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the politics of madness

SS246 critical psychology
by

Matthew Adams

on 21 October 2015

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Transcript of the politics of madness

The politics
of madness
SS246 Critical Psychology
why is madness
political?

How humans treat other humans
How we respond to suffering of others
Stigmatization
Distribution of resources
Power, accountability & responsibility
Involves relationships, institutions, organizations, media, culture & society - not just individuals
Late 18th > early 19th century
Madness & Civilisation (1961) Michel Foucault's first major book
Example of his ‘archaeological’ approach & emphasis on discourse and power
contesting

history
Argues that ‘madness’ is socially constructed
‘Moral/humane’ treatments alternative forms of discourse, power & control
Michel Foucault
euthanasia
From being confined, chained, beaten and starved to…
… liberation? Philippe Pinel & Jean-Baptiste Pussin (1745-1811), Asylum de Bicêtre, Paris, 1793
Standard textbook history suggest Pinel marks a progressive transformation in understanding and treatment of madness:
‘Pinel… released the patients from their chains and allowed them to roam around the asylum grounds… Pinel’s humane approach… was mirrored in other places’ (Schacter et al. 2012: 611-12)
Challenges idea of brave psychiatrists and physicians using treatments in ‘the forlorn hope that something might work’ (Schacter et al. 2012: 612)
Instead a reflection of power relations & dominant discourse
Unsettles broader discourse of ‘progress’
critical psychology?
mid-late 20th century
a story of manoeuvrings &
counter-manoeuvrings
Development of drug treatments (1950s+)
Antipsychotics first wave (to treat e.g. schizophrenia)
Early versions: Chlorpromazine (‘chemical lobotomy’), thioridazine & haloperidol
Marketed as sedative + therapeutic benefits
Accompanied initial moves towards deinstutionalization
2nd generation of drugs worked on dopamine & serotonin receptors - reuptake blocked
Psychiatry is no better than a den of apes… who possess nothing to mitigate the appalling states of anguish and human suffocation but a ridiculous terminology Antonin Artaud (1896-1948)
into the 20th century
Containment still the norm
‘Medical’ & moral practice offered promise of reform but slow to gain widespread approval
Medical practice asserted as effective but highly problematic; e.g. transorbital labotomy, euthanasia, eugenics
trans orbital lobotomy
‘with regard to the 80,000 or more idiots and imbeciles in the country... These are... incapable of being employed... their care and support absorbs a large amount of the time, energy, and money of the normal population... many... are utterly helpless, repulsive in appearance, and revolting in manners... In my opinion it would be an economical and humane procedure were their existence to be painlessly terminated...’
A Text-Book of Mental Deficiency (Amentia) by A. F. Tredgold, Consulting Physician to University College Hospital, London. Seventh edition 1947. Page 491.
euthanasia
into the 20th century
why critical psychology?
the development of drug treatments
still mid-late 20th century
Rise of ‘counter manoeuvres’ within & without psychiatry
Sociological, psychological & literary critique (e.g. Goffman, Kesey, Szasz)
Increase in testimony from psychiatric survivors; e.g.
1. taboo of silence broken (1950s +)
R.D. Laing (1927 – 1989)
Born 1927 in Glasgow
Trained as a medical doctor then psychiatrist
Early career in military hospitals 1950s
Published key works in 1960s and gained celebrity status
Founding member of Kingsley Hall & the Philadephia Associaton
key to the development of anti-psychiatry
2. anti-psychiatry & R.D. Laing
‘Are the experience and behaviour that psychiatrists take as symptoms and signs of schizophrenia more socially intelligible than has come to be supposed?’ (Laing & Esterson, 1964: 12)
Laing’s early career marked by willingness to spend time with psychotic patients
Maintained this emphasis in early experiments
Advocates the intelligibility of experience
The Divided Self (1961) & Sanity, Madness and the Family (with Aaron Esterson, 1964)
Laing & intelligibility
‘Our ‘normal’ ‘adjusted’ state is too often the abdication of ecstasy, the betrayal of our true potentialities… many of us are only too successful in acquiring a false self to adapt to false realities’ (Laing, 1967: 24)
Laing’s later career marked by a more radical approach to psychiatry & capitalist society
The Politics of Experience & The Bird of Paradise (1967)
Laing's practice - e.g. Kingsley Hall
Laing & anti-psychiatry
Refute biological basis of mental illness
Medication reflects exploitative pharmaceutical industry
What comes to be understood as mental illness is culturally specific
Suffering is a cause of toxic society
Against forcible committal or medication of individuals
Challenge the categorisation of madness & sanity
Criticise psychiatry’s social control function in a capitalist society
tenets of anti-psychiatry
Definitions of madness reflect power
Policing women’s roles
Actively maintaining status-quo
Chesler’s Women & Madness (2006) & Elizabeth Showalter The Female Malady (1987)
Women’s testimony & feminist movement vital for overdue recognition of patriarchal dimension of madness
3. feminism
