The Rise of Anti-psychiatry: A Historical Review
Oliver Josef Dumolo Ralley
University of Manchester
This paper provides a historical review of the anti-psychiatry movement, its origins and the details of its major discourses. The term ‘anti-psychiatry’ is described and the article explains how it represented a unique affront against mainstream psychiatry by the exceptional nature of its criticisms. Anti-psychiatry challenged the very foundations of psychiatry and its role in treating the mentally ill. These foundations are traced back to their nineteenth-century origins. This paper then follows the main proponents of anti-psychiatry through the development of their ideas; from a reframing of the concept of mental illness to speculation as to interpersonal, family and social aetiologies. The article examines how psychiatry itself came to be held into account for its perceived abuses of human rights and for the controlling force it played for society. Lastly, it tackles how anti-psychiatry was received as a threat by mainstream psychiatry but also how it came to influence and embroil with the coinciding emergence of counter-culture in the 1960’s and ‘70’s.
What was anti-psychiatry?
The modern use of the term ‘anti-psychiatry’ refers to an international movement which arose during the 1960’s and 70’s, so called for its centrally critical stance on psychiatry. The term ‘anti-psychiatry’ was coined by British psychiatrist David Cooper (1931-86) and expounded in his book Psychiatry and anti-psychiatry (1967) (Cooper, 1967), which was just one of many publications to have arisen within the same decade that challenged the theories and practises of mainstream psychiatry. A number of key critics are regarded as having developed the founding ideas which would become the focus of anti-psychiatry; among them, Cooper, R.D. Laing, Joseph Berke, Thomas Szasz and Franco Basaglia are of note. They produced a new body of ideas which stemmed from a highly varied background of locations and sources, leading to a movement which comprised of many different geographical and conceptual centres. While there was much agreement across the board, with many critics joining together to promote alternative approaches to psychiatry, there were also important disagreements that ran between them. Laing and Szasz are commonly cited as two of the main proponents of anti-psychiatry, and indentified as thus by Cooper, despite both publically rejecting the use of the term and disagreeing with many of the connotations that came with it (Double, 2006).
The common understanding of anti-psychiatry, then, is a more general designation of a critical movement than was Cooper’s. The sociologist Nick Crossley makes an attempt at this more general definition and explains why anti-psychiatry may be labelled as a movement and is distinguished as such from any previous critical attacks against psychiatry. His crowning distinction is that, quite apart from questioning the certain therapies or policies of psychiatry, anti-psychiatrists “questioned the very basis of psychiatry itself: its purpose, its foundational conception of mental illness and the very distinction between madness and sanity itself” (Crossley, 1998). They commented on psychiatry’s function as an agent of social control, its invalidity as a medical speciality and its tendency to harm those it professed to help. It was these commonly held themes that formed the unifying threads that bound the different critics together as so-called anti-psychiatrists. Further to the exceptional nature of their criticisms, Crossley makes the observation that the figures of anti-psychiatry were all psychiatrists themselves; adding that anti-psychiatry was a “revolt from above,” and therefore distinguished from other threads of criticism including those ‘from without,’ such as the attacks from the Church of Scientology, and ‘from below’ such as the formation of the Mental Patients’ Union in 1973 (Crossley, 1997). This allowed the anti-psychiatrists to have a powerful influence within their profession as well as the reading public. They received wide publicity throughout the era and enjoyed a popularity in the growing culture of left wing politics in 1950’s and 60’s Britain. Anti-psychiatry was brought into the social sphere by its supporters, transforming it far from just a collection of similar theories and criticisms into a cultural phenomenon, and its key figures became the spokespeople of a new movement.
To fully appreciate the sense in which anti-psychiatry meant to question the very foundations of psychiatry, it is first necessary to appreciate what these foundations were and where they came from. Many of anti-psychiatry’s contestations resonate throughout the course of psychiatry and the same dilemmas which faced mid-twentieth century psychiatry had been faced before by mid-nineteenth century psychiatry, and again long before then.
In his renowned work, The Greatest Benefit to Mankind (Porter, 1999), historian Roy Porter explains that it was with the rise of the lunatic asylum in the nineteenth century that madness was first placed under the charge of the medical profession. Prior to this the mad were the responsibility of the community and were routinely kept indoors, ousted, jailed or confined within the madhouses. Religion and common morality had the duty of care and physicians would play only a small and customary role. But the asylum facilitated a growing interest of medical inquiry into madness, allowing large numbers of the mad to be gathered together, studied in detail and classified for the first time just like any other disease (Franz & Sheldon, 1967). Mad-doctors became increasingly popular and a speciality of medicine materialised where there were new voids of knowledge to be filled and much renowned to be earned. The progressive French physician Philippe Pinel (1745-1852) believed that institutionalisation provided better conditions of living for the insane (Franz & Sheldon, 1967). His ‘striking the chains off the mad’ symbolised a stand against the mistreatment of the mad and a call to view them as people who were simply ill, and whose illnesses could be understood and provided for by therapy.
