Running head: ANTIPSYCHIATRY: EVOLUTION AND CONTEMPORARY INFLUENCE
Antipsychiatry: Evolution and Contemporary Influence
by
Brianna E. Cheyne
201104592
Presented to Dr. J. Edwards
in Psychology 300
History and Theory of Psychology
Department of Psychology
St. Francis Xavier University
November 13, 2013
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Psychiatry, or the study of mental suffering, is centrally involved in the complex
world of human reality (Bracken & Thomas, 2010). Its efforts lie at the interface of a
number of discourses, such as genetics, neuroscience, psychology, sociology, philosophy,
and anthropology. These areas of study provide society with lenses through which
different conceptions of mental disorder could be understood. At various times in the
history of psychiatry, particular manifestations of understanding have become dominant
and worked to marginalize the contributions of others. The antipsychiatry movement
thrived in the 1960s and 1970s by challenging the dominant view of mental disorder of
its time. It served as the product of a growing counterculture movement that helped to
question the scientific and ethical legitimacy of the psychiatric medical model. With the
backing of intellectual psychiatrists like Thomas Szasz and R.D. Laing, this initial phase
established antipsychiatry as a formal movement. Although the movement gained
momentum during this time period, it has endured as an ex-patient consumerist coalition.
It is evident that antipsychiatry is not simple a historical curiosity; rather it is a living
tradition that continues to fight for justice in the mental health system.
While the antipsychiatry movement is largely viewed as being a product of the
1960s and 1970s, its antecedents can be traced to the beginning of the twentieth-century
when psychiatry experienced divisions from the field of medicine (Rissmiller &
Rissmiller, 2006). During this time, psychiatry transformed from a relatively small,
unified, institutionally based specialty to a large bifurcated field (Dain, 1989). This field
consisted of its traditional element – the hospital practice that treated severe mental
disorders, or psychoses, and the private practice that treated a new, less severe set of
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disorders called “neuroses.” New psychotherapeutic techniques were developed to treat
neuroses, with the most popular being psychoanalysis.
The grounds for accepting psychiatry as a medical specialty had always been that
insanity was a natural disorder like any other (Dain, 1989). Disease was only said to be
present when the physical soma became involved. At most, a patient’s outward
expression of emotional disturbance was viewed as behavioural. The medical model of
the early 1900s clearly distanced itself from a discussion of the mind, psyche, or soul in
favour of observable, material causes. Psychoanalytic psychiatrists and neuropsychiatrists
struggled to balance their support of this physical etiology with an absence of evidence
for it in their practice (Dain, 1989).
Although psychoanalytic psychiatry’s focus on psychogenesis (psychological
causes) made the private practice fashionable, it also made it vulnerable to the challenges
put forward by the biological bases of medicine. Rather than including biological
intervention, it was centered on subjective non-somatic treatment that relied heavily on
talk therapy. In hospital settings, biological successes in discovering the causes or cures
of psychoses were often credited to medical science instead of psychiatry (Dain, 1989).
As a result, hospital psychiatry lacked conclusive research or reliable treatments for many
of the disorders that it dealt with. Patients were routinely admitted involuntarily to these
institutions, where they were encouraged to take high does of antipsychotic drugs and
underwent convulsive and psychosurgical procedures with limited value and negative
side effects (Rissmiller & Rissmiller, 2006).
Despite these discrepancies, psychiatry increased in status and prestige in the
years after World War II. Wartime experiences were thought to have shown that
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community and outpatient treatment of persons with mental and psychological disorders
was more effective than institutional care (Grob, 2010). Within the field of psychiatry
itself, there was increasing receptivity to the psychoanalytic approach and its focus on the
potential role of life experiences and socio-environmental conditions in the development
of mental disorders. Psychiatrists and other mental health professionals began to believe
that psychiatry could work in tandem with social and behavioural sciences to improve
these conditions. In this way, psychiatry expanded its professional sphere beyond the
traditional boundaries of diagnostic and therapeutic medicine and opened the field to
greater sources of criticism (Grob, 2010).
The late 1950s saw the emergence of a critical body of literature that analyzed the
field of psychiatry in sociological and anthropological terms. This literature sparked a
wide range of debate, including the questioning of traditional mental hospitals and the
belief that psychiatry had gone beyond its medical boundaries by exploring socioenvironmental issues. While the context and specific subject matter of these works
differed, they acted as a prelude to the formal antipsychiatry movement that appeared at
the beginning of the 1960s.
