The goal of antipsychiatry is quite simple—nothing less than the abolition or end of the psychiatric system. Herein lays its ultimate distinction. While people critical of psychiatry but not fully antipsychiatry may take certain kinds of changes as sufficient—the advent of informed consent, less use of drugs, a kinder gentler industry, or diagnostic categories which are less overlapping, for example… antipsychiatry holds that no changes will be sufficient, for the institution is too flawed and dangerous simply to be tinkered with. – Bonnie Burstow1
Yet, for all of [antipsychiatry’s] radicalism, this professional-led revolt against psychiatry had a degree of elitism. People in positions of power who did not experience madness themselves were telling the mad masses what was, or was not, good for them. Is this any different from mad studies? Time will tell, and those who will do the telling should be mad people outside of the academy rather than those of us inside for it to have any meaning beyond self-justification. – Geoffrey Reaume2
Introduction3
This article explores antipsychiatry, and specifically the use of language within antipsychiatry and its role within the wider field of mad studies.4 Situating the methods and language use of antipsychiatry as abolitionist matters within mad studies facilitates a discussion about the philosophical and methodological relevance of antipsychiatry. Exploring language use as a type of methodology allows for a tracing of psy dominance into diverse facets of people’s lives. While language has long been of central concern within antipsychiatry, the relevance of contemporary antipsychiatry itself is less clear. By unpacking language use within antipsychiatry as an abolitionist practice, I re-imagine the critical role of antipsychiatry within the fast-growing field of mad studies. I begin with a discussion of antipsychiatry and the attrition model of psy abolition, including strategies and critiques of approaching abolition as gradual erosion. I then explore the historical roots of antipsychiatry, calling attention to the professionals who established and developed antipsychiatry theory and practice, and complicating discussions on the professional origins of the area. Questioning whether mad studies is critical enough without the inclusion of antipsychiatry, I discuss language use as a type of mad methodology and present a re-imagining of the place of antipsychiatry as the abolitionist branch of mad studies.
Through attention to language, and refusal to participate in dominant frameworks of psy complex naming, a degree of criticality is maintained simply by the act of naming otherwise. Given my focus on antipsychiatry and language, I aim to use more critical language and framings, drawing on terms like psy complex to denote what is often referred to as the mental health complex/industry, or a conglomerate of medically-oriented services generally under the purview of psychiatry, psychology, social work, and related industries. Similarly, I use the term mental health to discuss its cultural relevance rather than denote some medicalized meaning of people’s experiences. Instead of mental health, I use different terms based on context, including madness to describe experiences and states often diagnosed as psychiatric disorders, or psychiatrized to describe psy complex entanglements and framings, regardless of whether these are consensual (i.e. sought out vs forced interventions). In unpacking antipsychiatry and the area’s commitment to avoiding uncritical use of psy language, I explore whether this commitment can provide methodological guidance.
This exploration involves tracing strands of theory, history, and language use as methodology, and in some ways, tracing these strands is part of my method. In my dissertation, I described a multiplicity of orientations to tracing as a way to proceed, explaining that my doctoral research was guided by “tracing ideologies, tracing threads, tracing processes and logical leaps, tracing distant outcomes, and, overarchingly, counter-tracing that which has been severed from its context. … By tracing in ways that allow an excavation and unsettling of constructed objective certainty, I counter-trace supposedly objective psychiatric research and ideology to their subjective roots, steeped in the context, biases, and interpretations of a prominent group of professionals and intellectuals.”5 At the time, I was tracing the professionalization of psychiatry in Canada, trying to find fissures where experiential reality and claimed psychiatric facts became disconnected from one another. I now find myself, somewhat unexpectedly, applying some of these same orientations to tracing to identify a type of professionalized anti-professional: the antipsychiatry scholar.
