ANTIPSYCHIATRY

The spirit of the 1960s brought about a cultural revolution. Metaphorically, one could say, as if an enormous stone were thrown on the quiet surface of the social ocean, causing turbulence that propagated in all directions. I was born 10 years too late to take part directly in this revolutionary epoch, but in the 1970s, I still felt their ripple effect, which made it possible to experience the “Big Bang” of the sixties. Among other things, it gave birth to ideas fashioned within the antipsychiatry movement. These ideas were generated not only by psychiatrists but also by philosophers, sociologists, and other intellectuals in response to a repressive state both in society and in official psychiatry. It was a rebellion against the established way of dealing with mental illness, abuse of power, and deprivation of individual freedom and rights. Under the influence of antipsychiatry, many of us were forced to delve deeply into the interior of the mind and examine our own conscience. As a result of this process, we recognize that mental illness is at least partially a social construct and not a simply biopsychological disorder. Antipsychiatrists have demanded the return of denied dignity and fundamental human rights for people who are often treated as prisoners and perpetrators of the most serious crimes by institutions in which individual action is limited and subject to strict control.

Dr. Rosenhan’s experiment with pseudopatients

I was first introduced to antipsychiatry’s ideas while studying psychology. At that time I learned about the experiment of Dr. Rosenhan, a professor of law and psychology at Stanford University in California. David Rosenhan wanted to ascertain whether the symptoms that have been identified as pathological and marked by a specific psychiatric diagnosis are found in the patients themselves as objective indicators of mental illness or are conditioned by the environment in which the persons in question found themselves. He wondered: “If normality and madness exist, how do we distinguish between them?” * To determine this, he organized an experiment in which he himself participated along with a group of eight volunteers. We'll call them pseudopatients because they've never had a mental health condition, but according to the experimental protocol, they were simulating a symptom, an auditory hallucination.

They sought admission at various psychiatric hospitals across the US because of vague voices that spoke the words “empty,” “hollow,” and “thud.” Without too much fuss, they were all admitted to the psychiatric ward. By prior agreement, on admittance, participants stopped simulating any psychiatric symptoms. Despite their completely normal behavior, they were never unmasked. On the contrary, during their stay in the ward, the staff interpreted many of their usual habits and activities as symptoms of a mental disorder. All cases except one were diagnosed as schizophrenics, treated as such, and released, on average 19 days later, only after they “confessed” that they were insane, but they're better now. Rosenhan writes: “The psychiatric label becomes like a living thing and as such has an effect regardless of the behavior of the person to whom it is attached.” * From this it can be reasoned that labeling is a form of social control that has the ability to “grab” both the user and the person to whom the label is “attached.” Once a label is applied to an individual, everything they do or say is interpreted in light of this label. This is why hospital staff failed to detect pseudopatients because they were “bewitched” by their diagnostic label. That was not the case for “true” patients, who often saw through “false” patients.

In the second part of the experiment, Rosenhan made an agreement with the administration of a renowned hospital, which was familiar with his work, to send new pseudopatients to their hospital. The management of this hospital claimed that its staff would readily recognize the “intruders.” Although Rosenhan didn’t send any pseudopatients the hospital reported that among the 193 people who approached it for help over the next three months, it found 41 “intruders” and suspected another 42. All of the rejected individuals were in fact, actual patients.

After the publication of the results of this experiment in the renowned journal Science in January 1973 under the title “Being Healthy in Unhealthy Places” *, a social scandal broke out and Rosenhan became an international sensation overnight. In America, his work spurred further changes in the reform that had begun, which led to the closing or downsizing of large hospital asylums, the opening of mental health centers, improved diagnosis of mental disorders, and advocacy for patients' rights. His experiment and results were “like a sword thrust into the heart of psychiatry”, as the author of an article in the Journal of Nervous and Mental Diseases commented three decades later. **