Antipsychiatry originated as a transnational movement consisting of individuals
from within the profession as well as scholars from other fields. Most influential among
the antipsychiatric views of mental disorder were those of Thomas Szasz and R.D. Laing.
While the theories that they propounded were disparate, they each questioned the
“medical model” of psychiatry and even the existence of mental illness itself. It was not
a coincidence that a powerful critique of mainstream medicine flourished at this time.
The middle to late 1960s were characterized by intense political and social activism, as
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previously accepted authorities and systems of belief were challenged (Rissmiller &
Rissmiller, 2006). Antipsychiatry evolved alongside a predominantly Western
counterculture that rebelled against several forms of political, sexual, and racial injustice
and inequality. The civil rights movement of the United States brought attention to the
seemingly arbitrary commitment of individuals with mental disorders to institutions and
the dubious treatment that they received. This interest in civil rights was accompanied by
a new claim that psychiatry served as an instrument of social control (Grob, 2010).
Prominent voices of the antipsychiatry movement were influenced by and attempted to
address these issues.
Arguably the most instrumental internal critic of psychiatry was Thomas Szasz of
the United States. Nineteenth-century liberalism and its assertion that individual liberty
was the highest virtue formed the basis of many of Szasz’s intellectual convictions. Szasz
was deeply critical of any actions of the government, noble or not, that served to limit
individual liberty. He expressed the view that psychiatry was a specific tool implemented
by the state to inhibit individuals’ liberty, stating that it rejected values such as “personal
autonomy, liberty, and responsibility” (Grob, 2010). In other words, the state perceived
psychiatry as a means for excluding nonconformists and dissidents from society. This
provided sufficient reasoning for enforcing psychiatry’s use coercion. Citing the principle
of “separation of church and state,” Szasz argued for a similarly clear division between
psychiatry and state (Rissmiller & Rissmiller, 2006).
In his pivotal paper and book by the same name, The Myth of Mental Illness,
Szasz contended that mental disorder existed outside of the boundaries of what could be
legitimately considered an illness. He described diseases as being pathological and
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maintained that difficulties with our thoughts, feelings, behaviour, and relationships were
simply “problems of living.” In his view, medicine was only scientific if it dealt strictly
with the workings of the body. The standard scientific measure that he supported, or his
“gold standard” of disease was “bodily lesion identifiable by anatomical, physiological,
or other physico-chemical observation or measure” (Bracken & Thomas, 2010).
Throughout the 20th century, schizophrenia was the object of substantial research
initiatives, enabling it to serve as a convenient reference point for criticism of the
conventional view of mental illness. Szasz claimed that schizophrenia was incorrectly
classified as a disease because it demonstrated no discernible brain lesion (Bracken &
Thomas, 2010). Overall, Szasz believed that there was little reliability or validity to the
classification of “problems of living” as mental illnesses and that subjective forms of
human and social sciences were ineffective in the treatment of legitimate illnesses (Grob,
2010). To Szasz, the term mental illness amounted to a form of social labeling that only
served to secure power for organized psychiatry and the state . He suggested that
“autonomous psychotherapy” was the only sound response to states of distress and
madness (Bracken & Thomas, 2010). This would involve individuals voluntarily seeking
therapy from members of society that they saw adequate to help them. Szasz believed
that psychotherapy was a non-medical process that could be performed by anyone and
should never be provided by the state (Bracken & Thomas, 2010).
R.D. Laing, a citizen of Great Britain, offered an additional critique of
antipsychiatry. While Szasz’s main objective was to testify that, “mental illness” was a
myth and that the medical model could not effectively alleviate so-called psychiatric
problems, Laing challenged common ways of understanding psychotic experience. Laing
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joined the forces of many authors of the 1950s and 1960s that attempted to identify the
social origins of behaviour. He held that mental illness had social causality, stating that
insanity was a label that resulted from an individual’s refusal to adapt to social and
cultural norms. Laing participated in existential philosophy in order to, “locate patients
within their intersecting personal and social worlds” (Halliwell, 2013). In The Divided
Self: An Existential Study in Sanity and Madness, Laing stated that it was misguided to
view a patient with psychosis as showing signs of a disease; instead it was more accurate
to view this behaviour as being expressive of the individual’s existence. Rather than
being indicative of an illness, the paranoid delusions associated with schizophrenia were
a justifiable response to an “inescapable and persecutory social order” (Rissmiller &
Rissmiller, 2006).
