Psychiatry has a long way to go. With or without good intentions, there have been some inhumane treatments and serious abuses committed throughout the history of psychiatry. There is a lack of choice, and financial injustice in our current mental health system. Therapeutic methods have improved since Freud (although it can still be quite the challenge to find a good therapist, much less one who takes insurance) but psychiatric drugs are in their infancy. There needs to be more research, more neuroimaging etc. Constructive criticism of psychiatry, wanting the field to evolve and improve, is not what I mean by antipsychiatry.
So what do I mean?
My definition of antipsychiatry is an ideology which makes the following claims:
1) No psychiatric conditions have any biological or physiological basis.
2) Psychiatric labels are merely a way to pathologize normal variations of human thought and experience.
3) Psychiatric patients must leave the system of psychiatric treatment in order to “recover” from their condition.
Many anti-psychiatric believers are former psychiatric patients who claim that they have recovered, often with some form of special diet or spirituality. They feel that they were wrongly plastered with psychiatric labels, stigmatized and given harmful treatments. I felt somewhat like this at one point in my life, so I’m sympathetic.
But, while I can’t argue with their personal experience (including the possibility that they were misdiagnosed and inappropriately treated, which happens), I believe the ideology they have adopted as a way to make sense of that experience actually contributes to stigma against people like myself, who accept the labels we’ve been given and continue to make use of psychiatric treatment despite its shortcomings.
First, I’ll try to explain why I disagree with each of anti-psychiatry’s claims.
1) It’s true that there’s a lot we don’t know about the brain, that psychopharmacology is largely experimental at this point, placebo effect is a tricky factor, and many psych meds are actually medicines for other conditions (e.g. lamotrigine, an anticonvulsant used to treat bipolar disorder), their psychiatric effects having been discovered accidentally. Finding a medication that works for an individual is a process of trial and error that may involve unpleasant side effects and worsened symptoms along the way. Side effects can be serious, even life-threatening.
But all this is true of other areas of modern medicine as well. For instance, when I was in preterm labor I was given shots of terbutaline – an asthma medication that happens to be used off-label for preterm labor. How is this any different from lamotrigine being used as a mood stabilizer? My son tried three different reflux medicines before we found one that was effective and did not have unacceptable side effects. Yet no one is using this to argue that gastroesophageal reflux is not a real, biological disease. Why then do people take seriously the anti-psychiatric claim that trial and error with psych meds proves our conditions have no physiological basis?
Furthermore, why are the side effects of these medications considered acceptable when treating seizures but not bipolar disorder or schizophrenia? Isn’t it because people more readily acknowledge the reality and seriousness of seizures than of mental disorders? But these disorders can also be matters of life and death. (I’ll note here that people go on special diets for seizures just as they do for depression, sometimes with positive results. The lines between so-called mental and neurological conditions are much finer than anti-psychiatry acknowledges.)
Believers in anti-psychiatry often say that these drugs are overprescribed. I do believe that some drugs, like antidepressants, are overprescribed, but that’s largely because they are handed out like candy by primary care providers. I’ve experienced that firsthand (being prescribed an antidepressant by an OB who hadn’t done much of anything to gather my psychiatric history and refused to follow-up or adjust my dose) and I also have friends whose PCP prescribed antidepressants when what they really needed was therapy. The fact that people who don’t have a physiological mood disorder are being prescribed antidepressants by doctors who aren’t psychiatrists does not mean that no one has a physiological mood disorder.
2) Sure, schizophrenia is a normal variation of human thought and experience. So is having a brain tumor. I’ve volunteered at downtown homeless shelters and talked to plenty of people with untreated schizophrenia. I have a relative living with untreated psychosis. I also know people who are being treated for various forms of psychosis, with varying degrees of success. Schizophrenia is a real and serious condition and antipsychotic meds can help in pretty amazing ways. There are always resistant cases.
