Bozuk Psikiyatri: Direnci Kuramlaştırmak ve (D)evrimi Tasarlamak - İngilizce kopya
Bozuk Psikiyatri (ya da Psikiyatri Bozuldu; ya da Psikiyatrinin Bozukluğu):
Table of Contents
Contents
Copyright
Acknowledgments
Foreword
Preface
1 - Impassioned Praxis: An Introduction to
Theorizing Resistance to Psychiatry
2 - Becoming Perpetrator: How I Came to Accept
Restraining and Confining Disabled Aboriginal Children
3 - The Withering Away of Psychiatry: An
Attrition Model for Antipsychiatry
4 - Psychology Politics Resistance: Theoretical
Practice in Manchester
5 - From Subservience to Resistance: Nursing
versus Psychiatry
6 - Developing Partnerships to Resist Psychiatry
within Academia
7 - “We Do Not Want to Be Split Up from Our
Family”: Group Home Tenants Amidst Land Use Conflict
8 - Disability, Divisions, Definitions, and
Disablism: When Resisting Psychiatry Is Oppressive
9 - Convention on the Rights of Persons with
Disabilities and Liberation from Psychiatric Oppression
10 - Deeply Engaged Relationships: Alliances
between Mental Health Workers and Psychiatric Survivors in the U K
11 - Trans Jeopardy / Trans Resistance: Shaindl
Diamond (S D) Interviews Ambrose Kirby (A K)
12 - Take it Public: Use Art to Make Healing a
Public Narrative
13 - Feminist Resistance against the
Medicalization of Humanity: Integrating Knowledge about Psychiatric Oppression
and Marginalized People
14 - Sly Normality: Between Quiescence and Revolt
References
Contributors
Index
Contents
Cover
Copyright
Acknowledgments
Foreword
Preface
1 - Impassioned Praxis: An Introduction to.
Theorizing Resistance to Psychiatry
2 - Becoming Perpetrator: How I Came to Accept
Restraining and Confining Disabled Aboriginal Children
3 - The Withering Away of Psychiatry: An
Attrition Model for Antipsychiatry
4 - Psychology Politics Resistance: Theoretical
Practice in Manchester
5 - From Subservience to Resistance: Nursing
versus Psychiatry
6 - Developing Partnerships to Resist Psychiatry
within Academia
7 - “We Do Not Want to Be Split. Up from Our
Family”: Group Home Tenants Amidst. Land Use Conflict
8 - Disability, Divisions, Definitions, and
Disablism: When Resisting Psychiatry. Is Oppressive
9 - Convention on the Rights of Persons with
Disabilities and Liberation from Psychiatric Oppression
10 - Deeply Engaged Relationships: Alliances
between Mental Health Workers and Psychiatric Survivors in the U K
11 - Trans Jeopardy / Trans Resistance: Shaindl
Diamond (S D) Interviews. Ambrose Kirby (A K)
12 - Take it Public: Use Art to Make Healing a
Public Narrative
13 - Feminist Resistance against the
Medicalization of Humanity: Integrating Knowledge about Psychiatric. Oppression
and Marginalized People
14 - Sly Normality: Between Quiescence and Revolt
References
Contributors
For those who inspire us
– psychiatric survivors,
The editors would like to acknowledge the work of
the many people and organizations whose assistance along the way has made this
book possible. First and foremost, we would like to acknowledge the efforts of
psychiatric survivors and other activists whose sterling work over the years
underpins much of the theorizing. We could not have theorized, nor would anyone
be writing in this area, if the stories of survivors had not moved us and if
their strategic efforts had not tutored us. We likewise acknowledge the various
contributing authors whose chapters make this book what it is. Whether it be
theorizing trans resistance or the efforts of progressive psychologists, thank
you for rising to the occasion and agreeing to be part of the team putting out
this ground-breaking book. We thank the kind and expert staff at McGill-Queen’s
University Press and would particularly like to single out the helpful work of
our acquisition editor Jacqueline Mason and editor Kathryn Simpson. We were
likewise blessed with exceptional graduate assistants who networked with authors,
edited, gathered information as needed, worked long hours so that deadlines
could be met – Laura McKinley, Lauren Spring, Griffin Epstein, and the graduate
assistant without whose expert knowledge of the Chicago Manual we would have
been in dire distress – the multi-talented Mary Jean Hande. We acknowledge the
assistance provided by the Ontario Institute in Studies in Education for
providing Burstow with four one-year graduate assistantships. This book has
been published with the help of a grant from the Federation of the Humanities
and Social Sciences, through the Awards to Scholarly Publications Program, using funds provided by the Social Sciences and
Humanities Research Council of Canada, and we would like to thank SSHRC. Publication of this book has been supported by funding from the
Memorial University of Newfoundland, whom we additionally thank.
Foreword
PAULA J. CAPLAN
Activism to improve the way we deal with
emotional suffering is essential, and the time for it is now. This book’s title
announces that revolution is needed, given the magnitude of past, current, and
– unless we act now and act large – future suffering.
Many of us have
spent decades writing and speaking about the harm done by not all but far too
many professionals, but far too little has changed. Let me offer a perspective
from my experience, and keep in mind as you read that I am only one of a great
many who have tried to impel significant improvements and are saddened by the
paucity of progress despite massive public education, and by marked increases
in the harm caused by some whose job is to help.
I was at American
Psychiatric Association headquarters as it prepared an edition of its Diagnostic and Statistical Manual of Mental
Disorders (D S M) in the mid-1980s, thereby falling through a rabbit hole into the realm
of psychiatric diagnosis, where I learned of a myriad of problems that can
cascade from the applying of a mental disorder label. The diagnostic system is
the first cause of everything bad that happens in the mental health system, because
labeling is used to justify “treatments” that are often damaging and
destructive. If the powers-that-be deem you normal, there’s much less they can
do to hurt you. I started a petition protesting two proposed DSM categories that would have been especially dangerous to women. The
petition ultimately represented more than six million people, but virtually
nothing changed (Caplan, 1995). Decades later, I started a change.org petition
called “Boycott the DSM : A Human Rights Issue” (http://www.change.org/petitions/boycott-the-dsm-a-human-rights-issue),
and nothing changed.
I learned from the inside about the enterprise of creating diagnostic
categories when I spent two years on two DSM-IV committees,
resigning in horror after seeing how starkly D S M -I
V head Allen Frances and his cronies misused junk
science to suit their purposes and ignored, distorted, even lied about good
research that conflicted with their aims. I tried using the power of theatre
and created videos about harm from diagnosis, created a website and a Facebook
page and a blog, organized two Congressional briefings, and called for
Congressional hearings, but nothing changed. I have tried in vain for decades
to find lawyers who will file lawsuits against the APA and to explore
ways to stop the harm caused by the psychiatric diagnoses in the D S M and International
Classification of Diseases.
I organized the filing
of nine ethics complaints with the APA’s Ethics Committee,
describing how complainants had been damaged because of the false advertising
of the DSM as scientific and helpful and the failure to warn of the harm it often
causes. They summarily dismissed the complaints on highly spurious grounds,
with no attention to their merits. Despite dismissing the complaints, they
could have made restitution and implemented the complainants’ many suggestions
to prevent future harm, but they did nothing. When four of us went peacefully
to A P A headquarters simply to request a meeting, someone apparently ordered
security guards to eject us from the building. Five of the complainants also
filed complaints with the Office of Civil Rights of the United States
Department of Health and Human Services, since psychiatric diagnosis is entirely unregulated – a
fact that ought to be universally known, and that Department is the obvious one
that should be providing regulation. At this writing, while we await word of
their decision, we are exploring a possibility for complaints to a quite
different government entity. After all this and the work of many others, so
far, nothing has changed. As Parker warns in this book, massive social change
can seem impossible, but, says Parker, it is dangerous in the face of the slow
pace of change to ignore the need for radical social changes and escape into
the “psy-” realm instead, portraying social problems erroneously as individual,
psychological ones.
This book is thus
sorely needed and offers a glorious array of forms of activism, some clearly
descending from the work of psychologist and feminist Phyllis Chesler. Chesler
(1972) in her pioneering Women and
Madness compellingly exposed and cried out for abolition of many abuses in the so-called mental health
system, including but not limited to its prejudices and human rights
deprivations. In founding, respectively, MindFreedom International and
PsychRights, David Oaks and James Gottstein created vehicles for radical
change, MindFreedom through public education and actions like the famous hunger
strike (which revealed as unfounded the psychiatric establishment’s claim that
emotional suffering is caused by chemical imbalances), and PsychRights through
filing of courageous lawsuits against Pharma and involuntary commitment.
Many of the
chapters reveal that it is about far more than psychiatry specifically. Some
therapists – pastoral counsellors, social workers, psychologists, marriage and
family therapists, nurses, or psychiatrists – have been compassionate and
helpful to those who suffer, and some have done so without pathologizing them.
But too many in each category have caused far too much harm.
As Burstow and
LeFrançois write in their chapter, the harm is disproportionately done to women
– as well as, as Diamond shows in her chapter, to old, racialized, trans,
and/or poor people and children but also even to white, heterosexual, wealthy
men. The harm comes in a wide array of forms, including but not limited to
skyrocketing self-doubt, shame, loss of custody of one’s children, loss of
employment, and loss of the right to make decisions about one’s medical and
legal affairs. In this book we see other kinds of harm, perhaps all due to what
Withers astutely describes as the relative powerlessness that can result from
being called mentally ill. Minkowitz displays her incisive thinking and dynamic
leadership in the struggle for international recognition of human rights
violations of people regarded as mentally ill, writing that “disability is
treated as a disqualification for the exercise of fundamental human rights and
freedoms” and showing where mistreatment constitutes torture. Chapman, in a
courageously confessional chapter, describes having perpetrated violence
against disabled Aboriginal children because of being wrongly taught by others
that “our violence was only ever a response to [the children’s] violence.”
Finkler shows how, because of having been labeled “mentally ill,” a group of
people sharing a residence was subjected to oppressive laws not applied to
others. Diamond and Kirby address the damage caused by the pathologizing of
people for being transgendered or transsexual, and they note the disturbing
phenomenon, due to the psychiatrizing of society, that some
people who have suffered because of being considered abnormal actually seek psychiatric labels
as “evidence” that they have been so mistreated as to become mentally ill. This
sad pattern parallels the knee-jerk diagnosing of those who have been to war,
raped, or injured in automobile accidents or lived through natural disasters as
mentally ill with “Post-traumatic Stress Disorder,” which is officially listed
as a mental disorder. We ought to offer suffering people help and support
without insisting that they agree to be called mentally disordered.
To read this book
is to learn about a host of avenues for activism. Mills relates how two people
pathologized in the system found ways to resist individually. Adam offers
examples of nurses whose radical thinking has led to sorely needed critiques of
mental health practices (great models for others who wish to become activists),
as well as analysis of why so few nurses have done such work. Beresford and
Menzies urge academics to recognize the importance of the knowledge and
perspectives of service users / survivors in creating research aimed at
bringing about radical change, and McKeown, Cresswell, and Spandler illustrate
and call for more “reciprocal democratic” alliances between mental health
workers and psychiatric survivors. Finkler describes the inspiring way that
mental health survivors living together pronounced themselves a family in order
to challenge land-use laws, and Diamond and Kirby show the need for service
providers to follow the lead of some in Canada who refuse to call being transgendered
or transsexual a mental illness. Barnes and Schellenberg inspire us to turn to
alternative approaches to reducing human suffering, showing the importance of
speaking and thinking in terms of “emotional pain” rather than “psychiatric
disorder” and using art events to treat such pain with respect rather than
shaming, to promote healing through the arts by finding or creating meaning, to
inspire others to do the same, and to educate the public about the varieties of
human suffering. Minkowitz’s call to recognize the Convention on the Rights of
Persons with Disabilities and apply these rights to those diagnosed as mentally
ill reveals a crucial and international arena in which activists can join the
struggle. Providing important context for all activism, Burstow cautions that
in planning actions, we must avoid legitimizing the currently harmful system
and widening its net, and she suggests numerous effective forms of activism,
including many through the legal system.
With the publication of this treasure trove of a book offering many
avenues for activism, no one can claim that they want to act but don’t know
what to do. Each of us has a moral responsibility to choose a route to stopping
the harm.
Preface
KATE MILLETT
There is a certainty about Burstow, LeFrançois,
and Diamond that could only have come from Canada. Psychiatry in whatever guise
is the enemy of common sense, reasonableness, empathy, even imagination. It is
breathtaking. It’s like the old days. Like Szasz, when psychiatry was
understood as a means of social control, a kind of voodoo, an invasion of state
power upon the individual will struggling with life, with death and debt and
unemployment, with the indifference of humanity. Now another element was added.
The evidence of the
state that one was unbalanced, crazy, inappropriate, “out of control,” insane,
incompetent; a danger to one’s self or others, and that was that. Then another
will imposed, substituted judgment. It no longer matters what you think. You
were a “nut case,” barely human; every notion you had was only proof that you
were “loco.”
As for their big
new stuff, electroshock? I recognized this was torture when I was only eighteen
years old and working at a summer job at St Peter’s Asylum in Southern
Minnesota. I refused to participate, whereupon I was transferred to night duty
in the geriatric ward, waking up old women to a day of nothingness. We ran out
of clothes half way through dressing them. Nothing so concentrates the mind to
one’s humiliation as going naked all day long. Similar situations pertain in
private homes even today.
The cruelty of
psychiatry has not changed. It has overwhelmed us: where Big Pharma sponsors
everything, every conference, every psychiatric journal, and corrupts law
enforcement, even immigration.
In hospitals there
is still the Thorazine Thirst, caffeine is no longer served on the ward; you
can lie in your own waste all day, hoping a nurse will stop
by and clean you up, you will eat what they want you to. Management is unafraid
to torment you. Forget freedom of movement. There is solitary confinement and
bondage, additional punishments and preventions. Don’t even dream of sexuality
or alcohol, listening to music, or enjoying nature. Life has increasingly less
to offer, the life of a prisoner without the thrill of wrongdoing. A confusion
of noise, always someone is screaming, yelling, protesting; it never stops. The
guards go home to quiet. The prisoners never do.
Elsewhere in the
system there is the torment of trans people, their fear of psychiatry, in the
definition of personhood, in the permission to surgery, bars often insuperable
to their youth and poverty. Then there is the oppression described by Tina
Markowitz, as a form of torture as the United Nations saw the Disability
Convention work its way through the nations of the world, emerging at last,
triumphant. A model for all States to follow, yet few do. Especially now in the
face of worldwide recession with migration problems besetting us, warring
factions of religion, the rights of women and racialized others so jeopardized.
How will we proceed?
Psychiatrists are
rarely sued, though they should be. They will respond with a prescription pad,
another pill, another bit of medicine to swallow, another part of the self,
condemned by them. No matter how proud you are, they’ll put you down, they’ll
settle your case, they will humiliate and patronize you.
I have observed
this through three generations of women in my own family – and the friends
around me. Psychiatry is very hard on women. There is a double standard, a set
of patriarchal practices. They are always at the ready to prescribe, usually
having no notion of the effects of the prescription; they will still prescribe
it confidently. Physician do no harm has no meaning for them. None.
It takes a brave
voice to contradict this, to argue the opposite. How necessary this clear call
for justice, for common sense against superstition and folly, the casual
cruelty of everyday behavior. Intent even in understanding the workings of the
mind and finding that useful and admirable. Instead of merely condemning,
asking why and how and actually wanting to know.
Barnes and
Schellenberg’s emphasis upon the arts is especially important. The way the arts
give an opportunity to bridge the gap between the public and emotional suffering,
nominating it as something everyone experiences. An image in a painting, a
gesture in a dance, an evocation of loneliness or despair
or joyfulness. The gesture itself, devoid of all syntax, held for a moment so
that any observer can give its own meaning.
What is most
important about the contributors to this volume is their readiness to
experiment, to emphasize, to inquire, to drop the entire pretense to science
and sanity, to be honest, to look chicanery in its face and to call quackery by
its name. To tell the experience of the people they report on truthfully and in
experiential detail. Not as miracle workers with some formula to sell, some
special point of view, some theory. They turn much of the accepted wisdom about
the human mind on its head, which is as it should be. So much of it is
nonsense, propaganda for a guild, even for corporate entities.
This is a landmark
book, testimony to honourable research and humane understanding. What is
remarkable, almost miraculous, is the sensibility that produced it, that
steadfastness in its editors and contributors, that precision, that argument.
That these three academics – Burstow, LeFrançois and Diamond – could come up
with something this amazing, groundbreaking – this is a book that will be
talked about for a long time.
Impassioned Praxis:
An Introduction to
Theorizing Resistance to Psychiatry
BONNIE BURSTOW AND
BRENDA A. LeFRANÇOIS
Psychiatry is not about benevolence, care, or
help. While psychiatric apologists such as Edward Shorter (1997) have long
positioned psychiatry as the liberators of the mad, in actuality psychiatry
imprisons and oppresses people labeled “mad” in astronomical numbers. At no
time in earlier eras was the number caught within the auspices of the mad
professions anywhere near the number today. While psychiatry supporters make
reference to the terror of Bedlam1 – currently still in operation, and the hospital in
medieval and Renaissance England synonymous with “booby hatch” and memorialized
in Shakespeare’s plays (see for example, poor Tom in King Lear) – the reality is that at any
given time during this period only twenty or thirty people were actually held
there; and as Porter (2002) makes clear, most people thought of as mad were
allowed to rove the countryside without incarceration and without drugs. Such
people were certainly often ill-treated – we are in no way depicting these
earlier times as good – but without the relentless infringement that
characterizes psychiatric practice today.
The history of
psychiatry is the history of a profession that ruthlessly drove out all of its
competitors – the women healers, the astrologers, ultimately even the
psychoanalysts – and completely medicalized any and all conceptualizations of
madness, developing both a “mental illness” construct and a world-wide crisis
of iatrogenically created drug addicts. In the epistemological violence of diagnosis, in the chemical violence of drugs that place one’s
very brain into a strait jacket, psychiatry attacks women. By the same token,
it attacks seniors. It attacks racialized people. It attacks trans populations.
It attacks children. It attacks poor people. However, what is most pernicious
about this institution is that it attacks not only these otherwise oppressed
groups, it attacks everyone – all this in the name of help. One need only look
at the multiplication of diagnoses in the progressive versions of the Diagnostic and Statistical Manual (DSM), to realize that this profession is intent on having more and more
people under its auspices. This is an institution that is ultimately about
pathologizing and “treating” everyday life.
We stand in a long
and proud tradition of resistance. It may be argued that resistance to
psychiatry is as old as psychiatry itself, albeit it is not until the
nineteenth century that we find clear records of such resistance. In the
nineteenth century, American psychiatric prisoner Elizabeth Packard brought a
writ of habeas corpus against her husband who attempted to reinstitutionalize
her; and, simultaneously, Hersilie Rouy, a psychiatrized woman in France and
Mary Huestis Pengilly, a psychiatrized woman in Canada were engaged in similar
activism (St-Amand and LeBlanc 2013). However we date it, there has long been
not only resistance but organized resistance to this institution. Inmates have
demonstrated against it, scholars have written about it. Feminized and
racialized people have objected to the targeting of their communities.
Historians such as Foucault, moreover, have rigorously sought out and surfaced
subjugated knowledges.
At times – and
necessarily so – this resistance is tied intimately to identity politics. This
has been enormously important and, indeed, the ongoing theorizing and
resistance to psychiatry by women in particular has contributed substantially
to the unmasking of psychiatry as an untenable, patriarchal, and otherwise
oppressive institution. As such, identity politics has an absolutely essential
role to play. In no way should that reality ever be questioned. As with all
identity politics, however, identity politics in this area can at times tip
into being exclusionary – and it is this that we question. The need to keep
“other” theorists with “other” identities (or those who refuse to identify) at
bay may be most keenly felt by people who openly identify as psychiatric
survivors, mad, or “service users.” People who identify as such often do not
want sane-identified people theorizing or engaging in activism on their behalf.
This is understandable given the history of harm,
domination, and co-optation by seemingly like-minded radical therapists and
academics who have benefitted from inequitable alliances with psychiatrized
people over the past half century. The marginalization, by seemingly radical
therapists, of psychiatric survivors in the U S A that led to
the creation of their psychiatric survivor movement is a clear example of such
unconscionable domination. Indeed, there are times in every movement, and there
are times in the lives of oppressed people, where it becomes important to keep
people who do not share that oppressed identity at bay. Nonetheless, in the
long run such divisions do not serve us, do not contribute to the task at hand.
Neither is it tenable to artificially create dichotomies and divisions between
activists and academics, between the openly psychiatrized and those who may
refuse classification of their experiences or those who have escaped
psychiatrization. The point is, given that we are all at risk of
psychiatrization, we cannot afford to exclude the work and theorizing of anyone
engaging in radical and activist scholarship, if we are to succeed. We indeed
want to underscore how critical the psychiatric survivor voice is in engaging
in a psychiatric survivor analysis (Finkler, 2013). However, identity politics
alone will not win this fight – any more than the fight against classism would
be won if we understood socialism as something that should only be theorized by
and fought for by low-wage earners. While honouring the enormous importance of
madness-related identity politics, accordingly, we theorize resistance against
psychiatry as we would any other (r) evolution: something that demands the
attention of all who are critical and where everyone has a role to play.
We use, and are
grateful for, the body of work that has been created to date in this regard.
Critical, radical, and mad activist scholars from all disciplines and walks of
life have been creating such ammunition precisely by exposing the violence of
psychiatry – by showing it as medically unfounded (thank you Thomas Szasz,
Peter Breggin, Robert Whitaker, and Sami Timimi); by demonstrating the blatant
sexism (thank you Phyllis Chesler, Kate Millett, Jane Ussher, Paula Caplan,
Jean Baker-Miller, and Dorothy Smith); by unearthing the racism and indeed the
colonialism (thank you Frantz Fanon); by demonstrating the enormous harm done
to individual lives (thank you Erving Goffman, David Brandon, Geoffrey Reaume,
Don Weitz, and Irit Shimrat); by critiquing the DSM (thank you
Stuart Kirk and Herb Kutchins); by unmasking sanism (thank you Michael Perlin, E.L. Finkler, Jennifer Poole, and Erick Fabris); and by
linking it to the larger neoliberal machine and biopower relations (thank you
Michel Foucault, Nikolas Rose, Peter Beresford, and Joanna Moncrieff).
What has been
created to date is of immeasurable value. What we have not as yet created,
though, is a body of literature that theorizes precisely how to resist
psychiatry. Knowing your adversary is good but not good enough: you must also
know how to disempower that adversary – hence our decision to create this
volume.
The title of this
book, Psychiatry Disrupted: Theorizing
Resistance and Crafting the (R) evolution, clearly
announces the intent, the content, the mission of this book. It is precisely
about creating and theorizing resistance to psychiatry, moreover, creating and
theorizing resistance that is organized, that is scholarly, that has the force
of a revolution. The contributors in this book go beyond theorizing what is
wrong with psychiatry to theorize how we might stop it. In the process, we draw
on feminism; on the use of the arts; on Marxism; on anarchism; on
anti-colonialism; on anti-racism; on disability studies; on mad studies; on
anti-psychiatry; on critical psychiatry; on legal theory; on critical
psychology; on trans theories; on prison abolitionist principles; on
progressive nursing praxis; and on trade unionism.
The diversity
evident in the above list is purposeful and necessary. One dimension of that
diversity arises out of the geopolitical. What is significant in this regard is
that the individual movements that form part of this global movement have
developed differently in different geopolitical and cultural spaces and as a
result may at times seem to clash with each other. We have neither standardized
the theory nor the language of our contributors but instead stand by the
importance of allowing the differences to co-exist. Some differences are in
appearance only; for example, in the British context, the term “service user”
may often be used to refer to politicized survivors of the psychiatric system
whereas in Canada the same term “service user” would tend to indicate an
uncritical and pro-psychiatry position. In other cases, the difference is as
big as it looks and we are pleased, in this respect, that there is more than
one position represented in this book. For example, Minkowitz takes a social
model of disability lens, while other writers take a critical disability lens,
and Withers takes a radical disability lens. In another example, Cresswell,
McKeown, and Spandler essentially take a reformist lens whereas
Burstow takes an unmitigated anti-psychiatry lens, which permits only very
specific kinds of reforms. As the editors of this book, we ask you to consider
all of these varied positions because all constitute important contributions to
the (r) evolution. Similar to Karl Marx, who neither created nor advocated for
a divisive dichotomy between revolutionary and evolutionary Marxisms but
instead acknowledged the crucial role of both in creating a class revolution,
we understand that crafting the (r) evolution vis-à-vis psychiatry requires a
variety of thoughts and actions, best devised as deeply considered and
impassioned praxis. At the same time, inclusion in this book does not mean that
we as editors agree with all of the positions taken. Nor are we taking an
“anything goes” stance. Instead we suggest that some reformist positions are
consistent with the ultimate revolution, while others reinstate or reproduce
psychiatry. The positions most critical to this struggle are those that are not
simply about tinkering but are based in a fundamental critique of psychiatry.
THEMES
The overriding themes of this book include:
patriarchy, racism, colonialism, classism, sexism, cis-genderism, ableism – and
the way these intersect with sanism – as well as such themes as rule by
bureaucracy, medicalization, and pathologization. What are likewise interwoven
throughout this book are the following subthemes specifically related to
resistance: macro strategies, co-optation, coalition building, policy, and the
use of narrative.
Macro strategies
are approached differently by our various contributors. Many draw on social
movement theory and practice to make concrete suggestions for strategizing. For
example, influenced by left-wing anarchism and Quaker praxis, Burstow
systematically draws on the early principles of prison abolitionists to
articulate an attrition model that can guide anti-psychiatry practice.
Specifically, she comes up with three “defining questions” to ask regarding any
activism being considered. She demonstrates in turn how these questions can be
used in determining which actions of allies to actively support. By contrast,
Parker; Menzies and Beresford; and McKeown, Cresswell, and Spandler all draw on
critical psychiatry, Marxist analysis, labour resistance, critical psychology,
and anti-liberalism to explore such vital issues as coalition building within
the labour movement, and the bringing together of academics
and psychiatric survivors. Theorizing in a different vein, Minkowitz and
Finkler both use legislation to undermine local policy and current practices,
all from a structural vantage point; Finkler draws on land use and housing
policies and Minkowitz draws on international disability rights legislation.
Rather than focusing wholly on the macro level, Mills, in making linkages with
the macro-narratives and strategies of colonized and racialized people,
theorizes the everyday covert micro strategies that psychiatrized people may
use when it is not safe to use more overt strategies.
Coalition building
is a particularly central theme. Indeed, the one thing that all contributors
are clear about is that coalitions are necessary and have to be improved.
Specific types of coalition proposals that weave in and out of the chapters are
coalitions between such groups as the disability movement and the various
movements that combat psychiatry (Withers); between the mad movement and the
anti-psychiatry movement (Burstow); between the organized labour movement,
critical psychiatry, and psychiatric survivor movements (McKeown, Cresswell,
and Spandler); between the feminist movement and the various movements that
combat psychiatry (Burstow and Diamond); and between trans movements and the
anti-psychiatry movement (Kirby). While all see coalition as vital, as people
who have been in the trenches, no one sees it as easy. Kirby, Burstow, Diamond,
and Withers all caution readers about the importance of coalitions that do not
sabotage each other, that do not undermine any of the groups vulnerable to
psychiatry or any of the movements with which the psychiatric survivor
movement, mad movement, or the anti-psychiatry movement overlap. Diamond calls
for sensitive coalition building between all constituencies that are critical
of psychiatry, while unearthing problems that are created when constituencies
limit themselves to protecting their own group.
Co-optation more
generally is a serious concern of many of the authors in this book. A number of
writers reference, as an example, the co-optation of the gay liberation
movement in the seventies (Kirby, Diamond, Burstow). Others also speak of the
co-optation of the feminist movement (Diamond). Burstow, additionally, draws
attention to the fact that in trying to procure “services” in areas in which
there are few services, co-optation frequently happens. Adams explores the
inherent and “natural” co-optation of nurses, which happens
by virtue of their being theorized and situated as the “handmaidens” of
doctors. Courageously sharing his own narrative, Chapman demonstrates the pull
to co-optation that occurs when people work within the psychiatric
establishment and the concomitant need to scrupulously examine one’s
rationalizations.
Contributors dealing
with professional and academic strategies approach the issues quite
differently. Chapman attempts to insert resistance to dominant practice into
the social work classroom, demonstrating how personal narrative and ethics can
be used to challenge violent, demeaning, and unreflexive practices. Focusing on
nursing, and hoping to inspire other nurses, Adam points to individual nurses
as examples of the types of resistance that is possible. Parker’s overall
approach is to bring academic and survivor critiques to bear on the
professional practices of the psy-disciplines, whereas Schellenburg and Barnes
bring survivors and professionals together through art in order to interrupt
dominant psychiatric understandings and practices. Finally, Menzies and
Beresford discuss what academics do to push resistance within the halls of
academia while detailing some of the obstacles and opportunities therein.
Another theme that
weaves through various chapters is engagement with policy. Finkler uses
official policy to sabotage policy through an incorporation of a psychiatric
survivor analysis. Minkowitz explores the evolution of international covenants
and instruments as they theorize disability and disability rights, with
particular emphasis on the Convention on the Rights of Persons with
Disabilities and the Report of the Special Rapporteur on Torture; and she
suggests that these can be used to challenge current mental health legislation.
Kirby problematizes the inclusion – and indeed the domination – of psychiatry
in policies around trans medical services.
A final dynamic
that plays out in a number of the chapters is the use of narrative. Situating
herself within the macro narrative of colonialism, Mills suggests that
survivors’ resistance may be theorized as anti-colonial resistance – and she
delves into how psychiatric survivors can and do resist on a daily basis. By
contrast, Barnes and Schellenburg, Withers, and Chapman all use their own
personal narratives to make visible how co-optation happens and / or how social
movements undermine each other. Withers, for example, uses personal narrative
to make visible how the knowledges of those with lived disability are
undermined. Barnes and Schellenburg used the visual
narrative of one survivor’s story to show how the paths taken in the face of
deep personal problems are complicated by the horror and complexities of
psychiatric violence.
ABSENCES
We have been discussing to date what you will find in this book –
what is strongly and wonderfully present. At the same time, what is as important
as what is present is what is absent. One cannot edit a book of this nature without being haunted by and
calling attention to the absences – what does not exist that inevitably drifts
in and out of what is so clearly present (Sartre 1943). No absence – and we
would like to particularly emphasize this – is quite so stark and commonplace
as the absence of older people and what might be thought of as a senior’s
perspective. This absence is particularly worrisome when you consider this
alarming reality: there is no constituency so subject to psychiatry as older
people. Walk through any nursing hospital and you will be hard pressed to find
any senior there who is not on psychiatric drugs. Correspondingly, the vast
majority of our seniors, by the time they are eighty, are on psychiatric drugs.
What adds to this horror is that they are typically and routinely excluded in
almost all theorizing about psychiatry.
We have an analysis
of how this comes to be. Anyone who suddenly becomes psychiatrized in the later
years is almost inevitably engulfed by the system. Accordingly, they are not
visible to other survivors and their allies and play little or no role in the
movement. Indeed, elderly survivors who are in the movement are typically
people who were psychiatrized in their younger years and it is this that they
theorize. While the resulting “absence” in theorizing is understandable, we
invite everyone – including ourselves – to do better. It is critical that these
voices be heard, and that the situation of elderly psychiatric survivors
substantially influences our practice. As Diamond points out, we will all be
old one day, which makes us all current or eventual targets of psychiatry. Just
as all people who are not currently disabled are simply temporarily able-bodied,
all people who have escaped psychiatrization have done so only temporarily.
A further absence
is theorizing resistance based on the perspectives of children. Although
Chapman discusses psychiatrized children, his narrative remains the perspective
of an adult. Regretfully, this absence here reproduces and
is representative of the general absence of children’s theorizing, children’s
voices, and even children’s active presence within critiques of psychiatry.
With the one notable exception of Michener’s (1998) book, written at the age of
sixteen, that provides a long and detailed narrative of her lived experience at
the hands of psychiatric and adult violence, children’s writings are neither
considered nor sought within activist scholarship that is critical of
psychiatry. Although some members of the movements against psychiatry have been
psychiatrized as children, and indeed some theorize about this, and narrate
their stories, these experiences are nonetheless set in a different time,
space, and political culture than what current children live in. As such, these
accounts, and the theorizing based on them, are necessarily historical accounts
of childhoods past rather than depicting the experiences of current children.
Children are being
massively over-drugged as a result of the complex relationships between
pharmaceutical companies vested capitalist interests and child psychiatry’s
subsequently entwined influence over parents, carers, and other professionals
working with children (such as within social work, nursing, and education).
This influence is made possible by psychiatry’s emotive and paternalistically
authoritarian posturing of “knowing” what is in the best interest of the child. As such,
children’s standpoints in relation to their lived experience of psychiatric
violence remains muted. For the most part, children are excluded from
involvement in all of the activist movements against psychiatry. In part this
is the direct result of systemic design relating to the adult-centric
definition, form, practice, and leadership of these movements,2 which ultimately are distinct from and exclude children’s
ways of knowing, children’s ways of being, children’s ways of relaying
information, children’s ways of interchanging with each other, and children’s
ways of organizing collectively. This adultism within the various movements
against psychiatry serves to reproduce child psychiatry’s reliance on
conceptualizing children as incompetent actors, as incapable of producing
knowledge, and as unable to function within, and as, a collective. Yet, most
children are more than able to demonstrate an activist stance against their
oppressors.
Although there are
many examples worldwide of children’s collective organizing, such as within
activists organizations run for and by children in state care and disabled
children, psychiatrized children have neither organized
themselves in similar ways nor have they played any central part within these
related communities. Coalition building – within the children’s rights
movement, between disabled children’s organizations or children in care
organizations – with psychiatrized children has not materialized. This has not
happened despite the common issues of living in a disabling world and despite
the overwhelmingly large number of children in care who have been traumatized
by abuse and other forms of adultist violence, which is then reframed as these
children suffering from “mental illness.” We question whether these exclusions
result from sanist attitudes that are perpetuated within these other children’s
movements by children who have escaped psychiatrization. Although sanism stems
from adult culture, it permeates and plays out within children’s culture, in
ways that further marginalize and isolate psychiatrized children.
Yet another absence
from this volume is those psychiatrized people who have specifically been held
under the criminal code. Significantly, both people who have been found unfit
to stand trial and people who have been found guilty but not criminally
responsible almost invariably fall under psychiatric rule. Typically, their
psychiatric incarceration continues far longer than most people’s and certainly
longer than a jail sentence. They are held involuntarily until they are proven
to be “not dangerous to society” – and we all know we cannot disprove a
negative. That is, dangerousness may be proven by reference to an overt action
that is deemed dangerous, whereas proving that one is not dangerous can only be
made through reference to the absence of an action, an absence that can never
be said or proven to exist indefinitely. This is its own horror and its own
trap and resistance to it needs to be theorized.
Equally important,
there is also an absence in this volume of the voices of racialized people.
Significantly, while some of the authors are indeed people of colour, their
chapters are not written specifically from the perspective of racialization.
Correspondingly, while there are some very good critiques of racism and the implications
of racism (see, for example, both Chapman and Mills) none of the authors
identify in this book as members of communities targeted by racism. Given the
widespread psychiatric targeting of racialized people, for example the
psychiatric attribution of schizophrenia to black people (Metzl, 2011), once
again we need to do better. Other racialized voices that we do not hear in this
book are Indigenous people, Jews, and members of various
other diasporas. Given the (often intergenerational) trauma associated with
lived experiences of colonization, the Holocaust, as well as occupation and
civil wars, Indigenous people, Jews, as well as refugees, asylum seekers, and
people living under occupation, all remain targets for psychiatric oppression –
in particular by psychiatry’s tactic of individualizing and reframing the
distress resulting from state-related violence as biogenetic and bio-chemical
induced “mental illness.” In this way, psychiatry remains the handmaiden of the
state in obscuring the impact of state-sanctioned violence, racism, and greed
as well as redirecting attention away from those who ultimately should be made
accountable for the distress of so many people.
VOICES
A number of voices and perspectives are loud and
clear in this volume. This being an academic book, first and foremost we hear
from scholars. Moreover, we hear from scholars of a variety of stripes –
sociologists, adult educators, historians, disability theorists, anti-colonial
theorists, people who theorize from at once within and against the
psy-disciplines. While academics are often and we would suggest erroneously
distinguished from psychiatric survivors in activist circles as if a person is
either one or the other, we particularly hear from psychiatric survivors, each
of whom are academics in their own right. We likewise hear from members of
trans communities, feminist communities, from organized labourers, activists,
and professionals. Most contributors wear more than one hat, often combining
activist with theorist, with psychiatric survivor, and oftentimes with
professional. It is precisely through reflecting on such complex identities
that a fuller analysis emerges.
WEAVING THEORY
We began by looking at the title of the book. We
have come full circle and are back again with the title. In subtitling this
book “Theorizing Resistance and Crafting the (R) evolution,” our evocation of
the image of crafting is intentional and multi-dimensional. For one thing, we
are calling attention to the fact that whether resistance takes the form of art
or the form of labour or labour demonstrations, all praxis that sets about to
change the world is necessarily creative. Also, if it is to
succeed, it must be intelligent; the word “crafty” signifies a practical
intelligence, something generally attributed to classes, genders, races, and
ages hegemonically deemed “inferior.” Moreover, the concept of “crafty”
connects with contributor China Mills’ phrase “sly normality.” The word craft
is also intimately connected to the concept of witchcraft, a term often used to
further dismiss, subjugate, and demonize women working outside of medicine, for
example women using natural, herbal, holistic, and/or spiritual healing
remedies. In addition, for us the word “craft” connotes cottage industry or
community-based work, often produced by poor folk, including poor women, poor
racialized people, and poor children. Despite lack of finances or material
goods, this crafting by poor people often demonstrates resourcefulness,
creating the extraordinary out of simple materials found nearby. So too we
acknowledge how activism and radical scholarship has worked to produce
alternative knowledges, usually without research funding and certainly without
corporate sponsorship, all amidst the dominance and privileged positioning of psychiatric
and pharmaceutical discourse. We likewise use the word “craft” to acknowledge
the seemingly small and daily efforts by which people resist, and we link this
up to the way in which women, girls, and other oppressed groups have typically
engaged in resistance.3 In this regard, we call attention to how women and girls
in the global north, in the early 1970s (including the two authors of this
chapter), talked over their kitchen tables, sometimes while knitting, sometimes
while making a tapestry, in some homes, theorizing the patriarchy, while in
other homes, plotting their escape from the effects of poverty.
We leave you with
one image of a working class woman’s resistance that was literally created
through and embedded within her craft. Significantly, throughout Charles
Dickens’ novel A Tale of Two Cities one woman can be seen, in scene after scene, knitting – the solitary
figure of Madame Thérèse DeFarge. Only toward the end of the novel, do we discover
what she is
actually knitting: a figure in the French revolution, she is knitting the names
of which aristocrats are to be beheaded and in which order. While we are in no
way calling for such violence, for we all look to this being a revolution of a
very different nature, we do connect the concept of the tricoteuse with the
crafting of the revolution against psychiatry.
In this spirit, as
young women, as middle-aged women, and as old women, the editors of this text
invite you to read, to enjoy, to ruminate, to disrupt, and
most of all, to pick up a thread and add to the tapestry.
1 Bedlam is
the colloquial term for the Bethlem Royal Hospital which was the first hospital
for the “insane” in Europe located in London, England. Historical accounts of
Bedlam consist of descriptions of moaning, frenzied, and chained inmates,
living in degrading circumstances and filthy conditions, with an inadequate
water supply, a frequently backed-up sewage system, and where malnourishment,
starvation, and other abuses were the norm. The term “bedlam” has since become
synonymous with “chaos,” “confusion,” “uproar,” “irrationality,” and even
“madness” itself. Still in existence today, albeit in a different location from
the original building and in what is characterized as more humane conditions,
Bedlam has been operating as a psychiatric hospital for over 600 years.
2 It is also
in part related to the lack of access that the movements have to psychiatrized
children – who tend to be as socially isolated as elderly psychiatrized people,
albeit for different reasons – and the lack of access that these children may
have to the adult movements.
3 Also, see Shaikh (2013) for her conceptualization of “crafting” in the
context of anti-racist feminist organizations.
Becoming Perpetrator:
How I Came to Accept Restraining
and Confining Disabled Aboriginal Children
CHRIS CHAPMAN
INTRODUCTION
Some people may not wish to read this paper. It
is an attempt to make sense of my own past perpetration of physical restraints
and locked confinement of disabled Aboriginal children. My nightmare scenario
of writing this is that it will do harm to people who’ve been subjected to such
violence and read it. If you have been subjected to physical restraints and
locked confinement, please know that this is the subject of the following
paper, and so you may or may not wish to read ahead. I could never know for you
whether or not you should proceed. On the other hand, if, like me, you have
perpetrated this kind of violence, then I would encourage you to read it. If
you feel defensive or otherwise strongly respond to what I write, I invite you
to consider that this may be a response that you can attend to ethically and
politically – and that it could possibly be an important response that may not
be primarily or only about what I’ve written. Of course I could never know this
for you either.
Hannah Arendt
wrote: “What I propose… is nothing more than to think what we are doing” (1998,
5), which I think fed her subsequent suggestion that a more rigorous
understanding of Adolf Eichmann’s account of his thinking about what he was
doing would have been politically useful for us all. In this paper, I take her
analysis of Eichmann’s accounts and use it as a starting point to explore resonances with how I thought about what I was doing in the
past as a residential counsellor. I then briefly connect this to my work today
as a social work instructor and some pedagogical considerations that guide me in
that context.
Over ten years ago
now, I worked as a residential counsellor in a treatment centre. Elsewhere I’ve
critically explored this work on a more systemic and theoretical level (Chapman
2012), but I’ve been hesitant to explore my own use of violence directly, in
physically restraining children as young as eight and locking them up. I
continue to struggle with how I was able to do that. I am not suggesting that
I, or other residential counsellors, can be equated with Eichmann, in that this
would surely do an injustice to many people in various ways. One of the perhaps
less obvious ways it would do so is by taking away from the particularity of
the ways that real people navigate real contexts, particularly when any one of
us does real harm to any other.1 I approach Eichmann’s accounts, then, as particularly
embodied and contextualized narratives of personal ethical navigation – as I
understand Arendt to have done. I believe that we all navigate our lives in
ways that are available to us, in part due to the structural contexts in which
we find ourselves and the stories we tell about ourselves and the world. I
believe this is a way to fruitfully approach how anyone lives in this world and
does things, whether it’s you, or I, or Eichmann. Of course every person’s
ethical navigations have particular and contingent effects on others, and few
people’s lives have as devastating consequences on so many other lives as did
Eichmann’s. Without minimizing the real consequences of people’s actions,
there’s something valuable in carefully attending to the “hows” of ethical
navigation – amongst those who do it very carefully, those who do it with
devastating consequences, and – like most of us, probably – those who do it
carefully sometimes and in certain contexts, and who also sometimes do it with
harmful consequences. This kind of analysis is distinct from an approach that
imagines that violence and atrocities are always committed by people entirely
unlike the rest of us – a view that, I would suggest, implicitly justifies
psychiatric and penal abuse and incarceration, as well as war. As an
alternative, I’m inviting curiosity about how someone becomes an administrator
of genocide, how someone else becomes a restrainer and confiner of disabled
Aboriginal children, and how we two very different people – and the rest of us
when we do harm – come to accept hurting and oppressing
others as normal or acceptable, and then go on with our lives. What makes this
possible? What might make it less likely to happen?
WHY I BELIEVE IT IS IMPORTANT TO TAKE
EICHMANN’S ACCOUNT SERIOUSLY
It’s easy for us to imagine that Eichmann was
simply a monster. And, of course, he was exactly that in terms of what he did.
But how he
became what he became is another question altogether (see Butler 2004; Patel
2009). According to Arendt, this is more complicated than we might assume. She
writes, for example:
Eichmann pleaded: “Not guilty in the sense of the
indictment.” [and so Arendt asked in what sense he thought] he was guilty…
First of all, [he claimed, ] the indictment for murder was wrong: “With the
killing of Jews I had nothing to do [he stated]. I never killed a Jew, or a
non-Jew, for that matter – I never killed any human being. I never gave an order
to kill either a Jew or a non-Jew; I just did not do it”… Hence he repeated
over and over… that he could be accused only of “aiding and abetting” the
annihilation of the Jews, which he declared in Jerusalem to have been “one of
the greatest crimes in the history of Humanity.” (1964, 25)
Elsewhere (Chapman 2010), I explore this dividing
line he draws, using Guatemalan human rights activists’ distinctions between
“material authors” and “intellectual authors” of genocide (Jesús Tecu Osorio,
in al Nakba 2008), in relation to other studies of people who have done harm
and the lines they draw to secure their own relative innocence (Fellows and
Razack 1998; Goodrum, Umberson, and Anderson 2001; Hatzfeld 2005; Heron 2007;
Wood 2004). Here, however, it is the second point of his plea, alongside his
statement that the annihilation of the Jews was “one of the greatest crimes in
the history of Humanity,” that interests me. His second point was this: “The
indictment implied not only that he had acted on purpose, which he did not
deny, but [that he had acted] out of base motives” (Arendt 1964, 25). He was,
he claimed, “not guilty in the sense of the indictment” because the indictment
assumed – as I think we all tend to do when we hear of others’ violence – that
his motivation was clearly, simply, and unambiguously to do harm, because he
was a certain kind of person unlike the rest of us.
In relation to the
idea that a given person “is” a certain kind of person, Michael White (2004a)
has provided a very compelling account of the distinction between what he calls
“the folk psychologies” that have always existed in all places and all times
and the relatively recent, putatively scientific, and Eurocentric “professional
psychologies.” These new ways of understanding humanity have tended to posit
that a core self is to be found in each of us and that what a person does can
be understood by interrogating things internal to that person’s individual
psyche, no matter whether a person is born with these internal characteristics
or whether they are aquired through socialization. Often we do not ‘know’ this
self, but it is imagined to be there to be found. This orientation of the
professional psychologies would have had no ground to flourish without the
likewise relatively recent and Eurocentric liberal individualist understandings
of personhood. Heron (2007) notes that liberal individualism enables
self-narratives that she describes as a “unitary moral self,” according to
which one is either good or bad, sane or insane, responsible or irresponsible,
and so on. And Foucault (1970) gives more detailed analyses of what made these
forms of objectification possible, describing certain developments as occurring
“at the level of what will soon be called psychology” (224). Further, he writes
that these were not politically neutral developments and that, in fact, case
notes taken in asylums were central to the development of liberal
individualism:
We cannot say that the individual pre-exists… the
projection of the psyche, or the normalizing agency. On the contrary, it is…
through disciplinary mechanisms that the individual appeared within a political
system. The individual was constituted insofar as uninterrupted supervision,
continual writing [i.e., of case notes], and potential punishment enframed this
subjected body and extracted a psyche from it. It has been possible to
distinguish the individual only insofar as the normalizing agency has
distributed, excluded, and constantly taken up again this body-psyche… The
sciences of man, considered at any rate as sciences of the individual, are only
the effects of this series of procedures. (Foucault 2008, 56)2
There is no reason for us to take for granted the truth claims of these
particular ways of understanding what humans are, other than habit. And I would
like to suggest that a critique of the objectification that is accomplished
through liberal individualism and the professional psychologies coincides with
the possibility that Arendt’s account of Eichmann may be useful for all of us
in understanding how a person becomes violent and oppressive, and especially
how a person narrates or rationalizes this process. Foucault writes:
Many factors determine power. Yet rationalization
is also constantly working away at it. There are specific forms to such
rationalization. The government of [people] by [people] – whether it is power
exerted by men over women, or by adults over children, or by one class over
another, or by a bureaucracy over a population – involves a certain type of
rationality [at the level, we might add, that has come to be called
psychology]… Consequently, those who resist or rebel against a form of power
cannot merely be content to denounce violence or criticize an institution… What
has to be questioned is the form of rationality at stake. The criticism of
power wielded over the mentally sick or mad cannot be restricted to psychiatric
institutions; nor can those questioning the power to punish be content with
denouncing prisons as total institutions. The question is: how are such
relations of power rationalized? (1994, 324–5)
It is this rationalization of relations of power
that seems to interest Arendt most in her careful study of Eichmann’s own
narratives. Arendt writes of what we most easily assume to be his
anti-Semitism, for example: “He ‘personally’ never had anything whatever
against Jews; on the contrary, he had plenty of ‘private reasons’ for not being
a Jew hater. [And then she adds] Alas, nobody believed him” (1964, 26). This “alas”
is very significant to Arendt’s project. I believe she’s concerned that
Eichmann is being misrepresented for
the sake of what we can learn from his example if
what he says is true (and even if it is only partially true). I’m following her lead
in assuming that what he says is at least partly true and in believing that we
can all learn from the ways that he accounts for the process of having
ethically normalized and rationalized his own perpetration of violence.
Narrativizing this violence as “aiding and abetting” rather than murder or
genocide surely played some role in such rationalization.
But how did he initially become comfortable with “aiding and abetting” what he
called “one of the greatest crimes in the history of Humanity?” He says he did
not initially experience this as anything like acceptable: “when he was told of
the Führer’s order for the ‘physical extermination of the Jews, ’ in which he
was to play such an important role [, he says that] he himself had ‘never
thought of… such a solution through violence, ’ and he described his reaction
[as follows]: ‘I now lost everything, all joy in my work, all initiative, all
interest; I was, so to speak, blown out’” (Arendt 1964, 31). Of course we all
know that this initial response did not last.
HOW THIS RESONATES WITH HOW I CAME
TO NORMALIZE MY OWN USE OF VIOLENCE
First of all, let me say again that I am not
equating myself with Eichmann. When I use the term “resonance” to describe a
relationship between our respective processes of normalizing and rationalizing
violence, this should not be read as a making of equivalencies. I am rather
using this term along the lines of what Tamboukou (2003) calls “dissonant
harmony” – which is to say a sense of some commonality that is also very much
“dissonant” or distinct. I also relate to Jenkins’ (2009) description of
“parallel, political journeys” by which he refers to the resonance between his
position as a therapist and that of the men who perpetrate abuse that he works
with: he’s suggesting that his own journey to be accountable for the real
effects of his actions on the men he works with and their families is
“parallel” to or resonant with the journeys of the men he works with to become
accountable to their families’ experiences of them. He is not suggesting that he
is himself a perpetrator of domestic violence, any more than I’m suggesting
that I’m “the same as” Adolf Eichmann. I’m rather attending to very particular
ways that I can learn from Eichmann’s accounts of his own process, allowing
myself to “sit with” what I feel is resonance with his accounts, and using this
as a starting point for my own reflexive exploration.
I can still
remember the specifics of the first two restraints I ever did – and no others
in the same kind of detail. I think these two continue to stand out for me
because, as Arendt says of Eichmann, my “conscience [initially] functioned in
the expected way” even if, relative to the rest of my life, it functioned
“within rather odd limits” (Arendt 1964, 95). Like
Eichmann’s, this initial, expected, conscientious response did not last.
I’d sought out a
social services job out of a sense of political commitment. I believed that
working with “disadvantaged” youth was a way to make a difference in the world
– along the lines of something like global justice. When I first started the
job, I had no training or experience, but I had a lot of ideas and enthusiasm –
which were politically, rather than individualistically, oriented. I imagined
watching John Wayne movies with the children and collectively critiquing their
racism, for example. And I imagined that doing so might be “therapeutic”
because of how I came into the job understanding what it meant to be
“disadvantaged.” But then I took on the training regime of what I needed to
learn to do my job (see also Chapman 2012). And so instead of watching cowboy
movies critically and asking the children what they thought, I watched things
like “Ten Things to Do Instead of Hitting” (Sunburst 1995) uncritically and
then told the children what to do. One of the things that my training regime
entailed, because of who I’d always been, was ongoing concern about my ability
to “set limits,” “establish boundaries,” and generally discipline and control.
I had to learn to be “the adult” in the relationship, even though I’d never had
an adult like that in my life. And one of the major things this entailed was to
physically restrain children.
In fact, untrained
and inexperienced, I soon found out that I had basically been hired on as
“muscle,” which seemed like a joke really. I was also to be a “male role model”
to the children, which was likewise a bit of a joke to me, but the concern
about male physical strength was explicitly stated. Before I was ever expected
to take the lead in education groups or counselling, I took the lead in
physical restraints. This because I was a man. Alongside sighs of exasperation
about there being no Aboriginal staff – and no serious efforts to address this
– the centre had a strict policy that half of the full time staff be male.
White women who had worked there casually for years were not hired, no
Aboriginal people were considered, and they took my effeminate,
university-dropout masculinity as the best they could do. I found myself with a
job involving pay and responsibility that was unparalleled amongst my peer
group at the time.
As I understood it
then, I was actually making a difference in the real lives of survivors of
family and colonial violence and getting trained and compensated to do so, and
so I was very much “elated” about aspects my situation (see Arendt 1964, 53–4,
on Eichmann’s strategies for achieving elation, which I
address below). But I also had to physically restrain children, which was
initially incredibly emotionally complicated for me, and was something which
nothing in my previous life had prepared me for. I can remember that when I
talked with friends and family, the restraints were a major focus of early
conversations. I would state my discomfort about what I was doing, but somehow
the self-centred story of the perceived ridiculousness of my body having been
chosen to do such a thing often won out. This “my body” completely ignored my
whiteness, non-disability, adulthood, and maleness and instead focused
exclusively on my effeminacy – the fact that it seemed funny to me that a
white, male, non-disabled, adult body was considered appropriate to overpower
disabled Aboriginal children clearly shows my sense of disconnect from legacies
of colonization and eugenic institutionalization (see Chapman 2012). “Can you
believe it,” I would say, “they hired me to do this? Some of those children are bigger than I am and I’ve never
even been in a fight.” This was funny to me, because it was so incongruous with
anything else I’d ever done or known, but it was also incredibly disturbing to do
these things. And, perhaps even more disturbing, somehow I knew that this
disturbance was to be psychologically “worked through” and “overcome” rather
than politically and ethically attended to.
