified as a mental disorder. You can have one without the other. Legitimate categories such as multiplicity, hearing voices, or Autistic would be recognized as cultural identities, similar to the way we now recognize gay as an identity, now that psychiatry finally let go of homosexual disorder to free its hands to grab transgender and asexual.
A pseudoscientific medical diagnosis is not necessary in order to get services such as communication devices, gender affirming surgery, and the anti-convulsants some people take to hear voices. The requirement of DSM classifications makes it harder to get those services, not easier. Under a system of informed consent, rather than the gatekeeping prescription model, cultural minorities would more often get the services they want and need.
13. Consent laws and consent culture would obsolete compliance.
Enough about information. What about the consent part? Atop the slain corpse of the mental health system, all procedures would require consent from the recipient. Consent must be freely given and can be revoked at any time for any reason. Patients checking into a medical facility would be able to leave whenever they want, not weeks later when the doctor finally signs the discharge papers because insurance ran out.
There could certainly still be conduct agreements, for example “no yelling in the meditation room,” but anyone who can’t or doesn’t want to abide by the rules can opt out of the entire situation.
Mental health is one of a handful of industries, along with education and government, where the person paying for the service, in effect the employer, is expected to complete arbitrary rigors and assessments, or else face inescapable consequences decided by their employee. Without the mental health framework, expecting compliance with doctor’s orders would no longer make sense, because the doctor-patient relationship can be terminated at any time. Instead, the professional would be expected to comply with the wishes of the person requesting their service, or else be fired and replaced.
14. Social Security would be replaced with Universal Basic Income.
Wait, what does welfare have to do with mental health? Well, the legal definition of a disability is still pretty stuck in the medical model — the idea that people are disabled by medical conditions, rather than by access barriers like stairs and strobe lights. Therefore, one must get a “diagnosis” from a doctor to qualify for any disability-based government program.
Aside from the inherent dangers in handing over your recorded history of madness to multiple corporations and the government, the current bureaucracy creates a problem within the mental health system itself: imbalance of power. Those who are unable to work due to systemic hiring discrimination rely on welfare programs, which require you to convince a doctor to say you’re unable to work. If you’re magical and manage to convince them that you’re a victim of discrimination, that doesn’t count.
If your survival within a capitalist system depends on you qualifying as legally disabled, and a doctor wields the power to decide whether you’re legally disabled, then the relationship you have with that doctor is inherently coercive. The doctor can let you die if they feel that your madness is too weird, or that you smell bad, or you didn’t say “please” enough.
Keeping doctors the gatekeepers of disability benefits is no better than keeping them the gatekeepers of drugs. You can’t revoke your consent to the doctor-patient relationship because the doctor holds something you need and can’t get without them. That is the definition of coercion. In order for patients to have the power to revoke the relationship with their doctor, they must not require a doctor’s permission to get the services they need, including income. In order to revoke the power of coercion from doctors, we would have to revoke the power of their signature in disability benefits.
15. Any use of force in a psychiatric context would be illegal.
In case it wasn’t clear, freeing ourselves from psychiatric tyranny requires the complete and total abolition of all interventions that lack the consent of the person whose life is being intervened in. Not reduction, not higher standards of proof, not “last resort” policies, total abolition.
Anything less than total abolition is playing within the system, using the master’s tools to ask for minor cosmetic changes and lip service. If nine hundred people were force-drugged this year instead of last year’s thousand, we still have a problem.
The master’s tools will never dismantle the master’s house. Create a list of criteria so the cops can’t just lock up anyone for any reason, and they’ll use those criteria to shop around for people who meet them. Make force a “last resort” and the first resort will be to halfheartedly skim through a checklist. Add a “peer specialist” to the team and they’ll hire someone who’s up to their eyeballs in the medical model and a paradigm of health first, liberty never.
We are not free from the mental health system as long as one person is under threat of legalized force. All the other changes on this list are ways to keep laws enforced or to reduce manipulation and coercion. But first and foremost, we need far-reaching legislation, with broad definitions, that makes every use of psychiatric force automatically a crime.
Number 16. Throw away “mental health diagnoses.” They enable bigots and cause undue pessimism in the labeled and the labeled’s family members. This would also minimize the need for financial support of any kind since they could find employment more easily.
Number 17. Do away with Day Treatment. The whole thing is infantilizing and a huge time sink. Involvement with a “mental wellness” center is a form of segregation. Ditto for “clubhouses.” If someone needs help reintegrating into society they can make a plan with help from a counselor–or better yet a peer manager. Volunteering, groups like EA or AA, clubs, etc. I find I get along better with people I meet this way, since we have more in common than being randomly lumped together as “mentally ill.”
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#18: Refocus research and intervention on individual and social trauma and disempowerment rather than blaming the biology of those who are traumatized or socially outcast.
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My disagreement starts with the first sentence.
“The radicalness of the anti-psychiatry movement has unfortunately become one of its greatest hurdles to overcome.”
Radical-ness is not the problem with the anti-psychiatry movement, at least the psychiatric survivor end of it. Focusing all the energy and blame on psychiatry alone is a big part of the problem. Where are psychiatrists without family members, politicians, law enforcement, psychologists and social workers, institutions of higher education, etc.? They’d be, of course, on the street or in the unemployment line.
“What would it take to go about abolishing psychiatry and the mental health system?”
Although you might be on board with # 1, abolition of psychiatry, I don’t think there is really a lot here on # 2, abolishing the system.
Let’s look at your 15 proposals. While I’m entirely in agreement with some, I end up shaking my head about most of them.
* = total agreement.
1. *
2. Institutions of higher education are as likely to replace psychiatry programs with Mad studies and neurodivergent studies programs as they are to replace law enforcement training programs with black history and minority studies. The fact that schools offer psychiatry programs is no excuse not to fight for the inclusion of Mad studies, disabilities studies, minority studies, and so forth.
3. Here’s where you rather than abolish the mental health system work in and for it, and, thereby, work toward expanding it. Needless to say, regardless of the specialist jargon and obfuscation used, I’m not going there.
4. You’re that much closer to ending suicide prohibition if you get rid of the hotlines altogether.
5. *
6. Get rid of the service providers altogether, and you don’t have to train them to slack off. Otherwise, reduce their numbers, and accomplish the same aim.
7. Expanding the “peer mental health” treatment system = expanding the system in its entirety. People need to learn how to, as in reverse magnetism, opt out of the system.
8. I don’t really think having health institutions serve as drug dispensaries is a good idea. The most effective way to decrease length of stay is through defunding.
9. I myself would not want to encourage drug use, pushing, promotion, and manufacture. I don’t think institutions or federal governments should do so either. We are, given the present opioid crisis, dealing with the consequences of living in a prescription drug culture, and I don’t think that’s a good thing.
10. This conflicts with #s 8 and 9 (i.e. drug selling and promo). We’re shown drug ads on television and the internet every day of the week that provide a lot of information on adverse effects that they expect viewers to simply ignore.
11. You wouldn’t have to launch drug withdrawal programs if you didn’t start with drug treatment programs. Stop drug peddling, and you eliminate both.
12. ALL psychiatric diagnoses ARE bunk.
13. *
14. People should not be paid not to work regardless of whether its through SSI or UBI. Jobs over bureaucracy!
15 *
The problem with # 15 is you don’t need to change the law so much as you need to repeal it. Without mental health law, this force we are presented with would be illegal anyway. Mental health law represents a loophole around criminal law.
