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- 1. Antipsychiatry Moderator Col Harpreet Singh Sr Adv (Psychiatry) CH(SC) Presenter Maj Jaspreet Singh JR-1 30/08/2019 1 Total Slides- 53
- 2. Outline • Antipsychiatry : Introduction • Historical Background of Antipsychiatry • Evolution of Antipsychiatry • Critical Analysis • Newer Concepts • Popular Literature • References 3
- 4. Antipsychiatry: Introduction • Term “Antipsychiatry” - David Cooper (1967) in his book “Psychiatry and Antipsychiatry” • Antipsychiatry: A construct, which resisted the basic concept & practice of psychiatry in yesteryears* • In early 1950s, evolving biological concept of psychiatry developed in opposition to psychoanalytical psychiatry 5 Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7 *Prakash J, Saini R. Antipsychiatry or Ante Psychiatry. Industrial Psychiatry Journal.2008, 17(2),p154-56
- 5. Antipsychiatry: Introduction (contd.) • Antipscyhiatry: Part of counterculture or antiestablishment movement (1960s) • Social & political movement that challenged: – Legal privilege of psychiatrist to detain & treat the mentally ill against their will – Labelling the mentally ill person as deviant or outcast – Use of psychopharmacology 6 Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7
- 6. Antipsychiatry: Introduction (contd.) • Grew with help of mass media, activist organisations & professional bodies • Organised as a groups of scholarly psychoanalysts & sociologists who believed the biological psychiatry is causing abuses in the name of science 7 Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6.
- 8. Historical Background 19th century • Mentally disturbed people were considered wild animals* • Confinement in Madhouses* • Use of coercive & dominating techniques Dain N. Reflections on antipsychiatry and stigma in the history of American psychiatry. Psychiatric Services. 1994 Oct;45(10):1010-4. *Crossley N. RD Laing and the British anti-psychiatry movement: a socio–historical analysis. Social science & medicine. 1998 Oct 1;47(7):877-89 9 Vienna’s Narrenturm: FOOLS TOWER, one of the earliest buildings specifically designed as a “Madhouse".
- 9. Historical Background 19th century • Policies lead to inflation of power of physician in relation to patient • Exponential rise in number of asylums & Involuntary Confinement • Medical personnel- Masters of Madness Crossley N. RD Laing and the British anti-psychiatry movement: a socio–historical analysis. Social science & medicine. 1998 Oct 1;47(7):877-89.. 10
- 10. Historical Background 19th century Willoughby CD. Running Away from Drapetomania: Samuel A. Cartwright, Medicine, and Race in the Antebellum South. Journal of Southern History. 2018;84(3):579-614. 11 • Dr. Samuel Cartwright: Drapetomania (1851) • A diagnosis for why slaves ran away from their masters • Later on abolished
- 11. Historical Background 20th century • Germany- - Medicalization of social problems - Systemic euthanasia of people in mental institutes in 1930s • Neuremberg Trials- Convicted Psychiatrists who held key positions in Nazi regime Prakash J, Saini R. Antipsychiatry or Ante Psychiatry. Industrial Psychiatry Journal.2008, 17(2),p154-56 Lapon L. Mass murderers in white coats: Psychiatric genocide in nazi germany and the united states. 1986. ISBN 096146193 12
- 12. Historical Background 20th century Soviet Union – political misuse of Psychiatry • Psikhushka Hospitals - Russian word for psychiatric hospital* • Isolation of political prisoners from the rest of society* • Term Sluggish Schizophrenia - 1960s, Soviet Psychiatrist Andrei Snezhnevsky *Prakash J, Saini R. Antipsychiatry or Ante Psychiatry. Industrial Psychiatry Journal.2008;17(2),p154-56 Kathleen H. Abandoned to the state: cruelty and neglect in Russian orphanages. Human Rights Watch. New York: Random Books; 1998. ISBN 978-1-56432-191-6 13
- 14. Important Personalities • Seminal thinkers – Michel Foucault (1926- 1984) in France – Ronald David Laing (1927- 1989) in England – Thomas Szasz (1920- 2012) in USA – Franco Basaglia (1924-1980) in Italy • The common belief – Personal reality was independent from any predetermined definition of normalcy imposed by organised psychiatry 15 Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6.