There are some interesting studies suggesting that long-term recovery rates for schizophrenia are better in some traditional cultures (eg. in Africa) where they don’t have these drugs and their understanding of the disease is different. Anti-psychiatry believers point to these studies to prove that psychiatry prevents recovery. However, I think it’s a stretch to say that people who believe their relative is temporarily possessed by evil spirits are treating schizophrenia as a “normal variation” whereas those of us who believe it has biochemical origins are “pathologizing” it.
I do agree that there is a danger of pathologizing every experience that doesn’t fit within our culture’s ideology, and that we have a tendency to do this. Giving an antidepressant to a teenager who’s depressed because her parents are getting divorced is one example. That’s an inappropriate use of psych meds. I don’t accept that I am “sick” because of the mood symptoms I deal with on a daily basis. That’s just my brain.
But when I’m having an acute and severe depressive episode, I’m every bit as sick as if I had the flu. If that’s pathologizing my condition, then so be it.
3) If you’ve recovered from your condition without psychiatric treatment, great. John Nash is one high profile person who reportedly did so. Different people define recovery differently. For some, it means having no symptoms; for others, it simply means living and functioning with your symptoms and accepting yourself as you are. I guess I could consider myself in recovery by that second definition, but it’s a temporary state of recovery because I know that at some point in the future I could wind up on a psych ward.
And that’s the thing: my condition is cyclical. When I was in college, I thought I’d recovered. Then lo and behold, I got depressed again. Exercise and eating right didn’t prevent it, nor did my meditation practice or my relatively newfound faith. So rather than clinging to the belief that I was recovered, I once again sought professional help. Therapy helped for a while, and then – while still in therapy and doing all those other good things – I got depressed again, quite badly.
I am grateful to psychiatry. Thanks to psychiatry, I survived my teenage years without permanent scarring or organ damage. Thanks to psychiatry, I was able to take care of my medically complex newborn when I became a mother. Psychologists and psychiatrists have been there for me during acute crises (and no, they didn’t charge me for needing them after hours). These are all serious and important things. Not everyone needs psychiatric treatment as part of their ongoing recovery; but I do.
And this is why anti-psychiatry stigmatizes people. It makes the claim that no one needs psychiatry – but what this really amounts to is a claim that no one should need it. It plays into the American notion that we have total control of our mental state, that mental disorders are the result of a weak character or need for attention. By implication, people who still utilize psychiatric treatment are stupid, deluded, misinformed; or they’re sheep who mindlessly do whatever they’re told; or they’re victims of the system who should be pitied and/or rescued. These ideas are more demeaning than anything a therapist or psychiatrist has said to me.
Just as there are bad psychiatrists out there, there are surgeons and gastroenterologists who are jerks (trust me, I’ve met them), who make their patients feel demeaned or who are incompetent in their fields, but this doesn’t prove that modern medicine is all a farce. Some people believe it’s a farce, usually based on one or two bad experiences with doctors; when I encounter such people, I generally find that they have a negative attitude towards my son’s medical team and our treatment choices. It’s hard to judge an entire field and all its practitioners without also judging the people who are benefiting from that field.
Anti-psychiatry believers complain about the stigma attached to diagnostic labels. I can’t help the feeling that at least some of these former psychiatric patients have chosen this ideology as a way to make a radical separation between themselves and the “psychiatrized” population. Psychiatric labels no longer apply to them, so neither does the associated stigma. They no longer take medications, so they don’t have to deal with the stigma of that, either. People who survive cancer don’t generally go on a campaign against oncologists and cancer treatments (although the treatments are brutal enough) or object that their cancer was pathologized. Is that because cancer is more “real” than mental disorders, or because it’s less stigmatized? Is it possible that anti-psychiatry among former patients is driven by internalized saneism?
For the rest of us, who accept our diagnoses – at least as approximations of an underlying reality – and find meds helpful, the stigma is still there.
Psychiatric conditions need to be normalized, but not by denying their reality or attacking treatments that help people, that literally save lives. That is the opposite of helpful.