Antipsychiatry movement

Antipsychiatry movement
   Early in the 1960s, as part of the general intellectual tumult of the time, a protest movement arose against psychiatry. Members of the movement were by no means all in agreement about doctrine; some argued that there was no such thing as psychiatric illness, others that adverse sociocultural conditions exposed members of marginalized groups to political repression conducted under the guise of medical diagnosis, still others that treating mental patients against their will was unethical, and that electroconvulsive therapy was brain-destroying rather than therapeutic. This grab bag of diverse claims and objectives came together under the banner "antipsychiatry." The movement crystallized around a number of prominent intellectual spokespersons.
   Thomas Szasz (pronounced SASS) (1920–). The credit for launching antipsychiatry among a mass audience goes to Szasz. Born in Budapest, Hungary, the son of a businessman, he emigrated to the United States at 18 years of age and in 1944 graduated in medicine from the University of Cincinnati. He trained in psychiatry in that city, then a hotbed of psychoanalytic thinking, and at the University of Chicago where a similar clime prevailed. From 1947 to 1950, Szasz studied at the Chicago Institute for Psychoanalysis, then went on staff there until serving 2 years of active duty in the U.S. Navy. In 1956, Szasz moved to the Veterans Administration hospital in Syracuse, where he remained as professor of psychiatry at the State University of New York Upstate Medical Center. While in the Navy, Szasz said, he had reflected about "what had long been on my mind," which turned out not to be psychoanalysis (although he already had a long publication record in the area of psychosomatic illness), but a dramatically libertarian conception of patients’ rights and a conviction of the uselessness of psychiatry as a discipline. For Szasz, there was really no such thing as psychiatric illness apart from organic brain disease; there were only "problems of living." This attack, first in a 1960 article on "The Myth of Mental Illness" published in the American Psychologist, then in a 1961 book of the same title, disputed the legitimacy of psychiatry’s claim to be a discipline. " ‘Mental illness’ is a metaphor," he said. "Strictly speaking, disease or illness can affect only the body; hence, there can be no mental illness." Moreover, "Psychiatric diagnoses are stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends others" (p. 267 of revised ed.).
   In 1969, Szasz became cofounder of the Citizens Commission on Human Rights of the Church of Scientology. As the steam started to go out of the antipsychiatry movement itself, a good deal of the popular agitation against psychiatry in the 1970s and after was funded by Scientology.
   Erving M. Goffman (1922–1982). It is ironic that the antipsychiatry movement should have received its launching shove among intellectuals from Goffman, one of the most luminious sociologists of the twentieth century whose research specialty was everyday behavior, what Goffman called "micro-sociology." Goffman tossed off his classic book Asylums almost as a second thought; certainly the book had less impact on sociology and anthropology than his other writings on such subjects as "the presentation of self in everyday life" (1959)—meaning day-in and -out behavior almost as a performance, stigma (1963), and social interaction (a series of works from 1963). The story: Born of a shopkeeper’s family in a small town in Alberta, Canada, Goffman received his Ph.D. from the University of Chicago in 1953, where he first heard the term "total institution" from sociologist Everett Hughes (1897–1983). Between 1954 and 1957, Goffman was the holder of a visiting scientist award at the National Institute of Mental Health in Bethesda, Maryland, and in 1955–1956 he did a year’s field work, masquerading as an assistant to the athletics director, at St. Elizabeths Hospital, affiliated with the Public Health Service and having then more than 7000 beds. The book Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (1961) emerged from that experience (as did a 1959 article on "The Moral Career of the Mental Patient" published in Psychiatry). Goffman’s argument was that mental hospitals exercised an ominous kind of control over patients because they functioned as "total institutions." "Their encompassing or total character is symbolized by the barrier to social intercourse with the outside and to departure that is often built right into the physical plant, such as locked doors, high walls, barbed wire, cliffs, water, forests, or moors" (p. 4). The new recruit to such an establishment "begins a series of abasements, degradations, humiliations, and profanations of self" (p. 14).
   That St. Elizabeths functioned as such an institution there could be no doubt in Goffman’s mind: "Like the neophyte in many of these total institutions, the new inpatient finds himself cleanly stripped of many of his accustomed affirmations, satisfactions, and defenses, and is subject to a rather full set of mortifying experiences: restriction of free movement, communal living, diffuse authority of a whole echelon of people, and so on" (p. 148). The book was highly influential in the subsequent unfolding of the antipsychiatry movement, and Franco Basaglia and Ronald Laing (see below for both), for example, often referred to it. Goffman thus counts as the intellectual godfather of antipsychiatry. He went on to become professor of sociology at the University of California at Berkeley, and from 1968 until his death from cancer he was Benjamin Franklin Professor of Anthropology and Sociology at the University of Pennsylvania.