- 15. Michel Foucault • Madness & Civilisation (1965) – Social context of mental illness driven by external economic & cultural interests • Psychiatry had become A third Order of Repression- a jurisdiction (legal power) without appeal in addition to Police & Court Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6 16
- 16. R D Laing • The Divided Self: An existential study in sanity and madness(1960) • Proposed that behaviour of a psychotic could be 1. Either a sign of disease 2. Or behavior expressive of person’s existence 17 Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7
- 17. R D Laing • Schizophrenia – Not a disease but an personal fight for freedom – Could be cured through Social Remediation* • Founded Philadelphia Association in 1965 along with David Cooper – 20 therapeutic communities in England including Kingsley Hall – Patients assumed equal status as staff – Medication was a choice (Voluntary Medication) Desai NG. Antipsychiatry: Meeting the challenge. Indian journal of psychiatry. 2005 Oct;47(4):185. *Laing R. The Divided Self: An existential study in sanity and madness. London: Penguin Books; 1960 18
- 18. R D Laing • “Psychiatrosis”- new type of mental disorder in Psychiatrists Desai NG. Antipsychiatry: Meeting the challenge. Indian journal of psychiatry. 2005 Oct;47(4):185. 19
- 19. Thomas Szasz • Social critic of moral & scientific foundations of Psychiatry* • Schizophrenia – No brain lesion – Classified as disease to gain power • Psychiatry-State Collusion – State legitimized the coercive practices to exclude non conformists – State & Psychiatry should be separate from each other • Defender of Radical Individualism Szasz TS. The Myth of Mental Illness: Foundations of the Theory of Personal Conduct. New York: Hoeber- Harper; 1961,p23-7 *Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6 20
- 20. Thomas Szasz • Libertarian Party in 1971- platform to halt government’s Psychiatry Mind control operations • Views about Psychiatry “whereas in modern medicine, new diseases were discovered, in modern psychiatry they were invented”. Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7 Szasz TS. The Myth of Mental Illness: Foundations of the Theory of Personal Conduct. New York: Hoeber- Harper; 1961,p57-9 21
- 21. Thomas Szasz • Coined the term – Pharmacracy • In 1969 collaborated with Scientology to form the Citizens Commission on Human Rights Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7 22
- 22. Thomas Szasz Famous books by Thomas szasz 23
- 23. Franco Basaglia • Italian Psychiatrist and Neurologist. • Founder of Psychiatria Democratica (1974) - association with anti institutionalization . . goal • Italian National Reform Bill, 1978 – Banned all asylums & compulsory admissions – Established community hospital psychiatric units (15 Beds) • Democratic Psychiatry Movement Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7 24
- 24. Famous Controversies Rosenhan Experiment • D.L. Rosenhan (1929-2012) • Psychologist at Stanford University • Conducted Rosenhan experiment or Thud Experiment to determine validity of psychiatric diagnosis • Published a study in Science Journal in 1973 – “On being Sane in Insane Places” 25 Dain N. Reflections on antipsychiatry and stigma in the history of American psychiatry. Psychiatric Services. 1994 Oct;45(10):1010-4 Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179(4070):p.250-8.
- 25. Famous Controversies Rosenhan Experiment • He highlighted the dangers of dehumanisation and labelling in Psychiatric Institutions. • He suggested the use of community approach concentrating on specific problems & behaviors rather than giving psychiatric labels 26 Dain N. Reflections on antipsychiatry and stigma in the history of American psychiatry. Psychiatric Services. 1994 Oct;45(10):1010-4 Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179(4070):p.250-8.
- 26. Famous Controversies Homosexuality & Antipsychiatry • In 1970, Antipsychiatrists joined hands with gay activists to form human chain to disrupt 124th annual Meeting of APA • In 1971, war on Psychiatry was declared for its classification of homosexuality as disorder • In 1973, deleted homosexuality as a mental disease by a vote of 58 percent Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6 27
- 27. Famous Controversies War Related Mental Disorders 28 . • PTSD – first appeared in 1980 in DSM III Hyams KC, Wignall FS, Roswell R. War syndromes and their evaluation: from the US Civil War to the Persian Gulf War. Annals of internal medicine. 1996 Sep 1;125(5):398-405.
