High Time for Anarchism in Mental Health

Itay Kander
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3203

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, Idan Gelbard, Veronica Song.

57 COMMENTS

  1. I loved this piece. Dark places of psychiatry exist for one reason, dark minds wield this barbaric hierarchy over the vulnerable. The sick ones, hiding behind their patients, and this will continue even if getting rid of enforced treatment. They will in one form or other not be cognizant of the oppression and killing of spirit they cause. One cannot ever educate or shake a psychiatrist’s belief system that he desperately clings to. They might eventually be forced to go along with a few changes, but overall, I doubt his mindset will change. In his mind, it is all about “those sick people over there”

  2. Thanks Itay,

    Bob Whitaker mentions Israels attempt at “Mental Health” liberation (in part) in this video presentation:-

    https://youtu.be/5DliuhZJR9A

    I notice South Africa has a big ‘export’ market in Rehab Care; and the Philippines has a big ‘export’ market in qualified medical staff (who refund the country). I’d imagine any country that develops Care that gets People Well – should profit.

  3. Governments need to stop intervening in our thought processes and behavioral options, that is, in our chosen ways of living. To call such interference annoying is to understate the case. One is not “wrong” or “sick” for thinking and acting outside the proverbial box of standardized conformism, somnolence and ignorance. Abduction, segregation, imprisonment, torture, and chemical control are totally uncalled for. If the mental health treatment police state were brought down entirely, we’d be none the worst. Its treatment tends to be all trickment anyway. It is high time we popped the mental health bubble.

    • Where on Earth did you get the impression that we are not talking about politics here with every word we utter? You’re trying to personalize this, which is a diversion from the issue. A larger — or equally important issue — is “anarchism” and “mental health” being portrayed as compatible.

      • We are certainly not arguing “medicine”. People are not imprisoned and tortured for medical reasons. The reasoning is more social, say, we can’t have a coo coo bird like that running around loose. It makes the rest of “us” look bad, therefore, coo coo bird facilities. People are entitled to rights, of course, but the people designation doesn’t include coo coo birds and ex-felons. We’ve sort of trashed the constitution in their particular cases in that regard.

        • Similarly we can’t have vicious bastards running around loose on the streets either so give them degrees and let them call themselves doctors or Mental Health Professionals. Anything as long as the rest of the community doesn’t have to interact with them on a daily basis. Get them into the locked wards and desensitize them for when they eventually need to be locked up and drugged for their crimes against humanity. A bit of luck they will eventually realise they are ill and get the ‘treatment’ they require, a bit like the doctor in Chekovs Ward 6.
          I’m reminded of the Eureka moment that the Operations Manager had when it was pointed out what she was doing was criminal and she came to her senses and spoke the truth. Rather than lying and saying “were here to help” she told me “we’ll fuking destroy you”. See, there is hope for these people, they just need to recognise their true inner feelings, and how to use their positions to abuse, torture, maim and kill. And as for Doctor “i’m the Boss around here” with his hot shots, an absolute psychotic, see it in his eyes while he is killing “patients”. Get some help Doc. Your conduct is more befitting the local football team pack rapist than a doctor.

    • Jim, I highly recommend a reading of Fredrick Jamison’s ” The Political Unconscious” At the beginning there’s a paragraph so remarkable, that I posted it on my fridge for a time. In that paragraph, after a blistering linguistic unpacking, Jamison posits that everything and everywhere is “political”. I can’t imagine reading Jamison (or dozens of others), with that of being reasonably conscious, and not understand this; however butchered the word is in our contemporary culture, etc.

      That said… beautiful article Itay!

        • Noted oldhead. But the point I was trying to make (however poorly) was that there is no apolitical, only the illusion and or delusion of being apolitical; thus the “unconscious” dynamic. That we believe ourselves “apolitical’ is but an arraignment of our (individual and or collective) unconsciousness through the limits of consciousness, i.e., intelligence, socializations and culture, time, and history’s ruptures and unraveling’s (shifting) etc..

  4. Hello Itay,
    I admit I struggled with your use of ‘anarchy’ in this article: I think your use of ‘egalitarian’ and some of your other word choices, at least to me, better represent what I believe is the intent of your message.

