In this session on the anti-psychiatry movement we explored the systems and enterprises that create “mental disorders”, “illnesses”, and “diseases” and for what purposes; as well as how the ingrained societal stigma around “mental diseases” influences our thoughts and behaviors — but most of all, how sick these systems and enterprises themselves actually are.
The facilitator wanted to organize this session because they themselves have had shit experiences with psychiatry. Psychiatry marginalizes (mental) difference and pathologizes (deviating) affect, this leads to people not being able to live their life fully and autonomously.
What follows are the (detailed) notes on the topics we discussed during the session. At the end of the page you can find a list of the ‘resources’ that were brought up during the session, as well as additional reflections by a member of the collective.
Pathology is the study of mental disease as disease: mental differences and/or states that are seen as problematic are considered diseases (i.e., mental states that deviate from the norm; the norm being those mental states in which you, as a person, have the ability to function in neoliberal capitalism), such mental states are pathologized, and hence problematized, as problems to be ‘solved’ by psychiatry.¹
Modern psychiatry is based on the biological model, meaning that mental differences are seen and/or are based on chemical differences/imbalances (e.g., serotonin or dopamine levels in the brain); the problem is that this ‘approach’ to mental health individualizes the issues, reduces it to individualized biological ‘problems’ that do not take social causes into consideration (e.g., stress caused by workload or living in poverty, both caused by the capitalist enterprise). So the biological model does not get to the actual or the very real problem that we are facing, that is, the social problems.
Modern psychiatry emerged with the industrial revolution, it was during this period in time that (work-related) depression and stress started to present itself in the population. The aim was, among other things, to ‘treat’ the people who were plagued with such mental illnesses so that they could continue their work in the factories.
Modern psychiatry is based on neoliberalism, more so tailored towards social control, and was an attempt to make psychology/psychiatry into an objective, measurable science.
As one of the participants expressed, the biological approach also medicalizes mental health issues. For example, they were prescribed with anti-depressants, heavy medication with a lot of adverse side-effects, their experiences were not so great. These anti-depressants did not actually help with their depression. However, boxing, exercise and relaxation did actually help, as well as embracing eastern philosophy — a worldview not recognized or sanctioned by modern psychiatry (until recently).
Eastern ways of thinking were not recognized or sanctioned (until recently) because it did not align with modern psychiatry’s objectives. Everything that was not from western cultures was therefore neglected, in favor of this western idea of mental difference: mental differences being treatable with medicine (i.e., mental differences being those that deviate from the norm); every affect that did not align or adhere to the ‘happy’ capitalist mode of production was labelled as depression, without taking normal (fluctuating) affect into consideration.
Everything that is or was an issue is being diagnosed, according to another participant, ‘not normal’ behavior gets diagnosed and problematized, especially in educational environments. You are expected to just sit still and do your work. If you do not want to be quiet, obey or sit still you must have a diagnoseable problem. This illustrates how psychiatry is rather a science of social control.
However, someone else stated that they had positive experiences with mental health professionals. They had a therapist who was aware of these issues. The therapist only used the ‘diagnosis’ or ‘label’ to get insurance money; the therapist stated that it is all basically an insurance scheme, people are naturally complicated, we cannot put a simple ‘diagnosis’ or ‘label’ on complex human behavior.
The DSM is used worldwide by psychiatrists, psychologists, doctors, and therapists to diagnose and label ‘patients’ or ‘clients’ (DSM stands for the ‘Diagnostic and Statistical Manual of Mental Disorders’); the DSM, however, is rooted in transphobia, homophobia and racism (for example, until the publication of the DSM-II in 1974, ‘homosexuality’ was labelled as a sexually deviant disorder, as a mental disease); even today, in order for trans people to get (institutional) gender care and/or hormone treatment, they need to be ‘diagnosed’ with gender dysphoria, this requirement impedes (gender) self-determination.
A lot of this institutionalized gender care is structured in cis-gendered ways (the ruling norm), based on one homogenous idea, story or narrative on what it means to be trans, one has to constantly prove they are trans by supporting this established narrative (e.g., the narrative that from early childhood your ‘gendered’ sense of self did not line up with the ‘sex’ you were assigned at birth and that the environment you grew up in did not support your ‘gendered’ self); basically, as a trans person, you are forced to make up stories and pathologize your childhood and your own sense of self in order to get (institutionalized) gender care. Psychiatry is essentially gatekeeping gender care.