- 28. Decline of Antipsychiatry • Began to decline in early 1980s • Biopsychosocial model reduced gap between analytical & biological practitioners • Neurotransmitter discoveries & Twin Registries- Schizophrenia is partially biologically based • ECT & psychosurgery have become marginalized as treatments with effective psycho pharmacotherapy Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6. 29
- 29. Decline of Antipsychiatry • Forced confinement came under judicial scrutiny in different parts of the world • Loss of support by leftist oriented movements of the Counterculture era Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6. 30
- 30. Current status of Antipsychiatry • Weakened antipsychiatry coalition has merged into Mental Health Consumerist Movement • Working model- Addressal of Mental health issues by political correctness rather than confrontation & radicalisation • Consumerist views – Antipsychiatry movement- intellectual exercise by psychiatrist intellectuals who had little interest to reach out to struggling ex patients – Antipsychiatry movement - mere campus based movement & could never become patient based Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6. 31
- 31. Current status of Antipsychiatry • Initial conception by Clifford Beers (ex patient) & organisations namely Anti- Insane Asylum Society & National committee on Mental Hygiene (1909) • Lead by ex patient leaders like to carry the message criticism of psychiatry forward – Leonard Frank (founder of Support Coalition International) • Internet Global community – Antipsychiatry websites- exert significant influence on mental healthcare system Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6. 32
- 33. Critical Analysis • Despite the scientific advancements, Antipsychiatry views propagated by journalists & critics • Most of the criticism is exaggeration attributed to an era of primitive understanding of brain disorders Nasrallah HA. The antipsychiatry movement: Who and why. Current Psychiatry. 2011 Dec 1;10(12):4-53. 34
- 34. Critical Analysis Overperceived misdeeds of Psychiatry 1. Original “Sin” of Psychiatry : Locking up & Abusing mentally ill patients in asylums 2. Deteriorating conditions of asylums were blamed on Psychiatry 3. Medicalizing Madness Nasrallah HA. The antipsychiatry movement: Who and why. Current Psychiatry. 2011 Dec 1;10(12):4-53. 35
- 35. Critical Analysis 4. Use of physical & Chemical restraints 5. Adoption of drastic measures to control serious mental illness in pre pharmacotherapy era o ECT o Lobotomies 6. Side effects of Antipsychotic medications Nasrallah HA. The antipsychiatry movement: Who and why. Current Psychiatry. 2011 Dec 1;10(12):4-53. 36
- 36. Critical Analysis 7. Arbitrariness of Psychiatric diagnosis o Based on committee consensus criteria rather than valid scientific objective o Lack of biomarkers o Labelling Homosexuality as mental disorder o Drapetomania, Sluggish Schizophrenia 8. Criticism of psychoactive drugs allegedly used on children Nasrallah HA. The antipsychiatry movement: Who and why. Current Psychiatry. 2011 Dec 1;10(12):4-53. 37
- 37. Critical Analysis • Psychiatry is far more scientific today than it was a century ago, but misperceptions about psychiatry continue to be driven by abuses of the past • Antipsychiatry has lead to improvement in psychiatric nosology • The best antidote for antipsychiatry allegations is a combination of personal integrity, scientific progress, and sound evidence-based clinical care *Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7 Nasrallah HA. The antipsychiatry movement: Who and why. Current Psychiatry. 2011 Dec 1;10(12):4-53. 38
- 38. Critical Analysis • Antipsychiatry is a demonstration of Psychiatry’s richness & complexity • Imperative to know Psychiatry for what to practice and equally important to know Antipsychiatry for what not to practice* *Prakash J, Saini R. Antipsychiatry or Ante Psychiatry. Industrial Psychiatry Journal.2008, 17(2),p154-56 Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7 39
