The "Antipsychiatry" Dilemma
I don’t particularly like the term “antipsychiatry” and I try to avoid using it wherever possible (especially in public communications), but the term has proven almost impossible to give up. To figure out why this is so, we have to clarify the many different ways in which the term is currently used. The label, ambiguous as it is, does capture certain phenomena of importance.
What’s the issue with “antipsychiatry”?
The main problem is that many feel that the term has been weaponized to spurn criticism of psychiatry. Daniel Burston articulates this quite well:
“the term’s persistence provides psychiatrists with a convenient omnibus term with which to disparage and dismiss all of psychiatry’s critics, including the ones they should listen to most.” (my emphasis)
James Davies argues that the term feels abusive to many critics:
“[The label “anti-psychiatry”] is now being deployed by many mental health professionals and psychiatrists, usually in the context of heated debate and usually pejoratively. This latter usage mostly occurs when someone labels a critic (e.g. a professional, a service user or an organization) as ‘anti-psychiatry’ without the consent or agreement of this critic, and without actually knowing whether the critic identifies with that phrase. This particular usage usually has the intention of denigrating the critic as irrational, unreasonable… This pejorative use therefore weaponizes the phrase in an attempt to silence, misrepresent or delegitimize critical debate and dissent.”
There is also a common sentiment among survivors/ex-patients/harmed patients that any use of the term “antipsychiatry” by default includes them as referents and their activism against iatrogenic psychiatric harm, even when such inclusion has not been made explicit (or even when it is actively denied).
All this makes debate and dialogue terribly counterproductive. It is not really possible to have a meaningful discussion with someone if they are constantly offended by how you characterize them.
Antipsychiatry: A Typology of Usage
Here is a preliminary outline of the different ways I have seen the term “antipsychiatry” being used. The different senses categorized here are not mutually exclusive. In fact, in most instances, more than one sense of the term applies. Not all uses of the term are disparaging or pejorative. This outline is also not an endorsement; it is more descriptive than it is prescriptive. I am not saying we should be using the term “antipsychiatry” in all these different ways.
1. Circumscribed historical sense
Such use of the term refer to the fierce scholarly and activist critique targeted at psychiatry in the 1960s and 1970s, centering around the work of psychiatrists and philosophers such as Thomas Szasz, R. D. Laing, and Michel Foucault. This is the sense in which I tend to use the term most often.
However, this historical usage is not without its problems either. The psychiatrist David Cooper endorsed and popularized the term, but the three figures mentioned previously are the most commonly associated with this movement in popular imagination, and all three of them rejected this label, and while they have some important superficial similarities, their conceptual arguments and approaches are very different from each other. So, even in the circumscribed historical sense, the individuals designated as antipsychiatrists were a diverse bunch and never really comfortable with this label. (See this detailed discussion by Daniel Burston.)
2. Extended historical sense
This is an extension of the prior use, where the term is not only used to refer to the past but also to any on-going philosophical extensions of the ideas of Szasz, Laing, Foucault, etc. Laing and Foucault’s arguments have been adopted by subsequent scholars in such diverse ways that the extended historical sense applies very poorly to them. I think it applies better to contemporary manifestations of Szaszian arguments. Neo-Szaszian thinking is particularly problematic in psychiatry and remains influential within critical circles.
3. Antipsychiatry as a form of self-identification
This usage exists as an open acknowledgment of one’s opposition to psychiatry. Phil Hickey, who blogged for Mad in America, is a good example of someone who embraced the label. Another example is Bonnie Burstow, who established the “Bonnie Burstow Scholarship in Antipsychiatry” at the University of Toronto.
4. Anti- as a neutral philosophical prefix
The prefix ‘anti’ means being opposed to, or being against, and is often used to denote philosophical positions that oppose another position. Think, for example, anti-realism (an opposition to the view that truth of a statement rests on its “correspondence to an external, independent reality”), or anti-art (wikipedia: “loosely used term applied to an array of concepts and attitudes that reject prior definitions of art and question art in general.”)
