First published on Mad in America

Book Review: Bonnie Burstow (2019) The Revolt Against Psychiatry: A Counterhegemonic Dialogue. Palgrave Macmillan, 243 pages

The focus of Burstow’s new book, The Revolt Against Psychiatry, “is not the problems that psychiatry presents but the attempt to counter them.” In the process, it raises vitally important questions about society as a whole.

For the general reader who might wonder why there needs to be a revolt against psychiatry, Burstow summarizes the reasons in one paragraph with references for further reading.

Psychiatry is a profession whose very foundational tenets have been repeatedly shown to be unscientific and lacking in validity, whose thinking is muddled, which is blatantly self-serving, and, moreover, whose “treatments” have been demonstrated again and again to do far more harm than good. The very real injury done to vulnerable human beings is particularly alarming and is what unites the people featured in this book. (p.2)

This book is addressed to a specific audience, “People who are part of the struggle against psychiatry and people critical of psychiatry who want to learn more about the revolt against it.” Its purpose is to explore how activists can reverse the juggernaut of psychiatric power that “continues to grow by leaps and bounds.” Burstow asks,

What pressures might we bring to bear to loosen the grip of psychiatry? We habitually seem to be losing the battle; so how do we turn the situation around? (p.1)

To answer this critical question, the author interviews 13 leading activists and, in turn, is interviewed herself. These 14 dialogues form the body of the book.

The interviewees live in the US, UK, Canada, Chile, Germany, and India. They include academics, radical practitioners, Indigenous scholars, a lawyer, a grieving mother, and a journalist. Many are also psychiatric survivors.

I was impressed by the courage and determination of these activists who persist against personal challenges, social opposition, and repeated setbacks. If they refuse to give up, neither should we. At the same time, it is sobering to see dedicated people work so hard and so long for so little progress.

When strategies that should work do not, then we need to re-think our understanding of the problem. Are we attacking psychiatry at its root or are we flailing at its branches? How can we distinguish root from branch? Burstow does not address these questions. Instead, discussion centers on the tension between efforts to reform psychiatry and efforts to abolish it.

Obstacles

None of the interviewees is hopeful that psychiatry can be reformed or made humane. However, there is little agreement on the alternative.

Psychiatrist Peter Breggin stresses the importance of getting out the facts and “laying bare the science.” Burstow replies, “Laying bare the facts is essential, I agree. At the same time, it has been shown to be not remotely sufficient as a strategy.” (p.40)

Lauren Tenney shares her experience of how identity politics (adopting one’s psychiatric label as a personal identity) can reinforce the psychiatric model of suffering.

When someone challenges the existence of a disorder in a Facebook group, I have seen people literally turn to the moderator and say, ‘This person is hurting me.’ (p.70)

Racism

Several interviews stressed the need to challenge psychiatric racism.(1) Tenney points out,

In New York City, with the Assertive Action Treatment teams, 18 percent of the people subjected to involuntary outpatient commitment are white, the rest, people of color. And more generally, the heaviest of psychiatric attacks land on people of color. And until this movement becomes reflective of who exactly is being preyed upon by psychiatry, we will be sadly missing the mark. (p.77)

Researcher China Mills is a leading critic of the Movement for Global Mental Health because it “reconfigures resistance to colonialism as mental illness” in order to “delegitimize that resistance.”(2)

You can see the almost exact same language within much of the writings on Global Mental Health that you see in classical colonial writings. You see the same elbowing out or demonization of other forms of healing because they are seen as irrational. (p.203)

Mills concludes that it is impossible to “de-colonize practices like Global Mental Health or psychiatry” because “psychiatry and psychology are bound up with colonial thinking and scientific racism.” (p.194)

Indigenous scholar Michael provides a sickening example:

I just visited my reserve last week. What a mess it was! There is a full-time doctor there doing nothing but prescribing psychiatric drugs. And that makes no sense. There never was a doctor present when people were sick from real diseases. Not even a dentist. (p.153)

Abolition

In her own interview, Burstow describes some of the harrowing experiences that compelled her to become an antipsychiatry activist, co-found the Coalition Against Psychiatric Assault in Toronto, and establish the ground-breaking Bonnie Burstow Scholarship in Antipsychiatry.