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Hi Frank,
I really appreciate your engaging with the material. This is exactly the sort of back-and-forth I was hoping the article would inspire.
I’m especially curious about your proposal to abolish psychiatry but not the mental health system. To me, these seem like two words for the same thing. What exactly do you consider to be the difference between the two?
In #2, my point is not to *wait* until we’ve removed the psychiatry programs. I would LOVE to see a Mad studies major at every university. All I’m arguing is that until the psychiatry programs are gone, we haven’t completely overthrown the system. Adding more good information can certainly be a strategy for combating bad information.
I could get on board with eliminating crisis hotlines. I wouldn’t go as far as a legal ban, but I would love to see a culture shift where people stop thinking of hotlines as an adequate replacement for friendship, human compassion and mutual aid.
I previously wrote on my personal blog, in an article about 13 Reasons Why:
“I don’t believe that this was an oversight. I believe it was a deliberate choice, because promoting suicide hotlines would undermine the central message of the show.
“The real reason people get uncomfortable with the lack of resources is not moral outrage at irresponsible triggering, it’s because they are yet again trying to find a way to make suicide the sole responsibility of the suicidal person and not anyone else. If calling a stranger on the phone is a magic pill to cure suicide, then every death is the fault of the dead person for not reaching out. By not inviting this supposed solution into the show, it was not invited into the conversation. The focus is kept instead on other people’s responsibility in causation or prevention.”
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I was proposing abolition of the “mental health” system, I wasn’t proposing the “mental health” system. I feel like the original psychiatric movement had this obsession with laying all the blame on psychiatry which was just short of the facts. Psychiatric nurses, psychologists, social workers, ex-patient psychiatric prison warders (i.e. turncoats), careerists of all sorts, I don’t think they are the good guys either. I thought you were providing many outs for people within the “peer” movement that actually worked towards expansion of the system. My issue with drop in centers, etc., is that they have become much more compromised in their position vis a vis mainstream psychiatry over time. Funding issues, for one thing, lessen their independence from the system and the government. What do you get out of this compromise? More “patients” (consumers, users, whatever) and more professional, even paraprofessional, staff. De-medicalization is opting out of the system altogether.
We are not free from the mental health system as long as one person is under threat of legalized force.
Perhaps, but I personally AM free of the “mental health” system. I don’t see why it shouldn’t be the same with others.
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I was proposing abolition of the “mental health” system
Does this represent a sea change for you?
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Not at all. We’ve talked about ‘dismantling the mental health system’ before. I don’t know how you would ‘dismantle’ it without ‘abolishing’ it. I just don’t focus on blaming psychiatry because I don’t think the fact that there is a psychiatry is a problem. The real problem is forced treatment, the legislation that has been enacted that gives such power over people’s lives to that profession. The community mental health system, a result of the community mental health act, was one of these things put in place to remove people from the big asylums into the community, but it’s just more of the same. You don’t need a community “mental health” system to release people from psychiatric prisons. All you need, if you want to be thorough about it, is demolition equipment and a demolition crew. If “mental illness” is actually a myth, as some of us insist, you don’t need a “mental health” system for maintaining the pretense that it isn’t so, that it’s a reality.
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This is contradictory. You want to abolish the “mental health” system but psychiatry isn’t the problem???
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Focusing on psychiatry alone is distracting and diversionary, yes. Force is the issue with me, psychiatry, in and of itself, not so much. On the one hand you have these moderates and reformists diverting attention away from the need to abolish the forced torture system, and, on the other, you have these people talking abolition of psychiatry– Whatever that means?–doing the same. Psychiatry isn’t the problem, force is. If you were to abolish psychiatry, and forced “mental health” torture still existed, what then? Reassess? I see any call to abolish psychiatry as confusing and distracting. It’s not that psychiatry exists, in any form whatsoever, it’s that it has been given a power by law courts that would be criminal in other hands. I don’t have a problem with psychiatrists in private practice, I just have no wish, nor need, to supply them with business. It is institutional psychiatry that must be abolished.
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O well, I thought you had an epiphany or something, instead it seems you’re regressing in your analysis, seriously. If psychiatry were abolished all things “mental health” would go with it. Instead you seem to be calling the main issue a “distraction.”
There is no such thing as non-coercive psychiatry btw; sometimes the coercion is just more subtle.
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I think there is plenty of room for disagreement on that subject. If psychiatry were abolished, we’d still have “mental health” law forcing people into treatment. Psychiatry and force are not synonyms. Plus, psychiatry has always had a heck of a lot of help doing its worse, and if that help is still in place, even if you eliminate it, you’ve done nothing. Rhetoric, OldHead, is still not reality, just as nonsense is not sense, even if it is espoused by OldHead. Psychologists, in a power struggle with psychiatry, want prescription privileges. So much for your honorable, and untouched, exploratory whatever. It is not like they are any better, nor is it like psychiatry could have done what it has done without their, if not blessing, at least, acquiescence. The “mental health” system is not, simply put, psychiatry. There’s no sense in pretending that it is. If you abolish psychiatry without abolishing non-consensual coercive maltreatment, I don’t want anything to do with your abolition. Get it!
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Coercive psychiatry exists, but saying that there is no such thing as non-coercive psychiatry is a lie. Say the psychiatrist is the guy, and his client is the girl, should the psychiatrist proceed when his client, in no uncertain terms, says “no”, that’s coercion.
If you can walk out of the psychiatrist’s office, and he can’t do anything to stop you, that’s non-coercive, however, if you try to walk out of his office, and he reacts by having a couple of goons tackle you, and stick a needle in your butt, that’s coercive.
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The “mental health” system is not, simply put, psychiatry.
OK that’s a new one — care to elaborate? Are you saying that there isn’t a psychiatrist (or group of them) calling the shots in every “mental health” apparatus?
If you abolish psychiatry without abolishing non-consensual coercive maltreatment, I don’t want anything to do with your abolition.
Nothing is “mine” here; anyway, we’ve established before that people have different definitions of “abolition,” not all of which are synonymous with outlawing something. Collective judgement borne of understanding is powerful as well, ultimately more powerful than laws. But we do need to deal with laws in the meantime.
I’d say it remains highly debatable as to whether there can be a truly non-coercive psychiatry when you consider the coercive environment in which most “private patients” enter into “treatment”; most often it’s simply to avoid a more barbaric version of psychiatry. Coercion is sometimes a matter of degree. So the question is, can “consensual non-coercive psychiatry” truly exist when the possibility of coercive non-consensual psychiatry lurks in the background?
If one’s analysis of psychiatry is that it is first and foremost, and literally, a tool for the enforcement of cultural and legal norms, it is understood from the start that we’re talking ultimately about coercion.
So I’m interested hearing some debate on this, not just between me & Frank.
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I’m saying psychiatry isn’t the law, forced treatment is the law. It is the law, in this case, that is our problem. It is a bad law that needs to be repealed. Do so, and you abolish non-consensual coercive (mal)treatment.
I’m not abridging the dictionary, and I’m not arguing definitions. Abolish means abolish, get rid of, do away with, eliminate. No need to mince words, and definitely no need to make words mean their opposite. People may have different definitions, in which case, I will resort to the one supplied by the dictionary. Were we building a tower of Babel…Well, you know the parable.
I don’t think it debatable at all whether psychiatry can be non-coercive. Much of it is non-coercive. Non-coercive, but expensive. Coercion is pretty black and white. Either one is compelled by law or force to do something one wouldn’t ordinarily do, or one is not. The locked closed ward, the psychiatric prison, is all coercion. It’s that coercion that I would see abolished.
