I highly recommend “Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy” by data analyst Cathy O’Neil.
Screening technology is only as good as its programming, which is socially biased and, therefore, self-perpetuating. This was proved with criminal risk assessment algorithms (computer formulas) that claim to predict criminality. Because Black people are disproportionately incarcerated, it is falsely assumed that they are more criminally minded when, in reality, they’re disproportionately incarcerated because of systemic racism. https://aeon.co/ideas/algorithms-associating-appearance-and-criminality-have-a-dark-past
Screening technology to detect ‘mental illness’ would also be skewed by social bias and would also confirm and strengthen that bias.
Our focus should not be on whether political figures or their followers are āmentally illā or āmentally fitā but which side they are on – the side of the oppressed or the side of the oppressors.
One reason why the American left is so weak is because of internecine fighting that builds nothing. We need to find more productive and comradely ways to engage with each other.
Even the best historical analysis is useless if we can’t build supportive organizations where people feel free to disagree without being pinned to the wall.
Effective organizations are not built on politics alone. We must give everyone the room to choose how, when, and with whom they share their thoughts. Anything less is tyranny, and we have more than enough of that already.
Richard and Oldhead – It pains me to say that your responses to my comments display the kind of negative tone that turns people off to discussions about socialism.
I was asked what I thought, I answered and was resoundingly criticized. I’m no shrinking violet, by any stretch of the imagination, however, I recognize bullying when I encounter it.
I was hounded to elaborate my views, which I am under no obligation to do. Negative assumptions were made about what I believe, which I am not obligated to correct. Nor am I under any obligation to save someone the cost and effort of reading a book.
While political clarity is critical, pissing contests over who is right do not clarify; they alienate. This is a key difference between top-down socialists, who claim a monopoly on what is right, and bottom-up socialists who prioritize building the confidence of ordinary people to act upon the world.
Effective socialists value people’s contributions, emphasize common interests, and are generous in our interpretations. We aim to build collaborative organizations that can support activists to learn together and resolve tactical differences in practice.
In my experience, political disagreements cannot be resolved in writing, in a public venue, among people who don’t know each other and have no commitment to work together.
I will say that the only people who have found me or my work “troublesome” have not been on my side.
Anomie – As you point out, humanity is facing an existential crisis of survival.
Covid-19 has exposed the utter failure of the capitalist class to protect humanity. Their bungled response to the pandemic has produced mass death and an economic crisis that will rival, if not surpass, the misery of the 1930s. Add to this the triple crises of toxic pollution, global warming, and the threat of war.
As Marx wrote, āAll that is solid melts into air, all that is holy is profaned, and humanity is at last compelled to face with sober senses their real conditions of life, and their relations with their kind.ā
There will be no return to normal. Society is being remade, and the only question is in whose interests, the profit-hungry elite or the majority who want a decent life. The stakes could not be higher. The opportunity could not be greater.
Racism is essential to capitalist rule, so Black rebellions always shake things up, paving the way for broader social revolt. This is as true today as it was in the 1960s. Everything that was previously accepted is now in question, and psychiatry is no exception.
You are right, more people need to understand that psychiatry is an arm of the capitalist state, that its power is directly related to the power of the capitalist state, and that the primary role of both is to maintain capitalist rule. This means that our liberation from psychiatric oppression cannot be separated from our liberation from capitalist rule.
I often encounter the comment, āthe left does not take psychiatric oppression seriously.ā Itās equally true that people who organize around specific oppressions donāt take capitalism seriously as the root source of their suffering.
As you say, we need to end capitalist rule. That is the only way we can end the social suffering that drives people to seek relief and transform the social institutions that interpret such suffering as individual, biological defects.
I’m organizing an online discussion group centered on Rebel Minds. Anyone who is interested in participating can contact me at [email protected].
Oldhead – If I could answer your questions in a few paragraphs, I wouldn’t have needed to write a book that explains the root cause of mass suffering, how suffering is concealed as personal defect, how rebellion against oppression is prevented from disrupting the social order, and how we can get ourselves free.
Because of its unique analysis, Rebel Minds was nominated for the 2020 Deutscher memorial prize “awarded for a book which exemplifies the best and most innovative new writing in or about the Marxist tradition.”
Richard – Like most socialist organizations, the RCP promotes a concept of socialism as a society managed for, not by, workers themselves – a form of radical reformism.
According to their website, Avakian believes that China was a socialist society until 1976 and Russia was a socialist society until 1956. Workers were not directing the economy in either country during those periods; they were brutally exploited and oppressed.
Avakian’s >100 page “Constitution for The New Socialist Republic In North America” is the quintessential definition of managerial. Revolutionary socialism is constructed from the bottom up by working people themselves, and it will look nothing like what anyone can imagine on this side of that transformation.
Yes, workers on the front lines of the class war must organize themselves in a political party that can lead the working class to power. I have not found any socialist organization or wannabe vanguard party that has worker-activists in key roles. Most are dominated by people from the managerial class. This is to be expected given the low level of struggle over the past decades; however, it must change as the struggle rises.
As I mentioned before, I discuss all this in my book.
Richard – The RCP is not a new formation by any means. It promotes a top-down ‘socialism’ run on behalf of workers rather than by workers themselves. This managerial approach inevitably leads to oppressive forms of state capitalism.
Genuine revolutionary socialism is built from the bottom up. In the process, it transforms every aspect of life, including how people relate to each other and how decisions are made.
Thank you for your work in documenting the history of protest inside the psychiatric profession.
As a baby boomer, I experienced that era and was influenced by the radical therapist movement to choose medicine/psychotherapy as a profession. By the time I graduated, the conservative backlash had begun and we’ve been losing ground ever since (‘we’ being those of us who saw the primary threat as coming from outside, not inside, people’s minds).
Thankfully, the tide has turned, and the same issues are back on the table. For me, the lesson of history is this: we must be much clearer as to the root cause of our problems in order to solve them. Chasing symptoms has proved ineffective. We need to aim higher and cure the disease.
I would argue that the ‘disease’ is a capitalist class who separate their interests from the rest of humanity, enrich themselves at the expense of everyone else, and defend this unjust social arrangement with all the forces at their command. This is the root cause of our suffering.
Iām delighted that the power of the Black Lives Matter movement has compelled psychiatrists to challenge the racist theory and practice embedded in their profession.
However, I disagree that it is possible to āroot out the problems of racism, colonialism, and bias that lie at the heart of psychiatry.ā
Racism cannot be purged from capitalism, from the police, or from psychiatry, because racism is necessary for their existence.
Of course, we want and should demand a less-racist capitalism, police, and psychiatry. However, “less-racist” is not good enough.
We can purge racism from the world by fighting for a society that doesn’t need it — a socialist society collectively managed by workers for their common good.
I want to add a huge thank you to Noel for her courage in writing this excellent article. Exchanging one form of oppression for another is no solution.
Too many people have bought into the concept of ‘mental illness’ and the supposed benevolence of the psychiatric system.
Mass rebellions against oppression have opened a space for us to push for a humane society that treats everyone as worthy and provides for everyone’s needs. We should accept nothing less.
The demand to abolish the police is the demand to provide people with what they need instead of punishing them for rebelling against their deprivation.
Living standards for the majority cannot be improved without reducing the wealth and power of the billionaire class who fear that if they open that door they will not be able to shut it. So they cap peopleās expectations for a better life by using cops to criminalize dissent and psychiatrists to medicalize it.
