What is antipsychiatry?

by TheEditor

Categories: Investigative, Medicine

It is important in the medical practice of psychiatry to understand forces opposed to psychiatry. From my experience, I have witnessed antipsychiatry views even among trained mental health professionals. I declare a professional bias that I have not found those views helpful to patients’ progress.

Introduction

Antipsychiatry is a movement and perspective that fundamentally challenges the assumptions, concepts, and practices of mainstream psychiatry. It arose in the 1960s and has evolved over the years, with variations in its scope and focus.

Antipsychiatry proponents argue against the validity of psychiatric diagnoses, the effectiveness and safety of psychiatric treatments (including both medications and psychotherapies), and the ethics and legality of psychiatric institutions and coercive treatments. Some even reject the very concept of mental illness.

Key figures in the antipsychiatry movement include R.D. Laing, Thomas Szasz, and Michel Foucault. Laing suggested that what is often diagnosed as mental illness is an understandable and rational response to a mad world. Szasz argued that mental illness is a myth used to disguise moral conflicts in society, and Foucault critiqued the power dynamics within the psychiatric profession and how they can lead to social control.

Many within the movement advocate for the rights of those diagnosed with mental health conditions, arguing for more compassionate, person-centred approaches. However, the movement has also faced criticism, including from those who contend that it oversimplifies or dismisses the complex realities of mental health disorders and the potential benefits of psychiatric treatments.

Foundations of Antipsychiatry

  1. Critique of Psychiatric Diagnosis: Critics point to research showing that psychiatric diagnoses often lack reliability and validity, meaning that different clinicians might diagnose the same person differently, and the diagnoses might not accurately capture the person’s experiences. The Rosenhan experiment, conducted in 1973, is a well-known study demonstrating this issue. Critics also highlight the subjective nature of diagnoses and the influence of societal norms and biases.
  2. Opposition to Psychiatric Treatments: Critics cite studies showing that psychiatric medications can have serious side effects and that their long-term effectiveness is often unclear. The controversy over the long-term use of antipsychotic medications is an example of this. Critics also point to the traumatic experiences of those who have undergone treatments like ECT or involuntary hospitalisation.
  3. Critique of Involuntary Treatment: Critics argue that involuntary treatment infringes on individual rights and can be traumatic. They also point to research suggesting that involuntary treatment is often no more effective than voluntary treatment, and can sometimes lead to worse outcomes. The United Nations has also raised human rights concerns about involuntary treatment.
  4. Promotion of Alternative Approaches: Critics point to research showing that alternative approaches, like peer support and trauma-informed care, can be effective. They also highlight personal testimonials from those who have found these approaches helpful. An example of this is the effectiveness of the Open Dialogue approach in Finland for treating psychosis.
  5. Critique of the Medical Model: Critics argue that the medical model neglects social, cultural, and personal factors contributing to mental distress. They cite research showing that these factors play a key role in mental health, and argue that the medical model can lead to overmedication and neglect of these broader issues.

A majority of the above points are rooted deep in the long gone history of psychiatry, so how can they have any force of validity today – is a mystery. The attack on the so-called ‘medical model’ in psychiatry is terribly misguided. Modern psychiatry in the last 20 years has moved on to embrace holistic approaches to assessment and treatment in the bio-psychosocial model. In any event the foundations of the medical model were rooted in empiricism and science. But the term medical model is used in a destructive way to portray psychiatrists as obsessed with things they can ‘poke’ in the body. The latter sort of representation is disinformation.

It is true that the antipsychiatry movement is not representative majority views on mental health. The  majority of professionals in the field of psychiatry do not align with the movement’s most radical critiques. It is also accurate that some of the movement’s critiques can be based on selective or anecdotal evidence, which does not reflect the complexity and diversity of experiences within psychiatry.