Psychiatry would not define itself as “first and foremost, and literally, a tool for the enforcement of cultural and legal norms”. I think we have to look at the way psychiatry defines itself, and also at how other people would define it, and not just at the way that it is defined by OldHead.
Like OldHead I would welcome any and all discussion on the subject.
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I can’t entirely agree about crisis lines. I think they are an outgrowth of the disturbing level of disorganization and oppression in society at large. They are more a symptom than a problem. The original crisis lines were entirely community based, manned by volunteers who were there to listen and care. They have been largely co-opted by the “mental health” system at this point, but there are still a few like the one I’m currently volunteering at in Olympia, WA, which runs on the old principles, including never tracing a call or dispatching the police to anyone who isn’t specifically asking for that kind of help.
In order to really eliminate psychiatry, there are some fundamental changes to our society that will have to be made, starting with encouraging community and putting some limits on the ability of commercial interests to keep the bulk of humanity in poverty.
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In order to really eliminate psychiatry, there are some fundamental changes to our society that will have to be made
So, so wrong!!! This implies that psychiatry fills a need and that to eliminate it something else must be found to fill that need. But psychiatry fills no need other than the need to repress societal dissent. It needs to be ABOLISHED, not replaced. This is hardly rocket science, Steve.
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Not sure you’re getting what I’m saying. Psychiatry DOES fill a need for society to keep us from getting together and rebelling.
But a crisis line was originally a rebellion AGAINST psychiatry. It was regular folks volunteering to help their neighbors in the community. As I said, most have been co-opted by psychiatric institutions, but the original concept was completely independent of psychiatry, and it was conceived of as a way for people to help each other WITHOUT “professionals” sticking their noses in. Or are you suggesting that people don’t need other people to talk to or a community to support them? Our communities ARE shattered and dispersed and it is the absence of such real communities that is at the heart of the angst and despair so common in industrialized countries, IMHO. So there is a need for people to connect, and it’s very real, even if that need is preyed upon by those trying to make a quick buck off of shutting up the distressed and the disenfranchised.
Capitalism has focused a lot of energy on undermining communities so they could have a mobile work force and so they could pollute and trash the environment without people being organized enough to resist. That’s what the Luddites were saying way back a couple hundred years ago.
A little history:
https://en.wikipedia.org/wiki/Crisis_hotline
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I wasn’t commenting on crisis lines. I’m responding to the idea that before psychiatry can be abolished there must be an “alternative.” If that’s not what you were saying no further discussion is needed, but it sure sounded that way.
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Not really saying there needs to be an “alternative.” I’m saying that the underlying social forces that lead people to seek out and/or accept psychiatric “treatment” need to be addressed. Otherwise, something else will emerge that is based on the same principles, namely, that reacting badly to the status quo is proof there’s something wrong with you. Schools are also run on this principle. Religions are often run on this principle as well. Oppression goes way beyond the purview of psychiatry, even if psychiatry has come up with a very efficient way of managing it.
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OK, that’s a little more clear. Until people understand these “social forces” there will always be a new hoax waiting in the wings.
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Agreed!
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Most people are sheep that’s why this oppressive system still exists.
I talk to victims of inpatient psychiatric abuse all the time in addiction recovery. Maybe they did not like how they were treated but most of them seem to think it was ok or recite the 5 word mantra of losers “it is what it is” and have no desire to do anything about it.
Us activists are a rare breed.
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As I said in an earlier comment, Cat, it’s much easier to convince people that psychiatry is full of corrupt practitioners than that the system itself is inherently corrupt.
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Agreed.
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These individuals probably don’t like being referred In that manner.
From time to time I rangle a compliment so as not to tarnish the dangerous road they traveled by. I may throw some sunshine their way and it goes “hey you are a strong person. You’ve been through a lot.”
Also to Peer or Recovery Support Specialist I say this again to you.
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I will have to agree with you here.
I am the staff moderator of a recovery group in the state “hospital” where I was once held. There are “patient” moderators that share guiding the group with me. What I’ve found is that there are very few people within the system who truly believe that they can recover, at least where I work. The only people who resist the message of “you’ll always be ill” are forbidden to come off the units so that they could attend the group because they refuse to “get with the program”. They usually end up drugged to the gills.
Few people want to attend the group (we can’t mandate that they come to the group because it’s a peer activity and peers are forbidden to make people do things) because we tend to ask questions about what people can do on their own to further their own recovery. All other groups in the “hospital” are mandatory. One older gentleman once called our group the most feared group in the “hospital” because it required you to actually think on your own and come up with answers for yourself rather than answers that someone else gives to you.
I’ve started going to the units to be and talk with those who resist since they’re the ones who give me any real hope that they just might gain their freedom from the system.
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The groups I attended semi-voluntarily were so defeatist and demoralizing that I had to leave to overcome my depression.
Lonelier than ever, but no longer going through the drivel of “you’ll never get better–just give up.”
This seems to run counter to the myth of the happy productive lives we’ll lead if we swallow our safe and effective pills. When I asked why we weren’t getting better everybody got angry. This was long before I discovered the truth about psych drugs too.
When I point out how people go downhill and become more cognitively impaired then ever people act shocked. Is it normal for people to stare vacantly into space, not be able to smile or weep, lose the ability to follow a page of sustained prose, develop drug addictions and binge eating disorders?
Had some people on this site tell me I’m a meany for “insulting” people victimized by shrinks somehow cause they’re better off lobotomized. Denial is more than a river in Egypt.
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Please look up the definition of prejudice. Then read your comment again.
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You’ve got that right.
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All the other groups in the “hospital” parrot the party line that you speak of here, the line that you need to always take your “meds” and “work your treatment”. The problem is that the only treatment is the toxic drugs that eventually debilitate people. The people on the units where I work are drooling on themselves, literally drooling, and the staff thinks that this is a good thing; at least they aren’t causing trouble and shouting obscenities.
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Thanks Au for your time, effort, and thoughts. I have issues but you have created a great framework for discussion.
In your community I am not sure where the issue of trauma lays.
My one and only concern is how can we- will we deal with trauma and for it to work we need to address it at almost all societal levels
I am coming from Caps for Sale approach to all of this as a worker and yes through my fault I did the dip in more babysitting than not work- I had no idea of what folks who were there were actually dealing with- then I have my time in MH system and then trying to live out of system but trauma issues are still present
We need to be able to meet in a safe place and organize. One of the student groups against gun violence laid out shoes in front of the Capitol steps for each child victim of gun violence since Sandy Hook – it was a visual like the Aids Quilt
And in a fully trauma aware world the shooters and other offenders of all ills would be at least understood to have some sort of trauma template in their lives.
No excuse but to understand is better than hating and or stigmatizing.
Keep up the work you all.
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A few more quick thoughts
Suicide- my friend lost her young daughter and received the most help and support from the military vets family who had lost loved ones to suicide. A bi issue for vets and other professions that is being covered up.
My local NAMI sent folks to the wakes. Don’t know how they got the info.
Not the best way to help.
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Not the best way to help.
But a great way to hand out drug brochures and info about the local mental illness factory that kindly allows them to use the facility after hours. 😛
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The radicalness of the anti-psychiatry movement has unfortunately become one of its greatest hurdles to overcome.
