I reject the pathology model of mental illness, as promoted by the psychiatric and medical community. There is something that strikes me as authoritarian in the notion that certain modes of thought are objectively sick. Ideally the notion of neuro-diversity should mean something more than begging for pity. This does not mean I don’t care about the plight of those labeled as mentally ill. Far from it. I mean that we won’t get any anywhere with psychiatric liberation until we discard the label of mental illness altogether. Furthermore, I believe it is necessary to consider psychiatry as an aspect of control, a component of the totality. It is tied in with the domination of the state, capitalism, and civilization.
To clarify this further, I believe there are individual psychologists and models of psychology which can provide benefit to our understanding of consciousness. Many of these can be beneficial to shifting conditioned cognitive patterns. For instance, the ideas of Reich, Lang, and the Gestalt theorists are all ideas I consider useful. These are all theorists who flipped psychiatric assumptions in important ways.
The core of psychiatry is a system of control. It is my belief that mental illness is a label placed upon people with mental, emotional, and behavioral traits that are disruptive to the functioning of capitalism and society. These traits are, of course, not necessarily positive just because they are disruptive. These labels are used to control, as justification for placing people within an institutional system. These institutional systems can be the old-style mental institutions, but they can be more contemporary forms, such as community-based systems.
An important concept of psychiatric control is normality. Anti-psychiatrist RD Laing said “what we call “normal” is a product of repression, denial, splitting, projection, introjection and other forms of destructive action on experience” (Laing 27). Whether Normality is based upon an ideal or an average, it represents the problematic idea that there is some state that is intrinsically better than others. Laing stated “the ‘normally’ alienated person, by reason of the fact that he acts more or less like everyone else, is taken to be sane” (Laing 27).
The method of using psychiatry as control is most obvious in forced institutionalization. Using a medical model, this control is justified and rationalized as being in the best interest of the inmates, in order to protect them. This rationalized practice allows ethical issues to be bypassed. It is no longer necessary to consider if it is okay to coerce someone, as they are constructed as being incapable of making their own decisions. Thomas Szasz documented many of the overlaps between psychiatry and penal discipline. He argued that “having paranoid schizophrenia, whatever the term means, is not a crime and hence not a ground for depriving the person who ‘has it’ of liberty” (Szasz, State 77). But the realms of penal and psychiatric power have become intertwined. Forced institutionalization is held up as a way to protect the individual from themselves. He further argues that the prohibition of self-harm is inconsistent with the “principle of self-ownership,” “free will,” and “self-responsibility” (Szasz, State 78).
There are campaigns for greater mental health programs, but if these programs are foisted upon people who do not desire them, then they are disciplinary. These models are becoming more generalized and at times more invisible. Subtle forms of manipulation are used rather than explicit coercion. The manipulations are everywhere, a point John Zerzan made when he said “The widespread allegiance to a therapeutic worldview constitutes a culture tyrannized by the therapeutic in which, in the name of mental health, we are getting mental disease. With the expanding influence of behavioral experts, powerlessness and estrangement expand as well; modern life must be interpreted for us by the new expertise and its popularizers” (Zerzan 54).
If the range of human behaviors considered to be symptoms of an illness increases, the range of potential human experiences diminishes. Furthermore, the individuals who are most controlled will be those with the least ability to fight back. The concept of mental illness can easily be used to justify the oppression of marginalized individuals. Until at least 1860 women could be institutionalized by their husbands for no reason at all (Szasz, Manufacture 14-15). I am sure this practice continued on a more covert level after that.
Psychiatry attempts to masquerade as a science, pretends that it is able to isolate aspects of the psyche. It is as if we can look at depression under a microscope. When you look at the criteria listed in the DSM-IV for any mental illness, what you find is a list of purely subjective symptoms, left up to the whims of a doctor to determine if one qualifies for diagnoses. Psychiatric labels are used to strip individuals of autonomy. “Schizophrenia is a label affixed by some people to others in situations where an interpersonal disjunction of a particular kind is occurring” (Laing 67). With advances in neurology, psychologists claim they can isolate neurological patterns and chemical traits that characterize mental illness. I would say that on the contrary, brains take on patterns based on how they tend to function. If one is depressed all the time the brain will take on that pattern. If one spends one’s time immersed in electronic media, the brain rewires itself to survive, becoming what is labeled attention deficit disorder. This is my understanding of neuroplasticity, which seems to be established by evidence and experience (see Carr).
