Anti-psychiatry Research Articles

Silent Cells: The Secret Drugging of Captive America by Anthony Ryan Hatch

Reviewed by: Silent Cells: The Secret Drugging of Captive America by Anthony Ryan Hatch Carolyn Sufrin Anthony Ryan Hatch. Silent Cells: The Secret Drugging of Captive America. Minneapolis: University of Minnesota Press, 2019. viii + 176 pp. Ill. $19.95 (978-1-5179-0744-0). It is no secret that institutions of incarceration in the United States remain some of the most opaque establishments in our society. Anthony Ryan Hatch delves into the logics and consequential harms of such secrecy in Silent Cells: The Secret Drugging of Captive America, exploring the deployment of psychotropics in the U.S. carceral apparatus. Just as important to his analysis of how psychoactive pharmaceuticals are used in carceral institutions is his epistemological excavation of the absence of knowledge about such activities. Silent Cells offers a compelling analysis that is both nuanced and clear, affirming in newly harrowing ways the unchecked mechanisms through which the United States' particular form of carceral violence inflicts psychic and physical suffering, both through direct action on people and through data elisions about these processes. Using publicly available archives, statistical reports, government audits, media accounts, pharmacy databases, prison records, corporate accounting, and court cases, Hatch shows how knowledge about mental illness management in the broader carceral state is produced and concealed. In Chapter 1, Hatch dissects the surveys through which federal agencies codify demographic and health data about people in prison, a venture he deems "prison pharmacoepidemiology." Government institutions, perhaps not surprisingly, document only limited information about the use of psychotropic medications in prisons, and this partial presentation of data not only precludes further questions, but enables abuses to flourish. Indeed, the same could be said of any health-related phenomenon in prison, as they all remain under-documented and partially construed. Chapter 2 reviews the results of thirty-one publicly available prison pharmacy audits from 2001–2015. Cost data, prescription logs, and auditors' comments on [End Page 174] missing data demonstrate the dysfunctional management of prison pharmacies. Some are managed by for-profit companies, which connects to Hatch's political economic analysis of the pharmaceutical industry's long-standing and profitable prisoner experimental apparatus in Chapter 3. The racist foundations of prisoner experimentation are complex, with under- and over-representation of black subjects being difficult to confidently know, and both with racist implications. Chapter 4 broadens the mechanics of psychotropic secrecy to other nonprison, total institutions like nursing homes, the military, and foster care to illustrate how similar controlling processes and epistemic elisions operate in the so-called free-world—reaffirming that the punitive, subjugating, controlling logics of incarceration sustain our entire, late-capitalist society. Hatch, in Chapter 5, uses contemporary instances of the role of psychotropics in prosecuting racially motivated gun violence, deporting unauthorized immigrants, CIA interrogations, and with sex offenders to show the expanse of how drugs are weaponized. He concludes with liberatory intimations, the contradictions of the anti-psychiatry movement; ultimately Hatch's intervention is to show that lack of knowledge is power—which opens space to rectify the gaps. Prisons and prison officials are notoriously difficult for researchers to access; for Hatch, this methodological fact was brilliantly central to his analysis of secrecy in prisons; that is, he wanted to document what can be known about these state institutions through public records. Yet ethnographers have entered prisons to study their everyday workings, and national correctional health accrediting organizations' standards and reports also delineate service delivery realities, and these data are not described. The omission of such on-the-ground information to contextualize Hatch's archival research is curious (especially since it contradicts Hatch's over-generalization that "most medications are administered by correctional officers" [p. 61]), given his formidable efforts to document what we do and do not know about prison psychiatric care. Hatch reviews several theoretical concepts on the workings of power on bodies and souls—Michel Foucault's "biopower," Achille Mbembe's "necropower," and Giorgio Agamben's "state of emergency." The applicability of these theories to U.S. carceral institutions is unquestionable. However, Hatch's data and arguments are cogent and sophisticated enough without needing to invoke these well-worn theories that appear mostly as accessory bookends. These are minor limitations to a thoughtful...