However, the influence of the antipsychiatry movement might be understood in a few ways:

  1. Highlighting Important Issues: While not all of their criticisms may be broadly applicable, antipsychiatry proponents often highlight issues that are indeed relevant and important, such as patient rights, the potential overuse of medication, and the need for more holistic and person-centred approaches.
  2. Providing a Voice for Discontent: The antipsychiatry movement provides a platform for individuals who have had negative experiences with the psychiatric system to express their discontent. While these experiences may not be representative of all patients, they are still important to acknowledge and address.
  3. Challenging Assumptions: The antipsychiatry movement challenges some of the fundamental assumptions of mainstream psychiatry, prompting reflection and debate. Even if one doesn’t agree with their conclusions, this can still be valuable for advancing the field.
  4. Influence on Policy and Practice: Some of the concerns raised by the antipsychiatry movement have influenced policy and practice, contributing to reforms like increased emphasis on informed consent, deinstitutionalisation, and the development of community mental health services.

The influence of Szasz

Thomas Szasz was a psychiatrist. He was born in Hungary in 1920 and emigrated to the United States in 1938. Szasz completed his residency in psychiatry at the University of Chicago Clinics in 1951. He was a well-known figure in the field of psychiatry, primarily for his criticisms of the mainstream psychiatric establishment.

Szasz was a professor of psychiatry at the State University of New York Upstate Medical University in Syracuse. He was a prolific author, publishing over 35 books and hundreds of articles throughout his career. His most famous work, “The Myth of Mental Illness,” challenged the prevailing view of psychiatric disorders and had a significant impact on the field.

Despite being a trained psychiatrist, Szasz was a controversial figure in the field due to his criticisms of key psychiatric concepts and practices. He disputed the concept of mental illness, arguing that it medicalised moral and behavioural issues. He was also a critic of involuntary psychiatric treatment and the use of psychiatric diagnoses in legal settings.

Szasz co-founded the Citisens Commission on Human Rights (CCHR) with the Church of Scientology in 1969. Szasz was a strong critic of the concept of mental illness and the practices of institutional psychiatry, views that aligned with the Church of Scientology’s own doctrine.

This historical connection is mentioned in multiple sources, including Szasz’s own writings. In his book “Psychiatry: The Science of Lies,” for example, he describes his involvement in the foundation of the CCHR.

The Church of Scientology’s website also notes this connection, stating, “In 1969, CCHR was founded by the Church of Scientology and Professor of Psychiatry Dr Thomas Szasz to investigate and expose psychiatric violations of human rights.” In other words Scientology draws on the strength of opinion from a seeming defector to psychiatry.

Szasz was criticised for his views across the following points.

  1. Defining Mental Illness: Szasz argued that mental illnesses are not “real” in the same way that physical illnesses are, because they lack a clear biological basis. Critics argue that this is an overly narrow view of illness. Many physical illnesses also involve subjective distress and social dysfunction, and many lack a clear biological marker. Moreover, research has increasingly identified biological factors associated with mental health conditions, even if the exact mechanisms are not fully understood.
  2. Neglecting the Biological Aspect of Mental Disorders: Critics argue that Szasz’s views neglect the biological aspect of mental disorders. While it is true that social and psychological factors are important, there’s also substantial evidence that biology plays a role in mental health conditions. This includes genetic factors, neurochemical imbalances, and brain abnormalities.
  3. Denying the Efficacy of Psychiatric Treatment: Szasz was critical of psychiatric treatments, particularly involuntary ones. However, critics point out that these treatments can be beneficial for many individuals. While it is important to acknowledge the potential for abuse and to ensure patients’ rights, critics argue that Szasz’s views can potentially deny individuals the help they need.
  4. Misunderstanding of Mental Health Diagnoses: Critics argue that Szasz misunderstood the purpose of mental health diagnoses. While it is true that these diagnoses can be used in harmful ways, they also have many beneficial uses. They can help clinicians communicate, guide treatment decisions, and connect individuals to resources and support. They can also validate people’s experiences and reduce self-blame.
  5. Lack of Alternatives: Critics also argue that Szasz failed to provide practical alternatives to the current system. While his critiques were often thought-provoking, they did not necessarily offer solutions for how to help those who are suffering from severe mental distress.