It is probably for the best that psychiatry is not a science. If it did succeed in isolating the components of the mind they would be all that much more easily manipulated. Psychiatry dreams of a psycho-socialized civilization, controlled and compliant. If psychiatry could achieve a status of objective science, this would mean that its technique of control had been perfected. Neither Pavlov’s dogs nor Delgado’s stimulation brain implants sound appealing to me.
Mental illness places blame on the individual, though the problem arises from the society which assaults us. Szasz argues that mental patients are “scapegoats of society,” sacrificed by “the community” in order to “‘purify’ itself and thus maintain its integrity and survival” (Szasz, Manufacture 260). He described institutional psychiatry as “an intellectually meaningful, morally uplifting and socially well-organized system for the ritualized affirmation of the benevolence, glory, and power of society’s dominant ethic” (Szasz, Manufacture 58). It is a ritual to reaffirm society and recuperate disruptions.
Erving Goffman described how the labels mentally ill or crazy fit into his “stigma-theory,” which was defined as “an ideology to explain his inferiority and account for the danger he represents, sometimes rationalizing an animosity based on other differences, such as those of social class. We use specific stigma terms such as cripple, bastard, moron in our daily discourse as a source of metaphor and imagery, typically without giving thought to the original meaning” (Goffman 5). Within this value judgment a hierarchy is formed. Those considered normal and healthy hold more power than those who are considered abnormal and diseased. The normal are considered to be of more value and utility. This value judgment is based on binary thinking wherein “human variation” is “consolidated…under an exclusive derogatory classification” (Mitchell and Snyder 852). I write this as one who narrowly avoided such designations, throughout childhood, from authority figures who thought there was something wrong with me.
As society became industrialized there was a rise in the confinement of the mad. The Hôpital général was founded in response to a French royal edict from April 27, 1656. This corresponds with the rise of industrialization in Lyons (Foucault 46-47). Confinement throughout Europe corresponds with the rise of industrialization. After a city industrialized they inevitably opened a mental institution. It is telling that the Zuchthaus in Hamburg forced all their internees to work, who they paid one quarter of the estimated value of their work (Foucault 51). At the initial foundation of many of these sixteenth century institutes there was no attempt made to deny that they were “prisonlike structures for the confinement of socially undesirable persons” (Szasz, Manufacture 126-127). Confinement seems to have been an early method of dealing with the unproductive and disruptive in industrial capitalism.
At the end of the eighteenth century the reform movement occurred within psychiatry, which is traditionally viewed as a time of growing compassion for mental patients. Figures such as Philippe Pinel are portrayed as being “sympathetic” and working towards “humane care and treatment” (Sarason and Sarason 17). Pinel is best known for the removal of the inmates’ chains at the asylum at the Bicêtre, and “replacing brutality with gentleness, isolation with activity, and filth with clean air and sun” (Myers 621). Brute force was rejected in favor of subtle force, concentrating on psychologic control. This was not due to an ethical decision, but because older techniques were “crude methods of control” (Szasz, Manufacture 146). Using surveillance and classification of the inmate, Pinel attempted to create “a juridical microcosm” (Foucault 265). By constructing the confinement as a medical issue, as opposed to a legal issue, the confinement changed from punishment to a curative measure. The actions were rationalized as being taken for the good of the patient, attempting to force inmates to internalize the system of social control. Interestingly, when this method failed Pinel was not opposed to returning offending inmates to the chains of confinement which it supposedly ended (Foucault 268).