At this time, our priority must be to abolish police and prisons and invest instead in meeting human needs. Doing that would dramatically lower the level of mental distress that drives people into the psychiatric system.
A series of crises have created an unprecedented revolutionary situation: On the one side, authorities are pushing for a quick return to unsafe work and more investment in police and prisons. On the other side, ordinary people are demanding safe work, an end to racist oppression, and more investment in education, health care, and social supports. The two positions cannot be reconciled.
As global conditions deteriorate, this conflict will intensify. Each and every one of us must decide which side we are on.
“Why is it close to impossible to get the truth accepted and to incorporate it in official guidelines?”
As I explain in Rebel Minds (https://remarxpub.com/rebel-minds/), global capitalism functions to transfer wealth from the many to the few, something it does exceedingly well. In the process, billions of people are exposed to preventable distress, disease, disability, and premature death.
To protect their system of grand thievery, the ruling class refuse to acknowledge the systemic sources of suffering. Instead, they blame individuals for ‘failure to cope’ (an actual medical term!) and direct people in distress to the medical system. The pharmaceutical industry parasitically profits by reinforcing the medical model of human suffering.
We don’t need more studies to prove what we already know. The truth does not matter in a system that hides the truth about so many things, especially its own role in destroying people’s lives. (See https://susanrosenthal.com/labor/a-socialist-response-to-covid-19/).
To quote Frederick Douglass, “The limits of tyrants are prescribed by the endurance of those whom they oppress. Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong that will be imposed upon them. Power concedes nothing without a demand. It never did and it never will.ā
Douglass was right. We need to organize a powerful mass movement to demand a very different society that will meet people’s needs. If that means sweeping the global capitalist class from power, then that is what we must do.
If you think that is impossible, pie in the sky, a pipe dream, consider this: When all āreasonableā solutions have proved inadequate to the task, then the only road left, however improbable, is the one we must travel.
Thank you for your well-researched and informative article.
I don’t think Trump and company got it wrong. They don’t care about right and wrong. They care about having power over others. They deliberately cast non-conformists and the mentally distressed as dangerous, immigrants as criminals, women seeking abortion as irresponsible, and Black people as bestial in order to justify exerting more control over people’s lives, especially those who have the least to lose by rebelling against them.
Experience shows that challenging “misconceptions” does not increase our power or decrease theirs. We need to challenge their right to rule.
While healthy diets and exercise can protect against many health problems, this may be an example of correlation rather than causation.
There is ample evidence that social class is a major determinant of health. Those who are better off socially and financially eat better, exercise more, experience less stress, and enjoy better health.
While healthy diets and exercise can protect against many health problems, this may be an example of correlation rather than causation.
There is ample evidence that social class is a major determinant of health. Those who are better off socially and financially eat better, exercise more, experience less stress, and enjoy better health.
As long as some people have power over others, there will be abuse.
Capitalism is a system of predator-prey relationships: exploiter-exploited; oppressor-oppressed, and so on.
In such a system, anyone in a position of power can target those with less power. This includes police, supervisors, bosses, bureaucrats, teachers, lawyers, doctors, parents, coaches, and so on. The ‘mental-health’ industry is no different.
The greatest predators are the people in power who are swallowing the planet for profit. In contrast, most ordinary people recognize the survival value of cooperation.
It’s a question of what we emphasize. Emphasizing the potential for cooperation puts us in the best position to fight for a truly cooperative and egalitarian society.
When people have what they need, including social support, they are much less vulnerable to any kind of abuse.
The āmental-health industryā is an instrument of social control so, by definition, all who work in it participate in imposing that control. Some relish that role. Others are repelled by it.
Most psy-professionals have also been service users, or have close friends or family who are service users, and most enter the industry to be helpful.
For both of these reasons, a great many āmental-healthā professionals are committed to patientsā rights. Prominent examples include Loren Mosher, Peter Breggin, and Jay Joseph, to name just a few.
In reality, no hard line can be drawn between psychiatric survivors and psy-professionals.
This argument parallels the divisions promoted by adherents of identity politics, who believe that others who have not suffered their experiences have nothing to contribute to ending them.
This is a dead-end strategy, because society can only be changed in a meaningful way by the majority. That is why I totally support Bruceās efforts to encourage people who are critical of the military-industrial complex to become equally critical of the psychiatric-industrial complex — and vice versa!
The power of Psychiatry only grows when we accept the lies that we are different, that others cannot relate to us, that our only option is to huddle in corners with our own kind, licking our wounds.
As Noƫl said, we are not defective or even that different. We are human beings struggling with incredible pain. And that puts us in the same category as billions of other people on the planet.
Of course each of our experiences is unique and must be recognized. At the same time, our liberation depends on the alliances we make with all who struggle against oppression.
There is a world of potential allies out there. We shoot ourselves in the proverbial foot when we isolate ourselves. We need to join with all who long for a supportive society, free of coercion, that actually meet peopleās needs.
1.The Myth of Personal Life
2. Whatās Wrong with Freud?
3. Mental Illness or Social Sickness?
4. The Madness of War (by Patricia Campbell)
5. Marxism and Psychology
While not specifically anti-psychiatry; it explains the political role of psychiatry under capitalism and why both are so oppressive.
I welcome any and all feedback, as it will be useful for the book I am currently writing – to be published in the summer of 2019.
WOW! Richard, you made my day. Your song is brilliant, and your article is spot on. Exactly what we need. Clear-headed and courageous.
I’m currently at a labor conference in Chicago along with 2,800 rank and file union members – trouble makers, the lot of us.
There are multiple workshops on how to combat racism, sexism, and other forms of oppression in the workplace and in the labor movement. What’s missing is the fight against psychiatric oppression. We can remedy this at the next conference in 2020.
We need to join this fight against oppression, bring our experience to the table, gain strength and power from our solidarity.
The time is now. Judi Chamberlin called on us to come out of the shadows. It won’t be easy, because the ‘mentally ill’ have been cast as society’s lepers. And yet my pamphlet on psychiatric oppression is selling better than any other publication on my lit table.
There are a lot more of us out there than anyone realizes.
As s first step, I invite any of you who are union members to contact me – [email protected].
I am concerned about the mental and physical health of everyone in the Middle East today. I cannot imagine the burden of living with so much insecurity and continual, immediate war. It must take a tremendous toll.
People need safe spaces, and war destroys the sense of safety. This larger context cannot be ignored in the discussion of mental health.
This is a healthy discussion that needs to happen respectfully.
I think that’s a great idea, asking a Palestinian survivor from the West Bank or Gaza to write an article about the psychological trauma of living under occupation.
Context is everything, and that is the problem with this article.
As much as I support the expansion of the Soteria model, I strongly object to Israel being lauded as āan inspiration for the worldā ā for any reason.
There is a growing international boycott campaign against Israel because of its racist and genocidal policies against the Palestinian people. To counter this boycott, Israel actively encourages international artists and intellectuals to promote Israel. This article does exactly that.
There is no acknowledgment of the inhumane conditions in Gaza, the largest outdoor prison in the world, where two million people are systematically deprived of basic necessities required for mental and physical health.
There is no acknowledgment of the fact that Israel could not exist without billions in military funding from the United States, money that could vastly improve mental and physical health in America.
This article disappears the suffering of Palestinians and whitewashes their oppressors.
Youāve landed on the wrong side of this one, Robert.
Thank you for your post. I have experienced everything you talked about, and it is tremendously disheartening.
