Disciplines of Dissent: On Antipsychiatry Within the Academy

In the 2018/19 academic year, I was named the first recipient of the Dr. Bonnie Burstow Scholarship in Antipsychiatry, a newly established scholarship at the University of Toronto and the first antipsychiatry scholarship worldwide. When officially announced, the controversial scholarship attracted both praise and criticism, with some hailing it a milestone in the fight for recognition of the rights of the psychiatrized and others critiquing the scholarship as a degradation of science and likening the antipsychiatry movement to Scientology. Those who identify as antipsychiatry believe there are better ways to approach human struggle and suffering outside of the ‘psy-complex’ (consisting of psychiatry, psychology, and social work) which currently holds the monopoly on definitions of ‘mental health and illness.’ Departing from psy-complex diagnoses, what I mean by ‘mental health’ is a person’s ability to cope within their context — a socially constructed definition, not a biological one.

While we are still far from seeing the establishment of an antipsychiatry department at any university, Burstow’s scholarship does add legitimacy to academic research that falls under the antipsychiatry umbrella. To be clear, this umbrella encompasses the work of scholars who understand people’s struggles and crises less as the result of biological psychiatric disorders and move towards explorations of the social, political, economic, and geographic underpinnings that shape the way each of us experiences our lives and distresses. This includes, for example, recognition that normal responses to ongoing trauma are often pathologized as psychiatric disorders. Sometimes, it seems, the context is sicker than the individual.

The trouble with recognizing mental health struggles as only or predominantly biological, as is the standard in the field of psychiatry, is that it can make individuals feel personally (or genetically) responsible for social contexts that are beyond their control, thereby making it far more difficult to critique the oppressive structures that cause so many to suffer. This is not to cast off the all too real biological impact of trauma, but rather to challenge the assumed biological etiology that we have been led to believe is at the root of psychiatric diagnoses. Within dominant psychiatry, there is little to no room given for appreciating the effects of poverty, racism, misogyny, or violence on a person’s well-being; rather, these traumatic factors become relegated to chemical imbalances, genetic predisposition, and faulty biology.

Burstow’s scholarship challenges the dominant narrative on mental health by funding the work of students who are critical of psychiatry. The work of my colleagues in this field, fellow grad students, encompasses wide-ranging and under-examined areas such as war trauma, man-made disability, critical psychiatric nursing, Indigenous genocide and mental health, and pharmaceutical sponsorship within public secondary school mental health programs. This work is necessary and rigorous — these are the scholars I stand amongst proudly.

My own work is largely archival and seeks to uncover overlooked psychiatric histories with the aim of building alternate histories; histories told from below. The way history is recorded and subsequently understood fundamentally affects how each of us contextualizes the present; what events, norms, policies, contingencies, and economics have led us to the current historical moment? History is not neutral, having somehow been recorded by an impartial observer — it speaks to the beliefs, biases, knowledges, and power structures of particular people within particular contexts. The history of psychiatry has largely been recorded by those with relative power in a given time period; people fluent in the language, writings, norms, and knowledges of their eras (such as doctors and other professionals). Excluded are the voices of the marginalized — those who actually experienced the treatments and supposed help provided by mental health professionals. My work stands among a growing group of scholars uncovering the voices of those excluded yet deeply implicated and marginalized by psychiatric practice, discourse, and philosophy; voices such as those of psychiatric survivors and their loved ones.

Very few come to a position of dissent without struggling long and hard for it, and this is true within antipsychiatry as with many other disciplines of dissent. The antipsychiatry field and movement is populated by those who feel they or their loved ones have been damaged, often irreparably, through involvement with the psychiatric system. In this regard, I am no different, having lost a brother who never recovered from the trauma of involuntary interactions with the psychiatric system; a system he viewed as arbitrary law where one can be severely persecuted for their thoughts and beliefs. Within several years, my brother was permanently damaged by psychiatric drugs that caused him to gain weight, develop a serious heart condition in his 20s, and left him feeling fundamentally not himself — all common side-effects. This painful journey, spanning over a decade, led me initially to question whether psychiatry was, in fact, the ultimate authority on people’s well-being, and eventually guided me towards finding a community of like-minded scholars and activists under the auspices of antipsychiatry. My story is not unique — it is a tiny square in the mounting mosaic of those who have realized too late that there are alternate ways of approaching people’s struggles and crises.

