Madness, Utopia and Revolt: An Interview With Sasha Warren

Sasha Durakov Warren is the author of the new book Storming Bedlam: Madness, Utopia, and Revolt published by Common Notions Press. Sasha is a writer based in Minneapolis. His experiences within the psychiatric system and a commitment to radical politics led him to co-found the group Hearing Voices – Twin Cities, which provides an alternative social space for individuals to discuss often stigmatized, extreme experiences and network with one another.

Following the George Floyd uprising in 2020, he founded the project Of Unsound Mind to trace the histories of psychiatry, social work, and public health’s connections to policing, prisons, and various disciplinary and managerial technologies.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Leah Harris: Welcome, Sasha, it is so great to have you here with us today. First of all, I want to congratulate and thank you for this outstanding new critical history of psychiatry that you’ve written. Maybe you can start off by telling our listeners a little bit more about yourself, as well as the genesis of this book?

Sasha Warren: Thank you so much for having me, I’m so delighted to be here. As far as the genesis of the book goes, psychiatry is a field that I’ve had a relationship to for pretty much my whole life, either personally or in my family. But it was also something that I just took for granted for a long time and didn’t think too much about.

I was always interested in radical politics since a very young age. I didn’t discover people like Marx until later, but I was reading a lot of anarchists and radicals of that milieu in my youth. At some point, I read some critiques by people in the field of disability studies and critical neurodivergence that connected some of these political/economic critiques that I had been thinking about and taking very seriously for a long time. The fields that regulate what we would call the difference between normal and abnormal—that was my entry point in thinking about that in a philosophical or theoretical way. What is normal and what is abnormal? It’s a big question.

The more I thought about it, the less clear that distinction became. I couldn’t help but wonder about all these different services that I’d experienced or seen, and these institutions or fields that rely on this distinction. What’s their purpose? How do they make that distinction on an institutional level? These were the questions that animated me when I first got into it. I still don’t have the answers to any of these questions necessarily, but they took me down that path.

As far as the book itself is concerned, after the George Floyd uprising in 2020, I was inspired to do something that collected all this thinking and research that I’ve been doing for a long time in a coherent project. I had this idea of doing about a six month-long Zoom series that would be about the intertwining histories of radical politics and the field of psychiatry. That series became the basis of the book. Even though at the time I didn’t necessarily have a coherent, all-encompassing theory, it gave me the impetus and the inspiration and the raw material that I ended up using.

Harris:  Sasha, talk about some of the archival research that you did in places like Minnesota, Massachusetts, and elsewhere. Tell us about that project, and especially any of the more memorable moments, surprises, or discoveries that you’ve had diving into the archives?

Warren: The fascination with diving into the archive started a ways back. I, like a lot of people who get interested in the field of psychiatry, became fascinated with the sites of asylums. They dot the landscape. They’re these massive, overbearing, heavy symbolic places. Everybody knows that an enormous amount of people were there, that an enormous amount of suffering happened there. But there’s a kind of wall between us and that experience that makes it hard to engage with it in a serious way.

I discovered at a certain point through doing independent research and wanting to find the resources to learn more about that experience, that the historical societies hold a lot of these records, and they’re available to the public. You don’t need to have any kind of special training or experience to access these.

I just started going, communicating with the archivists, telling them what I was interested in, and flipping through materials. As you go through it, you do learn about how to effectively filter through because you’re looking at thousands of pages of oftentimes very boring administrative details. And you also learn how to get a box, look through it, and then figure out what the next thing to look for might be. You follow the trails where they lead you.

Eventually, I discovered this massive wealth of institutional publications. Many long-term psychiatric institutions in the United States that we call asylums, perhaps most of them, had their own regular publications. Oftentimes, it was a weekly, or monthly. I had no idea that these existed. I discovered early on that you have to pay a lot of attention to the editorial and organizational details behind them, because oftentimes, the head editors would be somebody like the superintendent or the head nurse. Other times it would be run by the patients themselves. You could really tell the difference in tenor between these publications. There’s maybe a reticence about being completely upfront and honest about everything that’s happening. You have to read between the lines and understand the conditions of production. But even that sparks a ton of new questions and thoughts: What was this institution like? Especially when you have foreknowledge that the institution was particularly bad and then the writing is very exuberant and happy. You have to wonder: Okay, what’s happening here? Is this a special unit, maybe an outpatient unit, that’s very different from the day-to-day? Or is something happening on the editorial level?

What I’m bringing up with the editors is that you can’t just take them directly at face value. I don’t think you can take any social relationship directly at face value, because all of our social relationships are mediated through power dynamics, through institutional conditions, through the conditions of life itself and our limitations as a species. These documents are a perfect object for that type of mediated social study.