The Real End of a Nightmare

This article considers Jane Arden’s 1972 film The Other Side of The Underneath, a neglected work of British feminist experimental cinema that focused on experimental group therapy. Building upon the theatrical productions of Holocaust, a short-lived feminist group that Arden started in 1970, Arden’s theatrical and cinematic projects from the early 1970s involved both professional actors and untrained participants in a strange admixture of theatre exercises, group therapy, and feminist ritual. Illuminating overlooked cross-currents between the women’s liberation group-work, the anti-psychiatry movement, and the post-1960s avant-garde embrace of amateur modes of aesthetic expression and production, Arden’s work from this period refuses to accede to the tyranny of professionalised expertise – whether of the artist, actor, filmmaker, or psychiatrist.

Da relação com o saber medicalizante às práticas escolares em Florianópolis

Resumo O presente trabalho versa sobre a presença do saber medicalizante nas escolas públicas municipais de Florianópolis (SC). Ao problematizar a medicalização da educação formal, nos perguntamos sobre as consequências para o (in)sucesso escolar da(o) aluna(o) e a sua função ideológica que tende a ocultar a escola como reprodutora das desigualdades sociais. Demarcada no campo da sociologia da educação, esta pesquisa assume uma perspectiva quanti-quali, partindo do estudo da produção acadêmica relacionada ao fenômeno e das políticas educacionais e de saúde sobre práticas (não) medicalizantes para, em seguida, proceder ao “[...] estudo concreto dos contextos singulares de acção [...]” (SARMENTO, 2011, p. 4), com utilização de procedimentos de base empírica. Neste ensaio pretende-se refletir sobre a problematização do conceito de medicalização como instrumental para a pesquisa, a partir da concepção teórico-metodológica sartreana no campo da sociologia da educação. Por fim, analisamos aspectos da pesquisa sociológica sobre o tema da medicalização, constatando crescente interesse no campo escolar, bem como uma demarcação da abordagem sócio-histórica e relacionada a antipsiquiatria.

Maud Mannoni and Piera Aulagnier on Mental Illness and Disability: Parents at the Boundary between Society and Childhood (France, 1960–80)

This article reads Maud Mannoni's The Retarded Child and the Mother (1973) and L'éducation impossible (1973) in the context of French ‘institutional analysis’ in order to nuance criticism of Mannoni's work, particularly the criticism that Mannoni blamed mothers for the conditions of their children. Institutional analysis emerged in France after World War II. Institutional analysts drew from psychotherapy, sociology, and education in order to question power dynamics and the consequences of bureaucracy in their areas of research. Although often overlooked, this movement influenced Mannoni just as much as commonly acknowledged influences like Jacques Lacan and the anti-psychiatry movement. Moreover, connecting the preoccupations of institutional analysis with a more Lacanian approach, the thought of the understudied yet brilliant French psychoanalyst Piera Aulagnier (1923–90) offers crucial insights into the way political and social structures shape individual psyches. Retrieving these influences, we argue that Mannoni did not blame individual mothers for their children's pathologies. Instead, she identified the social and political dimensions of psychopathologies and suggested tackling the roots of psychic diseases in social institutions.

Criticising psychiatry is not 'antipsychiatry'.

Criticising psychiatry is not 'antipsychiatry'.

Classification of Psychiatric Disorders.

Because of the poor link between psychiatric diagnosis and neurobiological findings, it is difficult to classify mental disorders. The changes made to psychiatric diagnostic systems over the years can be understood in terms of "practical conservatism." The Diagnostic and Statistical Manual of Mental Disorders (DSM)-I and DSM-II were theoretically supported by the psychoanalytic and psychodynamic approach. Subsequently, psychiatric diagnoses of this kind were opposed by the anti-psychiatry movement, as well as by the findings of the Rosenhan experiment. Thus, the DSM-III revolution contained more empiricism, aligning psychiatry with biomedicine. Psychiatric diagnoses are classified and defined in terms of Kraepelinian dualism, using a categorical approach. The empirical trend was continued in the DSM-IV. To overcome the limitations of current psychiatric diagnostic systems and integrate fundamental genetic, neurobiological, behavioral, environmental, and experimental components into psychiatry, the Research Domain Criteria (RDoC) were established. To overcome the limitations of the categorical approach, psychiatrists have considered adopting a dimensional approach. However, their efforts were frustrated in the DSM-5 revision process. Thus, the DSM-5 is characterized by the rearrangement of psychiatric diagnoses, the partial adoption of a dimensional approach, the introduction of new diagnoses, and harmonization with the International Classification of Diseases.