BECOMING PERPETRATOR AS A PARALLEL,
POLITICAL PROCESS
TO BECOMING SELF-BLAMING OTHER
Of the Nazis, Arendt writes that, in terms of
affect and ethical self-governance, “the problem was how to overcome… the
animal pity by which all normal [people] are affected in the presence of
physical suffering. The trick used by Himmler – who apparently was rather
strongly afflicted with these instinctive reactions himself – was very simple
and probably very effective; it consisted in turning these instincts around, as
it were, in directing them toward the self. So that instead of saying: What
horrible things I did to people!, the murderers would be able to say: What
horrible things I had to watch in the pursuance of my duties, how heavily the
task weighed upon my shoulders!” (1964, 106)
At the treatment
centre, it was routinely acknowledged that it was disturbing to physically
restrain someone. This was spoken about as an “unfortunate” aspect of the job.
If only we could play games and have counselling sessions
all day, without the violence, without the time-outs even, of course we would
all prefer that. But one of the things that came with helping children who were
so damaged, as we narrated the encounter between us and them, was restraining
and confining. The idea that there could be a world without restraints and
locked confinement seemed clearly untrue, as evidenced by the children we
worked with (as we framed and perceived them). As a result, some of us had to
do the “unfortunate” work involved – narrated not as violence, but as
maintaining safety for them and others. It was not that we did not acknowledge
that these restraints were traumatic for the children being restrained or for
other children witnessing them, but we were the protagonists in the stories we
told and believed. Our violence was only ever a response to their violence. The
possibility of imagining their individual violence as a response to our
structural, epistemic, and individual violence – institutional, disablist, adultist,3 nationalist, colonialist, and racist – was not
available to us. And so because they were the initiators of violence, as we
understood it, there was nothing we could do to prevent it (see Butler 2004). We had nothing to do with
their violence until it erupted; and our only role was to keep everyone safe.
Even the room where children were locked up, which usually followed a physical
restraint, was called a “safe room,” which was clearly an act of manipulating
perception – but it’s hard to locate the agent of that manipulation. As staff, I think
we all believed it. We perceived it. There was no safety without the safe room, we said,
“unfortunately.”
“Unfortunately.” It
seems to me that what was once an ethical and political “crisis of conscience”
about what we were doing (Arendt 1964, 104) – for me and perhaps for others –
somehow gave way to this resigned “unfortunately,” as if it were merely
misfortune that placed the children upon the path to the treatment centre
rather than the effects of real people’s concrete decisions and actions (see Ahmed
2004). As if it were sheer misfortune that created the fact that almost all of
them were Aboriginal and almost all of us were white. And, “unfortunately,”
someone had to “care for them” – with all the sense of righteousness and
self-sacrifice that this phrase implied. In fact, while I was there, all of the
staff went away on a retreat for “secondary post-trauma” – the trauma
experienced as a result of exposure to others’ trauma. Doing what was clearly
“group therapy,” but calling it “professional development,” the purpose was for us to explore the effects on us of the stories we heard in
counselling conversations, rather than the effects on us of restraining
children, but nevertheless I can imagine a different “treatment” of our
feelings. Relative to the children we worked with, our traumas were much less
significant, but they were nonetheless real. And perhaps they could have
instead been taken for what Arendt calls “instinctive reactions” to both the painful
experiences the children told us about and the painful experiences we perpetrated. But by psychologizing and thus
depoliticizing our emotional and at least potentially ethical and political
struggles, we were actively steered away from interrogating our own violence
and the trauma we were causing. In her paper for the PsychOUT conference, Louise Tam
(2010) cited Mitchell-Brody of the Icarus Project, both of them using the
following statement to question the pathologization of people who are
psychiatrized: “there is much in our world to be angry, anxious, or sad about.”
I would like to suggest, here, that the “normal” or “instinctual” or at least
expected experiences of anger, anxiety, and sadness that staff experienced were
psychologized and abnormalized in a “dissonant” but complementary way to the pathologization
of the children we worked with and others who are confined in similar closed
sites. Taking up Jenkins’ (2009) language differently than he uses it, I would
like to suggest that this was a “parallel, political journey” – but it was not
one of “becoming ethical” in the sense that “ethical” sometimes means “moral.”
It was, rather, a process of becoming invested in a project of ethical
self-governance that would allow us to more comfortably occupy and perpetuate
our respective positions in systemic oppression.
I now consider my
worry, guilt, and anger about such things as important. The children I worked
with were pathologized of course, making our violence seem necessary, but
workers’ struggles with perpetrating violence were also psychologized and
individualized, thereby steering us away from approaching these struggles as
political or ethical concerns. When we restrained children, we “debriefed”
newer staff afterwards, knowing it was difficult to witness or participate in a
restraint, and approaching it as something to address through something like a
“talking cure” with a predetermined destination: to accept perpetrating
violence as necessary. The word “debrief,” in fact, as I understand it, is
primarily otherwise used in military contexts to work through having
participated in military violence and all that it entails – and when Global
North inhabitants come back from working in the Global
South. In the latter, we can imagine that if the discomforts of coming back to
Canada from Guatemala were approached as “ethical and political” concerns to
attend to, then this would result in a more normative fundamental questioning
of geopolitical inequalities, starvation, war, and what Heron (2007) calls
“colonial continuities.”
In the treatment
centre, our expected and therefore “normal” discomforts resulting from
restraining were differentiated from those of the children we worked with,
which served the purpose of implicitly threatening the staff with the
identification of “emotionally disturbed” if we were unable to “work through”
our initial discomforts. In fact, this was how we as staff made sense of the
“conscientious objector” staff person I describe a few pages below: she was
“not right” or “not healthy enough” to do the job, or something along those lines.
Our discomforts as staff, however unpleasant, could be worked through
“normally,” meaning without confinement or restraint, proving that we were
worthy of our freedom while the children we worked with, who seemed to need
these interventions, were exceptionally, individually disturbed.
This divisibility
of normal working through of difficulty from experiencing difficulty
pathologically also seems to present itself in other instances where violence
is rationalized. A few years ago, I presented on a panel with Shaista Patel
(2009) and Melissa Abbey Strowger (2009). Patel’s paper explored how “terror
suspects” were described in popular press sources using discourses of
“madness,” which both erased the possibility of understanding “terrorists” as
politically motivated and evoked a longstanding tradition of incarcerating
people who have committed no crime simply because of their “psychological
state.” Strowger’s paper also looked at popular press sources, although her
study was of the ways that Americans’ anxiety about “the war on terror” was
treated in these sources – anxiety that could, at least potentially, be related
to questioning the justice of American military action. This anxiety was unlike
the “madness” of the “terror suspects” that self-evidently required
incarceration. It was rather, according to some of her sources, to be worked
through using “relatively normal” practices often used in outpatient care for
those not “requiring” confinement, restraint, and so on: if you’re feeling
anxious about the war, here are some deep breathing exercises you could do, or
you might try positive aphorisms. “Parallel” to one another, and certainly
“politically,” some are psychologized to accept their own
implication in war with less anxiety and uncertainty, and others are
psychologized so that the rest of us can accept their indefinite detention and
torture. This was a “parallel, political” process to what took place at the
treatment centre where I worked; both processes created discursive contexts
within which people could engage in ethical practices of self-formation (see
Mahmood 2005). These ethical practices would, in turn (Foucault 1980b), reify
the naturalization of these discourses of rationality and inevitability and,
through them, people would constitute themselves as “willing” to do the
material acts also necessary for the sustenance of systemic oppression, such as
directly perpetrating violence themselves or electing officials who choose war,
indefinite detention, and torture.
Furthermore,
resonant with our staff retreat to deal with secondary trauma, and also with
newspapers advocating deep breathing and affirmations for anxiety about war,
Arendt writes the following of what we might call Eichmann’s “positive
self-talk”:
He had not forgotten a single one of the
sentences of his that at one time or another had served to give him a “sense of
elation.” Hence, whenever, during the cross-examination, the judges tried to
appeal to his conscience, they were met with “elation,” and they were outraged
as well as disconcerted when they learned that the accused had at his disposal
a different elating cliché for each period of his life and each of his
activities. In his mind, there was no contradiction between “I will jump into
my grave laughing,” appropriate for the end of the war, and “I shall gladly
hang myself in public as a warning example for all anti-Semites on this earth,”
which now, under vastly different circumstances, fulfilled exactly the same
function of giving him a lift. (1964, 53–4)4
And what held all
the violence, care, and rationalization at the treatment centre together as
sensible, but which has no secure foundation, is the myth of achieving an
enduring state of normalcy, free from emotional discomfort, even in the face of
violence and oppression. The children and staff were both disciplined toward
this imaginary state, parallel to one another, but distinctly. Following
restraints, we “debriefed” new staff to help them feel at peace with
perpetrating these forms of violence; and then we “processed” with the child who had just been restrained, requiring them to accept “full
responsibility” for having individually caused the entire situation (see
Jenkins 1990). Any suggestion from a child that staff, other children, or the
system played any part whatsoever in their individual choices or actions, would
result in another fifteen minutes of locked confinement, after which we would
give them another opportunity to take “full responsibility” – unless some other
duty delayed us, which sometimes happened but was never our responsibility
either. Their discursively construed and structurally coerced “responsibility”
shaped their – and our – ethical and political possibilities of becoming who we
were becoming. We were all being trained to more fully inhabit our respective
positions within systemic oppression, and to feel fully responsible or not at
all, accordingly.
THE IMPORTANCE OF ALTERNATIVE ACCOUNTS
TO PROCESSES OF ETHICAL SELF-FORMATION
Significantly, we were not aberrational in our
normalization of our particular kind of violence. It is normative, at least for
those living in our time and place with systemic privilege, to imagine the
inevitability of the police, the army, psychiatric confinement, prisons, and so
on. I struggled initially with my role in this place and practice, but it was not until I left the job that I
began to imagine a world without such places and practices. “As Eichmann told
it, the most potent factor in the soothing of his own conscience was the simple
fact that he could see no one, no one at all, who actually was against the
Final Solution. He did encounter one exception, however, which he mentioned
several times, and which must have made a deep impression on him” (Arendt 1964,
116).
In terms of
encounters with exceptions, critiques, and alternatives, a difference between
Eichmann and I is that I had direct and sometimes very close relationships with
every one of the children I ever restrained. The children very clearly told us
as staff that what we were doing to them was “contrary to morality”; they
“appeal [ed] to our feelings” (Arendt 1964, 131) in deeds and words of a wide
variety of forms and intensities. But one of the things that today I find so
astounding in thinking back on this is that all of those words and deeds only
served to justify what we were doing (see Chapman 2009; Jenkins 1990, 1991).
The necessity of our “Nonviolent Crisis Intervention”5 was proven by their violence6 (see also Butler 2004). Our control
of them, and our need for control of them, was rendered completely natural and
not the least noteworthy or up for consideration. And the same was true for our
violence. This is connected to legacies of disablement, colonization, classism,
and adultism. Due to these interlocking forces, the children in the treatment
centre could not effectively call our actions into question, no matter how they
tried. Even when they questioned our violence and control in calm, articulate,
curious ways, or through tears, even
then we as staff were entirely sure about the
morality of what we were doing – or at least its inevitability. This was just
how things were, and the only people who could change that were the children:
if they were never violent again, we would never be violent – simple.
Unlike Eichmann’s
solitary exception, I also had access to several critiques from the margins of
the staff team. These shook up my certainties more than the children’s
protests, but it wasn’t until I left the job that my uncertainties really
flourished. At one point, I visited a former co-worker who had moved away. She
had been “night staff,” which meant that, according to local beliefs in the
centre, she was less capable, less knowledgeable, and so on, when it came to
dealing with the children. Sometimes, if a child were upset, “day staff” like
me would stay late until the child was asleep, because it was generally
understood that “night staff” did not have the skills to deal with the children
when they were upset. They did not do counselling and they did not do
restraints, so one of us had to be around if there might be a need for either.
The difference between night and day was a hierarchical one: we were more
skilled and competent. Although I was friendly with the night staff, and was
only hired on as day staff because of my gender, it never occurred to me that
there might be alternative ways of understanding this. But what this former
night staff told me during our visit was that she did not feel too incompetent to restrain
children. She was, rather, ethically opposed to it. She said something like:
“you day staff: a child cries and you go in and tell them to stop or we’ll lock
you up. Children were sometimes upset at night after all of you left. We read
to them, or just sat with them, or got them a cup of milk. That’s what you do
when children are upset. You care for them. You don’t threaten to lock them up.
When any of you heard about it, all you could say is: they’re manipulating you,
don’t be so soft. But that’s what you do when kids are upset.” These are
responses I would much prefer if I were upset, and it is certainly what I would
want for my son if he were, which invites all sorts of
reconsideration of the ways we made sense of parents and families. But sticking
with the issue of restraint and ethical navigation, night staff never had to
restrain children, because of what they did when children were upset, she said
– implying that we had to because of what we did in initial response to the
children being upset. I think this significantly influenced my decision to
leave the job, although I wasn’t sure I agreed with her. The very possibility
that she could believe it shook me up. And I was very surprised by her anger about
it. Why was she angry about how I was with the children? I was great with them.
I thought everyone knew that.
And then there was
a woman who, in the three years I worked there, was the single person who
clearly conscientiously objected to physical restraints. On her first day, we
restrained one of the children. She wasn’t involved, but I knew that witnessing
it would have been disturbing to her, so I approached her to “debrief,” again
depoliticizing her response as psychological and requiring correction, rather
than ethical or political. She gathered up her belongings and said, “That was
horrible. I can’t do this,” and she left, tears in her eyes.
I recall that staff
mobilized non-professional discourses of psychopathology – “not right,” “not
healthy enough,” “too emotional,” and similar phrases in order to contain this
person’s response as aberrational and about her, rather than about what we had done.
Perhaps we could not use terms from the professional psychologies – which we
used liberally in other contexts – because this would raise questions about how
she got hired in the first place, which might even unsettle the normal /
abnormal binary that we needed in order to feel okay about restraining and
confining other people’s children. So she was narrated as occupying an
interesting informal middle category that people seem to use to situate
abnormality within the margins of normality and yet outside of professional
intervention: phrases such as “nervous breakdown” or “not right.” The
implication was something like this: maybe she just had to work on her positive
self-talk or her deep breathing, or even see a private therapist, and maybe
then she would be healthy enough to restrain children.
One day a friend
who worked in a very different social services setting walked me to the centre.
One of the children hung out of his window to happily greet me and, in front of
this friend, I “directed him” to go back into his room, knowing that he was
surely in his room for some disciplinary reason and should
not be hanging out of the window or generally enjoying himself. My friend was
shocked at how I spoke to him. The Chris who had so carefully crafted his
professional “adult / child boundaries,” Chris the “child care counsellor,” was
not the Chris she knew. And again, I found the anger directed at me, her anger
for how I had spoken to a child, very disruptive of my sense of what was what.
I had already set my departure in motion, but this certainly heightened my
sense that things were not right. And I knew as soon as I drove away from that
city, with complete certainty, that I would never do those things again.
ALTERNATIVE ACCOUNTS, ETHICS, AND ACCOUNTABILITY
IN THE SOCIAL WORK CLASSROOM
So what does this all have to do with what I do
today in social work classrooms? I will briefly outline one example here.7 I designed and taught a full-year history of social work
course at Dalhousie University, in which I centred historical accounts about
the helping professions told from the perspectives of groups that are
overrepresented as non-voluntary clients. I want students to be able to
perceive their future clients’ protests as something other than proof of our
necessity and benevolence. If a child says “you’re ruining my life,” I want
them to think of the various histories we have read in which at times
well-intentioned experts and professionals really did ruin people’s lives. To
this end, we read First Nations, anti-racist, mad movement, prison abolitionist,
and disability studies histories of professional helping, as well as reflexive
critical accounts of these histories written by helping professionals.
But what I also try
to do in this course is have students generate what Michael White called a “territory
of preferred identity” (2004b, 2006) from which to situate themselves in these
critiques. This involves encouraging them to relate to how the histories
resonate in their own lives – not so differently from what I’ve done here with
Arendt’s Eichmann – both in relation to the ways that they might have lived
some aspects of their life in the margins, as members of oppressed communities,
and also in relation to the privileges that they embody or, at the very least,
will embody as a paid professional social worker, and perhaps in the ways that
these two intersect – along the lines of my particular manifestation of what I
experienced as an “alternative” masculinity playing a role in obscuring my recognition of my role in colonial, adultist, and disablist domination.
Creating this “territory of preferred identity” is, I believe, what made it
possible for me to write this exploration of my own perpetration of violence
against disabled Aboriginal children. I can inhabit an ethical and political
territory that is clear about restraints and locked confinement being wrong,
which allows me to explore how I was so clear about it being right – or rather alright even if
“unfortunate.” Writing this was not easy for me to do, but I am now able to
perceive the associated discomfort as a political aspect of my life. I choose
to attend to such discomfort in this way, rather than psychologically, which
allows me greater options in terms of what to do ethically and politically with
it, in part because it allows me to reflect upon it from a territory of
preferred identity rather than from a sense that something is individually
wrong with me. It is this increased awareness of options that I hope to
facilitate amongst my students.
CONCLUSION
Whether or not there ought to be some people in
our communities who are paid to be “helpers” is an important question, although
it is one that I have not touched upon. But likely there will continue to be
professional helpers. And as long as there are (and likely even if we were to
abolish this particular hierarchical structure), those who help need to be
aware of the likelihood that we will also harm. We need to become better at
becoming ethical and accountable, both when those who we are supposedly helping
tell us that we are doing harm, and also when our own consciences do. My hope
for this paper is that it might assist others in this process of becoming
ethical.
1 See Ahmed (1998, 2004, 2006), Arendt (1964), Butler (2004), Chapman
(2007, 2009, 2010b), Derrida (1995), Fellows and Razack (1998), Foucault (1994,
2006), Goodrum, Umberson, and Anderson (2001), Hatzfeld (2005), Heron (2007),
Jenkins (1990, 2009), Mahmood (2005), Neu and Therrien (2003), and Wood (2004).
2 See also Chrisjohn, Young, and Mauran 2006; and Davis 2007, for the
ways that this continues to obscure power relations.
3 Brenda LeFrançois (2013) offers the following definition of adultism:
“Adultism is understood as the oppression experienced by children and young
people at the hands of adults and adult-produced /adult-tailored systems. It
relates to the socio-political status differentials and power relations endemic
to adult-child relations. Adultism may include experiences of individual
prejudice, discrimination, violence, and abuse as well as social control and
systemic oppression. At an individual level, it is characterized by adult
authoritarianism toward children and adult-centric perspectives in interacting
with children and in understanding children’s experiences. Systemic adultism is
characterised by adult-centric legislation, policies, rules, and practices that
are imbedded within social structures and institutions which impact negatively
on children’s daily lives and result in disadvantage and oppressive social
relations.” In the treatment centre, adultism was inseparable from colonialism,
disablement, and classism – although teasing them apart analytically can be
somewhat useful. For example, the four oppressions each work to render the institution
and its violences natural, inevitable, and so on. If our adultism was called
into question, classist or colonial notions of bad parenting could explain why
our control and violence was necessary, benevolent, and politically neutral
with these particular children. If the colonial racism of our intervention was
called into question, disablism or adultism could serve to erase race from the
equation – but again always with an individualizing pathologizing gesture that
rendered the children’s confinement and subjection to violence exceptional. We
would not want our children to be treated this way, but these children are
exceptions. Indian Residential Schools were colonial and violent for aiming to
segregate all Aboriginal children from their communities, but with these
particular children there is no other option.
4 On this last point, see also Ahmed (2006) for a critique that may also
pertain to my project.
5 “Nonviolent Crisis Intervention Training Program,” Crisis Prevention
Institute, Inc. (2010), http://www.crisisprevention.com/program/nci.html. Last
accessed 10 October 2012.
6 “Belief Statement and Position Paper,” Citizens against Restraint
(2006), http://www.citizensagainstrestraint.ca/. Last
accessed 10 October 2012.
7 Although I describe another aspect of this course in Chapman 2011, and
describe a social work ethics course motivated by these same concerns and ideas
in Chapman 2010b.
The Withering Away of Psychiatry:
An Attrition Model for Antipsychiatry
BONNIE BURSTOW
Of all tyrannies, a tyranny sincerely exercised
for the good of its victims may be the most oppressive… The robber baron’s
cupidity may sometimes sleep, his cupidity may at some point be satiated, but
those who torment us for our own good torment us without end for they do so
with the approval of their own conscience… Their very kindness stings with
intolerable insult. To be “cured” against one’s will and cured of states that
we may not regard as disease is to be put on a level with those who have never
reached the age of reason and those who never will.
C.S. Lewis 1970, 292
For over 35 years, I have been an antipsychiatry
activist. While the quotation above is one with which I think that all of our
community can agree, and so one that I wanted to start with, this analysis more
specifically comes out of that antipsychiatry background and perspective.
Antipsychiatry is a very particular perspective. It differs from the
perspective of many people who critique psychiatry, which is just fine, for a
vibrant movement needs multiple perspectives and the fact that so many perspectives
are represented in this book is encouraging. To be clear, antipsychiatry – the
perspective from which I speak – is not one that I ask be adopted, or expect to
be adopted, by fellow radicals in this area who hold diverging views. The point
is, we form a community – the community of people who unite to combat
psychiatry. It is a wonderful community, a vibrant community. Our community
encompasses differences, and we need those differences. We need all of us –
antipsychiatry activists, mad activists, professionals,
survivors, artists – if we are to bring about the life-enhancing, more tolerant
society toward which we are all striving.
It is critical that
this be clear from the outset. One error that has tended to plague our
community, as indeed it plagues almost every social movement, is that we have
often fallen into vilifying others in the community with different
perspectives, which is not good, or tried to convert each other, which is also
not good. The fact is that we are not each other’s worst enemy. The fact is
that there is far more that unites us than divides us, and we need to hold onto
that. The fact is, trying to convert each other is not what good allies do. My
hope and trust is that we can be good allies – that we will work together where
we can and in what ways we can, and where we cannot, that we will agree to take
a pass, but that we will do so respectfully – that we will do so, that is,
while preserving our relationships so that on all sorts of other fronts we can
continue to work together.
None of this means
that people who are part of particular constituencies should not try to develop
their perspectives. That, in fact, is precisely what I am trying to do. I am
using this chapter to flesh out a model for one such constituency – the antipsychiatry
constituency. I do so because I believe in the importance of the antipsychiatry
agenda. I do so because at the moment, I see this constituency as in trouble,
and as far as I am concerned we need all of our community to be at the top of
their game. As I look over our diverse community and how it has operated over
the last couple of decades, I would have to say, I see greater clarity and
greater progress in other constituencies. For some time antipsychiatry per se has been
floundering.
One reason it is
floundering no doubt is precisely because it has not always been respectful of
other parts of our community. And I would like to believe that those days are
over. It is floundering more significantly because the powers lined up against
it are becoming increasingly stronger, increasingly more entrenched. The power
of psychiatry, its continual growth, its ever more tenacious entrenchment in
the state is a brutal reality and not one for which we bear responsibility. I
would like to suggest, however, that antipsychiatry is also floundering because
it has no model or models to guide its action.
The point is,
antipsychiatry is not a new movement or constituency. A movement can proceed
quite nicely for a long time fueled by passion, sincerity, vision, and ever-sharper
critiques. If that sufficed to win the battle, however, we
would have succeeded long ago for we have always had such attributes in
abundance.
There comes a time,
moreover, when not only does that not suffice, you start to move backward. That
is the nature of movements. You have successes for a while. You have successes
even without being shrewd activists. You have successes almost no matter what
you hitch your wagon to – the politics of compassion, for example, or the
politics of entitlement like the ones associated, say, with human rights
battles. And I know because I have had such successes – I have been there, and
done that. However, inevitably the people in power who have something to lose
by your winning push back with all the strength that their position affords
them. And when they do, that is when you need to learn how to be really good
activists. Correspondingly, that is when you absolutely need to bring something
to the table to help guide action. That is the ultimate purpose of this chapter.
That is, it is to start fleshing out the beginnings of a much-needed model for
guiding antipsychiatry.
Before I go any
further, I know that some people are not exactly sure what I mean by
“antipsychiatry” and are not exactly sure what makes an antipsychiatry
perspective different than the various other perspectives which inform this
book. As those differences play a pivotal role in the model, it is critical
that I clarify.
All of us who have
contributed to this book are profoundly unhappy with psychiatry. If we were
not, we would not have become involved in penning this anthology. What
distinguishes an antipsychiatry stance is not simply that it is critical of
psychiatry. It is that its adherents hold that psychiatry is unqualifiedly
untenable, untenable as it stands today, untenable even if it improved itself
substantially. To put this another way, what distinguishes antipsychiatry from
other critical positions is the conviction that critiques of psychiatry are
sufficiently conclusive, compelling, foundational, and damning to render
psychiatry as an institution inherently undesirable and irredeemable (see
Burstow 2006b).
This position
arises from the bitter experiences of survivors and their writings – writings
that go back to Madness Network News, Phoenix Rising, and which continue to this day. More formidably, the unqualified
rejection inherent in the antipsychiatry position rests on a number of
foundational critiques. I will not be going into them in depth, but they
include: Szasz (1974) and Leifer (1990), who demonstrate that the foundational
philosophical and scientific concepts of psychiatry are
flawed; Breggin (1991) and Colbert (2001), who demonstrate that the treatments
are intrinsically damaging; systemic thinkers like Mirowsky (1990), who
demonstrate that the entire system of diagnostic categorization lacks validity
and coherence; and labeling theorists like Goffman, who as far back as 1964
unmasked psychiatry as a form of social control.
The goal of
antipsychiatry is quite simple – nothing less than the abolition or end of the
psychiatric system. Herein lies its ultimate distinction. While people critical
of psychiatry but not fully antipsychiatry may take certain kinds of changes as
sufficient – the advent of informed consent; less use of drugs; a kinder,
gentler industry; or diagnostic categories that are less overlapping, for
example – as clarified in documents like the Coalition against Psychiatric
Assault’s (C A
PA) fact sheet, antipsychiatry holds that no
changes will be sufficient, for the institution is too flawed and dangerous
simply to be tinkered with.1
A vital question
arises from this goal. Namely: if the abolition of psychiatry, however
conceived, is the goal, in light of that goal, how might antipsychiatry
activists proceed? The question is far from simple. The fact remains that while
a rigorous antipsychiatry position entails some type of abolitionist stance, no
one should be under any illusion that any demands or well-worded critiques will
suddenly lead to the closing of institutions or the cessation of damaging
treatment. And in fact, demands that psychiatry be curbed in any more than a
mere reformist way are themselves likely to lead to terror on the part of the
general public and an increased emphasis on the myth of the dangerous mental
patient, who must be kept under control by all available means. The point is
that we are up against a very complex system, with huge vested interests, with
the complicity of the state, and with the blessings of a fearful general
public. We are also up against thousands of years of prejudice against people
whose ways of thinking and processing differ from those of folk deemed “normal”
– prejudice that, as theorists and members of the mad movement such as Esther
(2000) correctly point out, predates the medical model and predates psychiatry,
but has been made far more formidable by the veneer of science. Additionally,
some who use psychiatric services are legitimately worried that without
psychiatry, they will be out in the cold.
All that being the
case, there will be no quick “win” on this issue. It is in this larger context
that I ask: what might be used to guide action? If
abolition on some level is the goal, what might be used as a model or
touchstone in deciding what to do, what not to do, what to support, what not to
support?
In foraging about
for how to conceptualize a model, I have been reminded of a movement that has
much in common with antipsychiatry – the prison abolition movement. While
prison abolitionists uniformly agree that some people (a very small number) may
need to be confined, and the details are still to be worked out, prison
abolitionists, too, take abolition as the goal. Moreover, they too have been
struggling with a situation where the general public approves of and indeed
considers essential the very industry, approach, and complex machinery that the
abolitionists hope to dismantle. Additionally, in their case too, the
problematic institution in question is upheld by the state, and it is not going
away overnight. Furthermore, in their case, too, albeit to a lesser extent,
some inmates voluntarily seek out prison “services,” with people, indeed,
committing crimes precisely to get back behind bars.
What distinguishes
the prison abolition movement is that it has long had a model. Now, indeed, it
has had a number of models, but the most widely accepted one by far is called
“the attrition model.” The attrition model for prison abolition was spelled out
as early as Knopp (1976) and has been reaffirmed and modified over the decades
(e.g. West and Morris 2000). In the early ground-breaking book that announces
the model, Knopp et al. state: “We have structured an attrition model as one
example of a long range process for abolition. ‘Attrition, ’ which means
rubbing away or wearing down by frictions reflects, the persistent and continuing strategy
necessary to diminish the function and power of prisons in our society” (62).
The attrition model
as articulated here has at once united prison or penal abolitionists and given
them a long-range basis on which to plan. Anyone who was ever been active in
prison abolition will not fail to recognize the hallmark question that
typically arises when a new action or campaign is considered: “Will it move us
any closer to the long-term goal of prison abolition?”
An attrition model
assumes that nothing as extensive and entrenched as the institution in question
can be changed quickly, that something as ambitious as abolition takes place
slowly and for the most part by attrition – by gradual but persistent rubbing
away and wearing down. Correspondingly, it is predicated on the proposition
that not all change that seems positive has the capacity to bring a movement
closer to the abolitionist goal and indeed, on the contrary, some of what looks promising would
actually undermine the long-term goal in question.
Herein lays a
conceptualization that holds promise for antipsychiatry. My intent in this
chapter is to do for antipsychiatry what was long ago done for prison abolition.
The purpose of the chapter is to construct, articulate, and help readers make
sense of the bare bones of an attrition model. In no way am I suggesting that
it is the only possible model. Nor am I suggesting that an attrition model per se is straightforward
or absolute. It is clear, however, that an unpopular movement that is at odds
with the state and with prevailing hegemony as well as with a massive and
entrenched industry begins at a serious disadvantage. It is further
disadvantaged if it has no vision about how to move closer to the goal it
espouses.
In presenting this
attrition model, I am aware that my most focal audience are fellow activists
who are antipsychiatry or who verge on it. What I can promise people from other
constituencies, however, is: I’ll not be forgetting you.
That said, we come
to the model. It proceeds by questions – what I call “defining questions.”
While the number is somewhat arbitrary, let me propose three related questions
that antipsychiatry activists operating from an attrition model need to ask
when making major decisions. The first is the most pivotal question. The next
two are auxiliary questions that might best be thought of as derivative of the
first. The three questions are:
1.
If successful, will the actions or
campaigns that we are contemplating move us closer to the long-range goal of
psychiatry abolition?
2.
Are they likely to avoid improving
or giving added legitimacy to the current system?
3.
Do they avoid “widening”
psychiatry’s net (creating conditions which allow psychiatry to “scoop up” ever
more people)?
To shed light on
these, the first is the most formidable of the three for it states in general
terms what the model is all about and as such gives abolitionists a quick
reference point. Say that an action or campaign being considered is worthwhile
on other grounds, but we have no reason to believe that its success will move
us closer to the goal of abolition. In that case, someone else might take it
up, but it would not be the proper focus of abolitionists.
To be clear, abolitionists may or may not choose to endorse such changes or
campaigns, depending on whether or not it undermines the long run goal among
other things, but they would not become active in them. The point is that an
attrition mandate would require that only changes that are abolitionist in
nature and not merely reformist be actively pursued.
Now looked at
superficially, this guidance would appear to rule out any actions not directly
related to major changes. However, that is far from the case. Part of the
beauty of the attrition model is precisely that it is predicated on the passage
of time. In other words, time must be factored in, and certain types of minor
changes, which build over time, have the potential of shifting worldviews. For
example, any action that helps de-medicalize the language used about people who
process differently than those deemed “normal,” or live in alternative
realities, or are in emotional turmoil could be seen as an abolitionist change,
for if enough of the language shifted over time, it would chip away at the
impression that psychiatrists work so hard at maintaining – that such states or
ways of being are “medical issues” and hence the proper domain of doctors. The
language of the mad movement is an example of what could be supported in this
regard. While antipsychiatry activists in the past have been critical of mad
language as not antipsychiatry per se, this model would ask antipsychiatry activists to take another look.
The next question
complicates what might have initially looked simple: while question 1 asks, if
successful, would our campaign or intended actions move us closer to psychiatry
abolition, question 2 asks: are they likely to avoid improving or giving
legitimacy to the current system?
While an offshoot
of question 1, question 2 raises the bar. If a campaign or action is likely to
lend legitimacy to the current system, it would make no sense for abolitionists
to support it, for it undermines the ultimate goal. In fact, if lending
legitimacy to the current system is among the primary consequences of a given
action then, even if it is otherwise benign, it would not be sensible for an
antipsychiatry group to even endorse it. Examples of activities sometimes
engaged in by people who combat psychiatry that this question would rule out
are: sitting on task forces making recommendations on how to improve
psychiatric institutions; taking part in reformist agendas such as those
associated with organizations like the Mental Health
Commission of Canada; taking part in any events or initiatives sponsored by
psychiatry – including purely cultural ones for they too lend it legitimacy,
indeed, making psychiatric facilities appear like friendly community centres –
a valuable part of the life of the community.
Question 3 asks: if
successful, would the actions or campaigns that we are contemplating avoid
widening the net. What is meant by “widening the net”? It means allowing more
and more people and more and more situations to fall under the auspices of
psychiatry. Widening the net of psychiatry is tantamount to helping psychiatry
grow as opposed to forcing it to wither. What is the intent of question three?
The intent is that no initiative be adopted whose success carries with it the
likely consequence of widening the net – that is, of placing more people or
people at more times under the auspices of the psychiatric system.
Correspondingly, where such initiatives originate from within the system, for
the most part they should be actively resisted.
An obvious example
of a campaign that would widen the net which originated from within the system
was the push for community treatment orders.2 Despite the rhetoric behind them, it was clear from
the outset that community treatment orders would widen the net because they
would drastically extend psychiatric control both temporally (past an inmate’s
release date) and spatially (extending the grasp of the hospital further into
the community). Antipsychiatry activists, psychiatric survivors, and others
critical of the system immediately saw what was at stake and while
unsuccessful, quickly mobilized against the initiatives.
Psychiatric
measures like this, which constitute obvious power grabs, fortunately are
fairly easy to identify. By contrast, measures originating from within the
community critical of psychiatry that inadvertently widen the net are not so easy to identify. Nonetheless, they too fall
under the purview of this question, and while resistance would generally not be
in order, for we do not obstruct our allies, they should not be supported or
endorsed. An example of an action that would err in this regard is getting on
the bandwagon clamoring for “mental health services” to be brought into an area
when “mental health services” largely means psychiatric or services controlled
by psychiatry.
Questions two and
three may often prove difficult to hold onto, for they have the potential to
place us at odds with what appears as progress, but this is
precisely why they are important. Quite simply, they let us navigate tricky
terrain. Let us say, for instance, that there is no service in a major city
that offers emotional support for women who have undergone the shattering
experience of giving birth to a stillborn child. The community responds by
pushing for the creation of a service, and willy-nilly, it is decided that it
will be psychiatric. Alternatively, let us say that there is a psychiatric
service for women who have experienced stillbirth, but that the service is seen
as deficient in some way, and the community begins pressuring to have that way
addressed – say, to have the service in question expanded or otherwise
improved. Given that services are direly needed for women facing this
devastating life experience, one feels drawn to support both of these
initiatives – for, on some level, progress is happening. As abolitionists,
however, it is important to keep in mind that supporting such changes means (a)
helping psychiatry get bigger, (b) helping psychiatry become firmly entrenched
in yet another area, and indeed, helping psychiatry appear benign, and (c)
placing an entire group of vulnerable women in more jeopardy from psychiatry
than they were previously – for the inevitable depression could result in
drugging, institutionalization, and even electroshock. Correspondingly, it
essentially cedes the ground to psychiatry in yet another area, relegating any
other services including self-help to becoming at best an alternative for those
seen as least affected, and at worst an adjunct to psychiatry. These two
questions about legitimating and broadening the basis of psychiatry help us see
what we might otherwise fail to see. Difficult though it may be to hold onto
the last two questions, accordingly, the questions are pivotal for they keep us
from going off course.
Together, the three
questions, along with a knowledge of how psychiatry operates, suggest obvious
directions for abolitionists. What goes beyond that, they also provide
antipsychiatry with one way of prioritizing – and let there be no mistake about
it, we need to prioritize for we cannot do everything.
How does one
prioritize using these questions? In a nutshell, the method is as follows:
assume that the action or campaign being considered will be successful or at
least reasonably successful, then evaluate from there. The closer to abolition
some actions or directions would bring us, short of there being other
objections to them, or reasons to prioritize other campaigns, the more focal
they should be to antipsychiatry organizing. Correspondingly, anything that actually attacks psychiatry’s power base is particularly
important and, so should be given top priority.
To spell out what
some of those top priority actions, directions, or campaigns might be – and
people familiar with the terrain will recognize most of these – particularly
apropos and indeed, more central than they are currently, would be actions or
campaigns that put the state on the defensive when it comes to psychiatry or
weakens the state’s unilateral endorsement or funding of psychiatry. The reason
why this direction is singularly important is the pivotal role of the state in
psychiatric rule. Psychiatry has the power it does only because it is an
extension of the state, is part of the apparatus of the state, and as such, is
additionally handsomely funded by the state. Loosen the tie with the state,
eliminate all or a sizable part of the state’s sanction or support, and
psychiatry’s size and power to harm begins to evaporate.
Examples of actions
or campaigns that might be taken up in this regard – and most of these have
long figured in our community arsenal – include: directly suing the state for
damages; suing hospitals for damages; challenging the constitutionality of laws
that the state has enacted to empower psychiatry; appealing to a power outside
the state, whether it be the U N or some other
international body. I give kudos here to the work of people like David Oaks.
Other less foundational but also critically important measures on the same
continuum include: demanding moratoriums on new psychiatric hospital
constructions; pressuring for the end to involuntary commitment; initiatives
that support increased patients’ rights or the upholding of current rights;
advocating cutbacks in funding for psychiatric services and increased funding
for more benign services; waging campaigns to de-fund private psychotherapy
delivered by doctors, or what I think might well serve us better, to fund
equally psychotherapy delivered by others (psychiatry could not have the power
which it has today without the state giving it a virtual monopoly).
Many of the other
initiatives that survivors and other critics of psychiatry commonly take up
would also be focal. Included, in this regard, would be consciousness-raising,
for consciousness-raising can also clearly help us, as a society, move toward
attrition. Included are attacks on other parts of the psychiatric industrial
complex – not the least of which are the pharmaceutical companies upon which
psychiatry fundamentally rests. Foundational critiques – that is, critiques of the basic tenets underpinning psychiatric
practice – are particularly important.
By the same token,
actions that are abolitionist in nature with respect to any of the current
“treatments” can be seen as in line with the abolitionist agenda. This, of
course, would include the rigorously abolitionist campaigns currently waged by
heroic survivors and their allies to ban electroshock (for more detail, see
Weitz 2008). Nevertheless, it would also include actions, campaigns, and
recommendations that are not immediately abolitionist with respect to current
treatment, but which are likely (if successful) to contribute to attrition. An
example is a number of the recommendations put forward in a report submitted by
a panel that oversaw Toronto-based hearings into psychiatric drugs in 2005.
None of the recommendations in the report were abolitionist in the immediate
sense of the term. If enacted, however, most would further the long-term work
of attrition.
Take, for example,
the recommendation “all doctors who prescribe psychiatric drugs be required by
law to review the choice of drugs and the amount of the drug administered…
doctors in particular be required biannually to consider less powerful drugs,
drugs with less negative effects… smaller doses, and withdrawal itself.”
(Burstow, Cohan, Diamond et al. 2005). Clearly, if measures such as these were
enacted, they would contribute to the weakening of psychiatry and the gradual
loosening of the psychiatric drug stranglehold. Note, in this regard, that besides
the fact that any substantial loosening of the drug stranglehold is desirable
in and of itself, in addition psychiatry’s claim to jurisdiction over madness
lies largely with the drugs. Any attack on the drugs is, in the long run, an
attack on psychiatry’s relevance.3
Many, albeit not
all, of the examples articulated so far are obvious. What is particularly
useful about an attrition model, however, is that it helps activists and
analysts engage in the reasoning, weighing, and balancing needed when
confronted with choices that are not at all obvious, or what is not uncommon,
where disagreement arises. And such guides are essential to better functioning.
To offer a
practical example of how attrition-type reasoning helped an antipsychiatry
group work through a difficult and contentious issue, I would highlight a
situation that arose recently in C A P A . A request came
from a member-at-large to endorse a bill most everyone here is aware of – the
New York bill banning involuntary electroshock on children
under sixteen.4 As the request came during the summer when CAPA was not meeting, it fell to the executive to decide. Initially, the CAPA executive was seriously split. Initially, most of the executive did
not want to endorse because C A PA’s own position is
the complete abolition of electroshock, also because they feared that any new
law of this nature would lend legitimacy to electroshock. On the other hand,
the rest of the executive and the member-at-large were convinced that the
initiative should be endorsed because if such legislation were passed, it would
stop some people from being electroshocked, also because it moves in the
direction of the abolition of shock.
To be clear, this
dispute predates any articulation of an attrition model for antipsychiatry.
Attrition, nonetheless, was at issue from the beginning, and it is a careful
focusing on attrition that allowed this question to be resolved. One of the reasons given
against endorsing drew on a principle inherent in the attrition model – that
such a new law would lend legitimacy to the electroshock industry. All of the reasons to
endorse connected with attrition principles: that is, it prevents some people
from being electroshocked, or to put it another way, would narrow the
electroshock net. Additionally, it would begin chipping away at electroshock.
The point is, if electroshock is not good for children, it could be argued, it
is also not good for the elderly. Accordingly, the successful passing of such a
bill would take New York one stage closer to abolishing electroshock for other
populations and potentially ultimately for everyone.
The principles of
attrition allowed us to quickly work through what began as a divisive and hotly
debated issue. It was determined that the worry that such a new law would lend
credibility to the electroshock industry was ill founded. Additionally, it was
agreed that such a law would protect some people, narrow the sway of
electroshock, and lead in the direction of electroshock abolition.
Significantly, all members of the executive followed the logic. What is also
significant, none of these deliberations weakened or any way altered CAPA’s own commitment to personally launch only ECT actions that
call for complete abolition. However, it did allow us to work through the
endorsement issue and quickly transit from a seemingly irresolvable standoff to
endorsement of a bill that merited our support.
The three questions
I have been discussing are the definitional ones, and indeed, are the questions
that ensure that antipsychiatry initiatives are compatible
with the ultimate antipsychiatry goal. This notwithstanding, given the
complexity of the issues, given the vulnerability of some who access
psychiatric services, and given our broader commitments as human beings, of
course, these are not the only questions that antipsychiatry activists should
be asking when contemplating new actions or campaigns. While it is beyond the
scope of this chapter to discuss these, besides questions of strategy,
additional questions that I would recommend organizations or individuals
holding an attrition model ask themselves include: What sorts of
non-psychiatric services, what sort of help – self help, for example, or
withdrawal centres – are we advocating or supporting? Are we finding ways to
link up with others in the critical of psychiatry community – psychiatric
survivor organizations and mad groups in particular? Given that psychiatry is
not the first oppressor of the people deemed mad, what measures are we taking
to avoid helping pave the way for another oppressor to replace psychiatry?5 Is the initiative that we are considering compatible
with the creation of a more caring society? Does it leave any vulnerable people
in the lurch? Does the initiative that we are considering in any way empower
the people most affected or most at risk from the psychiatric system (past
psychiatric patients, current psychiatric patients, people who would appear to
have psychiatry on their horizon)? Are we paying sufficient attention to the
special jeopardy in which psychiatry places otherwise oppressed populations?
Women? People who are homeless? Racialized people? Lesbians and gays?
Transsexuals – transsexual youth in particular? Arguably, most importantly of
all, the elderly?6
As regards this
last item, the point is that psychiatric oppression intersects in horrific and
manifold ways with all systemic oppressions, and it is critical that it be
critiqued and attacked with that awareness. Hence, the profound significance of
such developments as feminist antipsychiatry, and the very particular agendas,
mandates, and priorities that these open up.7
At this point, I
have given some idea how this model can be used to determine what to actively
take up and what not take up, what to support and what not support. I have also
shown how it can be used to establish priorities, and what some of those
priorities might be. At this juncture I want to enter trickier territory. I
indicated at the beginning that use of the attrition model would inevitably
lead to a re-examination of some of the types of activities that some of us would have supported in the past, and I want to touch on
some of the areas where the model would encourage rethinking. One such area is
certain measures taken up – and understandably taken up – with regard to
different oppressions.
Notwithstanding the
enormous importance of paying rigorous attention to systemic oppression and
notwithstanding the legitimacy of differing priorities, there have long been
initiatives related to oppressed groups that an attrition model require be
looked at more critically. These include: pressuring for the removal of
specific noxious diagnoses that particularly or uniquely oppress members of an
otherwise oppressed group, and advocating for culturally sensitive psychiatric
services.
First, critiquing
specific diagnoses is not only unproblematic, it is a critical part of
consciousness-raising, on which all attrition models depend, and as such, it is
mandatory for antipsychiatry. Indeed, targeting specific diagnoses has quite
rightly been one of the hallmarks of feminist antipsychiatry. Whether as women,
or as racialized people, or both, we want the damage done to our communities
acknowledged and stopped. Correspondingly, oppressed populations have ample
reason to want specific diagnoses removed from the books that uniquely
pathologize these particular populations and make it easy for psychiatry to
intrude. Included, in this regard, are such historical diagnoses as
“ego-dystonic homosexuality” and “hysterical personality disorder” (currently
“histrionic personality disorder”), which have oppressed the lesbian and gay
and the women’s community respectively, and current diagnoses as “gender
identity disorder,” which are oppressive to the trans community.8
That women,
lesbians and gays, and trans people work to have such diagnoses quashed is
hardly surprisingly. The primary question here is not whether women, gays and
lesbians, or trans people should organize against such diagnoses, or even
whether people generally critical of psychiatry should organize against them.
It is whether or not mobilization against such diagnoses is a proper
antipsychiatry initiative. Herein the attrition model sheds its own light,
albeit I have no questions that intersecting identities make this issue
particularly complicated for many.
Ultimately, for an
attritionist, the issue at hand boils down to: How does the existence of a
campaign against one or other diagnosis measure up to the definitional
questions? That is, do the successes of such campaigns contribute to the
erosion of psychiatry? Do they avoid widening the net? And
do they avoid improving or lending legitimacy to psychiatry? Now the question
of widening the net is unclear. However, enough of these campaigns have
“succeeded” to demonstrate that there are no encouraging answers to the other
questions. A number of diagnoses that we, as women, and as lesbians and gays,
rightly find oppressive have been struck down – and yet these successes have
not impeded psychiatry, changed it significantly, or resulted in fewer
diagnoses. On the contrary, the number of diagnoses continues to skyrocket (see
Kirk and Kutchins 1992, 1994). Given psychiatry’s ingenuity in hiding old
unpopular diagnoses behind new labels (for a discussion of this tendency, see
Burstow 1990), and given its ability to turn acknowledged oppression into a
syndrome, it is often unclear what is achieved for the actual population in
question. At best, the new diagnoses constitute somewhat of an improvement,
albeit not the kind that contributes to attrition; and at worst, they only
appear to improve, drawing people who began as critical into their terrain in
the process. What is also problematic, such campaigns give legitimacy to
psychiatry for they tacitly acknowledge its authority by the sheer act of
appealing to it. Moreover, the apparent success of such campaigns has lent
psychiatry the further credibility of allowing it to appear progressive. As
such, involvement in such campaigns is questionable for abolitionists, although
progressive professionals with antipsychiatry leanings such as Caplan have long
engaged in them, and continued discussion is important.9
A similar problem
arises with respect to campaigns for more culturally sensitive psychiatric
approaches – and, what is particularly problematic, for the creation of new
culturally sensitive psychiatric programs. Again, it is totally understandable
that populations affected by psychiatric racism, or sexism, or transphobia
would push for such changes. And given the dearth of funding for services not
under the auspices of psychiatry, it is totally understandable that communities
that are not mainstream – especially those subject to significant
transgenerational trauma and/or insidious trauma – would ask for the creation
of culturally sensitive psychiatric programs, whether it be the trans community
or the Aboriginal communities.10 Nonetheless, such campaigns are in conflict with all
three major tenets of an attrition model: they do not move us closer to
abolition; they do not avoid improving or lending legitimacy to the current
system – in fact they are precisely reformist changes, which
serve to improve psychiatry and give it greater credibility; and they widen the
net, allowing more and more members of the populations in question to fall
under psychiatric auspices, and now with the active cooperation of their
community. As such, campaigns for such services are at odds with psychiatry
abolition and arguably hazardous for the communities in question.
If an attrition
model became a standard part of an antipsychiatry toolkit, inevitably, other
types of mobilization that currently may look benign or like a reasonable trade
off would likewise start looking increasingly problematic or minimally
incompatible with an abolition mandate. The question would be to weigh
carefully, to be open to reconsidering, to factor in other questions as needed
– and what is particularly important, to understand that allies who make
different decisions remain our allies.
Throughout this
chapter, I have been demonstrating how an attrition model can help
antipsychiatry activists make choices, establish priorities, and rethink
directions and initiatives. While I do not suggest that is equal, in ending, I
would like to suggest that there is something in this model for other
constituencies in our community as well. Now I do not wish to overstate my hand
here, for it could sow division as well. If applied sensitively, this model
might nonetheless be of assistance in easing some of the tension between
antipsychiatry activists and others in our community and in creating bridges.
It might foster clearer communication and understanding, for example.
Additionally, it might enable antipsychiatry organizations to support and join
with others in more initiatives.
Significantly,
while not identified as antipsychiatry, many of the initiatives, focuses, and
actions specific to other critical constituencies have the potential of
whittling away at psychiatry, and as such, could be supported by the
antipsychiatry community far more enthusiastically than they have been in the
past. An example is the creation and defense of a mad culture – Mad Pride
events, articulations of mad theory – which to date, sadly, has received little
support from antipsychiatry. The attrition model provides a way of recognizing
points of meeting that are obscured by other types of abolitionist stances, for
these become visible when approached from the vantage point of slow but
persistent wearing away. It also provides others in the larger community with a
view of what might be added or what modifications might be made to turn an
action inimical to antipsychiatry into one that antipsychiatry groups can
actively support or minimally endorse. While I would not
wish to overstate the case, the model also might be of more direct assistance
to the broader activist community. The point is, while other constituencies
legitimately have other priorities – and I am speaking particularly to
activists who organize in relation to psychiatry here – I can see the value of
groups with different perspectives engaging with the attrition model from time
to time.
Bottom line: those
of us who organize in this area have this in common: None of us are deliriously
happy with psychiatry. All of us minimally would like it smaller, would like it
curtailed, would like room for more benign help to take root. In other words,
all constituencies in our community in some way favour some type of withering.
Accordingly, groups with other perspectives may be served by at least
occasionally having these three questions among the ones they consider when
choosing actions or campaigns.
In conclusion, I
invite others to come up with their own models and to share them, whether they
be models for antipsychiatry, models for the mad movement or models for the
psych survivor movement. The reality is, we need a plethora of workable models
if we are to bring about the more caring, tolerant society for which we are all
fighting. And let there be no mistake about it. Besides that they have the
lion’s share of the power, people who successfully make this world a living
hell for others – who rob others of their freedom, who subject them to
torturous treatments – tend to be very good at what they do. We need to be equally
good.
1 In 2008 CAPA created a myth/fact sheet to correct misimpressions about
antipsychiatry, as well as to help bring the community together. For C A P A’s
Antipsychiatry Fact Sheet, see http://coalitionagainstpsychiatricassault.wordpress.com/fact-sheet/./mental-health/brief-psychotherapy-centre-for-women-%28bpcw%29463/.
2 For an insightful critique of community treatment orders as well as a
compelling read, see Fabris (2006).
3 For a highly informative exploration of the role of psychiatric drugs
in entrenching and propping up psychiatric power, see Scull (1977).
4 Sponsored by Assemblyman Ortiz, the bill may be found at http://assembly.state.ny.us/leg/?bn=A08779&sh=t.
5 Earlier oppressors include the church and businessmen. See, in this
regard, Szasz (1977).
6 For an examination of the special jeopardy of oppressed populations,
see Breggin (1991) and Burstow (2003). For an examination of the massive
psychiatrization of the elderly and its tragic effects, see Breggin (1991). For
a revealing look at ageism in the administration of electroshock, see Weitz
(1997).
7 See, in this regard, Blackbridge and Gilhooly (1985); Burstow (2003);
Chan, Chunn, and Menzies (2005); Chesler (1972); Grobe (1995); and Smith
(1987).
8 For a discussion of various diagnoses that have historically served,
or currently serve, to pathologize people from the L G B T Q
community, see Burstow (1990). For a discussion of diagnoses oppressive to
women, see Unger (2004) and Caplan (1995). For the articulation of the
diagnosis gender identity disorder, see D S M - I V -T R (American
Psychiatric Association, 2000, 576ff.).
9 For Caplan’s own account of her involvement in this regard, see Caplan
(1995).
10 Transgenerational trauma is trauma passed down from one generation to
the next. Insidious trauma is the everyday trauma of living in a world in which
you are oppressed. For further elaboration on these terms, see Burstow (2003).