Laing articulated that the concept of insanity did not have biological roots; it was
based on a statistical statement of normality (Grob, 2010). According to Laing, defining
insanity in such terms originated from a failure to question or to criticize dominant
societal and cultural values. Since insanity was not a disease, but an existential struggle
for personal freedom, it could be treated through social remediation. Laing actively
practiced such remediation by establishing over 20 therapeutic communities throughout
England. Each community was intended to be an asylum in the original Greek sense of
the word: a refuge from unwanted or unwarranted interference (Rissmiller & Rissmiller,
2006). Staff and patients were equal in status, medication used was voluntary, and it was
accepted that people could come and go as they pleased.
By the 1980s, organized psychiatry had addressed a number of the key grievances
of the antipsychiatry movement. Consequently, antipsychiatry diminished in its sway as
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an organization (Rissmiller & Rissmiller, 2006). Involuntary commitment to state
institutions decreased dramatically, high dosage and overreliance on antipsychotic drugs
was reduced, and electroconvulsive therapy and psychosurgery became last resort
treatments. Antipsychiatry’s criticisms and attacks on the specialty of psychiatry
encouraged biological psychiatrists to strengthen their research in order to move in line
with mainstream medical practice. Ironically the, the medical model that many critics of
psychiatry disagreed with was what aided the reform that they had strived for; new
pharmaceutical agents managed patients’ symptoms to the extent that they could be
safely released into the community (Dain, 1989). The discovery of neurotransmitters and
the study of twin registries demonstrated that biology played a role in the appearance
schizophrenia (Grob, 2010). Overall, empirical research began to support a
biopsychosocial model of psychiatry, changing psychiatry from a bifurcated field to a
united front once more.
Perhaps most damaging to the antipsychiatry movement was its loss of broadbased counterculture support. The political landscape of the Western world transformed
from being radically leftist to representing a prevalence of conservative sentiments
(Rissmiller & Rissmiller, 2006). Antipsychiatry could no longer retain the backing of
other student, feminist, black, and gay coalitions. The utopian, antiestablishment ideal of
many counterculture movements became increasingly irrelevant in the political arena.
The rising mental health consumerist movement provided a new platform for the
antipsychiatry coalition to be heard amongst changing social and political attitudes. The
consumerist movement appealed to conservative politics because of its reliance on
political alliances opposed to confrontation. The idea that patients might be able to help
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other patients posed the possibility of reducing costs of mental health treatment
(Rissmiller & Rissmiller, 2006).
The 1980s saw the antipsychiatry movement change hands from psychiatrists and
scholars to those of prior patients. Ex-patients were viewed as most capable to carry the
antipsychiatry message because they had actually experienced pharmacological
treatment, coercive hospitalizations, and authoritarian psychiatric practices. These
individuals believed that it was unnecessary to give leadership to intellectuals that had
not reached out to them during the formal antipsychiatry movement. In this new era, the
founders of antipsychiatry became “bystanders to the movement that they had begun”
(Rissmiller & Rissmiller, 2006). Ex-patients began to create their own organizations in
which they could express their feelings of pain and abuse, deny the appropriateness and
effectiveness of the therapies offered to them, proclaim that they could pass judgment on
their own treatment as well as establish their own alternative programs to hospitals and
mental health facilities (Dain, 1989).
These new organizations sought to foster a new generation of consumerism in
which clients were inclined to be active, informed participants in the mental health
system. While ex-patients and consumerists were of diverse backgrounds, they shared a
common ideology that societal change was the only solution to the improving the
circumstances of those deemed mentally ill (Dain, 1989). In particular, the consumerist
movement regarded accountability of psychiatrists and other mental health providers as
being central to this reform. The consumerist movement began as a series of small,
disconnected entities like the Insane Liberation Front and the Network Against
psychiatric Assault that came to fruition in the United States (Rissmiller & Rissmiller,
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2006). These groups functioned fairly independently because they were only able to meet
through annually held national conferences. The appearance of a growing Internet
community in the 1990s saw antipsychiatry websites that linked antipsychiatry
movements in over 30 countries.
The consumerist movement in the past and present has shown concern for many
issues undertaken by the antipsychiatry movement of the 1960s and 1970s. The medical
model of mental health continues to fall under scrutiny, as the consumerist movement
argues that it marginalizes and oppresses consumers that do not accept psychiatry’s
diagnostic labels or do not respond in the desired way to an accepted medicalized
treatment of their distress (Hopton, 2006). Consumerists encourage advocacy and selfdeterminism among patients in order to combat this issue.