Past and current concepts of “Anti-Psychiatry”: Does it have a future?

Anti psychiatry can better be called Anti Establishment Psychiatry has been propounded be cause of the differences it had with the establishment of Psychiatry of those days for lack of humanitarian approach and not considering the social causation, and leaning so much on somatic treatments whose mode of action is questionable. Unlike Scientology which meant abolition of Psychiatry as a speciality , the anti Psychiatry movement envisaged only reforms in approach to a Psychiatry patient.

Postcolonialism and (Anti)psychiatry: On Hearing Voices and Ghostwriting

Postcolonialism and (Anti)psychiatry: On Hearing Voices and Ghostwriting

“A Genius for Unreality”: Neurodiversity in Elizabeth Bowen's <em>Eva Trout</em>

For decades, critical debate around Elizabeth Bowen's Eva Trout (1968) has focused on the novel's enigmatic heroine. Though Eva is often perceived as flat because of her non-normative behaviors, the novel's portrayal of her neurodivergent sensory relation to the world actually becomes a way for Bowen to gesture to her complex interiority. Taken together, the 1960s anti-psychiatry movement and a twenty-first-century under-standing of neurodiversity offer the possibility of seeing Eva as creative, emotional, and imaginatively connected to the world, rather than as unthinking and detached. Bowen extends the novel's representation of cognitive atypicality to Eva's teacher, Iseult, and thereby calls into question the normativity of apparently neurotypical minds.

Mad studies and social work: Conceptualising the subjectivities of service user/survivors who experience significant mental health problems

This article draws on contemporary and classical psycho–political theorists to conceptualise ‘mental illness’ as a social construct. The research employs a Mad Studies and anti-psychiatry perspective to reframe ‘mental illness’ from an individualised pathological defect to a socially constructed reality (Foucault, 1967; Menzies et al., 2013). The study applies a qualitative biographical methodology to analyse the subjectivities of people with severe mental health problems, their family members and mental health practitioners. In this study, once individuals were conceptualised as pathologically ‘ill’ they were then medicated and often institutionalised as a form of ‘treatment’. The findings present a theoretical analysis of participants’ subjectivities to examine historic and contemporary psychiatric practices. The article will conclude by discussing how Mad Studies can offer social work practice an alternative theoretical standpoint to conceptualise ‘mental illness’ as a social rather than a pathological phenomenon.Keywords: mad studies; anti-psychiatry movement; ‘mental illness’; biographical methodology; institutionalisation; medicalisation; family

Locura y neoliberalismo. El lugar de la antipsiquiatría en la salud mental contemporánea

Este artículo pretende analizar los cambios en la comprensión de la locura luego de la irrupción del movimiento de la antipsiquiatría y examinar los procesos de adaptación de sus planteamientos en el marco del ascenso y auge del neoliberalismo. De acuerdo a la observación crítica de los postulados del movimiento de «ex pacientes o sobrevivientes de la psiquiatría» y el modelo de “recuperación” [recovery] en salud mental, se describen las transformaciones ideológicas en la comprensión y abordaje de la locura en la salud mental contemporánea. Finalmente, se examina la vigencia de la antipsiquiatría en un contexto neoliberal en base al reconocimiento de la importancia de la defensa de derechos de ciudadanía, el fortalecimiento de la autonomía y la construcción de una política de alianzas en el campo de la salud mental, así como el potencial transformador de los espacios comunitarios y movimientos sociales que reivindican la locura como base de su identidad colectiva.