Psychology Politics Resistance:
Theoretical Practice in Manchester
IAN PARKER
This chapter teases out principles and dynamics
associated with a particular moment of resistance that went by the name of
“Psychology Politics Resistance” and occurred in Manchester in the 1990s, and
which bears a special relationship to psychology. While not explicitly
targeting psychiatry, the chapter figures in this book on resistance to
psychiatry because psychology is not an isolated practice or domain of thought
but part of what is commonly called the psy-complex (Rose 1996). Included in
this complex are psychiatry, psychology, and psychotherapy, and by extension,
psychiatric social work and psychiatric nursing. As the various elements within
the psy-complex are intricately related, resistance within or with respect to
one element necessarily has implications for resistance by or with respect to
the others. What is equally significant, this moment in Manchester was a
historically important moment of resistance.
The campaigning
group “Psychology Politics Resistance” (P P R) was part of
a wave of radical activity in and against the discipline of psychology in the
1990s. Following its founding conference in Manchester in 1994 the group
published six newsletters, and its members were involved in a number of
different campaigns before it effectively dissolved itself into Asylum: Magazine for Democratic Psychiatry (which still incorporates the PPR Newsletter).1 This chapter reviews the specific cultural-economic
conditions of the 1990s that facilitated and hindered the development of the
group, explores the assumptions it made about what was possible and the
rationale for the name, and draws out theoretical and practical lessons.
P P R , or something very like it, is just as necessary today, if not more
so, and this account is also designed to stimulate the rebirth of the group. We
will begin with the “time” of PPR.
WHY PPR THEN?
The founding conference of “Psychology Politics
Resistance” in Manchester on 2 July 1994 was the culmination of a series of
meetings of radicals in the U K dissatisfied with the
discipline of psychology from the mid 1980s. The founding 150-strong conference
was deliberately international in character, and included guest speaker
contributions from a psychologist working in the prison system in Barcelona
(Pep Garcia-Borés); a psychologist active in the struggle against apartheid in
South Africa (Don Foster); and an educational psychologist (Snezana Frzina)
from Sarajevo then in exile in Manchester as a result of the civil war. A
collection was taken for the campaign support group “Workers Aid for Bosnia.”
Key to the thinking of PP R was that it needed to
draw together three different kinds of networks. Academics who taught and
researched psychology, and who were mainly based in psychology departments,
were at the core of the group, and they used their institutional resources to
build meetings and distribute campaign materials, including the P P R newsletters.2
These academics
were reluctant to take a lead, however, and made an initial alliance with
professional psychologists who saw firsthand the problematic nature of the
different models and treatments offered by the discipline. These two networks,
academic and professional, then sought to make a further alliance with groups
of what are sometimes called “users,” sometimes “consumers,” and sometimes
“survivors” of psychology services. These labels are each inaccurate, and
either reclaimed or avoided by different groups. It is this third part of the
alliance – those who suffer firsthand what psychology does, and speak out
against the discipline – that was the heart and conscience of P P R . A guest speaker, Ron Coleman, at the founding conference, for
example, was from the Hearing Voices Network and Asylum: Magazine for Democratic Psychiatry.
In this sense, the decision to fold the PPR newsletter into
Asylum at
the time of the re-launch of the magazine in 2002 (one of its many
“re-launches,” it should be said) was a logical step. That decision marked the
end of an eight-year span of life for PPR in its first
incarnation, and it is worth reflecting for a moment on the
context of that existence, then, in order to understand something about its
specific “conditions of possibility.”
One reason the
founding conference was “international” was because we knew already that the
cultural-economic climate at home – in Manchester and in the UK – was a difficult one, and that we needed to maintain connections with
like-minded colleagues in other countries if we were to survive. After the
election of Margaret Thatcher at the head of the Conservative Party in 1979,
psychology was the site of an immense ideological assault by the ruling class
as it sought to roll back the post-Second World War welfare state and throw the
population into the maelstrom of neoliberal economic policies. Those were early
days of this assault, one that has become significantly more intense since the
capitalist economic crisis and the securitization agenda of the state to deal
with dissent.
It is possible to
see more clearly now that neoliberalism – a transformation of capitalism that
privatizes collectively held resources, and demands that each individual
configures themselves as a resilient flexible entrepreneur of their own selves
willing to adapt to changing market conditions – required more psychology. The
neoliberal turn has a particular impact on women, and all the more so when the
service sector in nations within the global north becomes the fastest-growing
part of the economy. And in many other nations in the global south, the service
sector, which has a high proportion of female employees, is also now the
dominant sector of the economy. This is a continuation of a mutation of
capitalism into so-called “late capitalism” that began with an electronic
“third industrial revolution” after the Second World War, and which entails a
globalization of production and consumption (Mandel 1974). The service sector
relies on stereotypical women’s abilities to resonate with the needs of others.
Women as caregivers and centres of emotional support are harnessed by the
service sector – in restaurants, hotels, and leisure facilities as well as in
“customer care” and personnel departments of large companies – in the form of “emotional
labour” (Hochschild 1983).
This means that not
only is the family still effectively a kind of prison for many women –
idealized as the place where all should be safe at home in the care of women
but often a place of silent misery where the power of the man is allowed to
actually govern its internal structure – but it is no longer sealed off as any
kind of haven from the outside world (Zaretsky 1976). Women
are expected to be as busy ministering to the needs of others in their
workplace as they are at home, and the “emotional labour” they undertake leads
to deeper and more draining forms of alienation. Women, and the men who learn
from them how to behave nicely to customers and clients at work, are thus
expected to engage more fully in their work and the stage is set for more
pressure and more personal breakdowns for those who are eventually unable to
cope. Even in the early 1980s academic psychologists could see a consequence of
this neoliberal turn; the discipline of psychology became much more popular as
people were ideologically corralled into finding individual solutions to the
problems they faced, and came to believe that “psychology” itself was one of
those solutions.
On the left too
there was disenchantment with a political-economic explanation of the crisis,
and there were attempts to understand “Thatcherism” as a specific
cultural-ideological phenomenon that called upon some kind deep-seated
psychological investment in authority. Some therapist-activists even sought to
revive Wilhelm Reich’s psychoanalytic writings on the mass psychology of
fascism in the 1930s and use a version of those ideas to explain the mass
psychology of Thatcherism (Chaplin and Haggart 1983). Other radical academics
looked to a combination of psychoanalysis and “post-structuralist” theory to
account for the “new times” we faced, and this ethos underpinned the work of
one of the influential radical psychology journals Ideology and Consciousness (that ran from
1977–81) and then the path-breaking book Changing the Subject (Henriques et al.
1984) published a few years later. By that time the terms “ideology” and
“consciousness” had themselves became embarrassing reminders of an attachment
to what they saw as old-style Marxist and feminist politics, and shortly before
its demise Ideology and Consciousness was abbreviated to “I & C.”
The deep
disappointment with the failure of the left in the 1970s led many activists
into psychotherapy, and a good proportion of those into training as
counsellors, psychotherapists, or psychoanalysts themselves. This meant that
even at the moment of an intensification of appeals to “psychology” under
Thatcher, there was likewise a retreat into some kind of psychology by those
who knew that something was deeply wrong with this retreat into the interior of
the individual. It is in that context, in those “conditions of possibility”
that a small group (Erica Burman, Corinne Squire) who had been
inspired by the critique of psychology developed in Changing the Subject set up small group
meetings to discuss the ideas in the book. And it is in that context that we
found ourselves complaining about a discipline that was increasing in strength
and visibility in culture around us. One of the uncomfortable paradoxes of
those times was that because higher education institutions were keen to expand
their market-share, they were also willing to tolerate the work of young
critical academics wanting to put on conferences and short courses on what was
wrong with psychology. Up until the 1980s we would have been closely
scrutinized concerning the content of such activities, and asked whether this
was genuinely part of psychology. From that moment, however, the only question
the colleges and universities were asking was how many people could be
recruited to take part and, if at all possible, how much money they would bring
in.
WHAT IS IN THE NAME?
The name we chose was to be punctuated, concluded
with the term “resistance.” Why? First we need to step back and understand
something about the nature of signifiers, for example “resistance.” Signifiers
are elements of meaning, the material inscription of meaning in what the
linguist Ferdinand de Saussure (1974) called the “sound image.” The concept we
each attach to the sound image or signifier “resistance” will be different, but
an important factor that links the concepts we might have with each other, and
which makes collective meaning-making and political activity possible, is that
the meaning of a signifier is given by its relation with other terms. It is
that relation we had to weigh up when choosing how to name our group.
We had earlier
meetings in the late 1980s in London and Manchester (and there were similar
meetings in other cities in the U K) under the name
“Changing the Subject,” for example, but this phrase seemed too closely tied to
an academic psychology book – an internal scholarly argument – and a bit too
playful and cryptic for us. Anyway, for those who are on the sharp end of
psychology, is not the discipline always trying to “change” them as subjects,
to make them adapt to what the discipline wants them to be? By 1989 we opted
for a much broader accessible name “Psychologists for Social Justice and
Equality” (P SJ
E), and we got as far as setting out a
“general basis,” “aims and objectives,” and an outline of “organization and
activities” (which specified that there should be four coordinators and that
there would be a “differential” in membership subscription prices between waged
and unwaged). Looking back at this now, I am struck by how bureaucratic it
looks, and it seems to combine in its name a well-meaning liberal ethos with
the assumption that everyone involved would be “psychologists.” It is then
entirely understandable that PSJE should state (in its
“general basis”) that it would be “committed to developing psychological ideas”
and that it wanted “psychology to change from a conservative into an openly
liberatory discipline.”
There were two
practical-theoretical steps we needed to take. One was to see that such a group
needed to dislodge the priority given in the name P S J E to
“psychologists.” Surely the fact that psychologists were telling other people
how to behave and think was precisely the problem, and this problem would not
be resolved by us telling people that they ought to be in favour of “social justice
and equality.” In other words, we had to realise that there is a difference
between an ethical stance we might take in relation to the discipline – an
ethical stance of “resistance,” as we came to name it – and the suffocating
“moral” standpoint which tried to get people to conform to what we thought was
right. Morality specifies what is right and what is wrong, and operates as a
series of codes to which people should adjust themselves. Ethics, on the other
hand, opens up the possibility for people to decide for themselves and to make
alliances to say no to power, and to remain faithful to events that have
changed the coordinates of taken-for-granted reality (Badiou 2001).
The second step we
needed to take was to avoid the surreptitious reintroduction of something
psychological, as commonly understood, into the process of resistance itself.
We took the first step with a renaming of the group, later in 1989, as
“Psychology and Social Responsibility” (PSR), but we needed
to take a second step away from the notion of “social responsibility” itself,
which I think we can see now was a psychologized (and rather moralistic) phrase
that risked inviting people into exactly the kind of position that the
psychologists would like them to adopt. That is, one of the defining
characteristics of psychology as a discipline is precisely that it aims to turn
its subjects into self-governing individuals who will take responsibility for
their own actions, as if it was all down to them, and they
are seen as pathological if they are not willing to do that (Rose 1996).
If we reflect for a
moment on “Psychology,” “Politics,” and “Resistance” as signifiers, and upon
“Psychology Politics Resistance” combined as a signifier, we can see that there
are some important theoretical issues at stake (Howarth et al. 2000). First,
what the name came to mean is itself a signifying process, and it breaks usual
grammatical rules by avoiding commas between the terms or adding “and” between
the politics and resistance. The three words are chained together in a quite
specific way, in a relation of succession and, almost, of equivalence. There
was thus ambiguity that was not present in the previous incarnations of the
name of the group over what the place of “psychology” was in relation to power
and resistance, and certainly it did not suppose that any kind of psychology
was part of a solution or alternative to politics and resistance.
Second, we can ask
what types of signifiers were mobilized in this naming of the group. There are
certain kinds of signifiers in a language that anchor meaning and in tying it
down they operate as “master signifiers.” Other signifiers are more ambiguous
and there is an ideological battle over who can claim them and over what they
will mean in relation to the other signifiers around them. These signifiers
operate as what have been termed “floating signifiers.” And there is a third
kind of signifier, which comes to stand in for the impossible fullness and
universality of society that people fill with their hopes and dreams for a
better world, for the best possible world – and these are “empty signifiers.”
The third
theoretical issue concerns the historical context, which gives sense to terms
in a language. Because the meaning or value of terms is given by their place in
a particular signifying system – language at a moment in time – we need to be
able to step back and map what these values are so that the choice we make for
the name of our group will function in such a way as to both resonate with and
contest prevailing meanings. To show how and why this is important, let us look
at what “psychology,” “politics,” and “resistance” have come to mean to us.
PSYCHOLOGY, POLITICS, AND RESISTANCE
P P R was sometimes given the full title “Psychology, Politics, Resistance,”
with commas separating the three key signifiers from each other.
The removal of the commas, to give the accurate title of the group, chains
these signifiers together in a more direct way, and produces a new combined
signifier. This new signifier, if my memory is right, was suggested by some
colleagues (John Bowers and Liam Greenslade) who were particularly interested
in the work of Michel Foucault, and they had most probably noticed the
productive concatenation of terms in books of his such as “Language, Counter-Memory, Practice” (Foucault 1977b) (which did even then retain the commas) and “Power / Knowledge”
(Foucault 1980a).
Foucault had been a
key point of reference for those of us reading Changing the Subject (Henriques et al.
1984) and organizing meetings to discuss the book. Some of Foucault’s ideas
about power surfaced in far-left politics in London in the wake of the
“post-structuralist” and arguments from the work of the Italian Marxist Antonio
Gramsci inside the “eurocommunist” Communist Party of Great Britain in which
the ideas of Laclau and Mouffe (1985) were moving the party in a more
rightward, social democratic direction before its eventual dissolution (Mandel
1978). A small group (Labour Briefing) inside the Labour Party attempted to
push the Greater London Council further to the left – for example with the
slogan “Labour – Take the Power!” (Reicher 1987). There was some small overlap
between the membership of P P R and its earlier
incarnations and Labour Briefing in the late 1980s. And, crucially, Foucault’s History of Madness
(2009) in its earlier, abridged, English-language version had made an impact on
the user / survivor movement, and his work on surveillance and control
(Foucault 1977a) resonated with those on the sharp end of psychiatry. Some of
his ideas that were accompanying the debates in the left now came to augment
the arguments made by activists in groups like the Mental Patients Union –
groups that had always combined radical theory with practice (Spandler 2006).
PSYCHOLOGY
Foucault was a psychology instructor for several
years, and a broad critique of the psy-complex that includes psychiatry,
psychology, and psychotherapy haunted his writing from the book on “madness” to
his last writings on the formation of the subject (Ingleby 1985). At the theoretical
core of his historical investigations is the question of how the human subject
in Western Enlightenment comes to fold around and reflect
upon itself, how reflexivity as such begins to operate as a touchstone for how
people think and act upon themselves.3 This personal connection between theory and practice
– the Kantian injunction to have the courage to think for yourself4 – is sedimented in the discipline of psychology,
which turns that ethic into a form of morality. What should be noticed now,
however, is that the development of psychology out of the tradition of the
Western Enlightenment is concerned with truth as an empirically verifiable
system of knowledge about the nature of the human being.
“Truth” is very
different in various cultural traditions, which is something the globalization
of English-language forms of subjectivity (of which psychology is a key part)
is now obscuring (Tazi 2004). What the discipline of psychology does is to drum
in particular ideas about what it is important to know about human beings in
order to educate and treat them, and – this is essential – to enforce a
particular view of what that truth as such should look like. When we ask
ourselves the question “What is psychology” we are therefore brought
face-to-face with a fundamental question about what counts as truth, and who
should do the counting (Canguilhem 1958). Psychology as a discipline aims to
accumulate knowledge about the individual human being, and operates on the
assumption that empirical study of behaviour is the basis for modelling
internal psychological processes and so then knowing how to put them right when
they have gone wrong. What psychology refuses to do is to step back and notice
how its description of us as cognitive behavioural mechanisms is actually a
function of capitalist society. Because it refuses to do that it turns its
descriptions into prescriptions for good behaviour and correct cognition that
adapt us, make us fit all the more tightly and willingly into the way the world
is now (Parker 2007).
This poses a huge
challenge to radical or “critical” psychologists, one that was tackled over and
again in PPR, to give up their well-meaning idea that if the bad bits of the
discipline were scraped off then we would be left with some good authentic
descriptions of psychology that could be useful. Meetings of P P R sometimes turned into debates about what bits of the discipline could
be retrieved, and we could see our colleagues at different moments attaching
themselves to “community psychology,” or “action research,” or even
psychoanalysis as a starting point for their critique of the other bits of the discipline they did not like. These apparently academic
questions did, of course, have immediate implications for professional
psychologists (though a group of psychologists working in the National Health
Service in north Manchester we once spoke to about P P R told us that
they actually had no time to do any “psychology” because they were too busy
giving advice about housing rights and supporting social networks).
For sure the
debates had implications for user / survivors of psychology. For them, a
psychological theory could be useful, but the grounds for judging that had
nothing to do with the criteria that were being used in the university
departments that carried out “research” or those used in the clinics that had
to meet “targets.” We learned that the “good” and “bad” of psychology was always
revealed in its practice, and that attempts to define what psychology really
was as a starting point was a topsy-turvy way of addressing the problem.
Psychology operates as a kind of master signifier that holds things in place
and psychologists learn to use other master signifiers to anchor their own
particular understanding of reality. Our task in PPR was to
destabilize that master signifier, and open up some space for those subject to
it.
POLITICS
In other words, and here the chaining of
“psychology” directly to the next signifier in our name is important, the
grounds on which we should assess what worked should be political. “Politics”
was, for some participants in the meetings, the most contentious part of the
equation. Unlike “social justice,” “equality,” or “social responsibility,” the
signifier “politics” forces us to engage with structural conditions and with
the multitude of different social actors who are aiming to change the world. It
goes beyond the rather vacuous earlier names which, in the words of one
participant in P
P R (Steve Reicher), boiled down to “psychologists
against bad things.”
There are two
aspects of the signifier “politics” that were important to us in PPR. One aspect concerned the state, the apparatus of last resort when
challenges to authority (and challenges to capitalism) become too much. Any
number of complaints against abuse by psychologists or demands for fair
treatment could be made that simply then result in the giving of a little more
leeway to those who complain and serve to humour and shut
up those who are complaining and demanding. But when the oppressed are
organized in such a way that they really might change the conditions that
perpetuate their oppression, we come up against the realm of the state.
The second important
aspect of the signifier “politics” was connecting with the realm of what we
ourselves learned to call our “psychological” being (that part of ourselves
that the psychologists are supposed to have expertise in understanding and
managing). This second aspect came to the fore with the development of a
stronger feminist presence inside socialist politics in the 1970s, and concerns
the way that everyday social relationships perpetuate wider power relations.
Socialist feminism brings in an aspect of politics that is captured in the
slogan “the personal is the political” (Rowbotham et al. 1980). A consequence
of that way of reconfiguring the nature of politics is that our attempts to
change prevailing social conditions should in the very process of change “prefigure”
what we would wish for as another world (Kagan and Burton 2000). Already, then,
the connection of the term “politics” with the term “psychology” produces a
change in “value” or meaning of each of the terms, so that we understand the
meaning of the terms “psychology” and “politics” differently.
There is a third
aspect of the politics of psychology that we now need to consider, something of
which we were dimly aware in the 1980s but which has become more salient now in
globalized neoliberal capitalism. That is, the temptation to respond to the
politics of psychology with a psychological approach to politics, and more
generally with an intensification of what has been termed “psychologization”
(De Vos 2012). Psychology today does not only operate as a discipline to which
people are subjected when they fall out of line, but it has proliferated in
everyday discourse and practices of self-monitoring and self-improvement in the
media and everyday life. This “psychologization” of our ways of relating to
ourselves and others is an intensification of the kind of thing Foucault
(1984b) was so interested in at the birth of the Western Enlightenment, and now
this intensification and regulation of subjectivity is being rolled out around
the world in new forms of cultural imperialism. If the new colonial subjects
want to make themselves understood they must speak about themselves in
psychological terms. By articulating “psychology” with “politics” then, we
thereby turn “psychology” into a “floating signifier” and
give it a new meaning as we draw it across into part of our discourse, into the
discourse of the oppressed, into the discourse of those who resist psychology.
RESISTANCE
Psychology is a profoundly “moral” discipline in
the worst sense of the term. Like the most apparently open and enlightened
versions of psychiatry, psychology wants the human subject to speak about
itself, and puts a moral value on “empowerment” and “participation” of subjects
in the forms of understanding and treatment that the discipline thinks it is
developing. This means that “resistance” to psychology can be quickly and
effectively psychologized; those who resist are thereby blamed and pathologized
for their “unreasonable” behaviour and their faulty understanding of what the
discipline can offer to them. The activities of PPR were designed
to thwart that effort at pathologization that psychology is usually so good at,
and that meant handling the question of the voice of the oppressed in a careful
practical and theoretical way (McLaughlin 1996).
Hence the diversity
of PPR initiatives, that included the “PPR Networks
Festival 1998” (which brought together a number of allied groups, some of which
we rather strongly disagreed with, a rather bruising experience). There was
“The North West Right to Refuse Electroshock Campaign,” which tactically put
aside the question about whether electroshock worked or not and honed in on the
rather more pressing issue of how those who are already vulnerable are
subjected to this “treatment” against their will. We connected with other
issues through the Women in P P R group and
participating in the “Asylum in the 21st Century” event, which broadened out
the signifier “Asylum” to bring in the question of asylum-seekers. That
widening of the scope of our work also led to “Psychologists against the
Nazis,” which responded to the real threat of a growth of fascist organizations
in the U K by pointing out that electroshock was developed in Mussolini’s Italy
and that the “mentally ill” were some of the first victims under Hitler in
Germany.
Resistance as an
abstract moral good could lead us to empty apolitical complaint about what is
being done to us, and some of the complaints about the inadequacy of
“resistance” draw attention to that problem (Žižek 2008). However, the production
of a new signifying chain that links “resistance” to
“psychology” and “politics” gives it a new value. Emptiness itself begins to
take on a positive aspect against the efforts of psychologists to tell us what
we are thinking and feeling. In this way “resistance” could be thought of as an
“empty signifier,” something that names the site of our struggle against
psychology without filling it in again with psychological terms.
CONCLUSIONS
PP R was, for a moment, an “empty signifier,” a site of resistance to the
discipline of psychology. In its theory and its practice it presented a puzzle
to the psychologists about what exactly it was that we wanted, and it also
provoked puzzlement among its own members. It was an unstable formation, and
necessarily so, and was uncertain about its role as a switching point to
connect other existing campaigns or as component of a broader struggle for
democratic psychiatry. It was an experiment, and unlike other kinds of
experiments in psychology it was designed to deliberately change what it
interpreted. Its very existence was a threat to psychology. Now it is an
experiment we must repeat.
1 Asylum has a good online presence now at www.asylumonline.net.
2 The P P R Newsletters
are available as a historical resource at http://www.discourseunit.com/psychology-politics-resistance/.
3 Michel Foucault, “What Is Enlightenment?” (1984). http://foucault.info/documents/whatIsEnlightenment/foucault.whatIsEnlightenment.en.html. Last accessed 14 May 2012.
4 Immanuel Kant, “An Answer to the Question What Is Enlightenment?”
(1784). http://www.marxists.org/reference/subject/ethics/kant/enlightenment.htm
From Subservience to Resistance:
Nursing versus Psychiatry
SIMON ADAM
INTRODUCTION
States of domination, Michel Foucault describes,
are those instances when a group “succeeds in blocking a field of power
relations, immobilizing them and preventing any reversibility of movement”
(Rabinow and Rose 2003, 27). Power relations that involve nursing, psychiatry,
and pharmacology are the focus of this chapter. The voices of nurses resisting
psychiatry have been emerging for some time now, but with a rather cautious
crescendo. Nurses organizing against psychiatry, whose recent work modestly
appears in the nursing and social sciences literature, emerged out of powerful
discourses. As such, these nurses often stand on unstable political ground.
These nurses are the trailblazers, the ruptures in the cooperation of nursing
with psychiatry. In this chapter, I start with the idea that this political
instability arose out of a resistance to powerful ruling discourses, into which
nursing consciousness is perpetually hooked in a state of submission. While the
very few radical nursing thinkers have begun a counter-narrative, I call
attention to some possible reasons why the majority has not joined in. The
discourses of pharmacology and psychiatry, as ruling apparatuses, are my
critical focus. I examine the state of domination that has enslaved nursing
consciousness, and from which a few nurses have been attempting to break.
RADICAL THINKERS IN NURSING
Cheryl van Daalen-Smith (2011b) brings stark
phenomenological attention to women’s experiences with electroshock. In her
study, seven women speak about their experiences as
recipients of electroconvulsive therapy. Van Daalen-Smith provides a visceral
rendering of the accounts of the women who described shock as having resulted
in “damage and devastating loss” (457). These seven women serve as a small
sample exemplifying the harmful effects of electroshock on people, particularly
women. Van Daalen-Smith explicates a contradiction in the perceived benefits of
electroshock. According to the nurses she interviewed, electroshock provided a
positive outcome for the recipients. Concurrently, van Daalen-Smith (2011)
examined the nursing literature that covers electroshock. She reports: “Very
often, only the pro-EC T arguments are given, only the pro-E C T research is cited, only the pro-E C T perspectives,
themes, and ethics are given a voice. Negative accounts of E C T are rarely to be found” (212). She interrogates the literature,
suggesting that there is dishonesty in the balance of positive / negative
accounts within it. Van Daalen-Smith (2011), through the critique of certain
aspects of psychiatry, pulls away a veil of ignorance that has long obfuscated
nursing consciousness. Her very inquiry demands that nurses question the ethics
of partaking in ECT and mechanically taking up the biases in the E CT nursing literature.
From another
critical perspective, Brad Hagen (2007) writes a compelling critique of the
Beck Depression Inventory and of the DSM’s depression diagnosis criteria in general. He reports on the
theoretical and practical problems inherent in this tool and cautions nurses on
its limitations, which include numerous cultural, gender, and theoretical
biases. In another inquiry, Hagen and colleagues (2008) probe the ethics of
accepting gifts from the pharmaceutical industry. They problematize the
pharmaceutical sponsorship of nursing and medical education, particularly the
education provided by health care institutions. Hagen and colleagues call into
question the motivations and interests of the pharmaceutical industry in
providing “free” medical education, directing attention to the nursing code of
ethics and specifically to the ethical principle of justice. They remind nurses
of their duty to “put forward, and advocate for, the interests of all persons
in their care… [Nurses] should promote appropriate and ethical care at the
organizational / agency and community levels… [and] should advocate for
fairness and inclusiveness in health resource allocation” (33). I would extend
this call to “fairness and inclusiveness” to van Daalen-Smith’s caution to
nurses regarding the E C T literature. I call upon nursing
scholars and nurse researchers to examine, as van
Daalen-Smith did, the biases in the ECT literature and to
respond to these biases. This very response is an example of advocacy for
fairness and inclusiveness in health resource allocation, given that the ECT literature is very much a health resource in the nursing academy.
Although the two
players discussed here take up a significant nursing role in resisting
psychiatry, they are part of a larger resistance structure that has been
cutting away at the foundations of psychiatry for decades. Dissident
psychologists, social workers, community activists, and psychiatrists construct
powerful counter-discourses that have been shaking psychiatry to its base. That
resistance to the medical establishment is politically dangerous is not a
phenomenon unique to nursing. Take the late Thomas Szasz, for example – a psychiatrist
whose antipsychiatry work plays a powerful role in leading the larger movement.
Having started as a psychiatrist only to later form perhaps one of the most
powerful critiques against twentieth century psychiatry, Szasz faced tremendous
professional and political hardships. While bringing to public light the
inherent problems with psychiatry, Peter Breggin, another psychiatrist and an
important figure to the movement, experienced longstanding collegial reproach,
rejection, and legal retaliation. As an example of his rejection of psychiatry,
Breggin describes having partaken in the administration of ECT as “the shame of my life” (Burstow, personal communication, 30 August
2012). Whether through the critique of literature, clinical practice, or business
relations, nurses too joined this much larger critique of psychiatry. It is
noteworthy that a more extensive literature review could not be done, given
that such thinkers are a rare occurrence in nursing. This raises a few
questions: why is it that a handful of the thousands of nurses have taken this
stand? Why is it that despite the obvious ethical violations psychiatry
commits, nurses remain silent? What are the institutional conditions under
which this silence comes to be? In the following section, I provide possible
reasons for this problem in and for nursing.
TWO DISCOURSES AND A NURSE
It is worth fully citing Dorothy Smith’s idea of
discourse. Dorothy Smith (2005) explicates a discourse as: “Translocal
relations coordinating the practices of definite individuals talking, writing, reading, watching, and so forth, in particular local places at
particular times. People participate in discourse, and their participation
reproduces it. Discourse constrains what they can say or write, and what they
say or write reproduces and modifies discourse. Though discourse is regulated
in various ways, each moment of discourse in action both reproduces and remakes
it” (224). Discourse shapes consciousness, constructs a certain way of knowing
phenomena, and to that effect, navigates the actions of those it encapsulates.
The various seemingly mundane and taken-for-granted routines, objects, and
languages are the powerful elements that hold discourse together and navigate
people. They are texts, procedures, and routinized utterances such as “vital
signs stable,” “patient received alert and oriented,” “the patient has a flat
affect,” and so on. These are the elements of discourse of which Dorothy Smith
speaks that mediate the translocal relations that coordinate people’s activities.
It is important to interrogate these elements, because by their very nature of
being routine and seemingly mundane, they implicitly dictate a certain way of
knowing for nurses – a specific consciousness from which to practice nursing.
It is beyond the scope of this chapter to analyze the major discourses that
impact nurses. However, two prominent discourses produce the “mental health”
consciousness of the nurse, and these are pharmacology and psychiatry.
THE DISCOURSE OF PHARMACOLOGY
Most of the nurses’ medication knowledge is
shaped by the discourse of pharmacology. Nurses assimilate their medication
knowledge first in the nursing academy. This knowledge becomes concretized on
the job by various texts and through various workplace-learning processes, such
as orientation programs, in-services, workshops, and drug-sponsored educational
sessions. Drug trial literature, medication manuals and reference guides,
pocket cards and other such tools, dosage calculation tests, as well as the
clinical application of all this information are elements absorbed by nurses
from the discourse of pharmacology. For the nursing student and the novice
nurse, the action of “tying” the theory together in applying pharmacology
knowledge in the clinic is an example of a textually mediated action. This
means that a specific text such as a dosage calculation exam authorizes, under
the surveillance of a nurse educator, specific knowable things about drugs,
their “indication,” application, and the implications for
their use. This textual authorization must also inhibit certain knowledge from
being taken up. This is the work of the translocal relations coordinating
through text – authorizing a certain knowledge yet constraining what nurses can
say, as Dorothy Smith suggests. What the nurses know, in such a case, is a type
of knowledge that has been pre-packaged by the institution. For example,
pharmacology education in acute care institutions places the nurse in a
discourse of efficiency and safety. In other words, learning about medications
and medication administration is only relevant in the context of efficiency and
patient safety (see Dyjur, Rankin, and Lane 2011). Pharmacology also appears in
the form of material imprinted with drug companies’ information, such as pens,
paper pads, pocket organizers, lanyards, buttons, posters, and so on. These too
are business strategies that are in a constant relation with the nurse, and
shape his or her consciousness in a specific way. They are cues that
consistently stimulate nurses’ sensorium and reinforce that a pharmaceutical
response to psychosocial suffering is indeed the most appropriate response.
Such items, and their creation, occur away from the bedside, in a place that
Dorothy Smith (2005) calls the translocal. In these diverse ways, the discourse
of pharmacology creates a rather accessible presence for the nurse in a way
that is inescapably submerging. Drug guides, online reference material,
workplace learning activities, and pharmaceutical marketing materials play a
dominant role, as major elements of the discourse of pharmacology, that shape
the consciousness of the nurse. In fact, even non-medication related
educational sessions, such as for example training nurses on the use of a new
intravenous catheter, are often sponsored by drug companies that have an
implicit presence. In teaching hospitals, drug trial research is the thing of
today. At any given point, several drug trial studies may be in progress, whose
preliminary findings are progressively communicated to nurses. This too creates
a sort of competitiveness between drugs as to the “best drug of choice” to
treat “mental illness.” What this also does is validate where the institution’s
priorities are: In the progressive “refinement” of drugs.
THE DISCOURSE OF PSYCHIATRY
The work of psychiatry pivots around the D S M . “Mental disorders” are defined in this text, out of which various
psychiatric treatment modalities and techniques are
theorized to “treat” such disorders. The D S M is the
starting point in a process that begins with the identification of “illness”
and ends with an intervention that may include the medicating, electrocuting,
or incarcerating of the “patient.” As psychiatry’s core text, the cognate
disciplines, nursing included, borrow their mental health / illness knowledge
from the DSM. The discourse of psychiatry, stemming out of the statistical
aggregation of “abnormal” behaviour dubbed mental illness, penetrates the
consciousness of nurses and nursing scholars. Psychiatry codifies and
categorizes human behaviour in the form of disorders and illnesses, updating
them every several years. The D S M , however, does not
make an appearance for the nurse in the clinic. Rather, in the form of
abbreviated concepts and categories, inserted into the nursing documentation forms,
assessment guides, and various legal forms, for example, the Ontario Ministry
of Health’s Form 1.1 The Form 1 is the document that authorizes the
psychiatric evaluation of the patient, and in the process helps shape the
psychiatric assessment. Most of the nurse’s work revolves around assessment and
documentation tools, which often differ from one department to the next but
carry similar elements, which guide the nurse’s assessment in a similar way
across departments. Very little physical assessment is done on mental health
units, where the bulk of the nursing assessment time is taken up by cognitive
and behavioural evaluations. The documentation tool guides the work of the
nurse to, for example, look for cues or evidence of potential or actual
self-harm, document the anxiety level of the patient, note appropriate eye
contact, look for insight into illness, and so on. Other discursive elements
include educational workshops specifically addressing the care of the “mentally
ill,” orientation curricula, and historical records of patients’ previous
hospitalizations.
NURSING ETHICS, BUT SO WHAT?
In contemporary acute care institutions, which
are driven by discourses of efficiency and fiscal micromanagement, nurses are
often caught in the grind of task-oriented care. Nursing work is constantly
monitored, evaluated, and recreated in various ways to respond to direct
budgetary cutbacks disguised as ideas of safety, access, and accountability.
The consistent emphasis on tasks for the perfect mechanical execution of
patient care is what produces the nurse as a drone-like
institutional actor often scurrying to do his or her work. It is not unusual
that nurses do not get a lunch break or leave their shifts on time, let alone
have the time to create any kind of authentic relationship with their patients.
That nurses are allowed no time to complete the necessary tasks to render good
quality care is an understatement.
Nursing ethics
teach us that the nurse ought to act with moral integrity, provide dignity, and
support patient autonomy, beneficence, and justice.2 Ethicists suggest that as nurses, we must respond to
the call of our patients, even when we feel that responding so risks
compromising our sense of professional and personal integrity (Yeo and
Moorhouse 2002). Such principle-based ethics assume that the nurse is first of
all aware that an ethical violation is being committed in order to then
identify which principle has been breached. Recount the description of the two
discourses above and recall the various elements that come into play with the
consciousness of the nurse. It is important to note that such elements are only
a small example of what perhaps can be an infinite number, all of which make up
discourse and its operations. A nurse caught in a minute-to-minute grind of
producing institutionally-authorized “efficient” care is strategically
navigated by the various translocal relations, such as the nursing assessment
form, the assessment itself, its intricate technique, and the method of its
documentation. To avoid describing in too mechanical a way how discourse
produces the actions of the nurse, I will maintain that discourse is too
complex, unstable, and always changing.3 Moreover, various overlapping discourses make this
production of actions and of consciousness even more unstable and difficult.
However, mapping out a clinical example may demonstrate how multiple
discourses, in this case those of pharmacology and psychiatry, reinforce and
reproduce one another in a synergistic fashion, using the nurse as the agent of
their reproduction.
A patient is
brought into the emergency department by the police. The “presenting complaint”
is that the young man was arguing with his mother, the argument became heated,
voices became elevated, and he picked up a glass mug and threw it against the
wall. The mother became frightened and called the police. Given that the young
man has a “history of mental illness,” the police arrested him under the
Ontario Mental Health Act and brought him to the emergency department for a
psychiatric assessment. The receiving nurse greets him in his room, and asks
him to undress and wear a hospital gown. His belongings are
gathered into a patient belonging bag and immediately removed from the room. An
assessment form is initiated by the clerk, stamped with his identifying
information, and placed on his chart. The nurse methodically goes through the
assessment, completing a quick physical assessment, then a nursing psychiatric
evaluation that involves delving into the patient’s history of illness,
medications, and current state of mental affairs.4 The assessment quickly proceeds to focus on the
presenting issue (violence) and is navigated by cues preprinted in the
assessment form to proceed towards explicating triggers, further potential
violence, possible involuntary committal, and so on. In the assessment form,
the nurse screens for risk, looking for “risk symptoms” such as suicidality and
past attempts, self-harming behaviours, and history of violence. A substance
use history and a legal history are also obtained and documented, and a mental
status exam is completed. Using the data gathered, a pre-diagnosis impression
is formulated, and then a psychiatrist provides the diagnosis. While looking
for psycho-cognitive reasons for the cause of the behavioural “problem,” the
nurse also considers the patient’s medications and considers whether or not
they are “effective” and whether or not doses need to be increased or new ones
should be added. In a few short minutes, the nurse interviews the patient, and
works towards understanding, from a pharmaco-psychiatric point of view, the
alleged violent event, its potential causes, and possible treatments. The nurse
then moves on to formulate a nursing plan of care.
The example above
is a routine and common occurrence in the work of the nurse in the emergency
department. It would appear that there are no ethical violations taking place
during this nurse-patient encounter. The nurse follows a structured
relationship-building exercise, provides specific instruction to the patient,
completes an appropriate physical and mental health assessment, and works out a
plan of care. All this occurs in a fast-paced environment laden with high
demands on the time of the nurse. Racing to make care ends meet, the nurse is
left with having to complete tasks and with no room to appreciate the patient
phenomenologically. During the often-frenzied attempts at a complete “nursing
process,” which involves an assessment, a plan, interventions, and an
evaluation (Wilkinson 2006, cited in Garber O’Brien and Tamlyn 2010), little to
no time is left to stand back and reflect. Given that the nurse is consistently
entrenched in institutional sequences of speedy mechanical
execution of care, how then, can he or she pause to critique any clinical
situation? Where is the space in which a nurse is allowed to ethically ponder
an incident, reflect, and emerge with a critical understanding of it? Nursing
critique does not extend beyond the biomedical paradigm. If it were to do so,
the nurse in the example above might take issue with the patient being labeled
violent, his being arrested and deemed mentally ill, and with her own practice
that stripped the patient of autonomy and dignity. Suddenly, the patient’s
medications would become problematic; the power relations between the patient
and the police, physician, and the nurse would produce ethical discomfort; and
the very idea of the patient being mentally ill would become unstable. I turn
to some of Michel Foucault’s (1977) work to examine why this kind of critique
is rare at the bedside.
NO ROOM FOR ETHICS, ONLY DOCILE BODIES
Foucault theorized the idea of the docile body
(Foucault 1977a). He suggested that a “mechanics of power” was created, “which
defined how one may have a hold over others’ bodies, not only so that they may
do what one wishes, but so that they may operate as one wishes, with the
techniques, the speed and the efficiency that one determines. Thus discipline
produces subjected and practiced bodies: ‘docile’ bodies” (138).
In the contemporary
clinic, a similar docility is being produced in nursing. The entrenchment in
the ruling discursive operations that Smith (2005) calls the ruling relations
is binding for the nurse. The repetitive engagement in such a practice and
other routinely executed care processes makes for the “practiced body” of which
Foucault speaks. This “practice” is what perfects the institutionally
premeditated actions of the nurse – that is, the actions that are coordinated
by the discourses of pharmacology and psychiatry.
These practiced
bodies are never left alone to “practice” as independent bodies of free social
agents. Nurses make up the largest number of caregivers in most health care
institutions in Canada, which places them at the centre of most administrative
fiscally oriented and efficiency related project reviews. Given that nurses
dramatically impact the bottom line of the institution, their work is closely
monitored and often harnessed to support many such projects. Nurses, therefore,
are well practiced in the art of being governed. Critiquing
psychiatry, its practices, its ethics, the labeling of patients, the very
practice of nursing itself, therefore, is a distant reality. It is by way of
this discursive containment of the docile nurse that most of the nurses have
not and do not join radical voices. What then, can nurses do to start an
emancipatory counter-narrative, as van Daalen-Smith and Hagen have? I maintain
that bedside nurses too, as nursing scholars and researchers do, possess the
power to critique, to call into question, and to resist unethical practices. To
make suggestions about how this counter-narrative can begin, I turn to a
salient concept in nursing that quickly became a buzz-word, and that is the
idea of critical thinking.
NURSES AS CRITICAL THINKERS
Three prominent ideas of the concept of critical
thinking currently occupy nursing textbooks. The Foundation of Critical
Thinking suggests that critical thinking involves employing an art in order to
analyze and evaluate thinking with the idea to improve it (Paul and Elder 2006,
cited in Garber O’Brien and Tamlyn 2010). Another view of the concept comes
from the work of Alfaro-LeFevre (2009), who suggests that critical thinking
involves “good problem solving and commitment to look for the best way, based
on the most current research and practice findings” (as cited in Garber O’Brien
and Tamlyn 2010, 4). The third, and perhaps the most helpful definition, comes
from the Canadian Nurses’ Association (CNA). The CNA defines critical thinking as: “A complex, active, and purposeful
process encompassing the essential skills of interpretation and evaluation and
requiring the RN to go beyond the role of performance of skills and interventions” (C N A 2007, as cited in Garber O’Brien and Tamlyn 2010, 4). According to the
C N A , critical thinking, “Compels the RN to identify and
challenge assumptions, use an organized approach to assessment, check for
accuracy and reliability of information, distinguish relevant from irrelevant,
normal from abnormal, recognize inconsistencies, cluster related information,
identify patterns and missing information and draw valid conclusions based on
evidence, identify different concurrent conclusions and underlying causes, set
priorities, and evaluate and correct thinking” (ibid). Although the CNA’s definition applies to critical thinking in the clinic, I also see
nurse educators applying this on a sociopolitical level. It is the same sort of
challenging of assumptions that Hagen and van Daalen-Smith
did when they stepped outside of the discourses that governed their consciousness.
It is the critique that arises out of the space to resist and talk back, for
example, to the academic psychiatrist who lodged a complaint against Hagen for
teaching out of an anti-psychiatry textbook (B. Hagen, personal communication,
3 July 2012). It is the very critique out of which a humanistic vision for
nursing care arises, one that facilitates a platform for the voice of the
electro-shocked patient that tells a strikingly different story than what is
narrated to nurses by the discourse of psychiatry.
Nurse educators, to
begin, must fully appreciate the potential of the power they possess, once they
recognize that they too can begin a critique of psychiatry. To mitigate the
risk of appearing politically naïve here, let me suggest that beginning such a
critique is not without risk. For the nurse clinician, the risks stemming from
critiquing psychiatry or psychiatric practices may involve being labeled a
pessimist or gaining a reputation for being too critical a practitioner, and
often being dismissed by colleagues and nursing leadership. For the nurse
academic, the risk can range from one’s views simply being dismissed, to
difficulty in obtaining access to conduct research, to rejection of potential
publications, to dismissal! The radical nursing thinkers did not engage in
critique without such risks, as others did long before nursing joined in (e.g.
Thomas Szasz and Peter Breggin). However, as Paul and Elder (2006) suggests,
critical thinking is the artful analysis and evaluation of thinking with a view
to improving it. This art is the strategic way to step outside of ruling
structures that authorize what nursing consciousness knows. As radical nurses,
psychiatrists, psychologists, social workers, and other activists risked
repudiation and suppression, they realized that the areas where they
encountered more resistance were the ones they ought to investigative,
question, critique, and resist. Under the auspices of academic freedom, nursing
scholars, once ready to fully be as critical as the CNA suggests we
ought to be, can continue the crescendo of critical voices.
Drawing on our
ethical training and from the strength of our personal moral bases, all nurses,
scholars, and clinicians alike can resist. Clinicians must interrupt the
institutionalized, task-oriented nursing work that has become the thing of
contemporary health care institutions and realize that a human-relational
nursing approach is possible. Levine states: “Ethical behavior is not the
display of one’s moral rectitude in times of crisis. It is
the day-to-day expression of one’s commitment to other persons and the ways in
which human beings relate to one another in their daily interactions” (1977,
846). In relating to their patients, nurses can invoke empathy – the capacity
to understand another’s feelings and provide compassion. Through every
interaction in every nurse-patient relationship, nurses can, through empathic
critique, resist task-oriented nursing and make space in their consciousness to
disrupt this ruling. Clinicians can start by casting doubt on the
pathologization of human pain and human behaviour. An instability of the notion
of “mental illness” can begin a cascade of changes. Once clinicians and
academics together take up the falsity of “mental illness,” an alternate consciousness
may emerge, one that will break free from the chains of psychiatric ruling.
1 “Form 1 – Application by physician for psychiatric assessment,”
Ministry of Health and Long-Term Care (2000), http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?openform&ENV=WWE&NO=014-6427-41. Last
accessed 3 June 2012.
2 “Code of Ethics for Registered Nurses: Centennial Edition,” Canadian
Nurses’ Association (2008), http://www2.cnaaiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf. Last
accessed 13 March 2012.
3 Although I make use of Smith’s idea of discourse, it is Foucauldian
theory on which she draws to carve out this idea of discourse. For more on
Foucauldian discourse, see Foucault (1970).
4 The nuances of the processes of patient registration and assessment
may differ somewhat between hospitals; however, the processes by which patients
are taken through triage assessments, registrations, and nursing and medical
assessments are very similar across most acute care institutions in Canada.
Developing Partnerships
to Resist Psychiatry
within Academia
PETER BERESFORD AND ROBERT MENZIES
INTRODUCTION
If we are to make better sense of practice and
theory in relation to resisting psychiatry in academia, then we will need to
gain a better understanding of two recent and related developments. These are:
first, the emergence of “service user involvement” in and beyond psychiatry,
and second, moves beyond professional, to more inclusive partnership-based and
collaborative approaches to opposition to psychiatry. In recent years, there
has been an increasing international interest in including the perspectives,
comments, and presence of “mental health service users” in both academic and
policy settings. This has been framed in different ways in different countries,
for example, as “user” or “consumer” involvement, “community engagement,” and
“empowerment.” This is because both nationally and internationally, there is
little consensus about language or understandings. There is no agreed-upon
language, or conceptualization around user involvement. In the U K , the term most often used is “service user,” although some people
reject this as passive and unhelpful. Some prefer “psychiatric system
survivors,” others see this as confrontational and unhelpful. Some service
users seek to reclaim the language of “madness”; others see it as inevitably
pejorative.
Not only mental
health service users, but a wide diversity of groups associated with long-term
use of health and social care services have been included
as “service users,” ranging from older and disabled people, to people with
life-limiting and long-term conditions, people living with HIV/AIDS, and people with learning difficulties. Other terms are also used for
user or consumer involvement, like partnership, engagement, and participation.
In some countries, rather than service user, there is talk of self-help,
advocacy, and mutual aid activities and groups, which have a far longer history.
Different terms for “service user” emerged as having a different significance
at different times, in different countries, and for different stakeholders.
“Client,” “service consumer,” and in some settings, “patient” are all used. In
the U SA, for example, advocacy groups tended to favour the term “consumer,”
while social workers used the word “client.” We therefore begin with a problem
since we do not have a shared language and what is acceptable for some is
demeaning and incomprehensible to others. In this discussion, for simplicity’s
sake we will use the term mental health service user / survivor, treating it as
a political identity that acknowledges the oppression inherent in the existing
role, while seeking to be as inclusive as possible semantically (Beresford
2005a). There have been many reasons for this development, but conspicuous
internationally, there have been two very different impulses.
THE CONFLICTING ORIGINS OF INVOLVEMENT
The first of these was the political shift,
initially framed in terms of the emergence of a “new political right,” opposed
to state intervention and committed to “free enterprise economics.” More
recently this has been reframed in terms of neoliberalism, with a powerful
commitment to the market, deregulation, reduction in public spending, and a
globalised economy. These political and economic developments have both been
strongly associated with the rhetoric of consumerism and as pressure has
increased for human and public services to be provided by the market, there has
been a growing emphasis on the “service user” as an active and involved
consumer, contributing to their own well-being both financially and as active
agents, as well as being consulted and market researched, like consumers of any
other goods or services (Simmons, Powell, and Greener 2009).
The second pressure
for participation has come from the emergence of international “service user”
movements, most conspicuously the disabled people’s
movement, but also notably the mental health service user/psychiatric system survivor
movement. While these movements have varied, between different countries and
between different groups of service users, they have generally been underpinned
by a central concern to have more say, to act on their own behalf, and to
democratize policy and practice. Generally rights, rather than being welfare
based, have developed their own cultures, histories, ideas, theories,
struggles, and collective action and have begun to impact on wider policy and
thinking (Oliver and Barnes 2012).
As has often been
observed, the politics of the supermarket do not necessarily sit comfortably
with the politics of liberation. Consumerism and democratization can make
uncomfortable bedfellows. This is certainly true for the politics of
participation and involvement, where the two competing forces, market-driven
neoliberalism and user-led ambitions for empowerment, have encouraged confusion
and misunderstanding as to the aims and purpose of user involvement. It is the
tensions between these two that explain many of the difficulties and
shortcomings increasingly recognized in relation to such user or public
involvement.
Involvement based
on consumerist consultation is very different from involvement based on a
democratic model committed to changing the distribution of power between
services, service users, and professionals and increasing service users’ say
and control. While one is essentially concerned with feeding into dominant
professional understandings with the locus of decision-making remaining
unchanged, the ambition of the other is to develop different user-led
discourses and user knowledge based on direct experience, with the aim of
changing where power lies and understandings and responses to the personal and
political situation of service users (Beresford 2010).
Not surprisingly,
power inequalities between state and citizens, psychiatry and service users,
have tended to mean that consumerist understandings of user involvement have
predominated over democratizing ones. Thus the dominant model of user
involvement has been based on a managerialist / consumerist approach, even
though its emergence has provided windows of opportunity for service users and
their commitment to democratization. What this has tended to mean, however, is
that the involvement of service users internationally has more often been used
to feed into and reinforce existing structures,
interpretations, and models of policy and professional practice than to
challenge these.
DEVELOPING COUNTER DISCOURSES
OR BEING SUCKED INTO PSYCHIATRY?
This tendency was highlighted by one of us
(Menzies 20101) in an earlier discussion of a petition circulated by
the then-president of the Vancouver / Richmond branch of the Schizophrenia
Society of British Columbia (Inman 2007) in protest against the 2008 “Madness,
Citizenship and Social Justice” conference held at Simon Fraser University (S F U) and concerned with organizing resistance against psychiatry. It is
worth looking at this petition more closely within its wider context, and in
association with other equivalent examples.
In her criticisms
of the human rights conference (which was still in its planning stages at the
time), the originator of the petition – one Susan Inman, author of After Her Brain Broke: Helping My Daughter Recover
Her Sanity (2010) – essentially upheld a
psychiatric standpoint. The petition, which was sent to the conference funders
and SFU President (among others), was clear in its adherence to “scientific”
models that equated emotional and spiritual distress with biogenetically-based
brain disease. “The ‘medicalization’ of serious mental illnesses that you
object to,” asserted Ms Inman, “has, in fact, dramatically improved the
situation of people with mental illnesses and the families who care for them.
It has lead (sic) to improved treatments, better research, decreased stigma,
and improved public understanding of these devastating brain disorders.”
Further, the
petition condemned the supposed failure of the event to include the perspectives
of psychiatrists and mental health service users’ families.2 In being so apparently sectarian the conference
organizers were said to subvert the very causes we claimed to uphold, by
choking off “the voices of people whose lives are dedicated to improving the
situations of people who live with serious mental illnesses: families and
mental health professionals whose work is based on scientifically established
best practices” (2007). The document concluded by challenging the very right of
the conference to receive governmental funding: “I am surprised,” wrote Ms
Inman (2007), “that a major university and the major Federal agency promoting
research in the humanities and social sciences3 are comfortable funding a
conference that is exploring a major social issue from such a deeply biased
perspective.”
On first reading,
as argued in the earlier paper (Menzies, 2010), it is tempting to brand such
antipathy toward human rights initiatives in mental health as “backlash,” in
the reactive sense of that term. But just as Walby (1993) argues in another
context, the “backlash” metaphor is a limited one. In practice we are
contending with something far more entrenched and enduring than merely a
defensive reaction against gains by anti-psychiatry and psychiatric survivor
movements.
In the case of the
Schizophrenia Society of Canada (SSC) and its assorted
provincial and local branches, we encounter an influential and well-funded
advocacy organization which enjoys close ties with the State and corporate
sectors. Formerly known as Friends of Schizophrenics, the Schizophrenia Society
has been in existence since 1979. The S S C explicitly advances
biogenetic understandings of psychosis-as-disease, advocating aggressive forms
of psychiatric, pharmaceutical, and legal regulation for people diagnosed with
major psychoses. Its members have long supported “early intervention” policies
and “assertive treatment” practices in the community. As Erick Fabris has
chronicled (2011), the Society’s Ontario branch was instrumental in that
province’s enactment in December 2000 of the infamous Community Treatment Order
(C T O) legislation known as Brian’s Law. Further, the Society stands for the
long-term (and, where applicable, compulsory) use of neuroleptic drugs4 (not incidentally, a sizable portion of the
organization’s funding comes from the pharmaceutical companies whose products the
Society endorses5). At all levels, moreover, the Schizophrenia Society
nurtures a close relationship with departments of psychiatry in the country’s
medical schools. The British Columbia branch, for example, maintains a Medical
Advisory Board and has funded the research programs of several psychiatrists
and other clinical health professionals on faculty at the University of British
Columbia.6
Contradictions
abound in these cross-cutting relationships. On the one hand, the Society
embraces the language of anti-stigmatization, public education and inclusion,
“[a] dvocating,” according to the home page of its website, “on behalf of
individuals and families affected by schizophrenia and in need of mental health
help.”7 On the other hand, its intimate ties to medical and
corporate elites, coupled with its consistent failure to dialogue with psychiatric
survivor and social justice communities, have seriously
limited the Schizophrenia Society’s breadth of vision while positioning it at
the very centre of the policy establishment. In these respects it is no
surprise that the Society’s leadership would express such enmity toward an
event like the S
F U conference which was publicly challenging the
“science” model of “mental disease” and advancing the autonomy and citizenship
rights of psychiatric user-survivors.
