Deconstructing Antipsychiatry: Introduction

If you’re reading this, you likely already have some idea what antipsychiatry is about. You may be currently under the care of a psychiatrist, or considering whether to take medications to help with some mental health difficulties, or you may have had a bad experience with the mental health system, or know someone else who has.

You may have read some persuasive antipsychiatry writings that introduce you to many troubling aspects of psychiatry. Perhaps you have a nagging feeling that, while you believe a lot of what you read, you’re not being told the entire truth. Or perhaps you’re here to defend antipsychiatry from another Big Pharma funded smear campaign trying to cover up the truth so as to ensure continued profits.

Most of all, you probably want to do the right thing to help yourself, a family member, or friend. You’ve probably got plenty of questions about what that right thing is, and not a lot of good answers.

You’re not going to find passionate cheerleading on behalf of psychiatry here. Psychiatry is far from perfect, and anyone who tells you otherwise is either delusional or trying to deliberately manipulate you. But the picture that antipsychiatrists paint goes to the other extreme.

To misappropriate the quote about democracy and government often attributed to Winston Churchill:

No one pretends that psychiatry is perfect or all-wise. Indeed, it has been said that psychiatry is the worst practice for dealing with significant mental health concerns except all those other forms that have been tried from time to time.

Those who have courageously shared their stories and experiences have helped bring to light issues that could have too easily remained hidden. I greatly support those who want to engage in serious discussions about psychiatry’s strengths and weaknesses, flaws and fixes, with the goal of making things better for people suffering from mental health issues.

But that isn’t what antipsychiatry is about. Antipsychiatry is a position that psychiatry is 100% flawed, has no redeeming features, is built on a stack of lies, necessarily does harm to all who encounter it, and must be abolished in its entirety. Moreover, the real proponents of antipsychiatry do not want to seriously engage in discussion with the broader community. They are not interested in critique, or divergent opinions, but only discouraging those seeking treatment, and attracting new followers to their movement.

To me, this all sounds a bit extreme. And while I’d seen some antipsychiatry Internet trolls with pretty extreme viewpoints, I was more surprised to see this from some fairly intelligent people, including a few journalists and university professors. That seemed odd to me, because someone saying “X is 100% flawed, false, and is of no benefit to anyone,” where “X” is any large, complex practice (e.g. capitalism, socialism, democracy, or as here, psychiatry) doesn’t seem the sort of thing intelligent people say, or at least not on a regular and consistent basis.

I was curious to know more. I’m sympathetic to people who may have criticisms of psychiatry, but this “all or nothing” stuff seemed way over the top. What was behind that? What were they really telling people? What kind of arguments were they trying to use to justify such an extreme perspective? And why?

Psychiatry and the Business of Madness

One of the people who’s published frequently in the area of antipsychiatry is Dr. Bonnie Burstow (BB), who has for the last 20+ years been working at the Ontario Institute for Studies in Education (OISE), part of the University of Toronto (UofT) in Canada; she’s currently an associate professor.

I first came across her work via a blog she writes for a left-wing website I frequent (rabble.ca). She’s written a number of substantial articles and books on antipsychiatry. As she’s in Canada, her work includes a good amount of material based on mental health in the Canadian system, which I’m more familiar with than the American one.

The impetus for starting this article came when I read about a new antipsychiatry scholarship at OISE. I was somewhat astonished that a generally respectable university was supporting an antipsychiatry scholarship. Again, it’s not the critique of psychiatry I find objectionable. Antipsychiatry appeared to me to reject critique of its own work, which seems out of place for a secular, Canadian university. To get a flavour of this, check out the comments, many by her students, to this article.

When I tried to ask more about aspects of her perspective, she suggested reading her recent book, whose full title is “Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting” (PBM). This certainly sounds like a quite serious academic title, and at 300 pages, quite weighty (no comment on the latter, as I bought the ebook).

Like many such tomes in the antipsychiatry genre, it goes into considerable detail, providing well-referenced evidence and logical arguments, all making the case that psychiatry is in its entirety a lie, conspiracy, threat, and must be replaced. Sounds like some good light reading.

I would add that while to me PBM appears to be a good representative of antipsychiatry writings, contains many arguments and references commonly seen in such writings, and covers a broader range of topics than most, it doesn’t have any special status within the community (it’s not a “Boss text,” as BB would say).

Who am I and Why am I doing this?

To start with, I’m not a psychiatrist, nor do I play one on the internet. Nor do I work for Big Psychiatry, Big Pharma, or Big Government, nor are any of them (or anyone else) paying me to do this. I have no special qualifications or insider status here (beyond, as will surely be pointed out, white male privilege).

My interest in psychiatry is twofold. First, I’ve had ongoing, mild-moderate problems with depression, and have been on psychiatric medications (via family doctors) for around 15 years. Second, my wife is a psychiatrist, and we’ve been together since she was in medical school, through her psychiatry residency, and about a dozen years of practicing in various clinical settings in Ontario, Alberta and BC. I’ve also helped her out with the administrative side of a couple of private practices she’s had, getting to know a lot of her patients, etc.

As a frequent internet user, I’ve read and commented on many things related to this interest in psychiatry and mental health. I’ve seen the good (and some bad) that psychiatry can do. I believe that antipsychiatrists denying mental illness exists, denying that psychiatry can in any way help, etc. and trying to scare people away from getting medical help for mental health problems is not only misdirected but incredibly dangerous.

