Anti-Psychiatry and Critiques of Psychiatric Expertise

1. Anti-Psychiatry and Critiques of Psychiatric Expertise

2. Michel Foucault (1926-1984) Histoire de la Folie (1961) published in abridged English translation as:Madness and Civilization (1965) Moral treatment in the asylum as a form of social control

3. Erving Goffman (1922-1982) Asylums: Essays on the Social Situation of Patients and other Inmates (1961) “total institutions”

4. 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

5. “…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)

6. Labeling theory (1966)

7. 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 environment—the powerlessness, depersonalization,  segregation, mortification, and self-labeling— seem undoubtedly countertherapeutic.”

8. (1975) (1962)

9. R.D. Laing (1927-1989)

10. 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)—Schizophrenia 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.

11. GREGORY BATESON (1904-1980) DOUBLE BIND HYPOTHESIS Schizophrenia as a product of disordered communication in family

12. “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.

13. Kingsley Hall, East London

14. Mary Barnes (1923-2001)

15. Mary Barnes’ Paintings—Exhibition at her death, 2001

16. Phyllis Chesler (1972)

17. Credo for Psychiatrists, American Psychiatric Association conventionMay 1970 “It’s not penis envy or inner space or maternal urges or natural passivity or hormone-caused emotionality that determines our lives. It’s 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)

18. 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 one’s homosexuality • Ego dystonic homosexuality removed as a disorder—DSM III revised (1987)

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

20. 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 • 1987—DSM IIIR (revised—30 new categories) • 1994---DSM IV (365 disorders), biological • 2000—DSM IV-TR (Text revision)

21. PTSD first appeared in DSM-III (1980)

23. 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.