Antipsychiatry movement

Dr Madhur Basnet, MD(Psychiatry)B. P. Koirala Institute of Health Sciences,

Dharan, Nepal

ObjectivesDefinitions: Psychiatry, antipsychiatry.Historical evolution of antipsychiatry

movement.Prominent leaders/proponents of the

antipsychiatry movement and their views.Antipsychiatry and psychiatryPros and cons of antipsychiatry movement.Take home message.

2ANTIPSYCHIATRY MOVEMENT

To define antipsychiatry and antipsychiatry movement.

To know about the historical evolution of antipsychiatry movement.

To know about the pros and cons of antipsychiatry movement.

To know about the current status of the antipsychiatry movement.


Coined by Johann Christian Reil, German physician and anatomist in1808GreekPsyche: Mind/ soul/butterfly. Iatry: To treat


Johann Christian Reil

Coined by: David Cooper (1967)*A set of criticisms of psychiatry,understood as a medical

specialty centered on hospital practice (Cooper 1967) More comprehensively, antipsychiatry was a social

movement that questioned not only the legal privilege of psychiatrists to detain and treat individuals with mental disorders, especially in a compulsory manner, but also the increasing “medicalization” of madness.

Questioned the very existence of mental illness itself.

*David Cooper, Psychiatry and Anti-Psychiatry, Paladin, London, 19675

ANTIPSYCHIATRY MOVEMENT


Conrad and Schneider : deviance designations in different historical periods*

Deviance as sinDeviance as crimeDeviance as sickness


*Conrad, Peter; Schneider, Joseph (1992). Deviance and medicalization: from badness to sickness. Temple University Press. pp. 36.

Vienna’s Narrenturm- 1784

Various 19th century critiques of the newly emerging field of psychiatry overlap thematically with 20th century anti-psychiatry.*

e.g. their questioning of the medicalisation of "madness".

Occurred at a time when physicians had not yet achieved hegemony through psychiatry, however, and so there was not such a single unified force to be "anti-”.*

* Nick Crossley R. D. Laing and the British anti-psychiatry movement: a socio–historical analysis Social Science & Medicine Volume 47, Issue 7, 1 October 1998, Pages 877-889

ANTIPSYCHIATRY MOVEMENT 8

The Alleged Lunatics' Friend Society arose in England in the mid-19th century to challenge the system and campaign for rights and reforms- July 7, 1845.

In the United States, Elizabeth Packard (1868) published a series of books and pamphlets describing her experiences in the Illinois insane asylum to which her husband had had her committed.*

*N Hervey (1986) Advocacy or folly: the Alleged Lunatics' Friend Society, 1845-63. Med Hist. 1986 July; 30(3): 245–275.


As psychiatry became more professionally established during the nineteenth century and developed allegedly more invasive treatments, opposition increased.*

Clifford W. Beers- A Mind that Found Itself(1908),campaigned to improve the plight of individuals receiving public psychiatric care -> founded the National Committee for Mental Hygiene -> the National Mental Health Association.**

*Kleinman, Arthur (1988). Rethinking Psychiatry: From Cultural Category to Personal Experience. Collier Macmillan. ISBN 0029174422.

**Dain, N. (1989)Critics and dissenters: Reflections on anti-psychiatry in the United States Journal of the History of the Behavioral Sciences Volume 25 Issue 1, Pages 3 - 25


Introduction and widespread use of several controversial medical practices including inducing seizures (by electroshock, insulin shock therapy or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy) from the 1930s -> more widespread concern and opposition.*

*Whitaker, Robert (2004). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Basic Books. ISBN 0-7382-0799-3


In 1950s-Introduction of antipsychotics like chlorpromazine with various side effects.

Opposition of Psychiatry by a right wing anti-mental health movement seeing it as left-wing, anti-American or pro-Communist;

Widespread fears that it threatened individual rights and undermined moral responsibility.

Opposition by behaviorists- Hans Eysenck, and clinical psychologists.*

*Mark S. Micale, Roy Porter (1994) Discovering the History of Psychiatry Oxford University Press US, 1994 ISBN 0195077393


Term “anti-psychiatry” coined by David Cooper in 1967 Movement that vocally challenged the

fundamental claims and practices of mainstream psychiatry.