- 39. Critical Analysis Antipsychiatry – Reminder for Psychiatric introspection • Disproportion b/w social expectations & objective capabilities of Psychiatry • However, the still existing stigmatization of psychiatry, psychiatrists & psychiatric illness has roots in past – Psychiatrists in past themselves disappointed in psychiatry from subjective reasons – Non medical professionals for mental health – Patients were largely dissatisfied with the treatment called them as survivors Pajević I, Hasanović M. Antipsychiatry as the stigma. Psychiatria Danubina. 2017 Dec;29(5):890-4. 40
- 40. Critical Analysis Antipsychiatry – Reminder for Psychiatric introspection Stigmatisation • Leprosy patients were stigmatised in middle ages • Psychiatric illness will also cease to be stigmatized when convincing cures are found Pajević I, Hasanović M. Antipsychiatry as the stigma. Psychiatria Danubina. 2017 Dec;29(5):890-4. 41
- 42. Postpsychiatry • Postmodern era of medicine 1. Concern about values as well as evidence 2. Preoccupation with risk rather than benefits 3. Rise of the well informed patient • Postpsychiatry: – Beyond Antipsychiatry & Psychiatry 43 Bracken P, Thomas P. Postpsychiatry: a new direction for mental health. Bmj. 2001 Mar 24;322(7288):724-7
- 43. Postpsychiatry • Context: families, communities, societies & cultures Understand disorder at the level of • Engagements with contexts • Priorities given to values, partnerships Proposes responses in terms of • Seeks to separate engagement and treatment from coercion Relationship to coercion 44 Bracken P, Thomas P. Postpsychiatry: a new direction for mental health. Bmj. 2001 Mar 24;322(7288):724-7
- 44. Positive Psychiatry • Practice of psychiatry focussing on PPCs ie Positive Psychosocial Characteristics – Resilience/ optimism/ social engagement/ low level of perceived stress/successful psychological ageing/ personal mastery and coping self efficacy/ spirituality • PPCs are addressed to lesser extent in psychiatric textbooks and empirical reports • Omission might have hindered Psychiatry’s ability to effect the positive change in patients’ lives 45 Jeste DV, Palmer BW, Rettew DC, Boardman S. Positive psychiatry: its time has come. The Journal of clinical psychiatry. 2015 Jun;76(6):675.
- 46. Clifford Beers (1876- 1943) • Founder of the "National Committee for Mental Hygiene" (1909) • 1900 - Confined to a private mental institution for depression & paranoia.* • Experienced & witnessed serious maltreatment at the hands of the staff • A Mind That Found Itself (1908)* – Autobiographical account – Hospitalization & abuses – Bestseller, still in print 47 *Szasz T . Psychiatry: The Science of Lies. New York: Anchor Books; 2008,p98 Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7
- 47. One Flew Over the Cuckoo's Nest (1962) • Novel • Oregon Psychiatric Hospital • A study of institutional processes & the human mind as well as a critique on behavior control • A tribute to individualistic principles • 1975 movie – Won 5 Academy Awards 48 Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6 Kesey K. One Flew Over The Cuckoo's Nest . New York: Viking Press; 1962
- 48. References 1. Prakash J, Saini R. Antipsychiatry or Ante Psychiatry. Industrial Psychiatry Journal.2008, 17(2),p154-56 2. Cooper D. Psychiatry and anti-psychiatry. London: Tavistock Publications; 1967 3. Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European archives of psychiatry and clinical neuroscience. 2003 Apr 1;253(2):61-7 4. Rissmiller DJ, Rissmiller JH. Open forum: evolution of the antipsychiatry movement into mental health consumerism. Psychiatric services. 2006 Jun;57(6):863-6. 5. Dain N. Reflections on antipsychiatry and stigma in the history of American psychiatry. Psychiatric Services. 1994 Oct;45(10):1010-4. 49