When it comes to ethnicity or cultural differences, especially black children are often (mis-)diagnosed with anger disorders; this results from different cultural ways of expressing affect and/or emotions that do not follow the dominant white and/or western ways of expressing affect and emotions. At one point in time ‘not wanting to be a slave’ was even considered a “mental condition”.
This all goes to show that psychiatry is enforcing social structures.
Schizophrenia, in the West, is negatively framed, someone with schizophrenia is considered scary and crazy, as someone who is to be feared, avoided and, ultimately, (socially) ostracized. In spiritual and/or shamanistic cultures, on the other hand, ‘schizophrenia’ is more positively framed. People with ‘schizophrenic’ symptoms are considered to have a deeper connection to other (spiritual) worlds, they are considered wise and perceptive. The images they see when they ‘hallucinate’ (for lack of a better word) are also totally different. In the West, hallucinations are often negative, laden with heavy negative affect and images (e.g., Christian demons/Cops coming to get you), while in spiritual and/or shamanistic cultures such hallucinations are non-existent, serene and positive even. This suggests that the way a culture views ’schizophrenia’, whether a culture stigmatizes it or not, affects those who experience ‘hallucinations’.²
In general, stigmatizing is a huge issue. Stigmatizing often leads to self-stigmatizing, where you no longer trust yourself, your own perceptions, thoughts, and feelings. It is this self-stigmatizing that, in a sense, makes you more ‘ill’ than you already are. It is a vicious cycle, a system, a way of thinking that is (almost) impossible to get out of. You are perpetually alienating yourself: you are the one who is doing the alienating and are being alienated. It is a very isolating experience.
On that note, stigmatizing also causes isolation. If you are diagnosed with Borderline, for example, it is often the case that people do not want to ‘deal’ with you, whether this be friends, family, love interests, or even therapists. This stigmatization leaves you out of the (social) loop, which is incredibly difficult to deal with. Being invalidated makes this even worse. Basically that you, your experiences, feelings and behaviors are being reduced to your “Borderline” label. Strong affects/moods are fun, to be enjoyed and seen as a part of a (livelier) life — these affects are experiences, not an illness.
Labels can be incredibly helpful to get together and create a community. However, such labels are also a cause of many of the issues we have discussed thus far — this is, unfortunately, also the case when it comes to creating a community. Self-stigmatizing and self-labelling can also cause people to wallow (in self-pity). They either treat themselves as victims or tend to ‘problematize’ their entire being. This in itself can already be an incredibly isolating experience, blocking any kind of meaningful connection with others. Even more so if you are a person in such a community who rather wants to celebrate their neuro difference than to wallow (in self-pity) together with those who share the same label.
Labelling has pros and cons. What is crucial to remember though, is that you do not forget that you are a person, that you make a distinction between you and the ‘disease’; that there is basically distance between you and the ‘disease’, that you are someone who is not the ‘disease’.³
Other people (easily) label you, they try to fit you into a box, reduce you to your label. Labels can create community. Yet such labelling can also be individualizing, it is isolating: instead of looking for sameness among those with the label, they treat you as an individual suffering from the ‘disease’, this ultimately blocks community building.
There should be a more sustainable, healthy and destigmatizing way to relate to labels. The facilitator voiced their frustration with people treating them as a label: “… ask me what my needs are…” instead of assuming what these needs are based on a certain label.
One of the participants suggested that a more healthy way of living (or dealing with the label) could (already) be the consciousness of feeling and/or an awareness of what you are feeling and what your needs are; that you move from the brain to the body, from the biological model to your own feelings, sensations and needs, that is.
Another participant shared how, in their experiences, labels are often unhelpful when it comes to getting the ‘right’ or ‘actual’ treatment. The more specific the label the longer you have to wait, nowadays there are long waiting lists for people with specific “diseases” and/or needs, they have to wait months to get institutional help; after waiting for months, the ‘mental health professionals’ started with administering standardized tests and treatment, they do not look at your own specific needs and/or you as a person; if you voice that you are actually uncomfortable with the treatment or approach these ‘professionals’ basically tell you that “you do not put in the work”, in other words, you get silenced; you are the “problem” and they exert their authority by telling you that “we want the best for you”, that “you are sick” and “you do not actually know what is best for you”.