Took on a national and international character, with access to the mass media and incorporating a wide mixture of grassroots activist organizations and prestigious professional bodies.*

* Mark S. Micale, Roy Porter (1994) Discovering the History of Psychiatry Oxford University Press US, 1994 ISBN 0195077393


David Cooper (South Africa) Ronald D. Laing (Britain) Michael Foucault (France) Franco Basaglia (Italy) Erving Goffman (USA) Thomas Szasz (USA) Aaron Esterson (UK)


South African Britain based psychiatrist.Coined the term antipsychiatry in 1967.Was a Marxist and viewed mental illnesses

as a product of influence of oppressive society over an individual.

Believed that madness and psychosis are the manifestation of a disparity between one's own 'true' identity and our social identity.


Psychoanalyst.The most influential figure of British

antipsychiatry movement.Based his theories in Humanistic

Psychology- freedom & subjectivity over determinism.

Schizophrenia – response or adaptation of sensitive individuals to mad world.


Schizophrenia- “a gifted & creative state of consciousness that took over sanity &

could produce superior human beings.”*“Psychiatrosis”- new type of mental d/o.Laing, with Cooper founded the Philadelphia Association in 1965, set up

over 20 therapeutic communities including Kingsley Hall, where staff and residents theoretically assumed equal status and any medication used was voluntary.

* Laing RD (1967) The Politics of Experience. Penguin, London


Comments:oNo place for the suffering & disability created

by the disorder to the pt. and the surrounding.oFailure of the therapeutic communities that he

claimed to cure the malady.


American psychoanalyst.Professor Emeritus of Psychiatry at the

State University of New York Health Science Center in Syracuse, New York.

Social critic of the moral and scientific foundations of psychiatry, and of the social control aims of medicine in modern society.

Author of The Myth of Mental Illness (1960) and The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (1970).

ANTIPSYCHIATRY MOVEMENT19

Libertarian.Denied the existence of mental illness as a

medical entity- “whereas in modern medicine new diseases were discovered, in modern psychiatry they were invented”.*

Disease means bodily disease. The mind (whatever it is) is not an organ or part of the body. Hence, it cannot be diseased in the same sense as the body can.**

*Szasz T (1960) The Myth of Mental Illness.Hoeber-Harper,New York.

**Szasz T (1973) The Manufacture ofMadness.Granada,St.Albans


All behaviors are rational (or @ least intentional) and individuals are always responsible for it.

Mental disorders should be explained in terms of the “acting out” of family and religious games, and ethics and morals might better substitute for psychiatry.


Psychiatric labeling undermined personal rights and moral responsibility.

Viewed psychiatric diagnoses as the tools of control and opposed the use of psychiatry to forcibly detain, treat, or excuse.

“coercive” psychiatric treatment resulted, he said, not only in an exacerbation of patients’ symptomatology, but also in their infantilization.


The myth of mental illness.Separation of psychiatry and the state.Presumption of competence.Death control.Abolition of the insanity defense.Abolition of involuntary hospitalization.Rights to drugs.Coined – Pharmacracy.


Objected to being called anti-psychiatrist and overtly critical of anti-psychiatrists

such as Laing and Cooper, regarding them as “woolly minded and misguided socialists.

In 1969 collaborated with scientology to form the Citizens Commission on Human Rights.

Still active and disseminating his views though slightly modifying with some acceptance of biological concept.


Comments:◦ Disease has no such concrete patho-anatomic

concept alone. ◦ “psychiatric disorder must be disease with

discernible histopathology & pathophysiology”- other aspects of defining disease include Distress experienced & reported by the patients. Level of disability associated. Pattern of behavior. Level of statistical deviation. E.g. hypertension, headache.


Canada born American Sociologist.Book - Asylums: Essays on the Social

Situation of Mental Patients and Other Inmates (1961)- account of observations he made during fellowship in 1955–1956 at the National Institute of Mental Health in field work at St. Elizabeths, an institution that, at the time, had over 6,000 patients.


There was no such thing as mental illness and the pretension of professionals to treat

it was nothing more than a shameless power-grab.

Mental hospitals- Total institution, brain wishing machines responsible for ◦ infantilizing patients.◦ and restricting their freedom.


Relatively more powerful impact among psychiatrists and health policy makers as compared to Laing and Szasz, who were more widely read.*

Provided Health Departments and taxpayers with a justification for closing large numbers of expensive hospitals.*

* Berlim M.T. et al. Notes on antipsychiatry. Eur Arch Psychiatry Clin Neurosci (2003) 253 : 61–67.