In presenting antipsychiatry as a position of radical critique against the psy complex, I balance critiques against antipsychiatry with its unwavering goal of de-medicalizing non-normativity. I proceed with the assumption that any abolitionist effort stemming from within a predominant institution such as the university or psy complex merits interrogation. Moving away from distinctions based on self-identifications with madness or mental health that foreground lived experience as the primary form of legitimacy, a different distinction emerges: That between the professional vs. non-professional critic of the psy complex. Notably, none of the terms referring to psychiatric resistance within the academy (i.e. antipsychiatry, critical psychiatry, mad studies/activism) are particularly rigidly defined. In all their differences, each of these areas is relatively small and considered emerging, if considered at all.
Antipsychiatry, the Mad Movement, and Abolition by Attrition
There is no single agreed-upon definition of antipsychiatry. In general, what sets antipsychiatry apart from other critical mad movements is the twofold belief that: 1. What is currently taxonomized as mental illness does not fit the criteria for medical disease, and 2. That medical treatment of distress, crisis, or non-normative behavior is inappropriate and potentially harmful to its recipients.6 This makes antipsychiatry a necessarily abolitionist position, namely because of its core belief that non-normative mental life should not be defined or acted upon as medical illness. Ideas about how to otherwise address non-normative, distressed, or distressing people outside of a psy dominated medical model vary widely.7
The term antipsychiatry itself, and identifications with this term, are far from straightforward. Approached as a broad-based coalitional movement comprised of different facets, the mad movement in Canada has long included an abolitionist constituency. For the most part, those identifying as antipsychiatry, or advocating psy abolition, have been integrated within broader movements and tend to work in allyship and collaboration with people who are not psy abolitionists.8 While some scholar-activists openly identify as antipsychiatry, the term has also long been used by psy supporters to dismiss anyone with any critique of the psy complex, regardless of whether that critique hinges on psy abolition or the medicalization of non-normativity. As described by activist-historian Geoffrey Reaume, beginning in the 1990s, the term became used by historians seeking to marginalize and dismiss those with critical interpretations of psychiatry that differed from their own. Reaume states, “As there are significant differences between the ideas of such a diverse group of people to whom the term ‘anti-psychiatry’ has been imposed, this label can be a lazy shorthand for lumping critics of psychiatry together as belonging to one undefinable type, who are therefore all the easier to dismiss.”9 By imposing the label of antipsychiatry on any critique raised by mad activists or academics, a multi-layered dismissal has occurred: Not only are diverse critiques of the psy complex dismissed, but they are dismissed because the people articulating these critiques are denounced as antipsychiatry; a seemingly radical position challenging widely accepted psychiatric knowledge-power. In the process, the term antipsychiatry itself becomes a denigrating label that mad activists must separate themselves from if they want to be taken seriously.10
The dismissal of abolitionist activists and movements is not unique to antipsychiatry. Yet, building on the 1970s prison abolition movement, antipsychiatry activists in Canada identified the goal of abolition as a gradual erosion of the psychiatric system rather than a sudden overturning. In a 2014 chapter presenting an attrition model for antipsychiatry, Bonnie Burstow states, “The fact remains that while a rigorous antipsychiatry position entails some type of abolitionist stance, no one should be under any illusion that any demands or well-worded critiques will suddenly lead to the closing of institutions or the cessation of damaging treatment. … [W]e are up against a very complex system, with huge vested interests, with the complicity of the state, and with the blessings of a fearful general public.”11 Burstow identified part of the public fear as rooted in long traditions of sanist and ableist oppression against those who veer away from the category of normal, constructing the so-called mentally ill as potentially dangerous and unpredictable. Yet, as articulated by the editors of Madness, Violence, and Power, while mad people or those labelled as mentally ill are often perceived as potentially dangerous, these populations are particularly vulnerable to experiencing violence at both systemic and interpersonal levels.12 In seeking to shift western discourse away from the medicalized underpinnings of the term “mental illness,” antipsychiatry scholars, activists, and activist-scholars have worked to highlight non-normativity as socially constructed and bound. Scholarly and activist action toward the gradual erosion of the psy complex, then, must carefully avoid falling into the trappings of an ever-growing and shifting psy complex.
Drawing on the prison abolition handbook Instead of Prisons, Burstow adapted the attrition model of abolition and applied this to antipsychiatry, challenging activists and scholars to consider the following questions when deciding whether an action was truly abolitionist:
1) If successful, will the actions or campaigns that we are contemplating move us closer to the long-range goal of psychiatry abolition?