- 49. References 5. Crossley N. RD Laing and the British anti-psychiatry movement: a socio–historical analysis. Social science & medicine. 1998 Oct 1;47(7):877-89.. 6. Willoughby CD. Running Away from Drapetomania: Samuel A. Cartwright, Medicine, and Race in the Antebellum South. Journal of Southern History. 2018;84(3):579-614. 7. Lapon L. Mass murderers in white coats: Psychiatric genocide in nazi germany and the united states. 1986. ISBN 096146193 8. Kathleen H. Abandoned to the state: cruelty and neglect in Russian orphanages. Human Rights Watch. New York: Random Books; 1998. ISBN 978-1-56432-191-6 9. Foucault M. Madness and Civilization : A History of Insanity in the Age of Reason. New York: Random House; 1965 50
- 50. References 11. Desai NG. Antipsychiatry: Meeting the challenge. Indian journal of psychiatry. 2005 Oct;47(4):185. 12. Laing R. The Divided Self: An existential study in sanity and madness. London: Penguin Books; 1960 13. Szasz TS. The Myth of Mental Illness: Foundations of the Theory of Personal Conduct. New York: Hoeber- Harper; 1961 14. Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179(4070):p.250-8. 15. Hyams KC, Wignall FS, Roswell R. War syndromes and their evaluation: from the US Civil War to the Persian Gulf War. Annals of internal medicine. 1996 Sep 1;125(5):398-405. 51
- 51. References 16. Nasrallah HA. The antipsychiatry movement: Who and why. Current Psychiatry. 2011 Dec 1;10(12):4-53. 17. Szasz T . Psychiatry: The Science of Lies. New York: Anchor Books; 2008.p.98 18. Pajević I, Hasanović M. Antipsychiatry as the stigma. Psychiatria Danubina. 2017 Dec;29(5):890-4. 19. Kesey K. One Flew Over The Cuckoo's Nest . New York: Viking Press; 1962 20. Bracken P, Thomas P. Postpsychiatry: a new direction for mental health. Bmj. 2001 Mar 24;322(7288):724-7 21. Jeste DV, Palmer BW, Rettew DC, Boardman S. Positive psychiatry: its time has come. The Journal of clinical psychiatry. 2015 Jun;76(6):675. 52
- 52. Thank You 53
Editor's Notes
- Good Afternoon
- Term was coined much later. The movement had already gained momentum Psychoanalytical psychiatry was subjective and involved prolonged sessions of psychotherapy. -now since antipsychiatrists were influenced by some psychoanalytical concepts there was a belief mental illnesses were caused by repressed desires from childhood. Like psychoanalysysts, antipsychiatrists also believed that everybody had some degree of neurosis that could be resolved through analysis. They referred to symptom free individuals as normal neurotics
- Counterculture movement involved a large number of youth, who rejected many beleifs held by the society at large Now to understand more comprehensively Labelling because they did not follow the rules of the society, don’t fit into the established societal structure Later on, use of psychopharmacology, against the wishes of the patient and neglecting its side effects Chlorpromazine or Thorazine 1950 – chemical straitjacket effect, tardive dyskinesia, neuroleptic malignant
- The growth of the antipsychiatry took place with the help of print media and other activist organisation
- -The Narrenturm in Vienna is Europe's oldest building for the accommodation of psychiatric patients. Built in 1784, it is next the old Vienna General Hospital, and is now converted to Federal Pathology-Anatomy Museum Vienna. Psychiatry came into bad light -Coercive techniques : isolation, confrontational interogations, punishment techniques such as cold showers- physical beating -restriant chairs, st -Nevertheless, there was increasing concern at the ease with which people could be confined, without asking any questions
- Deterioration of the physician patient relations to complete subordination & servitude. They had become unquestioning authority Physicians had literally became Asylum keepers appointed by the establishment to get rid of unwanted people from society With such conducive environment & backing from the authorities, there was a huge rise in the asylums
- American physician The disease were belived to be suffering who ran away from their masters out of their own desire, out of their own free will. Scientific racism, sometimes referred to as race biology, is a pseudoscientific belief that empirical evidence exists to support or justify racism (racial discrimination), racial inferiority, or racial superiority.