One Flew Over the Cuckoo's Nest

Another memorable event was watching the movie One Flew Over the Cuckoo's Nest in Belgrade in 1976. The famous team led by director Miloš Forman, producer Michael Douglas, and Jack Nicholson and Louise Fletcher in the main roles made an exceptional film. It's considered one of the best movies ever made, so if you haven't seen it, I definitely recommend it. Of course, I will not get into the details of the description of the movie here. The action takes place in a mental hospital, which is portrayed through its representatives as an institution that tries to control and “normalize” mentally disturbed people, rather than treat them. A variety of methods of subduing patients, such as electroshock and lobotomy, had been demonstrated in the movie. The message is that forcing people to conform to social norms is detrimental to the health of the mind and body. The film uses the conflict between the patient and the nurse as a representation of a microcosm of society. Ken Kesey's book with the same name came out 13 years earlier and influenced the antipsychiatry movement which was in full swing in the 1960s. But the movie, rather than the book, had a much greater impact on public opinion in Yugoslavia. Numerous mental health experts were interviewed, especially with respect to the use of electroshock therapy and lobotomy as depicted in the movie.

The Divided Self

And then followed the reading of the book The Divided Self by Robert Laing ***, a psychiatrist and one of the main representatives of the antipsychiatry movement. I read the book in one sitting. Laing writes in the beginning that the primary goal of this book is to make madness understandable. That reason immediately appealed to me. I remembered growing up thinking about psychotic patients with whom it was not easy to establish “normal” communication. I was wondering if they had any insight into their psychotic state. I don't know why I thought that way, but it is obvious that my mind “wanted” to address this issue, perhaps intuitively sensing the need for clarification. Laing describes his patients with empathy and concludes that those who have developed schizophrenia have done so due to disturbed family relationships. In the beginning, it led to “ontological insecurity” in the child who progressed to schizoid personality, then to psychosis, usually in adolescence or later. Laing interprets the patients’ way of communicating as their covert attempt to retain a part of their identity. He states that the child withdraws from others in order to maintain his fragile identity and protect himself from external danger, in other words from an abnormal family situation. In Laing's opinion, the interpretation of the patient's subjective experience is the basis of “antipsychiatric” therapy.

In 1965, Laing formed a community of patients based on the idea that psychosis is a state of reality similar to a waking dream. It is a state of trance rather than a disease that is simply eliminated by electroshock therapy, which was widely used back then. He sought to provide a space for schizophrenic patients to explore their madness and inner chaos. Community residents were treated with kindness and respect with sincere efforts to alleviate their suffering, which contrasted with the prevailing attitude of official psychiatry towards these patients. Unfortunately, this experiment did not last long. The events in this community were beautifully portrayed in a recently released movie that follows the rise and fall of that five-year project. ****

Antipsychiatrist par excellence

Let me now mention the arrival of David Cooper in Belgrade in the late 1970s. He was a charismatic personality, the most radical of all, a Marxist in face and deed, and the first to use the term antipsychiatry. His arrival in Belgrade was attended by a huge crowd of interested people who came to listen to him at the Student Cultural Center. I was also among them. The details of his presentation were blurred in my memory, but I remember the boiling atmosphere of excitement due to the presence of this revolutionary with a huge “Marx’s” beard. He lifted psychosis to a pedestal as a permanent revolution in human life, a deconstitution of oneself with the implied promise of a return to a more fully realized world.

Cooper sought alternative ways of understanding human experience and behavior, as well as responding to human distress. In 1962, he played a key role in establishing a radical enterprise known as Villa 21. This was a special place where many young people diagnosed with schizophrenia lived without drugs, electroshock, or other biological therapies. Villa 21 was run on the principle of egalitarianism by abolishing the traditional hierarchy between doctor and patient. Cooper highlights the hidden potential of the patient's inner world on the road to mental health. The journey to the center of psychosis and back is the method of true healing. Therefore, a radical approach is not to interfere during this “anti-therapy” process. Cooper believed that insanity and psychosis are manifestations of the discrepancy between one's own “true” identity and the imposed social identity. According to him, normality and health are not synonymous. Cooper argues that the normal person is one who has renounced the capacity for spontaneous and immediate experience in order to adapt and integrate into the social order. Cooper's ultimate solution to healing was through a revolution in which the reason for psychiatry ceases to exist.

The myth of mental illness

Finally, I will mention the reading of American psychiatrist Thomas Szasz's book The myth of mental illness ***** in which he claims that mental illness is not a disease but a metaphor that describes an offensive, shocking, or disturbing behavior, action, or pattern of behavior. For Szasz, the disease can only mean something that people “have”, while the behavior is what people “do.” The diagnosis of “mental illness” is a way of social control under the auspices of psychiatry, which often uses brute force (forced treatment and violation of basic human rights to freedom) as well as subtle indoctrination and manipulation. Relations in psychiatric institutions are authoritarian and patients are treated as depersonalized objects.

