Our history of psychiatry branches a bit now. I'm going to start to talk about the anti-psychiatry movement, and I'll do de-institutionalization next. But both of them were happening at the same time, so these are both mid-20th century events. The anti-psychiatry movement is usually described as emerging in the 1950's, 60s' with major points of activity in the United States, the UK and parts of Europe. Of course, that wasn't the first time that there have been criticisms of psychiatry. Essentially, since the time that psychiatry organized itself as a profession that defined and dealt with madness, there were people that were critical of that role. The anti-psychiatry movement was different because it merged from within the profession itself. The term anti-psychiatry was actually coined by a leader of the movement, psychiatrist David Cooper. However, many of the people who are associated with that movement really didn't embrace the term. The anti-psychiatry movement had many different threads. But the ideas that were most commonly associated with it were challenging the power that psychiatrists had to, had to detain and treat people, especially involuntarily. Challenging the use of a medical model to explain madness. And for some, challenging the actual existence of mental illness. The critiques of the a psychiatry were not isolated. They were very much a part of the times, in that they were part of general sentiments rejecting institutional power in western society as the tool of oppression, repression, and social control. The anti-psychiatry movement was part of a wave of anti-establishment activism at the time. But it was certainly bolstered by parallel developments within psychiatry, like the development of alternatives to pharmacological treatments, like psychoanalysis and other psychotherapies. The perception that with the advent, with the advent of pharma, pharmacological treatments, psychiatrists have become over reliant on them and, in fact, have really lost interest in trying to understand their patients. And also the attention of various social theorists we've already referred to Goffman and Foucault, who persuasively argued that mental illness was just a label given to people who deviated from acceptable social norms. In addition, there were some serious problems with the way that psychiatry was being practiced. Although the 20th century had begun with optimism about the great contributions that would be made by the mental hygiene movement and the promise of a new scientific era of mental health treatment, the promises of cures for mental illness were not fulfilled. In fact, many of the treatments of the time had turned out to be ineffective or even harmful. Treatments like insulin shock therapy, early versions of electroconvulsive therapy, and psychosurgeries, like lobotomies, had caused tremendous harm and sometimes permanent damage to patients. Even the medications of the time were fairly blunt instruments. Patients could have severe, long-term side effects. Until recently, it was still not uncommon to see patients with drug-induced movement disorders that were the result of treatment with those earlier medications. In addition, psychiatrists have been revealed as untrustworthy. Psychiatry was implicated in the abuse of political power in various parts of the world. Diagnosis and institutionalization were used to silence political dissidence. North American psychiatrists were revealed to be participants in government experiments on unsuspecting unconsenting patients. European psychiatrists were implicated in the sterilization and murder of thousands of mentally ill and disabled people. The potential for psychiatry to be harmful was appallingly clear. Even aside from those types of extreme circumstances, psya, psychiatric diagnoses were not seen as reliable and validated at the time. although we had already seen the development of the Diagnostic and Statistical Manual of Mental Disorders,, the first one is available in 1952, and the International Classification of Diseases, which is used in much of the world included mental disorders for the first time in 1949. But really, what was available in those manuals wasn't based on, on systematic research. And this was really demonstrated quite clearly when Rosenhan did his 1973 study about faking mental illness. If you're interested in this study and you haven't heard about it, I really recommend taking a look on the Internet. There's lots of information about it. But, a quick summary of it is that Rosenhan sent people into psychiatric hospitals faking mental illness. And as soon as they were admitted, he had instructed them to start acting as they would normally and to tell people that they were no longer experiencing any symptoms. What they found was that although these people were, had faked their way in, and were now acting normally"", they were still diagnosed with major mental illnesses, and they weren't allowed to go until they were willing to accept the diagnosis and willing to accept treatment with anti-psychotic medication. psychiatrists were of course, very upset [LAUGH] by this, by this experiment, and they challenged Rosenhan to do it again to see, to prove that they could do better a second time. Rosenhan said he would, but he actually didn't send anybody to the hospitals. And in this case situation, the psychiatrists ended up identifying fake patients that were actually people who were legitimately dealing with mental health problems. So, you can imagine that people were really beginning to wonder if psychiatrists actually knew what they were doing. Some of the big players associated with the anti-psychiatry movement are probably known to you. Because part of what made them big players was that they wrote internationally best selling books criticizing psychiatry. R.D. Laing, who was author of The Divided Self,, Sanity, Madness and the Family.. He suggested that what we call mental disorders, especially schizophrenia, were actually a normal response to a mad world, sometimes a response to problems in the family. You may note the similarity here to earlier thinking about insanity being the response to an overwhelming world. But an important difference here is the Laing did not see this illness as an infirmity. In fact, he thought that