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The suggestion embedded in this article's title seems counter-intuitive. How could the tide be turning on psychiatry when the institution has never been so strong? And indeed indicators of its growing strength and tenacity are all around us. The exporting of its model to the global south via the World Bank, the emergence of outpatient committal, the explosion of funding for psychiatric research (see Bonnie Burstow, 2015). Correspondingly, daily are there calls for most aggressive "detection" and "treatment" (e.g., Jeffrey Lieberman, 2015). And the mainstream press has never been more closed to truly foundational critiques. That acknowledged, let me suggest that such intensification is common when an old system is in the early days of crumbling.
Of course, intensification itself is hardly an indicator that a reversal is at hand. So how would we know? Examples of possible indicators are: ever-growing critiques from inside and outside the profession, growing discomfort with "anomalies" (in essence, the indicators of a paradigm shift spelt out by Thomas Kuhn, 1962). Established moral authorities making unprecedented negative pronouncements about the current state of affairs. The surfacing of more and more tales of corruption and fraud. The rising up of those subjected to it. Each of these signs and more we are experiencing now with psychiatry -- hardly conclusive individually, but taken together, convincing portents of a societal shift.
While psychiatric anomalies have always been with us, note, never have they been so visible. Even as we hear calls for the early detention and treatment of "mental illness" to prevent school shootings, for instance, we discover that the majority of the shooters were on psychiatric drugs. Correspondingly, as the system pushes western ways of handling "schizophrenia" on the rest of the world, World Health Organization studies conclude that the countries with the highest rates of "recovery" are those without the "benefit" of modern "treatment" (see Robert Whitaker, 2010). As for the dissatisfaction experienced by people in the psychiatric and related professions, just check out the speakers at the 2015 conference of the International Society for Ethical Psychiatry and Psychology, and you will quickly get a sense of it. Telling likewise is what happened in the years leading up to the release of DSM-5. While their goal, of course, was not "changing" but rather "saving" the current paradigm, well in advance of DSM-5's release, in what was a historically unprecedented move, the two previous taskforce chairs, Robert Spitzer (2009) and Allen Frances (2009), each came out with hard-hitting critiques of what their colleagues were doing, describing it as once bad science and an exercise in subterfuge -- critiques echoed, I'd add, to an unparalleled degree by mainstream media. At the same time, a plethora of radical survivor groups have sprung up. And sites dedicated to deconstructing psychiatry are legion (e.g. madinamerica.com and endofshock.com).
By the same token, proofs of fraudulent trials and fraudulent claims of discoveries abound. Witness David Healey's (2009) unearthing of the systematic "cooking" of drug trials. Witness the exposés on the Breggin site. And note the publishing this year of a book which clearly establishes that the American Psychiatric Association has intentionally misled the public throughout its history -- about "mental illness" being a proven brain disease, for example, about the efficacy of the drugs (Robert Whitaker and Lisa Cosgrove, 2015).
Even as these developments unfold, major international organizations have cast doubt on psychiatry both morally and scientifically. Take the aforementioned World Health Organization's studies. And what is particularly suggestive, in its role as moral compass, two different United Nations instruments have declared involuntary neurolepticization a form of torture. Moreover, trace the practical implications of the recently minted Convention on the Rights of People with Disabilities (CRPD) and it becomes clear that it positions the key modus operandi of psychiatry everywhere -- involuntary treatment and "mental health detention" -- as a human rights violation (for details, see Tina Minkowitz, 2014, also CRPD article 14).
Another salient indicator comes from non-psychiatric medical practitioners and students, for quiet though they remain about it, cogent evidence suggests that their opinion of psychiatry has plummeted. A major study written up by H. Stuart et al. (2015) involving 1057 non-psychiatric medical teaching faculty in 15 countries, for example, shows that the vast majority hold a highly negative view of psychiatry. They find psychiatrists, for instance, too powerful, "unscientific," and "illogical." Correspondingly, there is currently a formidable decline in the percentage of medical residents open to specializing in psychiatry. In the U.K., for example (once a psychiatric hotbed), less than five per cent of medical students choose to enter psychiatry (see John Read, 2015).