   Michel Foucault (1926–1984). Born in Poitiers, France, into a surgeon’s family, Foucault became an influential practitioner of theory-based history and an important philosopher. In 1946, he was admitted to the prestigious École Normale Supérièure in Paris, an elite training school outside the university system, and in 1952 he received a graduate degree in psychopathology. He taught abroad for the remainder of the 1950s, returning to France as the head of the philosophy department at Clermond- Ferrand university. Among his many interests was the history of psychiatry, and in 1961 he published Folie et déraison (Madness and Unreason), which in 1964 came out in an abridged paperback edition under the title Histoire de la Folie à l’âge classique. It was that abridged edition that was translated into English in 1965 as Madness and Civilisation: A History of Insanity in the Age of Reason. The book rocketed into prominence in 1967 with an enthusiastic review by Ronald Laing (see below) published in the New Statesman. Thereupon, Foucault became the name to conjure with in the antipsychiatry movement.
   Foucault’s idea was that the discipline of psychiatry served as an agency of social control, imposing order upon those who did not fall in line behind the capitalist factory system. The function of the hospices and workhouses during the "grand con- finement" of the seventeenth century was clear: "It was no longer merely a question of confining those out of work, but of giving work [in the hospices] to those who had been confined and thus making them contribute to the prosperity of all. The alternation is clear: cheap manpower in the periods of full employment and high salaries; and in periods of unemployment, reabsorption of the idle and social protection against agitation and uprisings" (p. 51). There was also the role of the asylum in the imposition of industrial work discipline: "In the classical age [seventeenth century], for the first time, madness was perceived through a condemnation of idleness. . . . This [industrial] community acquired an ethical power of segregation, which permitted it to eject, as into another world, all forms of social uselessness. It was in this other world, boxed in by the sacred powers of labor, that madness would assume the status we now attribute to it" (p. 57). These ideas exercised great influence upon the intellectual class in the late 1960s and 1970s and became the bowsprit of the antipsychiatry movement.
   In 1968, the year of revolution in Paris, Foucault returned from Tunisia, where he had been living with a lover, to Paris to become head of the philosophy department of the University of Paris at the Vincennes campus. In 1970, he was elected to the Collège de France, and in 1984 he died of AIDS, one of the first prominent intellectuals to be thus stricken.
   Franco Basaglia (1924–1980). Born in Venice, Basaglia served for 12 years as an assistant at the university psychiatric clinic in Padua before becoming superintendent in 1961 of the asylum in Gorizia (Görlitz) at Italy’s eastern border with Yugoslavia. He was already much inclined against institutional psychiatry from the work of Erving Goffman on "total institutions" (see above) and resolved to implement in Gorizia the kind of therapeutic community he had learned of in visiting Maxwell Jones in England. (See Psychotherapy: therapeutic community [from 1939].)
   Basaglia believed in the reality of psychiatric illness but thought it should be treated in the community rather than in isolated mental hospitals that functioned as prisons. In Gorizia, Basaglia implemented a system of humane care, an open-door policy, and implemented the discharge of many patients into the community. Yet, these measures seemed halfhearted to many of the radical young men and women who were streaming to Gorizia from all over Italy, some being admitted as patients.
   Thus, Basaglia left Gorizia in 1968; from this period resulted his book Refusing the Institution (L’istituzione negata; 1968).