This silencing, or loss of agency, resonated with another participant who shared that when you have ‘autism’ your label tells you that “you do not have agency”, you basically lose your agency; every misstep you make could be used against you, to basically remove your agency even more; knowing (and having experienced) this makes you extra careful not to mess up, you internalize it and that makes life (even) more difficult than it already is.
Everyone that does not ‘fit in’ is removed from society, no effort is made to integrate them into society; or they must go to special places, such as segregated schools for ‘special needs’. It is also in this sense that psychiatric hospitals are prisons; they should be places for activity, yet the prescribed and forced medication is a ‘fast solution’ that makes you inactive.ª
According to one of the participants, about 70% of the medication works for unknown reasons, that is, ‘professionals’ do not know why they are actually working, they especially do not know why certain medication is not working (when it should). In most psychiatric contexts, finding the ‘right’ medication often involves a process of trial and error, it seems to work 70% of the time, but it really depends…
This also raised several questions: What is the objective of medication? To reduce suffering? What are they ‘solving’? What are these ‘diseases’? Are they chemical issues in the brain? Are they the effects of environmental influences? Or are we looking at an interaction between the two?
This makes it hard to pinpoint why medication is working or not working (when it should).
Sedatives are a huge part of psychiatric medication. The problem is that sedatives and antipsychotics can even cause (more) psychotic episodes and issues related to psychosis.
ICARUS project (see resources below) states that there is often a lack of informed consent when it comes to medication. SSRIs (Selective Serotonin Reuptake Inhibitors) function similar to nicotine, for example, they do not solve the issues in the long run (but make you feel better on the short term).
The goal of medication therefore seems to be to allow people to function under the oppressive clutches of capitalism; it would allow them to function more efficiently and to ignore affect so that they are able to perform for extended periods of time.
How to tackle these issues? How do we move forwards? It is apparent that not functioning in (capitalist) society is deemed as disorderly conduct, you get assigned a disorder if you do not fit in. How do we get rid of these systems (if only momentarily)?
Precarious situations create mental distress: situations like poverty, financial instability, unsafe living conditions, not having stable friends and/or family, not having a community or network to fall back on, all cause mental distress; pathologizing mental distress reduces (mental) troubles and suffering to individual problems, it depoliticizes social precarious situations; for instance, those in power do not do anything to combat poverty as long as they can still blame the individual for their (mental) problems.
Therefore, communities are very much necessary, not only to help each other but also to (constantly) remind each other that these are real and systemic issues we are facing. Communities are also able to spread the word, to fight collectively against these real and systemic issues.
Examples of such communities are: the NeuroQueer Group, this collective is about finding (more) connections and to help each other; Patriarkraakt, in the meetings from Patriarkaakt (mental health) issues are discussed, in particular issues that revolve around the patriarchy (e.g., toxic masculinity); friends with who you can talk about your problems; affinity groups; yet there also needs to be an awareness within such groups that you cannot ‘solve’ each other(’s problems).
Affective alienation impedes community building. Affective alienation is, in brief, a type of affect-based estrangement, where one feels affectively isolated from others (and society in general). There are often these affect-based, pervasive, dominant, oppressive ideas about how one should feel, that there is supposedly a right type of emotion, or that there are right and wrong ways to feel certain emotions; it is a form of emotion(al) (self-)policing. Under capitalism, you must always pursue happiness, you are essentially not allowed to feel ‘negative’ emotions; and if you do feel them, you must do everything in your power to not feel them (in any way possible), or you are only allowed to feel them under certain conditions (e.g., it is appropriate to feel sadness when faced with the death of a loved one, it is not appropriate to feel rage against the police). When you feel ‘negative’ emotions (under conditions that are deemed inappropriate), you feel estranged from those around you; you are supposedly the only one who feels this way, whereas all those others are perfectly happy and productive people who have no issues with the world at large at all.