2) Are they likely to avoid improving or giving added legitimacy to the current system?
3) Do they avoid “widening” psychiatry’s net? 13
Burstow articulated that an attrition model assumes that no structuring societal institution will change quickly, and that abolition takes place slowly, by working toward a gradual wearing away of the power of an institution. The attrition model highlights the important overlap of activism and scholarship brought together under antipsychiatry; an area that is necessarily overtly political through its abolitionist position and guidance.
Still, the attrition model has been critiqued as essentially reformist in that slowly withering away the power of institutions lacks attention to structural oppression and risks reifying both carceral logics and pre-existing power relations.14 In Decarcerating Disability, Liat Ben-Moshe states, “Decarcerating or removing from psychiatry’s control by attrition would mean that some populations would be closer to freedom.”15 Ben-Moshe explains that if abolition is understood as a subjugated knowledge and as ridding ourselves of certain logics, then “[t]he problem of chipping away at the margins of a system is that the center, the logic of incarceration itself as neutral and essentially benign, …remains intact.”16 Whether by slow withering, removal of legal power from carceral institutions including psy institutions, or systemic overthrow, the project of psy abolition, and how to go about achieving it, remains contested.
The Short History of Antipsychiatry Casts Long Shadows
In exploring the distinctions between histories of antipsychiatry, critical psychiatry, and the increasingly prominent emergence of mad studies, Geoffrey Reaume identifies the formation and development of antipsychiatry as based within psy professionals who were mostly relatively privileged white men, generally psychiatrists.17 This is an important observation given the term “anti-psychiatry” was coined in 1967 by psychiatrist David Cooper and popularized by his colleague, psychiatrist R.D. Laing.18 The term was further developed and nuanced by psychiatrist Thomas Szasz, who critiqued the foundations of psychiatry, claiming that if a physical cause were found for mental illness, it would cease to be a mental illness and become classified as a brain disease, to be treated by medicine proper rather than through psychiatry.19
Importantly, the above-named psychiatrists and pioneers of antipsychiatry were all in some kind of relation and dialogue with psychiatric patients when they developed their works. For example, R.D. Laing was a practicing psychiatrist when he published, along with A. Esterson, interview transcripts of family therapy sessions of institutionalized women diagnosed with schizophrenia along with their notes and impressions of the women’s behavior. Through their interactions with these women and their families, the authors came to believe that what was often diagnosed as schizophrenia became intelligible behavior when considered in the context of their family dynamics. The authors state, “we ourselves are not using the term ‘schizophrenia’ to denote any identifiable condition that we believe exists ‘in’ one person.”20 In noting the intense and ongoing influence on each other’s behaviors within these complex family dynamics, the authors, to the best of their ability, tried to understand the perspectives of the young women diagnosed as schizophrenic and institutionalized. Their taking seriously of and attempt to understand the women’s perspectives as intelligible allowed these psychiatrists to recognize the social construction of madness, in this case schizophrenia. While the relational aspects of this work are often unnoticed, access to their patients’ lack of adherence to psy logics provided the foundation of early antipsychiatry theorizing.