I came to the conclusion that many people who say they to want to hear ‘the other side’ actually don’t. They want to feel smug in their ‘open-mindedness,’ but they are threatened by any hint of real change.
It’s called cooptation – they pretend that you have a place with them, but that place is only to make them look better than they are.
I have become much more careful about when, where, and with whom I put myself on the line. I would rather organize with people who are truly open to hearing what I have to say than to bang my head against a wall in the hope that the politically deaf will grow a pair of ears.
Thank you for drawing attention to this research. People who are distressed for any reason are more likely to smoke, possibly because nicotine has been shown to have antidepressant properties.
The problem is not lack of knowledge or not enough science; the problem is that capitalism is invested in explaining all human maladies in biological, individual, blame-the-victim terms. If it did not do this, it would have to take responsibility for an immense amount of unnecessary suffering.
This is a political problem, and it can only be solved politically.
Psychiatry is so woven into the fabric of capitalism that one cannot be abolished without abolishing the other. As I see it, this can only be done from the bottom up.
When society goes into revolutionary crisis, every institution splits along class lines, with employers and managers on the one side and workers and service users on the other side. A great many will waffle in the middle, shifting back and forth as the struggle develops.
As workers take collective control of their workplaces, they will change how the work is done, for their own benefit and for the benefit of those they serve. This will generate much discussion about what is needed, what is effective, and what should no longer be done. Everyone will be involved in this discussion, including service users.
Out of this genuinely democratic process will develop systems of meeting peopleās needs that are completely different from what we have today. And in the process of transforming society from the bottom up, human beings will also be transformed in ways we cannot imagine.
Critics will say that this is an impossible pipe dream, but I think it is far more achievable than the impossible task of convincing the powers-that-be to abolish psychiatry.
Richard, I apologize for my delay in responding to the rest of your postings.
I share and appreciate your optimism for revolutionary change. As you say, just because the first attempt to create socialism was defeated doesn’t mean that we should give up and accept the horribleness of capitalism. Thank you for that – it is most welcome at a time when so many people are pessimistic.
There is much to consider in everyone’s comments, far more than can be clarified in a comments section. If anyone wants to communicate with me in more depth, feel free to contact me through my website: http://www.susanrosenthal.com/
I agree that psychiatry should be abolished, along with all of the oppressive institutions of class rule. The problem is in the practice.
When we call for psychiatry to be abolished, who do we think will do the abolishing? The capitalist state will not do it. The only social force capable of abolishing psychiatry is the majority working class, and they can only do this in the process of transforming all of society.
Of course, there are humane alternatives to psychiatry, but they will never become mainstream as long as capitalism needs psychiatry for social control.
So the question of abolishing psychiatry must be put in context. Are we moralists and libertarians who want to replace psychiatry with individual solutions that only the fortunate few can access?
Or are we revolutionary socialists who understand that abolishing psychiatry can be achieved only in the process of remaking society from the bottom up? To my mind, that is the only way we can end the horribly oppressive conditions that push people over the edge and the only way we can build a completely different society that provides what everyone needs to thrive.
Psychiatry is a state institution and so are hospitals. Both need to be reconstructed from the ground up in the process of remaking society to meet human needs. I don’t believe we will need psychiatry under socialism, however, we will always need ways to support people in distress.
Because the revolutionary left has not been involved in the anti-psychiatry movement, it has left a vacuum for the libertarian right to dominate. This has to change if we hope to demolish a psychiatric system that profits from the misery that capitalism creates.
It’s true that libertarians and other right-wingers typically oppose psychiatry. They oppose all social services and supports, including those that most people need, like subsidized education, unemployment insurance, medicare, and child support.
For those with lots of money, social supports don’t matter. But for the majority of ordinary people, they mean the difference between being able to manage and falling apart.
Thank you for this very important article. We need to pay a lot more attention to the role of racism in psychiatric oppression. It isn’t that long ago that we were called ‘a race of mental defectives.’ Race theory erases individuality by attributing negative, biologically-based characteristics to every member of a designated group.
At the core of psychiatric oppression lies the racist claim that āmental illnessā is a biological defect, that a psychiatric label will tell you everything you need to know about a person, and that everyone who shares a label is the same. That is racism.
If we acknowledge the racist core of psychiatric oppression, we could link with other groups and organizations fighting different forms of racism. Working together, we would have a greater ability to demolish the biomedical model that oppresses us all. Common cause for mutual benefit.
I apologize for the length of this comment. It’s a letter to the Canadian Medical Association Journal that I think adds something important to the discussion. Bottom line – we must trust people to make their own decisions, right or wrong. Anything else is disrespectful and opens the door to tyranny. Psychiatric survivors, more than anyone, know this to be true.
Letter: Availability of medical assistance in dying can be therapeutic
by Ian M. Ball, MD and Scott Anderson, MD
The legalization of medical assistance in dying (MAiD) in Canada has created many logistical challenges for institutions and health care providers. In a country where diversity is not merely supported, but encouraged, it is not surprising that there are many outspoken critics of MAiD. One of us (I.M.B.) is the medical chair of our hospital MAiD committee; the other (S.A.) acts as a MAiD provider. Having been involved in over 30 referrals since June 2016, we have several important observations to make.
The gratitude expressed to us by families and patients is staggering. A recurring theme is that patientsā moods are tremendously improved with the knowledge that MAiD gives them control over their disease. In some completed cases, symptoms were not controlled to an acceptable degree by aggressive palliative care. In some other cases, despite excellent symptom control with palliative care, patients desired control over the circumstances and timing of their deaths, and so chose MAiD. As per the law, all MAiD patientsā natural deaths were reasonably forseeable. For patients who received MAiD, being able to prepare for their deaths, assemble their families, and die in a comfortable, dignified manner, were the universally espoused virtues of MAiD.
We have found that MAiD deaths provide a greater level of patient comfort than even the deaths from the withdrawal of life support in intensive care units. MAiD allows the use of intravenous medications in anesthetic doses, combined with neuromuscular blockade. At our institution, the procedure lasts only a few minutes, and avoids the dyspnea and increased work of breathing, which is so often associated with even the best palliative care or withdrawal of life support.
Although we support palliative care and believe it to be the right experience for most individuals, we have witnessed cases where palliative care was insufficient to manage the degree of suffering, or where patients simply wanted to avoid perceived indignities and loss of control associated with their progressive diseases. It has impressed us tremendously that the availability of MAiD has improved the outlook of many patients who have not chosen the procedure. The knowledge that MAiD is an option, should symptoms become unbearable, is very reassuring for patients and their families.
I am much more optimistic. In my lifetime, I have seen radical and surprising change – the fall of the Berlin wall (which no one anticipated), the growing acceptance of gay marriage on the one hand and on the other hand the reversal of many rights won in the 1970s.
Change is constant. Which way it goes depends on what we do.
Discussion forums are excellent for promoting clarity; however, to create real change, clarity must be married with organization, the willingness of like-minded people to work together to do something constructive. If we work together, learn together, and act together, we can make big things happen.
Get-together, meetings, and conferences are important for building activist networks, raising issues publicly, and planning how to reach more people more effectively.
Isolation kills. At every level, personally, socially, societally, we go forward together, or not at all.
Thank you for sharing this, Helen. I canāt imagine working in such a traumatic and re-traumatizing environment.
Your story is important not only because it exposes the immense cruelty of the system but also because it challenges the rigid separation between those who work in the psy-industry and those who are victimized by it.