Far from being
reactive, however, the Schizophrenia Society’s ardent promotion of biogenetic
psychiatry – like that of its counterparts elsewhere such as NAMI8 in the United States and SANE9 in the United Kingdom – is the outgrowth of a
systemic, business-as-usual paradigm of control which pervades virtually every
aspect of modern life. This paradigm fosters a way of thinking about so-called
“sanity and madness,” of mental “good and ill health,” which follows a long
tradition of privileging those who stake their claims to normality and reason
on the objectification and exclusion – and too often the persecution – of
others. It expresses a deeply ingrained and naturalized way of practicing sanism
(Perlin 2003, Poole et al. 2012), of regulating mental “otherness,” and of
constructing psychiatric “illness” as brain disease.
Yet at the same
time there is something new and alarming about the militant brands of
latter-day pro-psychiatry activism that animate these organizations. In
contrast to prior generations, which witnessed a series of wild pendulum swings
between alternative ways of regulating the mind – from the blatant oppressions
of somatic psychiatry, eugenics, and Big Pharma, to the “softer” theories and
practices of moral treatment, psychoanalysis, and their many variants – in the
twenty-first century we are encountering hybrid forms of power over
psychiatrized people that are more complex and difficult to engage than ever
before.
This “new realist”
paradigm for regulating madness – to import a term from criminology (Lea 1987,
Matthews and Young 1992) – is fluid, fragmented, reflexive, multi-sited, and
therefore able to adjust and reinvent itself constantly. New realist mental
health is a moving target. It blurs the boundaries between State and civil
society, between the public and private. It blends together the dominant ideas
of psy-science (Miller and Rose 2008) and the pharmaceutical empire with
popular understandings of sanity and mental “difference.” It speaks the
language of compassionate care, human rights, populism, inclusiveness, and
empowerment. In so doing, it threatens to capture the high
ground of liberal rights equality talk. In the deceptive reversal of victim and
oppressor that follows suit, it is those activists and academics struggling to
carve out spaces for antipsychiatry and pro-survivor praxis who are the ones
deemed to be elitist, exclusionary, unscientific, and outdated.
As we observe in
the Schizophrenia Society’s response to the above-discussed human rights event
at S F U , as well as in mainstream academic and media coverage of similar
initiatives elsewhere (see the below discussion of the 2010 PsychOUT conference), to contest the powers of psychiatry is allegedly to undermine
the very system of medical ideas and practices on which the lives of
‘brain-diseased’ people depend. Generations of pseudo-scientific theories,
bogus diagnoses, ineffective treatments, invasive interventions and human
rights abuses aside, to stand between the psychiatric professional and her /
his patient is to place the latter – quite often our very selves – in harm’s
way. In so doing, if our motives are not downright pathological, they are at
least – so the story goes – the product of unreasoning idealism, not to mention
naïveté, self-involvement, and ingratitude.10
THE GREY ZONE AND THE ACADEMY
In his work on governmentality and the
psychological complex, British sociologist Nikolas Rose has written extensively
about this new control paradigm and the discourses that sustain it (Miller and
Rose 2008, Rose 1999b). Rose’s point, following Michel Foucault (1991a), is
that the fusion of government and mentality lies at the heart of neoliberalism (see
Dean 1999, Gordon 1991). We cannot understand the workings of mental health
systems without considering how mind/ body control reflects and sustains
broader currents of governance – currents that are both remaking our political,
economic, and cultural (and, not incidentally, psychiatric) selves and
reworking our relationship to the structures and projects that define our very
way of living and being (and of being normal, moral, (re) productive, pacified,
self-surveilling, and risk-free).
When it comes to
psychiatry and mental “health,” the vision advanced by the champions of
biogenetic psychiatry and new realist mental health is abidingly neoliberal.
The new discourse constructs a psychiatric subject who stands in contrast to
the robust, autonomous, trustworthy, self-governing citizen of the liberal
dream. This psychiatrically outcast subject is an alien,
an object of sympathy, and/or derision (or simply an object), a victim of a
“broken brain” (Andreasen 1985), a being to be spoken and written about (but who
cannot take part in the dialogue herself), and above all else “a problem” (Du
Bois 2005 [1903]) to be risk-monitored and rehabilitated through the
application of law, science, and technology.
Under
neoliberalism, and within systems of mental regulation that have prospered
under its banner, the psychiatric subject stands outside citizenship
altogether. Except as a bundle of traits to be measured and controlled, she who
encounters the powers of psychiatry is an invisible, silent (or rather,
unheard) outsider, to be domesticated and contained – ill-equipped as she is to
take part in this governance project herself. Official “stakeholders” know this
to be true, because under neoliberalism the spaces between government, science,
mental life, and the body have closed up. Government has, for all intents and
purposes, become science, and the science of governance gets applied above all
to the minds and bodies of those whose citizenship has been disabled, unmade,
literally switched off. Through a quite breathtaking fusion, those of us who
happen to think, speak, write, and live outside the neoliberal norms of reason
are simultaneously held to account and deemed incapable, unfit, irresponsible,
lacking in mens rea, in need of “substitute decision-making” – all code words that stand
for psychiatric non-citizenship.
And this is where
the halls of academia re-enter the conversation. For backing up this new
realist mental health system is a vast “assemblage” of technicians of the
normal (Foucault 1977a), practitioners of what Rose (1999b) calls the “grey
sciences” (administrators, insurers, educators, psychometrists, knowledge
workers, assessors, and advisers of all sorts). These technicians work to shore
up the neoliberal project by patrolling its boundaries and keeping watch over
the countless so-called “deficient,” “disordered,” and “risky” semi-, non-, and
anti-citizens who find themselves shunted to the social margins. For its part,
the twenty-first century university has become a key breeding ground for Rose’s
grey scientists and their involvement in the differentiation, discipline, and
exclusion of people deemed psychiatrically unfit for citizenship.
Even so-called
“liberal arts” institutions – those which typically lack medical schools or
centres of psychiatric training – have become part of this assemblage. In these
ways, the modern university has become complicit in establishing the standards
by which “normality” and its absence get defined and
measured. Within clinical and forensic psychology programs, criminology
departments, health sciences and studies faculties, and the like, scholars and
practitioners who embrace biogenetic approaches to mental “illness” attract the
bulk of available funding.11 They are the main gatekeepers for the professional
networks and business sponsorships, which pass for “community-building” in the
new corporate academy. They are front and centre in both media and university
(meaning “senior executive”) accounts of mental health scholarship. They
publish articles in the highest-ranking journals. And they groom successive
generations of students who (with important exceptions) faithfully reproduce
their core values and methods. The “grey scientists” (Rose 1999b) who patrol
these academic spaces have been successful in promoting the very kind of
objectifying, depoliticizing, reductive, and essentialist vision of normality
and deviance, of health and illness, of sanity and madness that defines the
biomedical establishment within the political and intellectual order of
neoliberalism.
THE ALIEN WITHIN US
However, there is an important point to make
here. It is not only policy, services, service providers, professionals, and
family members who may speak from an essentially psychiatric / biological
perspective. This is also often true of mental health service users / survivors
themselves / ourselves. That is certainly true from the U K experience (Beresford 2005b). This is not necessarily because they
support it and give it their allegiance. The likelihood is that this is the
only model of understanding that they have been exposed to. Many mental health
service users speak from within an essentially psychiatric discourse, talking
in terms of their diagnosis (often internalizing and becoming dependent on it),
basing their understanding of themselves and other survivors on individualizing
psychiatric interpretations – because this is all they know. It is often only
when mental health service users begin to get actively involved with others in
politicized survivor organizations and movements, that they have opportunities
to learn about, develop, and share different oppositional ideas. Even then, not
all activists share a common theoretical or philosophical understanding. Some
reject psychiatric conceptualizations; others are still positioned within it to
a greater or lesser extent. What we may also be seeing in the biomedical
rhetoric issuing from some activist communities (e.g.
Inman 2007, 2010) is the internalization of dominant psychiatric understandings.
Given the power and legitimacy afforded to these, this is hardly surprising.
When mental health
service users were asked about their understanding of models of madness and
distress in a U
K study, most said that they thought the medical
model was unhelpful, and felt that more social understandings were preferable,
but participants were heavily divided when asked if they thought that a social
model of madness and distress based on the social model of disability would be
helpful (Beresford, Nettle, and Perring 2009). The social model of disability,
which draws a distinction between individual impairment (the loss or limited
function of a limb or sense), and disability (the negative social reaction to
people with perceived impairments), has been increasingly influential
internationally. At the same time, it has taken a long time for disabled people
to become familiar with it and many are still subject to dominant medicalized
/biological individual models of disability (Campbell and Oliver 1996, Oliver and
Barnes 2012).
WORKING IN PARTNERSHIP TO RESIST PSYCHIATRY
Having begun to explore the complexities and
ambiguities of user involvement, we now move to our second focus, moving beyond
professional, to more inclusive partnership-based and collaborative approaches
to opposition to psychiatry, which involve both service users and
professionals. This needs to build on the points raised above: that many
service users may still be subordinated to psychiatric understandings, which
may have a damaging and divisive effect on the potential for partnership with
progressive academics and other professionals. Similarly the latter need to be
aware that service users are often and indeed understandably suspicious of
them, having some inkling of academic and professional constraints that may
operate on them (against service users’ interests) and also the competitive and
individualizing logic of the academy.
At the same time,
these challenges and uncertainties can be turned to advantage. As critical
scholars and activists have noted, and often illustrated through practice,
neoliberal regimes of governance – the corporate university among them – are
self-limiting and primed for resistance along multiple fronts. Throughout the
neoliberal world, and on campuses everywhere, openings abound and fault lines penetrate deep. As Dorothy Smith (1990) has written with
respect to women and “the conceptual practices of power,” these cracks in the
foundations of the neoliberal order can be creatively worked to advance the
causes of justice, empowerment, and social change. Opportunities for creative
partnerships between scholars and activists are arising in all the expected
places, as well as many that astonish and inspire. Following bell hooks’s
(1984) well-travelled metaphor, the margins and centres are forever engaging
each other in dynamic and potentially transformative ways.
For reassurance
that, pace Yeats, the centre cannot hold and the struggle has never been more
vital, we need only look to the remarkable legacy of advocacy that over recent
years has issued from the coalition work of academics and grassroots activists;
to the arrival of a new generation of critical young scholars, some of whose
work is being showcased in this collection; to the global community-building of
the International Network Toward Alternatives and Recovery, the World Network
of Users and Survivors of Psychiatry, and MindFreedom International’s Academic
Alliance; and to the “conscientizing” (Freire 1970) initiatives in public
education and consciousness-raising about psychiatric rights that are
flourishing in all corners of the planet.
In this late modern
age, whether we occupy the halls of academia or the corridors of State power or
the storefront, office, or street – and whether we are involved in resistance
against system oppression or the “life politics” of identity and social
position (Giddens 1991) – it is both our burden and our blessing to be
endlessly negotiating the intersections between systems of power and the
liberating possibilities that these systems reflexively bestow. As with so many
other social movements that harbour the potential to change our world for the
better, the struggle against (bio) psychiatry – within the academy and beyond –
gains its strength from the hard-won ability of people in resistance to
penetrate and explode the myth of a seamlessly repressive monolith of mental
regulation.
BUILDING OPPOSITION, ALTERNATIVES, PARTNERSHIP,
AND INCLUSION IN THE ACADEMY
Crucially, what this demands are new alliances
and partnerships between the academy and its professionals and service users
and their organizations. As academics committed to challenging the hegemony of psychiatry, and service users committed to
freeing ourselves from its damaging dominance, we need to review our
relationships. If we are to take these partnerships forward with maximum
effectiveness and in equal and inclusive ways, then we must learn new ways of
working together and make a long term commitment to such “co-production,” as it
has come to be called in the U K . Otherwise, as has
sometimes been the case, instead of working in true partnership we may find
ourselves perpetuating and mirroring the same subordinations, oppressions, and
exclusions that operate in the dominant psychiatric and neoliberal systems. The
issue is not merely one of reversing “under” and “over” relationships between
academics and service users, but of transforming them into more truly equal
ones.
While there are
still complaints, from service users, of professionals, including radical
professionals, still taking the ground from them, rather than ensuring service
users opportunities to speak for themselves, there is already much positive
experience of partnership and collaboration. Partnerships between academics and
service users are already developing internationally, and have the potential to
challenge psychiatry in the academy. In the U K , for example,
mental health service users / survivors are increasingly being employed in
academia to advance user involvement and highlight user perspectives. There are
developing examples of high level partnerships, like the S U R E (Service User Research Enterprise) project at the Institute of
Psychiatry, King’s College, London. This is jointly directed by a survivor and
non-survivor academic and undertakes large scale user-led research and
evaluation projects. The Centre for Citizen Participation at Brunel University,
directed by one of us, has a service user advisory group, which includes a
large number of mental health service users / survivors who shape its agenda and
activities.
Elsewhere we have
the example of MindFreedom International’s Academic Alliance, which under the
directorship of M
F I director David Oaks and intern Piers Gooding
has, since 2009, been sponsoring a global forum of critical scholars with the goal
of integrating the latter into user-survivor activist communities and their
knowledge-sharing and social justice projects. What is innovative about this
program is that academics are being recruited according to an agenda that is
explicitly carved out and directed by activists “in a spirit of mutual
exchange”12 with the realization that “academics who are working to
end human rights abuses in the psychiatric system [must]
not only be aware of each others’ work, but also… be engaged directly with
community-based activists like M F I .”13
Similar principles
are put into practice across assorted other contexts as, increasingly,
activists and academics with mental health system experiences and interests
find themselves navigating common fields. Conferences like PsychOUT – held in Toronto in 2010, and New York City in 2011 – exemplify the
politics of co-production at its best, as scholars in those two cities offered
their universities (not without some institutional resistance, and bad press
from the local media14) as the sites of cross-community engagements and
partnerships in the struggle against biogenetic psychiatry. In the UK, the Asylum! events in Manchester have played a similar role in
linking critical knowledge production with coalition building and cultural
celebration in the transgressively spirited tradition of Mad Pride. The
publications that emerge from these and other collaborative ventures – this
book, the Canadian Mad Matters collection (LeFrançois, Menzies, and Reaume
2013), and Asylum Magazine being three recent examples – help to raise critical
consciousness in important ways. So, too, does the galaxy of user/
survivor-oriented, anti-psychiatry, human recovery-focused, and “alternative”
mental health advice websites that now populate the World Wide Web.
In the realm of
post-secondary education, mad-identified and mad-positive members of university
faculties are involved in shaping curricula and mounting courses that aim at
correcting the longstanding omission of users’ and survivors’ words and deeds
from conventional academic discourse. In so doing they build on an important
and growing legacy of critical teaching and learning that has been pioneered by
feminist, queer, anti-racist, and post-colonial scholars, alongside
anti-psychiatrists and mad academics working across a broad range of
disciplines. Just one among many examples of this trend can be found at Ryerson
University in Toronto, where Geoffrey Reaume and David Reville – both
self-identified psychiatric survivors and long-time educators, writers, and
activists – have been instrumental in crafting an award-winning classroom and
online course through which, to date, hundreds of students have learned about
the history of madness from the standpoint of those who lived it (Church 2013,
Reville 2013). Such ventures in political education around mental health
criss-cross the boundaries between academy and community in empowering ways.
Further, in a context where experiential and critical learning continue to
thrive despite the restraints imposed by the neoliberal
corporate university, the educators who spearhead these projects can become
mentors and role models for students who come to identify themselves as users,
consumers, survivors, and / or members of mad communities.
If such trends are
to become a routine expression of academic approaches to madness and distress,
they will need active, practical support and encouragement. One of the most
helpful ways of developing this is to build links – as does MindFreedom
International – between academics and their departments and service user/
survivor controlled organizations. The latter have a particularly helpful role
to play in advancing the practicalities of partnership between professionals
and service users as well as supporting service users’ empowerment.
Service user
trainers equipped with training and qualifications can play a specific part in
this, helping service users and academics work better together in inclusive and
accessible ways. This can both help progressive academics learn better how to
link up with service users and their organizations and also help equip service
users with the increased confidence, self-esteem, expectations, and practical
knowledge to become equal actors in the endeavour. The official requirement for
user involvement in professional social work education courses in England
provides a valuable case study of how to take this forward. Since 2003, all
professional qualification courses for social work are required actively to
involve service users and family carers at all stages and in all their aspects,
including for example, student recruitment, assessment and teaching. This has
resulted in service users being involved in the selection and assessment of
students, in providing teaching, influencing the curriculum, and evaluating
courses. Each university department has received ringfenced /dedicated central
government funding to support this and the U K model has
become an increasing role model for other professional learning, with major
implications for psychology and psychiatry courses (Branfield, Beresford, and
Levin 2007; Branfield 2009).
User or survivor
controlled research offers a particularly important route to challenging the
dominance of psychiatry. It is now emerging as a major new research approach,
drawing on feminist, black civil rights, LGBTQ, and
community education studies and underpinning a significant and growing number
of national and international research projects, employing
qualitative, quantitative, and mixed methods. User or survivor controlled
research makes it possible to develop a counter discourse to psychiatry, based
on survivor knowledge and “lived experience” that is evidence-based and which
can challenge the “scientism” of psychiatry, where mental health service users
shape the research question and focus, are involved in carrying out the
research, producing its findings, disseminating them, and deciding on follow-up
action and are in control of all these aspects of the research process. From
small starts, this is now emerging as a credible research methodology, with a
growing canon of work and rising influence (Sweeney et al. 2009). It is helping
to shift the focus from narrow medicalized and individualized interpretations
of madness and distress to broader social understandings and responses that
take into account the experience and context of mental health service
users/survivors, all the while building their own knowledge base.
Not only are
specific roles being developed for service users in U K universities,
for instance, to advance user involvement. The increasing emphasis on
participation is encouraging more people with lived experience as disabled
people and mental health service users to become both students and educators
and to be “out” about their experiences. However, if this is to develop
effectively, it will also need the determined and systematic application of
anti-discriminatory policy and practice and for mental health service users,
serious revisions in syllabuses that are still influenced by psychiatry, to
challenge their inherent “madist” – the equivalent of “disablist” (Oliver and
Barnes 2012) – logic, assumptions, and oppressiveness.
It is also likely
to be helpful to strengthen links between nascent “mad studies” and burgeoning
international disability studies. As well as strengthening their joint
understandings and exploring the relations of their theory and modeling, it is
important to build connections between mad activism and studies, on the one
hand, and disability activism and studies on the other (Campbell and Oliver
1996; Beresford and Campbell 2004). We already have powerful examples from the
world of disability activism of how disempowered service users can be supported
to be equally involved in the activities of the academy. One such example is
supporting people with learning difficulties to carry out their own research,
where they receive support, but stay in control (Brennan, Forrest, and Taylor
2012).
Having said all this, we have to acknowledge that
psychiatric models are powerful. They are heavily ingrained in public,
political, and academic consciousness. The job of challenging them will be a
demanding, difficult, and long term one. In the ways that we have canvassed in
this chapter, the road ahead is all the more daunting for the presence of
twenty-first century forms of governance that have sponsored a toxic blend of
neoliberalism and biogenetic psychiatry in the mental health system and the
many institutions and communities (including the academy) with which the mental
health system intersects. The impact of these regimes cannot be overstated. Nor
can the pace and intensity with which they have transformed all our lives.
Just as
biopsychiatry constructs us as the inert and inept objects of scientific and
chemical technology, so neoliberalism tries to isolate us from each other with
the message that we are responsible solely for maximizing our own usefulness as
economic beings, managing our risk to ourselves and others, and generally
falling into line with the reigning order of things. Even within post-secondary
centres of teaching and learning – among the key custodians, in our world, of
critical thinking and engagement – these twin pillars of science and governance
have colluded to promote the medical model of mental “illness” and complicate
efforts to challenge the psychiatric status quo.
Yet as we have also
witnessed above, and as this book of essays passionately attests, this sword,
too, cuts both ways. From grassroots community activism to global democracy
movements, the neoliberal age has also been a time of unprecedented human
rights awareness, advocacy, and coalition building (Chomsky 2012). When it
comes to mental health, psychiatric survivors, system users, and mad pride
activists have been the vanguard of a collective movement (however partially
formed and loosely coupled) that has the potential, in David Oaks’ words
(2008), to launch a genuine “nonviolent revolution.” This is not to say that
biomedicine and neoliberalism will not continue to colour our experiences of
emotional and spiritual diversity and distress, nor that many of us will not
still internalize the values and beliefs these systems promote. Nor, for that
matter, can we discount the contradictions that underpin, and sometimes undermine, various strands of our communities (Diamond 2013).
Yet through the many solidarity projects, partnerships, and experiments in
empowerment and inclusion that are flourishing worldwide – and through the
alliances that we are forging with kindred movements from disability rights to
post-colonialism to queer and trans emancipation – the dialectics of
oppression, resistance, and social change will continue to play out (as ever,
in unforeseeable ways) as the future unfolds.
New discourses are
being developed by mental health service users / survivors out of their
situation and the present neoliberal politics and economics. While these are
constantly at risk of being overshadowed and overpowered by psychiatry in
association with the dominant politics, nonetheless they represent a
fundamental break from both. We can have no idea what impact this new
development will ultimately have, because it is essentially unprecedented. It
is resulting in changes within people and beyond in their social, cultural, and
political worlds, as a result of their collective action. Such new discourses
offer routes to and the promise of both bottom-up and top-down change. But
while we cannot know what future it has, it is difficult to believe other than
it is the star that the academy and its professionals must hitch themselves to,
if they are to be true to their responsibilities to pursue knowledge, rigour,
social justice, and the rights and interests of the world in which they exist.
They have a key role to play here in partnership, but equally an opportunity to
fulfil their true academic ethos.
1 R. Menzies, “Navigating the
Grey Zone: Advocacy for Psychiatric Citizenship in the Academy” (paper
presented at the PsychO U T Conference, Toronto, 7–8 May 2010), http://individual.utoronto.ca/psychout/panels/menzies.html. Last
accessed 7 September 2012.
2 In fact, the conference organizers extended an open invitation to
participate, and no paper or panel submissions were rejected. Several
psychiatrists and other clinicians spoke at the conference, and numerous
delegates had family members with histories of involvement with the mental
health system.
3 The Social Sciences and Humanities Research Council of Canada was one
of the conference funders.
4 See the S S C ’s “Position Paper: Early Intervention in Schizophrenia,” available at
http://www.schizophrenia.ca/docs/EarlyInterventionInSchizophrenia.pdf.
5 Among its most generous supporters, the 2012–13 Report of the
Society’s Ontario chapter lists Lundbeck Canada Inc., Bristol-Myers Squibb
Canada, Pfizer Canada, Hoffman-La Roche Limited, Sunovion Pharmaceuticals
Canada Inc., Novartis Pharmaceuticals Canada Inc., Pfizer Canada Inc., and
Janssen Inc.
6 The B C chapter’s Research page includes sections entitled “More Clues in the
Genetics of Schizophrenia,” “New Antipsychotic Review: Z E L D O X ,”
“Twins Help Find Cause of Schizophrenia,” and “The Insanity Virus” (the latter
item favourably cites a 2011 article in Discover
Magazine with the caption: “Schizophrenia may not
be just a matter of bad genes or bad luck. A growing group of psychiatrists
says the real culprit is a virus entwined in every person’s D N A .” See http://www.bcss.org/category/aboutbcss/research/).
7 See http://www.schizophrenia.ca/advocacy_papers.php
8 Founded in 1979 and based in Arlington, Virginia, the National
Alliance on Mental Illness (N A M I) describes itself as “the most formidable grassroots mental health
advocacy organization in the country.” The N A M I website can
be found at http://www.nami.org/.
9 SANE is a mental health charity founded by journalist and campaigner
Marjorie Wallace CBE that came to prominence at the time of the tragic killing of Jonathan
Zito by the mental health service user Christopher Clunis in 1992. While it is
now presented as an organization committed to increasing support and
understanding for mental health service users, it came to prominence on an
unsubstantiated wave of political and media concern about the increasing risk
and danger posed by mental health service users following de-institutionalizing
mental health policies in the 1990s (Szmukler 2000; Taylor and Gunn 1999). In
fact a major problem facing service users like Christopher Clunis was the lack
of available psychiatric help when they sought it.
10 The dominant paradigm of mainstream biogenetic psychiatry is so
pervasive that it extends far beyond the clinical professions, pro-psychiatry
interest groups, and the general public. As Reaume (2000) has shown in his
review of academic portraits of people with psychiatric diagnoses, scholars who
profess critical leanings, as well as members of the Left more widely, are by
no means exempt from such attitudes. Shortly after the above-mentioned
discussion of the Schizophrenia Society petition appeared in the online
proceedings of the PsychO U T conference (Menzies, 2010), one of us [RM] received an email from a
sociologist colleague from another university who – citing the case of a young
woman whose medications “rescued [her] from bizarre asocial behaviour” and
“enabled [her] to function and enjoy life” – characterized my critique of
biogenetic psychiatry under neoliberalism as “very misdirected,” and declared
that my “preferred discourse… exceeds its own limits,” is “absurd (and hurtful)
and “appl [ied]… in an indiscriminate manner.” The colleague concluded by
advising me: “take off your own ideological lenses and look at the facts of the
individual case.”
11 For instance, a search of the Canadian Institutes of Health Research (C I H R) data base,
using the key words “mental health,” shows that the vast majority of the 842
currently funded projects in this field (with grants totalling nearly $150
million) are proceeding from an explicitly clinical and / or biogenetic
perspective. Research which embraces explicitly user-survivor, critical and /
or feminist approaches to the study of psychiatry and mental health is
conspicuously absent from this list.
12 “MindFreedom Academic Alliance: MindFreedom’s Network of Allies in the
Academic World,” D. Oaks (2012). http://www.mindfreedom.org/campaign/development/academic-alliance-launch. Last
accessed September 7, 2012.
13 See Gooding in: “MindFreedom Academic Alliance: MindFreedom’s Network
of Allies in the Academic World.”
14 See, for example, Joseph Brean’s article on the first PsychOU T conference in
Toronto, which characterized the meeting’s delegates as a “motley bunch” of
ideologues and extremists who were pushing an irrational antipsychiatry agenda.
Joseph Brean. “Mind control.” National Post, 8 May
2010, 8. For a response to Brean’s polemic, see David Oaks’ posting on the
MindFreedom website: http://www.mindfreedom.org/campaign/media/mental-health-bias/joseph-brean
“We Do Not Want to Be Split
Up from Our Family”:
Group Home Tenants Amidst
Land Use Conflict1
CHAVA FINKLER
INTRODUCTION
There exists a significant scholarly literature
that examines psychiatric survivor2 housing experiences of homelessness (Shartal et al.
2006) as tenants in public housing (Jones et al. 2003) and in supportive
housing (Schneider and McDonald 2008). However, there has been little written
about psychiatric survivors’ experiences living in group homes or boarding
homes (Capponi 1992) and, in particular, about how land use law constructs tenants’
relationships with one another. This chapter examines the ways in which group
home tenants resisted the imposition of medico-legal interpretations of their
relationships with one another and subverted definitions of group homes in land
use law. Simultaneously, this chapter demonstrates the flexibility and
relevance of a psychiatric survivor analysis3 to scholarly endeavour.
A psychiatric
survivor analysis considers the impact of social and legal processes upon
psychiatric survivors as central, rather than peripheral, to scholarly
understanding. Such an analysis directly challenges conventional social and
legal practice (Finkler 2013). Although many survivors offer a psychiatric
survivor analysis (Beresford 2005b), one need not be a survivor to do so
(Kaiser 2001). A psychiatric survivor analysis integrates an understanding of
sanism, a form of systemic discrimination that targets psychiatric survivors. There is cumulative evidence of sanism’s pervasive
presence in multiple milieux. Psychiatric survivors have often had limited
access to mental health care (Steele, Glazier, and Lin 2006) and physical
health care (Campbell et al. 2007). Psychiatric survivor labourers worked long
hours in sheltered workshops or hospitals for little or no remuneration (Reaume
2000). Some survivors were sterilized against their will (Cairney 1996). Until
1988, psychiatric inpatients in Canada did not even have the right to vote in
federal elections.4
A psychiatric
survivor analysis is not a description of psychiatric survivor perspectives or
preferences. Rather, a psychiatric survivor analysis examines socio-legal
circumstances in the context of sanist power relations. Sanism intersects with
other forms of oppression such as ableism (Bahm and Forchuk 2008), adultism
(LeFrançois 2011), ageism (Ontario Human Rights Commission 2012), anti-Semitism
(Strous 2009), classism (Cran and Jerome 2008), colonialism (Fanon 1968), heterosexism
(Daley, Costa, and Ross 2012), racism (Dhand 2011), and sexism (Burstow 2006a).
If psychiatric survivors belong to another oppressed group, the discrimination
they experience increases exponentially (Ontario Human Rights Commission 2012).
I introduce the
concept of a psychiatric survivor analysis as an activist antidote to
mainstream land use planning practices, such as zoning, which often ignore
psychiatric survivor realities. While policymakers concur that survivor
perspectives must be considered when contemplating service provision, the
legislature rarely applies a psychiatric survivor analysis to land use law.
Similarly, psychiatric survivor analyses are virtually absent from the
scholarly planning literature.
Academic articles
have been written about psychiatric survivor housing preferences (Forchuk et
al. 2006). Researchers could argue that survivors participate in housing
studies by offering feedback and, sometimes, by interviewing other survivors
(Reeve et al. 2002). However, survivor participation in research is
significantly different from psychiatric survivor directed or controlled
research (Beresford 2002).
Some academics may
support psychiatric survivor housing but nonetheless use offensive language.
For example, scholars have referred to psychiatric survivors using phrases such
as “service dependent populations” (DeVerteuil 2011; Dear and Wolch 1987). The term “service dependent populations” suggests that
psychiatric survivors engage solely in relationships of dependence. However,
psychiatric survivors may participate in reciprocal relationships, sometimes
bonding with other survivors.
Survivors on social
assistance often do depend on mental health services for their well-being.
However, wealthy non-survivors may be equally “dependent” on nannies,
housecleaners, and personal trainers. Members of privileged classes pay for
services whereas persons living in poverty receive mental health services for
free, whether they want them or not. Language that emphasizes dependence as a
prominent psychiatric survivor trait reflects an outlook based on the privilege
of able-bodiedness and wealth. Two economically divergent groups “depend” on
service providers but only persons living in poverty are characterized by
relationships of dependence. The latter relationship is marginalized while the
former is normalized.
Michel Foucault
(1995) portrays the norm as part of a complex system of social control that
strictly enforces socially accepted standards of human behaviour, noting: “It
is easy to understand how the power of the norm functions within a system of
formal equality, since within a homogeneity that is the rule, the norm
introduces, as a useful imperative and as a result of measurement, all the
shading of individual differences” (184). In response to this intricate web of
control, Foucault anticipated resistance. In his essay, The Subject and the Power, Foucault maintained: “If it is true that, at the heart of power
relations and as a permanent condition of their existence, there is an
insubordination and a certain essential obstinacy on the part of the principles
of freedom, then there is no relationship of power without the means of escape
or possible flight” (Rabinow and Rose 2003, 142). It is precisely the effort to
challenge the nature of the “normal” that I wish to describe. In fact, “normal”
is not “natural” at all. Rather, in the group home context, the concept
reinforces socially constituted differences embedded within planning
legislation.
THE ORIGINS OF THE GROUP HOME
While group homes are considered a modern social
innovation, they may also have represented one possibility on a continuum of
housing options for psychiatric survivors as early as the 1890s in Ontario.5 Over a hundred years ago, asylum administrators advocated the use of cottages (sometimes referred to as the
“villa system”) as a means by which to provide greater liberty to inmates
within asylum walls. These small homes provided a residential alternative to
overcrowded wards in the main hospital buildings.
Today, remnants of
the cottage system remain in use in places like Riverview Psychiatric Hospital
in Coquitlam, British Columbia (Figure 7.1). Although Riverview Hospital closed
in 2012, cottages on the hospital site still house psychiatric survivors in the
forensic system. Cottages appear to have been precursors to the modern day
group home. They dispersed psychiatric survivor inhabitants within a contained
space, permitting “freedom” while retaining control.
Advertisements seeking
group home staff appeared in the classified section of the Toronto Star as early as
1961.6 A Toronto
Star reporter first mentioned group homes in 1963
as an alternative to foster homes for youth (Bruner 1963). Today, social
service organizations establish group homes for psychiatric survivors and other
marginalized groups.
GROUP HOMES’ LEGAL STATUS IN ONTARIO, CANADA
Tensions, both ideological and practical,
surround group homes’ status in residential areas. The specificity of the group
home designation presents an inconsistency. On one hand, the appellation
describes a “home,” i.e. a residential use. However, provincial government
funding in concert with strict municipal regulation is typically associated
with institutional settings. Because of this inconsistency, adjudicators have
often been asked to determine whether a group home is a home or an institution.
Definitions of the group home exist within both provincial statute and
municipal bylaws. Usually, definitions of the latter are based on the former.
In Ontario, Canada,
s 163 (3) of the Municipal Act contains the governing definition: “‘group home’
means a residence licensed or funded under a federal or provincial statute for
the accommodation of three to 10 persons, exclusive of staff, living under
supervision in a single housekeeping unit and who, by reason of their
emotional, mental, social, or physical condition or legal status, require a
group living arrangement for their wellbeing.” The Municipal Act indicates that
inhabitants live in group homes due to an impairment. The definition identifies
housing for psychiatric survivors as housing for persons with a specific
condition, who are not “normal,” whose bodies and minds do not comply with standards
set by legislators and regulators of social behaviour.
Figure 7.1 : An Example of a “cottage” at Riverview
Hospital in BC. (Photo by Chava Finkler, courtesy of Chava Finkler)
Disability studies
theorist Rosemarie Garland-Thomson (1997) wrote, “The term “normate” usefully
designates the social figure through which people can represent themselves as
definitive human beings. Normate, then, is the constructed identity of those
who, by way of the bodily configurations and cultural capital they assume, can
step into a position of authority and wield the power it grants them” (8). In
this theoretical context, group homes are housing created for the “not-normal,”
not-powerful, not-useful, the social detritus that must be socially deterred.
Since psychiatric survivors are the designated “not-normal,” relationships they
have with each other can be considered of only minimal significance. It is
precisely because of this “not normal” status that many mental health
professionals emphasize community integration. In this paradigmatic paradox,
relations between the normal and not-normal are judged to be of greater import
even though the normal are reluctant to relate to their “not-normal”
neighbours.
Amendments to the
Municipal Act changed the definition of group home, deleted the previous phrase
“live as a family” and instead, inserted the term, “single
housekeeping unit.” Although R.v. Bell stipulated that municipalities could zone only the land use (but not
the user), group home legislation still describes types of tenants and their
relationships with each other. While provincial legislation provides an
overriding definition, municipalities exert control by altering the meaning of
group home in zoning bylaws. For example, some towns have limited group homes
to a maximum of three inhabitants.7 Other municipalities may enact minimum separation
distance requirements that limit the proximity within which group homes can be
located (Finkler and Grant 2011).
As Foucault (1995)
noted, power is dispersed and exercised in the minutiae of everyday
interaction. It is not only cataclysmic events that shape and determine social
position but rather the details of daily life that govern subject populations.
While provincial statutes govern planning processes in Ontario, zoning bylaws
enacted by municipalities have an immediate and daily impact upon citizens.
They function as the asylum walls of yesteryear to contain and constrain
psychiatric survivor lives.
LAND USE LAW PROCESSES
When organizations wish to establish a group
home, they typically negotiate with municipal planners to determine location,
structure, number of rooms, etc. Depending on zoning bylaws, a group home may
or may not be permitted in the desired area. On occasion, an agency or operator
is required to apply for a variance that permits the group home despite a
restrictive bylaw. For example, a group home may require a wheelchair ramp that
would decrease distance between the house and street. In many circumstances, an
inch or two would be insignificant. Property owners receive routine approval
for many variances from municipal Committees of Adjustment. However, if
neighbours oppose a group home in principle, they can use the requirement for a
variance to deny the organization its request.
The sponsoring
agency or operator could, in that situation, reconfigure the group home
structure or move it elsewhere. If the request for a variance is denied by a
municipality, or alternatively, if neighbours wish to challenge group home
approval, either side may be able to appeal to the Ontario Municipal Board (O M B), a provincial administrative tribunal. Usually, O M B adjudicators are final arbiters of land use disputes.
This chapter is based upon mixed methods research
undertaken from 2005–08. Using grounded theory (Glaser and Strauss 1967), I
read, analyzed, and coded over 1,000 pages comprised of two O M B case files, thirty-one OMB decisions, a
compilation of forty-five municipal bylaws, and transcripts from twenty-six
semi-structured interviews. Analyzing the data I identified key themes,
including “group home as home, group home as institution.” Although this
research is part of a larger study investigating the way that notions of
disability are socially and legally produced in Ontario planning processes,
here I focus on ways in which land use law constructed the group home as a home
outside the norm, and the ways in which psychiatric survivor tenants resisted
this designation. Municipal minutiae such as zoning bylaws exerted social
control. In response, psychiatric survivor tenants resisted socially sanctioned
sanism by physically and metaphorically traversing “home” territory.
Scholars identify
over-regulation and / or rejection of group homes as manifestations of the
Not-In-My-Back-Yard (N I M B Y) phenomenon. Instead, I suggest
that NIMBY is but one example of sanism in the housing context. As Perlin noted,
“The concentrated efforts to ‘zone out’ group homes and congregate residences
for the mentally disabled offers a paradigm of sanist behaviour” (1991, 92).
My case study
involved a land use dispute in a mid-sized Ontario town I call Placeville. A
private operator wished to open a licensed group home in a pre-existing
building, partially located on a flood plain. Prior inhabitants were sixteen
members of an extended family. The operator wished to house sixteen tenants,
psychiatric survivors who had lived together previously. The operator did not
request structural alterations. At the time, Placeville had no group home
bylaw. The local Conservation Authority would not approve the group home
because its flood plain location could have jeopardized efficient emergency
evacuation of tenants.8
Flood plain management
required that municipal officials contact police and implement local evacuation
plans. In an emergency, it was considered more difficult to manage an
evacuation if residents had mobility impairments (Conservation Authority
Employee). The dangers facing disabled persons in flood situations have been
well documented, particularly after Hurricane Katrina (National Council on
Disability 2006). In Placeville, pre-existing residential uses were permitted to remain on the flood plain area. However, new
residential development was not allowed (Conservation Authority Employee). In
the OMB case, the flood plain area covered only a small portion of the group
home’s back yard. The parking lot, main entrance, and fire escape were all at
street level, well above the flood plain. Tenants were psychiatric survivors
capable of escaping the premises independently.
Correspondence
between the Town of Placeville and the Conservation Authority revealed that the
town had no definition of “group home.” The planning director nonetheless
treated group homes as a residential use. S/he wrote, “The Town while
acknowledging a difference between types of group homes and institutional forms
of residential care facilities, is evaluating the current application as a
group home (as defined by the Town’s current Official Plan) as residential use
and not as institutional.” Planner #1, employed by the Conservation Authority,
wrote to Placeville colleagues: “The proposed group home residents will require
24-hour supervision and would appear to fall within the broad institutional
intent of the policy… staff cannot recommend that the proposed use be located
in the flood plain since regional storm events are difficult enough for
individuals without handicaps to deal with.” This comment presumed that tenants
had mobility impairments. They did not. The planner also presumed psychiatric
survivors required “supervision,” a common sanist presumption I noted elsewhere
(Finkler 2006).
In a divergent
view, the group home operator described flood plain location as a red herring,
stating: “There are no people in wheelchairs living in the house. The tenants
can run out easily. The last flood in the region was 50 years ago. That’s what
I went through. Everything they could put in my way, they did.” In his / her comments,
the operator referred obliquely to prevailing N I M B Y
sentiment. Neighbourhood opponents stated clearly in interviews that they did
not wish to have another group home close to downtown.
In contrast to
planners, municipal officials, and the landlord, tenants indicated that they
wished to live together because they considered one another “family.” Some
tenants knew each other from previous homes. One town councillor, present at
both the public meeting and the OMB hearing, described a
tenant’s testimony thus: “One [tenant] spoke beautifully. Some [tenants] have
been in the [same] group home for… close to fifteen years, so they were definitely a family and had not caused any issues within
the community in their tenure together… [s/he] touched my soul… [s/he] did not
want to be split up from [his/her] family… the only environment [s/he’d] really
known.” This perspective, describing tenant relationships, is rarely considered
in land use deliberations. Usually, the building’s presence is negotiated before
space is rented. Here, tenants moved together to the new location because they
were displaced by fire. The operator may have introduced tenant testimony at
the OMB to bolster his/her claims. Nevertheless, tenants prioritized their
relationships to one another rather than their relationship to the operator.
By speaking of each
other as “family,” tenants’ testimony resonated with a description written by
psychiatric survivor Pat Capponi (1992), who noted in her autobiography, Upstairs in the Crazy House, “Imagine being told… for years that you have to be locked up. Then,
some clown is standing there, talking about how it’s time for you to go; being
in hospital for so long isn’t good for you. Here’s a ticket and an address; a
welfare worker will be by to see you, good luck. Imagine you have no more
control over this than anything else in your life. This hospital, this staff,
the patients, and people you’ve been locked up with for years have become
closer than siblings you no longer remember, but no one seems to mind that for
the second time, you’ve been surgically removed from your family” (29). During
deinstitutionalization, the emphasis was on physical placement in the
“community.” The implications of emotional dis-placement were not considered.
Restrictive forms
of zoning not only restricted psychiatric survivor housing, they simultaneously
“disciplined” (Foucault 1995) survivor tenants by demanding self-imposed
invisibility. This territorial negotiation was evident in the visual
relationship between survivor tenants and non-survivor homeowners next door.
The operator landscaped the backyard so tenants could congregate there. Tall
trees graced each side of the yard, blocking sightlines, and thereby ensuring
that tenants remained invisible to neighbours. Tenants, however, refused to
adhere to this attempt at visual buffering. Tenants first resisted NIMBY sentiment by testifying at the OMB and then
resisted that sentiment again in their own home.
Instead of
remaining in the backyard, tenants stood at the front of their premises where
they could both see neighbours and be seen by them. Tenants occupied
“transitional spaces” (Knowles 2000) such as the parking
lot and fire escape, usurping them for their own purposes such as smoking,
chatting, or reading the paper. Rather than moving through these areas on their
way somewhere else, psychiatric survivor tenants staked their claims to these
unmarked territories. Significantly, tenants moved in groups of two or three,
rather than as individuals. Their collective identity may have influenced this
spatial configuration.
We can understand
these spatial negotiations by incorporating Foucault’s depiction of the
clinical (or observing) gaze. Foucault stated: “The observing gaze refrains
from intervening: it is silent and gestureless. Observation leaves things as
they are; there is nothing hidden to it in what is given. The correlative of
observation is never the invisible, but always the immediately visible, once
one has removed the obstacles erected to reason by theories and to the senses
by the imagination. In the clinician’s catalogue, the purity of the gaze is
bound up with a certain silence that enables him to listen” (2007, 131). This
all-knowing, medical / visual interrogation, described by Foucault as the
clinical gaze, manifested itself in the tensions between psychiatric survivor
tenants and their neighbours during the land use dispute. While the clinical
gaze often exercises its authority when the powerful examine the weak, in this
case study, neighbours in power prevented psychiatric survivor tenants from
viewing them. Visual buffering asserted homeowner supremacy since structural
changes, such as the transplanting of fully-grown trees and the installation of
double trellises blocked sightlines. These moves revealed neighbours’ efforts
to visually repel the psychiatric survivor gaze while simultaneously insisting
tenants be properly “supervised.” Negotiations involving visual accessibility
reflected power relations between psychiatric survivor tenants and non-disabled
homeowners and demonstrated ways in which the landscaped environment can
spatially reproduce relations of power and privilege.
ASSERTION OF PSYCHIATRIC SURVIVOR TENANTS
AS “FAMILY”
Neither neighbourhood opponents nor Placeville
employees challenged tenants’ versions of their relationships with each other.
It appears that persons related by shared histories of confinement or
psychological condition do not fall within definitions of “family” established
by nondisabled society. Tenants’ assertions to the contrary,
therefore, could easily be ignored. Clearly, psychiatric survivors can
constitute “family” for one another. The reluctance to view bonds between
psychiatric survivors as central, rather than peripheral, exemplifies sanist
sentiments.
Tenants’ relationship
to one another was central to an analysis of the group home. If tenants were
“family,” the group home was considered a “home.” If tenants were not family,
the group home was considered an institution. If the group home was a home, it
could locate on a flood plain. If the group home was an institution, it could
not locate on a flood plain. If the group home could not locate on a flood
plain, then the operator would have had to close the group home. Tenants would
have been forced to move and be separated from one another. Ultimately, the
issue was decided by the O M B. The adjudicator
declared: “The Board does not agree that a group home is an institutional use.
It is a residence, a “home,” for certain persons who qualify to be residents of
the group home. It is not a hospital and the residents are not physically sick
and therefore incapable of leaving the home in the unlikely event of a regional
storm occurring. It is merely steps to the street which is not in the
floodplain.”9 The operator subsequently opened the group home and
Placeville enacted a group home bylaw.
The tenants in the
case study are certainly not alone in their self-identification as “family.” In
the land use context, Heslin et al. (2011) described sober living homes in
which tenants consciously referred to one another as family members. Heslin et
al. also referred to a US case in which developmentally disabled persons living
in a group home were considered an “alternative family” and noted: “These cases
illustrate how public policies and the rhetorically potent concept of family
can help validate the close personal relationships of disabled people” (2011,
478). When group home tenants defined themselves as “family,” they stressed the
importance of their relationships with one another. Tenants were unlikely to
choose their roommates (Schneider 2010); these decisions were typically made by
staff. Nonetheless, tenants asserted a bond with those who shared their living
space. This was no small feat, given the “self-stigma” (Corrigan and Watson
2002) many psychiatric survivors felt.
Self-stigma, or
what can be referred to as “internalized sanism,” can occur when psychiatric
survivors adopt the same values and perceptions non-survivors use to oppress
them (Corrigan and Watson 2002). As psychiatric survivor advocate, Judi
Chamberlin, wrote in her classic call for survivor
autonomy, On Our Own: “Like racism and sexism, mentalism infects its victims with the
belief in their own inferiority, which must be consciously rooted out. By
working together in self-help organizations, ex-patients can gain experience in
helping themselves and one another. But the belief in one’s own inferiority can
continue unless active efforts are made to combat it” (173).
There are good
reasons for the creation of a “chosen family.”10 Tenants may develop bonds in order to respond to the
challenges inherent in congregate living. Group home situations are often far
from ideal. There are tales of abuse11 and even death (Canadian Medical Association Journal
2002). According to one government policy analyst, inspection and ongoing
scrutiny of group homes is crucial: “There have been difficult situations of
tenant exploitation. Once, we had only sixty days to locate new homes for a
large group of tenants. Now we insist a transfer agency be involved to monitor
group homes.”
Despite media
coverage detailing sometimes intolerable conditions in group homes, evidence in
the case study OM
B file indicated the operator advocated effectively
on behalf of tenants. When the operator examined tenants at the O M B hearing, s/he framed questions in terms of “rights” and asked tenants
whether they ought to be able to live wherever they wished. This rights-based
approach suggests entitlement to a home, a position uncharacteristic of
landlords generally.
Tenants may
consider one another family, given the significant periods of time they spend with
one another. Problems with public transportation (Muir et al. 2010), lack of
access to a vehicle (due to poverty) (Filion 2000), or an inability to drive
(due to an impairment)12 may limit physical mobility outside the home (Gold
2008). In addition, the cost of socializing outside the home can be prohibitive
(Miflin and Wilton 2005). Housemates are physically accessible and there is no
financial cost associated with social interaction. Furthermore, service
providers often “cream” potential tenants (Schneider 2010) offering housing to
those most likely to succeed. Therefore it is possible that tenants will be at
a similar stage of recovery. Consequently, there may be a built-in degree of
interpersonal compatibility.
Some tenants may
prefer congregate living as a form of social support. Studies have shown that,
for psychiatric survivors, living independently is
associated with increased social isolation (Beal et al. 2005). Physical
integration in a neighbourhood does not often constitute social integration
with local inhabitants (Abdallah et al. 2009). Non-survivor neighbours often
reject psychiatric survivor tenants via legal or architectural choices.
Neighbours routinely oppose group home presence13 and if unsuccessful in barring the home, may harass
new arrivals14 or install visual buffering such as frosted windows
(Finkler 2006) to block sightlines between properties. Prospective neighbours
do not wish to see psychiatric survivors; they also do not wish to be seen by
them.
Given frequent
rejection by neighbours, group home inhabitants do well to seek support from
one another. Certainly, when being deinstitutionalized: “Being relocated
together means individuals have… contacts who may provide support as new
relationships are negotiated. Experiences of mental illness and… a shared
history of services often mean that people with mental illness living in the
community feel more comfortable socializing with their peers than [they do
with] people without the experience” (Forrester-Jones et al. 2012, 11).
Harley et al. noted
that “[o] f 79 [research] participants with friends, 75 named someone amongst fellow
service users, who they met at hospitals or day centres. They appreciate shared
experiences and mutual support” (2012, 1298). Tenants in supportive housing
explained they chose other survivors as friends because: “Mental illness can be
so isolating that… many of us are very lonely… we get socially awkward…
Sometimes, if you share your own wounds it makes it easier for all of us. There
are times where it’s really helped” (Bendell et al. 2010, 33). Another
psychiatric survivor elaborated: “I am more comfortable with people who have
had experiences of mental health problems because you do share something and
have something to talk about. I haven’t been in society for many years… . I
can’t hold conversations with normal people… I [would] sooner not be bothered”
(Harley et al. 2012, 1296).
Some scholars
mention the crucial role reciprocity plays in friendship. Researchers noted:
“Participants with psychiatric disabilities who were given monthly stipends,
but not matched with a peer with whom to spend the money, tended to use
stipends to purchase items for persons who provided assistance in the past”
(Wong et al. 2009, 62–3). When considering the centrality of “give and take,”
perhaps psychiatric survivor tenants felt most comfortable with one another as
they could participate in similar forms of reciprocal engagement, i.e. offer emotional support as opposed to financial support.
This interplay acknowledges not just common psychiatric history but similar
class status.
Tenants’
characterization of themselves as a “family” may also have been an attempt to
normalize their relationships, i.e. to present themselves, and possibly staff
and landlord, as being related to one another. However, this depiction carries
with it an uncritical assessment of power dynamics both between tenant and
landlord and amongst tenants themselves. Fenby (1991) asserts that defining
tenants of a community based residence as a family in fact re-segregates
psychiatric survivors, and reinforces patriarchal relationships between tenants
and staff: “From the denial of adult sexuality through the use of double
bedrooms to the potential for staff to define any deviant behaviour as mental
illness, the community residence is a powerful strategy for the social control
of disabled people. By keeping clients in one place and under surveillance,
bureaucrats can minimize interactions between clients and the community. The
mentally ill remain hidden, under the eye of the Father and away from public
attention” (132). Brown and Smith, feminist advocates, also criticize the
reproduction of the family in group home settings: “New services have tended to
imitate the nuclear family in grouping people together in small houses, [and]
women in these groups are likely to find themselves in a housekeeping role…
servicing men whom they have not chosen and with whom they do not have close
personal ties” (1992, 159–60).
Group home tenants
may indeed constitute family for one another. However, following Fenby (1991),
I suggest that including staff in this relationship dynamic would be
inaccurate. Relationships between paid staff and tenants are contingent on
salary. It has been painful for psychiatric survivors to realize that emotional
bonds with staff are time and place specific (Shaunessy 2001). Certainly,
“group homes are a risky environment due to frequent changes of staff
personnel, high workload of staff, discontinuity in staff presence and limited
opportunities for individual support” (Schuengel et al. 2010, 39). Indeed,
employee loyalty is to the employer rather than to tenants. It can be dangerous
for tenants to rely on paid staff for friendship or emotional support, as there
may not be ongoing contact once employees resign.
Critical scholars
argue that group homes are mini-institutions (Sinson 1993). Psychiatric survivors
and developmentally disabled persons describe a lack of control over their own
finances (Sinson 1993), lack of control over choice of
roommates (Forester-Jones et al. 2002), strict and inflexible housing rules
(Bendell et al. 2010), and staff interference with expression of sexual
orientation (Abbott and Howarth 2005). From residents’ perspectives, group
homes can reproduce aspects of asylum life (Drinkwater 2005).
There must also be
a critique of the family as it functions in patriarchal society. The male
figurehead who dominates the nuclear family can, as Fenby (1991) suggests, be
reproduced by the group home operator as he uses or abuses his power. While the
notion of family is used by both group home tenants and the operator to assert
their similarity to local inhabitants, the ideal of family itself is
problematic. The designation of group home tenants as “family” has implications
far beyond the emotional connections that tenants and / or staff may share with
one another. First, if municipal government had conceived of tenants as
“family,” there would have been no public hearing. Indeed, the structure under
dispute, which housed sixteen tenants, had previously housed an extended
family, also comprised of sixteen people. The structure became the focus of
opposition only when the operator applied to open a group home.