When asked what she means by ‘abolishing’ psychiatry, Burstow replies,

Not only would [psychiatry] have no state power, it would not be propped up in any way by the state. Not stated funded, not state promoted. Not officially recognized as a “medical” discipline.” (p.167)

Asked how abolition could be achieved, she explains,

As far as I can see, there are two ways to go, and one is direct opposition. This is what Gandhi did when he said: We’ll break your laws and we’ll obstruct business as usual. And the other is to create experiments, trying out new ways of helping people. (p.202)

Burstow notes that successful actions require leverage.

Gandhi’s leverage arose from the sheer numbers involved — you can hardly jail the entire population of India. And one can go on strike and jeopardize the economy — also leverage. Here’s the difficulty: Psychiatrized people have almost no leverage. This is a group that gets drugged and has difficulty sustaining action. (p.213)

Funding

Kim Wichera in Germany, Ian Parker in the UK, and Tatiana Castillo in Chile describe the difficulty of obtaining funds for alternate services without succumbing to State control. At Berlin Runaway House, “a highly supportive and democratic house for homeless people trying to escape psychiatry,”

We are not allowed to address certain kinds of stuff in our house. For example, we have to have a certain percentage of social workers. And this is tied to the issue of funding. We have to have at least one social worker in the house for every two residents. (p.88)

Castillo reports,

It is difficult for us to acquire spaces for free, and universities help us a lot with that. But now they can want to put their stamp on our events and to have some say over what we do. (p.111)

Burstow describes the fate of Soteria House in the 1970s.

One of the things we know about the original Soteria House is that it worked so incredibly well that the authorities closed it down, for it was clear proof of a reality that the establishment did not want known: that so-called schizophrenics do not need to be on drugs — indeed, do better if they aren’t. Cutting off funding, that’s what the authorities do when something non-medical is shown to really work. (p.131)

To circumvent the limitations of direct action and lack of funding, Burstow proposes an “attrition model.”

The attrition model of psychiatry abolition is predicated on the awareness that you can’t get rid of psychiatry over night. If you want psychiatry abolition, you have to wear away at the institution bit by bit. (p.215)

At best, an attrition strategy can nibble at the heels of the psychiatric giant, and Burstow acknowledges that much more is needed.

Revolution

Tatiana Castillo calls for revolution.

We don’t need a revolution in what is called ‘mental health,’ but rather a larger societal revolution. (p.117)

Don Weitz agrees,

I don’t think the organizing in the US or Canada has ever made the systemic visible. We need an attack on the system itself. (p.129)

Robert Whitaker concurs, “We need to have a ‘revolution.’ We need to start over.”

You have to remake everything. And not just the institution [of psychiatry]. You have to remake the whole societal response to how we care for ourselves and each other. (p.62)

How can we remake everything when the State is so effective at neutralizing opposition to the status quo?

Cooptation

Human rights lawyer Tina Minkowitz laments the “perennial problem” of cooptation, where individual activists and innovative programs are absorbed into established institutions and rendered ineffective.

Minkowitz helped to draft the UN Convention on the Rights of Persons with Disabilities that states, “detention based on disability is unlawful under international law and obliges states to remove this power from psychiatry.” Implementing this ruling has been a huge challenge.