People who work in the industry are more similar than different from the people we ātreat.ā We are more likely (than the general population) to be trauma survivors and to have been given psychiatric labels. Our experience of trauma is a major reason why we enter the field. This is a closely-guarded secret because workers who are āoutedā as having psychological difficulties can lose their careers.
Itās important to challenge the mistaken idea that providers and users can never work together. The psychiatrists who abuse their power are not on our side, no question. However, most of us entered the field in order to help people, which gives us a common interest with those who seek help.
We have a common enemy – a medical system that prioritizes controlling people over caring about them. When we don’t see that, when we let them turn us against each other, then we all suffer.
I know many providers like yourself, I am one of them, and we are organizing for mutual support. Please contact me: [email protected]
Given the evidence, I don’t see how we can ethically recommend neuroleptics for anyone. Especially since there are so many alternatives, and more could be developed if there was a will to do so.
If one must use a drug for acute psychological crisis, why not use short-acting opioids as an adjunct to social support? They are calming and induce a sense of well-being when people are frightened or in pain.
As with post-surgical pain, withdrawal or dependence is not a problem after a few days of opioid use. But I cannot imagine the establishment going for that. Too much is invested in the way things are. And too little is invested in providing what people really need.
I am deeply indebted to you for opening my eyes to the medical disaster that is psychiatry.
I have made Mad in America required reading for the MA-level course I teach, Social Dimensions of Psychotherapy, and I have requested that our graduate school invite you to speak at our 40th anniversary celebration in 2018.
You ask the most important question at the end of this article. I believe that psychiatry has gained so much power that it will take a massive social rebellion, even greater than the one that challenged it in the 1960s-70s, to uproot it. I believe that the groundwork for that rebellion is being laid today and that you are an important part of that process.
I thank you from the bottom of my heart for your courage and integrity in showing us what needs to change and for launching the frame of an organization (this website) that can take us forward.
As someone who has been on both sides of the patient/provider divide I can totally relate to your comments.
Those of us who enter the medical industry are taught that the priority is patient well-being. We soon discover that the reality is something else ā protection of the profession (cover your ass) and subservience to the hierarchy (mind your betters).
Professional training takes people who truly care about others and teaches them that those āothersā are nothing like them. In dividing us from our patients, they divide us from our humanity, and they block our efforts to do anything else.
Jeff Schmidt’s book, Disciplined Minds: A Critical Look at Salaried Professionals and the Soul-battering System That Shapes Their Lives (https://www.amazon.com/Disciplined-Minds-Critical-Professionals-Soul-battering/dp/0742516857) explains that the role of professionals is to help manage capitalism, so professional schools weed out those who won’t go along. Those who slip through the cracks are ‘sidelined’ or ‘frozen out.ā I have been ostracized and threatened with the loss of my licence to practice for treating people humanely. That is the true meaning of insanity.
Nevertheless, I am hopeful. Medical workers are under attack from the same system that attacks our patients. More of us are suffering burnout from impossible demands, suffocating red tape, micro-managed working conditions, etc.
Patients and providers have a common enemy and a common interest in defeating that enemy.
We cannot let them divide us. As you pointed out, we all lose when that happens.
Privatized reproduction lies at the root of many problems, including women’s oppression and the oppression of those who are seen as less productive.
When the weight of caring falls on individuals, they cannot do it all, so caring becomes ‘control.’ In contrast, when caring is a shared social responsibility, there are more than enough resources to meet everyone’s needs.
Diversity is a threat to class societies and an asset to egalitarian societies.
In societies where human needs comes first (meaning everyone’s needs), there is more acceptance of, and support for, those who are different – for whatever reason.
I totally get your frustration and rage. However, your anger is misdirected.
People to come to realizations in their own time in their own way.
I admire Stephen for showing his vulnerability, for how far he has come, and for how much he is helping young people to stop blaming themselves for how they manage overwhelming emotions.
When you are ready, I encourage you to watch the rest of the TED talk.
I think you will find that his views and yours are not so different.
We all internalize our pain – that is inevitable.
And we all need support to work our way out of self-blame.
“the base for organizing within this movement will be among psychiatric survivors and their families…While of secondary importance, there IS definitely some value in attempting to win over and unite with dissident and open minded psychiatrists”
leaves out the many working-class people who form the base of the psy-industry, the ones who do the grunt work.
Most front-line psy-workers are also psychiatric survivors or are closely related to them. They are overworked and underpaid. They are expected to solve complex social problems while being denied any power to actually do that. This powerlessness defines them as workers and not as managers or directors of the industry. They direct their frustration against themselves and their clients, and rarely against their impossible situation.
On the other hand, psy-workers are the base and foundation of a powerful industry. They have the collective power to challenge it and (most important) transform the system that requires it. We got a tiny glimpse of what is possible in the strike of mental health workers at Kaiser Permanente in California. http://www.beyondchron.org/when-workers-fight-nuhw-wins-battle-with-kaiser/
Ultimately, the demand for better working conditions runs parallel to the demand for better life conditions for those we serve. ‘Better conditions’ means the right to choose what happens. Every psychiatric survivor has experienced that right being violated – the right to be safe, understood, accepted, and cared about.
We can join forces. We can choose to over-ride the needs of the system in order to serve the needs of our clients and patients – as YOU communicate them to us. We can go forward together.
I am sorry that you have suffered such oppression.
Other oppressed groups have organized in self-defense and, if anything is to change, we must too.
The first step is telling the story, and I so admire your courage in doing that here.
A Canadian psychologist told his story of self-harming behavior in a TED talk (The Skeletons in My Closet – https://youtu.be/G17iMOw0ar8) and also in an article in the Canadian Medical Association Journal (Cutting Through the Shame – http://www.cmaj.ca/content/188/17-18/1265.full.pdf+html)
I wish you all the best.
I highly recommend “Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy” by data analyst Cathy O’Neil.
Screening technology is only as good as its programming, which is socially biased and, therefore, self-perpetuating. This was proved with criminal risk assessment algorithms (computer formulas) that claim to predict criminality. Because Black people are disproportionately incarcerated, it is falsely assumed that they are more criminally minded when, in reality, they’re disproportionately incarcerated because of systemic racism. https://aeon.co/ideas/algorithms-associating-appearance-and-criminality-have-a-dark-past
Screening technology to detect ‘mental illness’ would also be skewed by social bias and would also confirm and strengthen that bias.
Recognition technology cannot solve social problems because it targets the victims, not the social conditions that create their suffering.
https://susanrosenthal.com/oppression/big-brother-meets-covid-19/
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Wonderful! Powerful! Defiant!
Just the way I like it!
Thank you!
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A psychological focus on the behavior of political leaders prevents a political understanding of their role in the capitalist system.
As I explain in my article, “Donald Trump is NOT ‘Crazy,” Trump represents a section of the capitalist class who will keep on backing him as long as he serves their interests and, in many ways, he has served their interests very well. (https://susanrosenthal.com/oppression/psychology-psychiatry/donald-trump-is-not-crazy/)
Our focus should not be on whether political figures or their followers are āmentally illā or āmentally fitā but which side they are on – the side of the oppressed or the side of the oppressors.
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One reason why the American left is so weak is because of internecine fighting that builds nothing. We need to find more productive and comradely ways to engage with each other.
Even the best historical analysis is useless if we can’t build supportive organizations where people feel free to disagree without being pinned to the wall.