The spatial
organization of the group home did not reflect what might be considered a
typical “family” home in Placeville. While the exterior of the house was
home-like by comparison to psychiatric hospitals, interior arrangements
revealed aspects of institutional life. Although the operator argued at the O MB that the group home was indeed a home and should not, therefore, be
subject to flood plain restrictions pertaining to institutional use,
nevertheless the group home manifested several institutional features. For
example, an online description of the group home indicated that tenants had to
request permission to place computers in their rooms. Adult members of a
typical family unit would not have needed such permission. Obtaining operator
“approval” infantilized tenants and removed their autonomy.
Similarly, the
eating area, as presented in an online image, was inconsistent with the
operator’s views articulated during the O M B hearing. In a
“family” home, the dining room would have had one large table around which
everyone sat. In the group home, there were five small tables and, usually,
three chairs. Such seating arrangements resembled a restaurant, or perhaps a
nursing home environment. The owner also altered the use of transitional and /
or recreational spaces. By using the main foyer as an expanded dining area, the
operator effectively decreased the common space within the
home. Because of decreased space inside, tenants were forced outside if they
wished to socialize with one another.
While tenants
themselves referred to each other as “family,” spatial arrangements within the
group home attested to the power exercised by the landlord. Furniture
arrangement and use of space demonstrated limited support for tenants’
relationships. If development and maintenance of familial links had been a
priority, tenants would have been seated around one table and informal social
spaces would have been created. The evidence provided at the public meeting and
later at the O
M B supported the assertion that tenants were
“family” to one another. But these relationships appear to be sustained in
spite of, rather than because of, the operator’s influence.
CONCLUSION
Land use law, which regulates group home
location, reflects inherent tensions. On one hand, the group home in this case
study was a “residential” use. Nonetheless, it was subject to specific
restrictions other “family” dwellings did not face. Since physical structure
was not at issue, one can only conclude that psychiatric survivor inhabitants
attracted greater scrutiny from the municipality. Tenants’ assertion of a
family relationship established their dwelling place as a home, a conclusion
ultimately supported by the O M B . Despite this concerted
effort to assert the centrality of their relationships to one another, the
landlord ultimately controlled interior physical space and exerted strong
influence on exterior space as well.
Psychiatric
survivor resistance to land use law in this case study manifested in two ways.
First, survivors identified as a “family,” despite its non-traditional nature.
Tenants also resisted efforts at visual buffering and the “medical gaze” by
their lack of compliance with landscaped terrain outside their home.
Foucault (1984)
insisted upon an analysis focused on the centrality of power. He also insisted
that such an analysis did not preclude the struggle for social justice. As
Foucault famously noted, “liberty is a practice” (1984, 245). It is precisely
this analysis of freedom, as a vital force, in action, that encouraged
psychiatric survivors to challenge the idea of normalcy itself. It is precisely
this analysis of freedom that offered psychiatric survivor tenants the
opportunity to reconceptualize themselves, not as loosely connected
individuals, but rather, as members of a community.
1 Thanks to Jill Grant whose
feedback on earlier versions of this chapter helped clarify my arguments and
strengthen my writing and to Howard Epstein, whose comprehensive knowledge of
land use law guided my analysis of legislation. Thanks also to S SHRC and the
Trudeau Foundation who funded the research on which this chapter is based.
Finally, I express my deepest appreciation to members of the psychiatric survivor
community without whose support I would not have been able to write this
chapter.
2 I use this term to indicate that “psychiatric survivors” often survive
experiences of oppression, such as sexism, racism, etc., and medicalization of
their psychological distress. While the term “psychiatric survivor” can be
criticized for defining persons solely in the context of their relations to the
psychiatric system, the term has also been used to signal that one has survived
one’s own psychological distress.
3 This chapter uses a psychiatric survivor analysis to understand the
experiences of group home tenants. Psychiatric survivor struggles are also
linked more broadly to the struggles of disabled persons. Psychiatric survivors
may live with an impairment such as depression or disassociation. Because of
the impairment, survivors may also experience disability. For example, a
manager may discover that their employee once experienced depression.
Subsequently, the employee may be fired because their boss believed they would
be unreliable, even if there was no immediate evidence to support their
assumption. In the above circumstance, the psychiatric survivor lost their
position not because of the impairment, but because of disability i.e. an
experience of marginalization due to sanism or systemic discrimination.
4 D. Davidson and M. Lapp, “The Evolution of Federal Voting Rights for
Canadians with Disabilities,” (2004), http://www.elections.ca/res/eim/arti-cle_search/article.asp?id=17&lang=e&. Last
accessed 5 November 2012.
5 “At the Asylum,” Globe and Mail, 5 April
1890.
6 Author unknown, “Seeking House Parents,” Toronto Star, 16 January 1961.
7 The City of Cornwall amended its group home definition in 2002 to read
as follows: “Group Homes” shall be defined as a single housekeeping unit in a
single family or semi-detached dwelling in which no more than three (3)
(excluding supervisory staff or receiving family) live as a family under the
responsible supervision consistent with the particular needs of its residents.
8 In addition to the conflict regarding the application of municipal
bylaws, the case revealed a conflict between Placeville’s understanding of
“group home” and that of provincial statute. A group home, as defined in the Municipal Act, had a maximum of ten
tenants. The operator in the OMB case had sixteen tenants. In legal terms, the operator was not
operating a group home and could not be found guilty of that offence.
9 No case citation is noted in order to maintain confidentiality of
research participants.
10 Members of the queer community use the term “chosen family” to
describe those to whom they have no biological relationship but with whom they
are deeply bonded. The song “We are Family” by Sister Sledge is particularly
popular at gay and lesbian events (Weeks, Heaphy, and Donovan 2001). The song
is also mentioned on the website for Family Home Ontario, an organization that
links developmentally disabled adults to caregiving families (see http://www.familyhomeontario.org/).
11 Canadian Broadcasting Corporation (C B C), “Manitoba
Launches Review of Group Home after Allegations of Abuse,” News Online, 27 June 2008, http://www.cbc.ca/canada/manitoba/story/2008/06/27/lost-inquiry.html. Last
accessed 5 November 2012.
12 “Physicians’ Duty to Report Patients,” Ontario Ministry of
Transportation, 2012, http://www.mto.gov.on.ca/english/dandv/driver/medical-review/physicians.shtml. Last
accessed 3 November 2012.
13 E. Reilly, “Council Votes against Group Home Move to Corktown,” Hamilton Spectator, 26 April 2012, http://www.thespec.com/news/local/article/712656--council-votes-against-group-home-move-to-corktown. Last
accessed 4 November 2012.
14 R. Aulakh, “Napanee Group Home Owners File Human Rights Complaint,” Toronto Star, 7 August 2012, http://www.thestar.com/news/canada/article/1238592--napanee-group-home-owners-file-human-rights-complaint. Last
accessed 4 November 2012.
Disability, Divisions, Definitions,
and Disablism:
When Resisting Psychiatry
Is Oppressive
A.J. WITHERS
Psychiatric consumer, survivor, ex-patient, and
mad (pride) movements have made incredibly important gains for psychiatrized
people and for society as a whole. I am personally inspired and influenced by
the rich history of psychiatric consumer, survivor, ex-patient, and mad (also
known as c/s/x/m) organizing. However, like all movements, there are areas that
merit critical re-examination. Geoffrey Reaume (2012), historian and
psychiatric survivor, asserts that “being inspired by those who went before can
be as good a reason as any to engage in this research, so long as we are also
critical about those we may admire, whilst also recording how they made mistakes
and could be as offensive as anyone else” (63). I am writing this chapter with
critical admiration. This chapter examines sites in which disablism is present
in c/s/x/m organizing and calls on organizers to work to undo disablism rather
than reinforce it.
I am raising these
issues as a physically disabled person1 in helping to make a useful critical intervention
into some problematic tendencies that I have noticed in these movements. I am
also psychiatrized as a trans person, because my gender identity is constructed
as a mental disorder.2 I’m writing out of respect and in the hopes that
disablism can be eliminated in these movements in order to make them stronger,
more inclusive, and more just.
By no means do I
intend to suggest that psychiatric survivors, ex-patients, mad people, and/ or
consumers are not also oppressed by other disabled people
organizing for social change. Examples of physically disabled people excluding,
erasing, discriminating against, stigmatizing, marginalizing, dominating, or
being otherwise oppressive towards psychiatrized people are commonplace. A
number of physically disabled people resisted the inclusion of psychiatrized
people in the Canadian Charter of Rights and Freedoms (Vanhala 2011). Further,
the social model, one of the primary alternatives to the medical model within
the disability movement, was not initially developed with psychiatrized people
in mind (Oliver 1996). Only after this theoretical model had been elaborated
was room made for the inclusion of psychiatrized people (Thomas 2004). I’m not
trying to minimize or erase the marginalization of psychiatrized people and
psychiatric-survivor perspectives from the disability movement in focusing this
chapter on disablism in c/s/x/m movements. Nor am I trying to erase the many
times these movements have been heterosexist / homophobic, racist, sexist,
classist, cissexist, ageist, or otherwise oppressive. Even radical movements
led by thoughtful, rigorous, directly affected people have a tendency to
reproduce other forms of social / political oppression while they fight to
dismantle a particular kind of oppression or gain particular rights.
WHAT IS DISABILITY?
I want to be very clear in what I mean when I say
disability. I am invested in the radical model of disability (Withers 2012).
Within this framework, disability is about power and oppression; disabled
people are labeled as disabled because we are considered un (der) productive
within the capitalist economy. Disability is socially specific and has been
viewed very differently in different times, places, and cultures. This is how
the same person can be labeled as disabled and condemned, stigmatized, and
vilified for having visions in one culture but celebrated in another. This is
also how a Deaf person can be labeled as disabled in one time and place but in
another be viewed as a normal contributor to society (for example, Martha’s
Vineyard in the early twentieth century [Groce 2003]). Similarly, in a world
without stairs, a wheelchair user may not be considered disabled.
There are four key
components to the radical disability model. The first is that disability is a
social construction not a biological fact. This is not to say that biology
isn’t at play (we are all biological creatures) but, rather, that we actively
attach meaning onto people’s minds and bodies. There is no fundamentally
biological basis of disability. In the 1970s, physically
disabled activists created the social model of disability, separating
disability (social barriers) from impairment (physical limitations) (Oliver
1996). The radical model rejects this dichotomy for a number of reasons;
particularly, because impairment itself is socially constructed. This isn’t to
say that disabled people don’t have difficulties with our minds and bodies. All
humans sometimes have difficulties with our minds and bodies; however, such
difficulties are neither a prerequisite nor necessarily sufficient for being categorized
as disabled. The radical model is opposed to the medical model of disability.
The medical industrial complex, including psychiatry, is fundamentally flawed
and perpetuates the oppression of subordinated groups. Condemning this,
however, is not condemning the people who access its services nor is it
condemning the idea of care.
The second key
component to the radical disability model is the idea that disability is about
power; as Devlin and Pothier observe, disability “is a question of politics and
power (lessness), power over, and power to” (2006, 44). The way that people are
categorized as disabled or non-disabled occurs because of the desire to
maintain domination over people and control resources. In a capitalist economy
these are generally people deemed to be un (der) productive.
Third, disability
must be approached from a perspective that recognizes interlocking oppressions.
Some members of all subordinated groups are disabled. Eliminating disablism
means both working for the elimination of all oppression, and acknowledging
that disabled communities are diverse.
Finally, radical
access is a key component of radical disability politics. Access becomes much
more than physical accessibility and includes, but is not limited to, social,
economic, cultural, and intellectual accessibility. The definition of “access”
goes beyond the provision of ramps and lifts, towards creating non-oppressive
spaces that are inclusive to many different communities (Withers 2012).
DISABLISM IN THE MOVEMENT: LANGUAGE
There are two key ways that I have observed
disablism occurring in c/s/x/m movements: the use of disablist language and the
reluctance to be called disabled/ included in the disability community. When I
talk about the way that disability is portrayed by these movements, I do not
mean to raise trivial points, or to give credence to the liberal notion of political correctness. Barnes, Mercer, and
Shakespeare affirm that “the language and concepts we use influence and reflect
our understanding of the social world” (1999, 11). When disability is portrayed
negatively, this indicates that disabled people are being undervalued and
stigmatized.
Members of the
c/s/x/m movement warn of psychiatric drugs and their “brain-disabling” effects
(Breggin 1997, 2008), call them “crippling,”3 and argue they “disable and disempower through their
unique disabling effects.”4 Similarly, electroshock is also said to have “brain-disabling”
(Breggin 1979) and “disorienting and disabling” (Breeding and Scogin 2012, 60)
effects. Activists also called for E C T to be banned because
it “frequently causes learning disabilities and other intellectual (
“cognitive”) impairments” (PsychO U T Conference 2010).5 Psychiatrists as a whole are said to: “frequently
cause harm, permanent disabilities, death – death of the body-mind-spirit.”6 This particular line of discourse is actually doing
something quite regressive; it uses a stigmatized identity of one group as
shorthand for representing the victimization / disempowerment / oppression of
disabled people. This practice ultimately reinforces all disabled people’s
oppression, which works to reinforce oppression generally.
It is possible that
some of these authors are trying to evoke images of disabled people to repel
people from psychiatry and/or specific psychiatric interventions. It is also
possible that some of these authors would argue that these words, words like
“disabling,” “crippling,” and “impairments” have definitions that do not
necessarily imply oppressed identities. However, I think Chris Chapman is
correct when he asserts that while words “have acceptable usages about things
other than people, in terms of what dictionaries say… it is impossible to use
these words without evoking people.” He continues: “whatever dictionaries say –
it would be impossible for me to say ‘gay’ and have it only signify ‘happy’”
(2010a, n.p.). When arguments are made against psychiatric interventions using
this type of language, they are made at disabled people’s expense.
Disability,
including disabled people, is used as shorthand to represent things that are
bad, negative, and undesirable. I do not dispute the fact that there can be
awful consequences from psychiatry and psychiatric treatments. I do, however,
resent the use of my identity as in need of being prevented and the result of
harm. It is important for everyone engaged in these movements (and everyone,
generally) to be more intentional with their language. The point of protest is actually suffering, pain, harm, infringements on autonomy,
domination, abuse of power, violence, forced “treatment,” and/or oppression –
not disability, or disabled people. Sometimes, this means using more words and
saying the things that are actually meant rather than using the perceived
tragedy of disabled people’s lives as shortcuts.
“WE’RE NOT DISABLED”
The other site where disablism occurs in these
movements is through the conscious distancing of psychiatrized people from
disabled communities. I have identified some key themes with respect to why
many psychiatrized people do not identify as disabled: the belief that disability
is “real” and psychiatric diagnoses are not; the belief in the permanence of
disability; the concern about being further stigmatized; the distancing from
and erasure of people labeled as intellectually disabled; and the belief that
psychiatry alone is a form of social control, to the exclusion of other areas
of medicine. While all of these themes are interrelated and, as I will argue,
rooted in disablism, I will address each one of them individually.
“There’s Nothing Wrong with Us”
A common assertion made by the anti-psychiatry
movement is that disability is real and psychiatric diagnoses are not,
therefore psychiatrized people are not disabled. For instance, Barbara Everett
argues that adopting, or accepting, the label of disability is inappropriate
because psychiatric labels are socially constructed. Everett asserts, “no one
can dispute a developmental handicap or the reality of the loss of limbs or
eyesight. Yet, almost every aspect of mental illness is contested ground. Some
of us even argue that it doesn’t exist” (2000, 199–200). Similarly, Liz Sayce
has argued that some psychiatrized people do not identify as disabled because:
“Disabled people (some user / survivors believe) have a tangible impairment,
for example, being unable to walk or see. A diagnosis of mental illness is much
more in the eye of the beholder; it is not clear that there is something
‘wrong’” (2000, 133).
Many
psychiatric-survivors, consumers, ex-patients, and / or people who identify as
mad are “unwilling to see themselves as disabled. They associate disability
with the medicalization of their distress and experience.
They reject the biological and genetic explanations of their distress imposed
by medical experts. They may not see themselves as emotionally or mentally
distressed either, but instead celebrate their difference and their particular
perceptions” (Beresford, Gifford, and Harrison 1996, 209). Similarly, Recovery
Network: Toronto (2012) asserts: “If we hear voices it does not mean that we
are ill or disabled – it simply means that we hear voices.”7 Likewise, EleMental, a U K based self-help
recovery organization with a presence in Canada and the United States, argues:
“Mental distress is not a disability so why try to turn it into one?” These
organizations imply that hearing voices and mental distress can be a normal
part of the human condition but disability and illness are negative and
abnormal.
There are two
problematic things that are happening within these lines of argument. First,
the maintenance of the myth that disability is fixed and biological is an
integral component of maintaining disablism against both intellectually and
physically disabled people. Second, these kinds of “we’re not disabled because
there’s nothing wrong with us” statements imply there is something wrong with
disabled people. In challenging the pathologization of certain people and
certain kinds of pathologies while upholding the systems that allow for and
legitimize pathologization, there is a clear effort to distance psychiatrized
people from others classified as disabled, leaving disablism intact.
Recovery vs. the Permanence of Disability
Another reason that psychiatrized people resist
inclusion within the disability label is the view that disability is permanent.
Sayce reports that there is a belief that “Mental distress is not a disability
because it is not something that you are born with and it is not permanent;
people recover, they are ‘survivors’” (2000, 134). EleMental asks: “Why jump on
the Disability Rights bandwagon? People can and do recover from mental health
problems” (n.d.). This position seems to put forward the idea that disability
is inherent to certain individuals. However, most disabilities are acquired
rather than inborn.
Even when
psychiatrized people do adopt the label of disability, they can still reinforce
the notion that disability is inherent to certain people. For instance Gisela
Sartori, founder of the Second Opinion Society, says of
her organization, “we came to the point of saying ‘Yes. We’re disabled; we
don’t have an inherent disability, but the system has made some of us
disabled’” (in Shimrat 1997, 131) because of the effects of psychiatric drugs.
Even here, where disability is accepted in some circumstances, people reject
that psychiatrized people are necessarily disabled while, at the same time,
implying that other disabled people are inherently disabled.
Stigma
Fear of being further stigmatized and
marginalized is another reason that psychiatrized people, mad people, and
psychiatric survivors resist categorization as disabled. Sayce explains this
perspective: “taking on the term ‘disability’ means taking on another stigma.
Having one stigma is bad enough” (2000, 135). This has been the position of
many in c/s/x/m movements since at least the early 1970s (Chamberlin 1990).
However, this is not how stigma works. People do not get to choose if they are
oppressed – they simply are. Vic Finkelstein, while writing about a similar
pattern of distancing from the disabled community by the Deaf community, points
out: “Regardless of personal wishes… being labelled disabled in the
contemporary world is a fact of life for all disabled people” (2000, 268). Like
it or not, the disabled identity is not one that is within the control of most
disabled people, and the experience of disablism certainly is not. This is
partly because disability (including impairment) is a social construction, and
there are no fixed borders to determine who is and who is not disabled. You are
disabled if you are constructed as disabled, and stigma and subordination comes
along with that. In addition to the fact that the label “disabled” is outside
the realm of control of psychiatrized people, there is another serious problem
with the attempt to resist additional stigmatization by not identifying as
disabled: simply working to not be considered disabled in order to avoid stigma
without doing anything to a challenge the stigmatization of disabled people is,
at best, a demonstration of a lack of solidarity, and at worst, complicity in
oppression.
Erasure of People Labeled as Intellectually
Disabled
It is particularly interesting that some c/s/x/m
activists endeavor to unravel the DSM (American Psychiatric
Association [APA] 1980, 2000) by working to uphold certain parts
of it. I am speaking specifically about the disablism directed at people
labeled intellectually disabled. Intellectual disabilities are pathologized
through the D S
M in the same way that other psychiatric illnesses
are named and categorized. However, I could find no discussion of intellectual
disability as psychiatrization within c/s/x/m literature. As discussed
previously, intellectual disability is named as a consequence of psychiatric
treatment – one that should be avoided. In an interview, psychiatric survivor
Joe Baletta recounted how he resented his treatment in a psychiatric
institution in part because it was assumed people there were “brain dead,
retarded, and had no potential.”8 Intellectual disability is also said to be an
indisputable reality (Sayce 2000) rather than a social construct – a point
disputed by myself and others (Goodley and Rapley 2001, McDonagh 2008, Rapley
2004, Withers 2012).
I suspect that the
erasure of this group of people from the movement and community is a direct
result of disablism. This disablism is likely functioning both in the belief
that people labeled as intellectually disabled are intellectually inferior and
in the belief that intellectual disability (diagnoses of mental retardation,
learning disorders, etc.) is a wholly biological fact rather than a social
construction. Intellectual disability is conspicuously absent in discussions of
how the DSM operates to maintain social control within c/s/x/m movement
literature.
Medicine as Social Control
Many anti-psychiatry and c/s/x/m organizers argue
that psychiatry is used as a tool for social control9 (see also Breggin 1991, Burstow 2006b, Szasz 1977a).
Psychiatric survivor activist Don Weitz asserts that the DSM is a “catalog of negative moral judgments.”10 Subordinated groups, including women (Burstow 2006b,
Chesler 2005, Ehrenreich and English 1973), racialized people (Baynton 2001,
Greger 1999), Aboriginal people (Dick 1995), poor people (Yolles 1965), queer /
lesbian / bi / gay people (Bronski 1984, Foucault 1978, Silverstein 2008), and
trans people11 (see also American Psychological Association 1980,
2000) have been the targets of psychiatric professionals. The pathologization
of oppressed groups helps legitimize their oppression, on the grounds that
because they are inferior they are in need of special limitations or
protections (Ehrenreich and English 1976, Withers 2012).
I have no objection to the argument that psychiatry has been and
continues to be used as a tool for social control; I think that is an accurate
and important argument. My objection is that people combating psychiatry often
imply that psychiatry is socially construed and used for social control while
the rest of the medical establishment is helpful, legitimate, not used for
social control, and / or based in unbiased science. This is far from the case.
While psychiatry has targeted oppressed groups, so, too, has the rest of the
medical establishment. Women (Conrad 2007, Ehrenreich and English 1973,
Riessman 1998), Aboriginal people (Hoffman 2005), racialized people (British
Medical Journal 1901, Haller 1995), poor people (Lidbetter 1921),
queer/bi/lesbian/gay people (Ordover 2003, Rahman 2005), and trans (Geddes
2008)12 people have all been identified as inferior, as
disabled, by medical disciplines beyond psychiatry as well.
THE MAINSTREAM GAY RIGHTS MOVEMENT
AND RESISTANCE TO PATHOLOGIZATION
A part of winning rights for all of the groups
that I listed above has involved distancing themselves from their previous (or
current) classification as disabled. One example of this is the mainstream gay
rights13 movement, which worked very hard to distinguish
itself from both psychiatrization and disability. This movement serves an
example of a campaign against the psychiatrization of (certain) people, and
there are a number of parallels between this early anti-pathologization
movement and components of contemporary c/s/ x/m organizing.
In the 1960s,
organized gays and lesbians took an active role in fighting for change. One of
the key aims of the struggle was to establish homosexuality as a “minority
group” rather than a (psychiatric) disability. Frank Kameny, one of the most
well-known American gay rights activists and self-proclaimed founder of the gay
rights movement in Washington, D C (Kameny 2009), argued
that the categorization of disability needed to become one of the key
battlegrounds in the rights movement. Homosexuality had been labeled as a
psychiatric illness, or disability, and Kameny, along with the mainstream gay
rights movement, organized against the disability or sick label. In a 1964
speech Kameny said: “We cannot ask for our rights from a position of
inferiority or from a position, shall I say, as less than whole
human beings. I feel that the entire homophile movement, in terms of any
accomplishments beyond merely ministering to the needy, is going to stand or
fall upon the question of whether or not homosexuality is a sickness, and upon
our taking a firm stand on it” (Kameny 1965, 12). This position was echoed by
other members of the gay and lesbian community (Esterberg 1990, Silverstein
2008). The mainstream gay rights movement built itself through its separation
out from under the disability umbrella.14
The A P A was (and remains) the gatekeeper of all psychiatric diagnoses and had
the power to un-psychiatrize homosexuality. A flier distributed by members of
the mainstream gay rights movement reads: “It matters not whether the word used
be sickness, disorder, affliction, disturbance, dysfunction, neurosis,
immaturity, fixation, character personality disorder, or any other – or whether
homosexuality be considered as merely symptomatic of these – the effects are
the same: (1) To support and buttress the prejudices of society and to assist
the bigots in the perpetration and perpetuation of their bigotry; and, at least
equally important (2) To destroy the homosexual’s self-confidence and
self-esteem, impair his or her self image, degrade his or her basic human
dignity.”15 The association of pathologization of identity with the
degradation of human dignity is both fair and accurate. However, the authors
and protesters consciously associated sickness or disability with the absence
of human dignity. This criticism was not of pathologization or the oppressive
nature of the classification of disability in general, simply that those in
power had erred in classifying them as disabled. This strategy actually worked
to maintain disablist oppression and the status quo while negotiating
privileged homosexuals’ co-optation.
It should be noted
that there were some mainstream gay rights activists who did criticize
psychiatric pathologization. Charles Silverstein (2008), a gay psychiatrist,
presented a paper to the Nomenclature Committee. In it, he argued: “To continue
to classify homosexuality as a disorder… is as valid today as was the diagnosis
of masturbation in the 1942 edition. What we hope to convey to you is that we
have paid the price for your past mistake. Don’t make it again” (282). While he
criticized psychiatry’s moral judgments placed on certain sexual deviancies, he
did not apply that criticism to many of the people outside of sexuality and did
not question the legitimacy of the American Psychiatric Association or anyone
else to pathologize deviant minds and bodies.16
In 1973, the mainstream gay rights movement was successful in getting
homosexuality delisted as a psychiatric disability. Silverstein called it “the
most important achievement of the Gay Liberation Movement” (2008, 227).
Homosexuals would no longer be forcibly confined, electro-shocked, drugged,
lobotomized, and subjected to other horrors simply for being homosexual. The APA, however, classified sexual orientation disturbance (homosexuality) as
a mental disorder when homosexuality itself was removed. Those people who were
“disturbed by, in conflict with, or wish [ed] to change their sexual
orientation” (1973, 1) were still considered to have mental disorders.
Undoubtedly, the depathologization of homosexuality is an incredibly important
event in this history, and one that I have personally benefited from;
nevertheless, it is important to examine this event critically. It was a
victory for many homosexuals at the time but a lot of homosexuals were left
behind.
Establishing
“ourselves” outside of the rubric of disabled meant that not only did the
mainstream gay rights movement sell out its disabled members (not to mention
its racialized, poor, trans, intersexed, two-spirited, and, oftentimes, women
members),17 but also that it sold out its future. Fighting to remove
itself from the categorization of disabled, rather than working with others
classified as disabled to challenge the systems that permit the
characterization of undesirable people as disabled, the mainstream gay rights
movement has ensured the queer community is at perpetual risk of being
repathologized as those in power see fit (the perpetual threat of the discovery
of the “gay gene” and subsequent development of prenatal screening of gay
fetuses is but one example).
To be gay or
lesbian is no longer to be pathological, as white, middle- and upper-class
homosexuals and bisexuals, especially gay men, are considered to be productive
and useful in contemporary society. The mainstream movement has rallied around
assimilationist issues like gay marriage, gays in the military, and adoption
that work to uphold capitalist values and social norms. This is done instead
of, and at times at the expense of, organizing in defense of “deviant” queer
lifestyles like polyamoury, sex work, transsexuality, and genderqueerness that
challenge those values and norms. Indeed the actions of the mainstream gay
rights movement have, at times, actively marginalized such lifestyles, and the
people who choose them.
The struggle to have homosexuality unclassified as a psychiatric
disorder was beneficial to homosexuals who were not otherwise psychiatrized or
considered disabled. Nevertheless, it’s incredibly problematic to purchase
privilege at the expense of more marginalized members of the community.
LEARNING FROM HISTORY
I tell this story of the mainstream gay rights
movement’s co-optation and precariousness because I think there is an important
lesson to be learned here about the way the disability movement is approached
by those who remain categorized as disabled within broader society. I would
argue that c/s/x/m movements are engaging in types of actions that the
mainstream gay rights movement engaged in during the 1960s and 1970s, including
the use of similar rhetoric. While this strategy could potentially benefit some
psychiatrized people, I do not believe that it is in the interest of
psychiatrized people as a whole, and it actively works to reinforce the
oppression of disabled people.
Let’s say for a
moment that you aren’t buying my argument at all. Let me ask you then, what
happens with psychiatrized people who would otherwise be classified as disabled
even if psychiatric diagnoses were no longer considered disabilities?
Purchasing privilege on the backs of disabled people could actually make many
psychiatrized and otherwise disabled people’s lives worse. Fellows and Razack
argue that “competing parallel narratives ignore the interlocking nature of
systems of domination and the complex ways in which they simultaneously secure
relations and sites of domination” (1997–8, 339). Separating out psychiatrization
from disability and making it a parallel struggle works to erase the ways that
interlocking oppression plays out, particularly for psychiatrized and otherwise
disabled people.
CONCLUDING THOUGHTS AND MOVING FORWARD
While I have argued for psychiatrized people to
identify as disabled and remain under the disability umbrella, I am,
nevertheless, conscious of the concerns of psychiatrized people about
maintaining their own histories and identities. There are concerns that this
could “dilute or co-opt the survivor movement voice.”18 Frank Bangay argues: “While it is
important to link up and campaign about issues that affect us all, such as
benefit cuts, we need to hang onto our own history and acknowledge our struggle
for rights. Otherwise, our views are diluted” (2000, 102). I think that this
argument, unlike many of the others, is made in a way that is respectful of
disabled people as a whole. I respect this concern. However, I disagree that
accepting being labeled as disabled would necessarily mean this loss of history
and identity. I believe that a careful, thoughtful, and respectful merger under
the rubric of disability can take place without there being a loss to
psychiatrized people, including those who identify as mad, psychiatric
survivors, ex-patients, and / or consumers.
Unlike the social model, the radical model was
developed with psychiatric, intellectual, and physical disability in mind.
While the primary developers of this radical model that I am promoting are
physically disabled (myself and Loree Erickson), our work was done in close
consultation with psychiatrized people, and draws on many of the important
contributions that the psychiatric survivor movement has made.
In spite of divisions, there have been important
instances of the c/s/x/m organizations and disability organizations working
together (Morrison 2003). The Disability Action Group (it later became DAMN), which I was involved with included a number of community organizers,
including psychiatric survivors, psychiatrized people, and physically disabled
people. This action group had five key demands, including changing certain
social assistance regulations, increasing physical accessibility, and
eliminating psychiatric abuse.19 There are undoubtedly many instances of coalitions that
emerge out of these communities to work together to achieve specific goals.
Psychiatrized people and members of c/s/x/m
movements have the choice to identify as disabled but they do not have choice
regarding if they are identified as disabled, nor if they experience disablism.
There are only two ways to eliminate disablist experiences of psychiatrized
people: to no longer be considered disabled, upholding (even intensifying) the
oppression of those disabled people they leave behind; or, to eradicate
disablism and the systems of classification that allow some people to be
considered unfit, defective, and disabled. Both projects have been struggles
for activists and academics for many decades and would, no doubt, take many
years, even generations, longer to succeed. The former would require complicity
in maintaining the oppression of others and will only be
successful if those with power make it so; the latter, however, works towards
the liberation of all disabled people and, indeed, all people and, I believe,
will be successful – there is no alternative.
1 I am using the term “disabled” people because disability is a
political action. Disability is imposed upon us, making us disabled people.
2 I am not claiming an “insider” position here, however. Like most trans
people I know, the psychiatrization of my trans identity is a relatively
insignificant part of that identity.
3 “What’s Needed to Improve Mental Health Recovery Rates?”
Mind-freedomvirginia 2012, https://lunatickfringe.wordpress.com/2012/02/18/whats-needed-to-improve-mental-health-recovery-rates/. Last
accessed 23 August 2012.
4 M. McCubbin, D. Weitz, P. Spindel, D. Cohen, B. Dallaire, and P.
Morin, “Submissions for the President’s Consultation Regarding Community Mental
Health Services,” Radical Psychology 2,
no. 2 (2001): n.p., http://www.radicalpsychology.org/vol2-2/submission-mccubbin.html. Last
accessed 14 October 2012.
5 This was the original wording of a draft resolution for the PsychOUT conference.
However, it serves as a positive example of how change can happen. A number of
us raised the issue during the conference and worked to educate people about
how this language was problematic, and ultimately it was changed.
6 “25 Good Reasons Why Psychiatry Must Be Abolished,” D. Weitz, n.d., http://www.antipsychiatry.org/25reason.htm. Last
accessed 15 July 2012.
7 Recovery Network: Toronto, “Jennifer Hudson Sang Again after Hearing
Dead Brother’s Voice in Her Head” 2012, http://recoverynetworktoronto.wordpress.com/2012/01/05/jennifer-hudson/. Last
accessed 25 August 2012.
8 MindFreedom Personal Story Project, “Personal Stories: Joe S.
Baletta,” n.d., http://www.mindfreedom.org/personal-stories/balettajoes. Last
accessed 15 August 2012.
9 “25 Good Reasons Why Psychiatry Must Be Abolished.”
10 Ibid.
11 N. Mulé and A. Daley, “Queer Lens of Resistance: A Critical
Anti-oppressive Response to the DS M -V” (proceedings of the PsychO UT Conference, Toronto,
7–8 May 2010), http://individual.utoronto.ca/psychout/papers/mule-etal_paper.pdf. Last
accessed 14 October 2012.
12 The pathologization of transsexualism is also a good example of the
arbitrary divisions between psychiatry and the rest of medicine. It is argued
that there are physical brain differences that are caused by the presence of a
gene that interprets hormones differently than people without this gene do, and
that this gene is (often) linked to transsexuality. This could be classified as
genetics, as endocrinology, as psychiatry, or as other disciplines within
medicine.
13 I use “gay rights,” “gay and lesbian,” and “homosexual” in the
historical discussion because those were the words used at the time. While I
most frequently use queer now, queer had a very different meaning during the
anti-pathologization campaign.
14 It should also be noted that early mainstream gay rights activists did
not just work to establish themselves as non-disabled, but also as white, as
middle / upper class, and as gender normative. Kameny compared gays to Black
people, implying that there were no gay Black people (Kameny 1965). The
movement also required people to wear gender normative business attire (Alwood
1996, Kissack 1995), making it inaccessible to poor people who didn’t have
business clothes and marginalizing many trans and genderqueer as well as women
who wanted to wear pants for either political or personal (or both) reasons.
15 B. Gittings and F. Kameny, “Gay, Proud, and Healthy,” The Kameny Papers (n.d.): n.p., http://www.kamenypapers.org/correspondence/gayproudandhealthy.jpg. Last
accessed 3 February 2010.
16 Charles Silverstein continued to practice psychiatry.
17 The gay
liberation movement, as opposed to the mainstream gay rights movement, did have
an anti-racist, anti-sexist, anti-war, and anti-consumerist, if not
anti-capitalist, platform (Rimmerman 2008).
18 M. McKeown, “Alliances and Communicative Action: One Possibility for
Reframing Theory and Praxis” (paper presented at the Distress Or Disability?:
Proceedings of a Symposium, Lancaster University, Lancaster, 15–16 November
2011 (2011 [1994]): 71), http://www.lancs.ac.uk/cedr/publications/Anderson_Sapey_and_Spandler_eds_2012.pdf. Last
accessed 14 October 2012.
19 “Demands,” Toronto Anti-Poverty, n.d., http://torontoantipoverty.tao.ca/torontoantipoverty.tao.ca/demands.html. Last
accessed 12 September 2012.
Convention on the Rights of Persons
with Disabilities and Liberation
from Psychiatric Oppression
TINA MINKOWITZ
This chapter derives from the experience of the
author in working on the drafting of the Convention on the Rights of Persons
with Disabilities (C R P D). The drafting was an extraordinary
experience of cooperation and shared power that is particularly unusual in the
experience of users and survivors of psychiatry. The combination of
international human rights and a social model of disability that highlights
discrimination allowed us to bring into focus the violations we experience, and
allowed the other parties involved in the drafting and negotiations process to
accept a radical change to international law, which is now working its way into
the recommendations of human rights monitoring mechanisms, and into proposals
for law reform.
The concept of
being persons with disabilities is controversial for survivors of psychiatry
since many of us entirely resist mental illness labels. However, the notion of
being regarded as persons with disabilities, and discriminated against on that
basis, resonates with many of us. Being “regarded as” having a disability is
one of the bases for protection against discrimination under the Americans with
Disabilities Act, and a similar concept of “perceived” disability exists in
international discourse. Furthermore, the prospect of eliminating
discrimination, including the laws that have allowed psychiatric incarceration
and forced drugging / electroshock, opens up a greater freedom for us to
acknowledge a need for reasonable accommodation or support
without having to risk destructive, harmful, and violent responses.
Resistance to
psychiatry can take many forms, and has taken the form of challenges to the
laws that permit psychiatrists to take away our freedom and violate our minds
and bodies. In the past, such challenges had failed in the legal arena, at best
securing reforms within a framework of overall permission and impunity for acts
of psychiatric violence. The non-discrimination principle, coupled with the
aspirational quality of the human rights framework ( “aspirational” in the
sense of seeking a higher good and reaching beyond current political
realities), and a politicization of disability that had taken place in an
earlier United Nations (U N) process, resulting in
acceptance of persons with disabilities as spokespersons and experts on their
own needs and interests, were decisive in allowing something different to
happen with the CRPD.
ARE WE PEOPLE WITH DISABILITIES?
Disability is a heterogeneous concept, one that
comprises many variables such that there can be members of the class of “people
with disabilities” whose experience of “disability” has nothing in common.
Disability can refer to negative judgments by society about some aspect of a
person’s way of being in the world, whether physical, mental, or behavioral, as
being outside the range of human diversity tolerated in our usual descriptions
of what a human being is like.1 Disability can also refer to a situation in which
subjective experience of impairment or limitation is combined with intolerance,
failure to accommodate associated ways of being in the world, and failure to
meet needs connected with the impairment/ limitation, or with this way of being
in the world. Both these formulations are legitimate in terms of the social
model of disability.2
The concept of
disability is continually evolving such that being mad, being autistic, being a
Down syndrome person, being a Deaf person using sign language and experiencing
life within Deaf culture, being a person with any kind of body configuration
and body experience, may one day no longer be classified as disability. The
concept itself may one day be obsolete. But it has utility as a way of
describing a cluster of situations relating to discrimination, the hegemony of
“normality” as a value judgment against the full range of human diversity,
needs that are not being met in environments designed
without appreciation of such diversity, and either subjective experience of
limitation or impairment in one’s own mind, body, or behavior, or being
regarded by others as having such a limitation or impairment.3
The value for users
and survivors of psychiatry is twofold: to enable us to name the discrimination
that predates and underlies psychiatric oppression, and to allow us to stake a
claim of dignity in expressing our needs and expecting them to be met as a
matter of ordinary human solidarity. Paradoxically in naming the discrimination
and calling attention to the needs there is a risk of a discriminatory,
violent, and objectifying response, an essentializing of our identity that
diminishes our full humanity. This is the challenge faced by every
equality-seeking movement and it is not the end of the story but, rather, is an
ongoing call for humanity to grapple with injustice.
CRPD STANDARDS AND IMPLICATIONS
FOR USERS AND SURVIVORS OF PSYCHIATRY
NON-DISCRIMINATION: FORMAL
AND SUBSTANTIVE EQUALITY
Human rights norms create positive obligations
for countries to safeguard and implement our rights and freedoms, including by
changing domestic laws that conflict with these norms. The Convention on the
Rights of Persons with Disabilities takes as its starting point that people
with disabilities must be guaranteed the same rights and other freedoms as
others. In applying this principle to specific rights and freedoms, the C R P D incorporates both formal and substantive equality. Formal equality
means that our rights and freedoms must be recognized as a matter of law as
being equal to those of others. Any law that establishes inferior rights
protection based on a disability, as written or applied, is contrary to this
principle.
Substantive
equality means that people’s diversity needs to be accommodated so as to ensure
the practical conditions necessary for enjoyment of equal rights. This
principle is violated when a person is expected to conform to a way of being in
the world that is impossible for them, as a condition of obtaining access to
the means necessary for life, well being, participation in a community or
communities, learning, work, and any other activities by which human beings relate to the world. Instead of denying access based on such
disqualifications, it is a collective responsibility of society, including
those currently being denied access, to use imagination and innovation to
create means by which all people can access such basic goods. The capabilities
approach developed by Amartya Sen (2009) has contributed to an appreciation of
substantive equality, but neither Sen nor his frequent collaborator Martha
Nussbaum (2006) has satisfactorily addressed the interplay between formal and
substantive equality from a disability perspective. Nussbaum in particular
claims that some types of disability, particularly cognitive disability, imply
that the individual is no longer entitled to the status of personhood. She
situates persons with disabilities as being under conceptual and actual
guardianship in a similar way as animals or the natural environment. Her accounts
of persons with disabilities all speak of children with developmental
disabilities from the standpoint of their families, which is offensive and
reinforces negative stereotypes when these accounts are treated as emblematic
of the disability experience. A key tenet of the disability rights movement and
of all equality-seeking movements is the central position occupied by those
with direct lived experience, who represent and speak for themselves.
The CRPD is legally binding on all countries that have accepted its obligations
by ratifying it. In addition, the C R P D standards also
influence the interpretation of human rights obligations under other treaties
that a country may have ratified, and under customary international law. The C R P D represents the most highly developed and focused thinking on the
meaning of non-discrimination in situations affecting people with disabilities,
and so it is natural for it to be taken as a point of reference and source of
authoritative guidance for other human rights mechanisms. Significantly, the C R PD standards and related arguments by users and survivors of psychiatry
encouraged the Special Rapporteur on Torture and Other Cruel, Inhuman, or
Degrading Treatment or Punishment (S R T) (2008) to formulate
detailed standards for recognizing forced psychiatry as torture and
ill-treatment, which will be discussed further below.
LEGAL CAPACITY
C R P
D Article 12 on legal capacity is designed with
both formal and substantive equality in mind.4 There is the formal equality obligation to recognize
that people with disabilities have an equal legal capacity
as others to make decisions in all aspects of life. This recognition must be
incorporated into law, so that it is no longer possible to deny the legal
validity of a person’s decision on the basis of disability.
The dual meaning of
capacity as intrinsic ability ( “capacity to [rationally] understand and
appreciate the nature and consequences of a decision”) and extrinsic office (
“capacity” to be recognized as a valid decision-maker in the eyes of the law)
allows for, or intentionally suggests, a blurring of meaning, so that
disability is treated as a disqualification for the exercise of fundamental
human rights and freedoms. This is what C R P D explicitly
rejects, so that there can no longer be a questioning of a person’s capacity to
make decisions. Instead there must be supportive and cooperative processes
whereby all people can explore and act on their own choices.5
In addition, there
is the substantive equality obligation to make available the support that
individuals may need in exercising their legal capacity. Safeguards must be
established as well to ensure that support measures do not interfere with the
guarantees of formal equality. That is, such measures must respect the
individual’s autonomy, will, and preferences; supporters must act responsibly,
by abstaining from conflict of interest and undue influence; and states must
provide for feedback mechanisms to ensure good quality support that is working
to meet people’s needs.
The practical
import of this for people labeled with psychiatric disabilities is greater than
it may appear at first glance. Involuntary measures in psychiatry – both
detention and forced interventions – are implicitly or explicitly premised on
the notion that a person lacks requisite capacity to make a decision. It is
difficult to counter such an allegation as an individual, since it is both vague
and arbitrary, and amounts to an assertion of authority to determine the
validity of another person’s choices. Involuntary measures based on this notion
that someone else knows better what is for my own good can evoke feelings of
shame if I begin to doubt myself as a result, and set up a situation of
conflict that is contrary to the good intention to offer help and solidarity.
The C R P D recognition of legal capacity without distinction based on disability
prohibits forced interventions of all kinds as well as the removal of rights
and responsibilities in areas of life such as parenting, voting, legal
proceedings, and financial decisions.6 It respects the “dignity of risk” and assures
equality before and under the law and the right to legal recourse against acts
of harm.
It can also encourage people to ask for the support that they might
want but that they have hesitated to mention because such a request can easily
be met with coercion and abuse. If support did not mean giving up rights or
freedoms, or giving up power and authority to another person, more of us might
feel comfortable asking for it. We already see this happening with practices
like Intentional Peer Support,7 where our community has something to offer the rest
of the world from our hard-won experience in promoting positive relationships
not based on the deficit of any person, and encouraging mutual learning and
growth.
Legal capacity implies
taking responsibility for our actions and our decisions. We cannot claim a
right to make our own choices, and then object that no one stopped us from
doing an act that we later regret. This does not mean that we should accept
isolation or an alienated individuality. On the contrary, it increases the
importance of developing good, trusting relationships in which people feel free
to express concern for each other while maintaining respect for difference and
for the ultimately unknowable nature of each human being to every other.
We are responsible
for the choices we make and so we need to do our best to be satisfied with
those choices. We also are accountable to others for choices we make that limit
their choices or that cause harm. For this reason, criminal defenses based on
disability, like the insanity defense, need to be abolished in favor of a
holistic approach that takes account of all the circumstances of a crime in
order to fairly assign blame, and that also takes account of a person’s
circumstances and needs so as not to impose a sentence that will be
disproportionately demanding or harmful for the person to serve.8
From a restorative
justice perspective, the blame and punishment approach to responding to harms
done by any person to another is always harmful and needs to be dismantled.9 The US penal system in particular has been justly
criticized for massively incarcerating African Americans and serving a purpose
of racial repression and control (Alexander 2012); it is likely that other
countries’ systems similarly serve to perpetuate unjust inequalities and do not
meaningfully redress the wrongs done to victims. When we open up the question
of what constitutes justice in circumstances where extreme mental/emotional
states play a role, without relying on an excuse that diminishes the person’s
legal and social equality and capacity to take responsibility for harm done to
others, it helps to make visible the need for a
restorative justice approach and contributes to the collective understanding of
what restorative justice includes and requires.
It will be
important to ensure that restorative justice, prison abolition, and penal
reform movements do not uncritically rely on mental health services to meet the
needs of those who commit harmful acts for healing and support of their own.
Our movement has to become involved in figuring out what really meets such
needs, as survivors working with Substance Abuse and Mental Health Services
Administration’s (S A M H S A) trauma-informed care initiative
have begun to do in prisons as well as in mental health settings.10 Practices like Intentional Peer Support, Hearing
Voices Network,11 and other peer support and peer advocacy work need
to be made available and the same critiques we apply to mental health services
in general apply here. Mental health courts that shift the question of guilt to
a question of “need for services,” particularly those that require a guilty
plea and can impose a prison sentence should the person stop complying with
prescribed treatment, are completely a wrong approach if we are committed to
full legal capacity and equal rights. Such courts violate both the right to
equal legal capacity (CRPD Article 12) and the right to be free
from disability-based detention (CRPD Article 14).
LIBERTY
C R P
D Article 14 prohibits deprivation of liberty based
on the existence of a disability.12 Laws and practices that target people for
deprivation of liberty based on an alleged disability, such as psychiatric
detention and civil commitment, are in violation of this standard and need to
be abolished. There is no possibility of saving such laws and practices by
including additional criteria such as “danger to self or others,” or “need for
care and treatment.” So long as the detention is limited to people who are
alleged to have a disability, it is discriminatory and cannot be sustained.
Laws that allow preventive detention for individuals alleged to be dangerous to
self or others, or to impose unwanted care and treatment, and that apply to
everyone without reference to disability, would also violate C RP D Article 14 if it were shown that the underlying purpose was to
continue disability-based detention, or that as applied it actually targeted
people with disabilities.
Similarly, it is not enough to provide due process guarantees such as
legal representation and a court hearing with the opportunity to cross-examine
witnesses (Minkowitz 2011). While there should be remedies to challenge any
detention that is committed in violation of domestic or international law
(including psychiatric detention, which is per se unlawful under the CRPD),13 these remedies must preclude the judge having any
authority to declare that psychiatric detention is lawful. In other words, once
it is demonstrated that a person does not wish to remain in a psychiatric
facility, the judge must order his or her release. There also need to be
systemic measures put in place to re-orient policies, shift resources to
services and supports that meet the C R P D standards and
values, re-train professionals and staff working in mental health services, and
inform people of their newly recognized rights in the mental health system, so
as to prevent the occurrence of detention that might happen despite its being
abolished by law.14
The Committee on
the Rights of Persons with Disabilities has called for mental health services
to be based on free and informed consent of the person concerned (Committee on
the Rights of Persons with Disabilities 2011a, para 35), in compliance with
Article 14. This reading of the article recognizes as a practical matter the
unity of psychiatric detention and forced interventions of all kinds, and
merges the right to liberty with free and informed consent (Article 25) and the
right to exercise legal capacity (Article 12) with regard to all inpatient and
outpatient services. It also underlines that mental health services are
services, and are therefore not to be used as measures of control or security.
Even within a prison setting, mental health services, and housing within a
mental health unit, are subject to the person’s free and informed consent.15
CRPD Article 19 (a)
addresses the right to live in the community with choices equal to those of
others, guaranteeing the opportunity to choose where and with whom to live on
an equal basis, and prohibiting measures that compel a person with a disability
to live in a particular living arrangement. This provision prohibits
involuntary institutionalization, and regimented group housing, that fails to
respect or accommodate individuals’ autonomy, choices, dignity, or privacy. In
addition, Article 19 (b) and (c) require that a wide range of supports and
services be provided to support life in the community and to prevent isolation;
and that services available to the general public be open
and welcoming of people with disabilities and responsive to their needs.
FREEDOM FROM TORTURE AND ILL TREATMENT,
RIGHT TO RESPECT FOR INTEGRITY
The CRPD lays the basis for
finding that forced medical interventions constitute torture and ill treatment,
but the 2008 report of the U N Special Rapporteur on
Torture (S RT) has articulated more detailed standards, drawing on the C R P D as well as the Convention against Torture. CRPD Article 15
directs governments to protect persons with disabilities from torture and ill
treatment on an equal basis with others, and makes explicit reference to freedom
from non-consensual medical and scientific experimentation, a norm already
established in the International Covenant on Civil and Political Rights (1966).
Article 16 sets out obligations to prevent and redress all forms of
exploitation, violence, and abuse, and Article 17 states that persons with
disabilities have an equal right as others to respect for their physical and
mental integrity. Article 25 (d) directs that health care be provided to
persons with disabilities on the basis of free and informed consent. The
Committee on the Rights of Persons with Disabilities has so far addressed
freedom from forced psychiatric interventions under Articles 15 and 17. Under
Article 15 the Committee has expressed concern about “consistent reports of
continuous forcible medication, including neuroleptics” and urged the
establishment of voluntary mental health services (Committee on the Rights of
Persons with Disabilities 2012, paras 30–1); under Article 17 the Committee has
expressed concern about forced mental health treatment and urged the legal
abolition of treatment “without the full and informed consent of the patient”
(Committee on the Rights of Persons with Disabilities 2011b, paras 28–9).
The Special
Rapporteur on Torture adopted a standard first proposed by the World Network of
Users and Survivors of Psychiatry16 in the course of the CRPD drafting
process. In this formulation it reads: “Medical treatments of an intrusive and
irreversible nature, when they lack a therapeutic purpose, or aim at correcting
or alleviating a disability, may constitute torture and ill-treatment if
enforced or administered without the free and informed consent of the person
concerned” (S R
T 2008, para 47). The significance of this standard is that it recognizes the gravity of forced medical
interventions in which a person’s body, mind, behavior, or consciousness – part
of their humanness and unique personhood – is being rejected, objectified, and
subjected to violent and non-consensual change. It is a dual violation of
autonomy and integrity, as well as the added harm of discrimination, which
should result in such interventions being recognized per se as torture (as rape
has finally been recognized) under the definition in the Convention against
Torture.17
As explained by the
S RT, that definition contains four elements – severe pain or suffering,
intent, purpose, and state involvement (2008, para 46). Both the purpose and
intent elements are satisfied when pain or suffering is inflicted on persons
with disabilities for reasons based on discrimination. The catalogue of
purposes in the C
A T definition explicitly lists “reasons based on
discrimination of any kind” (2008, para 48); furthermore, intent “can be
effectively implied where a person has been discriminated against on the basis
of disability” (2008, para 49). State involvement is present in the failure to
exercise due diligence to prevent, investigate, prosecute, and punish acts of
torture as well as in the direct participation by public officials; a legal
framework that permits acts of torture and ill treatment by medical
professionals would certainly incur both types of responsibility. The level of
suffering may vary case by case, but the combined violation of autonomy and
integrity motivated by discrimination is recognized as bringing forced
psychiatric interventions in general, including forced drugging and forced
electroshock, within the realm of torture and ill-treatment (S RT 2008, paras 39, 40, 47).18
The recognition of
forced and non-consensual psychiatric interventions as torture represents in
itself a step towards reparation of the harm done by these acts of violence. It
means that, just as we are claiming the status of moral subjects responsible
for our own lives and actions, we are also moral subjects in that acts of harm
committed against us by others must be accounted for and not trivialized or
rationalized away as “therapeutic necessity”19 or being “for one’s own good.” It may be a symbolic
achievement and cannot stop there; recognition of harm does not by itself stop
the harm from continuing. But it remains significant as a beacon of hope for
social and legal change, all the more so because it responded to the call from
our own community by hearing and embracing our expressed needs.
CRPD Article 4 on general obligations requires governments to abolish laws
and practices that constitute discrimination against persons with disabilities,
to enact new laws, and to take a variety of other measures to ensure “the full
realization of human rights and fundamental freedoms for all persons with
disabilities without discrimination of any kind on the basis of disability.”
Article 8 mandates awareness-raising campaigns to combat stereotypes and
bigotry, and other action-oriented obligations appear throughout particular
articles. In carrying out these obligations, governments must closely consult
with the representative (democratic) organizations of people with disabilities,
including children with disabilities (C R PD 2007, art 4.3), and
they must also establish focal points for implementation and one or more
independent monitoring bodies at the national level (CRPD 2007, art 33).