Legitimizing antipsychiatry as an academic discipline, a discipline of dissent, is a step towards recognizing the trauma of those who have been harmed by psychiatry; some on an individual level, but many on a systemic one. It also works towards opening a dialogue that politicizes understandings of those groups who tend to be over-represented in psychiatric diagnoses — black and Indigenous people, poor people, women, refugees, queer and trans folk, the disabled, those living in war-torn countries, those surviving ongoing domestic violence and abuse — are we really to think the struggles of these populations has less to do with their ongoing oppression than it does their faulty genes?

Of course, antipsychiatry is not the only, and certainly not the first, discipline to be borne out of dissent and recognition of marginalized knowledges. Queer/trans studies, women and gender studies, black studies, critical disability studies, and Indigenous studies are only a few examples of academic disciplines that have struggled to receive legitimacy within the hegemony of more traditional forms of academic knowledge.

Queer/trans studies, to focus in on one example of a now-legitimate discipline of dissent, was initially rooted in the social, political, and economic oppression of Western queer people. Prior to the advent and eventual acceptance of queer/trans studies within the academy, queer people in North America organized for decades, arguing that the discrimination and social ostracism they faced daily was detrimental to their health, lives, and well-being. In fact, queerness, under various names, remained a diagnosable mental illness until 1987 and the trans identity remains a diagnosable mental illness still. Few continue to challenge whether queer/trans studies is a valid academic discipline, yet at its inception, the controversy of whether the marginalized voices of queer and trans folk should be taken up within academia had many arguing that incorporating this field would erode academic integrity and rigor.

The pathologization of queerness as a mental illness is not a unique example within the psy-complex. The history of what we today call psychiatry serves as a humbling reminder that diagnoses of mental illness have often had more to do with politics and social norms than they have science or medicine. In the mid-19th century, drapetomania was the conjectured mental illness thought to cause slaves to run away from their captors (of course, it couldn’t have been the dehumanizing conditions of slavery nor the desire for freedom). Until the 20th century, women who felt discontented in their narrow and marginalized lives were diagnosed as hysterics, with a common treatment of being masturbated by their male doctor. The practice of lobotomy, a practice that has since been replaced by electroconvulsive therapy (ECT) and psychiatric drugs, was commonly used until the 1950s to subdue those seen as too difficult to handle. The brain damage caused by lobotomy was one and the same as the desired effect of making problematic people easier for others to deal with. The result, people unable to string together a coherent sentence, often incontinent and requiring care for the remainder of their shortened lives, was exactly the sought-after effect that was argued to constitute lobotomy a successful treatment. The victims of this cruel practice were often women, queers, and visible minorities. Given this troubling history, is there really good reason to be so confident as to think that today’s diagnoses and treatments are any less influenced by the politics, economics, and social norms of our times? Again, the psychiatric pathologization of queerness serves as a contemporary reminder that psychiatric disorders are a social construction rather than a medical fact.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), alternately known as the bible of psychiatry and published by the American Psychiatric Association (APA), is far more a political document than it is a medical one. Currently in its 5th edition, what becomes clear when reading the DSM is that today’s definitions of mental illness are contingent on a person’s ability (or willingness) to work — a clearly political and economic requirement that relates to medicine only insofar as a physical or cognitive impairment might prevent a person from working. As demonstrated by Bruce Cohen, contemporary psychiatric diagnoses speak to capitalist ideals of productivity, where being ‘unproductive’ is the defining factor of being mentally ill. Again, what begins to become clear is that the psy-complex defines mental illness into existence through social norms; scientific medicine this is not.