Communities are a way to break (affective) alienation: validation and recognition for what one feels or experiences is perhaps the most crucial way to do away with such harmful affect-based ideas, to really connect with your fellow human beings in order to combat isolation, and to resist the stigmatization and pathologizing of affect — of actual feelings. That means that there would be no (or at least less) secondary emotion, an emotion, most times negative or shameful that’s a reaction to a primary (first) emotion. The secondary emotion makes it harder to let go of the initial emotion and therefore prolongs suffering. Part of breaking (affective) alienation is also expressing your emotions and feelings, to let others know that they exist in the first place; that is, others must, first and foremost, know that such emotions and feelings exist before they can validate them.
Having communal spaces where people can breathe and share, where one is recognized and validated, are pivotal. It is a form of exposure therapy. You expose yourself to your own feelings and emotions, you let them breathe. You acknowledge them. Through it, you are able to recognize and validate your own feelings and emotions: give space to affect, where affect is otherwise policed and sedated. In the same way are others exposed to your feelings and emotions, are able to recognize and validate them themselves, and feel affected by them. In turn, you can recognize, validate, and be affected by those feelings and emotions of others. It is a reciprocal relationship.
Such communal spaces are crucial. Even friends can shy away from your emotions, feelings and affect; it can make them awkward, they feel like they cannot be (truly) honest with you, it can make you feel incredibly (affectively) alienated; the care they (do) provide can feel superficial, detached, sterile, even medicalized. This goes to show that your support network of friends do not or cannot always provide the care you need.
These aforementioned groups and communities allow you to (momentarily) step out of the oppressive capitalist systems, the systems that in one way or another cause such issues and harm to begin with (e.g., work pressure, precarious living conditions, affect policing, alienation).
One of the problems that could arise with (attempts at) community building (and affect sharing) is that people are trying to ‘help’ you; and that those who are trying to ‘help’ you, whether professionals, friends and/or relatives, do not see to what extent they themselves have been indoctrinated by the capitalist systems that pathologize (affect); how such systems construct and streamline what is considered (ab)normal. It is a barrier that is difficult to break down or overcome.
Another obstacle to community building and affect sharing is that people have trust issues. Those who have been subjected to these systems and their effects find it hard to trust others; these issues tend to arise from abnormal and destabilized situations, and are, in that sense, normal, sensible responses to the situations people have found themselves in, it is something that has been done to them.
You have to work from this situation of distrust to be able to overcome it. To recognize your own doubts, wariness, and distrustful feelings and find ways to either break these feelings down, to adapt to it, or to find ways to (slowly) (re-)connect with others and (re-)build trust.
Narcotics anonymous (NA) was for the facilitator a way to (re-)connect with others and to (re-)build trust. Similar to the preceding groups and communities, NA fosters an environment that encourages community building and sharing; a place where you share your feelings and emotions, validate each other, and where you feel connected to others through this shared commonality. This helps to break the (general) barriers of distrust. The first step to do this, according to NA, is to accept that you are powerless and give yourself over to a higher power (whatever that ‘higher power’ may be for you). By accepting that you do not have control, you also acknowledge that you cannot control relationships or control the ensuing pain that could arise from people hurting you, the people who you thought you could trust — the thing you are trying to control in the first place by putting up these barriers of distrust.
For others, developing spiritual practices has helped them to overcome this, these rituals ground them into reality, enabling them to connect with others; these are, what they consider to be, playful rituals such as doing tarot card readings with and for others; connecting with others around such rituals has truly helped to regenerate, it has been a healing experience for them.
Yet another obstacle to community building, connection and sharing, is the fact that we collectively have been taught to mistrust those who are deemed abnormal or diseased, or suffer from ‘madness’; it is seemingly dangerous to associate and/or connect with those who fall outside the mainstream, as if you could get infected (with dangerous deviant thoughts and behaviors).
“De Dolende Mens” (roughly translates to ‘the wandering soul’ but could also be used to refer to a ‘rambling person’) is a long term project by theater maker Rianne Meboer that brings theatre, art and dialogue together. It is an exploration and inquiry into how we as a society deal with ‘confused people’, or more accurately, people with (temporarily) confused behavior. She talks to these ‘confused people’ to (better) understand them, to once again make them human beings — to subjectivize them, to de-pathologize them, as it were. This project challenges the assumptions and prejudices we (tend to) have about ‘madness’. To (perpetually) take issue with ‘madness’ is an exercise we should embrace if we wish to challenge the internalized beliefs about ‘madness’ (see resources below for links).