Comments: oPositive :

brought forward the serious weaknesses prevalent in the then mental hospitals

helped in the revision and refinement of many mental health policies as well as practices.

oNegative : denial of the very existence of mental illnesses led to the rapid closure of large no. of mental

hospitals without alternative measures resulting in rapid growth in mentally disordered homeless individuals and thus more stigma regarding mental illness.


Italian Psychiatrist and Neurologist.Neo-Marxist.Founder of Psychiatria Democratica – a

nationwide association with anti-institutional ideal.

Architect of the Law 180 in 1978 that led to the dismantling of the then existing large asylums and prohibited forceful admission of the mentally ill to mental health institutions.


Italy: Viewed by the supporters of the antipsychiatry movement as the museum for the antipsychiatry theories. Argued the cause of mental illness to be social violence and exclusion patient’s symptoms arise from their

“political dialectical inability” to be face up the contradiction of reality.

Compared mentally ill to the poor and condemned: all victims of the selfish society.



Psychopharmacology and other t/t nothing more than instruments for the

control of deviant individuals by the system responsible for the status quo of capitalism.

Actual treatment: when patient gain insight into their exclusion from society and learn to refuse it.

Led to the development of community psychiatry in Italy.


Comments:o Positive:

Brought forward the prevailing inhumane and non scientific practices prevalent in the asylums

Led the foundation to an entirely new concept of community psychiatry.

oNegative: Simplicistic equation between poverty and

deprivation is wrong. More politicized than scientific

• Did not give the alternative solution.• Obstacle to progressive reform.


Thomas Scheff, Howard Becker..Mental disorder

◦ Labels arbitrarily assigned by the society and confirmed by the psychiatrists rather than “defined by nature”.

◦ With intent of coercing and controlling individuals whose deviant behavior threatens society’s orderliness and welfare.

◦ A means to control over individuals.◦ Often refer to Rosenham (1973) experiment.


Alleged lunatics’ friend society.National Mental Health Association.National Society for Lunacy Law Reform.Consumer/survivor/ex-patient movements-

World Network of Users and Survivors of Psychiatry; European Network of (ex-)users and Survivors of Psychiatry.

Church of scientology.Citizens Commission on Human Rights.Civil rights movements.Antipsychiatry.org.


Basically being carried on by diverse groups of activists and organizations basically run by “patients”/“ex-patients”.

No uniformity between them.United basically by a common goal-criticism

of psychiatry. Asian Subcontinent:

• No literature could be found but being advocated by a diverse group of mental health activists and ex-patients through various organizations.

• Nepal: No literature in medical journals; Nepal Mental Health Foundation.


Less vocal than the 1960s and 70s but still powerful enough to affect the Mental Health Policy and Practice worldwide.


The fear, stigma and denial of mental illness and the mentally ill prevalent in the society itself a part of antipsychiatry.*

Prevalent from the general public to the psychiatrists themselves.

Reason : the still prevalent vagueness in the etiological causes, pathophysiology and treatment in mental illnesses despite the achievements made till date.

* Ironside W. Antipsychiatry, Psychiatry and Medicine. Australian and New Zealand Journal of Psychiatry (1975) 9 : 69


Antipsychiatry in miniature form has been present since the time unknown and still prevalent.

Antipsychiatry movement arose as the Zeitgeist of the 1960s & 1970s epitomized by the rebellion against the “system”.*

An ideological movement based on a politicized and reductionist understanding of psychiatry devoid of an empirical basis; putting itself in clear opposition to any scientific data from the medical specialty of Psychiatry.

* Berlim M.T. et al. Notes on antipsychiatry. Eur Arch Psychiatry Clin Neurosci (2003) 253 : 61–67.


Antipsychiatry movement has thus been a loose association of diverse group of people- the ex-patients to the psychiatrists themselves : there was debate over whether it was a new phenomena, who "owned" it, and whether it even constituted a genuinely singular movement.*

Has considerably lost its vigour of the 1970s with the intrinsic evolution within psychiatry and the changing worldviews of the major critics.**

*Paul Laffey Antipsychiatry in Australia:Sources for a Social and Intellectual History Health & History, 2003. 5/2: 17–36

**Tantam D (1991) The anti-psychiatry movement. In: Berrios GE, Freeman H (eds) 150 Years of British Psychiatry: 1841–1991.Gaskell, London, pp 321–352


While antipsychiatry may have fallen from grace and was no longer be led by eminent psychiatrists, it was argued that it had in fact only been handed over to the team.*

Antipsychiatry had little discussion of the deteriorating situation of the mentally troubled in American society. Antipsychiatry crusades have thus been charged with failing to put suffering individuals first, and of thus being guilty of what they accuse psychiatrists. **

*Mervat Nasser The rise and fall of anti-psychiatry Psychiatric Bulletin (1995). 19, 743-746.