Then the other surprise came when I ventured out of Minnesota. I visited some archives in Massachusetts, in Amherst where they have a large collection of works from the American anti-psychiatry movement—Judi Chamberlin, The Mental Patients Liberation Front, and other groups. They have a massive collection. I spent a couple of days there just flipping through these old journals.

I also went to Weill Cornell’s psychiatric archive in New York and I had a great experience there. I went there hoping to read volumes of The Opal, this journal from the Utica Lunatic Asylum in New York, from around the 1840s to the 1870s. That is an incredible resource of some of the most fascinating writing from psychiatric patients in an institution, particularly because it seemed like there were very few editorial constraints. The patients would just openly talk about the conditions of the asylum. There were jokey articles about organizing a revolution. It has a very silly, but also very direct, tone.

But what was even more surprising is the absolute exuberance of the patients for this system of moral treatment. That was definitely shocking. I did not expect that of people who were living in an asylum with a very, very rosy view of the form of treatment being offered, even while being very direct about certain conditions or institutional problems. That was a major discovery that I had to grapple with. When you go into the archive, what you’re trying to discover is reality as it was, not as you expect it to be. That’s part of the joy: confronting things that force you to think about something in a different way, or to ask questions that you never would have asked. Sometimes you meet somebody who changes the direction of your entire research program.

Harris: I wonder if you could talk about some of the founding myths of psychiatry that you interrogate in the book? In particular, you write about the mythos surrounding Philippe Pinel, who you write about as having achieved a sort of mythic status in modern psychiatric history for “liberating patients from the asylum.” What have we gotten wrong about his story, and why does this matter?

Warren: I opened the book talking about Pinel and this repetition of certain myths throughout the history of psychiatry. The Pinel myth, in brief, is that he was this unsuccessful family doctor who got his first major position in the Salpêtrière, which was the major women’s asylum in Paris. He’s so aghast at the institutional conditions. He enters and he sees it’s this dungeon, people are kept in chains. He’s horrified at this really deep moral level and he has this strong reaction. He, at a certain point, breaks the chains, unlocks the patients from their shackles, and institutes this system called moral treatment that includes reforms at virtually every level of the way that mad people were treated in the late 18^th century, and is generally considered the birth of psychiatry or modern psychiatry, the transition to a fully new system and a revolution inaugurating a new period. That includes things like treating the mad person as a human being.

Then the myth goes that he inaugurated this new system based on principles of personal emancipation and the capacity to be healed or cured. And also, this new emphasis on an empirical classificatory system that we can know mental illness, we can categorize it correctly, and we can know what its outcome is going to be. These are all the components of the modern psychiatric myth.

The problem is that every part of the story is wrong. A big part of the myth relies on this back story of horror and degradation. They talked quite a bit about the madhouse system that they were replacing. The way they talk about it, it’s these massive congregate facilities that are more or less like big dungeons, prisons, where people are mistreated and beaten, and starved, and they’re treated like animals, and they’re thought about as animals.

There is truth in some of this. The madhouse system was real. It was especially big in the major cities in Europe—in Paris and in London. But the spread is definitely overstated. If you want to find a quality that characterizes the treatment of the mad prior to the psychiatric revolution, I would use the word “eclectic.” There’s no one overriding means or method. It really depends on the local conditions, in a way much more so than after the psychiatric revolution. They’re already wrong in terms of their back history, because they like to overstate the barbarity and the spread of these institutions, specifically, because it serves as a good grounds for revolution if you’re replacing something that’s massive, widespread, and horrible. It’s a gesture that allows you to separate yourself and tell the world about what’s new about you, so it’s a severing gesture.

Then in terms of what they actually do, it’s also very much overstated, and it’s incorrectly told too. There’s an author, Dora Wiener, who writes about how Pinel was very likely not the one who broke the chains at all. It was most likely [Jean-Baptiste] Pussin, the superintendent. Also, the story is always that it happened at the Salpêtrière, but it did not. It happened at the men’s asylum, the Bicêtre, in Paris. It happened in a different year than is often referred to. All the timings and place names are all mixed up.

There’s probably symbolic reasons why some of these things got mixed up. There’s this famous painting that I talk about in good detail in the book, of Pinel taking the chains off of a number of women at the Salpêtrière. I think the narrative of this paternal all-caring father figure helping the distressed mad come to their senses and become human again, was more powerful when it was a bunch of weak-seeming “hysteric” women, and not madmen.