In Psychiatry and Anti-Psychiatry, David Cooper builds on the work of Laing and Esterson, maintaining focus on finding intelligibility in the behaviour of those diagnosed as schizophrenic. Although he coined the term, Cooper does not provide a definition of anti-psychiatry. Rather, he presents it as emerging in response to, and against, psychiatric violence and erasures. What is needed, for Cooper, is an “anti-psychiatric situation in which people would not be invalidated or violated” beyond whatever they had already experienced when entering the psychiatric system.21 In other words, people requiring support should not be further traumatized, dismissed, and/or violated by the psychiatric system. In articulating his work, Cooper focuses on schizophrenia, defining it as a “micro-social crisis situation in which the acts and experience of a certain person are invalidated by others for certain intelligible cultural and micro-cultural (usually family) reasons, to the point where he is elected and identified as ‘mentally ill’ in a certain way and then confirmed (by a specifiable but highly arbitrary labelling process) in the identity ‘schizophrenic patient’ by medical or quasi-medical agents.”22 Identifying a pattern whereby finding intelligibility in the behavior of someone diagnosed as schizophrenic could be sought through consideration of their “micro-culture” (i.e. family dynamic), Cooper relied primarily on the observations and insights he obtained through working as a psychiatrist with patients and their families. At one point, Cooper provides a hypothetical example where he is “surreptitiously looking through a keyhole at an intimate scene in the next room,” shortly before becoming self conscious when he is discovered doing so.23 Yet, his writing, his theorizing, and his entire raison d’etre (and that of his colleagues as well) relies on what is essentially looking through a keyhole at an intimate scene in the next room; that of his patients interacting with their families. Of course, those psychiatrists credited with creating and developing antipsychiatry – Cooper, Laing, Szasz – indeed did the work of analyzing, organizing, writing, and publishing their observations. What is less often the object of focus is that these professionals did not base their work on their own experiences, but on their perceptions of the experiences of the psychiatrized people with whom they interacted.
While psychiatric hegemony continued relatively unhindered despite the antipsychiatrists’ best efforts, psychiatry is not the only place from within the psy complex from which defectors emerged. In Against Therapy, Jeffrey Moussaieff Masson discusses the troubling history of psychoanalysis and psychotherapy, articulating his journey from studying and practicing psychoanalysis to becoming so disturbed by its practices he could no longer continue. On his eight years of psychoanalytic education, Masson reflects: “I saw three possibilities: there was something wrong with me; there was something wrong with the particular training I was undergoing; or there was something wrong with the theory and the practice.”24 After exhausting the first two possibilities, Masson began compiling his decades of research into books critiquing psychiatry, psychology, and psychoanalysis.
That so much critique against the psy complex is borne from within those trained in its theories, philosophies, policies, and practices itself warrants scrutiny into its effectiveness. And yet, this also raises an important critique of antipsychiatry: Whose position does this perspective represent? Reaume explains that none of the initial central figures proselytizing psychiatric abolition academically identified as mad or experienced the psychiatric system they critiqued as patients, gesturing to the consequences of the area’s formations as casting long shadows into the present and perhaps future of antipsychiatry. Stemming from critiques initially published by psy professionals, antipsychiatry has indeed tended to focus on western diagnoses, the hegemonic power of psychiatry and the psy complex within contemporary western society, and the coercion that occurs within these systems. In this way, antipsychiatry has largely defined itself against psychiatric rule and practice but not necessarily toward something different, although efforts to articulate different possibilities have been made which have not been widely taken up.25
While antipsychiatry critiques may originate with psychiatrists and other psy practitioners, other academics have also critiqued psy authority to the extent of being labeled, if not self-labeled, as antipsychiatry. Perhaps most influentially, Michel Foucault’s work highlights that psychiatric care has less to do with the well-being of whoever is receiving that care than it does social control.26 Similarly, Bonnie Burstow critiqued psychiatric coercion as sexist and racist, while seeking to undermine psychiatric control by questioning the field’s medical underpinnings.27 Burstow explains that over time, the meaning of antipsychiatry shifted into psychiatric abolition, and that the work of Laing, Cooper, Esterson, and to a lesser degree Szasz, have become peripheral to antipsychiatry scholarly and activist efforts.28 Contemporarily, the work of a cluster of UK-based psy scholars to de-medicalize and undermine psychiatric framings, including the chemical imbalance theory, provides useful legitimization for those working toward psychiatric erosion as these powerful critiques originate with experts using the same tools as psychiatrists themselves.29 The work of psychiatrist Peter Breggin in documenting and extensively publishing about the physical and brain impairments created through psychiatric treatment unearths foundational critiques of psychiatry that cannot easily be addressed through reform.30 Yet notably, with the exception of Foucault, everyone listed above work (or worked) within the psy complex to some degree.