    I love Open Dialogue from ‘afar’ having never had the change to experience it on the healing journey that my wife and I have been on, but I was told by one of it’s practitioners that what I do with my wife fits very well with their philosophy.

    And I’m not sure why the swipe at marriage in the book you referenced: when my wife and I first began our journey together, over and over, she wanted to be reassured of my absolute commitment to her if she was going to visit the deepest, darkest corners of her childhood and it was ONLY within those safe confines of our marriage that she felt able to go where she had ignored for so long.

    But our egalitarian relationship and the contribution it engenders to our journey together most definitely fits with the spirit that seems to undergird your article. I have made attachment concepts the bedrock of everything we do to create a strong, cohesive relationship that can withstand the extreme pressure her many dissociative issues have brought our way…and thus far that has meant the difference of us not only staying together but growing stronger as a couple and family as she has healed in ways that many say is impossible without the use of any drugs or being connected to the mental health system at all.

    I wish you all the best. We are excited to visit your country very soon!
    Sam

  5. Thank you Itay for a great piece! I appreciate the valuable work you are doing.

    These sentences speaks volumes – “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”. And re Open Dialogue – “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”.

    All countries should be implementing Stabilizing Houses and Open Dialogue now. It is high time indeed to bring some humanity to the very dark world of psychiatry.
    Keep up the great work!

    • LOL.
      Both capitalism and socialism are antique, rickety wooden fences which are easy to climb over, but not see through. Anarchy is a tall, chain-link fence topped with barbed wire….
      But none of them will let you into the stadium to watch the ball game close up.
      With all of them, you’re outside the fence, but at least you can see the game with anarchy….

  6. Hello Itay,

    Thanks for this wonderful piece. A long time ago, I stayed in a place like that which ended up being closed down. I’m not sure why. It is described in the last chapter of my memoir, This Hunger Is Secret, which I published about a decade ago. It is now free for anyone to read. You can find it on my blog, http://juliemadblogger.com.

    It was my case manager’s idea to send me there. This was after shock treatments when I was having trouble thinking straight. I was frustrated and hopeless that I would ever get my mind back. They were going to send me to a state hospital. I went to the respite house instead. It was not at all like any place I’d ever been before. This was around the end of September, 1997.

    What was amazing was that there was this lack of hierarchy that was truly refreshing. The staff did not have those insulting “professional boundaries” that I saw in other places. They shared their lives with me. They even drove us in their own vehicles if we needed a ride. They weren’t therapists and weren’t trained as therapists, although one of them did end up converting.

    Not only that, but they had this staff office but it wasn’t off limits to the residents. We could come in there anytime we wanted. The door was open and there certainly wasn’t any insulting bullet-proof glass separating the staff office from the rest of the living space.

    You could come and go as you pleased. I had my bike there, too. They let me park it in the hallway. I can’t recall now how many weeks I stayed there.

    I spent a lot of my time just writing in my notebook. This was a habit I had developed as a result of shock treatments, but it grew into something more. I left the respite house. I was okay. By January, I was doing more serious writing. I enrolled in an adult ed writing class. In March I decided to try going back to college. I succeeded. I finished the first draft of a novel by August, 1998.

    I am not saying that the respite house was what saved me. I saved me. Good luck and lots of writing saved me. They allowed me the space to do it. I’m grateful.

  7. High time to escape the hawkers of “mental health” grab your individual freedom and live unbound to the preconceived notions , concoctions , torture devices , and torturing policies , of a credentialed goon squad ,and not to be fooled by whatever “helpful medical or other disguise they may wear.” You can find your way but you must first take freedom , no one will ever give it to you, and explore as you wish elsewhere away from the hawkers . Two time escapee from the ( once “vibrant” experimental torture “mental hospital prison “) in Acre 1968. Also 4 time escapee from 2 different mental hospital torture facilities in the USA. There were also 2 other torture chambers in the USA I could not escape from. Now a 72 year old survivor of psychiatric injections of toxic poisons and applications of electrical torture to the brain and other systemic tortures. Death to the mental health system, may it speedily be placed in the dustbin of history.Turned out I had mercury poisoning all along from amalgam dental fillings. Would never have known if I didn’t take my freedom first.
    Are “stabilizing homes” being funded so that certain Orthodox groups can have an easier path in their efforts to avoid military service?