This is totally false. Further,
Even in otherwise radical spaces like prison abolition, neurodiversity, or intersectional feminism, the most common reaction to anti-psychiatry ideas is to dismiss them as so intuitively ridiculous they need not be engaged with
I’m suspicious of “neurodiversity” as the term is vague and undefined from what I can see, and implies neurological impairment. “Intersectional feminism” I imagine is as bogus as “intersectional” anything else, i.e. not “radical” at all. So this is no doubt part of the problem, as currently many so-called “radical” activities are actually neoliberal and reactionary in essence.
Nonetheless I find many of these proposals viable. The problem is you are still looking for reforms to the “mental health” system rather than a path to revolution.
And fuck “Mad Studies,” we are not “mad.” Though some of us are very angry.
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I view “madness” as a condition but it would almost always be temporary if psychiatrists would bug off and let us recover.
So “Mad Studies” would be like “Migraine Studies”–putting migraine sufferers into a category different from others just because they had a bad headache 10 years ago. And no, there is no known biological reason for it. It’s not an illness or disease. But it’s terrifying, I can assure you.
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Well, how about antipsychiatry, or antipsychiatry movement studies? I don’t think you would necessarily eliminate a subject such as that one from the curricula. In my view, any course on antipsychiatry could include the mad movement (and any number of related movements), and vice versa.
As for “mad”, Google’s definition search gives us “mentally ill; insane”, and I think there is much room for improvement there, that is, I don’t see the three terms as necessarily synonymous. “Mad” came first, and it has since been sidelined by the “medical model”.
When we speak of “mad studies”, in my mind, we’re speaking also of the struggle of people oppressed by the psychiatric system for human rights, and I think there should be a place for that inside institutions of higher education.
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Well, how about antipsychiatry, or antipsychiatry movement studies?
That would be more appropriate, for sure.
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I agree. Studying the origins of psychiatry and how it has been used as a means of social control would be great.
I prefer the term “mad” to”mentally ill” because it’s not a pretentious pseudo-scientific term. There are bizarre, extreme states of mind. These are not brain diseases though–as everyone thinks of when they hear”mental illness.”
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Neurodiversity as a term is neither vague nor undefined. You must be thinking of mental illness.
Neurodiversity refers to the infinite variations of human minds, personalities, consciousness, and cognitive styles. This is apparent if you read the works of early and revered movement thinkers such as Nick Walker, Kassiane Asasumasu, Amy Sequenzia, and Lydia Brown.
It doesn’t imply “neurological impairment” either. It actually implies “neurological diversity”, hence the name.
I think we’re in agreement on intersectionalism. It’s a good concept but it seems like no one who uses the term actually follows the principles it’s supposed to represent. Or rather they follow the principles for intersecting gay, women’s, and racial issues, but make exceptions for young, disabled, Mad and neurodivergent people.
As for Mad Studies, the idea that Mad and ” mentally ill” are synonymous is exactly why we need Mad Studies. The history of Mad Pride is one of reclamation, of people saying that if being authentic about our emotions is madness, if hearing voices is madness, if not buying into the state religion is madness, then by god I’m Mad, and there’s nothing wrong with that.
I am Mad. I am Neurodivergent. And no one can take that away from me.
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OK, so define neurodivergent please, as it seems fairly meaningless to me. And please also define “mad” while you’re at it.
We need to get away from the idea of “mad pride.” It is based on the enemy’s definitions of our thoughts, feelings and emotions.
“Intersectionality” to me is another term that sounds progressive, but in fact seems to ignore that various forms of oppression do not “intersect” out of happenstance, but because they all serve capitalism and class rule, which is the mother of all oppression. Capitalism is not just another “ism” intersecting with racism, sexism, homophobia, etc.
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Wouldn’t “thought-divergent” be a better term? Folks on the autistic spectrum think differently as do others who aren’t on it. Like me.
Maybe brain chemistry/structure are behind this. But as Peter Breggin points out we’re very ignorant about the human brain. Figuring out how to understand each other’s thoughts is more productive than focusing on alleged neurological differences too.
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I think the terminology is important because “autism” is a much more ambiguous concept than what we were once led to believe, and there seems to be little consensus as to whether it is reflective of a neurological deficiency or simply a completely atypical framework of thought and perception which needs to be respected as a form of diversity, period. So if it’s the latter, which would be on the level of mind, “thought-divergent” would be more appropriate. If the former is true, which would be a domain of the brain, then “neurodivergent” might be more in order.
I’m not proffering an opinion either way; my point is that this is not simply semantic bickering.
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I can appreciate Au’s analysis, or at least the feeling behind the analysis. Overthrowing the mental health system is a good idea. I also get the sense that much of the antipsychiatry dialogue is a practice in hacking at the branches while missing the root. It is like chopping off heads of the hydra. Psychiatry did not emerge from a vacuum. Psychiatry has a long and sordid history, of theory and of practice, that must be exposed and opposed. Even if pharmaceutical companies, mental health facilities, psychiatric hospitals, and other nefarious institutions were demolished, the core of psychiatry would remain: the false philosophies and the pseudo-scientific hoaxes of “mental illness” and “chemical imbalances” in the brain. I can appreciate the efforts that people make in terms of activism, and I can appreciate the feeling behind Au’s analysis. As we work to abolish psychiatry, we might also want to think about striking at the roots, namely the ideas, such as the myth of “mental illness.” The myth is so pervasive and so entrenched in our society that it may just take a new, good myth to replace it. That is what I mean by slaying the dragon of psychiatry.
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I don’t see how anybody can strike out at the myth of mental illness without at the same time striking out at the myth of mental health. There was this business established around the idea of the management and “treatment” of the “mentally ill”, but it is based on the unsound proposition that minds, rather than bodies, can become “ill”, and in that regard it has more to do with morality than it does with physics.
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They only confuse the issue by calling it a brain disease. None of the bigwig shrinks believe in morality. They never talk about it in their books or papers.
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Agreed.
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Exactly Frank. Amen.
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Au, I completely agree with what you have to say about, “peer counselors.”
I’m somewhat dismayed to hear your criticisms of Open Dialogue and Emotional CPR which you say are, “rebrandings.” I wasn’t aware that there were any objections to these emerging techniques at all. They certainly seem to be essential to the toppling of the tyranny of the medical model. I support the promotion of these two strategies with consistent and generous charitable donations. Should I stop doing that?
You might be interested to know, for better or worse, that money was obtained by the University of Massachusetts from the Fund For Excellence In Mental Health, to adapt Open Dialogue for use in this country, (it originated in Finland.) This seems to be in the pipeline.
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Intentional Peer Support, Emotional CPR, and especially Alternatives to Suicide are wonderful programs that work towards training people out of the knee-jerk reaction to send people into the system against their will, assume the professionals know what they’re doing and wash their hands of it. They bring the conversation back to friendship, mutual aid and common sense.
My criticism is not of the programs, but of the environment that requires them to exist in the first place. Essentially they boil down to “don’t do Mental Health First Aid” or “don’t call the police” and the rest is just fluff to make them sound more like something social workers might accept into their existing paradigm. IPS, eCPR and Alternatives to Suicide are good tools for mitigating a big problem, but I long for the day they become unnecessary.
As for Open Dialogue, I have some reservations. Namely the idea of group decision making. It’s better than unilateral decisions by a parent or psychiatrist, but ultimately the person who’s going to be affected by the decision should be the one making them, and not need anyone else’s approval. It immediately reminds me of the IEP system in U.S. schools, where the family receives notice that “the IEP team has decided” something when the family is supposed to be part of that team. The target person in Open Dialogue has the right not to participate, but all that means is decisions being made without them even in the room. And all of this was pioneered as a way to “treat” hearing voices, which doesn’t need “treatment” in the first place.