Biologically based treatments are still questioned on the basis of safety and
effectiveness. Heavy reliance on chemicals and medical “experimentation” on mental
patients is seriously opposed. The nature of modern research has been criticized for what
consumerists view as an overemphasis on the value of randomized controlled trials as the
most reliable form of evidence (Hopton, 2006). This stands in sharp contrast with the
early antipsychiatry movement that provided very limited evidence to support its
therapeutic interventions. The current consumerist movement argues that mental health
professionals should consider a wider picture than that provided by random controlled
trials. This issue may have existed in the evaluation of selective serotonin reuptake
inhibitor antidepressant drugs. There is evidence that possible problems of dependence
and withdrawal were overlooked due to the focus on specific clinical trials for the
effectiveness of these drugs. As pharmaceutical research has grown, there have also been
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apprehensions about the role of manufacturers in the generation of the available
information about psychiatric drugs (Hopton, 2006).
The consumerist movement has been criticized for having internal conflicts of its
own. One significant point of criticism has been that of voluntarism, which is at the heart
of antipsychiatry and consumerist philosophy. Some activists condemn psychiatry under
any conditions, voluntary or involuntary, while others believe that it is the right of the
people to choose to undergo psychiatric treatment (Dain, 1989). A heavy concentration
on alternative, voluntary, treatment centres is perceived by consumerists as a means to
give patients the ability to control their lives. Critics have brought attention to the large
masses of people like the criminally insane, terminally ill, and the elderly who may need
assistance in finding psychiatric help.
The consumerist movement has also been criticized for focusing too heavily on
the wrongdoings of specific psychiatrists while downplaying the surge of mental health
services like nursing homes and community mental health centres that are run by
nonpsychiatric professionals. Critics contend that this new system has generated its own
problems and abuses that should be taken into account. To many activists, the existence
of psychiatry has legitimized the existence of mental illness. Many critics believe that
even if this were true, it would not follow that if there were no psychiatrists that there
would be no such disorder (Dain, 1989). Although psychiatrists of the past could be
conveyed as authoritative, unapologetic, and obstinate, the profession always included a
minority of members that did not display these tendencies and actively criticized their
own field. Consumerists have been urged to increase their collaboration with such
psychiatrists who can help to implement their reforms.
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Throughout history there have been dramatic changes to the mental health system,
including changes to nomenclature, to those in charge of giving care, and to the body of
available research. Still, people continue to suffer from behavioural, emotional, and
cognitive disorders. The key issue has and always will be the perplexing phenomenon of
mental disorder, as it remains imperfectly understood, interwoven throughout public
policy and public opinions, and is inconsistently responsive to known therapies. This
conclusion is evident in many years of progression and regression, optimism and
pessimism, and reform and reaction throughout the world. Antipsychiatry, with its new
embodiment in the consumerist movement, continues to have a role in stimulating
debates and discussion about this phenomenon and how society approaches it. The
existence of the consumer movement is vital to providing patients with an independent
voice that shares their perspectives and plights. This voice needs to be accessible in
professional and academic research and publications. As our understanding of mental
disorder evolves alongside changing political, economic, and social forces, it is important
that the consumer coalition poses similar questions to those of the original antipsychiatry
movement in the 1960s and 1970s. Issues of the origins and management of mental
distress, the validity of involuntary treatment, and other potential forms of oppression still
hold relevancy today. The goal of an integrated forum of reform has become realizable
through growing discussion of these issues between psychiatrists and consumerists. It is
clear that the antipsychiatry movement is here to stay.
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References
Bracken, K. Thomas, P. (2010). From Szasz to Foucault: on the role of critical
psychiatry. Philosophy, Psychiatry, & Psychology, 8(3), 219-228.
Dain, N. (1989). Critics and dissenters: Reflections on 'anti-psychiatry' in the United
States. Journal Of The History Of The Behavioral Sciences, 25, 3-25.
doi:10.1002/1520-6696(198901)25:1<3::AID-JHBS2300250102>3.0.CO;2-G
Grob, G.N. (2011). The attack of psychiatric legitimacy in the 1960s: rhetoric and reality.
Journal of the History of Behavioural Sciences, 47, 398-416.
doi:10.1002/jhbs.20518
Halliwell, M. (2013). Therapeutic revolutions: medicine, psychiatry, and american
culture, 1945-1970. New Brunswick, NJ: Rutgers University Press.
Hopton, J. (2006). The future of critical psychiatry. Critical Social Policy, 26, 57-73.
doi:10.1177/0261018306059776
Rissmiller, D.J., Rissmiller, J.H. (2006). The evolution of the antipsychiatry movement
into mental health consumerism. Psychiatric Services, 57(6), 863-866.