Effective organizations are not built on politics alone. We must give everyone the room to choose how, when, and with whom they share their thoughts. Anything less is tyranny, and we have more than enough of that already.
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Richard and Oldhead – It pains me to say that your responses to my comments display the kind of negative tone that turns people off to discussions about socialism.
I was asked what I thought, I answered and was resoundingly criticized. I’m no shrinking violet, by any stretch of the imagination, however, I recognize bullying when I encounter it.
I was hounded to elaborate my views, which I am under no obligation to do. Negative assumptions were made about what I believe, which I am not obligated to correct. Nor am I under any obligation to save someone the cost and effort of reading a book.
While political clarity is critical, pissing contests over who is right do not clarify; they alienate. This is a key difference between top-down socialists, who claim a monopoly on what is right, and bottom-up socialists who prioritize building the confidence of ordinary people to act upon the world.
Effective socialists value people’s contributions, emphasize common interests, and are generous in our interpretations. We aim to build collaborative organizations that can support activists to learn together and resolve tactical differences in practice.
In my experience, political disagreements cannot be resolved in writing, in a public venue, among people who don’t know each other and have no commitment to work together.
I will say that the only people who have found me or my work “troublesome” have not been on my side.
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Anomie – As you point out, humanity is facing an existential crisis of survival.
Covid-19 has exposed the utter failure of the capitalist class to protect humanity. Their bungled response to the pandemic has produced mass death and an economic crisis that will rival, if not surpass, the misery of the 1930s. Add to this the triple crises of toxic pollution, global warming, and the threat of war.
As Marx wrote, āAll that is solid melts into air, all that is holy is profaned, and humanity is at last compelled to face with sober senses their real conditions of life, and their relations with their kind.ā
There will be no return to normal. Society is being remade, and the only question is in whose interests, the profit-hungry elite or the majority who want a decent life. The stakes could not be higher. The opportunity could not be greater.
Racism is essential to capitalist rule, so Black rebellions always shake things up, paving the way for broader social revolt. This is as true today as it was in the 1960s. Everything that was previously accepted is now in question, and psychiatry is no exception.
You are right, more people need to understand that psychiatry is an arm of the capitalist state, that its power is directly related to the power of the capitalist state, and that the primary role of both is to maintain capitalist rule. This means that our liberation from psychiatric oppression cannot be separated from our liberation from capitalist rule.
I often encounter the comment, āthe left does not take psychiatric oppression seriously.ā Itās equally true that people who organize around specific oppressions donāt take capitalism seriously as the root source of their suffering.
As you say, we need to end capitalist rule. That is the only way we can end the social suffering that drives people to seek relief and transform the social institutions that interpret such suffering as individual, biological defects.
I’m organizing an online discussion group centered on Rebel Minds. Anyone who is interested in participating can contact me at [email protected].
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Oldhead – If I could answer your questions in a few paragraphs, I wouldn’t have needed to write a book that explains the root cause of mass suffering, how suffering is concealed as personal defect, how rebellion against oppression is prevented from disrupting the social order, and how we can get ourselves free.
Because of its unique analysis, Rebel Minds was nominated for the 2020 Deutscher memorial prize “awarded for a book which exemplifies the best and most innovative new writing in or about the Marxist tradition.”
So, yes, you need to read my book.
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Richard – Like most socialist organizations, the RCP promotes a concept of socialism as a society managed for, not by, workers themselves – a form of radical reformism.
According to their website, Avakian believes that China was a socialist society until 1976 and Russia was a socialist society until 1956. Workers were not directing the economy in either country during those periods; they were brutally exploited and oppressed.
Avakian’s >100 page “Constitution for The New Socialist Republic In North America” is the quintessential definition of managerial. Revolutionary socialism is constructed from the bottom up by working people themselves, and it will look nothing like what anyone can imagine on this side of that transformation.
Yes, workers on the front lines of the class war must organize themselves in a political party that can lead the working class to power. I have not found any socialist organization or wannabe vanguard party that has worker-activists in key roles. Most are dominated by people from the managerial class. This is to be expected given the low level of struggle over the past decades; however, it must change as the struggle rises.
As I mentioned before, I discuss all this in my book.
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Richard – The RCP is not a new formation by any means. It promotes a top-down ‘socialism’ run on behalf of workers rather than by workers themselves. This managerial approach inevitably leads to oppressive forms of state capitalism.
Genuine revolutionary socialism is built from the bottom up. In the process, it transforms every aspect of life, including how people relate to each other and how decisions are made.
I explain this in my book Rebel Minds: Class War, Mass Suffering, and the Urgent Need for Socialism: https://remarxpub.com/rebel-minds/
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Thank you for your work in documenting the history of protest inside the psychiatric profession.
As a baby boomer, I experienced that era and was influenced by the radical therapist movement to choose medicine/psychotherapy as a profession. By the time I graduated, the conservative backlash had begun and we’ve been losing ground ever since (‘we’ being those of us who saw the primary threat as coming from outside, not inside, people’s minds).
Thankfully, the tide has turned, and the same issues are back on the table. For me, the lesson of history is this: we must be much clearer as to the root cause of our problems in order to solve them. Chasing symptoms has proved ineffective. We need to aim higher and cure the disease.
I would argue that the ‘disease’ is a capitalist class who separate their interests from the rest of humanity, enrich themselves at the expense of everyone else, and defend this unjust social arrangement with all the forces at their command. This is the root cause of our suffering.
āTo maintain capitalist rule, it is necessary to cap peopleās expectations for a better life by using police to criminalize dissent and psychiatrists to medicalize it.ā (https://susanrosenthal.com/strategies/cops-criminalize-protest-psychiatrists-medicalize-it/)
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Iām delighted that the power of the Black Lives Matter movement has compelled psychiatrists to challenge the racist theory and practice embedded in their profession.
However, I disagree that it is possible to āroot out the problems of racism, colonialism, and bias that lie at the heart of psychiatry.ā
Racism cannot be purged from capitalism, from the police, or from psychiatry, because racism is necessary for their existence.
āTo maintain capitalist rule, it is necessary to cap peopleās expectations for a better life by using police to criminalize dissent and psychiatrists to medicalize it.ā (https://susanrosenthal.com/strategies/cops-criminalize-protest-psychiatrists-medicalize-it/)
Of course, we want and should demand a less-racist capitalism, police, and psychiatry. However, “less-racist” is not good enough.
We can purge racism from the world by fighting for a society that doesn’t need it — a socialist society collectively managed by workers for their common good.
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Noel,
Your excellent article inspired me to write a post, “Cops Criminalize Protest; Psychiatrists Medicalize It.”
https://susanrosenthal.com/strategies/cops-criminalize-protest-psychiatrists-medicalize-it/
I hope you don’t mind that I quoted you twice!
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I want to add a huge thank you to Noel for her courage in writing this excellent article. Exchanging one form of oppression for another is no solution.
Too many people have bought into the concept of ‘mental illness’ and the supposed benevolence of the psychiatric system.
Mass rebellions against oppression have opened a space for us to push for a humane society that treats everyone as worthy and provides for everyone’s needs. We should accept nothing less.
Susan Rosenthal
https://susanrosenthal.com/
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The demand to abolish the police is the demand to provide people with what they need instead of punishing them for rebelling against their deprivation.
Living standards for the majority cannot be improved without reducing the wealth and power of the billionaire class who fear that if they open that door they will not be able to shut it. So they cap peopleās expectations for a better life by using cops to criminalize dissent and psychiatrists to medicalize it.