Wilhelm Griesinger (1817-68), a German psychiatrist, was another leading figure who spoke of the virtues of medicalisation. He shared the common sentiment of the time that while accepting psychological and social factors, madness was essentially organic and rooted in lesions of the brain (Porter, 1999). The treatment of madness was within the medical domain and must be seen within the medical model of illness. He made the resounding remark that ‘mental illnesses are brain diseases,’ and followed that by giving a diagnosis of disease patients’ were also given dignity. An organic origin to madness laid a hope in science, Griesinger believed, and transformed what was formerly a stigmatising label into a medical condition.
The profession was established in 1841 with the Association of Medical Officers of Asylums and Hospitals for the Insane, the forerunner to the present-day Royal College of Psychiatrists (Hunter, 1994). Psychiatry saw a continuing development of its theories well into the twentieth century with many notable physicians such as Kraepelin, Wernicke, Alzheimer and Charcot making names for themselves by describing new syndromes and speculating as to their aetiologies. But while classification within the asylum advanced into the twentieth century, therapies continued along an experimental course which combined moral approaches and lifestyle changes with a mishmash of more extreme methods. These would span from the early nineteenth century - with excessive bloodletting, cold water immersion and forced spinning whilst strapped to a chair - right through to the twentieth century - with insulin shock therapy, electro-convulsive therapy and psycho-surgery (Franz & Sheldon, 1967). While some of these were said to be effective, and others gained worldwide acclaim, there was a growing criticism that treatments were inhumane and their extremity a sign of desperation. Around 1900 the asylum came under fire, with scandals, alleged mistreatments and abuses being exposed all over the world. Clifford W. Beers (1876-1943), a former patient and Yale graduate, formed The Mental Hygiene Society which was one of a number of pressure groups aimed towards improving the standard of care for the mentally ill (Porter, 1999).
Asylums were then cast under a poor light and a process of reform was called for. Many lost faith in the values of the asylum and newer psychological approaches such as Freud’s psychoanalysis and Jung’s analytical psychology introduced original theories which gained wide popularity. Despite this, psychiatry dominated the care of the mentally ill and the advent of psychopharmacology saw a faith renewed in science and its ability to treat. First lithium in 1939 and later antipsychotics and antidepressants were introduced, working to restore the credibility of psychiatry (Porter, 1999). Medications dominated care and pushed patients away from mass institutionalisation towards a more community and outpatient based approach. Others felt that a positive change need not do away with the mental hospital and instead transform the paternalistic approach of the old asylums into a more equal communal set-up. With this notion in mind Maxwell Jones (1907-90) pioneered the ‘therapeutic community’ at Belmont Hospital in the late 40’s (Franz & Sheldon, 1967), in which doctors and patients could live together to co-create new approaches to therapy (Jones, 1952). Jones’s work would become a starting point of interest for many of the psychiatrists who later went on to be dubbed anti-psychiatrists. This growing interest in alternatives marks the beginning of the anti-psychiatrists’ story.
Reframing ‘mental illness’
During the early 1960’s a number of psychiatrists began to question the nature of mental illness and its place within the medical model. Schizophrenia was one of the most devastating of these illnesses and amongst the least understood. For this reason it was taken on by the anti-psychiatrists as the paradigm of mental illness and became the focus of review. One of the earliest to publish on the subject was a Scottish psychiatrist named Ronald D. Laing (1927-89). Educated in Glasgow and trained in psychoanalysis, Laing’s writing was heavily influenced by existential philosophers and intellectual authors. His first book, The Divided Self (1960), attempted to make sense of the process of going mad in the terms of existential phenomenology. Laing stated that people developed schizoid personalities, and later schizophrenia, because of a fundamental ontological insecurity (Laing, 1960); that is, a fundamental anxiety about their being in the world. In order to conform to the outside world the ontologically-insecure create false-selves in order to protect their true-selves from harm. However, while their false-selves are confirmed and accepted by the outside world their true-selves are, in effect, disconfirmed and threatened with annihilation. Further distancing of the true-self then occurs to protect from a further disconfirmation, and the cycle repeats itself until the true-selves have no other defence from external annihilation than a complete dissolution; a defence which realises exactly that which it means to defend against. This process was the basis of his divided-self concept.