In America there was a similar movement in views of the abnormal. Benjamin Rush, a signer of the Declaration of Independence, began medical treatment of madness, moving away from traditional forms of authority and toward medical forms of control. In order to cure mental illness he felt that “he had to gain complete control over the person of the madman” (Szasz, Manufacture 146). To calm patients he used devices such as the Tranquilizer Chair, a chair which combined sensory deprivation and restraints (Sarason and Sarason 18). These medical techniques were an important part of the evolution of a mechanistic psychology, which Michel Foucault stated “locates madness in an area of unforeseeable freedom where frenzy is unchained; if determinism can have any effect on it, it is in the form of constraint, punishment, or discipline” (Foucault 76). Rush’s medical treatments helped to change treatment from a criminal matter to a medical matter within the United States, a shift which changed the method of dealing with abnormality from the use of external authority to internalized authority.
Community based models of psychiatry have become the standard now. These are not necessarily better. John Zerzan argued that they are derived from the “Mental Hygiene Movement in 1908”: “Community psychiatry represents a later, nationalized form of this industrial psychology” (Zerzan 62).
In Naked Lunch Burroughs presented the character Dr Benway, “a manipulator and coordinator of school systems, an expert on all phases of interrogation, brainwashing and control” (Burroughs 19). The character is a satire on psychiatry, at times becoming almost a parody of humanitarian reformers, such as Pinel and Rush. This is seen in Benway’s statement:
“I deplore brutality,…It’s not efficient. On the other hand, prolonged mistreatment, short of physical violence, gives rise, when skillfully applied, to anxiety and a feeling of special guilt…The subject must not realize that the mistreatment is a deliberate attack of an antihuman enemy on his personal identity. He must be made to feel that he deserves any treatment he receives because there is something (never specified) horribly wrong with him” (Burroughs 19).
Often what is defined as mentally ill is characteristic of a vision all too clear. If you are depressed, there may be good reason. If you are disruptive, that is a positive trait. This reaches its ultimate absurdity in diagnoses such as oppositional defiance disorder, in which being an anti-authoritarian is contextualized as a sickness, instead of the virtue it is.
Madness has a political component. Madness is an escape trajectory. “The person is subjected to a discipline designed, at the expense of the sensuous, to make him or her an instrument of production. Mental illness is primarily an unconscious escape from this design, a form of passive resistance” (Zerzan 60). This concept of passive resistance is important. This is a tactic that is used when one has no other options. Mental illness is a response to a double bind, where all outcomes are equally bad. This becomes an anti-game theory. “Some people play games that break the rules of games that others play. Some play undeclared games, so rendering the moves ambiguous or downright unintelligible, except for the experts in such secret and unusual games” (Laing 51).
To be clear this is not to say that people do not have troubles. It is not to say that people should not support each other. I certainly believe that people need to support each other. I think it would be possible to do this better if people stopped degrading and subjugating themselves. The concept that there is something ill in a person for how they are should be rejected. It is degrading and does not help in dealing with actual problems.
Rather than allow traits to be used to force the individual into this nexus of power and discipline, I say they could be harnessed and used as weapons. As with any weapon, madness can be dangerous to those who possess it. There is no need to minimize this for some sort of purely positive view. Psychiatric control is one nexus of power in the totality, fighting to tear it down is part of a larger struggle.
Burroughs, William S. Naked Lunch: The Restored Text. New York: Grove Press, 1959, 2001.
Carr, Nicholas. The Shallows: What the Internet Is Doing to Our Brains. New York/London: WW Norton, 2010.
Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. Trans. Richard Howard. New York: Pantheon Books, 1965.
Goffman, Irving. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs: Prentice-Hall, 1963.
Laing, RD. The Politics of Experience. New York: Ballantine, 1967.
Mitchell, David and Sharon Snyder. “The Eugenic Atlantic: race, disability, and the making of an international Eugenic Science, 1800-1945.” Disability and Society 18.7 (2003): 843-864.
Myers, David G. Psychology (Seventh Edition). New York: Worth, 2003.
Sarason, Irwin G and Barbara R Sarason. Abnormal Psychology (Tenth Edition). Upper Saddle River, New Jersey: Prentice-Hall, 2002.
Szasz, Thomas. The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. New York: Harper & Row, 1970.
Szasz, Thomas. “Should Psychologists Be Coercive Agents of the State?” Current Psychology 24.2 (2005): 77-79
Zerzan, John. Future Primitive. Brooklyn/Columbia, MO: Autonomedia/Anarchy: A Journal of Desire Armed, 1994.