High Time for Anarchism in Mental Health

This article has been translated from Hebrew and edited voluntarily by a small team of people, mostly Hebrew-speaking anarchists. I thank them for their assistance.* The Hebrew version can be found here.

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The mental health system, in all its complexity, is the drainage hole of human suffering. From its overflow, pain often seeps into the groundwater but occasionally it reverses course and erupts into “normal” life as if from a geyser. Reducing a wide collection of psycho-social phenomena into a generic mold of “human suffering” without committing a grave injustice to the diversity of voices within the “patient” community, voices that yearn to be differentiated and heard, is particularly difficult. Nevertheless, my experience has shown that a certain pattern or structure does underlie most interactions in the mental health system — often, the pain encountered in its bounds combines a type of Hurt, the conviction that something wrong and unjust has happened to me, with some kind of Silence, indicated by a paucity of language in the interpersonal space and often, the inability to put one’s experience into words. These two features — Hurt and Silence — usually merge and become inseparable. Thus, in the interaction with the “consumer,” the mental health “professional” can either reinforce the foundation of hurt and sentence the “consumer” to continued silence or, alternatively, work toward the disentangling of these two elements.

Anarchism refers to a broad political spectrum defined by the aspiration for equality and freedom without elevating one over the other. Anarchism is also associated with dismantling unnecessary hierarchies that have a negative impact on the social fabric. In this short essay, I would like to examine how anarchist thought can contribute to a foundation of equality, impartiality, and freedom of choice in the delivery of mental health services for those in need.

The Starting Point: Israel’s Mental Anarchy

Perhaps a decent beginning for our journey will be the Israeli present. One of the tools that the anarchist has in her toolbox is almost passive in its nature: simply observing closely the myriad ways in which libertarian ideology is manifested in the actuality of life, whether this manifestation is a result of a unified intent or not (a completely different tool, which I intend to use in just a few paragraphs down below, is the tool of Imagination).

Today in Israel there exist seven “Stabilizing Homes.” These are institutes, houses really, where one can go through a so-called acute mental breakdown/breakthrough of the kind which will, in most cases and without one of these houses in sight, be handled in a psychiatric hospital. In contrast to traditional hospitals, there is barely any coercion of any kind in these homes —and most importantly, none of the brutal, physical kind. Because of that, the resident (a word given to the person in the stabilizing home instead of “mental patient”) can also leave the stabilizing home if he chooses to. Also, because admitting oneself to stabilizing homes is done on a voluntary basis, and is sometimes also free of charge — if health insurance covers it — it has allowed non-violent practices to develop (this has been discovered and discussed in detail by Social Worker Sivan Bar-on in her research on Stabilizing Homes).

These practices create linguistic bridges that connect supposedly far-removed worlds. For example, the world of “psychotic” cognitive states and the worlds of other, more socially-accepted cognitive states. Stabilizing Homes have gained great success, both in the past — in California, where they were first established in the 70’s — and in recent years, with the number of Stabilizing Homes in Israel growing from one home in 2017 to seven in 2019.

Can these Stabilizing Homes be understood as anarchist, or semi-anarchist, endeavors? Perhaps if we asked Colin Ward, the answer would be yes. Ward (1924-2010) is a well-known British anarchist who has written numerous eye-opening articles and books about welfare, health, education and housing policies, as seen through socialist-libertarian lenses. Ward’s general stance on public policy is that when facing a social problem, there are really two ways to go: Either we choose the authoritarian route, in which people are told what to do, or the libertarian way, in which people are allowed to freely create their own communal solutions.

One of Ward’s most excellent examples for this principle is “the free playground”: a specially allocated space in the midst of the urban jungle in which kids, with only a minimal amount of supervision, are given basic tools and are allowed to play with them in a plethora of ways. Ward presents research that shows that a libertarian environment like this, very much unlike the more structured experience of the common playground, sparks creativity in kids, builds important life skills, fosters cooperation instead of competitive and violent behavior, and has many other positive effects on the children.

Now we can return to the question which we have only briefly discussed before and inspect it thoroughly. The Stabilizing Homes have a manager, in them there is professional and non-professional staff and obviously, there are “residents,” who are informally patients. At first glance, these properties do not constitute a libertarian institute. It seems incomparable to Ward’s free playground. But I believe that on closer inspection, this is a relatively egalitarian, free and even anarchist project. We can better think of these houses as a dot placed on a line which starts with coercive and violent treatment inside a closed psychiatric ward, and ends somewhere far, far away in our imagination.

It is worth mentioning, in this context, a treatment method called Open Dialogue (disclosure: together with social worker Sivan Bar On, I am organizing workshops and lectures about this approach). The Open Dialogue approach attributes great importance to undoing the hierarchies existing between the Treating System and the Treated System, for lack of better terms. In a typical “Open Dialogue” meeting, all sit together for discourse in a circle, and ideas and suggestions brought up by any participant (even those of a qualified psychiatrist) are open to discussion and examination so that others can give their opinion. Despite the fear and contempt that these treatment models of Stabilizing Homes and Open Dialogue sometimes spark among experienced mental health practitioners, it’s these models that symbolize for me a ray of light within the mainly dark world of psychiatry.