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I heard that Open Dialogue has been hijacked by mainstream psychiatry in many places. Probably not everywhere in America, but this presents a real problem.
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Hi Au,
Let me start off by saying I love it when they post stuff you’ve written. I like what you have to say (content) but also appreciate the way you express yourself.
I have no experience or knowledge of Open Dialog, but I used to be a social worker on IEP teams- I was the bane of districts that railroaded families the way you describe. I was the type of advocate who would set the tone of the meeting right there as I introduced myself to the rest of the “team,” and remind them that the student and parents would be the ones driving the meeting, which put them front-and-center. Special educators loved me- they knew they could call me ahead of the meeting and let me know the real situation, not the district’s CYA version of things we would hear at the meeting, because in my role I could be effective at fighting for what the student needed without risking my job like they would be if they stuck their neck out. I really miss doing that job- I hated that the systems made it so difficult for families who were already facing so many difficulties/challenges. It was my honor and privilege to be on their side of the table, to be the one they knew they could call if they needed help.
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thank you this so much! reading this made my day and really cheered me up. this is such a good and rich start, hope that it will be widely used and elaborated further. many, many great points, also in comments.
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Au Valencia and All
A very positive blog that raises many important questions.
You said: “The master’s tools will never dismantle the master’s house.”
Here is where this blog falls way short in an analysis that can lead us towards ending all forms of psychiatric abuse.
Who is the “master” and what is his “house.”
Your blog makes no mention of the critical role of a profit based capitalist economic system in setting the terms for the perpetuation of class inequality and the violence of poverty pervading our society, and of course, extending (through Imperialist exploitation) around the world.
Psychiatry and their entire Disease/Drug based Medical Model has evolved in to an essential component of the entire capitalist system. The pharmaceutical industry is a vital (highly profitable) cog in the U.S. economy, and the entire “mental health” system has increasingly become an important means of social control on the more volatile sections of our society.
Labeling and drugging people is a crucial way to control and eliminate dissent.
“Genetic theories of original sin” turn people’s focus away from institutional forms of oppression by focusing attention on inherent “genetic” flaws that need so-called “medical” solutions, and “band aids” that become new forms of mental and physical chains.
And there can be no legitimate use of science as a liberating force for social change in society when it is constantly controlled and corrupted by those forces in society who place the bottom line of profit ahead of the search for the truth.
Psychiatric abuse in ALL its manifestations cannot be ended within a capitalist system.
Au Valencia, please raise your head and your sights just a little higher and begin to address these much bigger and essential questions that necessitate answers before we can truly create a world WITHOUT any form of a “mental health” system.
Respectfully, Richard
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Isn’t 9/10s of it just a money thing? To whit:
There is really only one symptom of “mental illness.” That symptom is not earning a living, if your life is such that no one supports you. Instead of the simple solution of giving money to people who don’t earn a living, the government lets them choose among this delectable set of offerings: crime, begging, inpatient human rights revocation and all the suffering that affords, and suicide. Well, maybe asceticism is a fifth choice. If there were one more choice: a decent room in a hotel-like place and a budget for food and books, there wouldn’t be much of a mental health crisis.
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There is really only one symptom of “mental illness.” That symptom is not earning a living,
Excellent insight.
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What about those who were earning livings until psychiatry interfered and made them unemployable? I wasn’t self supporting, but I was a full time college student with a part time job at the library till I was dumb enough to go on Anafranil.
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By the definition above I guess that would be the moment you “officially” became “mentally ill.”
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Yep. “It COULDN’T be the blessed medication’s fault. If you weren’t a defective with a messed up brain it wouldn’t have made you loony!”
Like justifying stomping on someone’s leg and breaking it. “Well, if your stupid femur weren’t so brittle, it wouldn’t have broken when I jumped on it repeatedly.”
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Hey there,
Well, you named Alternatives to Suicide so inevitably, I’m sure you knew, I’d pop up at some point. 🙂
There is plenty I agree with in what you wrote, but I guess I have a lot to say about the things I question or disagree with… I want to start with the opening paragraph:
“The radicalness of the anti-psychiatry movement has unfortunately become one of its greatest hurdles to overcome. Even in otherwise radical spaces like prison abolition, neurodiversity, or intersectional feminism, the most common reaction to anti-psychiatry ideas is to dismiss them as so intuitively ridiculous they need not be engaged with. Sanism, behaviorism, drugs and force have permeated our culture to the point many people literally can’t imagine life without them.”
I see others already disagreeing with your first sentence. I guess I do want to say a few things about the paragraph as a whole, though. I still think that ‘anti-psychiatry’ falls way short as a term. It implies focus on psychiatry rather than a whole system, and distracts from the actual arguments for being a term so often used as an attack or diagnosis against someone others wish to dismiss.
Meanwhile, I’m concerned about terms like ‘sanism,’ as well. I don’t get it. These terms seem to be raining down on us from leftist intellectual land, but I guess I don’t really appreciate what this one seems to suggest. If racism is a systemic oppression that centers whiteness and assumes it as society’s ‘default,’ and heterosexism does the same where heterosexuality is concerned… Are we saying that society society is centering those who are sane and setting that as society’s ‘default’ as opposed to those who are insane? I don’t get it. And I really, really do not accept the idea that I am ‘insane’ (or mad, etc. etc. etc.).
This language seems to fly in the face of the idea that we all have (or have the potential to have) deep distress, extreme states, etc. at various points, and that those experiences often make a ton of sense in relationship to our environments. It also flies in the face of the idea that experiences like hearing voices or seeing visions are the norm within some cultures, and can be a variation from the norm that does not mean anything is actually ‘wrong’ in our own. So, not only do I not really get that terminology… it actually seems actively harmful to me.
So, on to your second paragraph:
“On a good day, our leaders pontificate about “reforms” that would somehow fix a system whose deepest foundation is a bed of violence, oppression, and at best pseudoscience. They ask for cultural awareness training, yoga classes, art therapy, and healthier food options in psychiatric facilities, without ever questioning the confinement that made those things unavailable in the first place (let alone the coercion involved when participation in such activities becomes a condition of obtaining release).”
Wait, who are you thinking of as our ‘leaders’? And who on earth among our ‘leaders’ isn’t questioning the confinement and coercion? Myself and most (if not all) of my co-workers fall in the middle of the ‘reform’ vs. ‘abolition’ debate… Many of us believe abolition would be best and is a noble goal, but also that it is naive and harmful and unfair to desert those individuals still stuck in the system… And so we spend time working on making the conditions more tolerable, too. But we *NEVER* lose sight while engaged in our efforts in the latter of the force and coercion that occurs. We write articles about it, we talk to providers about it, we offer trainings that incorporate awareness of it, and – most importantly – we take action to push back against it wherever we can both in individual situations and overall.
I think there are some people who fit the description you offer, but it’s completely inaccurate to suggest that any and everyone who hasn’t invested all their time in abolition talk fits the definition you’ve provided here.
Another section I want to quote directly: “Mad and neurodivergent people would be managers, not “peer specialists…The essential function of a “peer specialist” is to appear non-threatening, earn people’s trust, and convince them to stay on their meds. Hiring managers know that these positions only exist because others don’t, that there are far more job-seekers than jobs to fill, and thus that anyone they hire is easily replaceable.”
