Antipsychiatry – What, Who and Why? Part 1

Antipsychiatry. Yes, I’m against it. I’m what you might call anti-antipsychiatry; if that didn’t sound just so darn silly.

But in saying that, perhaps we should take a greater look at antipsychiatry and what the possible benefits are of such a group (other than giving me writing fodder, naturally).

Do I Know what Antipsychiatry is?

People have accused me of not understanding antipsychiatry. Well, if you say so, but:

  1. The answer’s kind of in the question
  2. Far too many people identify as such for there to be any one definition

Luckily for me, Henry A. Nasrallah, MD put out an article: The antipsychiatry movement: Who and why. He expresses many of my thoughts on the group very nicely. He responds to their criticisms and admits that they can be seen as a useful force in psychiatry.

What is Antipsychiatry?

For those of you who don’t know, the term “antipsychiatry” is one given to a group of people who are, well, anti-psychiatry. Some would consider these people skeptics and questioners and not necessarily antagonistic, per se, while others consider this group a bunch of radical zealots that harm people with a mental illness. Any given antipsychiatrist will naturally fall somewhere within that continuum. And, as I’ve said, there is no single definition as many groups have taken this word as a label.

What are their Criticisms of Psychiatry?

Common to antipsychiatry though is the critical claims of the movement, such as, historically (as outlined by Dr. Nasrallah):

  • Locking people up and “abusing” the mentally ill (abuse is an arguable issue)
  • Medicalizing madness (contradicting the archaic notion that psychosis is a type of behavior, not an illness)
  • Drastic measures to control severe mental illness in the pre-pharmacotherapy era, including excessive use of electroconvulsive therapy (ECT), performing lobotomies, or resecting various body parts
  • Use of physical and/or chemical restraints for violent or actively suicidal patients
  • Labeling slaves’ healthy desire to escape from their masters in the 19th century as an illness (“drapetomania”)
  • Regarding psychoanalysis as unscientific and even harmful
  • Labeling homosexuality as a mental disorder until American Psychiatric Association members voted it out of DSM-II in 1973

And more recently:

  • Serious or intolerable side effects of some antipsychotic medications
  • The arbitrariness of psychiatric diagnoses based on committee-consensus criteria rather than valid and objective scientific evidence and the lack of biomarkers (this is a legitimate complaint but many physiological tests are being developed)
  • Psychoactive drugs allegedly are used to control children (antipsychiatry tends to minimize the existence of serious mental illness among children, although childhood physical diseases are readily accepted)
  • Psychiatry is a pseudoscience that pathologizes normal variations of human behaviors, thoughts, or emotions
  • Psychiatrists are complicit with drug companies and employ drugs of dubious efficacy (eg, antidepressants) or safety (eg, antipsychotics).

Each of these claims has merit, although many of the claims are exaggerated.

Historical Antipsychiatry Claims

Antipsychiatry CriticismsI really think historical claims are quite pointless. Did psychiatry make mistakes? Yes. Did they make big ones? Yes.

So did every medical specialty. We don’t judge surgeons because surgeries were once done without anesthetic because that was due to our medical understanding at the time. Psychiatry, and what we now consider atrocities, is like that – history that speaks to our lack of knowledge and understanding at the time. Now that we know better, we do better.

Current Antipsychiatry Claims

That still leaves many of the criticisms against today’s practice of psychiatry. I recommend you read Dr. Nasrallah’s whole article for his view, but I’ll look at a three.

Serious or Intolerable Side Effects of some Antipsychotic Medications

This is a valid criticism – that can be made of almost any drug on the market. There are people that take a pharmaceutical and get many side effects and there are people who take a drug and have none. Are antipsychotics particularly side effect laden? Well, not compared to, say, chemotherapy but yes compared to, say, the birth control pill. But the birth control pill has been known to kill people thanks to blood clots so nothing’s perfect.

Myself, I find the great majority of antipsychotics to be intolerable so I employ the extremely radical solution of not taking them. But that’s me.

Use of Physical and/or Chemical Restraints for Violent or Actively Suicidal Patients

This is a reasonable concern, to be sure. I would never want to be restrained either chemically or physically, but then I’ve never actively been a danger to anyone.

While, of course, that vast majority of us will never be in that position, what is one to do with a person who is violently out of control if not restrain them in some way? Doctors and nurses can’t run away from the danger – they must do something about it. And so what to do other than restrain? It’s unpleasant. It’s unfortunate. I wish it would never happen. But it’s an extraordinary measure for an extraordinary circumstance.

Psychiatry is a Pseudoscience that Pathologizes Normal Variations of Human Behaviours, Thoughts or Emotions

This one gets me every time. There is no doubt that people can meet some vague criteria for a mental illness and still be happy, functioning individuals.

However, this is not the issue because in every mental illness diagnosis there is a line that says that in order to be diagnosed with the illness the symptoms must cause great distress in the person’s life. Great distress. Not a bit unpleasant. Not make them quirky. But great distress. If you can manage to meet the criteria for depression and not be distressed by it, then I guess you’re not distressed – you just like being unhappy. Well goodie for you. Most of us don’t feel that way.

In the next article I’ll take a look at why antipsychiatry exists and the movement’s possible benefits.

In article three I talk about why some people gravitate towards antipsychiatry.

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