Although antipsychiatry critiques carry important cultural relevance, they may also be out of touch with those whose interest in which they claim to be acting. Such stark schisms between theorizing about madness and actually living through and experiencing alternate states and/or the psy complex are humorously reflected by poet Mary Ruefle, who, writing on menopause, states: “When you go crazy, you don’t have the slightest inclination to read anything Foucault ever wrote about culture and madness.”31 That Ruefle is writing on menopause only further highlights the professionalized largely-male origins of antipsychiatry, calling into question the area’s suitability to be levying the sharpest critiques against the psy complex, seemingly from the comfort of being in a lateral position to psychiatrists (if not actually a psychiatrist). To the extent that antipsychiatry, at least initially, was theorized from a position of privilege continues to be apparent in critiques of the area’s boundedness to psychiatry (rather than expansiveness beyond it) as well as its lack of attention to structural inequity. Regardless of the method by which psy abolition is pursued, some people still remain closer to freedom than others within these efforts.
This professional-led revolt against psychiatry, seemingly spearheaded by a few fringe psychiatrists, raises questions about the foundations of antipsychiatry, not least of which is who is it for? That said, just because somebody avoids psychiatric diagnoses or does not openly identify as mad does not immediately translate into them experiencing the world in ways that are typical or somehow not difficult, unusual, or vulnerable to psychiatrization. Sometimes, a critical scholar/activists’ lack of identification with psy terminology and concepts may have less to do with their struggles than it does their political and cultural commitments to avoid said terminology and concepts. Stated differently, someone who purposefully disassociates from the psy complex is unlikely to organize their experiences of non-normativity through psy language and concepts. Still, regardless of how a person identifies along the mad continuum, it is notable that antipsychiatry critiques originate from within the psy professions themselves. Perhaps, in moving away from identity-based distinctions of madness, another approach is to trace whether someone identifies as a professional (academic, in the psy disciplines, or otherwise). And, without exception, all of the above-named trailblazers of antipsychiatry did or do. Approaching the development of antipsychiatry as one led by professionals can shift the conversation, allowing more nuance in being able to recognize the multilayered absences and presence of psychiatrized people at the heart of this work.
Criticality and the Power to Name
Reaume notes that while mad studies is not abolitionist per se, the field can accommodate abolitionist positions while resisting any all-encompassing or absolutist solutions (such as a steadfastly abolitionist position).32 While mad studies can accommodate more broad and wide-ranging perspectives and, crucially, originates with the perspectives of mad people and psychiatric survivors, the field can also potentially accommodate those positions that advocate for expanding psy authority while simultaneously accommodating those critiquing said authority. While opening crucial grounds for the diverse perspectives of the mad or those labeled as mentally ill, the area, functioning as a kind of catch-all, can give no more direction as it can methods by which to pursue those directions.
While mad studies is the indispensable umbrella term to catch as broad of an academic community as possible while centering the perspectives of mad people, is the area capable of preserving critical perspectives over time? Given how prolific psychiatric diagnoses are, can anyone with a diagnosis claim a mad identity? Is such an identity limited to those with psychiatric diagnoses? The murkiness of madness as a self-proclaimed identity category and its overlaps with psy language and concepts suggest the need for ongoing critical analysis. Such need is addressed in various ways within mad studies, including long time mad activist David Reville’s call to take madness back into the community and away from the university.33 If mad studies is approached as a scholarly site from which to explore multifaceted perspectives, experiences, histories, methodologies, and philosophies, could there be a benefit to reconceptualizing antipsychiatry as the abolitionist branch of mad studies?
An important intervention of antipsychiatry is its focus on language and attempts to unhook from psy language and jargon as one crucial re-orientation away from dominant psy frameworks. These frameworks rely on vagueness to propagate their power and dominance through time. As it is difficult to pin down and specifically define, the concept of mental health functions precisely because of its flexibility; it can shift in an ongoing way, at least enough to keep up with the times and accommodate some critique. But such shifts never challenge the psy monopoly over defining the meanings of non-normative experience or behavior; rather critique is absorbed and enfolded into the psy complex, thus widening its power and capture rather than undermining it. Whatever critique cannot be accommodated can likely be ignored or dismissed by applying “antipsychiatry” as a denigrating label.