madness was an opportunity for personal growth, and that schizophrenia offered insights that many, many of us simply were not willing to accept, so we decided to call it illness. This was a view that was shared also by the South African psychiatrist David Cooper. Another big player, Thomas Szasz, also a best-selling author, wrote The Myth of Mental Illness and several other books. His position was that disease can only be defined on the basis of some kind of biological dysfunction, and therefore, mental illness was not a disease, what we called mental illness was not a disease. He felt that mental illness was really a metaphor that we use to describe misbehavior. He was especially opposed to involuntary hospitalization for the treatment of mental illness as he saw it as a tool of control that was used by the state and by families to deal with behavior that they did not want to tolerate. In the US, Szasz's critiques were further bolstered by widely-read books like Ken Kesey's One Flew Oh, One, One Who, what is it? One Flew Over the Cuckoo's Nest,, [LAUGH] and Irving Goffman's book about Asylums. Both of these other books reinforced his suggestion that psychiatric institutions were not places of healing, but instead places of great harm and, potentially, abuse. Goffman's book further elaborated on asylums as what he called total institutions, which created passive, unmotivated inmates. And effectively constructed the level of functioning that a psychiatrists then ended up calling chronic mental ill, illness. His voice joined with others that argued that instead of helping people, mental hospitals changed individuals into patients that were no longer able to function in the outside world. I also wanted to mention a European contribution to the movement as well because I had the opportunity to visit Italy for the World Psychiatric Association conference. And there was a protest during the conference that really showed that the anti-psychiatry movement was alive and well there. The work of Franco Basaglia had a huge impact on the Italian mental health care system. When he spent some time at an institution in the 1960's, he found deplorable conditions. Patients in mechanical restraints, living in filth, subjected to violence, and subjected to what he described as the most barbaric of the treatments at the time. In the book that he wrote about it, he asserted that psychiatric care of the time was not based on human need, but instead on the needs of the state. You're probably noticing a theme here. Unlike some of the others, he did not suggest that mental illness did not exist. But he said it was the result of social violence and social exclusion. And he developed a theory about the cycle of poverty and mental illness that really resonated with social critiques of the time. He was able to stimulate quite major mental health reform in Italy that continues to have an impact until today. Finally, the psychiatric survivor movements were also an important component of anti-psychiatry. So, you'll notice that I have several different terms here and these movements have different terms as well. Sometimes a consumer movement, a consumer survivor movement, an ex-patient movement. Sometimes it was rolled into the disability movement. So, a lot of different names and they really they had a few things in common which I I can say were that they really wanted to assert the right to self determination for people who were diagnosed with mental illnesses. And I would also say that they probably had in common a resistance to involuntary treatment. But but this, the movement's range, you know, really range from conservative to radical all the way from just wanting to have more say, in what, what kind of treatments people received and in being able to assert their own self-determination to again, deny that mental illness existed and just seeing psychiatry as a tool of social control. So, what did the anti-psychiatry movement actually, actually accomplish? I mean, a lot of people think that the anti-psychiatry movement had a lot to do with why de-institutionalization was going to come very soon, or at the same time. you'll see in the next segment that it's actually a little more complicated than that. But it certainly brought public attention to problems with the, the mental healthcare system. I think that one of the major contributions of the anti-psychiatry movement and its ungoing contribution is that it, it involved the actual users of psychiatric services in the critique of those services. And up until that point, really psychiatric patients had not had much of a voice. And it just was the right time that Zeitgeist was right. And in terms of disability activism feminism, civil rights of all kinds, that it was a time when psychiatric patients former patients, survivors could have a voice and really be heard as part of a larger agenda around human rights. I think that the other thing we want to remember is that anti-psychiatry also really started to get people thinking about the social context of mental health and mental illness as well. So, this is something that had always been with the system. But really looking at the possibility that part of what contributed to the mental illness we saw was the actual environments that people were living in was not something that was really discussed in a widespread way until, until the anti-psychiatry movement really was out there taking that to the public. And and then of course, the actual environment of treatment was also given a closer look because of the work of that movement. So, a lot of contributions. Some people are, are critical of anti-psychiatry because they feel that it it dissuades people from seeking help who need it. But the, the thing is if anti-psychiatry had, had the goal of tearing down psychiatry, it certainly wasn't successful in doing that. In fact, in many ways, psychiatry had a tremendous growth period at the same time that anti-psychiatry was going on. So so really, you know, it's, it's not that it, it destroyed things. But certainly, I think it started some conversations that maybe weren't happening beforehand. So, let's talk about what was happening in a parallel way in, within mental health care system that led to the thing that we call de-institutionalization.