Again, this seems misinformed to me. I certainly agree that a *huge* number of ‘peer’ roles are co-opted, poorly designed, and harmful. But the definition you offer defines the co-opted lot, and not what these roles are truly meant to be. And what they’re truly meant to be *does* exist in at least some peer-to-peer *and* provider settings. It also suggests to me that you’re unfamiliar with the true landscape of things when you say that there are far more job-seekers than jobs to fill. In many areas, people are struggling deeply to find qualified individuals to fill peer roles.
Also, there are a number of places where people who you might define as part of the ‘mad’ movement do hold managerial roles. I know many in my state alone. Although, what precisely are you suggesting they should be managers of, if the system will no longer exist?
I understand where you’re coming from with the following: “If the “peer specialist” has more power than the patient, then they’re not a peer, and if they have the same or less power, then they’re not needed.” Yet, it also seems a little misinformed to me. There’s still a tremendous need to have someone – even who has no more power than the individual stuck in the system – to be by their side, bear witness, help them strategize about how to get heard, help them learn about ways out, etc. There’s tremendous power in these things. Though, I’ll also add that of course people in peer roles don’t have exactly equal power as the person they’re trying to support.. They’re getting paid. They get to leave locked environments. They’ll be seen as more credible because they’re an employee. Etc. Etc. Etc. But if they’re well trained and supported, their role will be designed to reduce and avoid power imbalances as much as possible.
This is also inaccurate: “Currently, all hotlines train their staff as mandated reporters, to listen for key phrases and if the caller utters one of them, secretly send people with guns and a history of recklessly using them, directly to the caller’s location. The sole exception is Trans Lifeline, which is of course exclusively for trans people, only a fraction of everyone who might want to call a crisis hotline.”
Unless you’re not counting ‘peer support lines?’ The Western Mass RLC operates a Peer Support Line and we absolutely do not track calls or notify 911 no matter what someone says. I agree with you that what you describe is a huge issue among such lines, but please be careful about misrepresenting these points. I’m pretty sure there are at least a few others who do not track calls, too.
Meanwhile, I’m also concerned about your use of the language of ‘mandated reporter.’ While some employees within the system are misinformed that mandated reporter is generally connected to reporting people who are suicidal, this is not what it means in most places. Rather, ‘mandated reporter’ most commonly means that people are required to report known or suspected abuse or neglect of children, elders, or individuals labeled disabled by care givers. It’s important that we not further contribute to that common misunderstanding.
And there’s this: “In a post-psychiatry world, both would be regularly, sternly reminded of their humility. Moreover, they would be taught when not to intervene, and they would not need to have basic respect packaged as just another proprietary methodology, with a sexy name like “Open Dialogue,” “Intentional Peer Support,” “Emotional CPR,” or even “Alternatives to Suicide.” You follow this up with the following in the comments section: “Essentially they boil down to “don’t do Mental Health First Aid” or “don’t call the police” and the rest is just fluff to make them sound more like something social workers might accept into their existing paradigm. IPS, eCPR and Alternatives to Suicide are good tools for mitigating a big problem, but I long for the day they become unnecessary.”
So, first of all, I wasn’t aware that “Alternatives to Suicide” was a ‘sexy’ name, but… thanks? I will say that the rest of what you say about it here, though, is both confusing and offensive, if I’m honest. I’m not aware that you’ve been through the Alternatives to Suicide training… Have you? Am I mistaken about that? Caroline and I are currently traveling around Australia offering a variety of presentations and trainings on just that approach right now, and while I’ll agree with you that some of each training and presentation focuses on the research about how current approaches are harmful… There’s a heck of a lock more to the approach than ‘don’t funnel people into the system’ or ‘don’t call 911.’
We talk an awful lot in these trainings about what *to* do… How to respond… questions that can be really useful to ask… fears that can arise for the listener and how to work through or learn to sit with them… This is only the briefest of summaries. But the point is, it’s not ‘fluff.’ I also don’t experience Intentional Peer Support in the way that you describe.
And I wonder about the society where you feel these sorts of supports would have no use? Do you really mean to suggest that its only the mental health system that’s seen death and suicide as taboo? Cause I’m pretty sure religions that long preceded the mess we’re in now have had issue with it… And that families and communities have struggled in various ways since basically the beginning of time.
Are you really meaning to suggest that the absence of the mental health system trap would mean a lack of need for healthy supports for people who are struggling? Cause I can’t quite help but hear some of that in what you’re saying right now.
I’m going to stop going through your article point by point because it’s just so long and I don’t want to basically write a blog of my own in your comments section… I do agree (as I said at the start) with many of your points including the problems with the idea of rebranding (although I think there’s value in referencing psych diagnoses as opposed to most of the other terms as it’s simply a fact that one’s been diagnosed and said nothing about what’s *actually* going on), with the need to dispose of the diagnostic system, and with some of the overarching points about the problems with in and need to do away with the mental health system.
But I keep getting lost in what feels like a lack of full understanding, contradictions, and what feels like a disregard of how the mental health system and its functions and perspectives are rather inextricably linked to school systems, prison systems, capitalism, and so much else…
-Sera
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Thank you so much, Sera! You put into words much of what I was feeling about this article. The intent seems good, but the execution is both confusing and at times disrespectful of people who are working to end the current oppression both in and out of the system. And I VERY much appreciate your deconstruction of the concept of “saneism,” which seems to suggest that there IS some differentiation and the “sane” people are beating up on us poor, unfortunate “insane” folks, and they just need to stop being so “stigmatizing” and let us be nuts in peace.
Your clarity and honesty is refreshing, as usual.
— Steve
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Steve,
Thank you, but actually I think I appreciate your deconstruction of saneism above more than my own, so thanks for adding it! 😉
-Sera
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Sera – you are in Oz right now?
How can I contact you? I’m in Brisbane (I know, a backwater).
I’d love to know who you are working with and how, so that I can help channel people into positive resources when the mainstream resources let them down.
Always looking for alternatives, thank you!
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Hi Jan,
Yes, Caroline and I arrived on March 1 and begin our flight home late on the 24th. We started in Melbourne where we offered an Alternatives to Suicide facilitator training. We then went to Sydney and did a couple of related events with hopes to return in the future for more. We’ve been in Perth for a week now, and between last week and this one up we will have done several events and both a When the Conversation Turns to Suicide and an Alternatives to Suicide Facilitator training. 🙂
We didn’t get to Brisbane, unfortunately, but would love to in the future! 🙂
Sera
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When you do – find me! I’m reading your article at https://www.thesunmagazine.org/issues/496/an-open-mind and it’s brilliant!
Do you have recommendations – in other words, when I have someone in crisis in Sydney or Melbourne – who do they call to get your facilitators?
I hope you are having the Australian time of your life!
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Thanks, Jan! 🙂
So, we did do a facilitator training in Melbourne, and the e-mail address for folks in that area who are getting things up and running is this: [email protected]
We just did some broader events in Sydney and hope to go back to do a facilitator training at some point, but the contact e-mail publicly listed for that area in relation to the events we did do or bringing a facilitator training to that area is listed as [email protected]
In Perth, there’s a committee managing getting things up and running (we’ve done the largest number of events/trainings in Perth) and their e-mail is: [email protected]
It’s all still quite in the early stages, but hoping things develop soon. 🙂 🙂
-Sera
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Thank you! I’ll put these in my notes, to give people alternatives to BeyondBlue (pro-drugging, even if they don’t accept Pharma funds) or Lifeline (I’ve heard no complaints about them reporting, but sometimes it’s hard to get through). Thanks again!