Then of course, the future element is if you follow the path of Pinel, we’ll just keep moving forward in this linear motion, and achieve greater and greater heights of enlightenment and compassion. I think what you end up actually seeing in psychiatry is this very cyclical movement, this repeated recognition that they failed in their mission. That these palaces of the mad that are supposed to be these palaces of health and care end up being exposed as not too dissimilar from the madhouses that they supposedly replaced, of being sites of congregation and separation and abuse. This myth has served as a kind of rejuvenating symbol that appears time and time again. Whenever psychiatry is at its lowest, it looks back to this moment, or to these types of figures, as an attempt to break with the cycle of violence and failure and try something new again. A good part of the book is about tracing those cycles of failure, and why psychiatrists seem to be unable to escape from this cycle.

Harris: In this book, you don’t just reserve your critique for psychiatry. You are working on both sides of the psychiatry/anti-psychiatry binary, and you refer to anti-psychiatry as this “doppelganger of psychiatry.” Talk a little bit more about your research into anti-psychiatry, some of your main critiques of this movement, and things perhaps that you admire in it?

Warren: Whenever this question comes up you have to first acknowledge that it’s this ridiculously loaded conversation. It’s one of those signifiers that changes depending on who the person writing hates and wants to make fun of or dismiss. Depending on your angle, the position of psychiatry/anti-psychiatry is either the good one, or needs to be dismissed.

I don’t really sense there’s exciting movement so much as a pile of resentments that are going back and forth when these terms are thrown around. I wanted to do something of great violence to it and see what I could discover by characterizing it in a way that I think both sides would be unhappy with. I argue that because psychiatry has always required in its founding mythos and its form of organization a past tense to break with, it always requires this construction of “the madhouse people were doing these things in this horrible way and their institutional conditions lead to abuse, and we’re going to completely destroy that system and we’re going to end it and we’re going to bring in the reign of mercy, and the reign of true feeling.” This negative gesture is central to what psychiatry is and how psychiatry has permeated itself through society.

In a sense, every founding gesture of psychiatry is also an anti-psychiatric gesture. Psychiatry requires anti-psychiatry so that it doesn’t get stilted and stuck and frozen in place. It needs this negative gesture to break it up and allow it to flow more freely into other spaces.

That brings me into the critique of the anti-psychiatry movement. I think of it as what is called an “imminent critique” in the world of philosophy. I’m not critiquing it from a position that imagines itself to be outside of these debates or questions. I’m trying to perform a critique from within. When I’m critiquing anti-psychiatry, I’m critiquing it from its own premises, its own projection of itself, its own subjective position, and what it claims to be doing.

This part of the book required me to engage really deeply in these movements and read through all their journals. I went and found original copies of the Mental Patients’ Liberation Front print journals, I read through tons of transcripts of Judi Chamberlin, and even really boring administrative work that informs my knowledge. I read through a lot of phone transcripts between different anti-psychiatry groups in the ’60s and ’70s. I read about the crisis houses they attempted to open, and how things panned out. And of course, the later journals like Rough Times.

If I had to pick out elements of critique that I lay out, one of them is the idea that anti-psychiatric thinking or work somehow contributed to the period that we refer to as deinstitutionalization, but which I prefer to refer as to as decentralization. That there was somehow some direct agency that anti-psychiatric figures or groups or thinking had on that process, I think, is wrong. I don’t really see any strong evidence for that. I see a correlation between a kind of thinking and a social process that happened, but in my mind, the real process was elsewhere.

Doing this process of imminent critique was supposed to be a way to get straight through to the actual work that people did on the ground and what effect it had, engaging with them at the level of their own ideas and what they say. On that level, I think there are some things that we can critique them for that they actually were involved in. There’s a more common critique that you might hear even from someone like Allen Frances, of what is called the “psychiatrization of everyday life—” the increasing bounds of what is considered to be abnormal into increasingly microscopic differences. This is something that’s been critiqued by ton of critics on the right and left, and even some psychiatrists themselves.

I do think that some of the things that the anti-psychiatric groups from the ’60s and ’70s were arguing for was also leaning towards that direction, and maybe even had an actual effect on the process of psychiatrizing daily life. We’re going from “madness or mental illness is a condition that concerns a relatively small percentage of the population,” to people on the left arguing that mental illness is a concern that involves absolutely everyone. And not concerns in the sense that this is a social problem we need to work with or work through, but that everyone is in some sense mad or mentally ill.

There are consequences to that which I think people would now decry—like the aforementioned increasing pathologization of small differences, even if that wasn’t necessarily the intent.

Harris: You write about the limits of what you call “judicial activism” to fight, for example, forced psychiatric interventions. Specifically, you write, “Positioning the law as a shield against force conceals the way in which the law acts as force and is grounded in it.” Talk about some of the ideas you were trying to convey around the limits of judicial activism, and how we see them playing out in our current landscape?