Shifts to accommodate critique and the moving boundaries of normalcy or otherwise dismiss or ignore it are evident throughout the history of the psy complex. For example, the highly contested diagnosis of homosexuality was removed from the DSM (Diagnostic and Statistical Manual of Mental Disorders) when its third edition was released in 1980.34 Meanwhile, gender dysphoria remains a diagnosis that trans peoples’ access to healthcare can hinge on.35 Feminist critiques of sexism within both the theory and practice of particular DSM diagnoses, particularly personality disorders, highlight how gendered social expectations work to police the boundaries of what is normal while simultaneously pathologizing responses to gendered violence as mental illness.36 Many have demonstrated how minority groups pursuing social justice become pathologized, dismissed, presented as dangerous, and potentially incarcerated (psychiatrically or otherwise) through the psy power to diagnose and act upon those diagnoses, with assistance from other government branches including the police.37
These examples demonstrate how the psy complex is adept at ignoring, dismissing, or absorbing critique by shifting its parameters, yet never ceding ground to de-medicalizing approaches. As psy language and concepts adjust to changing cultural norms and practices, what becomes apparent is how bound this framework is to those cultural norms and practices. This raises questions as to whether psychiatric diagnoses connote objective medical illnesses, forays into the cultural boundaries of normalcy, or some complex combination of multiple cultural, environmental, individual, physiological, and perhaps other factors that cannot be disentangled.
Within all of this, language matters: How are human problems and differences being understood, articulated, and acted upon? What interventions are offered – what is the theory behind these interventions and how does this correspond with cultural framings? In other words, how are human problems, crises, non-normativity, difference, and/or distress being understood and addressed and what is the outcome of their redress? These may seem like straightforward questions, but in practice, they are anything but. Psy jargon has so entirely consumed western culture that it has become difficult to understand and articulate human difference or struggle through any other lens or terminology. Even those who appear critical of psy hegemony can slip into discourses that reify psy power, or worse, extend such power by framing the psychiatrized as the discerning customers of the mental health industry. This is demonstrated by the psychiatric user/consumer language featured even in critical mad work.38 The funneling of human problems and distress into medical conditions, and the co-optation of psy resistance through the market language of “consumers” and “stakeholders” speak to an orientation that accepts that first, human problems and distress are indeed solely or primarily medical conditions to be treated by experts, and second, that those afflicted decide to pursue psychiatric treatment among a myriad of available options and are invested in the ongoing continuation and improvement of the psy complex.
Without a position that is overtly political and abolitionist, like antipsychiatry, can the diversity of critical and less critical work done under the auspices of mad studies be construed as sufficient? Areas like mad studies that try to accommodate a broad range of positions can unwittingly favor hegemonic power by equating the positions professed by powerful institutions with those of the fringes critiquing powerful institutions, even if they are critiquing them from within the belly of the beast. By repositioning antipsychiatry as an abolitionist branch of mad studies, the field can continue to function as an umbrella while still attempting to maintain a designated space for those seeking to do psy abolition work.
Can Purposeful Use of Language Entail a Methodology?
La Marr Jurelle Bruce proposes a mad methodology as a “mad ensemble of epistemological modes, political praxes, interpretive techniques, affective dispositions, existential orientations, and ways of life.”39 In tracing various unruly movements of madness, Bruce centers a diversity of lived experiences and expressions while historicizing and contextualizing black radical creativity and madness. There are many reasons to conceptualize and trace some type of materiality through a mad methodology, not least of which is the historic and ongoing exclusion of those deemed mad or mentally ill from providing input into psy meaning making. In speaking to madness as a methodology, Bruce demonstrates the broadness of mad expression alongside cultural constructions of madness that ground the context of mad life within the social, political, and medical meanings ascribed to madness. Such a methodology maps well onto the goal of theorizing and honoring the diversity of madness while creating space to conceptualize and critically analyze diverse mad expressions. This overarching mad methodology provides a basis upon which more nuanced direction can be applied. Using this to guide antipsychiatry work, for example, may be insufficient because the goal is not necessarily to unearth meanings of madness but to shift the gaze to those defining the outskirts of normal as pathological through the psy complex’s power to name.