- Holocaust historians argued that the medicalization of social problems and systematic euthanasia of people in German mental institutions in the 1930s, unfit people were wilfully terminated showing them as euthanasia. It can be called as a prelude to mass murder in 1940. Nuremberg, Germany, was chosen as a site for trials that took place in 1945 and 1946. Judges from the Allied powers—Great Britain, France, the Soviet Union, and the United States—presided over the hearings of Nazi criminals. Twelve prominent Nazis were sentenced to death. Personal and increasingly also social problems such as poverty and unemployment are defined in medical terms and thus become subject to medical and pharmaceutical interventions. Rather than the medical profession, market (e.g., companies) and state (e.g., health policy) actors seem to be the engines behind medicalisation in the 21st century.
- -There was a official explanation was that no sane person would be against socialism. -In the Soviet Union, psychiatric hospitals were often used by the authorities as prisons, in order to isolate political prisoners from the rest of society, discredit their ideas, and break them physically and mentally. As such, psikhushkas were considered a form of torture. - 1940 -1960 -Sluggish schizophrenia or slow progressive schizophrenia characterized by a slowly progressive course; it was diagnosed even in patients who showed no symptoms of schizophrenia or other psychotic disorders, on the assumption that these symptoms would appear later. It was developed in the 1960s by Soviet psychiatrist Andrei Snezhnevsky and his colleagues, and was used exclusively in USSR , until the fall of Communism starting in 1989. The diagnosis has long been rejected because of its scientific inadequacy and its use as a means of confining dissenters. It has never been used not recognized outside of Soviet Union, international organizations such as the World Health Organization. It is considered a prime example of the political abuse of psychiatry in the Soviet Union. Stalin Mikhail Gorbachev
- Hegemonic – dominant in political and social sense
- Traced the social context of mental illlness & noted that during renaissance period, madmen were considered as fools who featured prominently in the writings of Shakespeare and Cervantes More intensified with the recognition of madness as mental disease with advancement in knowledge . Psychiatric authority which operated under the state to rid the society of unwanted individuals Cervantes- 1547- 1616, spanish novelist & poet, highly regarded in spanish literature
- Either considered a disease by the outside society or it could be expression of his inner world, his existence
- Kingsley Hall is a community centre, at Bromley-by-Bow in the East End of London. Social remediation in the form of congenial enviromnent where he can live, understand himself rather than being imposed upon In 1965 for treating people affected by mental health crisis. Kingsley Hall became home to one of the most radical experiments. The aim of the experiment by the Philadelphia Association was to create a model for non-restrainint, giving equal staus to the patients as staff, voluntary Medication.
- Gave a term psychiatrosis. Regarded the diagnostic processes of modern psychiatrists as a mental disorder in itself
- Ragarding psy state collusion The state to exclude non conformists and dissidents has legitimised the coercive practices if state & psychiatry together, state would ultimately corrupt psychiatry as happened in Nazi Germany and Soviet union Individualism- a social theory favouring freedom of action for individuals over state control
- Individualism- a social theory favouring freedom of action for individuals over state control
- The modern agenda for transforming human problems into "diseases" and judicial sanctions for "treatments," replacing the rule of law with the rule of medical discretion, leads to a type of government Thomas Szasz calls "pharmacracy." Citizens comission on human rights- encouraged the arrest of psychiatrists for their crimes againt humanity. was founded in the 1950s by L. Ron Hubbard. At the core of Scientology is a belief that each human has a reactive mind that responds to life's traumas, clouding the analytic mind and keeping us from experiencing reality.
- One line about each book Myth of mental illness 1961 criticizes psychiatry and argues against the concept of mental illness. It received much publicity, and has become a classic, well known as an argument against the tendency of psychiatrists to label people who are "disabled by living" as "mentally ill". The manufacture of Madness- Mental illness has been used to control and scapegoat certain kinds of people, Szasz asserts his belief that mental illness and mental health cannot be defined, depression and schizophrenia are not diseases, there is a distinction between individuals seeking mental health treatment and those who are institutionalized against their will.