Indeed, psychiatrists are aware of their faltering reputation. And in what is an unprecedented move, this January a major psychiatric journal (Acta Psychiatrica Scandinavica) devoted a special issue to psychiatry's "image problem" (Vol. 131; see here), with leading figures in psychiatry weighing in -- e.g., current and former presidents of the European Psychiatric Association and the current president of the World Psychiatric Association. What the very existence of this special issue seems to suggest is that so bad is the public image that the upper echelons of the industry are taking alarm. Correspondingly, their response is how regimes of ruling commonly respond when their seemingly unquestionable authority begins to slip away -- for example, portraying themselves as victims and blaming everyone else. Denish Bhugra (2015), current president of the World Psychiatric Association, for instance, lays the blame on the "anti-psychiatry media" -- ironic, given the enormity of the media's support.
That noted, if the tide is turning -- and, as shown, it is -- the question is how far? And what form will the change take? At the moment, despite critiques which demonstrate psychiatry's utter invalidity, the primary discourse is reformist. This news is worse than it appears, for throughout the centuries, in the long run, reform agendas have only served psychiatry. Temporarily, for sure, they create a modicum of improvement, like with "moral management." Nonetheless, as shown by Burstow (2014), each and every tempering of psychiatry under a reform agenda has culminated in the return of biological psychiatry with a vengeance. As such, despite good intentions, all "reformism" ultimately succeeds in doing is losing the momentum.
That said, at this point, many movement people are keenly aware of this dynamic. Correspondingly, we are seeing a renewed interest in psychiatry abolition, especially versions committed to societal rebuilding. The reception which I have been receiving among psychiatric survivors -- and survivors, after all, is where the resurgence of subjugated knowledge must come from -- is suggestive in this regard.
Significantly, up until a few years ago, there was but muted interest in psychiatry abolition within survivor circles. What I am seeing now, conversely, is an abundance of posts of the ilk "If antipsychiatry is what Bonnie says it as, then I am antipsychiatry." Additionally, more and more antipsychiatry websites are popping up. The point is, antipsychiatry -- and not just any type but one of a visionary nature -- is markedly on the rise.
And indeed, a visionary antipsychiatry is precisely psychiatry's worst nightmare -- hence the current barring of foundational critiques by the mainstream media and hence psychiatry's worried references to "antipsychiatry." Simple reform, as history shows, is inevitably co-opted. And critique alone can easily be dismissed. A true revolution -- one involving reclamation -- is a whole different matter.
In ending, let me invite those in the Toronto area interested in continuing this conversation to come to my book launch on September 18 (5:30, Floor 12, 252 Bloor West) for it will be a moment of co-investigation. And more generally, let me ask all readers: Irrespective of "add-ons," is a coercive, invalid, and damaging "system" really the best we can do? What makes restricting ourselves to but tempering it the "practical" option?
And now that the tide is turning, what can the average citizen do so that this time round, we as a society do not "squander" the moment?
(A slightly different version of this article was first published in BizoMadness.)
Bhugra, D. (2015). To be or not to be a psychiatrist? Acta Psychiatrica Scandinavica, 131, 4-5.
Burstow, B. (2014). Liberal "mental health" reform: A fail-proof way to fail. Mad In America. November 17 (http://www.madinamerica.com/2014/11/liberal-mental-health-reform-fail-proof-way-fail/)
Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave Macmillan.
Frances, Allen (2009). A warning sign on the road to DSM-V. Psychiatric Times. June 26 (http://www.psychiatrictimes.com/articles/warning-sign-road-dsm-v-beware-its-unintended-consequences).
Healey, D. (2009). Psychiatric drugs explained. London: Elsevier.
Kuhn, Thomas (1962). The structure of scientific revolutions. Chicago: University of Chicago Press.
Lieberman, J. (2015). How to halt the violence. The New York Times. August 28 (http://www.nytimes.com/2015/08/29/opinion/how-to-halt-the-violence-treat-mental-illness.html?smid=fb-share).
Minkowitz, T. (2014). Convention on the rights of people with disabilities and liberation from psychiatric oppression. In Bonnie Burstow, Brenda LeFrançois, and Shaindl Diamond (Eds.). Psychiatry disrupted (pp. 129-144). Montreal: McGill-Queen’s University Press.
Read, J. (2015). Saving psychiatry from itself. Acta Psychiatrica Scandinavica, 131, 11-12.
Spitzer, R. (2009). DSM transparency. Psychiatric Times. March 6. (http://www.psychiatrictimes.com/articles/dsm-v-transparency-fact-or-rhetoric).
Stewart, H. et al. (2015). Images of psychiatry and psychiatrists. Acta Psychiatrica Scandinavica, 131, 21-28.
Whitaker, R. (2010). Anatomy of an epidemic. New York: Broadway Paperbacks.
Whitaker, R. and Cosgrove L. (2015). Psychiatry under the influence. New York: Palgrave Macmillan.
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