The prefix has no necessarily positive (desirable, virtuous) or negative (pejorative) connotations. Understood in this manner, the term can refer loosely to an array of concepts and attitudes that oppose various dominant, mainstream aspects of psychiatric theory and practice. A strong conceptual opposition would include views such as: psychiatry is a pseudo-medical or pseudo-scientific discipline, it’s merely an instrument of social control, psychiatric diagnoses are so invalid and stigmatizing that they should be abandoned, and that psychiatric treatments are more harmful than helpful. Weaker version of opposition would include concerns about over-medicalization, over-treatment, iatrogenic harm, biomedical reductionism, neglect of the person’s psychology, phenomenology, and social determinants, etc. (such weaker concerns are fairly common, even within psychiatry, e.g. Allen Frances’s Saving Normal).
5. Antipsychiatry as biased, partisan hostility towards psychiatry
To understand this usage, think of how political commentators and talk show hosts at Fox News discuss Democrats and the liberal, progressive developments in society. It is a rhetoric dripping with self-righteous condescension, confirmation bias, selective reporting, and everything is given a negative spin and presented in as disparaging a manner as possible. This is how many talk about psychiatry. To give you a flavor of this, let us refer back to Phil Hickey, who wrote in his last blog for Mad in America:
“Although the anti-psychiatry movement has made a great deal of progress over the past fifty years, the psychiatric hoax is not only surviving, but is the dominant lens through which the great majority of people view personal distress and suffering. This is not due to any great psychiatric achievements or insights. Rather, it reflects psychiatry’s persistent use of deception and PR tactics to promote their guild interests at the expense of their customers.”
(Of course, from the perspective of these critics, they believe their hostility is entirely justified.)
6. Antipsychiatry as psychiatric critique based on conspiracy theories and pseudo-science
The classic example of pseudoscientific critique of psychiatry would be Scientology. However critiques in this category that have nothing to do with Scientology are also very common on social media, discussion forums, and blogs. Such critiques are akin to the anti-vaccination movement and QAnon in their approach to scientific evidence and their propagation on internet forums.
7. Antipsychiatry as misplaced activism against psychiatric diagnoses, psychiatric treatments, and involuntary psychiatric care
Activism might itself be a good or neutral thing, and many individuals are disgruntled with psychiatry due to the negative and traumatic experience they’ve had in their encounters with psychiatric care. In the case of antipsychiatry, given the general negative connotations, it is generally used to suggest that the activism is misplaced. Such activists, may, for instance, see psychiatric diagnoses and treatments as distinctively different from diagnoses and treatment in rest of medicine, and view them, on average, as more harmful than beneficial. With regards to involuntary psychiatric care, it is usually an uncompromising stance against all forms of involuntary psychiatric care, without adequate acknowledgement of the disability, disruption, harm, and vulnerability that necessitate such care in existing systems of care in the first place.
Such usage is also echoed by Rissmiller & Rissmiller (2006), who argue: “Radical antipsychiatry in the past four decades has changed from an influential international movement dominated by intellectual psychiatrists to an ex-patient consumerist coalition fighting against pharmacological treatment, coercive hospitalizations, and other authoritarian psychiatric practices.”
8. “Antipsychiatry” as a tool of delegitimization
This captures the sense I brought up earlier in the post and is the primary subject of my interest here. It is a pejorative label that is intended to discredit and delegitimize a particular person, organization, or platform by highlighting them as terribly biased, hostile, or irrational. It serves a similar sort of function as the terms “racist,” “sexist,” and “transphobe.” To call someone a racist, sexist, or transphobe is to offer a very negative evaluation of them. It is a condemnation. Why is why racists, sexists, and transphobes actually resent being called sexists, racists and transphobes!