- Worked at asylum of trieste - -This reorganisation of mental health services affected other parts of the world namely Europe, newzealand & australia where hundreds of psychiatric institutions were closed throughout democratic psychiatry movement-
- David Rosenhan, a psychologist & a Stanford University professor, and published a study the journal Science in 1973 under the title "On being sane in insane places". This study provided important and influential criticism of psychiatric diagnosis. The Rosenhan experiment or Thud experiment was an experiment conducted to determine the validity of psychiatric diagnosis. The experimenters feigned hallucinations to enter psychiatric hospitals, and acted normally afterwards. They were diagnosed with psychiatric disorders and were given antipsychotic drugs -The first part involved the use of healthy associates or "pseudopatients" (3 women and 5 men, including Rosenhan himself) who briefly feigned auditory hallucinations in an attempt to gain admission to 12 psychiatric hospitals in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had no longer experienced any additional hallucinations. All were forced to admit to having a mental illness and had to agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All but one were diagnosed with schizophrenia "in remission" before their release. - The second part of his study involved an offended hospital administration challenging Rosenhan to send pseudopatients to its facility, whom its staff would then detect. Rosenhan agreed and in the following weeks out of 250 new patients the staff identified 41 as potential pseudopatients, with 2 of these receiving suspicion from at least one psychiatrist and one other staff member. In fact, Rosenhan had sent no pseudopatients to the hospital. -The study concluded "it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of dehumanization and labeling in psychiatric institutions. It suggested the solution in the form use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution.
- David Rosenhan, a psychologist & a Stanford University professor, and published a study the journal Science in 1973 under the title "On being sane in insane places". This study provided important and influential criticism of psychiatric diagnosis. The Rosenhan experiment or Thud experiment was an experiment conducted to determine the validity of psychiatric diagnosis. The experimenters feigned hallucinations to enter psychiatric hospitals, and acted normally afterwards. They were diagnosed with psychiatric disorders and were given antipsychotic drugs -The first part involved the use of healthy associates or "pseudopatients" (3 women and 5 men, including Rosenhan himself) who briefly feigned auditory hallucinations in an attempt to gain admission to 12 psychiatric hospitals in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had no longer experienced any additional hallucinations. All were forced to admit to having a mental illness and had to agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All of them except one, were diagnosed with schizophrenia "in remission" before their release. - The second part of his study involved an offended hospital administration challenging Rosenhan to send pseudopatients to its facility, whom its staff would then detect. Rosenhan agreed and in the following weeks out of 250 new patients the staff identified 41 as potential pseudopatients, with 2 of these receiving suspicion from at least one psychiatrist and one other staff member. In fact, Rosenhan had sent no pseudopatients to the hospital. -The study concluded "it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of dehumanization and labeling in psychiatric institutions. It suggested the solution in the form use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution.
- There has been always a prolem of changing or flutuating diagnosis in psychiatric practice in the absence of specific etiology & antipsychiatry has been vey vocal about highlighting these facts. Ego dystonic homosexuality appeared in DSM III (1980)—one was in conflict about one’s homosexuality Ego dystonic homosexuality removed as a disorder—DSM III revised (1987)
- The vagueness, unreliability and fluctuation of diagnosis. Firstly , there has been Secondly, As we see in miltary psychiatry, the mental issues and conflicts faced during the war can be conviniently brushed off as nothing else but war fatigue. At the same time, they can be given the diagnosis of mental illness and labelled ( for whatever gains or losses individual might face due to the diagnosis). So it all very vague and unreliable. Decisions mainly taken on the requirements of the establishment.