At this time, our priority must be to abolish police and prisons and invest instead in meeting human needs. Doing that would dramatically lower the level of mental distress that drives people into the psychiatric system.
A series of crises have created an unprecedented revolutionary situation: On the one side, authorities are pushing for a quick return to unsafe work and more investment in police and prisons. On the other side, ordinary people are demanding safe work, an end to racist oppression, and more investment in education, health care, and social supports. The two positions cannot be reconciled.
As global conditions deteriorate, this conflict will intensify. Each and every one of us must decide which side we are on.
Susan Rosenthal
https://susanrosenthal.com/
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“Why is it close to impossible to get the truth accepted and to incorporate it in official guidelines?”
As I explain in Rebel Minds (https://remarxpub.com/rebel-minds/), global capitalism functions to transfer wealth from the many to the few, something it does exceedingly well. In the process, billions of people are exposed to preventable distress, disease, disability, and premature death.
To protect their system of grand thievery, the ruling class refuse to acknowledge the systemic sources of suffering. Instead, they blame individuals for ‘failure to cope’ (an actual medical term!) and direct people in distress to the medical system. The pharmaceutical industry parasitically profits by reinforcing the medical model of human suffering.
We don’t need more studies to prove what we already know. The truth does not matter in a system that hides the truth about so many things, especially its own role in destroying people’s lives. (See https://susanrosenthal.com/labor/a-socialist-response-to-covid-19/).
To quote Frederick Douglass, “The limits of tyrants are prescribed by the endurance of those whom they oppress. Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong that will be imposed upon them. Power concedes nothing without a demand. It never did and it never will.ā
Douglass was right. We need to organize a powerful mass movement to demand a very different society that will meet people’s needs. If that means sweeping the global capitalist class from power, then that is what we must do.
If you think that is impossible, pie in the sky, a pipe dream, consider this: When all āreasonableā solutions have proved inadequate to the task, then the only road left, however improbable, is the one we must travel.
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Thank you for your well-researched and informative article.
I don’t think Trump and company got it wrong. They don’t care about right and wrong. They care about having power over others. They deliberately cast non-conformists and the mentally distressed as dangerous, immigrants as criminals, women seeking abortion as irresponsible, and Black people as bestial in order to justify exerting more control over people’s lives, especially those who have the least to lose by rebelling against them.
Experience shows that challenging “misconceptions” does not increase our power or decrease theirs. We need to challenge their right to rule.
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At the risk of repeating myself:
While healthy diets and exercise can protect against many health problems, this may be an example of correlation rather than causation.
There is ample evidence that social class is a major determinant of health. Those who are better off socially and financially eat better, exercise more, experience less stress, and enjoy better health.
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While healthy diets and exercise can protect against many health problems, this may be an example of correlation rather than causation.
There is ample evidence that social class is a major determinant of health. Those who are better off socially and financially eat better, exercise more, experience less stress, and enjoy better health.
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As long as some people have power over others, there will be abuse.
Capitalism is a system of predator-prey relationships: exploiter-exploited; oppressor-oppressed, and so on.
In such a system, anyone in a position of power can target those with less power. This includes police, supervisors, bosses, bureaucrats, teachers, lawyers, doctors, parents, coaches, and so on. The ‘mental-health’ industry is no different.
The greatest predators are the people in power who are swallowing the planet for profit. In contrast, most ordinary people recognize the survival value of cooperation.
It’s a question of what we emphasize. Emphasizing the potential for cooperation puts us in the best position to fight for a truly cooperative and egalitarian society.
When people have what they need, including social support, they are much less vulnerable to any kind of abuse.
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The āmental-health industryā is an instrument of social control so, by definition, all who work in it participate in imposing that control. Some relish that role. Others are repelled by it.
Most psy-professionals have also been service users, or have close friends or family who are service users, and most enter the industry to be helpful.
For both of these reasons, a great many āmental-healthā professionals are committed to patientsā rights. Prominent examples include Loren Mosher, Peter Breggin, and Jay Joseph, to name just a few.
In reality, no hard line can be drawn between psychiatric survivors and psy-professionals.
This argument parallels the divisions promoted by adherents of identity politics, who believe that others who have not suffered their experiences have nothing to contribute to ending them.
This is a dead-end strategy, because society can only be changed in a meaningful way by the majority. That is why I totally support Bruceās efforts to encourage people who are critical of the military-industrial complex to become equally critical of the psychiatric-industrial complex — and vice versa!
The power of Psychiatry only grows when we accept the lies that we are different, that others cannot relate to us, that our only option is to huddle in corners with our own kind, licking our wounds.
As Noƫl said, we are not defective or even that different. We are human beings struggling with incredible pain. And that puts us in the same category as billions of other people on the planet.
Of course each of our experiences is unique and must be recognized. At the same time, our liberation depends on the alliances we make with all who struggle against oppression.
There is a world of potential allies out there. We shoot ourselves in the proverbial foot when we isolate ourselves. We need to join with all who long for a supportive society, free of coercion, that actually meet peopleās needs.
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Thank you for your encouragement.
I look forward to your feedback. The more we pull together, the stronger we become.
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Yes, oldhead. My pamphlet, Marxism and Psychology, was published in 2016 and is available at: https://www.remarxpub.com/marxism-and-psychology/. It’s a collection of five essays:
1.The Myth of Personal Life
2. Whatās Wrong with Freud?
3. Mental Illness or Social Sickness?
4. The Madness of War (by Patricia Campbell)
5. Marxism and Psychology
While not specifically anti-psychiatry; it explains the political role of psychiatry under capitalism and why both are so oppressive.
I welcome any and all feedback, as it will be useful for the book I am currently writing – to be published in the summer of 2019.
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WOW! Richard, you made my day. Your song is brilliant, and your article is spot on. Exactly what we need. Clear-headed and courageous.
I’m currently at a labor conference in Chicago along with 2,800 rank and file union members – trouble makers, the lot of us.
There are multiple workshops on how to combat racism, sexism, and other forms of oppression in the workplace and in the labor movement. What’s missing is the fight against psychiatric oppression. We can remedy this at the next conference in 2020.
We need to join this fight against oppression, bring our experience to the table, gain strength and power from our solidarity.
The time is now. Judi Chamberlin called on us to come out of the shadows. It won’t be easy, because the ‘mentally ill’ have been cast as society’s lepers. And yet my pamphlet on psychiatric oppression is selling better than any other publication on my lit table.
There are a lot more of us out there than anyone realizes.
As s first step, I invite any of you who are union members to contact me – [email protected].
In the words of Chelsea Manning, WE GOT THIS.
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I am concerned about the mental and physical health of everyone in the Middle East today. I cannot imagine the burden of living with so much insecurity and continual, immediate war. It must take a tremendous toll.
People need safe spaces, and war destroys the sense of safety. This larger context cannot be ignored in the discussion of mental health.
This is a healthy discussion that needs to happen respectfully.
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I think that’s a great idea, asking a Palestinian survivor from the West Bank or Gaza to write an article about the psychological trauma of living under occupation.
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Context is everything, and that is the problem with this article.
As much as I support the expansion of the Soteria model, I strongly object to Israel being lauded as āan inspiration for the worldā ā for any reason.
There is a growing international boycott campaign against Israel because of its racist and genocidal policies against the Palestinian people. To counter this boycott, Israel actively encourages international artists and intellectuals to promote Israel. This article does exactly that.