The undertaking of C R P D implementation, both by governments and by civil society, can be
approached in a spirit of restorative justice, particularly in relation to
ending psychiatric oppression.20 The oppression has been and continues to be
institutional and systemic; countless individuals have been involved as
victims, oppressors, and bystanders. We need a healing that ends the power of
the psychiatric “parallel state”21 and that puts law and resources in the service of human
dignity. This would have to be a decisive step, eliminating the laws permitting
psychiatric detention and compulsory treatment and putting in place effective
remedies against the continuation of these abuses. As part of the healing
process, an “appreciative inquiry”22 could be undertaken to understand the nature and scope
of harms suffered at the hands of psychiatric oppression, and to invite those
who have committed acts of harm to offer their apologies, to demonstrate a new
unity of solidarity and reject paternalism. We would want to honour the lives,
struggles, and voices of those who have been harmed by psychiatry, and make
space for a new way of listening to these stories and absorbing their lessons.
Good faith needs to
be demonstrated at the outset or developed in the course of the work so that
survivors of psychiatric oppression, including people currently resisting and /
or being victimized, do not give up their independence or their moral power to
accept or reject any course of action proposed by others.
It is only when the system of forced psychiatry is ended – when it is deprived
of legal permission and the backing of state power – that any legitimate “truth
and reconciliation” can take place, and all participants in any commission overseeing
the “appreciative inquiry” would be expected to admit to their own
participation in abuses and to not currently be involved in any psychiatric
oppression, force, or coercion. There are other ways implementation can happen,
of course – including large-scale consultation and reforms without an explicit
reconciliation process – and in most countries the reality is likely to be
piecemeal struggle through legislation, litigation, human rights monitoring,
publicity campaigns, alliance-building, and strategy. A restorative /
reconciliation approach is an option that would be conducive to the involvement
of ordinary people who have been harmed and continue to be harmed by
psychiatric oppression, and, by receiving the stories and supporting people
through the telling, could also contribute to building the social capacity to
do things differently.
IMPLICATIONS FOR RESISTANCE
The C R P D , created as a
labour of love and pragmatism, unites many seeming opposites: human rights and
social development, autonomy and solidarity, equality and diversity, freedoms
and entitlements. The elements of legal capacity, liberty, and freedom from
torture, which defined the human rights advocacy by users and survivors of
psychiatry for the C R P D, are united in the call for restoration
of our capacity as moral subjects in the eyes of the law and justice. Bringing
justice to justice, a fundamental aspect of equality and non-discrimination,
has begun to be accomplished; next, the restoration of justice needs to move
from the realm of international law to the national and local plane, and to be
experienced in our ordinary lives.
The potential of
the CRPD can only be fulfilled when users and survivors of psychiatry and our
allies actively organize and advocate for it to be put into practice. The first
step is to make people aware that this treaty exists. It is also essential to
ensure that it is being interpreted correctly by relevant decision-makers such
as government agencies, legislatures, courts, and human rights monitoring
mechanisms. In addition, we need to develop proposals for law reform, including
the repeal of mental health laws authorizing involuntary commitment, forced
interventions, and substituted decision-making. We can
also utilize human rights monitoring mechanisms to put pressure on national
governments to take required action.
For these purposes,
I established a user/survivor-run human rights organization, the Center for the
Human Rights of Users and Survivors of Psychiatry (CHRUSP 2009). CHRUSP contributes to ongoing international advocacy by the World Network of
Users and Survivors of Psychiatry, advises user / survivor organizations and
allies in all parts of the world, and conducts more focused activities in the
United States, where it is based. CHRUSP initiated a call for
a Campaign to Repeal Mental Health Laws23 in the US and Canada, which operates as an independent
collective of concerned activists pursuing the goal of repealing these laws and
abolishing forced psychiatry. Members of the Campaign are working on human
rights reporting to the UN , a Coming Out Campaign,
informal outreach, involvement with US ratification of the CRPD and Canadian consultations on implementation, and developing proposals
for law reform. There is also a “Repealing Mental Health Laws” group on
Facebook24 for related discussions.
Colleagues in other
countries have taken up the challenge and opportunities created by the C R P D , pursuing law reform, human rights reporting, awareness-raising, and
campaigns for C
R P D ratification. We have benefited greatly from
the work of users and survivors of psychiatry who were elected to serve as
members of the Committee on the Rights of Persons with Disabilities, and have
helped to ensure that the Convention is interpreted according to its intention
and principles, requiring the abolition of forced psychiatry and the
development of support that respects individual autonomy. It is essential for
us to exchange information, knowledge, and strategy ideas. Similarly to the
Occupy movement, this work is founded on principles that need to develop and
evolve over time and in different local circumstances to see their full
fruition. I have every hope and expectation that our resistance will wear away
the tyranny of psychiatry as a parallel state and we will succeed in its
abolition.
1 For example see “Psychosocial
Disability,” World Network of Users and Survivors of Psychiatry, 2009, www.chrusp.org/media/AA/AG/chrusp-biz/
downloads/199123/Psychosocial_disability.docx. Last accessed 22 October 2012.
2 For example see United Nations (2007, art 1).
3 The inclusion of those “regarded as” having a disability as persons
with disabilities, and / or as protected against disability-based
discrimination, can be found in the Americans
with Disabilities Act (2009, 42, s12102), the Inter-American Convention on the Elimination of All Forms of
Discrimination Against Persons with Disabilities
(1999, art 2.a), AG/RES. 1608 (XXIX-O/99), Art 2 (a), and the International Classification of Functioning, Disability, and Health,
Short Version (2001, 27).
4 Paragraphs 1, 2, and 5 of Article 12 mandate formal equality;
paragraph 3 mandates substantive equality, and paragraph 4 attempts to
reconcile them. In its origins, paragraph 4 drew on safeguards relevant to both
substituted decision-making and support, but the guarantee of formal equality
and the obligation to respect the person’s will and preferences rule out
substituted decision-making, as also recognized by the Committee on the Rights
of Persons with Disabilities (2007 para 34).
5 See materials on legal capacity through page links “Resources,” “More
Resources,” and “Good Practices” at www.chrusp.org.
6 See CRPD (2007) Articles 23, 29, 13, and 12.5 respectively. The CRPD articles
supporting prohibition of forced psychiatric interventions, Articles 14, 15,
16, 17, 19, and 25 are discussed below.
7 “Peer Support and Peer Run Crisis Alternatives in Mental Health,”
Shery Mead Consulting, n.d., www.mentalhealthpeers.com. Last
accessed 22 October 2012.
8 See materials on prison issues through page links “Resources” and
“Good Practices” at www.chrusp.org. See also Office of the High Commissioner for Human Rights (2009,
A/HRC/10/48, para 47).
9 Restorative Justice comes in many guises (McCaslin 2005, Pranis 2007,
Sullivan and Tifft 2001, Tutu 1999). For a cautionary note from a feminist
perspective, see Daly and Stubbs 2005.
10 I consider S A M H S A’s materials and approach (http://www.samhsa.gov/nctic/trauma.asp) to be of
mixed value but worth knowing.
11 “The International Community for Hearing Voices,” Intervoice, http://www.intervoiceonline.org. Last accessed
22 October 2012.
12 Article 14:
1 States Parties shall ensure that persons with
disabilities, on an equal basis with others:
(a) Enjoy the right to liberty and security of
person;
(b) Are not deprived of their liberty unlawfully
or arbitrarily, and that any deprivation of liberty is in conformity with the
law, and that the existence of a disability shall in no case justify a
deprivation of liberty. 2 States Parties shall ensure that if persons with
disabilities are deprived of their liberty through any process, they are, on an
equal basis with others, entitled to guarantees in accordance with
international human rights law and shall be treated in compliance with the
objectives and principles of the present Convention, including by provision of
reasonable accommodation.
Of particular relevance are paragraphs 1 (b) and
2, which deals with rights in the context of criminal arrest and prison, and
other deprivations of liberty. The whole article is copied here for reference.
13 See Article 13 on access to justice, which arguably gives rise to the
right to a remedy; see also International Covenant on Civil and Political
Rights (1976), Articles 2.2, and 9.
14 See Article 4 (a), (b), (c), (d), (e), (h), and (i), Article 8, and
Article 16.
15 See materials on prison issues through page links “Resources” and
“Good Practices” at www.chrusp.org. See also Office of the High Commissioner for Human Rights (2009,
A/HRC/10/48, para 47) and United Nations (Committee on the Rights of Persons
with Disabilities 2011a, para 35).
16 “Contribution by World Network of Users and Survivors of Psychiatry (W N U S P),” World
Network of Users and Survivors of Psychiatry, 2004, http://www.un.org/esa/socdev/enable/rights/wgcontrib-wnusp.htm. Last
accessed 22 October 2012.
17 That definition reads: For the purposes of this Convention, the term
“torture” means any act by which severe pain or suffering, whether physical or
mental, is intentionally inflicted on a person for such purposes as obtaining
from him or a third person information or a confession, punishing him for an
act he or a third person has committed or is suspected of having committed, or
intimidating or coercing him or a third person, or for any reason based on
discrimination of any kind, when such pain or suffering is inflicted by or at
the instigation of or with the consent or acquiescence of a public official or
other person acting in an official capacity. It does not include pain or
suffering arising only from, inherent in, or incidental to lawful sanctions.
(Convention Against Torture, 1984: art 1)
18 See also in 2008 S R T details on electroshock, forced psychiatric interventions, and
involuntary commitment (paras 61–5), medical context including experimentation
(paras 57–60), and less satisfactory details on “prolonged” restraint and
solitary confinement (paras 55–6).
19 The European Court of Human Rights adopted this standard in rejecting
the claim that being forcibly drugged with neuroleptics and handcuffed to a
“security bed” amounted to torture or ill treatment (Herczegfalvy v. Austria,
1992).
20 Given the widespread and systematic practice of serious violations
amounting to torture and ill-treatment, remedy and reparation are due under the
Basic Principles and Guidelines on the Right to a Remedy and Reparation for
Gross Violations of International Human Rights Law and Serious Violations of
International Humanitarian Law, A/RES/60/147 (2006).
21 For a useful analogy see Romany 1994.
22 A term that has been used in the context of Intentional Peer Support.
23 “Repeal
Mental Health Laws,” 2012, http://repealmentalhealthlaws.org/. Last
accessed 22 October 2012.
24 “Repealing Mental Health Laws,” Facebook, n.d., http://www.facebook.com/groups/356040824414503/?fref=ts. Last
accessed 30 September 2012.
Deeply Engaged Relationships:
Alliances between Mental Health Workers
and Psychiatric Survivors in the U K
MICK McKEOWN, MARK CRESSWELL,
AND HELEN SPANDLER
INTRODUCTION
This chapter explores the possibility of
alliances between mental health workers and psychiatric survivor movements – a
focus that has received little scholarly attention to date. Particular
attention is paid to alliances between survivors and public sector trade unions
in the UK. These alliances are replete with what, in a more general context,
Wendy Brown (2000) has called perils and possibilities. The possibilities of such alliances will be framed in terms of the
need to defend, as well as transform, health and welfare institutions from
threats presented by neoliberalism and bio-psychiatry, as well as the need for
a creative renewal of the activism of both the labour and survivor movements.
Models of reciprocal community trade unionism and relational organizing will be
presented as a potential way of developing “deeply engaged” and reciprocally
beneficial relationships (Tattersall 2006) that, we believe, are necessary for
the transformation of the mental health system.
We argue that the
formation of survivor and worker alliances opens up the sort of communicative
spaces wherein an alternative politics of mental health might be realized. Of
course, this is not the only way, and we want to be clear that we fully support
the importance of the autonomous organizing of psychiatric survivors as well as
alliances that reach beyond workers and trade unions to incorporate
the lessons of, for example, feminism and recent Occupy movements. Indeed, as
will become clear, we are acutely aware that it has been the failings of trade
unionism, often attributed to a narrow perspective of “workerism,” hierarchy,
and bureaucratization, that helped precipitate the growth of single-issue based
and identity-focused “new social movements” in the first place (Habermas 1981).
At the same time,
we think there are particular perils, and yet enormous possibilities, to be
derived from alliances between survivors and mental health workers. These
alliances are important for a number of reasons. We believe that there is great
potential for personal and wider social change, as well as reciprocal benefit,
from both formal and informal alliance-formation. We know that it is often the
relationships forged (or neglected) between workers and survivors that are at
the heart of people’s experiences of the mental health system – whether these
experiences are profoundly positive or negative. Indeed, front-line workers are
often seen as the bearers of a rightly maligned bio-psychiatry and, as such,
often bear the brunt of survivors’ critique. However, we think it is important
to see workers as potential allies, not least because of the interdependency of
workers’ and survivors’ interests and the fact that, often, both can feel
alienated by their experience of the mental health system and, therefore, have
a reciprocal interest in its democratic transformation.
Despite this,
recent examples of formal alliances involving public sector trade unions and
survivor groups are actually quite rare, and, when they do occur, they are as
likely to bring out tensions in the relationships as any easy solidarity. In
this chapter, therefore, we draw together some examples from England which
illustrate some specific perils and possibilities. These include reflections on
the establishment of the London Mental Patients Union in the 1970s (Spandler
2006); a social services strike in Sheffield in the early 1990s (Cresswell
2009); and, more recently, a mental health nurses’ strike in Manchester in 2007
(McKeown 2009). Whilst these illustrate what might be called “imperfect
solidarity,”1 it is a solidarity we argue is ever more urgent in
the context of neoliberal threats to the provision of welfare. Despite, or
perhaps because of, the challenges involved, we offer an optimistic analysis
that sees possibilities in even the perils and always considers the implicit
potentiality and creativity of community campaigning, political, and industrial
action.
However, we want to be clear about one point, despite our optimism. To
talk about the perils and possibilities of alliance-formation between survivors
and workers is not the same as invoking the politics of mental health as a level playing field in
which the power and knowledge wielded by workers, on the one hand, and
survivors, on the other, is, in practice, equal. We fully accept that what
characterizes the politics of mental health is a certain “legitimation crisis”
(Habermas 1976) in which the power and knowledge of workers has been
systematically portrayed as legitimate and objective ( “reasonable”) and the
power and knowledge of survivors has been historically subjugated as “mad.”
This crisis profoundly structures the politics of mental health and addressing
it, therefore, is a precondition for any democratic alliance worthy of the
name. In other words, sustained joint action between labour and movements of
psychiatrized people depends on a profound challenge to prevailing
understandings of “mental illness” or “madness” and a shift in the power relations between
survivors and professionals. Any alliance that simply reinforces the power of
the psychiatric profession is not what we seek. An appreciation of these issues
underlines our contribution. It is also one of the reasons why we refer to
psychiatric “survivors” throughout this chapter (rather than mental health “service
users” or “consumers”).
ALLIANCES IN ACTION: THREE UK EXAMPLES
One of the authors here, Mark Cresswell, was a
trade union activist for N A L G O,2 during a long, hard-fought strike in Sheffield’s
social services in 1991 (see Harrison 1992). The dispute was over pay,
conditions, and adequate access to training opportunities for Residential
Social Workers. A clear asset of this struggle was the degree of solidarity
demonstrated between the local survivor groups and the striking workers. This
solidarity was no accident, neither was it what Amanda Tattersall (2006, 590)
has called an “ad hoc relationship” or a “simple coalition”; rather, it was
more of a “deeply engaged relationship.” In fact, this relationship had been
forged over many years by a highly committed and powerfully unionized team of
mental health workers connecting with a historically established, strong
organization of survivors. One of the most spectacular features of the dispute
– certainly the one that received the most, and most
sympathetic, media attention – was that a group of survivors entered and
occupied one of the vacant premises, continued to make it available during the
dispute, and were supported by striking workers with food parcels and moral
support. The survivors and the strikers were, nevertheless, understandably
worried that management might use the strike opportunistically as an excuse to
cut services and close buildings.
On returning to
work after seven months out, the workers found a new and curious power dynamic
in their relationships with survivors. One might reasonably have expected a
state of enhanced reciprocity. Some of the survivors, however, especially those
who had been most active during the strike, began to question, at the most
basic level, their actual need for the services provided by the workers – the
very services that they had fought so hard, so recently, to defend. After all,
survivors argued, we demonstrated as much organization as you without the resources
of a trade union behind us; we demonstrated as much ingenuity as you and we’re
supposed to be “mad”; we demonstrated as much self-determinism as you and we’re
supposed to lack energy and direction. Could not these very qualities be
indicative of mental well-being rather than “madness”? Why should we now be
considered as somehow dependent upon you? What, then, is the point of this job
of yours, which we’ve all fought so hard to defend? Why should you get a pay
packet every month – now, an enhanced pay packet – and we, if we’re lucky, get Disability
Living Allowance?
This was a
challenge that certainly caused some consternation amongst the workers and the
union activists. The productive compromise reached was that more autonomous
spaces were provided within local authority premises for survivors to run
survivor-only groups. Day Centres, for instance, after much negotiation, were
made available for survivors to use at weekends without workers present. This
meant quite radical innovation for the time such as, for instance, providing
survivors with their own sets of keys. Such measures, however, in no way fully
responded to the sheer depth of the survivors’ critique.
A similar, but
earlier dispute helped to lay the seeds for a radical Mental Patients Union (M P U) to emerge in the 1970s. This was formed in the context of action in
1972 to defend Paddington Day Hospital in London from closure. The social
history of these important events has been explored in some detail (Crossley
1999, Spandler 2006, Survivors History Group 2012) – but a
couple of points are worth revisiting here. The service under threat was a
therapeutic community, and the forms of libertarianism and the democratization
of social relations it represented were important precipitants for the alliances
between workers and survivors that were to evolve in the course of the
campaign. Having said that, it is important to recognize that therapeutic
communities did not necessarily provide an environment that allowed survivor power to develop, and
conversely less democratic services did not necessarily prevent it. Whilst the
events in London may have helped raise the profile of this emerging new
movement, the first signs of a Mental Patient’s Union happened in a Scottish
asylum in 1970.3 Perhaps the interesting point here is that, whilst
the Scottish Union was developed by survivors autonomously, in solidarity with
each other, the London MPU was initiated by an
alliance between survivors and workers who together had forged links with other progressive political
groups and movements4 (see also Crossley 1999, Spandler 2006). This
connection with, for example, the organized left was, however, quite limited
(especially once the campaign had died down) and, despite representations by M P U members, the Trades Union Congress refused to recognize it or allow it
to affiliate as a “genuine” union (as patients were not workers).
A key issue that
arose after the largely successful campaign was that the service became
gradually removed from what survivors had originally been fighting for. In a
bitter and ironic turn of events a few years later (detailed in different ways
by both Baron 1987, and Spandler 2006) some of the survivors were actually
involved in complaints about the day hospital itself and it eventually closed down. Whilst the
merits, and indeed, the democracy of therapeutic communities are often
contested by radical survivors, it is perhaps unfortunate that therapeutic
communities are now few and far between in current mental health provision in
the U K where reciprocal learning and alliances can potentially flourish.
In another more
recent dispute, mental health nurses in Manchester took strike action as part
of a wider campaign to defend services from cuts and, specifically, to seek the
reinstatement of the psychiatric nurse and union activist Karen Reissman, who
was sacked for whistle-blowing management’s plans for the “reorganization” of
(i.e. cuts to) services (McKeown 2009). This dispute illustrates some key
issues for trade unions in their appreciation of the politics of mental health. The union’s critique of marketization was well
argued and the activist’s dismissal, which was clearly ideologically driven,
needed opposing.
However, the
potential for broader alliances between the union and the wider survivor
movement was limited by a number of factors. First, the union activists’
critique of the “cuts” rather too readily accused the Mental Health Trust of
“privatization” when it awarded a mental health service contract to a voluntary
sector provider, outside the National Health Service (N H S). This organization, unlike many State-run services, had actually
forged good links with local survivors and was subsequently well-liked, as,
indeed, was Reissman herself.
Second, despite
genuine efforts to form an alliance with local survivors, more broad-based
reciprocity with other activists in the region was potentially damaged by
failing to challenge some of the ubiquitous discourses about “risk” and mental
health. On the whole, the struggle to defend services was covered positively in
the local media, as was the alliance with survivors. The media and the
campaign, however, also reinforced a number of stereotypes, including articles suggesting
the services were primarily needed to protect the public from “dangerous”
individuals or portraying survivors as vulnerable and passive and, therefore,
in need of expert care. These media representations jarred with the actuality
of dynamic survivors demonstrating political agency in support of the workers,
participating in rallies, and speaking with conviction from public platforms.
One explanation for why the striking nurses did not oppose the media output is
that this portrayal of survivors actually served the interests of the strikers
(and to a lesser extent the survivors themselves): public fear or uncritical
compassion for “vulnerable people” was easily translated into popular support
for the strike and a defense of valued workers and services. However, more
broadly, these kinds of representations may be seen as collusions that
ultimately damage the potential for alliances with more radical members of the
survivor movement who seek to more deeply challenge our understandings of
madness.
Third, as with many
disputes like this, a lack of prior engagement with survivor knowledge and
experience limited the depth as well as breadth of potential alliances (Church
1995). The necessity of prior engagement stresses the need to build alliances
carefully before they can ever be mobilized in the service of reciprocally meaningful action (Wills and Simms 2004). Such circumstances, wherein
opportunities to advance more complex but progressive values in action are
constrained, have been described in terms of “imperfect solidarity.”5 On the positive side, the alliances that were forged
during the dispute have continued to be nurtured and drawn upon in the context
of united campaigns against more recent cuts to, and reorganization of, local
mental health services. This brings us to the need to understand the broader
landscape for alliances in the UK, against an economic
backdrop dominated by neoliberalism. This context presents a number of threats
to the politicization of both union and survivor organizations, and as such,
demonstrates why such alliances are increasingly challenging but remain no less
important as a result.
THE NEOLIBERAL CHALLENGE
TO ALLIANCE FORMATION
The last thirty years have ushered in the
ascendancy of a neoliberal project that presents a number of challenges, as
well as opportunities, for worker and survivor alliances. The first challenge
is the sustained attack on welfare provision in the U K and the rise of
marketization and privatization. After all, minimizing state welfare provision
is at the very heart of neoliberalism. The welfare state in general, and the
National Health Service (N H S) in particular has,
arguably, never been so vulnerable as it is now to what Colin Leys (2003) has referred
to as “market-driven politics” – a sub-set of which Alyson Pollock (2004) has
dubbed, sardonically, “N H S plc.” The relentless
individualization of current policy in health and social care undermines a
commitment to the collective provision of welfare. This is a peril that Peter
Sedgwick (1982) clearly anticipated in his ground-breaking book Psychopolitics and is a
core political feature of what Stuart Hall once called “the great moving right
show” (Hall 1979).
As we have seen
from our examples above, many survivor mobilizations in the U K have actually occurred in
defense of particular mental health services. This
is likely to continue in the years ahead, even though those services are far
from ideal. In addition to fears for the future of services, many psychiatric
survivors and disabled people face a concomitant assault on their right to
welfare benefits. This stark reality represents a possibility for workers and
survivors to find common cause in the defense of the NHS and wider welfare provision, and developing links with other social
movements, especially the disabled people’s movement (Morris 2011). For
example, the “Hardest Hit” campaigns, Mad Pride, and U K Uncut have
organized joint actions with Disabled People Against Cuts and these kinds of
examples are important because they unite the interests of survivors and
disabled people and connect with the wider anti-capitalist movement (see, for
example, Asylum Magazine 2012).
Closely connected
to the undermining of collective welfare provision has been a sustained attack
on the organized labour movement. In the last years we have witnessed steep
decline in the numbers of people belonging to trade unions in the U K , particularly in the traditional manufacturing heartlands of
unionism. Public sector trade unions, however, such as those operating in
health and social care, have remained comparatively resilient. Indeed most of
the largest UK trade unions are now to be found in the public sector; the biggest of
these, Unison, claims 1.3 million members. In parallel, the public sector now
accounts for the majority of industrial action with 59 % of all stoppages
(Office for National Statistics 2012). Because of these trends, public sector
unions are seen as central to the wellbeing of the wider U K labour movement. However, new systems of external commissioning of
services mean that, increasingly, many mental health workers are atomized with
a resulting tendency for workers to prioritize their individual survival, or
the development of their professional careers, over collectivism. While much of
the newer mental health workforce is un-unionized, the industrial power of N H S mental health nurses is arguably diluted by divided membership, with
large numbers belonging to professional associations rather than unions (Hart
2004).
This same period of
turbulence for trade unions has been accompanied by the rise of consumerist
policies in health and social care that, ostensibly, urge greater public
participation and “service user involvement” (Barnes and Cotterell 2012,
McKeown and Jones 2014). Although this opens up important opportunities for
survivors to have more of a voice, consumerist rhetoric is often cynically
mobilized to undermine workers (and arguably survivor’s) collective interests.
Indeed, it may be argued that the neoliberal project is precisely what social
movements in general, and survivors in particular, have been “co-opted” into.
In the U K , first New Labour and now the Conservative-led Coalition have
finessed a process of incorporation, which deploys
ostensibly progressive rhetoric – such as user involvement, choice, independence, social inclusion, and recovery – but this
has effectively become an ideological smokescreen for the neoliberal project.
Survivors who do get “involved” have arguably been pulled into the orbit of the
powers-that-be – what Michel Foucault (1991b) and others (see Jessop 2007) have
called the sphere of governmentality. The threat here is of co-option, of being
drawn into the very system that is being challenged so that resistance is
neutralized and nullified (Cooke and Kothari 2002, Morris 2011, Pilgrim 2005).
Indeed, studies of “user involvement” inside the mental health system have
shown that the degree of democratization is limited and that many important
topics of importance to survivors do not even make it onto official agendas
(Hodge 2005, 2009; Godin et al. 2007). Yet, at the same time, the invitation
for survivors to express their demands within services and policy bureaucracies
has raised the possibility for more radical voices in the wider movement to
begin to infiltrate these settings, squeezing through the cracks of power to
raise the standard for more democratic control.
Another challenge
to alliances is the pull in the direction of a legal and negative defense of
human rights, a situation that Wendy Brown has called the peril of “the
transposition of venue from the streets to the courtroom” (2000, 230). So, what
begins as collective action for wider societal change can become reduced to
legalistic and individualized tactics alone. Whilst clearly important, legal
frameworks have their limitations because their defensive focus on individual
“negative rights” tends to obscure the issue of “rights” being located in the
wider context of interdependence with others. Opposition to enforced treatment, or advocating for “due
process,” is insufficient if such arguments are not accompanied by a
concomitant demand for meaningful alternatives, such as the “minimal
medication” approaches, survivor-led crisis houses, and non-medical
sanctuaries, that survivors have long demanded (Spandler and Calton 2009).
Progressive though it may at times be, the “transposition… from the streets to
the courtroom” must, therefore, be placed within the political context of
demands for public assistance and collective provision. This is one of the
critiques leveled at the United Nations Convention on the Rights of Persons
with Disabilities (U N C R P D) by some survivor activists.6 Whilst the UNCRPD has rightly been
lauded as a ground-breaking legal framework against detention and coercion, it arguably lacks sufficient commitment to
“positive rights” (e.g. to support and sanctuary). This is another agenda
around which workers and survivors could collectively mobilize.
It is worth noting
that the ongoing global financial crisis has been a persuasive in vivo test of the
inadequacies of the neoliberal project – even as this ideology continues to
underpin the economic programmes of governments in the Global North (Quiggin
2010). Crouch (2011) sees the hegemony of neoliberalism as explicable via an
analysis of a constellation of political elites, multinational corporations,
and mass media conglomerates that are its props. The conspiratorial flavour of this
is reflected in analysis of the behind-the-scenes plotting to introduce market
forces and privatizations into the N H S , which is mostly
hidden from the electorate (Leys and Player 2011). Faced with such evidence,
any who would resist may be forgiven for taking the pessimistic view that the
neoliberal project is both omnipotent and omnipresent. More optimistically,
however, John Clarke (2007) looks for the very places and spaces where
neoliberalism is not omnipresent, and finds numerous examples of what he refers to as
recalcitrance: as a precursor to political strategies of transformation and
resistance. One way to mobilize recalcitrance is to configure alternative forms
of worker / survivor alliances. With this in mind, the next section reflects on
the value of what has been called reciprocal community trade unionism.
RECIPROCAL COMMUNITY ORGANIZING
The necessity for trade unions to resist
neoliberalism has meant that optimizing their organizing capacities has become
a key goal (Bach 2010, Gall 2009). One simple strategy for union renewal is to
concentrate on building supportive relationships within the union itself. For Paul Jarley,
such solutions need to “recreate community in the workplace” by focusing on
people rather than issues and building “personal relationships among all
members of the work group in ways that create an emotional bond among the
workers” (2005, 12–13). A notable model for this is the relational organizing
approach patented by the US Harvard
Union of Clerical and Technical Workers7 (see also Hoerr 1997). We should be critical,
however, of unions that only look inwards to improve their organizing (see
Jarley 2005). While this might improve ties between members, it misses the
opportunity to reach beyond the workplace. Interestingly,
after winning famous victories in organizing at the university, the Harvard
workers turned to the nearby hospital and formed an effective alliance with
service users under the reciprocal slogan: Pro-Patient, Pro-Union.
Organizing
initiatives that focus only on workplace issues are vulnerable to fluctuations
in effectiveness that vary with the rhythms of employer behaviour and may fail
to reflect the full range of worker interests, let alone community concerns. It
is not too great a leap to extend this philosophy to the desirability of
achieving close relational ties and reciprocity with community activists
external to the workplace. Therefore, various authors have promoted models of
reciprocal community unionism for achieving such alliances between trade
unions, community groups, and social movements (see Simms and Holgate 2010,
Tattersall 2010, Wills and Simms 2004). For our purposes, this must include
engaging with the psychiatric survivor movement, including those who are seen
as critical of the workers that trade unions represent. Such reciprocity is
predicated upon a commitment to democratic dialogue in which workers engage
with survivors and vice versa. In other words, any alliance between workers and
survivors needs to be, by definition, relational and reciprocal although crucially, we would argue, not symmetrical. Such asymmetry arises because
the politics of mental health is not a level playing field; relationality and
reciprocity must always be predicated upon the privileging of survivor
knowledge and experience before that of workers. But, to further complicate
matters, neither can we assume that “survivor knowledge” is necessarily
homogenous or united. This is why genuinely democratic dialogic relations with
survivors is such a challenge for workers and why its pursuit ushers in
distinctive “perils and possibilities.”
In effect,
survivors have announced that they will not be passive recipients of welfare;
that they will not be dependent citizens; that they demand a voice in the
services that are provided for them; and that those services must refuse to
stigmatize them. Accompanying such demands will be a multitude of experiences
of psychiatric oppression for which the movement seeks both redress and justice.
Therefore, one of the perils that emerge for trade unionists in the attempt to forge reciprocal
alliances with survivors is that it is the union, or at least, the public
sector worker, who may represent the face of an oppressive mental health system.
As much as survivors may wish to join forces and defend health and social care
provision, their genesis as an alternate political force
is fundamentally grounded in anger at the failings of welfare provision and
bio-medical psychiatry – anger that is trenchant and justified.
In this light,
trade unionists must not take it for granted that public services are popular –
they may be regarded with scepticism or even hostility by the public and social
movements alike. So, in pursuing reciprocal alliances between survivors and
trade unions, unequal power dynamics have to be negotiated and must not be
wished away by neoliberal gesturing in the direction of “consultation” and/or
“empowerment.” Of course, a complicating factor here, but one that also
provides the groundwork for true reciprocity, is that workers may be members of
“the system” – as trade union representatives, for instance – but, also,
simultaneously, as fellow survivors, families, and friends.
Survivor movements,
then, not only make demands upon the welfare state, they seek a transformed and
emancipatory mental health system. More than this, they also aspire to a
transformation of the power relations pervading our everyday lives. This latter
observation provides a key to understanding the curious dynamic noted in our
examples above, concerning the fraught relationships between survivors and
workers after the lengthy Sheffield strike. Survivors, having tasted power and
freedom through political activism, were no longer content to revert to the
role of a passive recipient of welfare predicated, as such a role undoubtedly
is, upon a distinction between them being labeled as “mad” and us (the workers)
being legitimized as “mentally healthy.” So, not only were survivors
challenging an essential distinction between madness and sanity, but by
extrapolation, they were also challenging a number of other fundamental
dualisms – so taken for granted that we consider them “common sense” – upon
which our Western culture and our public institutions rest. Such dualisms
include the apparently commonsense distinctions between health and illness,
normality and abnormality, disability and able-bodiedness, the worthy and
unworthy recipients of welfare, and the survivor / worker distinction itself.
The troubling of
these dualisms means that, although reciprocal challenges are necessarily a
two-way street, they remain, nonetheless, asymmetrical. The challenge posed by
the organized labour movement to the survivor movement has perhaps been the
less well articulated of the two but involves the survivor movement engaging
with the challenges faced by mental health workers within the constraints
of the neoliberal project and a bio psychiatric framework. Yet, the two-way
street is asymmetrical precisely insofar as recognition of the justified anger
of survivors represents a nonnegotiable condition of possibility for trade
unionists who seek a democratization of the mental health system. To put it in
a nutshell: autonomous survivor movements can do without trade unionists; but
trade unionists who seek a democratization of psychiatry cannot do without
survivors. What we are suggesting here is that deeply engaged relationships
between trade unionists and survivors necessarily entail a paradoxical
questioning of the public service cultures within which union activists work
and a paradoxical questioning of our roles and responsibilities as workers
within (and survivors of) them.
One peril here is
that such paradoxical questioning risks co-optation at the hands of
neoliberalism, which seeks to claw back the gains of the welfare state under
the ideological banner of “responsibility,” “self-care,” and “recovery.”
Examples of self-organization can all too readily be used as an excuse to
reduce welfare services in the name of combating the so-called “welfare
dependency” culture in the U K . Similarly, what may
be reasonable challenges to the “expertise” of mental health workers can
inadvertently be used as ammunition for attacking worker’s autonomy, decision
making, and collectivization – and it is precisely these conditions that are
being undermined by successive governments in the U K . Yet it is
these very attributes that have historically helped workers forge the important
alliances we referred to earlier. It is also what has enabled workers to fight
for welfare advances for individual survivors whilst preserving collective
provision. These paradoxes are not easy to resolve but require serious
consideration lest we fall into the dual trap of either merely “defending the
welfare state” or being lock, stock, and barrel “against” the mental health
system in a way that may be counterproductive.
In these debates we
often turn back to Peter Sedgwick whose lifework provides a number of lessons
which, whilst requiring rearticulation today (see Cresswell and Spandler 2009),
helps us plot a path through these paradoxes. We need to defend the welfare
state against the encroachments of the neoliberal project because it is only
within the context of State-funded welfare systems that the needs of human
beings in distress can be met en masse in a complex modern society. But this observation invokes
possibilities and perils all of its own. One peril is the
political defensiveness of trade unions that may, understandably, respond to
crises of the neoliberal project ( “austerity” measures) by a reactionary
defense of jobs and conditions to the exclusion of everything else. The problem
here, as Sedgwick observed, is that the political analyses that underpin such a
reaction are predicated upon economism, or what used to be referred to,
pejoratively, as “vulgar” Marxism.
Such a negation is
not just dualistically about us (workers) and them (e.g. those labeled “mad”).
Rather, it attempts to subsume both identities beneath the collective pronoun
we (Brown 1995). In advancing the cause of the welfare state on the grounds
that it provides for the mass provision of welfare, any alliance, by necessity,
defends the public sector against the twin encroachments of the neoliberal
project: privatization and marketization. Therefore, our point of departure
remains the imperative for political activism and the advance and
transformation of the welfare state. Any minimal-Statism or welfare
contractualism à la Hayek (2001), Popper (1945), or Szasz (1977) remain, therefore, deeply
problematic.
Yet, the primacy
that we accord the public sector inevitably raises another question about the
role and value of the voluntary sector. Indeed, the other dualism that we want
to problematize is that between the “public” and the “voluntary” sectors themselves.
It is because we recognize the need to transform everyday life and not just the
political economy of welfare provision that we require both thriving public and voluntary sectors.
Indeed, it is perhaps because the voluntary sector lies outside “the bureaucratic
compass of the State” that it is more able to promote the sorts of radical
innovations that answer some of the transformative demands of survivors
(Sedgwick 1982, 252). This means that seeing every form of alternative
provision merely as a form of “privatization,” as some trade union activists
do, is equally problematic.
Furthermore, we
need to be as concerned with the personal as well as the political aspects of
activism. This requires being animated by the lessons of feminism and engaging
with feminist critiques of both trade union organizing and survivor movement
politics (Lewis 2007). Trade union alliances with survivors, notwithstanding
that they are, of course, properly Political with a capital “P,” are
simultaneously personal with a lower case “p.” Deeply engaged relationships
between survivors and workers may threaten us, may challenge us, and may throw
into disturbing relief what Pierre Bourdieu (1990) has
called our habitus: our most deeply defended political and personal beliefs.
But this particular peril – which can feel itself like a form of madness – is
simultaneously a possibility that we may also strive to embrace. In other
words, the asymmetrical reciprocity within survivor/worker alliances may be –
and indeed, should be – unsettling for all participants (Church 1995). In this
context it is vital to consider the importance of various communicative spaces
in which alliances – however imperfect and unsettling they may be – can develop
and flourish.
COMMUNICATIVE SPACES
Without the space for dialogue and reciprocity,
political alliances will be superficial and are likely to flounder at the first
hurdle. Elsewhere, we have pointed to the value of both “convergent spaces,”
which bring together reciprocal interests, and also “paradoxical” spaces, where
issues of difference and diversity may be explicitly addressed (Spandler 2006,
2009). Here it is the very interaction of different perspectives that makes
room for the creative imaginings of alternatives. Habermas’s (1986, 1987)
theory of communicative action suggests one way in which we might think about
the quality and the asymmetry of relationships between survivor and worker
activists and how it might be possible to piece together an alternative
politics of mental health in democratic dialogue (McKeown 2012). Following
Habermas, an ideal type of communication within an alliance could be framed in
terms of deliberative democracy, wherein all participants are respectful of
difference, power imbalances are acknowledged and reduced, and each participant
attempts a presentation of arguments whilst remaining open to persuasion by the
other’s point of view.
Such a
communicative space need not privilege a narrow conception of Western reason –
as Fyodor Dostoevsky8 once remarked, where human experience is concerned, 2
+ 2 sometimes equals 5 – but would give equal weight to the expression of
emotion, generally, and rage specifically. This form of democratic reciprocity
will undoubtedly be difficult to achieve in the first instance and will
inevitably be a “work in progress.” Although critical survivor academics such
as Peter Beresford (2010) and others (Barnes et al. 2007) have argued that
deliberative structures may be one way of democratizing user involvement
practices, Hodge (2005, 2009) points out that current
communicative spaces fall a long way short of Habermasian ideals. But
communicative spaces involving survivors and workers in alliance would aspire
to represent a radically different order of dialogue than the typically
“reasonable” formats beloved of top-down strategies of “user involvement.”
More tellingly,
other critics have called into question the value of communicative action in a
mental health context. Primarily, this boils down to finding fault with the
notion of “rationality” or “reasonableness” at the heart of the Habermasian
theory. A number of problems arise from this concept, the most obvious being
the extent to which survivor voices have historically been subjugated or silenced
on the grounds of their putative irrationality (Bracken and Thomas 2005,
Campbell 2009, Coleman 2008). The criticism also extends to a perceived neglect
of important aspects of communication such as emotions and non-verbal
expressiveness and psychological theories, which rely upon a prejudicial
account of “disordered communication” (Barnes 2008, Crossley 2004). Not wishing
to throw the rationalist baby out with the bathwater, Gardiner (2004) makes a
case for revising the theory to take account of this critique whilst keeping
hold of the central idea of reasoned deliberative democracy and its usefulness
for disability movement activism.9 But this is insufficient in the context of survivor /
worker alliances, as we point out above, because deliberative democracy in the
context of such alliances must acknowledge both the principle of asymmetrical
reciprocity and a wider definition of “reason” that incorporates survivor
experience and knowledge. After all, the survivor movement has a noble history
of its own in providing a persuasive, reasoned, and moral critique of
bio-psychiatry and an equally compelling vision for change. These kinds of
discussions, debates, and alliances are happening in various contexts internationally.
To give one example from the U K , they are promoted in
the pages of Asylum: The Magazine for
Democratic Psychiatry.10
CONCLUSIONS: RECIPROCAL ALLIANCES BECAUSE
“ANOTHER WORLD IS POSSIBLE”
We have made a case for the development of
progressive alliances between survivors and workers as one means of challenging
and transforming the limitations of the mental health system. Whilst replete
with a number of “perils and possibilities,” we have suggested that reciprocal
democratic relations can open up the possibilities for reframing
the politics of mental health in ways that escape the strictures of narrow
bio-medical psychiatry and the paradoxes of state-provided healthcare. If the
possibilities we argue for are to transcend the perils we outline, then a
number of key factors are germane from our reading of previous attempts at
alliance formation.
These include the
communicative spaces in which alliances are formed, and the extent to which they
offer the sort of democratic space within which equal and imaginative
reciprocity can emerge. These alliances offer a glimpse or “prefiguration” of
the different kinds of social relations that we seek in a transformed society.
Overlain on this is the quality of any media coverage, and the need to offer a
concerted challenge to narratives that might undermine solidarity. The presence
of politicized individual survivors and workers who can take the first steps to
extend the hand of reciprocity and subsequently work hard to sustain the
alliance is important on both sides of the relationship. However, the heaviest
burden of responsibility for initiating these relationships will be placed on
workers – that is precisely what we mean by asymmetrical reciprocity. In
addition, reciprocity cannot be taken for granted just because a simplistic
reason for a common cause can be located – asymmetrical reciprocity will be the
enemy of alliance formation if it is not made the point of departure for
democratic dialogue. Lastly, if reciprocity is easier to forge against something,
rather than for something else, then building communicative spaces for dialogue is
necessary sooner rather than later.
Trade unions and
survivor groups clearly face significant challenges if they are to establish
the sort of alliances we envisage here. Yet we remain hopeful. There are
grounds for the sort of optimism that finds possibilities even in perils and,
ultimately, views recalcitrance and resistance in the face of neoliberalism and
bio-medical psychiatry as essentially creative acts. One person’s peril, after
all, is another’s possibility.
1 C. Millon-Delsol, “Barbarity and Solidarity,” Znak 543 (2000): 51–9. http://tischner.org.pl/thinking_pliki/thinking_1/tischner_6_delsol.pdf. Last
accessed 30 August 2012.
2 NALGO – the National Association of Local Government Officers, later to be
merged into U N I S O N in 1992.
3 A. Roberts, “Scotland the Brave,” Mental Health Today (July/August 2009). http://studymore.org.uk/mhtscot.htm. Last
accessed 9 November 2012.
4 Ibid.
5 Millon-Delsol, “Barbarity and Solidarity,” 51–9.
6 A good example can be found in: A. Plumb, “Incorporation, or Not, of M H Survivors into
the Disability Movement” (paper presented at Distress or Disability?
Proceedings from a symposium held at Lancaster University 15–16 November 2011).
http://www.lancs.ac.uk/cedr/publications/Anderson_Sapey_and_Spandler_eds_2012.pdf. Last
accessed 9 November 2012.
7 “Relational Organising: A Practical Guide for Trade Unionists,” L.
O’Halloran, 2006. www.newunionism.net/… /organizing/O’Halloran. Last accessed 5
January 2012.
8 See Notes from
the Underground (1864).
9 See also the work of Iris Young who makes the case for less
exclusionary deliberation. For example, I. Young, “Difference as a resource for
democratic communication,” in Deliberative Democracy: Essays on Reason and
Politics, eds J. Bohman and W. Rehg, 383–406.
Cambridge: M I T Press, 1997.
10 Asylum: The Magazine for Democratic Psychiatry, Special Issue: Anti Capitalism and Mental Health 19, no. 3 (2012). http://www.asylumonline.net/portfolio/19-3-autumn-2012/. Last
accessed 9 November 2012.
Trans Jeopardy / Trans Resistance:
Shaindl Diamond (S D) Interviews
Ambrose Kirby (A K)
This is an interview that took place between
Shaindl Diamond and Ambrose Kirby in Toronto, Ontario in September 2012. Both
are locally involved in organizing resistance to psychiatry as activists and
psychotherapists.
SD: Can you tell me a bit about your experience as a trans person
vis-à-vis psychiatry and the kinds of problems that you’ve seen in the
psychiatric system for trans people?
A K: What I see happening within trans1 communities is a real effort to get our identities
out of the DSM – out of a pathologizing framework. There has been an increasing
willingness by health centres and individual health providers across Canada to
recognize trans identity as regular, normal, not pathological. However, while
our identities are being normalized, our resistance to transphobia is
increasingly being separated out from our identities and pathologized. Instead
of being trans people who creatively survive transphobia, we are trans people
with anxiety disorders, anger disorders, bipolar [disorder], schizophrenia. Our
basic identities are less and less considered a “mental illness,” but our
strategies for surviving are being taken out of context and individualized as
“mental illnesses.” So that, to me, is the big shift that I see happening.
In the last two years, I’ve been working at the
Sherbourne Health Centre as a trans programs coordinator, working with trans
youth and adults who are considering transition or are in the process of
transition.2 In this work, I receive calls from people all over
the province and outside the province too. In all of that work, the
thing that stuck with me the most is the degree to which people are caught up
in the psychiatric system. For most trans people in Ontario, the only way to
access transition is by going through a lengthy process at the Centre for
Addiction and Mental Health (C A M H)3 – many are forced to travel or move so they can get
a psychiatric label that will get them access to basic health care. If there
are services where they live, most people will still have to be assessed by a
psychiatrist and get a label. And no matter what, if you want access to
government-funded surgeries, you have to go through CAMH. On top of
that, an alarming number of both adults and youth have additional psychiatric
labels like depression, anxiety, bipolar, OCD, and ADD.
Increasingly too, I
find that people, particularly youth, are seeking out a psychiatric label.
There’s a whole, insidious process here. There’s the desire to be validated for
the struggle that they’ve gone through, and there’s financial struggles that
are sometimes insurmountable. A lot of trans people are struggling at the edge
of poverty. Some go into sex work voluntarily or involuntarily, and
increasingly people apply for the Ontario Disability Support Plan (ODSP).4 The way to access ODSP support for
many trans people is to agree that “I have a mental illness” beyond gender
issues. ODSP is a more viable option for youth and especially older folks faced
with huge financial barriers. Sex work can be a viable option for trans people
too. It’s good money, you don’t have to have proper ID, you can assert
who you are and be respected in your chosen gender identity. Yet, it’s also
fraught with all kinds of danger, criminalization, harassment, and isolation.
So when you can’t get work because of transphobia or a gendered work history,
those two options can feel like the only viable ones for people. So, there’s
the legitimacy part, and there’s the financial part.
Recently, at the
Rainbow Health Ontario (R H O) Conference in
Ottawa, the psychologist and psychiatrist that run the gender clinic for adults
at CAMH did a presentation on what they call a new approach to the recently
re-released Standards of Care5 for trans people. They gave examples of when they would
block someone from transitioning – they didn’t call it “block” but that’s what
it is – and one of the examples was: when someone had struggled with anxiety,
and really struggled to leave their house and got a family member to do most of
the things that they needed to do outside of the house so that they wouldn’t
have to leave the house. This is an example of someone
they would try to block from transitioning until they got their so-called
“anxiety” under control. Another example I heard was someone who’s suicidal,
really desperately wants to transition but can’t because they’re depending on CAMH, and CAMH is saying, “Until you have one year when you haven’t tried to kill
yourself, we won’t consider allowing you to have surgery.” The implications of
that are astounding.
S D: So it’s like they’re treating gender identity as totally discrete
from all these other kinds of struggles people have.
A K: Yes. Exactly. As though you’re not anxious to leave the house because
you’re trans. It’s just a thing you have. It’s a “mental illness” that struck
you inexplicably. Not really sure why.
A person I know was
told they had a so-called “psychiatric problem” and recently, after years of
being on lithium, they came out to their psychiatrist as trans. The
psychiatrist was like, “Oh, OK, well let me re-look at what this diagnosis is.”
Like, suddenly they don’t have a “mental illness,” you know?
SD: So you mean, all that other stuff got erased in favour of gender
identity disorder in that psychiatrist’s eyes?
A K: Yeah – anything can be anything, if the psychiatrist says it is. So,
you know, you can have schizophrenia, which they insist is genetic or actually
“Oops! No, you’re just trans.” Clearly there’s no illness involved.
S D: It sounds like, from what you’re saying, the gender identity disorder
diagnosis is, in itself, not being conceptualized as illness in the same way.
A K: No, it is. But that’s changing. The same way that the lesbian, gay,
bisexual community mobilized to remove those identities from the DS M , similar actions are happening around trans identity.6 So, it’s not that psychiatrists don’t think it’s an
illness, it’s that the trans community doesn’t think it’s an illness, and
increasingly medical and health care professionals are getting on board and
recognizing that, including the World Professional Association for Trans Health
(WPATH).7
CA MH has gone through some
changes, including hiring people who were considered allies within the trans
community to do the approvals. So, on the surface, there seemed to be positive
changes. But in fact, these allies have really maintained the status quo, just
with new language. So, when the new WPATH standards of care
came out in September 2011, shortly thereafter a bulletin was issued
by CAMH about how they planned to integrate these exciting changes. When I was
at WPATH in September, when they announced the re-modeled Standards of Care,
one of the very first things that was said by the committee representative who
was presenting the changes was: “There. Are. No. More. Real-life. Tests.” And
people were ecstatic. They were so excited about it. So when CAMH put out their “changes” they accepted to have no more real-life tests.
Instead, there’s going to be “The Gender Role Experience.”
SD: How long is that for?
A K: It’s twelve months, and it’s the same criteria. According to them,
you can start hormones after three months. But there’s still a year-long
waiting list to get in. There are still several appointments that you have to
go through first before they can say “Yes, you can start hormones.” They’ve
changed the questionnaire because that was a big stumbling block for a lot of
people. They’ve eliminated all the questions except for personal info and one
question: “Tell us your life story.” But in fact, they now just include
questions like “what do you fantasize about while you masturbate” in the
interview instead. At that conference that I already mentioned, the Rainbow
Health Ontario (R
H O) Conference in Ottawa, I asked the CAMH people directly about that. I asked why that was necessary. And it was
very clear that they think it’s an important and relevant question to ask
somebody in addition to how often they masturbate and what their sexual
orientation is. Myself and another activist and psychotherapist asked those
very direct questions, and they defended their right to know saying that these
are relevant and important answers to get before allowing somebody to transition.
For sure, some changes
have happened as a result of community pressure. But the point is that people
are still being directed to go through the hoops of psychiatrists to get access
to medical transition. And it’s clear that psychiatry is holding onto the right
to classify and determine the best course of action for us. There is movement
outside of C A
M H , within medical and healthcare circles, to
shift more towards an “informed consent” model. This would mean that adults,
above eighteen, who are making decisions about their life and their bodies, as
long as they are being informed in a thorough way about the risks and
consequences attending transition, have the right to
choose. I mean, it’s so basic, but to the gender clinics and psychiatry, the informed
consent model doesn’t make sense. They are content to keep themselves as
gatekeepers.
The effects of
transphobia in trans people’s lives – and of course all the other violent
experiences they have with structures of power like race, class, and ability –
are so profound. I mean, trans people are among the poorest groups. Poverty is
through the roof. People can’t get housing or well-paying, secure jobs despite
being a highly educated population.8 Because of the effects of all of that, people need to
turn somewhere for support and because of this rampant discourse of mental
health and mental illness, the only place to turn, for a large part, is either
psychiatry or people who are working from deeply within a psychiatric model.
So people are still
turning to CAM
H for transition. Fortunately, there are now more
people outside of CAMH willing to work to create access for
trans people. What CAMH does, in terms of pressuring trans
people to jump through so many hoops that are quite abusive, is looked down
upon by people outside of CAMH in pretty dignified
ways. At the same time most folks who are critical of CAMH for how they deal with medical transition are still very committed to
the erroneous idea that there is such a thing as mental illness. People who are
otherwise quite progressive – in terms of defending their bodies and their
right to access and their right not to have to go to C A M H and their
right not to be seen as mentally ill simply because they’re trans – are still
committed to the idea that mental illness does exist, just not in me or just
not because I’m trans, but because my mom had it or because it’s genetic or
it’s in my family or because that’s the way I am. People are really up in arms
about not having to be labeled as mentally ill because they are trans. However,
they’re very much still committed to the possibility that you can be trans and
have a mental illness. S D: But in terms of the
transitioning piece itself, would you say that people are turning more to other
avenues outside of CAMH to get support around transitioning?
AK: Yes. Yes, but it’s still really slim. Like, in Toronto, it’s pretty
much a couple of health centres, with a few doctors in private practice too.
There are a few other health centres, like in Guelph, Windsor, Thunder Bay, and
Ottawa. So there are places across Ontario that are
actively working to support trans people with transition. What that means,
technically, is getting access to hormones, and information, and community
sometimes as well. It doesn’t mean surgery. Still, to get access to O H I P -funded surgeries, you have to go through CAMH.
SD: With the new Standards of Care and these kinds of new directions
being put out there, do you see that changing? Even if the change is not giving
total power to trans people themselves to make decisions about their bodies, is
there a shift to put that power in the hands of other types of health care
professionals or other doctors outside of the C AM H clinic?
AK: Well, what’s exciting about the new WPATH standards of
care is they explicitly state that in order to get approved for surgery, people
need the support of two medical or healthcare professionals who are competent
in this field. The wording is really particular in that regard. It doesn’t say
anywhere that those healthcare professionals need to be psychiatrists. The
qualification is that you need a Master’s degree and some competency and
experience working with trans people. That’s it. So, nowhere does it say that you
have to jump through the hoops of psychiatry and answer questions about your
sexual fantasies and how you masturbate – that’s C A M H holding
onto its old gate-keeping, oppressive ways.
