High Time for Anarchism in Mental Health

57
6008

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.

* * *

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.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

***

Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.

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”

    Report comment

    • Thank you Sam.
      I have had the experience of seeing quite a lot of people change their minds. Some have a met PLE psychologist, read a certain book, or saw a movie that effected their perspective. Others simply matured into a new point of view, or got fed up with a continuous feeling of failure. Although the majority of people cling to their old way of thinking, some change their minds. And when enough people rethink the old ways, a grand change is bound to occur. All of that is to say that I have not lost hope yet.
      Blessings.

      Report comment

    • I don’t think every article by an Israeli has to contain a sentence about the Palestinian struggle.
      I absolutely believe in the struggle, and there is much to say about Trauma in the region, but I decided against writing that into the article.
      The article was published originally in Haoketz, which is a website that has many articles about the zionist-palestinian conflict. Some quite enlightening.
      As an Israeli anarchist who writes mainly on Mental Health topics, I feel there are plenty of other writers, some are Palestinians, who write on the struggle from their perspective. My addition on this issue seems rather unimportant or unnecessary to me.
      So, in conclusion, I’d rather be truly helpful then “correct” in the eyes of my peers.

      Report comment

      • “Anarchism” and “mental health” should not be uttered in the same sentence. (You might ask Bonnie Burstow or Frank Blankenship their opinions on that.)

        Anyway, not suggesting you’re not a nice guy or seeing anything here that would so suggest. But, just as a comparable article by a South African during the days of Apartheid would have been expected to allude in some way to that ongoing war of liberation, the comparable situation in “Israel” inevitably comes to mind in this instance. Sort of like when Americans overseas during Vietnam were expected to answer questions about what their government was doing. Since anarchists generally see themselves as revolutionaries it makes sense to think that you might incorporate this ongoing nightmare into your theories, which is why I asked. (Btw why is “correct” in conflict with “helpful”?)

        Report comment

    • God willing, I hope the current and next generation of Israeli researchers will help in some indirect way not only to the ongoing revolution in the Israeli context, but also to groundbreaking work in communities all over the world. Then our joy will be yours.

      Report comment

  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.

    Report comment

  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.

    Report comment

    • 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.

      Report comment

      • 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.

        Report comment

        • 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.

          Report comment

    • 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!

      Report comment

        • 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..

          Report comment

  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

    Report comment

  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!

    Report comment

    • 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….

      Report comment

      • Thanks Itay, very helpful and enlightening information as various classifications/theories are sometimes misunderstood.

        As per the article “Anarchists are simply people who believe human beings are capable of behaving in a reasonable fashion without having to be forced to. It is really a very simple notion. But it’s one that the rich and powerful have always found extremely dangerous”.

        Yes it is high time for anarchism in the mental health industry!
        I also read this description for Anarchism:
        “The current State is ineffective; the best way forward to a better life is by immediately dismantling the existing system.”

        Report comment

          • Anarchism is a word with a definition. The definition of anarchism is, by the way, NOT disbelief in rules.

            In a Google search, the definition that comes up first, top of the page, is that from the Oxford Dictionary.

            Anarchism is, then, according to Oxford Dictionary…

            belief in the abolition of all government and the organization of society on a voluntary, cooperative basis without recourse to force or compulsion.

            Given that psychiatric institutions are very much into the use of force and compulsion, it would seem that the existence of such institutions, as they are presently constituted, must be incompatible with Anarchism in theory and practice.

            Report comment

          • Dictionaries are published by authorities, hence many anarchists would reject their definitions.

            Of course dictionaries DO suck — for example they often define “racism” as “racial prejudice,” i.e. an attitude as opposed to a practice.

            Report comment

  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.

    Report comment

  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?

    Report comment

      • Funny how history gets rewritten in Wikipedia.

        I know our Treasurer who was a bit of a character found himself in a little bit of trouble when he got really drunk and crashed into a few cars on his way home. Police went to his house and were highly likely to arrest him so he didn’t answer the door. He then fled the State and was receiving treatment for ‘bipolar’ disorder in another State, before returning and resigning his position as Transport Minister.
        Its always made me wonder why he had to get out of the State in such a hurry to receive treatment for this ‘bipolar’ disorder. Surely when police went to his home they could have done a referral and dropped him off at an Emergency Dept for ‘treatment’? Or don’t we have any doctors capable of dealing with that disorder here? Or might it be that he made an enemy of the Minister for Mental Health by sniffing her chair and grinding his hips in a sexual manner at a parliamentary party, and he knew the sort of purposes our Mental Health System was being put to? Might have found himself dribbling in a cell for some time if he had fallen into the hands of the wrong psychiatrist here.
        Still, it didn’t happen and no one asked and ……. he is receiving treatment from far away. Looks to me like these services are being used in some very creative manners. Still, I wonder if he realises that his human rights have now been removed and he is a “mental patient” forever more, or so the Chief Psychiatrist tells us. If you have ever spoken to a mental health professional, your a “patient” and can be snatched from your bed at any time the government wishes. So we all need to think back carefully about who we spoke to in school etc. Mind you, these sort of arbitrary detentions aren’t too bad, its the torture thats associated with it and the unintended negative outcomes that bother me. Not so much the general public, mainly because they’re being kept in the dark about it. News papers and media are not allowed to publish anything but “seek professional help” mantra.

        Report comment

LEAVE A REPLY