Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting
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A revolutionary new book on psychiatry, Psychiatry and the Business of Madness: An Ethical And Epistemological Accounting by Dr. Bonnie Burstow, was recently released by Palgrave Macmillan and has already drawn major conclusions and had huge societal implications.
The book deconstructs psychiatric discourse and practice and challenges the reader with such conclusions as: There is no credible basis for a single "mental disorder" and the drugs prescribed do not correct but create chemical imbalances.
Burstow challenges the reader to examine how society addresses certain problems and perhaps if we need to abandon psychiatry and rebuild lives together.
Lauren Spring, art-based trauma specialist and a doctoral student, sat down with the Burstow to discuss her latest book and the conclusions and implications it has achieved.
This is an abbreviated version of the interview.
Why do you feel this book is important for people to read now?
To be clear, the problems illuminated didn't just emerge. While I realize that this is contrary to people's image of psychiatry as a necessary service, as the book demonstrates, psychiatry can be roughly characterized as a regime of disinformation, intrusion, damage, and control -- in other words, there is a problem here; and the problem has been serious a long time. People are being treated as if their ways of being in the world, admittedly often troubled ways, are medical disorders, when in point of fact, they are not.
In the process, people are being brain-damaged and their lives substantially reduced. That said, what makes this particularly urgent is that psychiatry is a growth industry and so even more people are being damaged and diminished.
Bearing that in mind, who do you think should read this book? Who did you write it for?
I wrote it for psychiatric survivors, for their families, for professionals, for scholars. But first and foremost, I wrote it for members of the general public. This is our society: We have given immense authority over people deemed mad to this industry which is, in essence, declaring ever more and more people crazy, which is not solving but both creating and exacerbating people's problems in living. It's time for us to rethink and rescind that authority.
One of chapters that stuck with me most was that one about the health-care team, and this idea you bring up of professionalization. What I thought was very interesting was that you weren't demonizing the individual practitioners, but placing them in the context of this larger system. Could you speak to that?
The purpose of mental health professionalization is to serve the professionals; the purpose of the related industries to serve the industry -- and individual practitioners-in-the-making are partially unwittingly sucked into this.
To put this another way, people go into these different disciplines, in many cases, out of a heartfelt desire to help. And slowly but surely, they get socialized into modes of thinking that have them acting in these destructive ways.
In concert with this, just as professionals control the so-called mentally ill, they are themselves controlled. In this regard, I interviewed a large number of people from different disciplines that work in "psychiatric institutions," members of "the mental health team," as it's called. And what I discovered is that there's a party line, and people are more or less forced to toe that line. A nurse, for example, could not just ask other team members, "Why are we immediately turning to electroshock with this patient?" Indeed, one of the nurses interviewed in my research says, she was called on the carpet just for asking that question.
You give a very comprehensive history of the origins of psychiatry. And of course, historically, women were often psychiatrized for behaving in certain ways…or just existing in the world, right?
Women were psychiatrized either for stereotypically being women, or for veering too far from the stereotypes. Either one. As for what's happening now, today, there is no question that there are stereotypical women's diseases -- e.g., "borderline personality disorder" -- and there is no question that women are way more likely to end up being given a "disorder" than a man, also to be given more serious ones. That's true, I would add, of oppressed people in general. Of racialized people, poor people, trans people, etcetera. That noted, there is also a degree to which psychiatry is nonetheless an equal opportunity oppressor, in the sense that it is quite happy to psychiatrize anyone. With psychiatry's interest in continual expansion, that's the new reality that we are facing -- everybody is in jeopardy.
What role do you see the pharmaceutical industry playing in modern day psychiatry?
The pharmaceutical industry, for all intents and purposes, is modern day psychiatry -- all else are "add-ons." What's important to understand here is that in 1970s psychiatry found itself in danger of disappearing for non-medical professionals were frankly better at helping. Its solution was to hyper-medicalize -- that is, to create more and more the false appearance that what it was doing was medical.
In this drive to medicalize, the one thing that doctors are most noted for -- giving drugs -- became focal, for emphasizing it would really make their work look medical. Enter the foundationless claim of chemical imbalances and the drug push. Now we have an unholy alliance between psychiatry and the pharmaceutical companies, whose ultimate interest of course, is profit.
You refer in the book to the DSM [Diagnostic and Statistical Manual of Mental Disorders] as a "boss text." Could you elaborate?
As a central text, it sets practitioners up to look at distressed and/or distressing people in certain ways. So, if they go into a psychiatric interview, they're going to be honing on questions that follow the logic of the DSM, or to use their vocabulary, the "symptoms" for any given "disease" they're considering.
In the process it rips people out of their lives. And so now there's no explanation for the things people do, no way to see their words or actions as meaningful because the context has been removed.
In essence, the DSM decontextualizes people's problems, then re-contextualizes them in terms of an invented concept called a "disorder."
Let me give you an example. "Selective Mutism" is a diagnosis given to people who elect not to speak in certain situations. So, if I were a non-psychiatrist -- that is, your average thinking person who is trying to get an handle on what's going on with somebody -- I would try to figure out what situations they aren't speaking in, try to find out if there's some kind of common denominator, to ascertain whether there's something in their background or their current context that would help explain what they are doing. You know, as in: Is it safe to speak? Is this, for example, a person of colour going silent at times when racists might be present? Alternatively, is this a childhood sexual abuse survivor who is being triggered? Whatever it is, I would need to do that. But this is not what the DSM, as it were, prompts. In the DSM, "Selective Mutism" is a discrete disease.
So, according to psychiatry, what causes these "symptoms" of not speaking? Well, "Selective Mutism," does. Note the circularity. That's what all the "mental disorders" are like: No explanatory value whatever, just circularity -- and yet they have authority in law. And as such, they authorize what gets done to people.
One of the things so remarkable about this book is you're helping us understand through history. Why did you think it important to open the book with a history of psychiatry?
If we do not know where something comes from, we do not know where we are. So I wanted readers to see: How did decisions really get made? What was really behind them? Once you get through the history chapters, you have a sense of the territory.
Absolutely. I learned a lot from reading those chapters. To skip to the end, your final chapter -- and it's beautifully written and really sparks the imagination -- is about a world without psychiatry. Could you discuss that?
Questions that we need to grapple with and that are posed in this chapter are: What kind of society do we need to create so that people will thrive rather than feel alienated? How do we reconstitute society so that everyone helps everyone else and so that we deal with problems together rather than targeting individuals and having those targeted folk consigned to experts? In essence, how do we live together in kinder, more accepting, more participatory, and more egalitarian ways?
One final question: How do we stop seeing psychiatrists as heroes?
By being honest about the invalidity and the harm being done; by looking at the diminishment of community that happens when we hand the power to govern ourselves over to experts; by once again daring to dream. If we start doing that, might we not then individually and collectively be able to bring ourselves to admit that the rise of psychiatry was a colossal misstep?
For details about the research underlying this book, see http://bizomadness.blogspot.ca/
Dr. Bonnie Burstow is a faculty member at Ontario Institute for Studies in Education, a philosopher, a social theorist, a feminist therapist, an author, and a long time anti-psychiatry theorist and activist. Her books include: Psychiatry and the Business of Madness, Radical Feminist Therapy and The House on Lippincott, as well as two anthologies of which she is first editor: Shrink-Resistant and Psychiatry Disrupted.
Lauren Spring is a doctoral student at Ontario Institute for Studies in Education, where she is conducting extensive research into military trauma, specifically focused on the Canadian military. She is also an actor, a theatre director, a critic of psychiatry, and an art-informed researcher.