- The survival of Antipsychiatry movement was based on criticism of Psychiatry Antipsychiatry began to dampen down in 1980s mainly due to the upsurge of biopsychosocial model (1978) which brought about friendly rapport between analytical & biological practioners Neurotransmitter discoveries like dopamine excess state in schizophrenia Twin registries Common in developed countries……india twinning rate 7.2/1000….chennai twin registry july 2008 Relative effects of nature and nurture Neurobiological understanding of mental diseases can be achieved by genetic epidemiological studies like twin studies & chromosomal analysis
- Antipsychiatry surviced basically only on the reckless criticism of whatever psychiatry did - With Informed consent being mandatory for seeking psychaitric help, one more point of criticism got killed -Progressive leftist coalitions used to support the antipsychiatry movement. These were the feminist movements, the gay coalitions, black coalitions
- The psychiatric survivors movement (more broadly consumer/survivor/ex-patient movement) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who are survivors of interventions by psychiatry, or who are ex-patients of mental health services. - Has been able get the work done & made its presence felt in a more sensible way consumerist movement also done the ground work in various issues like it has addressed the issue of growing cost of mental health treatment -
- Started quite early by forefathers like Clifford beers, who himself was a survivor and had seen harsh conditions of asylum Leonard Frank, underwent over 80 insulin comas and electroshock treatments, became electroshock therapy outspoken critic. Antipsychiatry websites Support coalition international The antipsychiatry Coalition Mindfreddom international
- Coming to the analysis Talk about various allegations that antipsychiatry put on psychiatry, some of which were merely exaggertions & how they could be understood more rationally and contexually
- Views about disrepute of psychiatry
- 2 centuries ago was considered a humane advance to save seriously disabled patients from homelessness, persecution, neglect, imprisonment & victimization they were not blamed on the poor funding of such institutions in an era of complete ignorance about medical basis of mental illness when it contradicted the age old held notion that psychosis is type of behavior , not mental illness. Offcourse some diagnoses are still to be looked at with discretion like Drapetomania in America. The fluctuations which have been there in DSM and ICD which has lead to such impression. The endeavor to be more and more objective should be there
- 4. But it was reqd For actively suicidal pts in the absence of pharmacotherapy 5. Ect certainly was used without anaesthesia lobotomies was a desperate measure when nothing worked out. In 1949 the neurosurgeon inventor was given nobel prize. Portuguese neurologist António Egas Moniz 6. Huge hue and cry by antipsychiatry groups about side effects . Now understood & doses adjusted. Failed to recognise that there was no better way to control psychosis. It aslo led to the closing of asylums later on
- 8. Antipsychiatry tends to minimise and likes to live in the lalaland beleiveing as if there is no existence of serious mental illness in children like childhood depreession, anxiety disorders, ADHD although on the other hand physical illness are readily accepted Certain lacunae have been emphasised….Ritalin Debate in ADHD…..immaturity & bored of studies perceived by teachers as ADHD
- The fact that it is unthinkable to think about anti cardiologists and anti peditricians Finally as concluded by our prof
- Take it with a pinch of salt Today’s psychiatrits immersed in practice may rule it out Critical introspection reqd for many important ques in and around psychiatry There was a time when people thought that psychiatry will replace religion
- Similar to the state of leprosy in middle ages, Stigmatisation of psychiatric disorders is still existing and it will
- -Postmodern health will not strives to retain,and improve the achievements of the modern era, but also respond to the priorities of postmodern society 1.Concern about values as well as evidence; 2.Preoccupation with risk rather than benefits; 3.The rise of the well informed patient -Antipsychiatry argued that psychiatry was repressive , and its proponents wanted to liberate mental patients from its clutches. In turn, psychiatry condemned its opponents as being driven by ideology. -Postpsychiatry distances itself the ideology of antipsychiatry. Neither does it seek to replace the medical techniques of psychiatry to device new lesser known treatments . Wants to take a middle balanced path taking everything into consideration Postpsychiatry is not a set of fixed ideas and beliefs, more a set of signposts that can help us move on from where we are now. -
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- Beers was born in New Haven, Connecticut to Ida and Robert Beers on March 30, 1876. He was one of five children, all of whom would suffer from psychological distress and would spend time in mental institutions, including Beers himself (see "Clifford W. Beers, Advocate for the Insane"). Prevailing literature is always an apt reflection of what is going on in the society.
- Became almost a cult and gave huge push to Antipsychiatry . Talk about protangonist, how he ends up with brain lobotomy. - One Flew Over the Cuckoo's Nest (1962) is a novel written by Ken Kesey. Set in an Oregon psychiatric hospital, the narrative serves as a study . of institutional processes and the human mind as well as a critique of behaviorism and a tribute to individualistic principles.