When it comes to sexism, racism, and transphobia, a challenge we see is that many people are not flagrantly or openly sexist, racist, or transphobic, but rather they hide their attitudes behind a cover of other more respectable-sounding concerns, such as advocating for the rights of men, or declaring that one is trying to protect women-only spaces or to protect children from physical mutilation. This applies to many academics as well, who, for instance, offer sanitized critiques of COVID-19 vaccinations or trans rights that in practice end up advancing anti-vax and transphobic causes. Many people are able to see through this façade, and reasonably call them out. Many others are fooled, and may defend such individuals with arguments such as “They are just asking questions” or “Why can’t we have a civil debate?!” or “They are exercising their academic freedom.”
We see a similar sort of dynamic in the case of antipsychiatry as well. There are critics of psychiatry who are terribly biased, hostile, or conspiratorial, and who rely on mischaracterizations, vitriol, and propaganda to delegitimize psychiatry as a medical and scientific specialty. There are also academics, medical professionals, journalists, etc. who present sanitized versions of such attacks, and render them more respectable and palatable to a broader audience by giving them a cover of respectable-sounding concerns.
Antipsychiatry is an imperfect, problematic term, but there doesn’t seem to be a more suitable alternative for calling out such critics. What do you call the Tucker Carlsons, Matt Walshs, James Lindsays, Christopher Rufos, and Kathleen Stocks of psychiatry? If you don’t think such folks exist in the space of psychiatric critique, you are either in denial or living under a rock. Consider the critics who call psychiatrists “shock doctors,” who compare the concept of mental illness to Santa Claus and think diagnoses are similar in validity to attributions of demonic possession, who think that psychiatric diagnoses are inherently stigmatizing and unscientific labels, that psychiatric medications are so ineffective and toxic that they cannot legitimately be called “treatments” and the best thing you can do is to avoid them and get off them, and that psychiatric interventions are backed by evidence that is comparable in scientific rigor to that for homeopathy — these folks have such an openly negative assessment of psychiatry, one wonders why they don’t just come out and be proudly antipsychiatry. If psychiatry is indeed a fraud, then we should all be antipsychiatrists! But they don’t, for the same reason that most people don’t come out as proudly racist or proudly transphobic. They wish to be taken seriously and they are aware of the power of this label.
Psychiatrists, of course, are aware of the power of this term as well, and often use it irresponsibly, as a way to dismiss critiques that make them uncomfortable, that challenge their power and epistemic arrogance, that highlight the shortcomings of the profession, critiques that might be mistaken in some manner but nonetheless deserve to be respected and engaged with. I am very conscious of the misuse and overuse of the term “antipsychiatry,” hence my general reluctance to use it. An example of this overreach is when the psychiatrist and UN Special Rapporteur Dainius Pūras was accused of “anti-psychiatry bias” in the Australian & New Zealand Journal of Psychiatry due to his critique of biomedicalization of global mental health and involuntary psychiatric care.
A complication is that unlike thoroughly negative terms such as racist and transphobe, antipsychiatry has other uses that are neutral or critical but in a non-pejorative sense (as I’ve described above). Navigating this ambiguity becomes challenging in practice. Most people, after all, don’t bother to elaborate the precise sense in which they are using the term, or even when they do, they might still rely on implicit connotations to do the work.
So, as someone active in the space of psychiatric critique and someone seeking to engage productively and meaningfully with critics, I don’t like the term “antipsychiatry.” It has too much baggage. But I also find it difficult to eliminate from my vocabulary. I accept that the term is often inappropriately wielded as a weapon and I also accept that there are critics so partisan in outlook that the term appropriately applies to them. Clarity around the usage of the term, being mindful of its connotations, and using it as a last resort when no suitable alternative is available are perhaps reasonable strategies in such a situation.
Let me end by clarifying that nothing I’ve said above should be construed as a criticism or dismissal of the general project of psychiatric critique, which I see as an essential undertaking and necessary for psychiatry to become a truly humanistic and pluralistic scientific discipline. Nor should it be construed as a dismissal of the need to engage with patients, service users, survivors, and individuals with psychiatric disabilities, as well as movements such as Mad pride and neurodiversity. Such critical dialogue and engagement is necessary for the growth of psychiatric science and practice.
See also: It’s Time for Us to Stop Being So Defensive About Criticisms of Psychiatry in Psychiatric Times.
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