There is no acknowledgment of the inhumane conditions in Gaza, the largest outdoor prison in the world, where two million people are systematically deprived of basic necessities required for mental and physical health.
There is no acknowledgment of the fact that Israel could not exist without billions in military funding from the United States, money that could vastly improve mental and physical health in America.
This article disappears the suffering of Palestinians and whitewashes their oppressors.
Youāve landed on the wrong side of this one, Robert.
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Thank you for your post. I have experienced everything you talked about, and it is tremendously disheartening.
I came to the conclusion that many people who say they to want to hear ‘the other side’ actually don’t. They want to feel smug in their ‘open-mindedness,’ but they are threatened by any hint of real change.
It’s called cooptation – they pretend that you have a place with them, but that place is only to make them look better than they are.
I have become much more careful about when, where, and with whom I put myself on the line. I would rather organize with people who are truly open to hearing what I have to say than to bang my head against a wall in the hope that the politically deaf will grow a pair of ears.
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Thank you for drawing attention to this research. People who are distressed for any reason are more likely to smoke, possibly because nicotine has been shown to have antidepressant properties.
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The relationship between lower social status and sickness/mortality has been documented and redocumented since 1845: https://www.marxists.org/archive/marx/works/download/pdf/condition-working-class-england.pdf
In 1936, Hans Selye explained how it happens: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2038162/pdf/brmedj03603-0003.pdf
The problem is not lack of knowledge or not enough science; the problem is that capitalism is invested in explaining all human maladies in biological, individual, blame-the-victim terms. If it did not do this, it would have to take responsibility for an immense amount of unnecessary suffering.
This is a political problem, and it can only be solved politically.
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Psychiatry is so woven into the fabric of capitalism that one cannot be abolished without abolishing the other. As I see it, this can only be done from the bottom up.
When society goes into revolutionary crisis, every institution splits along class lines, with employers and managers on the one side and workers and service users on the other side. A great many will waffle in the middle, shifting back and forth as the struggle develops.
As workers take collective control of their workplaces, they will change how the work is done, for their own benefit and for the benefit of those they serve. This will generate much discussion about what is needed, what is effective, and what should no longer be done. Everyone will be involved in this discussion, including service users.
Out of this genuinely democratic process will develop systems of meeting peopleās needs that are completely different from what we have today. And in the process of transforming society from the bottom up, human beings will also be transformed in ways we cannot imagine.
Critics will say that this is an impossible pipe dream, but I think it is far more achievable than the impossible task of convincing the powers-that-be to abolish psychiatry.
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Richard, I apologize for my delay in responding to the rest of your postings.
I share and appreciate your optimism for revolutionary change. As you say, just because the first attempt to create socialism was defeated doesn’t mean that we should give up and accept the horribleness of capitalism. Thank you for that – it is most welcome at a time when so many people are pessimistic.
There is much to consider in everyone’s comments, far more than can be clarified in a comments section. If anyone wants to communicate with me in more depth, feel free to contact me through my website: http://www.susanrosenthal.com/
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I agree that psychiatry should be abolished, along with all of the oppressive institutions of class rule. The problem is in the practice.
When we call for psychiatry to be abolished, who do we think will do the abolishing? The capitalist state will not do it. The only social force capable of abolishing psychiatry is the majority working class, and they can only do this in the process of transforming all of society.
Of course, there are humane alternatives to psychiatry, but they will never become mainstream as long as capitalism needs psychiatry for social control.
So the question of abolishing psychiatry must be put in context. Are we moralists and libertarians who want to replace psychiatry with individual solutions that only the fortunate few can access?
Or are we revolutionary socialists who understand that abolishing psychiatry can be achieved only in the process of remaking society from the bottom up? To my mind, that is the only way we can end the horribly oppressive conditions that push people over the edge and the only way we can build a completely different society that provides what everyone needs to thrive.
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Psychiatry is a state institution and so are hospitals. Both need to be reconstructed from the ground up in the process of remaking society to meet human needs. I don’t believe we will need psychiatry under socialism, however, we will always need ways to support people in distress.
Because the revolutionary left has not been involved in the anti-psychiatry movement, it has left a vacuum for the libertarian right to dominate. This has to change if we hope to demolish a psychiatric system that profits from the misery that capitalism creates.
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It’s true that libertarians and other right-wingers typically oppose psychiatry. They oppose all social services and supports, including those that most people need, like subsidized education, unemployment insurance, medicare, and child support.
For those with lots of money, social supports don’t matter. But for the majority of ordinary people, they mean the difference between being able to manage and falling apart.
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Thank you for this very important article. We need to pay a lot more attention to the role of racism in psychiatric oppression. It isn’t that long ago that we were called ‘a race of mental defectives.’ Race theory erases individuality by attributing negative, biologically-based characteristics to every member of a designated group.
At the core of psychiatric oppression lies the racist claim that āmental illnessā is a biological defect, that a psychiatric label will tell you everything you need to know about a person, and that everyone who shares a label is the same. That is racism.
If we acknowledge the racist core of psychiatric oppression, we could link with other groups and organizations fighting different forms of racism. Working together, we would have a greater ability to demolish the biomedical model that oppresses us all. Common cause for mutual benefit.
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I apologize for the length of this comment. It’s a letter to the Canadian Medical Association Journal that I think adds something important to the discussion. Bottom line – we must trust people to make their own decisions, right or wrong. Anything else is disrespectful and opens the door to tyranny. Psychiatric survivors, more than anyone, know this to be true.
Letter: Availability of medical assistance in dying can be therapeutic
by Ian M. Ball, MD and Scott Anderson, MD
The legalization of medical assistance in dying (MAiD) in Canada has created many logistical challenges for institutions and health care providers. In a country where diversity is not merely supported, but encouraged, it is not surprising that there are many outspoken critics of MAiD. One of us (I.M.B.) is the medical chair of our hospital MAiD committee; the other (S.A.) acts as a MAiD provider. Having been involved in over 30 referrals since June 2016, we have several important observations to make.
The gratitude expressed to us by families and patients is staggering. A recurring theme is that patientsā moods are tremendously improved with the knowledge that MAiD gives them control over their disease. In some completed cases, symptoms were not controlled to an acceptable degree by aggressive palliative care. In some other cases, despite excellent symptom control with palliative care, patients desired control over the circumstances and timing of their deaths, and so chose MAiD. As per the law, all MAiD patientsā natural deaths were reasonably forseeable. For patients who received MAiD, being able to prepare for their deaths, assemble their families, and die in a comfortable, dignified manner, were the universally espoused virtues of MAiD.
We have found that MAiD deaths provide a greater level of patient comfort than even the deaths from the withdrawal of life support in intensive care units. MAiD allows the use of intravenous medications in anesthetic doses, combined with neuromuscular blockade. At our institution, the procedure lasts only a few minutes, and avoids the dyspnea and increased work of breathing, which is so often associated with even the best palliative care or withdrawal of life support.
Although we support palliative care and believe it to be the right experience for most individuals, we have witnessed cases where palliative care was insufficient to manage the degree of suffering, or where patients simply wanted to avoid perceived indignities and loss of control associated with their progressive diseases. It has impressed us tremendously that the availability of MAiD has improved the outlook of many patients who have not chosen the procedure. The knowledge that MAiD is an option, should symptoms become unbearable, is very reassuring for patients and their families.