I’m generally sympathetic to non-extreme activist movements, including those associated with environmental, human rights, and social justice causes. Yet, I think that social activists (or for that matter, practitioners of science) that eschew logic or evidence (from all perspectives) can be dangerous, crossing the line from activism to extremism.

Alice Dreger, a science historian writes eloquently about this in her book “Galileo’s Middle Finger: Heretics, Activists, and the Search for Justice in Science.” It chronicles the vicious repercussions that can come when confronting either a highly invested scientific establishment or an intransigent activist group (a cautionary tale as I write this article!). One quote:

Science and social justice require each other to be healthy, and both are critically important to human freedom… I have come to understand that the pursuit of evidence is probably the most pressing moral imperative of our time. All of our work as scholars, activists, and citizens of democracy depends on it.

So yes, I’m coming into this with a distinct bias and point of view, which I think is important for readers to recognize. BB also is very open in PBM about her antipsychiatry activism, and extensive work with people who have had extremely negative experiences with psychiatry. She doesn’t try to pretend she’s going into her investigations as a neutral observer.

I’ll also add that I’m not big on conspiracy theories. I generally assume that most people within the antipsychiatry movement are doing what they’re doing because they truly think it’s the right thing to do to help people (or prevent further hurt). If overt persuasion is being consciously used, it’s in their minds to serve that larger purpose.

My academic background is actually in computer science, which beyond some foundational material in logic and proofs doesn’t seem to give me a whole lot of credibility when it comes to writing about this topic. As noted, I’m no expert when it comes to psychiatry, psychology or neurosciences.

Only slightly more relevant is that my undergrad minor was in philosophy (ethics, epistemology, existentialism, etc.) and my work in grad school was in a field that had techies intermix quite a lot with sociologists and anthropologists working on ethnographic studies of work practices. These are areas where I’ve continued to read “for fun” (my Kindle library is a bit eclectic), and also happen to be some of the methodological and intellectual foundations used by PBM.

I’ve also written and reviewed enough academic papers to know the difference between a sound and convincing argument and someone trying to pull a fast one.

There have been a number of critical responses and refutations of many antipsychiatry works, including of PBM. Most take the form of relatively short blog posts or book reviews. To be honest, most practitioners are too busy to devote time to even reading 300 pages from what they perceive as a lunatic fringe.

I wasn’t aware of anyone that had more thoroughly deconstructed the arguments and fallacies used in a substantial work of modern antipsychiatry. And I also still didn’t fully appreciate why antipsychiatry was so completely uncompromising in its stance.

So why take this on? It sounded like something intellectually interesting to work on, that I hope may actually help people. I hope it highlights the difference between constructive critique and extremism. I hope it encourages some people to think about psychiatry from multiple perspectives. And I hope it dulls some of the scaremongering that discourages too many people from considering helpful treatments.

Topics to be Addressed

This article is not going to be a review of every argument used by antipsychiatry, or every argument in PBM. For one thing, this is an unpaid side project and I definitely don’t have the time for a more comprehensive review or critique.

For another, I don’t have enough knowledge and familiarity with certain practices in psychiatry to be able to intelligently comment on them. So I will try to restrict myself to topics that I feel confident to be able to address. This includes both arguments from PBM that I feel are flawed, but also deficiencies in psychiatry, many raised in PBM, that appear to me to need serious improvement.

I will, however, be addressing some of the key arguments used in PBM to claim that psychiatry is 100% flawed. So while this will be far from complete, I think it touches on some (but not all) of the major, overarching issues.

Moving forward in this article, I’ll start by enumerating many of the topics in PBM that I agree with (and a few others). I think the work that psychiatric survivors and other movements have done in terms of bringing critical flaws and abuses in psychiatry to light is incredibly valuable. It is also a viewpoint that I wish was better integrated into a more honest, open discussion with psychiatry practitioners. This appears to be a point of departure with antipsychiatry.

The next section will argue that despite its rigorous, academic appearance, PBM is written with the primary goal of persuading, and not informing the reader. The form, style and content of the writing is designed to remove any doubts from the minds of readers about its claims. The overpowering use of selective, one-sided references primes the reader so that they are more likely to believe the more error-prone and hyperbolic arguments. And attracting fervent believers is exactly what this book is trying to accomplish.

The next several sections tackle a number of the key arguments, used in PBM to discredit psychiatry in its entirety. These include arguments about mental illness having no basis in reality and being arbitrarily created, that psychotropic medications are necessarily harmful, and the exaggerated reductionism expressed as biological psychiatry. I will outline the arguments used, and explain the errors and misrepresentations inherent in them. I will also delve briefly into the practical concerns around involuntary commitment and treatment and how it does (or does not) affect people today.

I will then turn to the preliminary solution to the psychiatry problem that PBM proposes. A lack of alternative solutions has long been a criticism of antipsychiatry, so it is notable that PBM offers one. However, as we explore the proposal, we will see that while explicitly utopian in nature, it rests on problematic and highly unlikely foundations. We will understand better, however, the reasoning behind antipsychiatry’s “all or nothing” approach.

An Invitation to the Reader

Unlike those in the antipsychiatry community, I would explicitly welcome comments, suggestions, corrections and criticisms of this article. I see it now as being in a preliminary form, and expect to revise it over time with your feedback.

As I do hope to incorporate your ideas and suggestions into future versions, before sending any comments etc. to me, I’d ask you to please carefully read the information on commenting, so that we can agree on if and how you might be willing to share your thoughts with others.