Rise of medical-like diagnostic systems & orientation in psychiatry (1970s+)
Psychiatry today still a branch of medicine
2nd generation of antipsychotics (‘atypical’) since 1990s: clozapine, resperidone
Proliferation of medication for other disorders: anti-anxiety medication, antidepressant & mood stabilisers
contemporary critical approaches
Political critique of medical model
Some tenets of contemporary critical approaches
‘the human costs of the medicalization of misery and madness outweigh any benefit that the metaphoric transformation of suffering into ‘disease’ may once have offered’ (Rapley, Moncrieff & Dillon, 2011: 2)
political critique of medical model - more
Critique of medical model
Side effects
Over-prescription (including off-label)
Big(ger) Pharma & psychiatry
Some tenets of contemporary critical approaches
‘exposing the linguistic contortions by which the transposition of social and moral political issues into disease is acheived’ (Rapley, Moncrieff & Dillon, 2011: 5)
Strong constructionist strand
Constructionist strand - more
Example of social constructionist critique:
Mary Boyle on schizophrenia (e.g. 2004. 2006)
Establishes the evidence base as uncertain (e.g. Boyle, 2004)
Then asks how uncertainty managed:
‘how is the presentation of "schizophrenia as a brain disease" managed in such a way that the absence of direct evidence will not be noticed or not seem important?’ (Boyle, 2006: 9)
Some tenets of contemporary critical approaches
‘people who have first-hand experience of psychiatry and the mental health system are increasingly claiming the right to speak and act on their own terms’ (Holland et al. 2009: 144).
User-originated & orientated
c/s/x
The psychiatric consumer/survivor/ex-patient (c/s/x) movement
User-originated and orientated
Talking back / ‘counter-discourse’
Organisations of… rather than for…
Grew out of (critical) dialogue with anti-psychiatry
Form of identity politics
E.g. Hearing Voices Network, Mad Pride
Challenging media representations and government policy
Postpsychiatry & community psychology
c/s/x play a central role
Explicit alternatives to medical model of treatment
Understanding/intervention beyond individual and immediate interpersonal context.
Orientated to users/the community as the basic unit of analysis
Explicitly radical – tools for empowerment of groups excluded or marginalised
See Bracken & Thomas (2001) Postpsychiatry: A new direction for mental health. BMJ 322: 724-7
Historical & political approach to madness vital
Applies to the present day
Healthy culture of scepticism & resistance?
Progress in psychiatry (& psychology)?
The present & the future still to be decided...
summary & conclusion
the
end
‘the notion of mental illness has outlived whatever usefulness it might have had and that it now functions merely as a convenient myth’ (Szasz, 1960: 118)
‘Give us the grounds of your power! By what right do you exercise it? In whose name? To what advantage?’ Foucault, 2006 [1978]: 361
Matt Adams
Boyle, M. (2002, 2nd ed.) Schizophrenia: a scientific delusion? London: Routledge.
Boyle, M. (2006) It's all done with smoke and mirrors. Or, how to create the illusion of a schizophrenic brain disease. Clinical Psychology , 12, 9-16 http://www.critpsynet.freeuk.com/Boyle.htm
Excellent informative interview with Moncrieff available atwww.madnessradio.net/madness-radio-bipolar-medication-myths-joanna-moncrieff
Moncrieff, J. (2010) Psychiatric diagnosis as a political device. Social Theory & Health. Vol. 8, 4, 370–382 www.psychiatry.freeuk.com/Jodiagnosis.pdf
Moncrieff, J. (2003) Is psychiatry for sale? An examinination of the influence of the pharmaceutical industry on academic and practical psychiatry. London: Institute of Psychiatry. Available at: www.critpsynet.freeuk.com/pharmaceuticalindustry.htm
Holland, K.; Blood, R. W.; Pirkis, J.; and Dare, A., Postpsychiatry in the Australian media: The‘vulnerable’ talk back, Asia Pacific Media Educator, 19, 2009, 142-157. Available at: http://ro.uow.edu.au/apme/vol1/iss19/13
Millett, K. (1990) The loony-bin trip. New York: Simon and Schuster.
Additional References (with links)
Morrison, L. J. (2005). Talking Back to Psychiatry: The Psychiatric Consumer/Survivor/Ex-patient Movement. London: Routledge
Pilgrim, D. (2007) The survival of psychiatric diagnosis. Social Science & Medicine 65(3): 536–547
Rapley, M. Moncrieff, J. & Dillon, J. (eds.) (2011) De-medicalising Misery.
Showalter E (1987) The female malady: women, madness, and English culture, 1830-1980. New York: Viking.
Redman, P. (2002) ‘Love is in the air: Romance in the everyday’ in T. Bennet & D. Watson (eds.) Understanding Everyday Life. Milton Keynes: OU press.
Szasz, T. (1960) The Myth of Mental Illness. American Psychologist, 15, 113-118. Available at: http://psychclassics.yorku.ca/Szasz/myth.htm
Ussher, J. (1991) Women’s madness: misogyny or mental illness? New York/Hertfordshire: Harvester Wheatsheaf.
Wiener, D. (2005) Antipsychiatric activism and feminism: the use of film and text to question biomedicine", Journal of Public Mental Health, Vol. 4(3): 42 - 47
Wilson, M. (1993) DSM-III and the transformation of American psychiatry: A history. American Journal of Psychiatry 150(3): 399–410.s
Additional References (with links)
SS246 Critical Psychology / The Politics of Madness / Matt Adams
Full transcript