We have been marginalized by changes in the International Disability Alliance [IDA], which was taken over by staff, resulting in a centralization of power. IDA became a way for the UN to “manage” the international disability movement. (p.171)

Parker expresses similar concerns:

More and more psychiatrists are taking training in [Open Dialogue] and folding it into psychiatry. And it is functioning like a new opportunity for psychiatry to essentially glue people back into their families. (p.101)

Indigenous scholar Roland Chrisjohn condemns how the State imposes genocidal conditions on Indigenous communities, then pulls Indigenous service providers into psychiatric systems that pathologize their own peoples’ legitimate rage and despair.(3)

Why do we appeal to the State to alleviate oppression when the State is such a potent source of oppression? Burstow emphasizes, “Whatever the intention may be, turning to the oppressor as the solution can only lead to disaster.” (p. 21)

Quandary

Tenney’s interview touches on the dilemma of how to balance the need for political activism with the need for immediate social support. This problem confounds all movements against oppression.(4)

When the need for immediate support is overwhelming, as it typically is, efforts to meet that need can divert energy from the larger political struggle. Yet without a vibrant political struggle, alternate supports flounder or are absorbed by established institutions.(5)

The challenge is to provide immediate relief (reform) and also organize against systemic suffering (revolution) in ways that advance both goals. Internet groups cannot solve this problem. As Tenney explains,

With huge numbers of different people one way or another getting connected via the medium, what you have is no longer like-minded individuals getting together. And what results from this is conflict. Also cross purposes. While I am trying to organize activism, others are using these venues largely as a place of mutual support. And these very different purposes really don’t work well together. (p.73)

Burstow and Mills briefly discuss whether or not we should support efforts to retain or expand ‘mental health’ services. Should we welcome the loss of such programs as a social benefit that weakens the hold of psychiatry? Or would doing so embolden the State to defund beneficial services such as childcare support, disability benefits, and housing assistance?

On a practical level, should we support service providers who are striking to improve access to psychotherapy?(6) Or should we oppose their efforts for increasing the reach of psychiatry and side instead with their employers and the State? Increasing the power of the State to crush workers’ demands makes it easier to oppress all rebels.

To solve this problem, we need to understand the nature of the modern State and distinguish between struggles that can challenge the foundation of existing society and those that can be coopted into strengthening the system as a whole.(7)

The State

The capitalist class created the modern State as a weapon to defeat the feudal aristocracy. In the process of centralizing State power,

Every common interest was immediately severed from society, snatched from the activities of society’s members themselves and made an object of government activity – from a bridge, a schoolhouse, and the communal property of a village community, to the railroads, the national wealth, and the national University of France.(8)

The capitalist State removed control of medicine from the Church, taking over the training and licensing of medical professionals who, in turn, were expected to satisfy State demands, which included the control of “mad persons.”(9)

Medical practitioners resisted being seen as agents of State control, so they created a false sense of autonomy by interpreting State demands as medical problems needing treatment. Joanna Moncrieff writes,

Medical explanations for madness and the medical approach to treatment are grafted onto an older system of social organization and control. Once medicalization takes hold, it obscures the underlying functions, but the system remains, in essence, a moral and political enterprise.(10)

Interpreting suffering, non-conformity, and rebellion as medical problems shifts responsibility from a defective social system to ‘defective’ individuals requiring ‘treatment.’ Today, all medical disciplines, not only psychiatry, locate pathology within the individual and, in practice, disregard the damaging impact of social conditions.(11)

Minkowitz believes that progress will depend on “severing the relationship between the state and psychiatry.” (p.162) Is this possible?

The medical system forms one branch of a State apparatus that, as Marx wrote, “encoils living society like a boa constrictor.” The State defines what medicine is: medical schools and facilities are regulated by the State; only State-licensed professionals are allowed to practice medicine; and medical professionals are compelled to enforce State laws, even when doing so would harm their patients.

The capitalist class require a repressive State to enforce their rule over society. If we could sever the branch of psychiatry from the tree of the State, it would have to grow another branch to serve the same function of social control. Therefore, any strategy to abolish psychiatry that does not include dismantling the State and ending class rule can, at best, substitute one form of State coercion for another.