Undoubtedly, through his writing and activity, Szasz helped psychiatrists to better understand the importance of what they do, especially to reconsider the tendency to hospitalize patients indefinitely with little supervision. He fought for patients' rights, but this led to indiscriminate protection of autonomy, which often hindered the provision of services to patients with serious mental health problems, and which contributed to homelessness and imprisonment of such people individuals.

Legacy

According to antipsychiatrists, who primarily focused on severe mental illnesses such as schizophrenia, psychiatric institutions are authoritarian and repressive and have harmful consequences for patients. Therapies not only do not contribute to the recovery of patients but also make it impossible. For antipsychiatrists, such psychiatry is a reflection of society, and mentally disturbed people are created by society and ultimately alienated even more in psychiatric institutions. Social reality becomes the cause of mental illness as a reflection of general alienation in society, labeling, or in the service of concealing social contradictions. According to Laing, in the conditions of an inhumane social environment, where it is normal to be alienated, an individual defends himself from social pathology with madness, and only when he becomes psychotic does he have a chance for real healing.

Impact

How have the above ideas affected my professional life and work? In many ways. At the beginning of my career, the antipsychiatrists’ interest in schizophrenia and society's repressiveness towards seriously ill psychiatric patients coincided with my interest and work. Namely, the hospital in Vršac, my first workplace, was full of patients with this diagnosis, as well as examples of the negligence of society and the toxicity of the family in the origin and development of their illness. The greatest influence on me was Robert Laing and his book The Divided Self. It shows examples of the so-called double bind, which was first described by Gregory Bateson and his colleagues in 1956. A double bind poses a difficult dilemma in communication in which an individual (or group) receives two or more conflicting messages, where one message negates the other. A person exposed to a double bind is in a deadlock because whatever he does, he loses. It creates unbearable confusion and anxiety. Bateson and colleagues found that destructive double binds are a common communication pattern among families of patients with schizophrenia. They suggested that growing up under the influence of frequent double binds could lead to the learned patterns of confusion in thinking and communication so often seen in patients. ******

Laing described, using the examples of patients he worked with, that with a true understanding of the experiences of schizophrenics, their words and behavior can take on much more meaning than is apparent to the superficial observer. For me, he modeled a psychiatrist who spent time talking to patients and created an atmosphere where the patient felt safe to express his inner self without fear of being punished, in the past by his family, and in the present by repressive treatment in psychiatric institutions. Laing saw in madness not only a trapped or destroyed mind but a mind that has the potential for renewal and liberation from the constraints imposed by the family as the social representative of conformity.

The utopian idealism that characterized Laing and other antipsychiatrists could not be fully realized in practice, but it gradually influenced the attitude of society and official psychiatry to change for the better. Therapeutic communities and social-psychiatric orientation “recognized” the influence of social factors in the origin and development of mental illness. An attitude towards patients characterized by compassion, care, and understanding is now expected from all service providers. The involvement of society and family, the techniques and way of organizing the psychiatric service, as well as the work on the prevention and destigmatization of the mentally ill are widely present thanks to the amended laws and advocacy groups that fight for the rights of individuals and families affected by mental illness with the aim of building better lives.

* On Being Sane in Insane Places, by David Rosenhan, Science, Vol. 179 (Jan. 1973), 250-258.

** Pseudopatient or Pseudoscience, by Mark Zimmerman, The Journal of Nervous and Mental Disease; November 2005 - Volume 193 - Issue 11 - p 740-742

*** The Divided Self: An Existential Study in Sanity and Madness, by R.D. Laing, Harmondsworth: Penguin, 1960.

**** Mad to Be Normal (2017). A film directed by Robert Mullan.

***** The myth of mental illness: foundations of a theory of personal conduct, by Thomas Szasz, Harper & Row, 1961

****** Toward a theory of schizophrenia, by Bateson, G., Jackson, D. D., Haley, J. & Weakland, J., Behavioral Science, Vol. 1, 251–264, 1956