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Thanks for the appreciation, and the chuckle! I hope I get to meet you in person some time – I think we’d have a lot to talk about!
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I think it’s a great article that lays out a vision of abolition. It can’t do everything – can’t solve the problem of capitalism for instance. It sounds to me like Au Valencia is coming from a viewpoint that is libertarian as well as grounded in social solidarity. While the perspective and tone is confrontational, the substantive points made capture in clear and plain language the demands our radical movement has been making for a long time. I noticed that this article posted by official MIA account on facebook was getting over 100 shares to which I added my own. Au Valencia has done great work here that deserves our attention. How to take these steps, is all our responsibility. Personally I hope to see activists working for state-level legislative abolition of psychiatric force/coercion, lawyers working on strategic litigation theories and plans, and more. It is wonderful to see the clear thinking of more activists envisioning abolition.
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I’d say there’s a lot to chew on here, and guess I should check out the specific points more thoroughly. If nothing else it forces us to look at some of the contradictions which characterize the thinking of many who identify as “abolitionists,” and what sorts of activities are undergirded by a true anti-psychiatry analysis, and which contain the seeds of reformist ideology.
On the legal front I would defer to Tina on most things, as she demonstrates an unparalleled level of leadership, on the international front especially. I would like to ask, why do you believe that fighting for Miranda rights as per psychiatric “interviews” is not a priority, as you have stated previously?
Good to see you posting.
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Thanks to Tina’s comment I am back to this thread which became rather upsetting and reminded me why I never wanted to publish here. I wonder why can’t we just appreciate each other’s efforts instead of engaging in discussions that seem to be self-fulfilling and lead nowhere. As we all know – envisioning future without psychiatry or mental health or however we define it is so much harder than criticising and exposing psychiatry, capitalism etc. Investing into the articulation of several core issues is so much harder than elaborating on them same issues with more information and opinion. Coming back to Au’s list in order criticise it or take it apart will not bring us further, on the contrary – this kind of reception prevents people from daring to imagine, put their questions and visions into words and share them. Why are we so hard on each other when we know how bloody rare it is to read something that goes beyond always more evidenced and eloquent criticism of what we all know far too well? Why can’t we just cherish when someone moves towards breaking new ground? That is always risky and never perfect and above all – never for one person to achieve. Can’t we just take some break from our little egos and have guts to take this kind work forward rather than analyse into detail what was misunderstood and omitted on the way and prove how smart we ourselves are? Commenting on this site will change nothing. And these in-depth point by point text surgeries just put people off from contributing. Especially people from the outside of the US if that matters at all…
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Nice comment although if you commented more maybe commenters understand we have many viewpoints in this debate.
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Jasna,
Challenging feedback is hard, and I’ve certainly been subject to it myself when I’ve written here. However, I feel confused by your feedback which seems to be largely referring to my comment (though maybe I’m wrong about that?). I wasn’t simply looking for the fine points with which to argue for the sake of argument… I found pretty substantial issues with what was offered here that I think either confuse or take away from what was good, and I guess I don’t see the value in ignoring that. Endless fighting over irrelevancies won’t take us forward – you’re right about that… But neither will silence.
-Sera
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sera, i referred to several other comments including yours. never meant to say that people should stay silent or ignore content of this blog or its parts. on the contrary – i think that this can and should be taken forward in many different ways. i tried to raise the difference between taking the issues on this list forward or pulling them backwards. to me there are far better things out there to challenge than au’s suggestions, and personally i find their suggestions helpful simply because they go beyond fixing what can’t be fixed to begin with and because i greatly value that kind of effort. i’m afraid i can’t express this any better than what i already had written.
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Thanks for all the talking points.
What can we learn from South Africa,The Female vote, and Abolition of Slavery?
Many of these movements were multinational and reguired strange bedfellows to get the actually work done. It took decades and several generations before some of the goals were accomplished
Witness and bearing witness is such an important concept and role.
The immigration crisis and massaive refugee global issues – all play a role here because of the trauma issue.
Freedom House in Detroit caters to the needs of refugees who have experienced torture.
Our community might help here.
Have you ever met a refugee from a war torn and violent country. I just felt the absence of safety from them. It was clear they had been through a hell I never could fully imagine.
And in some countries -others- of all kinds are in unsafe zones.
So how to use history and how to expand a fishing net.
I don’t have the answers – and my locale in some ways is hard.
But we need to think on witness-trauma- and change or someday end the system as it is now.
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I would not title a post in the manner in which you have done.
“How Would We Know If We Overthrew the Mental Health System?”
There are a surfeit of traitorous turncoats in the psychiatric survivor movement as is, when it is just a matter of the “provided for” changing places with the “provider”, that is, the “mental patient” changing places with the “mental health” worker, or, more explicitly, the psychiatric prisoner changing places with his or her warders, or the oppressed donning the uniform and position of his or her oppressor. It is not that. What it is is a matter of ending this unjust relationship entirely and with finality.
We will know we have overthrown the system when there is no more system if, in this case, overthrow would be synonymous with abolition.
Some of us have overcome the system already having removed ourselves from that system. When we have all overcome the “mental health” system, voila, no more system.
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Thank you for this valuable article; I agree with most of it but also agree with those who feel that the term “neurodiversity” implies support for erroneous concepts of “saneism.”
I believe that we will know when we overthrow the “mental health” system when psychiatry is no longer an accredited medical science. The process of delegitimizing psychiatry should expose “mental health” as a pseudoscientific hoax that maligns the marginalized. The process of delegitimizing psychiatry should also end the hoaxes by promoting an understanding of emotional suffering (and other naturally painful problems with living) as natural and conflating “mental illness” with “demonic possession.”
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RE: #1 … there is an issue with no one at all being deemed incompetent, and I have witnessed this in my own family situation recently, as my family was involved in a legal dispute that hinged around the competence of a grandparent who had Alzheimers / Dementia. It was interesting to be in court watching a Geriatric Psychiatrist explain the evidence of my grandmother’s dementia, which made her vulnerable for “elder abuse” in which a relative was able to manipulate and extort money from her.
The thing is, with most “mental health” diagnosis, for example something like Schizophrenia or Schizo-Affective, it seems to be a different story compared to something like Dementia. For one thing, part of the evidence was a numerous series of tests which were done to assess our Grandmother’s competence. In the case of Schizophrenia, there are no such tests. If you meet the criteria for that diagnosis you are immediately deemed incompetent. I am not saying there necessarily should be tests, I am just observing some of the differences. Another important factor in dementia was that you could see that it was caused by visible brain damage due to a stroke, as well as Demyelination of the nerves. When it comes to something like Schizophrenia or other mental health diagnosis, they are different than something like Dementia in that there is no biological evidence of the “disorder” itself, and no damage or changes to the brain aside from that which is caused by the medication given to apparently treat it. So really, there is no way to have any objective hard evidence of Schizophrenia, and it all relies on personal opinion, for a professional to say “that’s what it looks like to me” which of course is pretty shaky as it’s all based a subjective perception and interpretation.
Another thing which I noticed recently, was I came across something about the history of the diagnosis of Schizophrenia, in that initially it was defined as Dementia Praecox, but that was dropped because it is not the same thing as Dementia, in that “intelligence and memory are unimpaired”.