Practically, getting
psychiatry to relinquish control over trans people’s lives is very hard. It’s
probably a big long fight. And whether we ever succeed in getting totally
outside of psychiatry, I don’t know. What’s happened in the last five years is
there was a huge effort to get a couple more sites that would be recognized by O H I P, outside of C A M H . It was a good three or four years
of work. It was a high-level negotiation. It was report writing and paperwork
and stats and long meetings and dialogue and negotiation with CAMH. At the end of the day, what happened is there wasn’t a political will
in government to make that change. S D: You spoke about adults
and this idea that adults can make important decisions about transitioning and
changes they want to go through medically. Have you any thoughts about
children? How do children fit into that picture?
A K: I do. I think kids are not respected enough. Children know exactly
what they need. By that, I don’t mean they know if they’re trans or not, but
they know that “wearing this shirt feels bad” or “I get so excited to play with
this toy.” All we need to do is follow their lead about
what empowers them. Children are so revealing in that way. You can see in an
instant whether something is working or not for them. I think we need only to
follow that lead and not make decisions. We don’t need to know if they’re just
different, just trans, just gay, just whatever. Children will tell you when
they’re ready. For sure by puberty or teenage-hood, youth really begin to be
able to articulate more and more who they are and make some decisions with
support. Support is key, support for parents to be able to tolerate that their
children might know something that they can’t possibly begin to understand. I
think, more than anything, children need to be protected from getting
diagnosed.
People do have big
problems in living, but I fundamentally believe that the medical model, the
psychiatric pathological model of human behavior, is scientifically unfounded
and is unhelpful in terms of getting at the heart of what human beings need to
thrive. And children are especially vulnerable to that. It can happen in a few
different ways. Really loving parents turn to authorities that they expect to
have some kind of knowledge or wisdom and get sucked in. Or, there are people
who want to fix their children and make sure that they don’t turn out gay or
trans and so they take them to people like [Ken] Zucker at CAMH and he helps them with that. He doesn’t help the children; he helps
the parents stay stuck and keeps the children disenfranchised.
And then there’s just
neglect. A lot of the youth that I work with have such intense histories of
trauma and violence, sexual abuse, neglect, intense poverty, parents who
provide neither food nor nurturing. Some children get kicked out or told
they’re bad because they’re different or they get humiliated routinely by
teachers and students at school because they’re different. So, the trauma of
not fitting in and the violence that comes with that, this is what is happening
to youth. Their social awkwardness is getting labeled, their anger is getting
labeled, their cutting and self-harm is getting labeled, their extreme rage
when they’re pushed is getting labeled. Yet, no one wants to talk about the
abuse that children go through, the complete disempowerment that they face, and
the disbelief that can be so damaging.
SD: Do you think we can create services that meet the needs of trans
people within psychiatric institutions?
A K: As long as we, as trans people or gender different people, continue
to subscribe to the psychiatric model in any regard, we put ourselves
at risk, and we put other people at risk. It’s not enough to get our identities
out of the D S
M , because somebody else’s identity is in there.
It doesn’t say in the DSM anywhere “young, black men’s anger
syndrome,” but it might as well. There are a disproportionate number of young
black men diagnosed with schizophrenia. Soon it may not say “gender identity
disorder,” but it will say “anger disorders,” “oppositional defiance disorder,”
“anxiety disorder.” They might as well call those “people who have been
oppressed disorders.” And that includes us as trans people. So, it’s not enough
to just take our identities out of the DSM, and it’s not enough to
have this psychiatric model that we tweak. It’s a model that we need to get rid
of, and we need to get rid of it precisely because, at the heart of that model
is this idea of mental illness – mental illness that you cannot find in the
brain if you do an autopsy.
Let me put that into
context. One of the people who is writing the new version of the diagnosis for
“gender dysphoria” for children is Zucker at CAMH. He has been
widely discredited for his views that children who are cross-gender identifying
or who are gender independent can be “cured” through reparative therapy. “They
were assigned female at birth? No problem! We’ll make sure they turn into a
good little girl. Here’s what you do: Deny them the opportunity to hang out
with boys, don’t let them have so-called ‘boy’s toys.’” This is Ken Zucker’s
approach to gender independent children. And he’s unabashedly unashamed about
it. He is writing the pathological definition of what it means to be a gender
creative kid and how to fix it. He’s the “expert” who is majorly contributing
to this section of the DSM.
This whole structure
is so obviously flawed that if we simply take ourselves out of the D S M or out of C A M H and go to the psychiatrists at the
Sherbourne Health Centre or Hincks-Dellcrest9 to get our support and approvals, we will continue to
be pathologized. What we’ll do is we’ll become complicit in erasing the context
of our own and other people’s struggle for self-determination. S D: That makes a lot of sense in terms of theoretically where things have
been headed and practical implications for that. I am wondering about when
pockets of alternative programming are created within the system.
A K: Are you thinking about the Hincks-Dellcrest?
S D: Yeah, I was thinking about that. You know, at the Gender and Sexual Orientation
Service at the Hincks-Dellcrest, children don’t go there
to get diagnoses. But it’s still within this institution, and there’s a
gatekeeper. It’s just a gatekeeper with a different vision. A K: It’s not enough. As long as we’re talking about mental health, we’re
not talking about solidarity, support, community development, access. That’s
what we’re actually talking about. So people who are setting themselves up as
gatekeepers or insisting that people who are gender-different or
gender-independent need to go to clinics to get support, are missing a huge
part of the puzzle, which is the social, the societal – a political issue that
prevents adults and children from being who they are.
Discourses around
disability are really amazing at identifying what the real problem is – the
barriers presented by a society that refuses to acknowledge that it’s through
power that we erase people and prevent them from getting access to society. Let
me say that a different way because I said “we” and it assumes that people with
disabilities aren’t part of the “we.” That’s the problem; the “we” is the
normative, the dominant group, and everyone outside is seen as imposing on the
norm to get special access. Whereas, gender-independent kids are everywhere,
kids with disabilities are everywhere, adults with disabilities are everywhere.
All kinds of people with all kinds of variations and differences and uniqueness
are everywhere. That is actually what society means; it’s everyone.
SD: What is your vision for how you would like to see the trans community
move forward in terms of activism and initiatives?
A K: I see many possible directions. This year, the title of the Canadian
Professional Association for Trans Health (C PA T H)
conference is “Beyond Pathology.” So, there’s an awareness that we need to get
trans people outside of this pathologized model and integrated in a more
meaningful way into all aspects of life – and not just included as an add-on to
professional knowledge about healthcare or education or prison. And I like that
shift. I like it because the Trans Pulse Survey that surveyed about 500 trans
people living in Ontario came out with the result that almost 75 % of trans
people had either attempted suicide or actively considered it. Seventy-five
percent! And that’s the ones who are still alive, never mind all the people who
have killed themselves. The other thing that they found is that suicide risk is
the highest at the very point when someone has decided to transition and they
get blocked from transition. That means CAM H’s one-year
waiting list to get a first interview, that means being
interrogated about sexual preferences, that means having gatekeepers tell you
how long you have to prove to them that you’ve been “stable” before you can
access hormones or surgery, that means not being able to go across town to your
family doctor for info and access, never mind all the other hoops about
changing your name. And how do you apply for a job when all of your work
history is gendered or you can’t get references from the past? There are so
many hoops right there when people are at the point of wanting to take a risk
to really be themselves. So I think that’s where I see the activism happening;
in that zone; creating quicker, ‘informed-consent access’ to transition and beyond
– access to schooling, work, housing, all of those kinds of basic things.
I feel that same fear
about psychiatry as I do about the prison industrial complex and trans people;
that there’s this intense risk of being erased as a person, a creative person
who has survived. I don’t know how to describe it, but usually I describe it
as, before transition, I was under the surface of life, and after transition,
I’m able to break that surface and see what’s out there in life. Of course, not
all trans people are going to identify in that way, or want to transition, or
all of those things.
I’m trying to make
this a bit personal as well and say I don’t know what the big picture answers
are. I see little pieces about depathologizing trans people, but also de-pathologizing
our resistance to transphobia. That’s the key and that’s going to happen in so
many different ways, through art and culture, through politics and through
education and healthcare, the whole works, housing, shelter. People are doing
amazing things out there in different ways. S D: Do you see
people in the trans community working in antipsychiatry or psychiatric survivor
initiatives? Do you see much crossover, or areas where there could be crossover
where there isn’t? A K: Well, in terms of psychiatric survivor
organizing, a crossover I see is around access to supportive health care
services, not pathologizing ones. Trans people do need access to medical
procedures, medical hormones, surgery, and often want to have supportive
counselling services, not because there’s something inherently wrong with us
and we need to sort it out in counselling, but because we face so much
oppression. You know, there’s so much stigma and shame. We are communities that
are shunned by society as a rule. If you experience other realities, if you are
assigned “male” at birth and you wear a dress; these are
equivalent in our society to being unacceptable: “there’s something wrong with
you.” The most benevolence we can hope for is “It’s not your fault that you are
like this or that this happened to you.” So, in terms of resisting that
individual pathologization, there’s so much overlap between being trans and
being a psychiatric survivor.
In terms of
antipsychiatry organizing, I can’t think of a community that is better suited to
take part than the trans community – except for the fatigue in terms of having
to struggle day in and day out to walk down the street, to talk on the phone,
to have a job, to sit in school, to be in public. Aside from the fatigue
factor, working to abolish psychiatry and abolish prisons would do wonders for
trans people. It would eliminate two options by which we are routinely
dismissed and discredited. And it would force people to have to deal with our
difference and the fact that trans people are under-housed, over-drugged, too
visible yet invisible, and marginal. So I see a lot of potential for alliances
and combined actions between all of those communities.
SD: Do you see any barriers? I know you spoke about how tiring it is to
experience oppression in many different ways, on a daily basis. That can really
make it hard for people to engage in some manifestations of political action.
Are there any other kinds of barriers preventing that from happening?
A K: I think trans people are working tirelessly to get out from the DSM in such a way that it could lead to distancing ourselves from those
who have been psychiatrized, even though we are people who are psychiatrized. A
common stance is “I’m not disabled,” “I’m not mentally ill,” which is not
helpful because there are people who identify as being disabled, and they don’t
feel that that’s a curse word or lesser identity, and they shouldn’t. And I
know that there are other trans people who identify as disabled or as
psychiatric survivors so there’s already overlap that’s happening. Eli Clare10 is coming to mind. But I think, just as any other
community, we’re very much caught up in dominant narratives about who’s normal
and who’s not. And we’ve definitely internalized a lot of that. “Who passes” is
a big one in our community. Who’s a real trans person, who isn’t? Gender
non-conforming or gender-queer people are not considered trans enough
sometimes. There’s as much difference in our communities as there is in any
community, and that can pose barriers to solidarity.
Competing for scarce resources is always a barrier. It is classic
divide-and-conquer. If we’re always competing with each other then we’re
fighting ourselves instead of working with other communities to make broader
social change.
I don’t think in
antipsychiatry or psychiatric survivor circles there is a lot of awareness
about what happens to trans people in psychiatry. I haven’t seen that. I don’t
want to make huge generalizations, but in my experience, it hasn’t been very
important.
A very interesting
barrier that I face is that I’m dependent on CAMH to approve me
for surgery. I’m really stuck at the moment. I’m so angry that I can’t even
make myself put pen to paper and fill out that application. As an
anti-psychiatry activist, to willingly submit myself to C A M H for examination and approval feels so mind-blowingly terrible. It’s a
huge barrier for me. It makes sense that people don’t want to fight psychiatry
because we’re dependent on them. That’s huge. I’ve had the application for six
months. It’s just sitting there.
S D: That’s really hard.
A K: It’s so hard. So, the daily dependence on psychiatry precludes the
possibility of organizing against psychiatry in some pretty major ways. That
goes for not only accessing surgery, but accessing financial supports as I
said.
SD: Is there anything you want to add?
AK: Yeah. As a white, trans man, a lot of what I’m saying is loaded with
my own perspective and my own identity. I haven’t meaningfully addressed status
issues, immigration issues, prisoner issues. But I wanted to speak, to try in
my way to contribute to this conversation. I hope that this will be, at some
point, one of many voices talking about this from different perspectives.
I don’t have all the
technical inside and out knowledge, but I do know that trans people are
disproportionately told that there’s something wrong with us. And most of us
end up in a relationship with psychiatry. Whenever the numbers are that high,
there’s something to be extremely concerned about. Indigenous youth are
experiencing suicide or thinking that that’s a viable option in staggering
numbers in this country – the same goes with trans youth and adults. That
suicide is such a viable option is not just sad or tragic; it’s a sign of a
bigger political and social problem. Like indigenous youth, trans people aren’t
born wanting to die – we live in a world that actively
resists our existence and seeks to control and contain us. We don’t need
psychiatry, we need solidarity and justice. We need room to live.
S D: Thank you, Ambrose.
1 Trans refers here to a range of identities including but not limited
to transsexual, transgender, gender queer, gender independent, M T F, F T M, M T M , F T F, transgirl,
transboi, transman, and transwoman. It is still an insufficient term to
represent the stories and diversity of all people who identify in these ways.
We use it to begin a conversation, not to limit or contain it.
2 I do not represent the Sherbourne Health Centre in any way. I name it
because it was there, in contact with so many trans people, that I really saw
the depth of trans people’s involvement in psychiatry.
3 CAMH is the Centre for Addiction and Mental Health, a psychiatric
institution in Toronto, with a long history of violence against trans people.
It is the only assessment site for government funded trans-related surgeries
for Ontario, Newfoundland, and Manitoba, and is a main referral site for a
majority of trans people seeking to transition medically.
4 ODSP is the Ontario Disability Support Plan. A person on ODSP can expect to
have a monthly income that is a few hundred dollars more than the amount of
regular social assistance.
5 The Standards of Care (SOC) for trans people were initially developed by sexologist Harry
Benjamin. Currently, the World Professional Association for Trans Health (WPATH) produces the
SOC. Version 7, released in 2012, can be found here: http://wpath.org/publications_standards.cfm
6 However, I would like to stress that despite these efforts,
homosexuality continued to appear in the DSM as a disorder, whether
it be called “ego-dystonic homosexuality” or other things. For a discussion of
this phenomenon, see Burstow 1990.
7 Note the change in title, for example, between the WPATH standards of
care version 6: “Standards of Care for Gender Identity Disorders” and the new
version 7: “Standards of Care for the Health of Transsexual, Transgender, and
Gender Non-conforming People” (http://wpath.org/publications_standards.cfm).
8 See the Trans Pulse Project e-bulletins at http://transpulseproject.ca/research-type/e-bulletin/ for
statistics relating to trans people in Ontario.
9 The Sherbourne Health Centre is a centre for trans-positive primary
health care and social / educational supports for trans and gender creative
people. The Hincks-Dellcrest is a centre for children and youth in Toronto and
has a Gender and Sexual Identity Team.
10 “Eli Clare weaves hope, critical analysis, and compassionate
storytelling together in his work on disability and queerness, insisting on the
twine of race, class, gender, sexuality, and disability.” See “Eli Clare:
Writer, Speaker, Activist, Teacher, Poet,” http://eliclare.com. Last
accessed November 4, 2012.
Take it Public:
Use Art to Make Healing
a Public Narrative
ROSEMARY BARNES AND SUSAN SCHELLENBERG
INTRODUCTION
S U S
A N: When my analysis work was coming to an end in
2003, I dreamed the face of a woman patient from 1953, my first year of nursing
training. I was taught that the woman’s rapidly clenching and unclenching
over-bite jaw, foul language, chloral-hydrate1 breath, and rage were signs that she suffered from a
psychiatric condition diagnosed as Korsakoff’s psychosis. The woman’s
presentation made it difficult for nurses to empathize with or go near her and,
according to my dream, difficult for this nurse to forget her. I understood the
dream to signal that this patient’s plight was one of the true faces of sexual
abuse that my culture had not previously recognized. I took the dream to
confirm as well that the same patient’s fate might have been mine had I not
found ways to access and clear the traumatic core of my 1969 breakdown.
In 1969 as a young
suburban mother of four small children, my three-week admission to Lakeshore Psychiatric
Hospital began. On hospital discharge, my husband and I understood my diagnosis
was schizophrenia. Convinced by my children’s need of a well mother and by the
definition of schizophrenia I learned as a nurse, I willingly submitted to
taking prescribed anti-psychotic drugs. Motherhood, religion, a corporate /
traditional style of marriage, and a view of my illness that conformed with
society’s “doctor/ god / patient / victim” narrative discouraged my questioning
why prescribed drugs were my only treatment. Until, after
ten years, I came close to suicide under the care of a diagnosis and
drug-focused psychiatric model. Soon after my decision to withdraw from drugs,
I made deep commitments to heal my mind from the causes of my breakdown, to
heal my body from the drug side effects, and to paint a record of my dreams as
my mind and body healed. For some years, I studied art, gained more knowledge
of dream interpretation, and painted regularly.
ROSEMARY: I trained as a clinical psychologist about seven years after Susan
was hospitalized with a psychotic break. After postdoctoral training, I worked
as staff psychologist at Toronto General Hospital, then chief psychologist at
Women’s College Hospital. I learned and practiced illness-focused, medical
model care. I had a professional career that I understood and enjoyed until I
realized that medical model care was often unhelpful and in some ways actually
harmful to people seeking help. After trying and failing to reform hospital
structures, I became lost and felt cynical, exhausted, and angry about my
apparently successful career. I learned of Susan’s experiences in 1992 when she
exhibited her paintings at Women’s College Hospital. What she had to say
reflected much of what I found troubling.
SUSAN
AND ROSEMARY: Since the 1990s, we have worked
together as artist and psychologist to share what we have learned about healing
from emotional pain2 (see also Barnes and Schellenberg 2004, Schellenberg
and Barnes 2009). We have never been in a doctor/patient relationship. In this
chapter, we tell a little of our own stories and describe a postmodern
perspective on resistance to medical model mental health care. We introduce
“emotional pain” as words that hold open possibilities for naming and
responding to experiences usually described publicly in medical model terms
such as “mental illness” and “mental health care.” We propose healing as an
organizing narrative for emotional pain. We explain how public art events increase
the visibility of ordinarily private stories where individuals with lived
experience name and respond on their own terms rather than deferring to the
words and constructs specified by mental health professionals. As private
stories of healing are made public, they reduce the stigma attached to lived
experience of the emotional pain usually known as “mental illness” and displace
medical model care as the dominant societal narrative for
naming and responding to emotional pain.
POSTMODERN THINKING ABOUT
RESISTANCE AND CHANGE
ROSEMARY: As Susan and I talked and wrote about well being and healing (Barnes
and Schellenberg 2004, Schellenberg and Barnes 2009), I came to appreciate the
healing potential of public arts events. I was also interested in postmodern therapies
and narrative therapy in particular (White and Epson 1991; Freedman and Combs
1996; White 2007, 2010). Arts events and postmodern approaches pointed out
avenues for change that I had not considered.
Social discussion
about individuals experiencing emotional pain often relies on a medical model
narrative where the individual in distress is encouraged to see an expert
doctor (i.e., physician, psychologist, social worker, and so on), and thus
become a patient. The doctor asks about symptoms and provides a diagnosis,
highlighting what is important and what meaning to ascribe to the patient’s
experiences. Typically, doctors diagnose patients as suffering from one of the
mental illnesses listed in the American Psychiatric Association’s diagnostic
manual, the D S
M - 5 (American Psychiatric Association 2000, 2013). Patients are encouraged
to return to normal by following the doctor’s orders, e.g., take your
medications or do the therapy homework. The experience is considered private.
The medical model
approach is modern. A modern way of thinking assumes that “The truth is out
there,” i.e., that with enough study and effort, we can ascertain what is
normal and what is illness. “Normal,” “mental illness,” and diagnoses are
treated as referring to certainties or realities, not just ideas about how to
understand life or emotional pain. A postmodern view, however, holds that
reality is neither fixed nor certain, but instead constructed through attention
and interpretation. Among the myriad possibilities of daily life, we notice or
perceive some aspects of experience and ignore others. Through our ideas, talk,
and practices, we organize perceptions into meanings, and meanings into
narratives or stories. Beliefs about reality or “truth” develop from a
continual process of noticing, deciding on meanings, and creating narratives.
To keep life manageable, we adopt a few narratives as guides for what to notice
and how to interpret what we notice. Such narratives can be described as dominant, and come to feel like reality. An individual’s
dominant narrative provides his or her primary basis for engaging in life. A
society’s dominant narratives provide the basis for social arrangements and
practices, i.e., laws, policies, organizations, and resource allocation. For
both individuals and societies, dominant narratives always co-exist with
marginal or potential narratives – that is, unnoticed experiences that could be
noticed and used to form meanings and stories, but that are not taken up and so
remain peripheral in directing attention and action.
Illness-focused
medical model care is a dominant social narrative. Such care has been critiqued
for many years and for many reasons (see, for example, Bentall 1990; Bracken
and Thomas 2005; Caplan 1995; Szasz 1974, 1988; Whitaker 2010). The most
serious concern is that despite “advances” in care, outcomes for people
identified as mentally ill are not better than they were sixty years ago and
may well be worse (Whitaker 2010). Adoption of the medical model narrative does
not ensure that those in emotional pain can expect to have better lives.
Modernist defenders of the medical model argue that our understanding is
imperfect, but that if we persist, if we do more and better-funded research, if
we learn more about neurotransmitters, or genetics, or brain structure, then we
will come closer and closer to the truth concerning mental illness and
treatment. However, sixty years of such research has been largely unfruitful
(Bentall 1990; Bracken and Thomas 2005; Szasz 1974, 1988; Whitaker 2010).
From a postmodern
perspective, the central problem with the medical model narrative is not our
imperfect understanding. The central problem is that the dominance of this
narrative constricts individual and societal possibilities by encouraging the
belief that mental illness is a fixed reality rather than just one among many
possible ways of naming and responding to emotional pain (Raskin and
Lewandowski 2000). Equating emotional pain to mental illness functions to
suppress other possibilities, other meanings, and other stories for naming and
responding to such pain. In order to explore other possibilities and to develop
richer understandings of emotional pain and possible responses, postmodernists
want to “discourage foreclosing meaning making experience through the
preemptive adoption of only one construction of disorder” (Raskin and
Lewandowski 2000, 19).
This well-known
image (Figure 12.1) offers a visual illustration of what I have in mind. In
this image, a black urn is present, but the two people who appear to be
conversing are also present. What is reality? An individual’s experience of the
reality depends on the individual’s attentional focus at a given moment.
Doctors conveyed to Susan and her husband that Susan suffered from
schizophrenia, let’s say an urn, so needed to be returned to her normal life as
a wife and mother. Susan, in the course of painting her dreams, identified
dialogues between her inner psyche and outer world awareness, that provided new
and deeply satisfying stories about herself and her life, e.g., her wounded
parents, her childhood pain, herself as an artist. She attended to the people
conversing. From a postmodern perspective, creating change has to do with
directing attention. So, if we prefer the story of people conversing rather
than the story of the urn, how can we direct attention to this story?
Figure 12.1 : Urn/people visual image. (Susan
Schellenberg, After Edgar Rubin’s Vase. Reproduced with permission)
S U S
A N: My dream art was first shown as part of Never
Again, a hospital event held to increase awareness about violence against women.3 The exhibit’s art and text recorded my growth from
my lowest point in 1980, after a ten-year course of anti-psychotic drugs, to the
time of the exhibit. At journey’s beginning, I was isolated in suburbia as well
as psychologically and philosophically distanced from the survivor /
anti-psychiatric movements. Where I now respect how the “my craziness is okay”
response can be an essential coping tool for some, I could not adopt this
option, as achieving a more whole sense of self through naming my “psychotic
symptoms” as “normal and okay” was counter to my nursing training and my need
as a mother to protect my own and my family’s well being. Who I was then
provided an ample supply of false selves for me to shed over the following
years as I worked at creating a new self and life and at gaining the needed
consciousness and psychic strength to resolve childhood trauma. The childhood
trauma involved abuse experiences that I had deeply repressed and that
prescribed antipsychotic medication had further buried.
When my
convent-school conditioning in ladylikeness collided with the near overpowering
rage I developed during a four-year supervised withdrawal from anti-psychotic
drugs, the anti-psychiatry literature of the time validated my rage but fell
short of telling me how to make sense and let my rage go. Deep shame and
concern for my children forced a dual role onto my rage, making it the foremost
influence on my eventual commitments to become well and to keep an art and
written record of my dreams and inner journey as my mind healed. Though I knew
that my children would be affected by my psychosis and the ways that I was
affected by anti-psychotic medication, I hoped that my art, writing, and
commitment to healing would offer my family a lived story of healing whether or
not they consciously chose to learn from it.
From the beginning,
I followed a pattern where commitment preceded story, and story expression
preceded growth in wellness. For example, one dream painting called Bury it with Respect
(Figure 12.2) shows the head and shoulders of a bishop resting on leaves. In my
dream, the bishop stood at the foot of my garden rockery and dissolved into a
pile of dead leaves. Dream work led me to realize that the bishop’s leaves
signaled the difficult decisions to leave my marriage, religion, and home that
I faced at that time while they were dually encouraging me to trust that those
same leaving processes would fertilize and nourish my next stage of growth.
Figure 12.2 : Susan Schellenberg, Bury It with Respect,
mixed media on paper, 27.5 x 38.25 inches. (Centre for Addiction and Mental
Health, Toronto. Reproduced with permission)
Once I committed to
heal and to record my dreams, mentors and helpers bearing story, myth, art,
drama, and movement skills began to appear in my life. From that time onward
each of my gains in consciousness marked the slow dissolve of my rage. Each
mentor brought an aspect of story that allowed me to better see and express my
dream journey in art and later in writing. Art, dream, and story helped me to
recover, own, and resolve the story of my breakdown. I came to regard healing
as growth in ability to love and forgive self and other, to cope, to feel
pleasure, to engage in meaningful activity, and to follow the psyche’s inner
direction away from addiction and towards greater
wholeness. This perspective is neither pro- nor anti-psychiatry.
EMOTIONAL PAIN
R O S
E M A RY: As Susan worked with her dreams and art,
she identified a story of herself as abused, rageful, then healing. She
preferred this story over the earlier story of herself as suffering from mental
illness. In order to remain open to noticing preferred, but marginalized,
stories of the kind that Susan tells, I began searching for words that are free
of mental illness / medical model implications. I wanted to avoid medical model
terminology unless in situations where I was discussing medical model
constructs. A friend with lived experience suggested “emotional pain,” and
these words seemed right. I use “emotional pain” to describe difficulties that
cause a person substantial distress, interfere with his or her ability to
achieve important life goals, or interfere significantly with his or her
ability to enjoy caring and mutually respectful relationships with others. I
prefer “emotional pain” because these words are ordinary; are not associated
with any theoretical or clinical construct; and are readily recognized as what
individuals experience when life is not going well.
But emotional pain
often feels frightening and chaotic. The medical model reassures because,
despite its failings, it provides an organizing narrative for such experiences,
both individually and socially. We need an organizing narrative for emotional
pain. So, if not the medical model narrative, then what?
A NARRATIVE OF HEALING
Like most people living in emotional pain, Susan
and I wanted to feel better in a sustainable way, that is, to heal in the way
that Susan defines it above. Healing involves an improved sense of wellness and
ability to engage in life, and is thus different from overcoming or curing a
disease. Healing is always possible, even when cure is not. Healing requires
committing to well-being and finding a refuge, then cultivating supportive
relationships; an ecology of healing; and confidence in life’s healing
capacities (Schellenberg and Barnes 2009). What we describe as healing is
similar to the recovery model (Davidson et al. 2005; Davidson, Harding, and
Spaniol 2005a, 2005b; Jacobson 2004) chosen as a central focus for
national mental health strategy by the Mental Health Commission of Canada.4
Susan’s art relates
a healing narrative. Such healing is not a rare exception, even among
individuals diagnosed with serious mental illness. A wellness and
healing-focused approach enables many people living with serious mental illness
to make remarkable improvement or to recover (Davidson, Harding, and Spaniol
2005a, 2005b). But why should a private healing experience be presented
publically?
S U SA
N: By the mid-1990s, I had developed a collection
of paintings that recorded my dreams as my mind and body healed. These works
provided a psychological portrait of the emotional pain that doctors identified
as a mental illness and demonstrated how dreams had guided and reflected the
healing of my mind and body. When I read the work of art historian Suzi Gablick
(1991), I became interested in art that is socially conscious and fosters
interconnection. I was inspired by Gablick’s view that an art aligned with
other social disciplines could mirror the collective effort needed to save the
planet as a place that sustains human life. As current human behaviours and
systems threaten the earth’s air, water, and living creatures, and thus human
survival, I believe Gablick is right in arguing for art forms that embrace
interdisciplinary collaboration and address the human spirit in ways that
nurture its will to change.
After reading
Gablick, I also began to recognize parallels between my own healing and the
healing of the planet. Just as my painted dream images helped to knit together
disparate fragments of myself to create a new life story, healing the planet can
be helped through our knitting together disparate fragments of understanding to
create a new story of ourselves and Great Mother Earth. I read Gablick close to
the time I was invited to join my first multidisciplinary collaboration. From
that time on, I began to realize that my own art could increase public
awareness concerning the helpful role art and story can take in the healing and
recovery process for an individual living in emotional pain and, by analogy,
for a planet in pain.
My painting and
involvement in socially engaged art at the 1992 Women’s College Hospital Never
Again event5 led to an offer to fund a permanent exhibit of my
dream paintings. Since the funding was conditional on the exhibit being mounted
at a psychiatric teaching facility, I began discussions with the Centre for
Addiction and Mental Health (C A M H), a
university-affiliated psychiatric hospital in Toronto. My mid-1990’s
collaboration with C A M H involved the permanent installation
of my dream art and text in that facility’s main lobby as the Shedding Skins
exhibit. The decision to align my Shedding Skins art to a healing perspective
meshed with my focus on healing from the early 1980s onward. Though able at the
time to express myself visually and with the written word, I had yet to resolve
the core issues of my breakdown, so at that time, lacked the clarity and
awareness to articulate a broader focus. Hospital staff involved with the
planning of the installation demonstrated unbiased, arm’s length respect for my
paintings and story through their careful listening and acknowledgement. Their
stance encouraged me to proceed with the exhibit and to gain unexpected and
significant healing from my exhibit involvement.
As my new vision of
my life expanded, I better understood how the long-term daily ritual of taking
psychoactive drugs had reinforced my and my husband’s belief that psychiatry’s
initial illness diagnosis and treatment was justified. When that belief fused
with the stigma of mental illness, it became near impossible to overcome. It is
difficult now to believe that I ever held such harmful beliefs, let alone
carried them forward until the mid-1990s. On completion of a series of
conversations undertaken in preparation for the Shedding Skins installation and
later for the Committed to the Sane Asylum book, these beliefs dissolved to the
degree I was able to decline CAM H’s offer to be named
that year’s “Courage to Come Back” award recipient. By then I knew that such an
award would require me to play the role of a psychiatrically helped and saved
patient and require me as well to deny both my wrongful psychiatric treatment
and the new story that my art and writing on the book was uncovering.
Since its 1998
installation, Shedding Skins has been viewed by hospital staff and visitors as
well as patients. The Department of Women’s Mental Health Research has
incorporated study of the Shedding Skins art and text into several of its
student psychology and psychiatry courses. Committed to the Sane Asylum has
prompted readers to visit the CAMH exhibit and is
available in the CAMH library.
TAKING IT PUBLIC
ROSEMARY: Had Susan kept her dream paintings in her home or confined them to
discussion with her therapist or with her family and friends,
the paintings would have remained an interesting approach to her personal
healing, but a private matter. However, Susan was determined to see the
paintings installed as a public exhibit. This could have been an exhibit at an
art gallery, as befits an artist whose work goes beyond being a personal hobby,
and Susan has exhibited at a gallery. But Susan chose to pursue having her
paintings installed as exhibits first at Women’s College Hospital, then at C A M H . These choices spoke to different purposes and possibilities for her
art.
Public events like
Susan’s that focus on emotional pain and healing provide public windows on
these vital, but ordinarily private, experiences, and thus provide
opportunities for public discussion. Though the medical model narrative
dominates public discussion, other responses to emotional pain thrive, but as
narratives that are publically marginal. Healing is often an organizing
narrative for individuals and families, but since emotional pain is treated as
private, the ways in which individuals or families decide to name and respond
to such pain often remain unknown publically.
Public focus on the
medical model narrative largely pre-empts discussion of other possibilities.
From time to time, public media pieces describe the problems of living with
significant emotional pain or otherwise comment on mental illness. Typically
such pieces enjoin readers to respond to emotional pain by seeing a doctor,
obtaining a diagnosis, and receiving medication. Such media pieces encourage the
public to name and respond to emotional pain via the medical model. Occasional
media pieces question the medical model. D S M -5 (American Psychiatric Association,
2013) has, for example, been subject to considerable public criticism,
including questions about the widespread use of psychoactive medication and the
problematic influence of pharmaceutical company marketing programs. However,
such critical media pieces generally fail to present any compelling alternative
to the medical model for naming and responding to emotional pain. The lack of
public visibility for healing, recovery, or other narratives serves to support
perception that, flawed though it may be, there are few if any viable
alternatives to the illness-focused medical model.
Susan’s work demonstrates
what can be achieved by making ordinarily private experiences public. Through
her art, Susan names her emotional pain in her own terms, for example, “the
faceless priest,” (see Figure 12.3) rather than in medical model symptoms or diagnoses. She honours the creative, healing capacities
within herself by recording and seeking the meaning of her dreams. She finds
meaning in experiences that doctors named as illness. She demonstrates the
effectiveness of a sustained commitment to well-being. She heals and offers
healing stories and images to others. She offers others fresh ways of
participating in both her life and their own lives (Barnes 2012). She
demonstrates how individuals who have suffered emotional pain contribute to the
larger society. In short, her work increases the public visibility of creative,
postmodern ways of naming and responding to emotional pain, demonstrates a
compelling healing narrative, and thus publically displaces the medical model
as the only possible organizing narrative for such pain.
PEOPLE ARE INTERESTED
Susan’s Shedding Skins exhibit is one of many
public events related to emotional pain. The public is very interested in such
events, first because such pain is so pervasive. Who among us has been
untouched by it? Emotional pain already makes prominent public appearances
under the name “mental illness” and “mental health care,” as research studies
typically use such constructs when investigating the extent and impact of
emotional pain. From such studies, we learn that millions are affected by
serious mental illness and that mental health problems are among the leading
causes of disability in terms of productive years lost6 (see also Simmie and Nunes 2001). In other words, emotional
pain is widespread and often disabling.
As well, people
demonstrate interest in public arts events related to emotional pain by
attending or funding such events. In Toronto, for example, theatre performances
by transgendered youth have received funding from the Toronto Arts Council,
Ontario Arts Council, and Toronto Community Foundation.7 An expressive arts group for women survivors of
violence has, for some years, had annual exhibits at Toronto’s Gardiner Museum
of Ceramic Art (Thomson 2011), and a three-month retrospective exhibit was held
in 2013. Touched by Fire,8 an online public art exhibit to honour and inspire
artists with mood disorder and their families is sponsored by Raymond James, an
investment firm, and has had exhibits at the Royal Ontario Museum and other
venues. The support provided by government, public institutions, community, and
corporate sponsors, and the good audiences attracted to such exhibits, indicate
the considerable public interest in events related to emotional pain and
healing.
Figure 12.3 : Susan Schellenberg, The Faceless Priest,
mixed media on paper, 28.75 x 40.75 inches. (Centre for Addiction and Mental Health,
Toronto. Reproduced with permission)
MEDIA REVIEWS COULD HIGHLIGHT
AND CRITIQUE PUBLIC EVENTS
Media analysis and critical reviews of public
arts events relating to emotional pain could publicize such events, help
audiences to become more knowledgeable, highlight insights, and comment on how
the larger community is invited to perceive and respond to individuals in
emotional pain (Barnes 2012). Some public arts events seem to publicize
illness-focused medical model narratives, for example, here is how the world
looks to people with a certain diagnosis; here is the
mental health victim; here is the rescuer doctor. Reviews could critique the
narrow scope or other limitations of such events. Reviews could explain events
that point to healing, recovery, or other narratives for naming and responding
to emotional pain. For example, in Panopticon, a 2008 drama produced by the Central Toronto Youth Services Gender
Play program, performers portrayed their own experiences and gave the audience
detailed direction about how to support transgendered youth. Reviews would
likely encourage readers to engage in discussion and debate about the multiple
narratives that can be the basis for responding to emotional pain.
PUBLIC ARTS EVENTS SUPPORT HEALING
AND REDUCE STIGMA
S U S
A N: Writer, storyteller, and friend Helen Porter
once said, “Susan, I am certain if on psychiatric hospital admission someone
had said ‘Once upon a time, ’ followed by a story, you would have healed much
sooner.” I painted, wrote, and publically shared my story long after my
psychiatric hospital admission, but those experiences brought the truth of
Helen’s words to light. Today, I am certain things would have been different
for me if on hospital admission psychiatrists had said, “Susan, we can easily understand
how your emotional pain may discourage you at this time, but when we see such
pain, we know something in your life has changed. We want to work with you to
bring something positive out of that change. It is sufferers like you who can
help us to help others with similar pain. We encourage you to believe the mind
has a capacity to heal and we want to share this wellness work with you.”
Had psychiatrists
used this approach, my 1960s belief that my badness caused my breakdown would
have lessened rather than flourished into the 1990s. Psychiatric staff
reinforced my beliefs of badness by initially assigning me to a basement ward,
then moving me to wards on progressively higher floors of the building over the
course of my hospital stay. My arrival at a ward on the third floor indicated
my “least bad” state had been achieved and that I was ready for discharge.
Rather than being encouraged to explore recovery tools during my hospital stay,
I learned to work a system to gain my discharge. Later observations of my
psychiatric hospital records confirmed that several of my caregivers had
projected badness onto me, e.g., naming my art as “a bid
for approval,” and my emotional pain as “a cauldron of snakes.”
Had a psychiatrist
explained my breakdown as having meaning and purpose, my later passion for
healing work convinces me that I would have responded favourably to any “good”
theory aimed at replacing my sense of “badness.” But no psychiatrist, no fellow
patient, no hospital artifact mirrored human goodness back to me in that space.
Moreover, anti-psychotic drugs compounded the silence. Until society values and
supports more humane approaches to emotional pain than the diagnosis/medication
model I experienced, I see my small awareness steps and the publicly shared art
and healing stories of others as necessary supports to those whose suffering
will mark the minutes as we proceed on that long path to improved societal
care.
Where “stigma” is
concerned, I believe that publicly shared art and healing stories offer opportunities
to highlight the actual contribution that individuals with lived experience can
bring to society. Whether the contribution is as large as the founding of
Alcoholics Anonymous by Bill Wilson and Dr Bob Smith or as individual as the
person who finds the courage to face, resolve, and later to share their story
in ways that add to our knowledge of how the mind heals, I feel such
contributions must be recognized and honoured. Until this valuing occurs
publically as well as privately and individually, current “anti-stigma”
campaigns will fail to erase the roots of stigma that lie embedded in the
illness-focused medical model narrative.
SUMMARY AND CONCLUSIONS
RO
SEMARY: Postmodern and well-being/healing
perspectives together suggest effective forms of resistance to the mental
illness / medical model narrative. Talking about “emotional pain” helps to keep
in mind that “mental illness” or “psychiatric diagnosis” are only a few of the
myriad of ways for naming and responding to such pain. An organizing narrative
is needed in relation to emotional pain. Narratives that focus on healing,
recovery, or other possibilities can provide a reassuring basis to name and
respond to emotional pain, but tend to be pre-empted in public discussion by
the dominance of the mental illness / medical model. Public arts events such as
Susan’s Shedding Skins exhibit can effectively direct public attention to
healing possibilities for naming and responding to emotional pain; can displace
the medical model narrative; and can thus undermine
perceptions that medical model care is the only viable response to emotional
pain. Public arts events related to emotional pain are particularly important
because of the pervasiveness of emotional pain in our society and the
considerable public interest in arts events that relate to emotional pain and
healing. Media reviews of such events could help to point out underlying
narratives and critique the narrow scope of events that encourage involvement
only in a mental illness/medical model care. Public arts events can contribute
to the healing of both individual artists and others living with emotional
pain. Such events also reduce stigma by honouring the ways in which individuals
with lived experience of emotional pain contribute to the larger society.
S U S
A N: I believe that individuals, along with their
communities and environment, benefit when an individual consciously sheds a
limiting or harmful behaviour and replaces it with one that brings them closer
to compassion for other and self. Unlike the media, which can trigger feelings
of being too small and helpless to make a difference in the world, dream and
art carry the potential to emphasize our oneness and ability to create change
by changing ourselves. In this context, I believe that my artistic work is the
radical individual offering to world-making that Gandhi described as, “Be the
change you want to see in the world.”
My hope for my
story and dream art is that they can contribute to contemporary meditations on
what it means to heal, and allow others to recall the world and peace-making
possibilities of their own dreams.
1 A sedative medication.
2 S. Schellenberg and R. Barnes, “Committed to the Sane Asylum: Art as
Political Action” (paper presented at PsychO U T: A Conference
for Organizing Resistance Against Psychiatry, Ontario Institute for Studies in
Education at the University of Toronto, Toronto, 7–8 May 2010), http://individual.utoronto.ca/psychout/abstracts/schellenberg-etal.html. Last
accessed 11 May 2012.
3 Schellenberg and Barnes, “Committed to the Sane Asylum: Art as
Political Action.”
4 In particular, see the strategies for both 2009 and 2012:
“Toward Recovery &
Well-Being: A Framework for a Mental Health Strategy for Canada,” Mental Health
Commission of Canada, 2009. http://www.mentalhealthcommission.ca/English/Pages/Reports.aspx.
Last accessed 30 December 2011.
“Changing Directions,
Changing Lives: The Mental Health Strategy for Canada,” Mental Health
Commission of Canada, 2012. http://strategy.mentalhealthcommission.ca/pdf/strategy-text-en.pdf.
Last accessed 15 May 2012.
5 Schellenberg and Barnes, “Committed to the Sane Asylum: Art as
Political Action.”
6 “Out of the Shadows at Last, Transforming Mental Health, Mental
Illness, and Addiction Services in Canada,” Senate Standing Committee on Social
Affairs, Science, and Technology, 2006. www.parl.gc.ca/39/1/parlbus/commbus/senate/com-e/soci-e/rep-e/pdf/rep02may06part1-e.pdf. Last
accessed 30 December 2011.
7 N. Brown and L.A. Miller, “Working with Trans Youth: Research and
Innovative Practice” (paper presented at Children’s Mental Health Ontario
Conference, Toronto, 21 November 2008), www.kidsmentalhealth.ca/documents/Res_CTYS_2008.pdf. Last
accessed 31 December 2011.
8 “Touched by Fire: A Unique and Exciting Online Gallery of Art by
Artists with Mood Disorders,” Mood Disorders Association of Ontario, 2011. http://www.touchedbyfire.ca/. Last
accessed 31 December 2011.
Feminist Resistance against
the Medicalization of Humanity:
Integrating Knowledge about Psychiatric
Oppression and Marginalized People
SHAINDL DIAMOND
Biological psychiatry is a massive enterprise
that is shaped by and interacts with other ruling institutions that are
likewise complicit in processes such as colonialism, capitalism, heterosexism,
transphobia, ageism, ableism, sexism, adultism, and patriarchy. Within this interconnected
web of power, certain marginalized people are particularly vulnerable to
psychiatrization.1 This has been demonstrated in various chapters
throughout this book by authors who address various ways that specific
marginalized groups are targeted by contemporary psychiatric discourses and
practices. Kirby writes about how trans people are forced to interact with the
psychiatric system in order to gain access to sex-reassignment surgery, thereby
opening them up to the medicalization of their oppression and resistance.
LeFrançois addresses how children and youth are disproportionately coerced into
relationships with psychiatry against their will, whilst officially appearing
on record as ‘involuntary’ or informal patients. In the next chapter, Mills
examines psychiatry as a tool of colonization that enforces dominant notions of
normality and “treats” those who do not pass as normal.
As institutional
psychiatry grows in power, more and more people are coming into contact with
the psychiatric system and are being labeled and subjected to different types
of psychiatric intervention. Women and girls coming from diverse social
locations are among the most vulnerable in this regard.
While there is a long history of women being conceptualized and treated as
insane, predating the current period of psychiatric dominance, biological
psychiatry is currently the prevailing force that labels and controls the
emotional distress and behaviours of women (Burstow 1992; Chesler 1972). There
are many disorders listed in the contemporary Diagnostic and Statistical Manual,
published by the American Psychiatric Association, that are predominantly
attributed to women: major depressive disorder; anxiety disorder; somatoform
disorder; factitious disorder; dissociative identity disorder, or
depersonalization disorder; adjustment disorder; sleep disorder; borderline,
histrionic, and dependent disorders; and post-traumatic stress disorder (Becker
2004; Burstow 2005a; Caplan 1995, 2004; Cohen 2004; Fish 2004; Gibson 2004;
McSweeney 2004; Rabinor 2004; Ussher 2011). Correspondingly, women are more
likely than men to be subject to psychiatric intervention, including
institutionalization, accompanied by restraints (Ussher 2011). They are three
times more likely to be prescribed electroconvulsive therapy and twice as
likely to be given psychopharmaceutical drugs (Burstow 2006a, 2006b; Ussher
2011).
This chapter will
look at feminist efforts to depathologize women’s responses to trauma and oppression.
I argue that these resistance efforts are most effectively understood in the
context of a larger struggle against psychiatric oppression – as outlined in
various other chapters in this book – and can offer insights that are useful to
a larger movement resisting psychiatric oppression and violence. My intention
is to demonstrate that feminist contributions are important in any struggle
against the medicalization2 of human experience. At the same time, I set out to
address how, at times, feminist efforts have fallen short of questioning more
insidious psychiatric theories and practices that pathologize human diversity
and responses to trauma. I will explore the importance of working towards a deeper
understanding of psychiatric oppression – one that resists the medicalization
of human experience in its many diverse forms.
GENDERING MADNESS
Women are not the only gender group subjected to
psychiatric labeling and intervention. Emotional, perceptual, and behavioural
experiences that are viewed as symptoms of mental illness are experienced by people of many different genders coming from diverse
social locations. Nevertheless, madness is a gendered experience, as the ways
people feel, perceive, and behave are judged differently depending on gender
role expectations (which are in turn shaped by race, class, disability,
sexuality, age, and other constructs) associated with the individual’s social
location (Ussher 2011). Madness is often attributed characteristics that are
associated with femininity – the irrational, emotional, weak, and hysterical –
and those who are read as mad within dominant culture are associated with these
signs of “femininity,” whether they are women, men, and / or trans3 (Chesler 1972). Furthermore, as mentioned earlier,
women are more often labeled with psychiatric diagnoses and are more frequently
subjected to different types of psychiatric intervention (Burstow 1992, Caplan
2004, Ussher 2011). Some groups of women are at even higher risk of being
psychiatrized, including elderly women, girls, racialized women, disabled
women, women in prison, trans women, and women living in poverty (Ali 2004;
Armstrong 2004; Bullock 2004; Burstow 1992, 2005, 2006; Javed 2004; Jordan et
al. 1996; Kilty 2012; Siegel 2004). The increased vulnerability of these women
is due to a combination of factors, including the ways in which they disrupt
patriarchal hegemony and the contact they may have with institutions (i.e.
nursing homes, prisons, schools, medical services, social assistance) that are
deeply invested in psychiatry as a means of controlling “deviance.”
Feminist critics
have frequently emphasized how psychiatric diagnoses ignore structural inequality
and oppressive conditions that shape women’s experience in favour of
individualized conceptualizations of biological deviations that reside in the
body (Caplan 1995, 2005; Chesler 1972; Penfold and Walker 1983; Ussher 1991).
Many have focused their efforts on deconstructing specific diagnoses, such as
major depressive disorder, borderline personality disorder, premenstrual
dysphoric disorder, and post-traumatic stress disorder (Burstow 2005a; Caplan
1995, 2005; Shaw and Proctor 2005; Ussher 2011). Rather than understanding
women’s experiences as a constellation of symptoms that are indicative of
mental illness, feminists have reframed these experiences as reasonable
responses to material inequities; oppressive gender role expectations that
limit women’s choices; and pervasive rates of sexual, physical, and emotional
abuse (Burstow 1992; Caplan 1995, 2005; Smith and David 1975). They recognize
that women respond to oppression, abuse, and violence in a
myriad of ways – they cut, they develop problems with eating, they express
emotional distress at home or in public, they use substances, and they act
angry (Bass and Davis 1988; Blackbridge and Gilhooly 1988; Burstow 1992). These
responses are viewed by many feminists as understandable reactions, means of
coping, surviving, and resisting oppressive conditions in women’s lives (Bass
and Davis 1988; Burstow 1992; Smith and David 1975). Challenging the
medicalization of women’s distress and coping is front and centre in feminist
resistance again psychiatric violence and oppression.
Feminists have also
emphasized the role of psychiatry as an institution of social control (Burstow
1992; Penfold and Walker 1983; Smith and David 1975). It is viewed as a tool
that supports patriarchy by forcing women into the roles of “good wives” and
“good mothers” and by silencing their responses to violence and structural
inequality (Chesler 1972). One feminist psychiatric survivor who I interviewed,
Jackie (cited in Diamond 2012), stated: “Psychiatry is where women end up after
they’ve experienced other forms of violence… abuse in the family, child abuse,
spousal abuse, rape, other assaults… and when they react… when they are not
functioning, in a way that makes others around them uncomfortable, they are
sent to the doctor… they are drugged, shocked into submission, until they learn
to act in a way more comfortable to others.” Psychiatric interventions,
including diagnosis, psychiatric drugs, electroconvulsive therapy, and
institutionalization, are viewed as a means of restraining women who are
behaving in ways that disrupt the hegemonic order (Burstow 2006a, 2006b;
Chesler 1972). Feminist campaigns have been developed worldwide to resist the
targeting of women with psychiatric procedures such as electroconvulsive
therapy (Diamond and Weitz 2008; Weitz, Maddock, and Andre 2010). Burstow has
named electroconvulsive therapy as a state-sanctioned form of violence against
women. Her qualitative research demonstrates how many women experience the
threat of electroconvulsive therapy as a coercive tool used to force them into
submission (Burstow 2006a, 2006b). Recognizing the lack of support that women
often receive when they turn to psychiatry, feminists have developed
non-medical services that recognize patriarchal oppression in the lives of
women so that they can seek support without being subjected to sexist notions
of how to adapt as a “respectable” woman (see also Baker Miller 1986).4
The groundwork feminists have laid over the past few decades is
extremely critical in larger discussions about resisting the pervasive trends
of biological psychiatry – trends that affect all of humankind. Deconstructing
the reasons why women experience higher rates of “symptoms” associated with various
diagnoses can help to shed light on why people of various genders and social
locations might have similar experiences of emotional distress. Understanding
why women experience depression in the context of patriarchal oppression and
violence can provide insight into why many differently situated oppressed
people are depressed (Ussher 2011). Such understandings can illuminate gendered
social relations; the ramifications of inequality and discrimination; and how
these cultural, social, and material realities shape the psychological
experience of humans. Likewise, analyzing how madness is theorized and treated
helps to provide insight into cultural expectations of gender and gender roles,
including what it means to be a respectable “woman” or “man.” Indeed, feminist
theorists and activists have offered critical understandings about how
psychiatry works to maintain the hegemonic order, and this work forms an
important foundation for the work differently situated people are doing to
depathologize and protect marginalized people from further psychiatric
intrusion (Becker 2004; Burstow 1992, 2005a; Caplan 1995, 2004; Chesler 1972;
Cohen 2004; Fish 2004; Gibson 2004; McSweeney 2004; Rabinor 2004; Ussher 2011).
DIGGING FOR THE ROOTS
OF PSYCHIATRIC OPPRESSION:
GOING BEYOND SINGLE ISSUE POLITICS
What is concerning is when feminist efforts or
the efforts of other marginalized groups fall short of considering the whole of
how psychiatry medicalizes emotional, perceptual, and behavioural experiences.
Some feminist theorists offer up in-depth critiques of how psychiatry enforces
gender expectations by punishing women who deviate from these expectations, but
then go on to suggest that there are some women who are genuinely mentally ill
and in need of psychiatric, psychopharmaceutical, or other types of
interventions (Penfold and Walker 1983). Certain diagnoses, such as
schizophrenia, appear to signify true biological fact and are left untouched by
many feminists who are otherwise very progressive about
contextualizing emotional distress and other facets of women’s experience.5 While this critique can be applied to many parts of
the feminist movement, there are numerous feminists who challenge this trend.
Some feminists are clear that the concept of mental illness itself furthers
psychiatric oppression and violence against women and girls, and partake in
psychiatric survivor and antipsychiatry initiatives (Burstow 1992, 2005b;
Diamond 2012).
The failure to
challenge all diagnoses, and the very concept of mental illness itself, reifies
the notion that some forms of emotional distress or human experience can be
reduced to naturally occurring biological functions in the body. This approach
ignores how differences in subjective experiences and bodily functions are
socially constructed as “sick,” “disabled,” “mentally ill,” or “in need of
correction,” and fails to recognize that much of the suffering associated with
these very same experiences can and does frequently arise from oppression and
trauma. There is of course very real suffering that people experience –
emotional distress, anxiety, and pain in the body – but medical discourses
designed to support hegemonic power relations largely define how we theorize
and interact with these experiences. While most feminists agree that intense
sadness, and problems with eating or cutting represent understandable responses
to trauma and oppression, many fear alternate experiences of reality or
perceptual experiences such as hearing voices and view these experiences as
legitimate grounds for physical psychiatric interventions. Treating certain
emotional and perceptual experiences as indicative of mental illness separates
women from one another and creates further divides among oppressed people of
all genders.
