Whither anti-psychiatry?

Back in those halcyon days of the late 1960s there were some unlikely heroes, who almost overnight seemed to rise into the stratosphere of celebrity (and cult) status.  One of these was Ronald Laing, a Scottish psychiatrist and psychoanalyst who had some ten years earlier written what must truly be one the seminal books on psychosis.

However, it was not The Divided Self that brought Laing first fame and then infamy.  Rather it was because he became one of the main spokespersons (albeit perhaps unwittingly) of a whole political movement: namely anti-psychiatry.  There is a lot that could be said about anti-psychiatry, including that it was politically naive (but then again there was a lot of that in the 1960s – and beyond).  Also, that it simply replaced one form of blame and determinism with another.  In other words, instead of holding genetics and/or upbringing responsible for most mental health problems, it was now the fault of society, and especially a capitalist, patriarchal society.

Thomas Szasz even went as far as to argue that mental illness was a myth, and that it should not be analysed in the way one might understand physical illnesses.  One of the problems with this argument is that there are some serious questions regarding the way we understand physical illnesses.  In many ways they are just as socially constructed as are mental illnesses (the anti-psychiatry argument).   Just to give a simple example: ideas of ‘health’ and ‘illness’ are historically and culturally determined (if I may use that word).  Yes, there is always the biological dimension, but there is also always the cultural dimension in deciding what constitutes ‘health’ or ‘illness’.

So rather than criticise the anti-psychiatrists for arguing that mental illness is a political and social construction, it is almost tempting to reply: so what – isn’t everything?   But to be fair, since the heyday of anti-psychiatry we have had forty years of social and cultural analysis, so what sounds a rather well-worn idea now, was very different then.  Furthermore, there are still many in psychiatry who still seem to hold onto the idea that, ultimately, in the last instance, at least some mental illnesses, such as schizophrenia and bi-polar disorder are biologically determined.  Most of these arguments are based on statistical analyses of identical twin studies, which have been subjected to years of critique, often by geneticists themselves.  Furthermore, these arguments seem to be ignoring the latest advances in genetics which suggest that the environment can actually alter our genes.

So there was, and still is, plenty to criticise psychiatry for.  However, as the anti-psychiatrists were quick to point out, psychiatry does not exist in a vacuum.  Psychiatry is as much part of the political and social apparatus as is education or the media.  And it’s also worth remembering it was psychiatrists themselves who started to question the clinical and philosophical assumptions upon which were based a whole raft of treatment and containment policies.  These arguments still rage until this day.  Many psychotherapists and psychoanalysts, including myself, entered this field precisely because we believed (and hopefully still believe) that there is a better way to engage with mental illness than medicating people up to their eyeballs and/or leaving them to struggle alone in the ‘community’.

But going back to Laing for a moment.  One of the key ideas he started to develop in The Divided Self was that we should listen to, and take seriously, what people with schizophrenia and other serious mental illnesses are telling us about their experiences, about the way they view the world.   Actually, this was not such a novel idea as it might have sounded to Anglo-American psychiatry in the late 1950s – it was very much in the tradition of continental European psychiatry in the late nineteenth and early twentieth centuries.

However, it was – and perhaps still is – a difficult idea for many people to swallow.  For example, if a woman tells you she is the Bride of Christ then surely she is not only crazy but what she is saying has no meaning?  But is this any more crazy or meaningless than Charles I telling his subjects, and reiterating at his trial, that he was answerable to no-one but God?  Of course, the simple answer to this is that Charles was saying this in a time when many people did still believe in the divine right of kings (although not enough, it seems, to save him).  So could we argue that our Bride of Christ is simply in the wrong place at the wrong time?  That in another era, in another culture, she would not only be taken seriously but venerated.

Maybe.  What this argument seems to imply is that for a person’s experiences to be taken seriously (and therefore, presumably, for them not to be mad) is that such experiences must chime, resonate, agree with, at least some sections of the wider society.  And in fact, most psychiatrists, if push came to shove, would agree with this.  However, the key point here is that the reason such experiences must coincide with at least some sections of the wider society is that if they don’t, then this can create all kinds of problems – both for the individual and other people.

So in fact the anti-psychiatrists were right when they argued that mental illness was, to large extent, socially constructed, and that the role of psychiatry was to ensure the mentally ill did not become a problem for society.  In other words, the experience, the thought processes, the beliefs of people with, say, schizophrenia, are, ultimately a social problem, not a biological or psychological one.  The biology – and, to a degree, the psychology, are only important insofar that such experiences, such thoughts and beliefs, can be moderated, suppressed enough, in order to stop the individual causing problems either for him or herself, or for others.

Of course, there is nothing new in what are, ultimately, social, and moral, judgements about other people’s experience and behaviour being dressed up in the language of medicine – and increasingly, psychology and psychotherapy.   Medicine, in the form of psychiatry, and clinical psychology give authority to what are essentially social and moral questions.  The fact that a particular form of experience or behaviour can be explained in terms of neuro-biology, cognitive processing, or upbringing explains very little – because all forms of experience and behaviour can likewise be explained.1.  Therefore in the end it comes down to deciding which particular manifestation of neuro-biology, cognitive processing, or upbringing is socially and morally acceptable.

This is not too suggest, however, that for some people, their thought processes, their experiences, are not a problem.  In fact, sometimes these experiences and thoughts can be unbearable.  And for some people, much of their life is taken up in trying to construct and sustain a structure of meaning which makes their life bearable, only to find it is in constant danger of collapsing.  However, to a certain extent the reason why such experiences and thoughts are so unbearable is precisely because they do not resonate with the experiences and thoughts of other people.  It is by no means as simple as that, but is perhaps something that could be taken into consideration the next time you bump into someone who tells you they are the Bride of Christ – or even Christ Himself.

In my view, the critical contribution that Laing made to discussions on mental illness is his idea that a person’s experience should be taken seriously, however strange it might seem to other people.  The problems begin, however, when such ideas are put into practice – and this is where anti-psychiatry perhaps took a wrong turn.  Validating another person’s experience is not the same as agreeing with it.  Unfortunately, being able to accept difference, which is all about validating but not necessarily agreeing with another person, is not something that comes easily in our society, in spite of all the rhetoric about diversity, multi-culturalism, etc.

  1. Or rather, in theory they could be: no-one seems too bothered about explaining apparently ‘normal’ behaviour []