Anti-Psychiatry and Critiques of Psychiatric Expertise

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Anti-Psychiatry and Critiques of Psychiatric
Expertise
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Michel Foucault (1926-1984)
Histoire de la Folie (1961) published
in abridged English translation asMadness and
Civilization (1965)
Moral treatment in the asylum as a form of
social control
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Erving Goffman (1922-1982)
Asylums Essays on the Social Situation of
Patients and other Inmates (1961) total
institutions
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Thomas Szasz (1920-
(1961)
(2002)
(1989)
Helped inspire Mental Health Law project
(1972)to restrict laws committing patients to
asylums to give patients the right to refuse
treatment
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• the notion of mental illness has outlived
  whatever usefulness it might have had and that it
  now functions merely as a convenient myth. As
  such, it is a true heir to religious myths in
  general, and to the belief in witchcraft in
  particular the role of all these belief-systems
  was to act as social tranquilizers, thus
  encouraging the hope that mastery of certain
  specific problems may be achieved by means of
  substitutive (symbolic-magical) operations.
• Szasz, The Myth of Mental Illness (1961)

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Labeling theory (1966)
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D.L. Rosenhan On Being Sane in Insane Places
January 1973 Science, Vol. 179 no.4070
It is clear that we cannot distinguish the sane
from the insane in psychiatric hospitals. The
hospital itself imposes a special environment in
which the meanings of behavior can easily
be misunderstood. The consequences to patients
hospitalized in such an environmentthe
powerlessness, depersonalization,  segregation,
mortification, and self-labeling seem
undoubtedly countertherapeutic.
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(1975)
(1962)
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R.D. Laing (1927-1989)
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R.D. Laing

• The Divided Self (1960)Schizophrenia as due to
  ontological insecurity, resulting in a false
  self/true self dichotomy.
• Sanity, Madness and the Family (1964)Schizophreni
  a as product of family dysfunction.
• The Politics of Experience (1967)Schizophrenia
  as journey of self-exploration, which can provide
  wisdom and spiritual knowledge to a mad society.

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GREGORY BATESON (1904-1980)
DOUBLE BIND HYPOTHESIS Schizophrenia as a
product of disordered communication in family
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• Instead of the mental hospital, a sort of
  reservicing factory for human breakdowns, we need
  a place where people who have traveled further
  and, consequently, may be more lost than
  psychiatrists and other sane people, can find
  their way further into inner space and time, and
  back again.
• Laing, Politics of Experience, p. 127-128.

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Kingsley Hall, East London
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Mary Barnes (1923-2001)
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Mary Barnes PaintingsExhibition at her death,
2001
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Phyllis Chesler
(1972)
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Credo for Psychiatrists, American Psychiatric
Association convention May 1970

• Its not penis envy or inner space or
  maternal urges or natural passivity or
  hormone-caused emotionality that determines our
  lives. Its an uptight, repressive male
  supremists (sic) social structure and set of
  social attitudes that prevents us from seeing
  ourselves as full human beings trying to live out
  our potential. Psychiatry that tries to adjust
  to a bad situation is not a help.
• Association for Women Psychologists (formed in
  1969)

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Homosexuality as Pathology in DSM

• Homosexuality as a perversion in 1952 Diagnostic
  and Statistical Manual of Mental Disorders (DSM
  1).
• APA meeting (1972) members voted that
  homosexuality was not a pathology
• Removed from DSM II as disorder (1973)
• Ego dystonic homosexuality appeared in DSM III
  (1980)one was in conflict about ones
  homosexuality
• Ego dystonic homosexuality removed as a
  disorderDSM III revised (1987)

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DSM-IV-TR (Text Revision) (2000) Issues of
Reliability And Validity
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History of DSM

• 1933 -SCND Standard Classification Nomenclature
  of Disease
• 1952-DSM I division between psychoses and
  psychoneurotic disorders.
• 1968-DSM II (185 disorders)
• 1980-DSM III (265 disorders), based on observable
  symptoms neo-Kraeplinian rejection of
  neurosis. Robert Spitzer
• 1987DSM IIIR (revised30 new categories)
• 1994---DSM IV (365 disorders), biological
• 2000DSM IV-TR (Text revision)

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PTSD first appeared in DSM-III (1980)
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(No Transcript)
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DSM IV-TR definition of a Mental Disorder (2000)

•   each of the mental disorders is
  conceptualized as a clinically significant
  behavioral or psychological syndrome or pattern
  that occurs in an individual and that is
  associated with present distress (e.g., a painful
  symptom) or disability (i.e., impairment in one
  or more important areas of functioning) or with a
  significantly increased risk of suffering death,
  pain, disability, or an important loss of
  freedom.  In addition, this syndrome or pattern
  must not be merely an acceptable and culturally
  sanctioned response to a particular event, for
  example, the death of a loved one.  Whatever  its
  original cause, it must currently be considered a
  manifestation of a behavioral, psychological, or
  biological dysfunction in the individual. 
  Neither deviant behavior (e.g., political,
  religious, or sexual) nor conflicts that are
  primarily between individual and society are
  mental disorders unless the deviance or conflict
  is a symptom of a dysfunction in the individual,
  as described above.
•