   After a sojourn in Parma, in 1971 Basaglia became director of the psychiatric hospital in Trieste. Now he directed his efforts to the actual abolition of the institution, and by 1978 he was able to announce its closing, except for 300 "guests" still remaining on the premises for whom no community placement could be found. Thereupon, Basaglia left Trieste for Rome to implement in the capital region a national law abolishing psychiatric hospitals that was passed in 1978, the so-called law 180. (The law mandated community treatment and the end of compulsory admissions to any institution save a general hospital.) In the meantime, the Italian antipsychiatry movement hooked up with the political Left to form a large political party, "Democratic Psychiatry" (Psichiatria Democratica) that explained diagnosis and confinement of psychiatric patients in terms of the Marxist theory of class. For his efforts, Basaglia became a virtual idol of antipsychiatric forces across Europe. His writings were collected by his widow, Franca Ongaro Basaglia, and were made available in a two-volume Scritti (Writings); volume one treating the period 1953 to 1968 ("from phenomenological psychiatry to the time of Gorizia" ["Dalla psichiatria fenomenologica all’esperienza di Gorizia"]), and volume two treating the period 1968 to 1980 ("from the opening up of the asylum to the new law on psychiatric care" ["Dall’apertura del manicomio alla nuova legge sull’assistenza psichiatrica"]), with both volumes published in 1981. His biographer, Anzel Finzen, in a 1980 obituary published in Psychiatrische Praxis, believes that it is unfair to refer to Basaglia as "the father of antipsychiatry," because he was not really antipsychiatric; he merely sought to overthrow the imbalance of political power that left patients defenseless in the face of arbitrary and autocratic institutional force (Basaglia: "Science is always at the service of the ruling class").
   Ronald D. Laing (1927–1989). Raised in Glasgow, Laing graduated with an M.D. from Glasgow University in 1951, training as a psychiatrist in the army and at Glasgow; from 1956 to 1960, he prepared as a psychoanalyst at the Tavistock Clinic in London, then came on staff at the Tavistock Institute of Human Relations. Between 1962 and 1967, he was director of the Langham Clinic. In 1964, he founded the Philadelphia Association, a network of group homes for schizophrenic patients in the community, its most celebrated being Kingsley Hall in the East End of London. Although he was the most prominent of English intellectuals in the antipsychiatry movement, he himself disclaimed the term. In a series of books that began with The Divided Self in 1960, Laing articulated the view that schizophrenia was not a disease in the classic sense, having no anatomical or biochemical lesion, but rather a reaction to a hopeless situation, such as in family life. The young man or woman chooses the symptoms as an exit from this intolerable pain. (One of the conflictual families described in the book was his own.) Laing became an icon of the New Left with his Marxist-style theory that the ego of the schizophrenic patient disintegrates as a result of revolution against the exploitative forces of the superego. In The Politics of Experience (1967), Laing called schizophrenia "a label that some people pin on other people under certain social circumstances. The ‘cause’ of ‘schizophrenia’ is to be found by the examination . . . of the whole social context in which the psychiatric ceremonial is being conducted" (p. 103). As Alec Jenner, a biochemically oriented psychiatrist, said later, "I knew Ronnie Lang very well. . . . He wasn’t totally antipsychiatry in what he said when he was talking to me. . . . The truth is that the medical world had almost no time for him. The arts faculty and the literary world were enamoured by him and the revolutionary attitude of students—the don’t-change-your-mind-there’s-a-fault-in-reality type of philosophy" (Healy, III, Psychopharmacologists, p. 154).
   David G. Cooper (1931–1986). Psychiatrist David Cooper revived the term "antipsychiatry"—first used in Germany at the turn of the century—in his 1967 book Psychiatry and Anti-psychiatry. Born in Cape Town, South Africa, into a pharmacist’s family, he graduated in medicine there in 1955, then gained a diploma in psychological medicine in England in 1960. After the end of his training, he served at a number of English mental hospitals, then, inspired by the experiences of Tavistock psychiatrists during the Second World War with therapeutic communities, from 1962 to 1966 at Shenley Hospital in Hertfordshire he administered "Villa 21," a therapeutic community housed in a converted insulin-coma unit mainly for schizophrenic young males, where power roles were inverted and the patients became the equals of the doctors and nurses in a complete leveling of hierarchical relationships. As this experiment was winding down—the result of the collective exhaustion of the medical staff—in 1965 Cooper joined Ronald Laing’s Philadelphia Association at its hostel, Kingsley Hall. The experiment was short-lived. In general, Cooper believed that the symptoms of schizophrenia were metaphorical representations of social relationships rather than symptoms of illness. Psychiatrists themselves, he said in his 1976 book, The Grammar of Living, were merely "a small part in an extensive system of violence." He saw the family in particular as a seedbed of failed communication and wrote in his 1970 book, The Death of the Family, that "the family must be abolished to enable people to love each other." In response to the antipsychiatry movement, at least in the United States, Canada, and the United Kingdom, the power of psychiatrists to commit people to hospital and to treat them under compulsion has been restricted by legislation. In many jurisdictions, independent boards or tribunals have been established to protect the civil rights of detained patients. Whether this restriction represents a plus or a minus for those with serious psychiatric illness remains a matter of debate.

Edward Shorter. 2014.

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