Antipsychiatry vs. Psychiatry: Essay by DJ Jaffe
There are two broad groups controlling the nation’s mental health agenda: antipsychiatry and psychiatry. They are both right about some things, and wrong about others. It is disappointing that there is no third group that fills the gap.
Antipsychiatry groups deny mental illness exists. And whatever does exist, is not medical in nature.
The antipsychiatry agenda is led by religious organizations (Scientology) and the separate organization they founded, the Citizen’s Commission on Human Rights (CCHR) joined by government-funded “survivor”, “consumer”, and “ex-patient” organizations. The gurus of the movement are Ron Hubbard, http://en.wikipedia.org/wiki/Dianetics Thomas Szasz and Peter Breggin. These are the organizations and individuals with highest book sales, budgets and influence, hence being characterized as the leaders. (8/2017 UPDATE: The Substance Abuse and Mental Health Services Administration (SAMHSA) and particularly its Center for Mental Health Services (CMHS) subsidiary, are now major funders of antipsychiatry as are several states. See analysis of SAMHSA/CMHS antipsychiatry efforts.)
Thomas Szasz claims schizophrenia is merely a “myth.” (T.S. Szasz, Schizophrenia: The Sacred Symbol of Psychiatry (1976). Dr. Peter Breggin argued that people with schizophrenia bring the symptoms on themselves because of “cowardice” or “failure of nerve.” (P.R. Breggin, The Psychology of Freedom (1980)). Scientology believes that “aberration” is caused by “Engrams” (past memories) that recording can reduce. They, along with Thomas Szasz founded CCHR which believes using psychiatry (vs. Scientology) is torture and therefore wants to end psychiatry. A SAMHSA funded ‘consumer” group claims schizophrenia is merely “severe emotional distress and loss of social role” brought on by “trauma.”
Antipsychiatrists will often say consumers should have choice and they are not against medications, while simultaneously distributing only information about the side-effects and no information about the benefits.
Believers in antipsychiatry use terms like “survivor” “ex-patient”, and “people who have been labeled with mental illness”. Using these terms allow groups to avoid acknowledging that mental illness exists, while simultaneously getting mental health funding. They promote “Alternatives” to psychiatry.
Antipsychiatry is against “force”. They believe we should either not be allowed to involuntarily treat anyone, or not allowed to involuntarily treat anyone until after they have already become danger to self or others. They oppose laws that would provide treatment to prevent dangerousness.
Psychiatry groups represent the other extreme: they believe almost everything is a mental illness. Their literature claims up to 50% of people had a “diagnosable” mental disorder during their life. ( http://archpsyc.ama-assn.org/cgi/content/abstract/62/6/593 )
Psychiatry is led by the National Alliance on Mental Illness (NAMI), Mental Health America (MHA) and—above all others—the American Psychiatric Association (APA) and pharmaceutical industry. They believe that almost every feeling (too sad, too happy, too removed, too involved, too bereaved) and social issue (bad marriage, poor grades, no job, love of internet) etc and “trauma” are mental illnesses that need earlier and earlier identification, treatment and often an expensive new medicine.
They have successfully directed mental health dollars to all these issues.
Interestingly, antipsychiatry and psychiatry share the same goal of expanding the definition of people with whatever it is they claim to represent. To both groups, casting a wide umbrella is the goal and narrowing focus is anathema.
Psychiatry casts it’s net through the publication of the Diagnostic and Statistical Manual (DSM).
Anti-psychiatry casts their net through the refusal to say who is in or out. Any “Person with Lived Experience (i.e., everyone) or as the Executive Director of one government funded group, said in response to a previous Huffington Post blog of mine, everyone who has had “severe emotional distress which interferes with community participation.” is welcome. So if you were ever mad at your brother and skipped his birthday party in protest, you are welcome to the club.
In this regard, antipsychiatry and psychiatry have made the term “mental illness” meaningless, which allows mental health dollars to be spent anywhere.
They both tend to shun highly symptomatic people with serious and persistent mental illness (at least from PR materials) because it interferes with their message that “people with mental illness are just like you and me.” They believe there is stigma to having a mental illness and showing the highly symptomatic (ex. those who killed someone) is stigmatizing.
ANTIPSYCHIATRY: THE GOOD AND THE BAD
Antipsychiatry has done a fearless job of identifying and publicizing many abuses in the mental health system: especially of people who have been mistreated. They have also done a good job at bringing the over marketing of psychiatric medications (especially to children) to the public’s attention.
Scientology and anti-psychiatry have done a brilliant job at confronting the APA, Big Pharma and NAMI for medicalizing everything.
Unfortunately Scientology and anti-psychiatry go to nonsensical next steps: because some things psychiatrists believe are mental illnesses really aren’t therefore mental illness doesn’t exist. They apparently believe every organ in the body, except the brain can have illness, and the brain is always functioning. As “proof” they point to the lack of biomedical markers sufficiently developed to be used to diagnose serious mental illness. This is akin to saying colon cancer did not exist before the invention of the colonoscopy. Antipsychiatry has tried to eliminate the right to choose electroconvulsive therapy, antipsychotics, hospitalization and others. They work to eliminate the right of people with anosognosia to receive treatment unless they are well enough to choose it.
Another widely shared belief among antipsychiatrists is that because some people were mistreated; the system of care should be eliminated. The Baby/Bath water syndrome.
THE GOOD AND THE BAD OF PSYCHIATRY
Psychiatry has done a good, albeit incomplete job of coming up with medications for people with serious mental illness and providing patients and their families educational materials on how to deal with serious mental illness. They have done a stellar job at getting mental illness covered under the insurance policies of corporations.
Unfortunately in their rush to medicalize “lived-experiences” they have, like antipsychiatry become a major force behind the elimination of services for the most seriously ill. (Ex. standing by as hospitals close; refusing to engage in efforts to reform involuntary treatment laws, etc)
As psychiatry demand that more and more services focus on the worried-well, fewer dollars are left for the seriously mentally ill. Their anti-stigma campaigns contribute to the problem because they only show the highest functioning individuals, leading to tremendous misunderstanding as to the nature of serious mental illness.
THE THIRD WAY
There is a desperate need for an organization that focuses on serious mental illness only.
An organization that accepts the antipsychiatry mantra that we have medicalized everything, and their devotion to confronting abuse, but rejects their position that mental illness does not exist. An organization that embraces their holding a microscope to the medical/pharmacological/mental health complex; but is grounded in science.
An organization that accepts pro-psychiatry philosophy that mental illness exists, and medications can work, but rejects their philosophy that everything is a mental illness and deserves equal funding.
An organization that acknowledges serious and persistent mental illnesses are no-fault biologically based disorders and therefore there is no stigma to suffering from it. (There is however discrimination).
An organization that believes it is important to focus dollars, policies and public attention on the most seriously ill. An organization willing to help them to the front of the line, rather than shun them to the back.
Some organizations fill parts of the gap. Privately funded research organizations like NARSAD, IMHRO and The Stanley Medical Research Institute are looking for cures for serious mental illness, but they only focus on research.
Organizations like the Treatment Advocacy Center focus on serious mental illness but intentionally and appropriately limit their campaigns to reform assisted treatment laws and changing Medicaid policies to insure more impatient treatment is available to those who need. They also do not organize at grass roots level.
A third organization is needed. One that brings together the best work on serious mental illness no matter where it comes from. Hopefully Mental Illness Policy Org will provide some of the information they need to undertake the task.