The phenomenon of
dominant power relations being reproduced in the context of progressive
political communities has been studied extensively by Black feminists. Audre
Lorde, for example, was among one of the first theorists to describe how these
dynamics are reproduced when marginalized people strive to attain the status of
the mythical norm, an ideal that is defined as white, able-bodied, hearing,
sane, rational, young adult, male, heterosexual, cis-gendered, Christian,
middle-class, and thin. Lorde (2007) explains that marginalized people often
identify one way in which they are different from the mythical norm and assume
this to be the primary cause of oppression, ignoring other misrepresentations
of differences, some of which they end up perpetuating themselves. The
collective consciousness of political communities is shaped by this mythical
norm, and while all people know on some level that they
can never attain this norm, they believe that the closer they get to attaining
it, the more respectability and power they will gain.
This desire to
ascend to the pinnacle to attain the mythical norm creates a hierarchical
structure within society that permeates all structures including social
movements. This poses major barriers to people coming together, to work in
solidarity to challenge systemic oppression at its roots. The question is: why
do political communities that are founded on liberation ideologies fall into
this trap? Fellows and Razack (1998) assert that it is an act of survival. They
argue that people fear their own erasure if they do not continuously prioritize
what they see as their primary issue and therefore focus on their own
subordination as a self-protective response. In addition, when individuals do
not relate to a specific manifestation of oppression, or are even privileged in
relation to others as a result of it, they are likely to discount others’
claims about injustice, just as dominant groups do when they hear the
narratives of marginalized groups (Fellows and Razack 1998).
As Fellows and
Razack point out, each individual is privileged by certain dominant
representations of the “other,” which they use to convince themselves that the
“other’s narrative” is not as legitimate as their own. To think or feel
otherwise, to focus on their own complicity in the oppression of others, is
experienced as a threat to their own claims for justice (1998). Where some
groups of people are set up to always be constructed as “lesser than” and their
oppression is naturalized through the power of the mythical norm, marginalized
individuals are pitted against one another in a race for respectability. In the
context of feminist efforts to depathologize women, frequently women who have
experiences that are not readily understood as resulting from violence are
excluded from non-pathologizing frameworks and are left in the hands of
psychiatry.
I do not mean to
suggest that the process by which certain groups are constructed as inferior is
accepted at a conscious level by those who construct some oppressed people as
mentally ill and others as sane while oppressed. Rather, this process is often
invisible to those who belong to dominant groups, those who are seen as “simply
human,” and who remain unmarked by identity labels. Fellows and Razack explain:
“The marking of subordinate groups and the unmarking of dominant groups leaves
the actual processes of domination obscured, thus intact.
Subordinate groups simply are the way they are; their condition is naturalized.
To be unmarked or unnamed is also simply to embody the norm and not to have
actively produced or sustained it. To be the norm, yet to have the norm
unnamed, is to be innocent of the domination of others” (1998, 341). In other
words, dominant culture conditions individuals to see human differences in simplistic
oppositional relationships that are constructed through binaries such as normal
/ pathological or superior/inferior (Diamond 2006; Lorde 2007; Wilchins 2004).
The “normal” subject is always positioned at the centre, while all other
subjects who deviate from the mythical norm are relegated to a “lesser than”
status. The “normal” is left unquestioned and unscrutinized, while all other
subject positions are under constant surveillance and re-evaluation (Wilchins
2004). The processes by which this happens are so ingrained in the organization
of the world, so built into language and the foundation of societal
institutions, that it creates a situation where individuals within political
communities have to work hard to bring them into consciousness and make them
visible.
Feminists have made
important advances by establishing non-medical counselling services, shelters,
and other crisis services for women who have experienced violence (see also
Baker Miller 1986).6, 7 These are invaluable resources for many women who
have experienced violence and can save many from entering the psychiatric
system by offering them non-medical places to turn to for support. However,
even within these services, some feminist practitioners believe that women who
they perceive as truly mentally ill are in need of some kind of psychiatric
intervention, such as drugs or institutionalization. Therefore, while some
women are spared psychiatrization, others who have been previously labeled as
mentally ill or who are having alternate experiences of reality are further
subjected to psychiatric intervention. For these women, even feminist
non-medical services can put them at further jeopardy. Perhaps it feels safer
to challenge the medicalization of experiences that are widely recognized as
symptomatic of inequality, oppression, and abuse while leaving psychiatric
conceptualizations of other experiences left unchallenged. Perhaps this allows for
some women to come closer to attaining the status of “normal,” thereby gaining
more influence within systems of power.
Another complicating factor is that feminist organizations running
support services and shelters for women are working with insufficient or
unstable funding and are often unsure of how they are going to keep their
services running. Important feminist organizations have been forced to close
their doors in recent times. For example, the Women’s Counselling, Referral,
and Education Centre (WCREC) in Toronto offered services to women,
including many psychiatric survivor women, for many years. This is a feminist
organization that actively supported psychiatric survivor and antipsychiatry
initiatives. The government cut funding for W C R E C , and in
2011, the feminists running this organization were forced to shut down the
critical services they offered. In more conservative political climates,
feminists may be afraid to broaden their analysis in ways that target
psychiatric ideology at its roots. Doing so may mean a loss of funding for
services that are critical in the lives of many women who have experienced
violence.
The ironic aspect
of this dynamic is that many women who identify as psychiatric survivors,
including those who are diagnosed with schizophrenia and those who have
alternate experiences of reality, are abuse survivors (Burstow 1992). Even
those who are not abuse survivors in the traditional sense are subject to
insidious forms of trauma that come from living in a racist, patriarchal,
classist, adultist, ableist, ageist, heterosexist, transphobic, and otherwise
oppressive society (Burstow 1992, 2005a). When these women are psychiatrized,
they are subjected to another form of institutional violence and are often
further traumatized. It is urgent that the feminist movement pay attention to
all women who are survivors of the psychiatric system and resist letting
psychiatric ideology limit the services they offer (or who they offer services
to) or their willingness to pay attention to the pathologization of a breadth
of human experience.
Contextualizing all
human experience is a critical step towards building stronger solidarity
networks within and among political communities that have vested interests in
challenging their psychiatric pathologization. Many marginalized people fall
into the trap of distancing themselves from those who they consider to be truly
mentally ill. Several examples appear in this book – in Withers’ chapter, which
mentions that some disabled people do not want to associate with psychiatric
survivors, and in Kirby’s interview, where he discusses the efforts of
transgender people to separate trans identities from
mental illness, while leaving the concept of mental illness itself
unchallenged. Another recurring example in this book is that of the gay rights
movement that fought for the removal of the diagnosis of homosexuality from the
D S M while failing to consider how many queer people would continue to be
psychiatrized for their responses to living in homophobic and heterosexist
contexts.8 It is often the case that individuals associated with
marginalized groups do not want to be viewed as “crazy” or “mentally ill” and
so distance themselves from people who represent what they accept as true
mental illness. They may at times forge strategic alliances with other
psychiatrized people, but ultimately, they fear further medicalization of their
own oppression.
These examples
demonstrate how the gains made by marginalized groups, which aim to achieve the
status of the mythical norm for some of the group members, takes place on the
backs of those most oppressed in their communities. It is understandable that
marginalized groups want to avoid being further pathologized, but in the long
run and in the bigger picture, these are not effective strategies. As Fellows
and Razack explain, “respectability is a claim for membership of another group;
attaining it, even one aspect of it, requires the subordination of Others.
Moreover, because subordinate groups that gain a measure of respectability do
not by definition possess all the attributes of respectability, they are in an
inherently unstable position” (1998, 352). In other words, while oppressed
people may feel they are advancing their own claim for justice by
differentiating themselves from other oppressed people, by failing to see one’s
own domination, they are leaving all the systems that privilege them and
oppress them intact, and thereby assuring the perpetuation of injustice.
Some marginalized
people have come to recognize the interconnectedness of differently situated
people’s liberation struggles and are digging for the roots of psychiatric
oppression. This is evident in certain events targeting psychiatric violence,
such as the feminist campaign against electroconvulsive therapy “Stop Shocking
Our Mothers and Grandmothers!” Many feminist and disability groups in Canada
have supported this campaign and recognize that electroconvulsive therapy needs
to be banned so that all people, regardless of how they are situated in
relation to psychiatry, are safe from this damaging procedure.
Audre Lorde argues that it is “the refusal to
recognize differences, and to examine the distortions which result from our
misnaming them and their effects upon human behaviours and expectation” (2007,
115) that separates us. All people exist within contexts where these
distortions shape our living, and it is the systems that create these distortions
that are common to all people. Yet in examining the histories of various
different groups of marginalized people, interdependence is revealed. It is
difficult, for example, for feminists to retain moral credibility while
pointing out the psychiatric targeting of women abuse survivors without
simultaneously recognizing how racialized survivors of violence are often
pathologized as schizophrenic (Metzl 2009; Sharpley and Peters 1999).
Similarly, it is problematic for psychiatric survivors to recognize the impact
of institutional violence within the psychiatric system without recognizing how
racism, sexism, ageism, adultism, heterosexism, transphobia, audism, and
ableism put specific groups of marginalized people at greater risk within the
system they are critiquing. Additionally, it is very impractical for all of us
to ignore the psychiatrization of elderly people, given that most people live
to be part of this group. As Hill Collins points out, the same inseparable
forces of domination shape the various experiences of marginalized groups, and
this recognition “can serve as a foundation for building empathy” among various
groups (2000, 247).
Diversity among
people resisting psychiatric oppression and violence elucidates the reality
that not all people experience psychiatry in the same way. In part, it is this
diversity of experiences that people have within the psy-complex (Rose 1999a)
that accounts for the different solutions people view as appropriate in their
healing, empowerment, and social change work. For example, the racialized woman
living in poverty who has been pathologized for how she copes with the
insidious trauma of living in a sexist, racist, and classist society may view
resistance against racism and classism to be central to her resistance efforts.
The woman who is psychiatrized because of how she has responded in the context
of an abusive relationship may find the most useful support from feminist
anti-violence initiatives. The child living in a group home who is
psychiatrized because of her reaction to sexual abuse perpetrated by adults may turn to a children-run organization, such as Youth in
Care Canada. The white man who is psychiatrized for hearing voices may find
home in a group focused on depathologizing his experiences and offering
alternative supports. The trans person who is forced to undergo psychiatric
scrutiny in order to access sex-reassignment surgery might be drawn to the
development of alternatives in healthcare for trans people. Narratives and
initiatives that resonate most with an individual’s firsthand experience will
have the strongest draw, and there is nothing wrong with there being a range of
healing, empowerment, and social change initiatives addressing the specific
safety needs and desires of particular groups of people.
At the same time,
as Black feminist Angela Davis points out, it is important to “be more
reflective, more critical” to recognize that “there is often as much
heterogeneity” within specific identity groups as within larger communities
(cited in James 1998, 299). It is important to recognize the specificities of
experience in order to develop initiatives that meet the needs of different
groups of people, as feminists working to depathologize and provide services to
women survivors of violence have done. It is equally important, though, to
allow these differences to lead us to a deeper understanding of connections
between us, and to use our understandings of local specificities to theorize
universal concerns more thoroughly. By doing so, differently situated people
who are resisting psychiatric medicalization can come to recognize how
resisting the medicalization of all identities will benefit us all. This is a
necessary part of doing more just and caring work that addresses inequality and
the suppression of many forms of oppressed people’s resistance. We must stop
being complicit in the medicalization and psychiatrization of humankind.
1 Psychiatry changes which
groups it targets at different moments in history and in different geographic
locations. As such, we must continuously re-evaluate which groups in society
are at greatest risk of psychiatric intervention.
2 As described by Kilty, medicalization “is a process through which an
entity that is not ipso facto a medical problem is responded to as a kind of
illness” (2012, 163).
3 I borrow Ambrose Kirby’s definition of trans here – to mean “a range
of identities including but not limited to transsexual, transgender, gender queer,
gender independent, M T F, F T M , M T M , F T F, transgirl, transboi, transman, and transwoman.” Like Kirby, I
recognize that this terminology may not “represent the stories and diversity of
all people who identify in these ways,” but we use it to begin this important
conversation.
4 “Women’s College Hospital,” 2012. http://www.womenscollegehospital.ca/programs-and-services/mental-health/. Last accessed 31 October 2012.
5 See the following sources: P. Chesler, “No Safe Place. The Phyllis
Chesler Organization,” (1998). http://www.phyllis-chesler.com/512/no-safe-place. Last
accessed 31 October 2012. “Brief Psychotherapy Centre for Women,” Women’s
College Hospital, 2012. http://www.womenscollegehospital.ca/programs-and-services/mental-health/brief-psychotherapy-centre-for-women-%28bpcw%29463/. Last
accessed 31 October 2012.
6 “Women’s College Hospital” (2012).
7 “Mission Statement.”
8 This example dates back as far as the early 1970s when the diagnosis
of homosexuality was still in the D S M . At this time, gay rights activists were fighting for the removal of
the diagnosis, arguing that being gay does not mean that a person is “mentally
ill.” While there was some overlap between the gay rights movement and the
ex-patient movement at that time, given the large number of queer people who
were labeled and treated as mentally ill, the arguments used to depathologize
queerness were based on, and reinforced, the normal / abnormal dichotomy. In
other words, the mainstream gay rights movement wanted gay people to be seen as
normal, respectable members of society, unlike those who were legitimately
viewed as sick and inferior.
Finally, in 1973, the
diagnosis of homosexuality was removed from the D S M due to
mounting pressures from the gay and lesbian community and changing societal
norms. It was replaced with the diagnosis ego-dystonic homosexuality, a term
used to describe a mental disorder related to the distress experienced by many
queer people. This diagnosis fails to take into account that one can expect to
feel distress when associated with an identity that is despised in dominant
culture. This again left the most marginalized queers behind in the fight for
respectability, as many lesbians, gay men, and other queer people, who did not
fit the mold of the “respectable” gay man or lesbian, were still constructed as
sick and abnormal by psychiatric discourse and by larger society. While
ego-dystonic homosexuality was eventually taken out of the DSM as well, the discourse used to depathologize gay men and lesbians
remains strong and does little to aid the situation of the most marginalized in
the queer community. To this day, for example, queer youth who are kicked out
of their family homes; those trying to support themselves as sex workers; and
those who cope with oppressive conditions by using strategies viewed as
deviant, such as drug use, remain marginalized and vulnerable to
psychiatrization because of discrimination and their reactions to poverty,
racism, homophobia, ageism, ableism, audism, adultism, heterosexism, and
sexism.
Sly Normality:
Between Quiescence and Revolt
CHINA MILLS
My psychiatrist asked if I heard voices. I
answered “No” [a lie]. My psychiatrist was glad to hear that: “Otherwise we
would have to hospitalise you in a psychiatric institution,” he said.
Ronny, in Romme et al. 2009, 27
When the great lord passes, the wise peasant bows
deeply and silently farts.
Ethiopian proverb, cited in Scott 1990, iii
I want to tell you two stories, stories about
pretending to agree, pretending to be “sane.” The first story is about Marie,1 she told it to me when I interviewed her about her
experiences within the psychiatric system.
MARIE
Marie heard voices for a long time; they helped
her and comforted her while her parents sexually abused her. However, sometimes
as an adult they caused her distress, usually a sign for her that she was
getting stressed or a reminder that she should tell someone about the abuse she
experienced as a child and kept secret for a long time afterwards. After a
particularly distressing experience she found herself involuntarily
hospitalized, face to face with a psychiatrist. She found the courage and told
him for the first time she had ever told anyone that she
was abused as a child. He told her “she was saying that because she was ill.”
She made a decision: she knew that this wasn’t somewhere she’d get well, so she
pretended to comply, pretended to agree, nodded her head to whatever the
psychiatrist said, in order to get out as fast as she could.2
The second story is
about George.
GEORGE
In the 1950s, George, who was labeled as a
“chronic schizophrenic,” was one of the first people in a psychiatric hospital
in the U S A to take part in a clinical trial for chlorpromazine (Thorazine); the
first neuroleptic to be used in psychiatry, the drug heralded as marking the
beginning of pharmaco-psychiatry.
No one had paid George any attention for years.
Now doctors, attendants, and nurses all talked to him and watched eagerly to
see what effect the drug would have. His condition improved rapidly. After only
two weeks of the drug treatment he was moved to a ward for less disturbed
patients where he took part in a number of activities. Soon he was doing so
well that he was promoted again. By this time he had lively relationships with
the other patients and many members of the hospital staff. He began to spend
several hours a day with paints and clays, using them to express the rich
fantasy life that had previously interested no one. His doctors marvelled.
Attendants praised his skill. George was released from the hospital
thirty-eight days after his first dose of Thorazine. While he was signing out
he remembered that he had left something behind, went back to his room, and
returned with an old sock. The puzzled attendant who asked to see it found
thirty-eight Thorazine pills carefully stashed inside the sock. Why, then, had
George suddenly come to life? (Dallett 1988, 15)
Pretending to
agree, pretending you don’t hear voices, pretending to be “normal,” pills
hidden under tongues, inside cheeks, and inside socks. Psychiatry is haunted by
such pretending, by a hidden territory of survival and resistance, like the
“infrapolitics” of disguise and deception employed by colonized peoples while
they may outwardly appear, in power laden situations, to willingly consent
(Scott 1990). While often not read as political, such
“keeping secrets and telling lies” (Siebers 2004, 1) marks a “veiled
resistance,” a troubled “political terrain that lies between quiescence and
revolt” (Scott 1990, 197 and 199). This is a space where official constructions
of “good adjustment,” maintenance, and recovery may work to mask “phantom
acceptance” and “phantom normalcy” (Smith 2006, 122).
This chapter is
about finding ways to read these stories and strategies of pretending, to see
if we can fleetingly glimpse how pretending might disturb our understanding of
what it means to be “normal,” how pretending might be subversive. This comes
out of and connects to a wider project of tracing how the colonial relation is
mobilized within psychiatric treatment (Mills 2014). This has the aim of
thinking through how the violence of colonialism may enable a rethinking of
contemporary forms of psychiatric violence, particularly the construction of
certain forms of violence as “natural,” “necessary,” and “normal” – that is,
violence in the name of “treatment” (Mills 2012a). Using post-colonial theory
here enables an exploration of how strategies of resistance to colonialism may
be read alongside and used to illuminate resistance to psychiatry – resistance
that may be secret, sly, covered up. At first I wondered if this pretending is
a strategy that has links to “passing,” as normal.
PASSING
Passing marks the crossing of lines, of
identities, of boundaries. It was first referred to in nineteenth-century US
posters offering rewards for runaway slaves who were attempting to pass as
white, and thus as “free” (Sollors 1997). Here “passing” meant escape and
freedom for enslaved peoples, escape from slavery into a world of white privilege.
The literature suggests different typologies of passing, between passing
voluntarily with its links to deception and political subversion, and passing
almost by accident (Sollers 1997).
There are also many
facets of learning to pass; the places out of bounds, “where exposure means
expulsion,” and the “back places” where concealment is not necessary (Goffman
1963, 102). This partitioning of the world into forbidden, civil, and back
places “establishes the going price for revealing or concealing and the significance
of being known about or not known about” (ibid., 104). This partitioned world
is evident in Scott’s account of colonial oppression where the “subordinate
moves back and forth… between two worlds: the world of the
master and the offstage world of subordinates” (1990, 191). It can also be read
in the experience of occupying other worlds, hearing voices, and dissociating.
This concealment is evident in another story:
A voice hearer is travelling by train from
Sheffield to London. He’s taken the advice of people in his support group and
pinned a small microphone to the lapel of his jacket. This way, he can talk
back to his voices and appear to be speaking into a mobile phone. Soon after
the train leaves the station, he, like other passengers, begins an animated
conversation. Nearing London, the train goes through a series of tunnels.
Everyone else loses telephone contact, but he keeps chatting. When the journey
ends at St Pancras station, a man comes up to him and says, “I’m sorry to
intrude, but I couldn’t help noticing that your phone kept working when none of
ours did. Could I just ask, what Network are you on?”’ (Hornstein 2009, 49)
Seemingly, then, people sometimes pass too well,
which hints at why passing held both anxiety and fascination for whites in the
nineteenth century Unites States, an anxiety that was muted by the assumption
that one could “always tell” (Sollers 1997, 250). While Ronny pretended not to
hear voices to avoid hospitalization, for Rosenhan in the 1970s, the opposite
was true. Rosenhan3 and a group of researchers pretended to hear voices
in order to be hospitalized, to put psychiatry’s assumption that we can “tell
the normal from the abnormal” to the test. Psychiatry didn’t do so well. Upon
telling a psychiatrist that they heard a voice that said “thud,” all the
participants were admitted to psychiatric hospitals, all then behaved as they
usually would, behaved “normally,” and many couldn’t get out for months. It
seemed then that a sane individual could not be “distinguished from the insane
context in which he is found.”4 In order to be released the participants had to
pretend to agree that they had been ill.
In Rosenhan’s
study,5 the researchers passed as voice hearers; they
passed, posed, masqueraded as what they were “not really.” Thus a passer is
usually considered a counterfeit, a pseudo, a phoney, or an impostor (Sollers
1997). But here the “not really” that one passes as suggests that there is a
real identity, a “firm and immutable identity” as which one is attempting to
pass (Sollers 1997, 250). There’s a problem here, then, in
relation to passing as sane, for if we assume that the person passing “really”
is mentally ill and is secretly passing for what they are not – passing as sane
– then this maintains the binary of sanity and insanity.
In the account of
passing above, passing is reliant on a prop, it is made possible because of a
microphone, a mobile phone “hands free” set. Many of my friends who hear voices
have told me stories about the freedom to talk to their voices made possible
through mobile phones. Might medication then also be a prop to enable passing?
However this is a prop that aims to eradicate the voices, to enable the person
to “become” normal, to be assimilated. This seems different to me from passing
as white, for while both enable the person whose identity is denigrated to
assume an appearance that enables them to access the more privileged position,
there is a difference. For while the person who hears voices is able to appear
“normal,” to blend in using certain props and strategies – these tactics also
enable them to hear and speak to the voices that psychiatry and society insist
are not really there – to speak to them, slyly. Thus while passing may at times
be sly, pretending seems always to be. Is it possible, then, to read the story
of pretending another way, a way that disrupts assumptions of a “real”
identity, and as a strategy that implies something other than assimilating,
adapting? We might read pretending through a post-colonial lens, as a form of
mimicry.
“ALMOST THE SAME, BUT NOT QUITE”
Pretending to be normal – mimicking – seems to
emerge in the stories of those who have survived the psychiatric system as a
tactic, a strategy of deception that enables some freedoms, at a cost. Stories
of pretending, of being sly, resonate with Homi Bhabha’s framing of mimicry as
a key colonial ambivalence, “the desire for a reformed, recognizable Other, as
a subject of difference that is almost the same, but not quite” (1994, 85).
Constructed around ambivalence, colonial mimicry must, in order to be
effective, continually produce its slippage, produce difference. This makes mimicry
one of the most “elusive and effective strategies of colonial power” (Bhabha
1994, 85). It is effective because colonial discourse, and arguably psychiatry,
frame the colonized (and the mentally ill) as similar to the colonizers, the
so-called sane, but not identical. If they were identical then
the ideologies that justify colonialism and psychiatry’s interventions could
not operate, because these “ideologies assume that there is structural
non-equivalence, a split between superior and inferior which explains why any
one group of people can dominate another at all” (Huddart 2006, 40). However,
mimicry, in its very effectiveness, is elusive because of the introduction of
difference, of the “almost the same, but not quite.” This difference, between
normal and abnormal, sane and insane, is “the disturbing distance in-between
that constitutes the figure of colonial otherness” (Bhabha 1994, 45). In this
between space, between difference and the same, a difference is enabled that
cannot be contained, a space is opened up for “something other, a difference
that is a little bit uncanny” (ibid., 131). It is here that the agency of the
colonized emerges.
MOTTLED AGAINST A MOTTLED BACKGROUND
Lacan says that “Mimicry reveals something in so
far as it is distinct from what might be called an itself that is behind”
(Lacan 1977, 99). Being distinct from an “itself” behind hints at something
more than blending in with the background of normative expectations. For Lacan,
nothing of what can be understood as adaptation (behaviour to survive) can be
found in mimicry. This is because mimicry operates “strictly in the opposite
direction from that which the adaptive result might be presumed to demand,”
thereby subverting assimilation. Here adaptation to one’s background is always
bound up with the needs of survival. To mimic one’s background “is not a
question of harmonizing with the background but, against a mottled background,
of becoming mottled.” Might we therefore infer that while adaptation solely
enables survival, mimicry works in the “opposite direction,” as disguise, and
as camouflage? Lacan likens this to the kind of camouflage practiced in human
warfare – thus suggesting that, more than survival; mimicry is a practice of
deception (1977, 99).
One key strategy of
mimicry for Bhabha is sly civility, summed up in the Ethiopian proverb “When
the great lord passes, the wise peasant bows deeply and silently farts” (1994,
141; cited in Scott 1990, iii). Slyness marks a “turning off” response; it is
“the native refusal to satisfy the colonizer’s narrative demand,” which
“represents a frustration of that nineteenth century strategy of surveillance,
the confession, which seems to dominate the ‘calculable’ individual by
positing the truth that the subject has but does not know” (Bhabha 1994, 141).
We could read
psychiatry then as a form of surveillance, a means to convert the “irrational”
into the “calculable” through diagnosis, which posits the psychiatric truth
that what some people have, but do not yet know it, is a “mental illness,” a
“biochemical imbalance.” This is a making calculable – or, for Fanon, making
“palatable” – of difference (1986, 176).
SLYNESS
Thus we could read pretending to be normal –
through hiding pills under tongues and inside socks, through pretending not to
hear voices – as a form of sly civility, or sly normality, that disrupts
psychiatry’s attempts to make people calculable. For Bhabha this slyness is
more than a refusal of a narrative demand for the “incalculable,” for it
produces a problem for colonial codifications, it generates an uncertainty in
its refusal to be intelligible, it “changes the narratorial demand itself”
(1994, 141).
This refusal to be
intelligible through appearing to be intelligible seems different from the
“refusal to reproduce hegemonic appearances” discussed by Scott (1990, 203).
Pretending to be normal – sly normality – is the opposite of this, as it seems
to work not through refusal of, but through the very production of the signs of
“normative compliance.” It appears to comply, it mimics normality, it fools the
eye. It works like the genre of art known as the “trompe l’oeil,” which
imitates “the depicted object so convincingly that the viewer is momentarily
seized by an inability to tell the difference between original and copy, reality
and representation” (MacLure et al. 2010, 496). Marie, George, and Rosenhan6 also “fool the eye” by imitating sanity and insanity
so convincingly that for a moment it becomes impossible to tell the difference
between them; they mock psychiatry’s claims to tell the difference, and raise
an anxiety that challenges the integrity of any model that can be mimicked and
then discarded so easily.
For Bhabha, this
marks an “area between mimicry and mockery,” a space that poses an imminent
threat to both “normalized” knowledges and disciplinary powers” because it
“quite simply mocks its [psychiatry’s, colonialism’s] power to be a model, that
power which supposedly makes it imitable” (1994, 86–8).7 This has echoes with the
strategies of creative self-protection employed by colonized peoples, the
“comical imitativeness which indirectly reveals the ridiculousness of the
powerful… an uncanny ability to subvert the valued skills or traits which may
ensure one’s adaptation to the ‘system’” (Nandy 1983, 84). Stories of
imitating, pretending, mimicking may enable self-protection because they
provide camouflage. Thus mimicry is linked to the visual, to invisibility,
faint figures, and partial presence. When Marie pretended to agree with her
psychiatrist and when Ronny pretended he didn’t hear voices, the penetrative
psychiatric gaze was dislocated by this pretence, as a space from which to look
back, partially unseen.
For Scott, “the
circumspect struggle waged daily by subordinate groups is, like infrared rays,
beyond the visible end of the spectrum” (1900, 183). This partialness could
itself be a symptom of colonialism and of oppression, of the surveillance of
psychiatry. Yet for Fanon, who was pointed at, hailed, through the look of a
white child, this surveillance does not make him invisible, it brings him into
being as a subject, as a black man:
“Look, a Negro!”… I was an object in the midst of
other objects… sealed into that crushing objecthood… my body suddenly abraded
into non-being… the glances of the other fixed me there… My body was given back
to me sprawled out, distorted… completely dislocated… I took myself far off
from my own presence, far indeed, and made myself an object. What else could it
be for me but an amputation, an excision, a hemorrhage that spattered my whole
body with black blood?… Where am I to be classified? Or, if you prefer, tucked
away? (Fanon 1986, 112–13)
“Objectified,” “sealed,” “abraded,” “crushed,”
“tucked away,” this language speaks of the force of colonial subject formation,
the spattering of identities that seems to resonate with the formation of
psychiatric subjects, the “stickiness,”8 the for life-ness9 of psychiatric diagnoses. Peter Bullimore, a
psychiatric survivor and voice hearer, was told by his psychiatrist, “you are a
chronic Schizophrenic, you will never ever work again, go away and enjoy your life.”
To him “the words were so damning… you may as well have just ripped my heart
out.”10 An amputation, spattering of black blood, hearts
ripped out, this is a language of the psychic violence enacted by
colonial and psychiatric systems of forming subjects. Here the violence of
colonial and psychiatric subject formation are more deeply entangled than mere
analogy, for psychiatry was a key tool of empire, a symbol of “civilization.”11
Fanon’s (1967)
encounter alludes to the partitioned partial worlds of the colonized, “a
doubling, dissembling image of being in at least two places at once”… a
peculiarly colonial condition,” like Fanon’s black skin, white masks (1986,
xvi). The idea of taking yourself from your own presence seems to resonate with
stories of how some people use dissociation to escape the trauma of their
immediate surroundings. This hints at a way of reading these experiences
psychopolitically, which in turn raises the question of how psychic oppression
and trauma are interlaced with the socio-economic.
Bhabha’s reading of
Fanon takes this even further. Fanon’s taking himself from his own presence
interrupts the interpellating hail,12 he “defers the object of the look” (Bhabha 1994,
79), the white gaze that spatters his body with black blood. For Bhabha this
invisibility, this non-being, in its refusal of presence (its refusal “to be”),
interrupts identification and interpellation, and therefore works as a strategy
of resistance and subversion, disrupting assumptions of the unitary subject.
Such techniques disturb the logic of “specular identification and reveals the
performative fictions at the centre of such categories” (Ginsberg 1996, 13).
Such secret arts
enable those who enact them to “subvert the perverse satisfaction of the
racist, masculinist gaze” that disavows their presence, “by presenting it with
an anxious absence, a counter-gaze that turns the discriminatory look… back on
itself” (Bhabha 1994, 67). These disembodied eyes of the subaltern that speak
and see from where they are not, disrupt and subvert both the presumed unitary
“I” of identity, and the surveillant, disciplinary “eye” of psychiatry. In
looking back, unseen, Marie and Ronny could be read post-colonially as
subverting the perverse satisfaction of the psychiatric gaze that denies their
experiences and delegitimizes their presence. They look back through a counter
gaze that turns the discriminatory and delegitimizing look back on psychiatry
itself.
For Bhabha there is
something particularly feminist in this representation of invisibility as a
form of subversion, this veiled resistance in mimicry as a “secret art of revenge”
(1994, 80). This is resistance read between the lines. This “veiled resistance”
has often not been read as political; however for Scott (1990) it marks a
strategy in the “infrapolitics” of subordinated groups, a
politics that leaves few traces, that covers its tracks. There is an
interlacing and yet also a distinction being made here between invisibility and
mimicry, a distinction between invisibility as adaptation (blending in) and
invisibility as resistance (being mottled, camouflaged).
The subaltern
instance of the slyly normal thus disrupts the boundaries of rationality and
normality, and “wreaks its revenge by circulating, without being seen” (Bhabha 1994, 79).
According to Bhabha these strategies do more than veil resistance – they create
a crisis in the representation of personhood that “at the critical moment,
initiates the possibility of political subversion” (1994, 79). But how do the
partial figures of the colonized and of the slyly normal initiate political
subversion? How does a shared critique of power translate into overt political
action, and how can it be used to make psychopolitical demands on those in
power? We might thus question the scope of resistance made available through
post-colonial readings of resistance to psychiatry. Although post-colonial
theory may provide useful conceptual tools for exploring and analyzing people’s
small, often passive acts of resistance, it remains difficult to see how such
strategies could have more wide scale sociopolitical significance.
“INFRAPOLITICAL SHADOWS”
Much writing on resistance by oppressed groups
assumes that within such groups there is a desire to speak back to the dominant
class, an accumulation of pressure from living under unequal conditions.
However critics differ in whether this desire is satisfied and thus pacified in
the “hidden transcripts” of the oppressed, the “backstage talk,” the “offstage
discourse of the powerless,” and whether these strategies are a substitute for
more “real” political resistance (Scott 1990, 184). Some feel these tactics may
quell or cool off the desire to resist, and so act as a “relief valve” to
preserve the status quo. However, for Scott, this debate presents an abstract
situation that assumes one dominant side and one powerless one, when in fact
subordination is rooted in material practices connected to appropriation. Thus
veiled resistance is enacted through a “host of down-to-earth, low-profile
stratagems designed to minimize appropriation,” acts such as pilfering, feigned
ignorance, shirking, careless labour, secret trade, foot dragging, and poaching
– small acts that carried out on a large scale can have
widespread economic effects (ibid., 188).
If we then read
psychiatrization (the understanding of ever-increasing experiences in
psychiatric terms) as a form of colonial appropriation – appropriation of the
psychic means of resistance, of personal and political understandings of
distress – then we might see sly normality as a strategy to minimize
psychiatric appropriation. In Scott’s terms, far from “letting off steam” to
retain the status quo, such hidden transcripts are “a condition of practical
resistance rather than a substitute for it” (ibid., 191). They form the
“infrapolitical shadow” that lurks behind every act of open resistance (ibid.,
184), a shadow that enables resistance to be sustained in situations where open
confrontation is not possible. This speaks to a further need, then, to
understand the conditions under which veiled resistance might speak its name
and also when open resistance might become veiled (Scott 1990).
Scott explores how
the disguised hidden transcript can, in theory, provide the conditions to
develop a shared critique of power. Such a critique could lead (and
historically has) to the development of networks of solidarity through collectively
defined common experiences of, and strategies of resistance to, social
inequality and coercive psychiatric treatment. Scott urges us to attend to
these offstage political acts of disguise, to enable us to “map a realm of
possible dissent” (ibid., 20). A map of the “lies, secrets, silences, and
deflections… routes taken by voices or messages not granted full legitimacy in
order not to be altogether lost” (Johnson 1978, 31).
How do we document
these experiences and strategies; how do we make such maps without having them
rearticulated within the technocratic language of the market (i.e. as manuals
where mimicry becomes a coping strategy, available to buy), without them being
capitalized upon as new commodities in a global (mental) health marketplace,
and without them being rearticulated as new disorders by the pharmaceutical
industry within an ever expanding Diagnostic
and Statistical Manual.
For example, in a
recent advertising campaign for Seroquel X R,13 an anti-psychotic used for “Bipolar Depression,”
viewers are informed that “Bipolar depression doesn’t have to consume you”
(presumably if you consume the drug), ending with the caption, “Don’t fade,
fight.”14 This implies that fading is the opposite of fighting
and that in order not to fade (to become visible) one needs to
consume medication – Seroquel XR. This sets up a false
binary between fading and fighting, as though fading implies that a person is
not fighting. This stands in contrast to the potential resistance and
subversion implied in being faint, how in fading a person might fight against
the normative gaze of psychiatry or pharmacology through their very denial of
fully “being”; the disruption of presence. While fading and mimicry might then
be strategies for refusing to be interpellated within the neoliberal market
economy, they may also be translated by psychiatry as a symptom of an illness
to be marketed, a commodity within the very market economy that they (as
strategies of resistance) sought to refuse.
“ALMOST ANOTHER SPECIES”
Perhaps, then, we are all pretending to be normal
– but seemingly some people occupy the position of having to pretend. They have
to pretend to be normal because psychiatric diagnostic systems work to
construct certain people as “outside” normality, and outside humanity; a set of
people who can be intervened with, rescued, and “treated” by others in their
“best interests,” with or without their consent (Mills 2012a). Here labels of
“irrationality” and experiences constructed in the language of pathology as
“symptoms” – such as hearing voices – act as tropes in which humans undergo a
suspension of their ontological status as humans (Spandler and Calton 2009).
This suspension seems linked to biological explanations of distress, found by
Read et al. to be understood by the public as implying that those with a
biochemically framed “mental illness” “were fundamentally different or less
human,” and “almost another species” (2006, 313 and 311). This has strange
echoes with colonial constructions of non-Europeans (and particularly women) as
either; “ripe for government, passive, child-like… needing leadership and
guidance, described always in terms of lack – no initiative, no intellectual powers…
or on the other hand… outside society, dangerous, treacherous, emotional,
inconstant, wild, threatening, fickle, sexually aberrant, irrational, near
animal, lascivious, disruptive, evil, unpredictable” (Carr 1985, 50). Thus
colonial constructions of the Orient as backward and wild, populated by
irrational, primitive natives in need of civilizing and rescue for “their own
good” has its parallels with psychiatry’s construction of particular people as
irrational, violent, and dangerous.
Invisibility, camouflage, and mimicry – the
psychological defenses of the colonized (including the psychiatrically
colonized) – may undermine psychiatry’s attempts at diagnosis and treatment,
showing the incomplete character of any civilizing or normalizing project to
fully produce a docile body or mind. Yet this resistance seems unable to
rearticulate the terms of subject formation insofar as to “thwart the
injunction to produce a docile body is not the same as dismantling the
injunction or changing the terms of subject constitution” (Butler 1997, 88). It
also may do little to get you released from a psychiatric facility. Moreover
such secret strategies and tactics can take their toll on people emotionally,
meaning that practicing “sly normality” can be hard work: “I find that having
psychosis is horrible, but unless I’m acting strangely no one knows and I’m
expected to seem normal. I hear very distressing voices all the time and
occasionally get weird delusions and see things in a way that other people say
are not real. I’ve been admitted to hospital and sectioned several times
because of it.”15 Here the expectation to seem normal may obscure the
performance of being slyly normal – how can we tell the difference? Seemingly,
in order to be slyly normal, one must always be aware of dominant models of
normality and know oneself to be disqualified from them – people must know what
“normal” is to be able to “do” it slyly. Thus for Marie to pass as sane, or
recovered, to be slyly normal, requires her to know what the norm is, to know
that she doesn’t fit that norm, and to know that in order to escape the
psychiatric gaze she must learn to emulate that norm.
While passing as
normal may help secure a place of privilege within the hegemonic, for
Titchkosky (2001, online), everything about those whose disabilities or
differences are invisible “can be made to signify normalcy” and furthermore
these invisible disabilities are “made invisible by the structures and
assumptions of normalcy.” To make visible these invisible disabilities, to come
out as disabled, one must then navigate normative practices of seeing
disability, where one may easily be seduced by normal understandings of
disability as lack, for example in naming one’s difference through a diagnosis
(ibid.).
In Loomba’s (1998) reading of Fanon, the black
person adopts white masks to enable survival and thus “black skin/ white masks
reflects the miserable schizophrenia of the colonized’s identity” (Loomba 1998,
124). Here schizophrenia is deployed as a figure to describe the colonial
condition. However it also opens up a reversal, the possibility of reading the
colonization at work within the diagnostic category of schizophrenia.
For Fanon it is
colonialism itself that is psychopathological, “a disease that distorts human
relations and renders everyone within it ‘sick’” (Loomba 1998, 122), which
hints at the possibilities of a psychopolitical reading of how psychiatry
renders increasing numbers of people as sick (Whitaker 2010). Fanon goes on to
explore how signs usually interpreted as caused by faulty brain structures
within the colonized may mark symbols of resistance. He cites the example of
laziness, reading it as marking “the conscious sabotage of the colonial
machine” by the colonized (1963, 239). He continues, “The Algerian’s
criminality, his impulsivity, and the violence of his murders are therefore not
the consequences of the organization of his nervous system or of the characterial
originality, but the direct product of the colonial situation” (Fanon 1963,
250). Here what psychiatry calls “mental illness” is read as a product of the
colonial situation, of inequality, and alienation; furthermore, in its
translations of this distress into psychiatric diagnostic categories,
psychiatry also alienates, colonizes. This is to read psychiatry critically
through a psychopolitical lens, one that for Hook is a move beyond solely blame
or emphasis on psychic damage, “towards a strategic consolidation of
psychopolitical resources, be those communal (a solidarity of the oppressed) or
subjective (a politics of everyday experience)” (2012, 40). In his “in-between”
reading, Bhabha is highlighting the disjunction inherent in colonial discourses:
that they contain their own undoing, that mimicry is “at once resemblance and
menace” (1994, 86). That, “in ‘normalizing’ the colonial state or subject, the
dream of post-Enlightenment civility alienates its own language of liberty and
produces another knowledge of its norms” (Bhabha 1994, 86). Marie’s pretending,
the mimicry of sanity and insanity might then work to produce another knowledge
of the normative assumptions of psychiatry, another language “that could help describe the dominant in terms different than its
own” (Achuthan 2005, cited in Chakrabarti and Dhar 2009). This has echoes with
Gandhi’s endorsement of the “non-modern Indian reading of the modern West,”
which was an attempt to refuse to meet the West’s criterion for antagonism
(Nandy 1983, 102). In so doing Marie’s pretending marks a refusal to meet
psychiatry’s criterion for what counts as “sane.”
This heeds Nandy’s
(1983, 12) warning that dissent to colonialism was often controlled by the
colonizers, who put forward a way of being anti-colonial that was promoted as
“proper,” “sane,” and “rational,” making it possible to “to opt for a non-West
which itself is a construction of the West.” Nandy continues: “Particularly
strong is the inner resistance to recognizing the ultimate violence which
colonialism does to its victims, namely that it creates a culture in which the
ruled are constantly tempted to fight their rulers within the psychological
limits set by the latter” (1983, 3). Reading psychiatry as enacting a colonial
relation, then, we might trace how it works to set the boundaries of what
counts as sane, promoting “sane” and “rational” ways to be anti-psychiatry – an
anti-psychiatry that is a construction of psychiatry. Although colonization
rarely destroys all creativity and resistance, for Gruzinski “it does succeed
more than often in weaving indissoluble ties between indigenous cultures and
the imported ones” (cited in Rahnema 1988, 169). Thus while resistance may be
sly, so too can be the monopoly of biopsychiatry as it weaves indissoluble ties
between people labeled as mentally ill and medication – ties that are socially
and biologically hard to break.
SLY NORMALIZATION
While some people may practice sly normality,
techniques of normalization operate slyly and invisibly too. Pharmaceutical
companies often do not make adverse and harmful effects of drugs found in
clinical trials public; they ghostwrite articles in psychiatric journals to
market their products; they pay for psychiatric conferences in exotic locations
(Healy 2006, Moncrieff 2003). I have heard many stories about the effects of
taking psychiatric medications; of drooling, of forgetting things, of not being
able to recognize the faces of friends. What happens, then, when medication
enters the performance of sly normality? How “sly” can you be when, as Pete told me he had felt while in a psychiatric hospital, you are
so heavily medicated that you’re like a “zombie,” when you can’t think anymore
and find it exhausting to speak. And what about if small doses of medication
enable people to be sly, help them to pretend in order to escape the
psychiatric gaze and then stop taking the medication given to them by
psychiatrists? Or does medication work to make people visible, to prevent
slyness? Is it possible to be sly in psycho-pharmaceutical spaces?
How can we know if
pretending to be normal is sly, and whether sly normality resists psychiatry
within its own limits, remaining an “homage to the victors” (Nandy 1983, 12)?
Sly normality as a hidden transcript, an infra-political strategy of resistance
(Scott 1990), thus leads us into a new terrain; one that is partial, secret,
almost invisible, but not quite. But with what tools can we recognize and “see”
sly normality? If mimicry and slyness provide camouflage – invisibility – born
of an awareness of unequal power relations, what are the ethics of “seeing” it?
If we “see” it, does this not diminish its subversive potential, the partial
visibility central to it as a strategy of resistance? Or is it in the breaking
of the illusion that subversion may lie? How can we encounter sly normality
without capitalizing on it, without assimilating it? And when we do encounter
it, how do we know if it is not recuperating the norm: how do we know if it’s
subversive? We will never know the number of pills hidden under tongues and
inside socks. This is sly normality as ambivalence, as seduction, as symptom of
oppression, and as subversion.
1 All names have been changed throughout (unless specified) to ensure
anonymity.
2 Story told to me during a piece of research titled “Young People’s
Stories about Hearing Voices” funded by Research Institute of Health and Social
Change (R I H SC), at Manchester Metropolitan University (M M U), December
2007–March 2008.
3 D. Rosenhan, “On Being Sane in Insane Places,” (1973). http://psychrights.org/articles/rosenham.htm. Last
accessed 28 June 2012.
4 “On Being Sane in Insane Places.”
5 Ibid.
6 Ibid.
7 This space between mimicry and mockery also seems to be at work in
spoof/fake adverts for psycho-pharmaceuticals; see C. Mills (2012b).
8 “On Being Sane in Insane Places.”
9 I. Tucker, “‘This is for Life’: A Discursive Analysis of the Dilemmas
of Constructing Diagnostic Identities,” Forum:
Qualitative Social Research (FQS) 10, no. 3 (2009):
Article 24. http://www.qualitative-research.net/index.php/fqs/article/view/1376/2872. Last
accessed 12 September 2010.
10 From an interview with Peter Bullimore as part of a research project,
funded by the Research Institute of Health and Social Change (R I H S C), at
Manchester Metropolitan University (M M U), December 2007–March
2008.
11 For a more detailed exploration of the intertwining of psychiatric,
and colonial, systems of subject formation, please see Mills, 2014.
12 This draws upon Althusser’s (1971) formulation of interpellation,
which occurs when a subject turns in answer to a shout in the street, similar
to the banal, everyday act of a police officer hailing a person – “Hey, you
there!” And by turning, the subject becomes the “you there,” meaning they come
into being through being hailed by an ideology.
13 “Seroquel X R Advertisement,” Seroquel X R , 2010. http://www.youtube.com/watch?v=ictonupsrb0. Last
accessed 27 September 2011.
14 Ibid.
15 P. Byrne, “Managing the Acute Psychotic Episode,” Clinical Review, British Medical Journal
334 (2007): 690. http://www.bmj.com/cgi/content/extract/334/7595/686. Last
accessed 22 May 2010.
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Contributors
SIMON
ADAM is a nurse and nurse educator. He is currently
completing his doctoral studies at the University of Toronto. Simon’s research
is in the area of nursing education and the teaching and learning of mental
health nursing, focusing on the power relations and language in education and
in clinical work. His community activism work involves working with psychiatric
survivors and antipsychiatry activists on various projects, including
abolishing electroshock and restricting the psychiatric drugging of children.
ROSEMARY
BARNES is a psychologist who has worked atToronto
General and Women’s College Hospitals and been affiliated with the University
of Toronto, York University, and the Ontario Institute for Studies in
Education. She is currently in independent practice. She is co-author of Committed to the Sane Asylum: Narratives on Mental
Wellness and Healing.
PETER
BERESFORD OBE is professor of social policy and
director of the Centre for Citizen Participation at Brunel University. He is
also a long-term user of mental health services and chair of Shaping Our Lives,
the U K independent disabled people’s and service users’ organization and
network. He has a longstanding involvement in issues of participation as a
service user, educator, researcher, writer, and activist. He is author of A Straight Talking Guide to Being a Mental Health
Service User (P C C S Books,
2010).
BONNIE
BURSTOW is a long-time faculty member in the
Department of Leadership, Higher and Adult Education, in the Ontario Institute for Studies in Education at the University of
Toronto. A prolific scholar, her most well-known work is Radical Feminist Therapy: Working in the Context of
Violence (Sage, 1992), and her most recent work is
“A Rose by Any Other Name: Naming and the War against Psychiatry” in Mad Matters (2013). She
has chaired many organizations involved in antipsychiatry organizing, including
Coalition against Psychiatric Assault, Resistance against Psychiatry, and
Ontario Coalition against Electroshock.
PAULA
J. CAPLAN, PhD, is a clinical
and research psychologist, advocate and activist, and Associate at Harvard
University’s DuBois Institute.
CHRIS
CHAPMAN is assistant professor of social work at
York University and holds a PhD in sociology and equity studies from O I S E / UT. His research explores how ethical self-governance and interlocking
oppression interact with one another. Examples of his publications are: Colonialism, Disability, and Possible Lives (2012) and Fostering a
Personal-is-Political Ethics: Reflexive Conversations in Social Work Education (2013; with Nazia Hoque and Louise Utting). He is co-editor of Disability Incarcerated: Imprisonment and Disability
in the United States and Canada (2014, Palgrave
Macmillan; with Liat Ben-Moshe and Allison C. Carey).
MARK
CRESSWELL is a sociologist at Durham University, UK. He is the author of many papers on the history and politics of
psychiatry, the representation of trauma in the cinema, and the theory and
practice of critical pedagogy.
SHAINDL
DIAMOND is a psychologist practicing in Toronto,
Canada. She has worked as an activist in the psychiatric survivor /mad /
antipsychiatry community over the past decade. Shaindl has co-organized
numerous community events including a global conference about resistance
against psychiatric oppression and a feminist global campaign against E C T.
CHAVA
FINKLER is an independent researcher and former
Trudeau Scholar. She has published widely in areas pertaining to disability,
human rights, and more recently, about land use law and affordable housing. Her
article in Plan Canada entitled “Planning vs Human Rights”
(about discriminatory zoning affecting psychiatric survivors) won a best
article award from the Canadian Institute of Planners in 2013.
AMBROSE
KIRBY is a community activist, educator, and
psychotherapist in private practice. Co-empowerment, self-determination,
shamelessness, integration, interdependence, and freedom are themes he addresses
in his work. He is studying at the Gestalt Institute of Toronto and has a
Masters of Education in Counselling Psychology from the University of Toronto.
BRENDA
A. LeFRANÇOIS is a faculty member in the School of Social Work at Memorial
University of Newfoundland. She is an activist who has contributed to
organizing against psychiatry on two different continents. She is co-editor
(with Robert Menzies and Geoffery Reaume) of the recently released book Mad Matters: A Critical Reader in Canadian Mad
Studies, and is guest editor (with Vicki Coppock)
of the 2014 special issue of Children
and Society on the topic of “Psychiatrised Children
and their Rights: Global Perspectives.”
ROBERT
MENZIES is professor of sociology at Simon Fraser
University. Over the past three decades he has written extensively on the
history of madness and legal order, the relationship between mental health and
criminal justice systems, and the sociology of academic criminology. He is the
author or editor of nine books including, most recently, Mad Matters: A Critical Reader in Canadian Mad
Studies (co-edited with Brenda A. LeFrançois,
Robert Menzies, Geoffrey Reaume, Canadian Scholars’ Press, 2013). Among other
projects, he is currently preparing a book on the cultural and institutional history
of “criminal insanity” in British Columbia.
MICK McKEOWN has been a union activist for all of his working life, about thirty
years, joining on his first day in work and becoming a steward shortly after.
His current job is principal lecturer, School of Health, University of Central
Lancashire, Preston, UK . He has published widely and
co-ordinated the production of the collectively written text: Service User and Career Involvement in Education for
Health and Social Care (Wiley-Blackwell). Mick is
very interested in making links between trade unions and communities and has visited Canada to meet with community activists from the
mental health survivor movement.
KATE
MILLETT, one of the most well-known radical
feminists as well as one of the most respected psychiatric survivors in the
world, was part of the historical Foucault Tribunal. A prolific author, she is
famous for ground-breaking books such as Sexual Politics (Urbana: University of
Illinois Press, 2000).
CHINA
MILLS is a researcher working on social isolation,
shame, and humiliation as “missing dimensions” of poverty analysis, at Oxford
Poverty and Human Development Initiative (O P H I). China has
just completed her first book, Decolonizing
Global Mental Health: The Psychiatrization of the Majority World, published by Routledge. Her research interests span interdisciplinary
approaches to exploring the interconnections and entanglements between Global
Mental Health, psychiatry, the pharmaceutical industry, and colonialism.
TINA
MINKOWITZ is a human rights lawyer and was one of
the drafters of the Convention on the Rights of Persons with Disabilities. She
is President of the Center for the Human Rights of Users and Survivors of
Psychiatry and International Representative of the World Network of Users and
Survivors of Psychiatry. She continues to work for full compliance with
standards set by the C R P D on the global level and in the
United States. Seewww.chrusp.org,
http://wgwnusp2013.wordpress.com
and http://www.madinamerica.com/author/tminkowitz/.
IAN
PARKER is Professor of Management at the University
of Leicester. He is a practising psychoanalyst in Manchester. His most recent
book was Lacanian Psychoanalysis:
Revolutions in Subjectivity (Routledge, 2011).
SUSAN
SCHELLENBERG is an artist and writer who began her
career as a public nurse. She co-authored Committed to the Sane Asylum: Narratives on Mental Wellness and Healing. Her Shedding Skins dream art and text is on permanent exhibit at the
Centre for Addiction and Mental Health, Clarke site, in Toronto and can be
viewed online at www.susanschellenberg.com.
HELEN SPANDLER is a reader
in mental health in the School of Social Work at the University of Central
Lancashire, Preston, England. She has written extensively about alternative and
innovative approaches to mental health care. She is currently editing a new
book about the links between distress, madness, and disability (Policy Press,
forthcoming). Helen is also involved in the U K-based Asylum: The Magazine for Democratic Psychiatry www.asylumonline.net
hspandler@uclan.ac.uk
A.J. WITHERS is a queer, trans, and disabled anti-poverty and disability justice
community organizer. They are the author of Disability Politics and Theory and the If I Can’t Dance, Is It Still My Revolution? blog (http://still.my.revolution.tao.ca/).
They are currently a PhD student at York University.
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