Within disability studies, Tanya Titchkosky has extensively analyzed how the language of framing disability as a lack speaks to a cultural milieu in which disability can only be imagined as a deficiency, problem, or misfortune.40 Framings of disability as lack – for example saying that someone is “tone deaf” if they fail to grasp particular social nuance, or using “blindness” as a metaphor for ignorance – highlights that words orient a person toward certain understandings, and those understandings are in turn reproduced through words. Through language, shared frameworks are drawn upon, even if the assumptions underpinning these frameworks are not always articulated or apparent. People regularly speak in the psy language of mental illnesses, including naming specific diagnoses, symptoms, and interventions, and in so doing, whether knowingly or not, they participate in and enact the psy complex, thereby helping it to persist and expand.41 In her chapter in Mad Matters, Bonnie Burstow drew a connection between purposeful naming in the battle against psychiatry and the type of world that can be imagined and manifested, stating: “The average person …speaks of ‘schizophrenia,’ of ‘mental illness’ or ‘symptoms’ of this or that ‘mental disorder.’ When we talk this way, irrespective of our intentions, we are performing our designated role in the work of psychiatry. Just like the nurse who picks up a chart, we are activating it; we are helping it to exist. On the other hand, when our talk is psychiatry-resistant or even psychiatry-free, we do something very different, potentially even revolutionary. Simply by how we speak, in other words, we are either tacitly upholding or undermining psychiatric rule.”42 Being unaware of the implications of language makes it difficult to know what we are participating in when we say certain things.
In paying attention to language, and veering away from institutional language, a critical junction emerges: Finding different language facilitates a move toward less (or non) medicalized framings. It also brings about a more thoughtful engagement with the concepts denoted through language just by the act of finding ways to articulate phenomena that do not activate and perform psy authority. The way that language is used provides theory and guidance: Initiated by an activist commitment to psy abolition, a person can refuse to participate in amassing the power of the psy complex by not enacting its language and concepts. By not participating in psychiatric hegemony, at least to the extent possible through language choice, new space emerges to articulate, analyze, imagine, and engage with human difference and distress otherwise.
Given prolific social media debates about recognizing the validity of self-diagnoses and reclaiming diagnoses and their associated cultures, an antipsychiatry language intervention could help guide such discussions away from hegemonic psy knowledge-power and perhaps, facilitate a move toward something different. Uncritical framings within psy resistance reflect the boundaries of what activists who use these framings can imagine and manifest. What we dream toward can provoke action, and action that is not deliberate can easily turn into criticism that becomes ignored, dismissed, or even absorbed into familiar power structures, leaving them relatively unchanged. Of course, all of this is easier said than done, not least because identifying or disidentifying with psy diagnoses carries material consequences, including access to government support and healthcare.
The types of change one can imagine and pursue are inseparable from the language used to name the goals of action within mad scholarly activism. As a catch-all for those with varying levels of criticality toward madness and psy hegemony, the mad movement is potentially one that can be accommodated by and enfolded into the psy complex. As the area grows and becomes bureaucratically sedimented through academic recognition, should there be organized attempts to protect criticality within mad scholarship? This raises an important question about both mad activism and mad studies: Namely, is there a way to honor diverse experiences and perspectives on madness and psy entanglement without falling into the capture of institutional language? This also raises the further question of whether one goal of mad activism and academic work is to accommodate all positions, including those that are not particularly critical. As a quickly solidifying area, is mad studies work necessarily critical? And if the answer is at least a partial yes, then how can criticality be protected through the process of being enfolded into academic legitimacy? Stated differently, as mad studies moves from emerging to emerged, how can the area preserve space for its abolitionist work?
The psy monopoly over the language of human difference and distress works to organize understandings of non-normativity and social suffering, circularly leading individuals to interpret descriptive features of psychiatric diagnoses during moments of distress as proof of their medical nature.43 Through this social organization, ways of being that are different or distressing become difficult to conceptualize as anything other than medical conditions.