** Mark S. Micale, Roy Porter (1994) Discovering the History of Psychiatry Oxford University Press US, 1994 ISBN 0195077393


Positive aspects:Led to considerable refinement in psychiatric nosology.Criticisms of the then prevalent inhumane conditions

and practices led to revision in the mental health policies and practices that actually helped in the progress of psychiatry and better delivery of care.

Demonstration of psychiatry’s richness and complexity: no “anti-cardiology” “anti-paediatrics”.*

Antipsychiatry’s legacy is likely derived much from the absorption and incorporation of its criticisms by mainstream psychiatry than from the direct application of its principles.**

*Bracken P, Thomas P (2001) Postpsychiatry: a new direction for mental health. BMJ 322:724–727

** Berlim M.T. et al. Notes on antipsychiatry. Eur Arch Psychiatry Clin Neurosci (2003) 253 : 61–67.


Antipsychiatry in “miniature form” has been present since the time unknown and likely to persist in future as well.

Antipsychiatry movement is a loose association of a diverse groups of people with ideology based on a politicized and reductionist understanding of psychiatry; mostly in clear opposition to all fundamentals of psychiatry and arose as a the Zeitgeist of the 1960s & 1970s epitomized by the rebellion against the “system”.


Helped indirectly in the growth of psychiatry itself.

Antipsychiatry’s legacy is likely derived much from the absorption and incorporation of its criticisms by mainstream psychiatry than from the direct application of its principles.


1. Berlim M.T. et al. Notes on antipsychiatry. Eur Arch Psychiatry Clin Neurosci (2003) 253 : 61–67.

2. Bracken P, Thomas P (2001) Postpsychiatry: a new direction for mental health. BMJ 322:724–727.

3. Conrad, Peter; Schneider, Joseph (1992). Deviance and medicalization: from badness to sickness. Temple University Press. pp. 36.

4. Dain, N. (1989)Critics and dissenters: Reflections on anti-psychiatry in the United States Journal of the History of the Behavioral Sciences Volume 25 Issue 1, Pages 3 – 25.

5. David Cooper, Psychiatry and Anti-Psychiatry, Paladin, London, 1967.6. Ironside W. Antipsychiatry, Psychiatry and Medicine. Australian and

New Zealand Journal of Psychiatry (1975) 9 : 69.7. Kleinman, Arthur (1988). Rethinking Psychiatry: From Cultural

Category to Personal Experience. Collier Macmillan. ISBN 0029174422.

8. Laing RD (1967) The Politics of Experience. Penguin, London


9. Mark S. Micale, Roy Porter (1994) Discovering the History of Psychiatry Oxford University Press US, 1994 ISBN 0195077393.

10. Mervat Nasser The rise and fall of anti-psychiatry Psychiatric Bulletin (1995). 19, 743-746.

11. N Hervey (1986) Advocacy or folly: the Alleged Lunatics' Friend Society, 1845-63. Med Hist. 1986 July; 30(3): 245–275.

12. Nick Crossley R. D. Laing and the British anti-psychiatry movement: a socio–historical analysis Social Science & Medicine Volume 47, Issue 7, 1 October 1998, Pages 877-889.

13. Paul Laffey Antipsychiatry in Australia:Sources for a Social and Intellectual History Health & History, 2003.

14. Szasz T (1960) The Myth of Mental Illness. Hoeber-Harper,New York.15. Szasz T (1973) The Manufacture of Madness. Granada, St.Albans.16. Tantam D (1991) The anti-psychiatry movement. In: Berrios GE, Freeman H

(eds) 150 Years of British Psychiatry: 1841–1991.Gaskell, London, pp 321–352.

17. Whitaker, Robert (2004). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Basic Books. ISBN 0-7382-0799-3

18. www,antipsychiatry.org(accessed on 2011.1.2519. http://en.wikipedia.org/wiki/Anti-psychiatry.




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