The VICE story: Beyond Anti-psychiatry
VICE News published the article 'The Movement Against Psychiatry' yesterday by Shayla Love. The article examines the anti-psychiatry and critical psychiatry movements, and also features several quotes from me. My communication with Shayla Love was more than just the featured quotes, and it has become apparent to me after conversations with several friends that I should offer more context and background. So, this blogpost is an attempt to do that.
I occupy a somewhat uncomfortable position on the critical spectrum. I do not identify as a "critical psychiatrist" because I do not think "critical" serves well as an identity function. The word also means different things in different contexts, and has different nuances and connotations, ranging from fertile and philosophically robust critiques to serving as a euphemism for views that embody anything but critical virtues. I am wary of extreme criticisms of psychiatry – of which there is no shortage – that rely on mischaracterizations, vitriol, and propaganda, and seek to delegitimize psychiatry as a medical specialty. Such views are typically characterized as "anti-psychiatry" but that is an imperfect term, because the term is at times applied rather liberally, the "classic" figures considered to be anti-psychiatrists rejected the label, and very few these days self-identify their views as being anti-psychiatry. As imperfect as the term is, there doesn't seem to be a more suitable alternative for extreme views that rely on dangerous disinformation. But denouncing such antipsychiatry views does not detract from the many meaningful critiques of psychiatry and contemporary practices that serve an important role; one can still recognize the tremendous need for reform, and acknowledge the valid ways in which an exclusive emphasis on medical conceptualization can be harmful. This is a delicate and qualified position and navigating a dialogue from such a position is subject to the constant pressure for the dialogue to collapse into one polar position or another. I do not always succeed in that, but I try. That has precisely been the function of my interview series for Psychiatric Times, "Conversations in Critical Psychiatry", where I try to engage with various critical and philosophical perspectives. This doesn’t mean that I am presenting myself as neutral; I am not neutral. I have opinions which form the reference points for my discussions. It’s just that these opinions don’t fit into the usual Procrustean traps.
Now, it so happens that most of my featured quotes in the VICA article are related to criticisms of "anti-psychiatry" views. As is the way with many news stories, comments are quoted by journalists based on a judgment of where they best fit in the story. It is important to note that my comments were made in the above-mentioned context which recognizes that framing the issue as psychiatry vs anti-psychiatry is not always the most helpful frame for critical discourse and acknowledges the need to resist sterile polarization.
So, when I say, "The vast majority of psychiatric critics have no realistic idea of what it means to provide medical care to someone who is actively psychotic...", my intended referent was the "anti-psychiatry" critics – not critics per se – because I was talking about the sorts of critics who view schizophrenia merely as a problem in living requiring no medical interventions. My discomfort with polarization is also reflected in my complicated relationship with Mad in America, which certainly earns me little favor among many colleagues. It is conveyed in the article correctly that I do not dismiss Mad in America entirely and that I think it does serve as a platform for certain essential perspectives (full disclosure: I have been interviewed by Mad in America in the past, but otherwise have no organizational links with them). Because Mad in America has emerged as the major platform in the US for critical and dissatisfied voices, it demonstrates the full yin-yang messy complexity of the bad mixed in with the good and the good mixed in with the bad. Some felt that my comments were targeted specifically at MIA’s research news team, but that is not correct. When I said things like I “shake my head with disappointment”, it is with regards to blogs and articles such as this one.
That is the background for my quotes which appear in the VICE story. And I believe that is in spirit with the conclusions of the article itself, in which Shayla Love recognizes the need to resist a polarizing discourse. She writes, "It's nearly as useless to be steadfastly pro-psychiatry as it is to be anti-psychiatry. Psychiatry is not a monolith..." and "the Cartesian desire to separate mind from body, soul from biology, trauma from medical symptom—may not prove to be useful to those who need help now". Our ultimate obligation is to those who need our help and focusing on that is perhaps our best way forward. One can recognize the need for meaningful criticisms and structural reform without delegitimizing the medical basis of psychiatry.