The medicalized language of difference and distress is not an accidental by-product, but a manifestation of a dominant story; one in which human problems are understood as medical disorders and the psy complex as the chosen solution that those afflicted are invested in maintaining and continually improving. Medicalized framings are not only problematic to those invested in psy abolition, but also because they reify structural inequities, colonization, and entrenched white supremacy by erasing these factors from being considered in the context of human distress and suffering. In their introduction to Social Suffering, Kleinman, Das and Lock articulate that social suffering destabilizes categories often thought of as discrete, including “health, welfare, legal, moral, and religious issues.” The authors state that “the trauma, pain, and disorders to which atrocity gives rise are health conditions; yet they are also political and cultural matters. Similarly, poverty is the major risk factor for ill health and death; yet this is only another way of saying that health is a social indicator and indeed a social process.”44 Drawing these connections aids in unearthing the ways that even health, and however it gets measured, is a social process. Yet these contextual links are made invisible through the language and framing of difference and distress as medical disease.
One difference between reformist and abolitionist positions can often be found in the uses of language. The fairly common terminology of “diagnoses,” “disorders,” “syndromes,” and “diseases,” and even more critical framings of “mental health service user” or “consumer” suggest that “mental health services,” entailing the offerings of the psy complex, are presented in response to consumer/market needs or desires. This erases the coercion many psychiatric survivors describe at the heart of their entanglements with psy authority. Much scholarship and activism within the mad movement importantly highlights that the civil rights of the psychiatrized are always in jeopardy and all too often do not factor into a person’s supposed treatment. Indeed, the psychiatrized represent one of the only groups that can be indefinitely incarcerated without having violated the law, or forcibly mandated to comply with psychiatric treatments, generally entailing psychiatric drugs.45 Psychiatric survivors critical of the psy complex frame psychiatric treatment, whether in institutional settings or mandated within the community, as its own form of incarceration, largely occurring through coerced decapacitation.46
Civil rights are absolutely important and the psychiatrized need these rights as much as any other citizen. But the limitation of civil rights activism is contained in the name itself; it is limited to those whose humanity is already at least partially recognized, leaving those most subjugated, once more, below thought. Appealing to the state for rights is a fight for state-recognized legitimacy; an appeal to be enfolded into a nationalist version of rights and responsibilities.47 Reformist positions are not radical in that their primary appeal is to the legitimacy of whatever institution they aim to reform. Even radical positions like antipsychiatry risk reifying structural inequality, as demonstrated by critique of the attrition model in approaching psy abolition gradually, and thus leaving some closer to freedom and others indefinitely further away. Still, as an abolitionist position, work done under antipsychiatry dares to dream anew, and the act of naming is of utmost importance in the task of reimagining.
Conclusion
To claim the revolt against psychiatry was a professionally led one is accurate. Yet, such a claim may also minimize crucial context; namely that the insurrection of knowledge by those with lived experiences of psychiatrization represented such a denigrated and dismissed position that some of the psychiatrized and their allies sought professional legitimization. This allowed for a powerful crack where academic spaces that might allow a platform for the voices of the psychiatrized could begin to be conceived. This was far from the only route taken toward greater inclusion of mad people, but it was one that often caught those with the harshest experiences and most tragic outcomes of psy involvement. Those who, after experiencing the diagnoses, treatments, and supports offered through the psy complex, insisted that reform was not enough, and nothing short of abolition would do.
The psychiatrists who initially developed antipsychiatry (Cooper, Laing, Szasz) leveraged their positions of power not based on their own lived experiences of madness but on their perceptions as those who had been doing the work of upholding psychiatric legitimacy and their belief in the stories of others with less power who were otherwise dismissed and not taken seriously. This power imbalance highlights a crucially important point of reckoning as the area of mad studies becomes increasingly bureaucratically solidified: What is the role of non-mad professionals now that their legitimacy is no longer needed to create platforms for mad and psychiatrized people? The future of antipsychiatry, and whether the area continues to center the critiques of professionals, remains as yet unmaterialized. Here I have presented the antipsychiatry use of language as one methodological intervention that can be useful to help provoke critical engagement with psy language within mad studies.