\u201cMay all Be Shattered into God\u201d: Mary Barnes and Her Journey through Madness in Kingsley Hall

Contributing to renewed scholarly interest in R. D. Laing and his circle, and in the radical therapeutic community of Kingsley Hall, London (1965-1970), this article offers the first article-length reading of Mary Barnes’ and Joseph Berke’s Mary Barnes: Two Accounts of a Journey through Madness. This text offers views of anti-psychiatry ‘on the ground’ that critique the 1960s utopianism of Laing’s championing of madness as a metanoic, quasi-psychedelic voyage. Barnes’ story, too, reveals tensions within the anti-psychiatric movement. Moving beyond existing criticism of the text, Barnes, it is argued here, emerges as far more than an exemplary patient, victim or anti-psychiatric puppet. Particular attention is paid in this reading of Two Accounts to the following: the ways in which the spiritually inclined Barnes and the psychoanalytic Berke differ in this dual narrative text; the ways in which each differs from Laing; the metaphor of the journey; and the setting of Barnes’ story in the often conflicted, experimental household of Kingsley Hall.

Tackling the Philosophical Foundations of Psychiatry

Back to table of contents Previous article Next article Residents’ ForumFull AccessTackling the Philosophical Foundations of PsychiatryAwais Aftab,M.D.Awais Aftab,Search for more papers by this authorM.D.Published Online:22 Jan 2018https://doi.org/10.1176/appi.pn.2018.1b18AbstractThere are numerous ways in which psychiatric concepts can be subjected to philosophical inquiry, and “philosophy of psychiatry” explores the intersection of these two fields. The importance of clarifying the philosophical foundations of modern psychiatry has long been recognized, with the work of German psychiatrist and philosopher Karl Jaspers being an example from the early 20th century. The most serious challenge to psychiatry in the form of the antipsychiatry movement was also philosophical in nature, with conceptual criticisms from figures like Szasz and Foucault. DSM-III led to a revolution in the practice of psychiatry with operationalized criteria, but it also highlighted philosophical problems surrounding the definition of “mental disorder,” a matter on which Drs. Robert Spitzer and Allen Frances have commented extensively.Philosophical questions commonly plague practicing psychiatrists as well as psychiatry trainees. In a survey of psychiatry residents at Case Western Reserve University/University Hospitals Cleveland Medical Center (CWRU/UH), 15 out 23 residents (65.2 percent) responded with “yes” or “definitely yes” to the statement that they struggle with conceptual and philosophical questions related to psychiatry (such as what is “normal” when it comes to human thought and behavior, and how do we decide what should be considered a “mental disorder”?). Furthermore, only one resident (4.3 percent) responded with “yes” or “definitely yes” to the statement that their residency training so far had adequately prepared them to address these philosophical challenges.I have developed and taught a didactic course on philosophy of psychiatry for psychiatry residents at CWRU/UH, with consultation from Drs. Nassir Ghaemi and Susan Stagno. A report on the details of this course and its reception by the residents was published online on November 17, 2017, in Academic Psychiatry. This report is a notable addition to the scant literature on teaching philosophy of psychiatry to psychiatry trainees. The course consists of six didactic sessions using a mix of presentations, readings, and group discussions:The Concept of Mental Disorder: The DSM definition of mental disorder was explored, philosophical tensions within the concept (such as empiricism versus normativity, and reliability versus validity) were highlighted, and philosophical ambiguity surrounding crucial elements of the definition, such as “dysfunction” and “clinically significant,” were pointed out.The Nature of Mental Disorder: This session addressed the question of whether a definition of mental disorder can be grounded in objective, natural facts, independent of our values and interests. The objective was to become familiar with and critically appraise the naturalist accounts of mental disorder offered by Christopher Boorse and Jerome Wakefield. Philosophical Aspects of the Antipsychiatry Movement: This session dealt with prominent philosophical themes of the antipsychiatry movement, with a focus on arguments by Thomas Szasz and Michel Foucault.Introduction to Pluralism in Psychiatry: Participants were introduced to Jasper’s methodological pluralism, followed by a critique of the biopsychosocial model, using the Perspectives approach by McHugh and Slavney as an example of a pluralistic model.Philosophical Issues in Psychiatric Nosology: This session highlighted philosophical difficulties inherent in the process of psychiatric classification.Philosophy of Mind and Psychiatry: Major philosophical positions relating to the mind-body problem were introduced. Also discussed was how certain positions, such as substance dualism and epiphenomenalism, are less compatible with psychiatry.The course was well received by the residents, with 18 or 22 attendees (81.8 percent) agreeing or strongly agreeing that the course had made them aware of philosophical and conceptual issues related to psychiatry that they were not aware of before; the same number agreed or strongly agreed that philosophy of psychiatry should be part of the psychiatry residency curriculum. It is about time that we provide the next generation of psychiatrists the conceptual tools they need to work through these philosophical questions. This curriculum is only one example of a preliminary effort to do so. “A Didactic Course on ‘Philosophy of Psychiatry’ for Psychiatry Residents” can be accessed here.Awais Aftab, M.D., is a PGY-4 resident and the chief resident for education and research at Case Western Reserve University/University Hospitals Cleveland Medical Center. He is also a second-year APA/APAF Leadership Fellow. ISSUES NewArchived