Social power

Opposition to psychiatric coercion is floundering because it has no revolutionary potential on its own. We made gains in the 1970s because we combined forces with other movements against oppression. We lost those gains, as have all oppressed groups, because we let ourselves be divided.

To acquire the social power we need to uproot coercive psychiatry and the State that requires it, we must join forces with all other oppressed groups and especially the largest oppressed group, the working class.

Workers are systematically deprived of social and economic power. Their oppression manifests in disproportionately worse health, shorter life spans, inferior schools, more exposure to industrial toxins, more poverty, and greater stress.

While oppressed individuals can be found in every social class, the discriminatory nature of oppression keeps most of them in the working class. As a result, the working class are not only the single largest oppressed group, they also include the largest numbers of people from every other oppressed group, including the psychiatrically oppressed.

Workers have massive collective power. They can stop the flow of profit and redirect production to meet human needs. That is some leverage!

Solidarity

In order to exercise their power, workers must put their common interests ahead of their differences. It is a matter of practicality. Workers who stand together can win more. Those who fail to challenge sexism, racism, and other divisive bigotries are defeated.

Currently, anti-government protests are sweeping the globe as millions of people rise up against decades of deepening austerity and rising inequality. Extended protests disrupt society, forcing ordinary people to organize the provision of food, childcare, and care of the distressed in new ways that meet their needs, not those of their rulers.(12)

Should global revolt become powerful enough to end capitalist rule, those new ways of organizing can grow into the new society we so desperately need, a society that treats everyone as equally worthy to contribute and equally worthy of getting their needs met.

As capitalism drags humanity deeper into barbarism, the need for solidarity grows.

A new generation of activists is seeking to identify and explain how militarism, imperialism, nuclear weapons, environmental degradation, gross economic inequality, and dehumanization by race, religion, gender, and sexuality all reinforce and legitimize each other, and many have concluded that none can be effectively opposed without addressing them all.(13)

Conclusion

The value of this book lies in its conversational style, the diversity of the interviewees, and a lively question-response format that invites the reader into the conversation. Many more issues were raised than could be addressed in this review.

Despite a hefty price that puts it beyond the reach of many activists, I recommend The Revolt Against Psychiatry as a springboard for broader discussion on how we can counter the stranglehold of psychiatry.

References

1. Metzl, J.M. (2011). The protest psychosis: How schizophrenia became a black disease. Beacon Press.
2. Prashad, V. (2019). The IMF is utterly indifferent to the pain it’s causing. Independent Media Institute, October 15.
3. Chrisjohn, R.D., McKay, S.M. & Smith, A.O. (2014). Dying to please you: Indigenous suicide in contemporary Canada. Theytus Books.
4. Brown, T.M. (2016). Working with the Panthers to transform health care for poor Black communities. Am J Public Health. Vol. 106, No. 10, pp.1756-1757.
5. Fancher, M.P. (2019). Surviving until the revolution comes. Black Agenda Report, October 30.
6. Castañeda, L. (2019). Kaiser clinicians and patients protest long appointment waits and not enough providers. The Mercury News, October 19.
7. Harman, C. (1991). The state and capitalism today. International Socialism, Vol. 2, No.51, pp. 3-57.
8. Marx, K. (1852). The Eighteenth Brumaire of Louis Bonaparte. Chapter 7.
9. Pinell, P., & Jacobs, A. (2011). The genesis of the medical field: France, 1795-1870. Revue Française De Sociologie, Vol.52, p.119.
10. Moncrieff, J. (2018). So what is mental disorder? Part 2: The social problem. Mad in America, March 14.
11. Rosenthal, S. (2019). Rebel Minds: Class war, mass suffering, and the urgent need for socialism. ReMarx Publishing.
12. Orwell, G. (1938). Homage to Catalonia.
13. Appy, C.G. (2019) Recovering the legacy of GI dissent, in Carver, R., Cortright, D. & Doherty, B. [Eds]. Waging peace in Vietnam: U.S. soldiers and veterans who opposed the war. New York: New Village Press.