The point of antipsychiatry is not, and has never been, to do away with science; it is actually a call for greater scientific integrity, accountability, and honesty. The myth of scientific consensus within the psy-complex is a dangerous one that promotes a false understanding of how the brain works. Let’s take the example of depression: simply presented, the dominant narrative is that the brains of depressed people produce lower levels of neurotransmitters such as dopamine and serotonin, therefore depression is caused by a chemical imbalance in the brain. Assuming the levels of neurotransmitters in a person’s brain are actually known (tests not commonly performed preceding a psychiatric diagnosis), the causal statement claiming that lower levels of dopamine and serotonin are responsible for depression is imprudent and negligent. As the popular adage goes, correlation does not equal causation. What we do know about the production of dopamine in the brain, to follow one neurotransmitter, is that it is triggered by factors such as connection, love, exercise, sunshine, meditation, and music, just to name a few. Can we really be confident in claiming that the circumstances of a person’s life, conditions that directly impact the levels of dopamine produced by the brain, have no effect on their supposedly biological depression? Put another way, are we really to believe that the quality of someone’s life has little to do with the functioning of the neurotransmitters in their brain? The manipulation involved in the chemical imbalance hypothesis serves to mask ongoing oppression and injustice far more than it serves to help individuals who are suffering.

I often hear arguments presenting the real problem as the severe underfunding of mental health. I think that what many people mean by this is the lack of accessibility to resources that can actually help those who are struggling, and in this sense, I agree. Psychopharmacology, the front-line of current psychiatric treatment, however, is far from underfunded, with the pharmaceutical industry raking in billions in profits each year and little else trickling its way down to actually help people. Unfortunately, at the present historical moment, the priority of psy-complex funding falls squarely within pharmaceutical interests. There exists a myriad of established alternative treatments that seem to help people far more than psychiatric drugs, especially when we consider long-term well-being. This is not to take away from the very real suffering and struggle that many people must learn to live and cope with on an ongoing basis. The depth of suffering and the variety of sometimes intense interventions needed by those in crisis might feel for many like only superficial solutions currently exist. For some, the most effective way to cope might be talk therapy, while others may prefer meditation, yoga, EMDR, massage therapy, micro-dosing, or a combination of the many alternatives that are out there, although often these are still not enough. Even if these alternatives were enough, most people who would benefit from them probably couldn’t afford them anyways.

On a larger scale, we might start by considering the types of community supports, life skills, connection to nature, and self-knowledge needed to survive such complex and oppressive social, political, cultural, and economic realities. The response to human suffering has no real solution, within the psy-complex or outside of it, and may require a trial-and-error approach for many until they find what works best for them. Given the alternatives, some people might still prefer psychiatric drugs as the treatment that helps them most, and in my opinion, that’s perfectly fine — who am I to decide for others what they feel is best for themselves? When funding is directed only in the service of psychiatric drugs, however, many are forced into this singular option or else must struggle without any support or resources at all. The point is less to decide what is best for others than to fight for choice and alternatives so that people can make informed decisions that suit their individual needs.

For better or worse, the success of most academics is contingent on their ability to secure grants and scholarships in order to support their research. Funding for disciplines of dissent, generally speaking, is far less than that of traditional disciplines. Research that is overtly political, that critiques with the intent to intervene, unsettle, and fundamentally disrupt, is also research that is the least likely to receive funding. Why would an institution, after all, want to fund that which defies its very legitimacy? I can certainly appreciate the contradiction of critiquing the hegemony of academia from within. Yet, academia still holds the authority on much of the debate and dialogue on significant issues, including antipsychiatry. So many crucial conversations are silenced for the very fact that those trying to have them continuously fail to secure funding from traditional venues. Unless one is independently wealthy, academic funding provides a meager lifeline for those who sincerely believe their disciplines merit discourse.

The academy does not provide a level playing field where research and writing is primarily evaluated by the quality of its arguments and scholarship. Counter-hegemonic research is easily dismissed or else never taken up in the first place in favor of work that does not challenge the status quo, or challenges it only insofar as it can be easily revised within current structures of power and authority. In order to survive, critical scholarship must often be watered down, thereby threatening academic freedom and presenting a scholarly discourse that even its authors realize is censored and largely illegitimate. The University of Toronto’s antipsychiatry scholarship is not just a win for academic freedom, it is a win for students and the options open to them. Disciplines of dissent, antipsychiatry being among them, tirelessly fight to be heard within dominant dialogues that prefer critique remain silenced. A recognized antipsychiatry scholarship works to both legitimize this growing field and allow scholars whose voices have remained largely buried a fighting chance at meaningfully contributing to the mental health discourse. On this note, I congratulate the courage and foresight involved in establishing such a scholarship, and as its first recipient, I will continue the hard work started by those before me to push towards the legitimization of this discipline.