Making sense of anti-psychiatry for the 21st century
As part of this year American Psychiatric Association annual meeting, held virtually, I organized and chaired a session which, among other things, brought together experts to discuss the past and future of the anti-psychiatric movement, which shows no signs of slowing down.
I co-chaired and co-presented this symposium with Awais Aftab, MD. Dr Aftab presented “the historical development of antipsychiatry”, a term he noted is often used as a pejorative criticism in itself. Instead, he recommended that the term be used only descriptively for those who have made central critiques of psychiatry, but that it not in itself be proof of the invalidity of these views. .
In fact, many of the criticisms of our field of medicine that can be described as “anti-psychiatry” are made by psychiatrists. Dr Aftab noted that the two main founders of the modern antipsychiatric perspective were both psychiatrists, Thomas Szasz and RD Laing, although they came to their critiques from different perspectives.
Current groups that one might see in the Global Antipsychiatry Camp include the Critical Psychiatry Network in the UK, many of whom are “Practicing psychiatrists eager to meet the intellectual and practical challenges they face”; the “Psychiatric Survivor Movement”, a group of “mental health consumers” who feel they have been harmed by psychiatric treatment and medication; Scientology, a religion that completely rejects psychiatry and even criminalizes the profession; and the “neurodiversity and mad pride” movement, which values the experiences that psychiatry pathologizes.
Dr Aftab urged clinicians not to be defensive in the face of such criticisms of psychiatry, nor to use the term “antipsychiatry” as a derogatory means of dismissing such criticism. Instead, we should try to understand the experiences and the conceptual claims that underlie them.
He then spoke of “philosophical responses to anti-psychiatry”. He noted that one answer is “pragmatic” (or as I would say, postmodernist, but more on that shortly). This is the view expressed by the leaders of the previous edition of the DSM, who argued that there is no truth, but that psychiatrists are the best judges of issues related to mental illness (as a baseball umpire calling balls and strikes). A second answer is “naturalist,” who argues that there are truths about mental illness that science will establish. A third response is “normativist,” who argues that psychiatry is about values and ethics, which require consensus.
Psychologist Derek Bolton has been cited for his “skepticism towards the soft variety”, which accepts many of the criticisms leveled against psychiatry, in the sense that it may not be possible to demonstrate the existence of “disorders”. mental ‘clear in nature, but nonetheless people have experiences of distress which bring them to caregivers. These experiences are real and caregivers can try to deal with the suffering they cause.
Postmodern Psychiatry and Scientific Skepticism
I presented on “Psychiatry and Antipsychiatry in the Postmodern Era”. My central thesis was that antipsychiatry is based on a postmodern ideology, just like modern psychiatry. As a result, despite the apparent conflict, they actually agree with each other conceptually. The problem is, they don’t realize that they both share postmodernist beliefs, and therefore they are arguing against each other.
What is postmodernism? It is our contemporary cultural ethic. Historically, it is labeled “post” because it began after the modern era, which roughly corresponds to the Renaissance and Enlightenment period until the World Wars of the 20th century. At that time, Reason and Science replaced God as the sources of Truth. I voluntarily write them in capitals to emphasize the value placed on these concepts.
Before the modern era, God and religion were the main sources of truth. After the modern era, God was proclaimed dead by Nietzsche; and later 20th century postmodernists like Michel Foucault and Martin Heidegger also tried to kill Reason and Science.
Scientific knowledge was not considered more valuable than any other type of knowledge, such as religion. All were “social constructs”, creations of human beings based on cultural consensus – not something related to the real world in an absolute sense. There is no Truth; all claims to truths relate to preferences and social norms.
Foucault made this criticism first and foremost against the psychiatric profession and the claims of mental illness. He saw psychiatrists as primarily medical policemen, performing a function of social control over those who are deviant but cannot be called criminals. I have argued that the fundamental critiques of psychiatry made by many antipsychiatric groups are based on these postmodernist ideas, which are relativistic and very skeptical of science.
The paradoxical problem is that the dominant direction in modern psychiatry is also postmodernist. DSM leaders admit that the main criteria for establishing and modifying DSM diagnoses are not scientific criteria but “pragmatic” criteria, based on the preferences of the psychiatric profession. These include economic (billing and insurance), legal (medico-legal) and cultural (clinician preferences) factors. This approach is a social construction and is therefore no different from the criticism carried by Foucault.
I have concluded that mainstream psychiatry is unable to respond effectively to critiques of antipsychiatry, given its own unscientific social constructionist assumptions. I have argued for a return to scientific realism, that is, accepting the limits of science and postmodern critiques of scientific work, while arguing that, when carried out correctly, legitimate scientific attitudes can reveal truths which are not related to human beings but actually reflect the realities of nature.
Nassir Ghaemi, MD, MPH, is Professor of Psychiatry at Tufts Medical Center and Lecturer in Psychiatry at Harvard Medical School. He is the author of several general interest books on psychiatry. He is currently working at the Novartis Institutes for Biomedical Research in Cambridge, Massachusetts. The opinions expressed here are its own and do not reflect those of its employers.