In fact, research upon research shows that the anti-authoritarian elements these methods have introduced to mental health treatment actually promote a stronger, fuller recovery in patients; and that they allow the patient’s voice to be heard far more than ever before, enabling patients to verbalize their personal suffering in an environment that listens to them. In this way, the Stabilizing Home and Open Dialogue methods are comparable with and parallel to the “Unschooling” education method — an approach that is also prospering and realizing itself these days. Finally, these institutional treatment solutions also confirm Colin Ward’s argument — that the libertarian solution is not only the most moral, but it is also the most efficient solution. The healing that is taking place in these institutions is by and large very effective.

Ending Our Anarchist Trip in the Realms of Imagination and Doubt

As an exercise for practicing our imagination and building healthy thought on the development of mental health services, here is a question I am curious about: What would a completely anarchistic treatment look like?

First of all, one option is that it won’t be a “treatment” at all. The treatment in itself is a power structure (similar criticism has already been proposed decades ago by the post-modern mental health approach and in Jeffrey Moussaieff Masson’s Against Therapy). As an alternative to the power structure dynamic in the patient-therapist relationship, I propose the idea of mutual alliance: an agreement which is not legally binding, serving as a framework where a group of people agree to help each other (unfortunately, my draft of such an alliance has not yet been translated from Hebrew). An alliance like this can be established in any place where it is needed, with no preconditions except one: that the participants are willing to partake in a community formally intent on mutual guarantee and solidarity. In our society, where individualistic fragmentation generates loneliness and depression, a mutual alliance might be just the right solution for us. It could also strengthen communities whose members are already under attack from “normality” and act in mutual solidarity as a way of life.

The obvious downside of an alliance of this sort is that it doesn’t necessarily include a person or group of people that accumulate information about psychological healing. Is this just a negative quality? Could it be a positive thing? For me personally, it is quite hard to decide. Perhaps in this way, the decentralized therapeutic knowledge will be accumulated and sustained collectively and will not concentrate in the sole mind of a single person, a single lineage or a single tradition. We can also imagine a similar yet different future from this vision of an alliance of alliances, in which different therapeutic communities, like the aforementioned Stabilizing Homes, will cancel the hierarchical relationship between patient and therapist, while keeping a great deal of the knowledge they have acquired. Such a movement will be a sort of return to the roots of the Stabilizing Homes — most importantly, to the Kingsley Hall experiment of R.D. Laing and the Philadelphia Association. Different therapeutic communities could then work in different ways — some could be mobile and others immobile. One can think of it as another piece, a therapeutic one, of the anarchist-cooperativist vision.

How far can we proceed in imagining an anarchist future in Mental Health? When do we hit a wall? Ursula Le Guinn (1929-2018) was one of the most influential science-fiction writers of our times, and in one of her books, The Dispossessed, she tells the story of a planet populated solely by anarchists. It is an anarchist planet — Anarres is its name. In Anarres there is no work and no government, no laws, no marriage and seemingly, no psychiatric hospitals. In Anarres we witness the growth of our hero, the brilliant physicist Shevek. One of his closest friends is the playwright and satirist Tirin, who, as we learn towards the book’s ending (I’m terribly sorry for the spoiler, but this regards a very minor plotline!), has exiled himself in the middle of his life to a remote location. There, for his own good — or at least so we are told — he is given psychoactive substances.

Ursula Le Guinn does a very good job describing how, in her opinion, human institutes will continue to exist in a society that doesn’t make any use of hierarchic authority. We could conclude from her book that the anarchist society continues to spontaneously generate “madness” and “mad” people. Mental health institutes can strengthen the meaning of these definitions, but the normative oppression (“The Courage to be Normal,” as the slogan of a famous Israeli homophobic campgain went) is an inherent part of being human. This is the pessimism presented in The Dispossessed: Even when there is no actual physical closed ward, human beings nonetheless continue to create invisible wards with invisible bars.

The Homecoming

By and large, the mental health system is a highly hierarchical system and uses authoritative measures generously. Forced institutionalization and coercive “medical treatment” are located on the far end of a long spectrum, and they are the most radical use of a multi-faced power, brought upon those who come to seek help from the system. In these days, with the deaths of Oren Shalom, who died due to criminal neglect in Abarbanel Psychiatric Hospital, and Israel Biadaga, who was shot by a sanist and racist cop; in these days, when the Israeli public is reconsidering the legitimacy of mechanically constraining patients in psychiatric wards — Anarchism has much to offer the debate. Anarchism can present a clear voice saying: Liberty is not an obstacle for quality treatment, it is rather the very basis of it. And even if we do not yet know the final limits of this freedom, both in terms of our capacities as a society and in terms of the maximum good we can give to the “patient,” the libertarian direction seems rather promising, and at any point along the way we could stop and reconsider our compounded benefits in comparison to our aggregated losses. Quite simply, we could experiment in different types of reciprocal responsibility and emotional assistance, and do so promptly, with no further delay, in our daily lives.

* Thank-yous: Roni Slonim, Y.R., Uzi Esh, Veronica Song.