Laing went on to explore how human interaction contributes to the aetiology of mental illness. His work at the Tavistock Institute of Human Relations lead to his second book, Self and Others (1961), in which he outlined the interpersonal processes that occur in a host of undesirable social positions; including pretences, elusions, collusions, injunctions and untenable positions (Laing, 1961). Such processes he linked with concepts which had gained ground elsewhere. Concepts such as the schizophrenogenic mother (Lidz et al, 1965) and Bateson’s double-bind manoeuvre (Bateson et al, 1956) were two such theories that also made an impact on the anti-psychiatrist David Cooper. Cooper, like Laing, believed that schizophrenia was not a disease in the traditional sense, but that it was a reaction to unbearable stresses of life. For him, these stresses began with the family and were perpetuated by society. In The Death of the Family (1971) Cooper describes the family as a conditioning system which imposes a false system of morals and exploitative ideals, reflecting the structure of society itself. This false system does fundamental violence to the self, and whoever deviates their behaviour from the expected norm is given the label of schizophrenia (Cooper, 1971). This idea has much in common with the Social Labelling Theory which was first described in Becker’s Outsiders (1963), which asserted that no behaviour is intrinsically deviant, but rather it is the reaction of others that designates an act as deviant or not, and leads to the labelling of those judged thus (Becker, 1963). This initial ‘primary deviance’ is then distinguished from a ‘secondary deviance’ which arises from labelled individual’s reaction to the responses of others to his initial abnormal act (Lemert, 1967).
By 1967 Laing too had shifted his focus onto society’s role with The Politics of Experience and The bird of paradise (Laing, 1967), in which he explains that “modern society clamps a straightjacket of conformity on every child that is born.” This leads to a life of alienation from one’s true potential self, and schizophrenia may simply be a creative and self-realising protest against this alienation.
The anti-psychiatrists had brought madness away from the medical model of illness and into the social sphere, offering an entirely new paradigm for the causation of mental illness. As Laing observed himself:
I have given a glimpse of a revolution that is currently going on in relation
to sanity and madness, both inside and outside psychiatry...The clinical
point of view is now giving way before another point of view that is both
existential and social. (Laing, 1964)
But while Laing, Cooper and many of the other prominent anti-psychiatrists were calling for a reframing of mental illness other writers were denying its existence altogether. Thomas Szasz (1920-present) is an American psychiatrist, trained in both medicine and psychoanalysis, and a prolific author of some nine books on the topic of mental illness. In his foremost work, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (Szasz, 1961), he explains how ‘mental illness’ cannot exist in any real sense and why psychiatry therefore has no right to rule over those who are diagnosed as ‘mentally ill.’ He maintains that illness and disease, in the true sense, are defined by a physical lesion which leads to a demonstrable alteration in function. This is what epitomises the medical model of illness. However, when the term illness is applied to a form of mental suffering, for which there is no demonstrable lesion, it is used incorrectly and may only be applied in metaphorical sense. Our use of the term ‘mental illness,’ is therefore semantically confused and misleading. Szasz holds that there are only either brain diseases or non-diseases, and that, like epilepsy and homosexually - which were both once considered mental illnesses and subsequently re-categorized as brain disease and non-disease respectively – before them, ‘mental illnesses’ ought to be re-described as either one or the other (Szasz, 1972). Hence, placing those conditions which are described by the metaphor of ‘mental illness’ within the medical model must then bring into the question the role that psychiatry, as a medical practise, can justifiably have in their treatment.
Psychiatry as social control
Szasz reflects that with the birth of modern psychiatry the criteria for defining disease were broadened to encompass not only observable and physical malfunctioning but also declared malfunctioning of any kind (Szasz, 1972). This broadening coincided with the increasing classification of mental illnesses throughout the late nineteenth century and well into the twentieth century, as mentioned above, which lead to myriad new diagnoses. But these declarations betrayed the medical model and instead took on a moral basis. Bad behaviours became symptoms to be treated by the psychiatrist. Szasz argues that psychiatry therefore takes on a function outside of its alleged scientific confines and attempts to “deal with moral problems which...they cannot solve by medical methods”(Szasz, 1972). For this reason he fundamentally opposes the powers that psychiatry has over the human rights of mental patients, contending that the moral management of the people is the duty of the state. Involuntary hospitalisation and insanity defences are outside the medical profession’s jurisdiction, and the ‘mentally ill’ should be placed under the criminal justice system instead (Szasz, 2001). This take is quite at odds with Griesinger’s nineteenth century belief that diagnoses gave dignity to sufferers. For Szasz, a diagnosis is a stigmatising label which wrongly assigns moral deviants the sick-person role and risks taking away their liberty.