Enter Scientology

The Church of Scientology has been notably involved in the antipsychiatry movement through its affiliate, the Citisens Commission on Human Rights (CCHR). The CCHR was co-founded in 1969 by the Church of Scientology and psychiatrist Thomas Szasz, a key figure in the antipsychiatry movement.

The CCHR argues against the legitimacy of psychiatric diagnoses and treatments, claiming that they are unscientific and harmful. It has been particularly vocal in its opposition to the use of psychiatric medications and electroconvulsive therapy (ECT), and it has lobbied for legislative changes to restrict the use of these treatments.

However, it is important to note that the involvement of the Church of Scientology in the antipsychiatry movement is controversial, even within the movement itself. Some critics argue that the Church’s motivations are not purely about patient rights or the critique of psychiatry, but are also tied to its religious doctrine and its opposition to competing systems of thought. The Church of Scientology’s antipsychiatry activities have been criticised for spreading misinformation and for their aggressive tactics.

The antipsychiatry movement is diverse and includes many perspectives, and not all of those who identify with the movement align with the views or tactics of the Church of Scientology or the CCHR.

Antipsychiatry today

The respect or acceptance of antipsychiatry views varies widely depending on the context. Here are a few perspectives:

  1. Within Mainstream Psychiatry: Antipsychiatry views are generally seen as controversial within mainstream psychiatry. While some of the critiques raised by the antipsychiatry movement have been acknowledged and led to changes in practice (e.g., improving the informed consent process, reducing the use of involuntary treatment, developing more person-centred approaches), many psychiatrists argue that the movement’s views are overly simplistic, misrepresent the complexity of mental health issues, and neglect the benefits that psychiatric treatment can offer.
  2. Within Other Mental Health Professions: Among other mental health professions, such as psychology and social work, there is often more sympathy for some antipsychiatry views, particularly critiques of overmedicalisation, the neglect of social factors, and the need for more holistic and person-centred approaches. However, these professionals also generally recognise the value of psychiatric diagnoses and treatments, and many work closely with psychiatrists in providing care.
  3. Among Service Users: Among those who use mental health services, views on antipsychiatry are diverse. Some individuals find that psychiatric diagnoses and treatments have been helpful for them and disagree with antipsychiatry views, while others have had negative experiences with the psychiatric system and find the antipsychiatry critique validating. There are also many service user-led movements that advocate for a range of changes in mental health services, not all of which align with antipsychiatry.
  4. Within the Public: Public views on antipsychiatry are also diverse and influenced by a range of factors, including personal experiences, media representations, cultural beliefs, and more. In recent years, there has been increasing public dialogue about the limitations of the medical model of mental health, the potential harms of psychiatric treatments, and the need for more holistic and person-centred approaches, all issues that the antipsychiatry movement has highlighted.

In summary, while antipsychiatry views are not broadly accepted within mainstream psychiatry, they have influenced discussions within the field and in broader society. However, these views are just one part of a wider spectrum of perspectives on mental health. Antipsychiatry views ought not to be crushed or cancelled because they are valuable to mainstream psychiatry for the purposes of reflection and further development.

Supplemental reading

  1. “The Myth of Mental Illness” by Thomas Szasz: This is a seminal work in the antipsychiatry movement, in which Szasz argues that what we call “mental illness” is often a way of medicalizing moral and societal issues.
  2. “Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill” by Robert Whitaker: This book offers a critique of psychiatric treatments, particularly medication, and argues that they often do more harm than good.
  3. “The Divided Self” by R.D. Laing: This book presents a compassionate view of schizophrenia as a rational response to a mad world, rather than as a biological illness.
  4. “Anti-Oedipus: Capitalism and Schizophrenia” by Gilles Deleuze and Félix Guattari: This is a complex and challenging work, but it offers a radical critique of psychiatric power and the concept of mental illness.
  5. “Madness and Civilisation” by Michel Foucault: This book explores the history of madness and how it has been constructed as a social phenomenon.
  6. “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America” by Robert Whitaker: This book discusses the rise of psychiatric medication use and questions its effectiveness.

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