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I recommend this comment on the above study by Richard Wilkinson and Kate Pickett, authors of The Spirit Level: Why Equality is Better for Everyone.
https://www.equalitytrust.org.uk/inequality-and-mental-illness-comment-lancet-psychiatry-professors-wilkinson-and-pickett
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I am much more optimistic. In my lifetime, I have seen radical and surprising change – the fall of the Berlin wall (which no one anticipated), the growing acceptance of gay marriage on the one hand and on the other hand the reversal of many rights won in the 1970s.
Change is constant. Which way it goes depends on what we do.
Discussion forums are excellent for promoting clarity; however, to create real change, clarity must be married with organization, the willingness of like-minded people to work together to do something constructive. If we work together, learn together, and act together, we can make big things happen.
Get-together, meetings, and conferences are important for building activist networks, raising issues publicly, and planning how to reach more people more effectively.
Isolation kills. At every level, personally, socially, societally, we go forward together, or not at all.
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Thank you for sharing this, Helen. I canāt imagine working in such a traumatic and re-traumatizing environment.
Your story is important not only because it exposes the immense cruelty of the system but also because it challenges the rigid separation between those who work in the psy-industry and those who are victimized by it.
People who work in the industry are more similar than different from the people we ātreat.ā We are more likely (than the general population) to be trauma survivors and to have been given psychiatric labels. Our experience of trauma is a major reason why we enter the field. This is a closely-guarded secret because workers who are āoutedā as having psychological difficulties can lose their careers.
Chapter 3 of Psychiatry Interrogated describes two psy-workers who lost their jobs (one also lost her licence to practice nursing) on the false assumption that mental illness = mental incompetence. https://www.amazon.ca/Psychiatry-Interrogated-Institutional-Ethnography-Anthology/dp/3319424734/
Itās important to challenge the mistaken idea that providers and users can never work together. The psychiatrists who abuse their power are not on our side, no question. However, most of us entered the field in order to help people, which gives us a common interest with those who seek help.
We have a common enemy – a medical system that prioritizes controlling people over caring about them. When we don’t see that, when we let them turn us against each other, then we all suffer.
I know many providers like yourself, I am one of them, and we are organizing for mutual support. Please contact me: [email protected]
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I agree with you, Seth.
Given the evidence, I don’t see how we can ethically recommend neuroleptics for anyone. Especially since there are so many alternatives, and more could be developed if there was a will to do so.
If one must use a drug for acute psychological crisis, why not use short-acting opioids as an adjunct to social support? They are calming and induce a sense of well-being when people are frightened or in pain.
As with post-surgical pain, withdrawal or dependence is not a problem after a few days of opioid use. But I cannot imagine the establishment going for that. Too much is invested in the way things are. And too little is invested in providing what people really need.
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I teach at Adler Graduate Professional Schools in Toronto – http://www.adler.ca/
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I am deeply indebted to you for opening my eyes to the medical disaster that is psychiatry.
I have made Mad in America required reading for the MA-level course I teach, Social Dimensions of Psychotherapy, and I have requested that our graduate school invite you to speak at our 40th anniversary celebration in 2018.
You ask the most important question at the end of this article. I believe that psychiatry has gained so much power that it will take a massive social rebellion, even greater than the one that challenged it in the 1960s-70s, to uproot it. I believe that the groundwork for that rebellion is being laid today and that you are an important part of that process.
I thank you from the bottom of my heart for your courage and integrity in showing us what needs to change and for launching the frame of an organization (this website) that can take us forward.
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As someone who has been on both sides of the patient/provider divide I can totally relate to your comments.
Those of us who enter the medical industry are taught that the priority is patient well-being. We soon discover that the reality is something else ā protection of the profession (cover your ass) and subservience to the hierarchy (mind your betters).
Professional training takes people who truly care about others and teaches them that those āothersā are nothing like them. In dividing us from our patients, they divide us from our humanity, and they block our efforts to do anything else.
Jeff Schmidt’s book, Disciplined Minds: A Critical Look at Salaried Professionals and the Soul-battering System That Shapes Their Lives (https://www.amazon.com/Disciplined-Minds-Critical-Professionals-Soul-battering/dp/0742516857) explains that the role of professionals is to help manage capitalism, so professional schools weed out those who won’t go along. Those who slip through the cracks are ‘sidelined’ or ‘frozen out.ā I have been ostracized and threatened with the loss of my licence to practice for treating people humanely. That is the true meaning of insanity.
Nevertheless, I am hopeful. Medical workers are under attack from the same system that attacks our patients. More of us are suffering burnout from impossible demands, suffocating red tape, micro-managed working conditions, etc.
Patients and providers have a common enemy and a common interest in defeating that enemy.
We cannot let them divide us. As you pointed out, we all lose when that happens.
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Privatized reproduction lies at the root of many problems, including women’s oppression and the oppression of those who are seen as less productive.
When the weight of caring falls on individuals, they cannot do it all, so caring becomes ‘control.’ In contrast, when caring is a shared social responsibility, there are more than enough resources to meet everyone’s needs.
Diversity is a threat to class societies and an asset to egalitarian societies.
In societies where human needs comes first (meaning everyone’s needs), there is more acceptance of, and support for, those who are different – for whatever reason.
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Thank you all for your thoughtful comments and suggestions.
Much appreciated!
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Brilliant!
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I think that is what happened.
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I totally get your frustration and rage. However, your anger is misdirected.
People to come to realizations in their own time in their own way.
I admire Stephen for showing his vulnerability, for how far he has come, and for how much he is helping young people to stop blaming themselves for how they manage overwhelming emotions.
When you are ready, I encourage you to watch the rest of the TED talk.
I think you will find that his views and yours are not so different.
We all internalize our pain – that is inevitable.
And we all need support to work our way out of self-blame.
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This statement,
“the base for organizing within this movement will be among psychiatric survivors and their families…While of secondary importance, there IS definitely some value in attempting to win over and unite with dissident and open minded psychiatrists”
leaves out the many working-class people who form the base of the psy-industry, the ones who do the grunt work.
Most front-line psy-workers are also psychiatric survivors or are closely related to them. They are overworked and underpaid. They are expected to solve complex social problems while being denied any power to actually do that. This powerlessness defines them as workers and not as managers or directors of the industry. They direct their frustration against themselves and their clients, and rarely against their impossible situation.
On the other hand, psy-workers are the base and foundation of a powerful industry. They have the collective power to challenge it and (most important) transform the system that requires it. We got a tiny glimpse of what is possible in the strike of mental health workers at Kaiser Permanente in California. http://www.beyondchron.org/when-workers-fight-nuhw-wins-battle-with-kaiser/
Ultimately, the demand for better working conditions runs parallel to the demand for better life conditions for those we serve. ‘Better conditions’ means the right to choose what happens. Every psychiatric survivor has experienced that right being violated – the right to be safe, understood, accepted, and cared about.
We can join forces. We can choose to over-ride the needs of the system in order to serve the needs of our clients and patients – as YOU communicate them to us. We can go forward together.
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I am sorry that you have suffered such oppression.
Other oppressed groups have organized in self-defense and, if anything is to change, we must too.
The first step is telling the story, and I so admire your courage in doing that here.
A Canadian psychologist told his story of self-harming behavior in a TED talk (The Skeletons in My Closet – https://youtu.be/G17iMOw0ar8) and also in an article in the Canadian Medical Association Journal (Cutting Through the Shame – http://www.cmaj.ca/content/188/17-18/1265.full.pdf+html)
I wish you all the best.
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