It is because of this mistrust, this perceived danger, that we (tend to) lock up those who suffer from ‘madness’, it is punishing, a punishment for not fitting it. Not only is this unjust, it also does not serve or help the one who is being locked up in any way. As we have discussed above, connections, affect sharing and community are so important in trying to make this world bearable for everyone. Locking people up only isolates them (even further). It is a way to discard the undesirables (within capitalism).
Most towns or villages tend to have certain ‘characters’, urban legends even, that may humanize the ‘mad’. An example was brought up of a middle-aged man who always wore a yellow tracksuit who proclaimed to be Jesus. Everyone in the town knew him, he was an incredibly kind soul, yet by many considered to be a lunatic. Interacting with this man made the ‘mad’ more human. However, there is also a lurking danger of fetishizing them.
Awareness at a young age about how the brain can function differently (i.e., neurodiversity) can actually help to counter such disconnect, this awareness can help you to better understand others, adapt to their needs, and build connections with them. This sensibility to neurodiversity can also help you to understand your own brain and its functioning, this applies to both neurotypical and -atypical people. This consciousness, for example, has allowed one of the participants to gain an enormous sense of control over the hallucinations they are/were experiencing. They now tell them to come back later (at a more convenient time). This sense of control has alleviated some of the discomfort and stress they have been experiencing due to the hallucinations.
It was (re-)stated that the problem is not so much that people do not or cannot communicate with homeless people with mental health issues (i.e., the ‘confused people’ or ‘wandering souls’), but that to a lot of (regular) people they are not to be trusted. The extend to which homeless people are able to have a(n emotionally safe) community boils down to our collective ability to build such communities, as well as our ability and willingness to look after one another. At one point in time, one of the participants was part of a homeless encampment, they looked after the ‘stranger’ members of their community, hiding them when the police showed up, for instance. The community protected their members against the police — they kept them safe. However, not all homeless encampments have this kind of support network, quite a lot of them are very much individualized, where people only look after themselves; encampments are difficult in general.
…
All the discussed topics intersect with one another; a complex web of pathology and social control has been spun, it is hard to escape its sticky grasp. Yet, we must make an effort to secure an autonomous existence for everyone, one that is free from the oppressive threads that have been woven to keep us in check. Let us perhaps spin a new web together, a web strong enough to support the weight of what has been done to us, a web strong enough to withstand the influences of capital and industry, a web strong enough to uphold our ‘confused’ communities — but, above all, a web strong enough to bolster our pride, the pride of the mad.
Project Icarus: https://site.icarusprojectarchive.org/articles
Project Icarus about coming off psychiatric drugs: https://site.icarusprojectarchive.org/alternative-treatments/harm-reduction-guide-to-coming-off-psychiatric-drugs
Project Icarus about community and friends: https://site.icarusprojectarchive.org/icarus-downloads/friends-make-the-best-medicine
“De Dolende Mens”. https://theaterstraat.com/projecten/de-dolende-mens/ (Only available in Dutch, unfortunately, “De Dolende Mens” roughly translates to ‘the wandering soul’ but could also be used to refer to a ‘rambling person’)
“Not made of Wood: A psychiatrist discovers his own profession” (In Dutch: “Wie is van hout…: Een gang door de psychiatrie”), author: Jan Foudraine
Therapy as in talking with each other and sharing skills we’ve found along our ways dealing with neuroqueerness in its endless forms and practicing them together.”
Radical Therapy (feminist group based in Utrecht and Amsterdam), they are doing therapeutic practices together, based on a Dutch feminist book, their Instagram is @radical_therapy_group.
¹ Here and many other places, you use the term pathologization and sometimes also medicalization. What I see in general and, also in this text, is that pathologization and medicalization are often used as very similar, almost interchangeable words but with two different meanings.
The first is that medicalization and pathologization describe the expansion of the medical field, as we traditionally see it, into areas of life that we might not think it should have a place at. The second is that medicalization and pathologization describe a social process of viewing a certain phenomenon as an illness.