Psychiatry, anti-psychiatry, and anti-anti-psychiatry: Rhetoric and reality

Psychiatry, anti-psychiatry, and anti-anti-psychiatry: Rhetoric and reality

The Experimental School in Bonneuil-sur-Marne…with Commentary from a North American Context.

This manuscript describes the operation of and principles that shape the activities of the children and role of psychoanalysis at the Experimental School in Bonneuil sur Marne. The ways in which the question of desire is built into the fabric and processes of the school are described in clear detail. Bonnueil's foundations in psychoanalysis, child analysis, and the anti-psychiatric movement of the 1960's and 1970's is also discussed. Particular attention is paid to the structure of the school as inside-outside in its organization. The commentary, from a North American psychologist's view attempts to further elaborate important principles and the pre-eminence of ethics and desire in the life at Bonneuil. The commentary also addresses views of psychoanalysis, especially Lacanian analysis, in North America in the context of how Bonneuil actually operates. Questions of how one can think psychoanalytically and institutionally (in the field of mental health) are taken up in both parts of the article.

The X Process: Anti-Psychiatry and Its Hopes

The X Process: Anti-Psychiatry and Its Hopes

Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency by Neely Laurenzo Myers

Neely Laurenzo Myers, Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency. Nashville: Vanderbilt University Press, 2015. 208 pp.Recovery has been a dominant paradigm shaping mental health policy in United States since turn of millennium. A treatment philosophy that emerged from disaster of deinstitutionalization and disappointment of psychopharmaceutical revolution, it draws on sources eclectic as antipsychiatry, psychiatric survivors and consumer rights movements, and psychosocial rehabilitation (Braslow 2013). Recovery advocates envision a new system of care that produces citizens no longer doomed by hopelessness of biological reductionism, nor dependent on social services. The central precepts of have been summarized as: renewing a sense of possibility, regaining competencies, reconnecting and finding a place in society, and repairing disruptions in self and career (Hopper 2007). The role of people with lived experience of mental illness, or peers is central to this approach at every level, from research, policy-making, and advocacy to frontline care provision. The movement's ostensibly radical core concepts of empowerment, self-determination, and freedom of (Myers 2015:7) were enshrined in George W. Bush's Presidential New Freedom Commission of 2003, an unfunded set of recommendations that many states have subsequently tried to implement. Critics see this embrace of by neoliberal reformers as a move to withdraw care and services from chronically mentally ill by declaring them recovered and substituting care with choice (Braslow 2013, Myers 2015:8).This is point of departure of Neely Myers's powerful book, in which she ethnographically documents how one community mental health agency in urban US, called Horizons, navigated shift from mental health services to recovery-oriented care through creation of a peer-led treatment program. Myers documents her own intimate journey as she developed relationships with staff and clients, or members, of agency. She provides a contextualized account of stark realities of living with severe, chronic mental illness and poverty in urban US, revealing promises, pitfalls, complexities, and contradictions of contemporary mental health reform and social abandonment members and staff worked against. Her detailed observations, poignant reflections, and incisive critique create a compelling account and an important contribution to medical anthropology and community psychiatry. Recovery's Edge is a story of relationships, therapeutic and traumatic, personal and professional, ruptured and repaired, lost and longed for, and often tragically unattainable.Myers's central thesis is that moral agency, the ability to be recognized as a 'good' person in a way that makes possible intimate connections with others, is oft-overlooked driver of recovery (13). Mental health crisis results in an initial loss of moral agency. This loss is perpetuated by ways people with mental illness are treated, both by society in general and by traditional mental health programs in particular. As a result, those with chronic, severe mental illness remain isolated and marginalized.Chapter 2, No Direction Home, establishes context with an account of history of deinstitutionalization and never-delivered promise of community-based care. A major theme introduced here is contradictions and double binds members faced as they sought to rebuild their lives despite recurring mental health crisis. One classic trap they faced was a dependence on Social Security insurance and Medicaid to pay for their high healthcare costs, yet full time, competitive employment would disqualify them of these benefits without providing a viable alternative. Members cycled through institutional circuit, including hospitals, jails, prisons, shelters, nursing homes, outpatient day programs, and streets. …