The Italian psychiatrist and neurologist Franco Basaglia (1924-80) saw the function of psychiatry similarly misplaced in its power to control. As he observed, psychiatry was a device which excluded an underclass of people who were not so much mad but miserable and poverty stricken (Basaglia, 1967). The asylum was “a dumping ground for the under-privileged, a place of segregation and destruction where the real nature of social problems was concealed behind the alibi of psychiatric treatment and custody”(Double, 2006). Basaglia, along with the anti-psychiatrists Cooper, Berke and Redler became interested by the therapeutic communities pioneered by Maxwell Jones; however, all were soon disillusioned and recognised that yet more radical changes would be necessary in order to reform a system which was controlling and harmful (Double, 2006). The anti-psychiatrists, Laing among them, went on to found the Philadelphia Association with the view to “change the way the ‘facts’ of ‘mental health’ and ‘mental illness’ are seen” (Cooper, 1994). Kingsley Hall was the first of several new communities set up by the Philadelphia Association which provided space for troubled people to comfortably live out the process of going mad. This supported the view that madness was a natural healing process and must be allowed to take its own course without the imposition of mainstream psychiatry’s medical therapies (Laing, 1967). It also provided a communal way of living which meant to escape the damaging structures of family and society. Cooper saw this as a blueprint for a revolution on a societal scale, and the only way to prevent the continuing violence of psychiatry (Cooper, 1971).
Basaglia, meanwhile, sought to change the system from within. He formed the pressure group Psychiatric democratica in 1973, with the aim to reform the laws that sanctioned confinement and marginalisation under mental health law. He was enormously successful and in 1978 ‘Law 180’ was passed which prevented the further admission to mental hospitals and encouraged care within society (Double, 2006).
The influence of anti-psychiatry
As previously mentioned, the founding ideas of anti-psychiatry all originated from within psychiatry itself; but, in fact, most of them were not initially published with the intention to challenge mainstream psychiatry at all. Laing wrote The Divided Self in an academic style and intended it to be of interest to a professional audience (Crossley, 1998). It was even reviewed as such by the British Medical Journal:
Though most psychiatrists will find the author’s approach uncongenial and
unhelpful therapeutically, they will recognise and even defend it as one
possible way of viewing and describing mental disorder.(BMJ 19/05/62).
But as there were an increasing number of publications that focused on alternative perspectives to mental illness, the key authors began to cross identify and reference one another in subsequent works (Crossley, 1998). By the time Laing’s The Politics of Experience and Cooper’s Psychiatry and anti-psychiatry were published their ideas had developed and grown in strength, taking on a significantly more critical tone. The style had changed too, from traditional medical exposition to a highly politicised polemic and, because of this, they were progressively marginalised from scientific journals (Crossley, 1998). Despite this, anti-psychiatry’s themes about society and freedom resonated with the political climate of the time (Musgrove, 1974). They found an increasing readership among the emerging new left crowd of the 1950’s and ‘60’s counter-culture scene. Indeed, much of anti-psychiatry was influenced by the same counter-culture enthusiasms, for communal living, love, LSD, and the like, making a fusion of values inevitable (Crossley, 1998). This shift amounted to a movement against psychiatry.
Influence within the profession was divided between those who stood by the orthodoxy of mainstream psychiatry and a generally younger generation of psychiatrists who became inspired (Crossley, 1998). Psychiatrist Anthony Clare claimed that Laing “...influenced an entire generation of young men and women in their choice of psychiatry as a career” (Clare, 1992). Continuing support from psychiatrists and patients alike encouraged anti-psychiatry based projects such as the Arbours Association (Double, 2006) and The British Network for Alternatives to Psychiatry to continue well into the ‘70’s (Ticktin, 1997). Mainstream psychiatry, on the other hand, saw the threat of anti-psychiatry against its core principles and it fought to maintain its integrity as a clinical science. Robert Spitzer headed a major operation to revise and enhance the definitions of psychiatric diagnoses in the American Psychiatric Association’s 1980 edition of the Diagnostic and Statistical Manual (DSM III) (Double, 2006). Ultimately this worked. Deinstitutionalisation continued into the ‘70’s and ’80’s (Franz & Sheldon, 1967) and anti-psychiatry went on to influence critical traditions still seen today with The Critical Psychiatry Network and post-psychiatry (Double, 2002), but anti-psychiatry qua movement lots its momentum in the late 1970’s and fell into the annals of history.
The anti-psychiatry movement was the result of a unique interplay between a small host of like-minded individuals and a political climate which was ripe for receiving the messages they collectedly had to offer. The message of anti-psychiatry was a call for a paradigm shift in the understanding of mental illness; then a call to question the systems that endorsed and acted on behalf of an alienating society, abusing and marginalising those who were wrongly seen as different, and coshing those natural behaviours with medications. Counter-culture identified with these themes and provided a platform whereby they could be pronounced widely and with great influence. Psychiatry was challenged in an exceptional way, and to the present day anti-psychiatry remains a lasting influence on those who stand critical against what is one of the most contentious medical specialties.
I would like to express my gratitude to Dr. Neel Halder for his kind support and guidance.
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Copyright Priory Lodge Education Ltd 2012 -
First Published November 2012