I do not know what the correct definition would be, I just think that these are two separate meanings that we associate with these words. I think that the first meaning is used when we criticize how the healthcare system individualizes social problems. For example, very simply, if someone is stressed, it is seen as an individual problem that should be treated by medical institutions and not by changing the way our society is organized, even though so many people are stressed that it cannot be an individual problem.
The second meaning does not necessarily include medical institutions and I found a concept that I think grasps this meaning very well. A 20th century sociologist, Talcott Parsons, came up with the idea of the so-called ‘sick role’. The sick role means that when someone is perceived as being ill, they are placed in the sick role which comes with certain exemptions and responsibilities. Those who are considered sick, are exempted from their regular duties as long as they remain sick while they also gain a new responsibility, which is getting out of the sick role as quickly as possible. This responsibility is still not necessarily individualizing as it often includes things like accepting help from others and asking for help from the relevant institutions that are accessible to the individual. In this sense, I think, medicalization is not necessarily a bad thing, but rather a tool for defining health, what do we consider healthy, and what do we consider as our ‘regular social duties’.
An example that I find really insightful is the medicalization of pain. Pain in itself is not an illness, but usually a sign of an illness, and, in a few cases, a ‘normal’ part of life. However, if we view pain as an illness, meaning that we medicalize it, people are put in the sick role because of their pain. This means that they get exemptions up until they stop feeling pain and their responsibility is actually to stop feeling pain. If we medicalize pain, we primarily treat it with painkillers and only secondarily do we look into what is actually causing the pain, the thing that might actually should be medicalized, in this sense. If we ‘demedicalize’ pain, the emphasis shifts towards finding the cause of the pain and we become more mindful about using painkillers.
An example of a ‘good’ use of medicalization might be that in certain more cooperative native communities, being greedy is viewed as a strange behavior. It could be said, that greed is medicalized, if the natives attempt to ‘teach’ the greedy person why is their behavior ‘wrong’ or how should they behave ‘well’, which means being helpful to and generous with the people in their community. So, here, I think, the concept of medicalization and the sick role can open up our political imagination as it can make us question what do we view as healthy and ill in our society, and what should we, as leftists, view as healthy and ill.
² I read an example in Gabor Maté’s 2022 book, The Myth of Normal, that I think is related and useful here. I am translating a paragraph from the Hungarian version:
“There are cultures, where those who have visions are considered to be prophets or shamans. In ours, they would most likely be called crazy. I am not sure what would the current mental healthcare system say about Jeanne d’Arc or Hildegard von Bingen, then medieval saint and composer. Or, what would happen, if I would confidently walk up to the Canadian prime minister and, in the style of Jeanne d’Arc, tell him that I saw the future in which he became the leader of the fight against climate change and he started this work by no longer accepting campaign funding from the fossil fuel industry.”
³ I agree with this, but I want to offer another perspective which points in the other direction. There is an argument, that separating your illness from yourself, saying that you ‘have’ a disease just like you ‘have’ a laptop or a book, can be harmful. The argument is that if we would view illnesses as dynamic processes happening in our minds and bodies, healing would be more reflective and nuanced. If we view illness as an ‘outsider’ or an ‘enemy’, we ‘attack’ it with a carefully predetermined plan that we execute as quickly as possible, leaving less space for understanding the causes of the illness that could help us ‘eliminate’ it more successfully in the long-term.
I feel like keeping some distance from an illness or viewing it is part of ourselves can be beneficial in different situations, so I just wanted to show this idea, that is seemingly contradicting, but actually not that much.
ª In the case segregated schools for ‘special needs’, the social construction of illnesses intersects with race, as well. Most research I read was done in the Czech Republic, but it is generally true in Eastern Europe, that Roma children are way more likely to be assigned to attend these schools by their teachers with or without sufficient reasoning, than the general population. These ‘special’ schools usually provide less education on purpose, so even if someone completes them with good results, they still have a harder time getting into university or potential employers still see them as worse labor force. I’m sure these things happen in other places all over the world with different racialized groups, but I think it is really important to highlight how these ‘special’ schools can impact children’s lives and futures so severely.