Warren: What I try to do in the book and with these kinds of questions is to balance the contradictions or hold the contradictions together in some way. Because on the one hand I think it’s irrefutable that giving a group of people who are facing widespread institutional abuse increasing judicial recourse to take some type of remedial action is a good thing, and it’s an option that they didn’t have before. That, in itself, is not under critique necessarily.

However, I think that some of the extreme focus that imagines the law as a potential shield, as I said, is faulty and can lead to some very precarious situations. I think that it’s brought us to the precarious situation that we’re in today, to some extent.

There’s a point in the book where I quote Kate Millet. Her point is that the law is this firm thing, you break it and you’re punished, and the action between those two things is relatively mechanical. You understand the law, you know there’s this distinction between what you’re allowed to do and what you’re not allowed to do. When you do the thing you’re not allowed to do you face the consequences, and it’s all very clear cut. When you introduce psychiatry into the question, you introduce all these layers of discretion. The psychiatrist has to make a subjective determination of whether or not you’re competent to withstand trial, or whether or not you are competent at the time of completing the crime.

I think what is wrong, ultimately, with this form of critique is not its depiction of psychiatry, but its depiction of the law. As if the law is this firm, clear object that acts mechanically in each situation. I don’t remember the exact number now, but the vast majority of cases, over 90% in the United States, are dealt with through plea bargains, which are these very loose, very discretionary decisions. It’s more of a deal made between the different parties that is not a direct response to the crime in question or the trial in question.

Then the trial process itself is extremely discretionary. You’re trying to convince a group of people of your side of the story and you hope that it goes your way. But we know in America it very often does not, and many, many people are rotting in prison and didn’t even do the thing that they were accused of.

I also lay into the idea of rights in the book, as if a right is an actual protective thing that you can have as property. That’s not exactly how rights work. A right is frequently invoked as a remedial action because you are already harmed. You don’t need to invoke the right unless you presume you’re about to be harmed or the harm has already happened. In the sense that you’re always invoking it in the past tense, does the right protect you from the abuse in the first place? No, it doesn’t. You hope that it changes something in the system in the future so that the next person, or you in the next case, don’t face the same type of abuse or the same type of harm. It doesn’t have this future capacity that people often act like it does.

We’ve created a mystification around rights as if they are a property that we own. It’s a process that we engage in when these incidences of harm and abuse come up, and we hope it goes our way. But it very often doesn’t.

Harris: In the book, you write about the International Network of Alternatives to Psychiatry, and you also have recently co-founded a North American chapter. Talk about this organization historically, what makes it significant, and what inspired you to get a North American network going?

Warren: The Network formed in 1974 at an international conference. The point was to establish strategic relations between people engaged in doing radical work around or in the field of mental health, and to refuse the siloing that often happens where people only study the history of psychiatry in their own country, or only engage in movements in their own country. It was an internationalist push. It was also a push to critically examine the ways that radical work in psychiatry was related to other social struggles. Central to their thinking was that the mad are engaged in some way with struggles of the working class and movements for Gay Power and Black Power.

In the mid 20^th century, the rallying point for this negative activity was the asylum. The asylum still exists. But it’s not as centralized as it used to be. It used to be that it was the central node around which everything was organized, and then it started to break up and shift. Interestingly, the Network was established in response to that shift. In France, it’s called “factorization” and in the U.S. they call it “community psychiatry”—the way that psychiatry and psychiatric power was increasing its tentacles into various regions and untouched, untapped reservoirs of human suffering.

We face the same problem today, I think even maybe more intensely. The purpose of us establishing this chapter—at the beginning, it was me and my friend Mel Butler—was to try to respond to this challenge once again. Internationalism is a major part of why we decided to create a collection of networks. And also, to respond to the increasing, or maybe just continued, diffusion of psychiatric power into so many different spheres, and even into common language.

Anybody who’s interested in thinking critically about the field of psychiatry and the field of mental health is invited to be a part of this. On the site there is a form that people can fill out with the name of their project, what they do, where they’re based. It’s intended to be a public resource, so keep that in mind. We’re trying to recreate some network affiliations and hopefully host some collective events and in-person meetings.

Harris: A very much-needed and exciting project. Sasha, how can people follow your work?

Warren: I still update my Substack blog, Of Unsound Mind. Right now, it’s at a bit of a slow point because of all the book stuff I’m doing. But in the future, there will be more going on there. I’m working on a very long-term project about madness before psychiatry, and how it was treated. I recently started a chapter of the International Society for Social and Psychological Approaches to Psychosis – US in Minnesota. If you’re interested in that group, reach out.

Harris: I’m sitting in gratitude for your work, as well as the many lineages of struggle and liberation that you’re drawing upon. Thank you so much again for taking the time to be with us today.

Warren: Thank you so much, Leah. It was a pleasure.

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