Psychiatry of the future: an overview of foreign scientists opinions of the position of psychiatry in the modern world

First part of this review (Chapter 1) demonstrates an ambiguous attitude toward psychiatry among professionals and in society in recent decades. The articles of supporters and opponents of psychiatry are also quoted. The authors describe the dynamics of the reflection of psychopathology in the main widely accepted classifications and manuals. Critical and negative opinions regarding the DSM-5, due to its role in the 'medicalization' processes, for the movement 'World Mental Health', are mentioned. The history of antipsychiatry movement and its results for psychiatry and society are analyzed as well. An analysis of the articles on the scientific basis of psychiatry and its intersections with other sciences is presented. Several examples of studies on brain networks in correlation with clinical data, which may have possible implications for the future, are quoted. The authors call for the 'cure for dichotomy' between mind and brain before treatment of the patient. According to the analysis of available data, this problem seems too hard to be solved, as it requires theological knowledge, of which we probably have not enough knowledge.

Putting Diagnosis Into Brackets: Franco Basaglia, Radical Psychiatry, and Contemporary Mental Health Services

Mental health services in England and Wales are facing a crisis. The vision of properly funded, flexible, and service-user focused community-based services, that was one of the key drivers of deinstitutionalization, has never been realized. This article argues that the failure of community care was the result of underinvestment. The current crisis is linked to the politics of austerity. The current landscape is a bleak one with a shortage of community-based alternatives, a shortage of beds leading to delays in admissions or patients being admitted to units far from their homes, and the Criminal Justice System becoming a default provider of mental health care. Mental health services have become dominated by a bureaucratic, risk assessment focused model of practice. The article uses John Foot’s recent magisterial biography of Franco Basaglia—a key figure in the anti-psychiatry movement of the 1960s—as a basis for a different approach to the provision of mental health care. Basaglia, a charismatic intellectual led a series of radical reforms to asylums in Italy in the 1960s and 1970s. These resulted in Law 180 sometimes referred to as Basaglia’s Law which resulted in the closure of the Trieste asylum. At the core of this work is a belief that services need to be based on relational therapeutic approaches. It concludes that far from being banished to the shores of 1968 radical movement excesses, Basgalia’s work has many important insights for mental health services today.

Où sont les fous ? Aperçus critiques sur le paradigme de la « santé mentale »

In the present article, “mental health” is addressed, not as a psychiatric or sociological concept, but as a paradigm that structures a wide range of discourses and practices, ideals and policies, institutions and professions. We chose to follow two lines of research, aiming at: (1) defining the contours of this new paradigm, studying a few distinctive features from the psychiatric and judiciary model inherited from the French Revolution; (2) shedding light on the genealogy of its emergence in the psychiatric and psychoanalytical discourse, be it through the internationalisation of the nosography derived from the DSM, the influence of the anti-psychiatry and institutional psychotherapy movements, or the development of work-related psychopathology and psycho-dynamics. We conclude on the specifically political dimension of this paradigm, eclipsed by processes of idealisation and subjection measures that are not recognised as such, and harnessed by a denial of reality (namely, the reality of castration) that precludes reflecting on (and thus putting into perspective) “mental health” and both the discourses and practices it commands.