In my own personal experience, these issues around competency all seem to do with the right to refuse medical treatment… in all other areas of medicine there is the right to informed consent, but in the area of mental health, that right is taken away… in this circumstance receiving treatment automatically negates the right to refuse it, without any assessments of the persons competency necessary to take away that right. The reasoning here of course is “lack of insight” and by psychiatric reasoning, insight is basically synonymous with compliance.
I was under a forced treatment order for a limited period of time but I was able to get out of that, and extricate myself from the psychiatric system and discontinue my medication on my own accord. While under that forced treatment order, aside from not being able to make the decisions in regards to refusal of treatment, there did not appear to be any other areas of my life where my personal agency and decision making were infringed upon. For example, for a period of time I had to put up with the psychiatrist trying to get me into some kind of a “group home” or “assisted living” where possibly my personal agency would be infringed upon further… but I never found myself in that position because they were not able to put me in that kind of living situation involuntarily. I was living with my Mother… and at that point all they could to was “suggest” a group home / assisted living, they could not force me into one of those places involuntarily… I wonder though, if in some situations it’s a different story?
But again, my main point is a bit of a question, that when it comes to competency, it seems like it’s a very different situation in Geriatric Psychiatry and situations of Alzhemiers / Dementia compared the world of psychiatry that deals with psychotic disorders. Most people I have met who have at some time received diagnosis along that spectrum do not appear to me to have any major cognitive impairment.. or at least, the experience of psychosis itself does not seem to necessarily go hand in hand with cognitive impairment, I would say that the majority of people who have received that diagnosis have just as much decision making capacity as any other person.. and the claim of “lack of insight” or being deemed incompetent seems to be strictly a form of control to enforce medical compliance. But doing away with this altogether might not work out very well because Geriatric Psychiatry appears to be a much different situation, in which people living with dementia may really have cognitive impairments which could put them in a vulnerable position.
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I’m not going to make a judgment about the competence of Geriatric cases. I am going to say that the reason there are competency hearings in some cases involving so-called “mental health” is because the person receiving treatment doesn’t have a caring family to fall back upon. The court appoints a guardian, and the patient can, in turn, be royally screwed by such a predicament. If they had a family who would take them in, they’d be better off. Without support at home, it takes longer to receive a discharge from the hospital as financial concerns and housing must be dealt with first, at least, that’s the way the hospital sees it. This means a longer stay, and those arrangements that are made by the hospital with other facilities in the community. A guardianship, that which comes of an incompetency ruling, takes much control for person’s life out of that person’s hands, and can be potentially devastating.
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So I’ll go through these as succinctly as possible:
#1: “Mentally ill” is a legal term which translates into plain language as “unable to make decisions.”
We know that — however having a bullet lodged in one’s brain could literally render one incompetent to make decisions, so this raises the “never say never” issue when you say “no one ever” should be deemed incompetent, so this could be more clearly defined. Certainly no such judgement should be respected if it uses psychiatric labels as justification.
#2: I’ve already stated my dislike of the attempted appropriation of so-called “madness” as a cause for “pride,” as in doing so we adopt their determination that we are “mad.” I’m still waiting to hear a viable definition of “neurodivergent.”
#3-13: OK now I see what Frank has been getting at here. All these points have to do with “services” and “programs” and how to fiddle with the details of such a context. But the context itself is oppressive, i.e. the assumption that people experiencing the trauma of living in this system most intensely need to be categorized, labeled, and treated as exceptions to the rest of humanity — rather than their expressions and interpretations of their alienation being recognized as par for the course under capitalism. It perpetuates the idea that, based on labels of whatever sort, these “exceptional’ people require “services” beyond what “normal” people have come to expect. The problem is that trauma is on a continuum, and there is no clear dividing line defining “disabling” trauma vs. “normal” everyday misery. The other constant problem is that rather than focusing solely on soothing and “working on” our pain we need to be fighting the objective conditions which perpetuate it. We don’t need to replace the “mental health” system with another one which serves the same repressive function of mystifying and individualizing our collective pain while exculpating the system which engenders it.
#14: I have long pushed for a guaranteed annual income, or universal basic income. Given current world conditions and the money economy it should be considered a human right. Plus it would render the “social disability” issue moot, as a “disability” definition would not be a prerequisite for receiving subsistence funds.
#15: This has always been the #1 demand of the anti-psychiatry movement, and many will argue that the abolition of force would portend the demise of psychiatry itself, and that psychiatry is force by definition.
So now that I’ve thought about it I disagree with Tina that this presents a clear vision of a “way forward” or a consistent understanding of what anti-psychiatry is, and tends to chop at the tentacles of the octopus rather than striking at its heart. Still the article serves the purpose of keeping these debates alive and vibrant, and leading toward the day when we have a clear enough consensus and the sort of pristine analysis that will take us beyond naïve speculation and closer to something resembling liberation.
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Well, OldHead, from my perspective, “consuming/using” psychiatry is not surviving it, not when it has a pervasive potential to maim and destroy. Assisting your murderer is not innocence. “Mental patient” liberation means leaving the system, that is, becoming an ex-patient (or, from another angle, an ex-worker in that system). Everything else, within and of the system, is a matter of feeding that system, and thus perpetuating it. Liberation is a matter of leaving the “mental health” system entirely.
I don’t buy the theory that people can’t leave the system because they are too traumatized to do so. All sorts of people have experienced all sorts of trauma, only people within the “mental health” system are expected to have had their resiliency so detrimentally effected due to that trauma that they are expected never to “get over it”. All you would have to do to get a different result is to change the expectation, however, why would “mental health” workers want the expectation changed? If all “mental patients” were liberated, they’d be out of a job, and out of business.
As far as I’m concerned, it is our job to put them out of business.
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An American guaranteed income is a free ride for everybody. Being that it is apparently doable outlined by the economist Friedman in the 1950’s my belief is it would be wise to go ahead although to cipher these guaranteed income funds into a comprehensive retirement system to supplement social security. Better to give to people that have worked whole life as opposed to money for everybody. That way America appropriately provides for its senior citizens.
I mean after all their work contributions over the decades pays for the social security disability payments which I say by the way are well deserved for mental health disabilities. I want to make that clear. These challenges are not insubstantial as commenters lay claim, but challenges are very harsh.
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Well done, well spoken, well-analyzed. Nice job!
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I think that UBI is a neoliberal trap.
http://ocap.ca/the-neoliberal-danger-of-basic-income/
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Could you explain that in your own words instead of relying on a link to what someone else says?
This seems odd for you to raise considering that it would render moot all those arguments about “disability” payments and who should or shouldn’t get them. Isn’t everything short of revolution a “neoliberal trap” for that matter? As a short term demand to address practical needs I believe it has a lot going for it.
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Sure. I think it’s a trap because it will be used an excuse to destroy what remains of the social safety net. It would also be used as a way to expand the current public subsidization of corporations who pay starvation wages. Meanwhile, most of the money will probably go straight back to the 1% in the form of personal debt repayment, which is probably why they are considering UBI in the first place. Why would the bourgeoisie hand the working class a permanent strike fund? They wouldn’t. It’s as simple as that.
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Same reason they accede to other demands, because the pressure to do so makes it more convenient to cut their losses. The same rationale as for welfare, as a bribe to forestall social unrest, or because someone shows it would help the corporate state save money. Though there would need to be safeguards against the kind of thing you mention, and it could not be used as an excuse to cut already existing benefits such as health & food allowances — which would be at very best a trade-off.
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