On the History and Development of Psychiatric Criticism

Sylvia Zeller
On the History and Development of Psychiatric Criticism, Antipsychiatry, and the Conceptual Use of the Term Antipsychiatry.

The Modern Insane Asylum as a Child of the Enlightenment
Around 1800, the first modern, state-run insane asylums were established. According to their own self-image, they were reform projects, shaped by the spirit of the Enlightenment, which appeared with the explicit promise of cultural progress based on the use of reason and propagated a new image of man. This was to lead to a paradigm shift in dealing with psychosocial deviants. In contrast to the custodial, disciplinary and administrative practices of the earlier feudal toll and workhouses, the asylums that were now founded followed a new model of promoting, stimulating and treating the inmates. Unreason was to be overcome by rational action, „for to think that all one had to do was to bring the irrationally unpredictable drives and desires under the control of the rational was, of course, characteristic of the Enlightenment everywhere.“ (Hannah Arendt in: On Revolution) Scientific attempts to explain and medicalize human behavior gained momentum, because it seemed desirable to systematize social and psychological phenomena into causal models and regularities as well. By classifying deviant behavior, i.e. behavior perceived as illogical or unreasonable, as a disease, it appeared curable and thus to be eliminated.

The Enlightenment arose with the claim to free man from his religious and class determinations. The French Revolution laid the foundation for the idea of the equality of all people and thus of human rights. All too quickly, however, the postulate of legal equality was confused with the idea of an anthropological, essential equality of all human beings. Anyone who attracted attention through „different“ behavior was now increasingly placed in a newly invented group of the „unreasonable“.

The Enlightenment also saw the emergence of a civic public sphere and corresponding legislation. For example, under the Prussian Land Law of 1794 and the General Rules of Court of 1795, the placement of patients in psychiatric institutions was ordered by the courts, and opinions of „expert“ physicians were obtained for this purpose.

With these changes, the asylums also began to be the subject of public discussion and criticism. In England, there had already been isolated protests by inmates against the treatment methods in asylums in the 18th century. The world’s first self-organization of former inmates (Society for the Protection of Alleged Lunatics) was founded here in 1840 after several asylum scandals. The Alleged Lunatics‘ Friend Society that emerged from this marked 1845 as the beginning of psychiatric criticism as a political movement and the efforts of those affected to be recognized as political actors in the sense of collective self-representation. The association’s demands were for improved housing, adequate boarding, and also the strengthening of patients‘ rights such as free choice of doctor and support from lawyers. The conditions in asylums and the practice of admissions became more and more part of public debates also throughout Europe and North America and were taken up by lawyers, journalists, doctors and former patients. The asylum system as such was called into question, more organizations critical of asylums were founded, and the first political successes and reforms were achieved.

Origin of the term antipsychiatry
It was the American Elisabeth P.W. Packard who first used the prefix „anti“ in connection with criticism of psychiatry in her writings in 1868. She called for the founding of a self-help organization, which she named Anti Insane Asylum Society. Elisabeth Packard opposed the power of psychiatric institutions after she was taken to the Jacksonville Insane Asylum by her own husband without an evaluation, merely because of her political and religious views that he disliked, and was incarcerated there for three years. Even after her release, she endured confinement and the worst treatment at the hands of her husband. She devoted the rest of her life, after a spectacular court case Packard v. Packard, to fighting for women’s rights and against the removal of people to existing asylums, and was able to bring about quite a few changes in the law to strengthen patients‘ rights, the so-called Packard Laws.

In 1895, the naturalist Henryk M. Bannister resumed the concept of „anti-asylum“ in an essay on the question of home treatment – which E. Packard had advocated – versus clinical treatment, which Burkhart Brückner sees as evidence that the topic with this apostrophe has had continuous significance in the public discourse in the USA since Elizabeth Packard. Bannister, however, spoke out in favor of consistent institutional treatment, contrary to Packard’s demands.

In 1893, under the title L’Anti-Aliéniste (The Anti-insane Doctor), a patient newspaper appeared in a well-known Parisian asylum. With its demands for reform, satires and polemics against the asylum doctors, this journal found its way into the spirit of French lunatic-justice activism, which is associated, for example, with the name of the politician Léon Gambetta.

In the last quarter of the 19th century, a wealth of writings appeared in Europe and also in the German Empire that opposed the treatment of people classified as mentally ill. Criticism was levelled at abuses in asylums and „unlawful“ admissions. The legal situation in the empire was inconsistent. In Prussia (the largest German state), for example, despite legislation to the contrary, forced placements were still de facto carried out purely by the police, i.e. without the involvement of a court, as late as 1900.

In 1891, a protest pamphlet entitled An die Vernunft (To Reason) was published by the Hamburg mariner Adolf Ahrens, denouncing the „unreasonableness“ of the physicians performing the examinations and calling for appropriate changes in the law. The Swabian farmer Wilhelm Kuhnle was psychiatrically treated for four years against his will because of so-called „Querulantenwahn“ and demanded his rehabilitation as a victim of political persecution in 1894.
Georg Wetzer, also as a victim, founded the League for the Protection of the Interests of the Mentally Ill in 1907, which criticized the practice of internment and the determination of mental illness and used the term „antipsychiatry“.

Against the background of the emergence of reform movements in various social fields from about 1890, the League for the Reform of the Law of the Insane and the Care of the Insane was founded in 1909 by Adolf Glöcklen, a Heidelberg businessman who himself had experience with mental hospitals, which eventually led to the term „antipsychiatric movement“. In 1909, the physician Bernhard Beyer polemically titled the in-house journal of the newly founded association „antipsychiatric central organ“. Such and similarly worded articles were formulated by some physicians in order to decisively oppose what they saw as an all too vocal and rapidly spreading movement critical of psychiatry. „Antipsychiatry“ had thus become a polarizing fighting term intended to ward off and denigrate criticism of the psychiatric system; it was and is certainly not an adequate description of the diversity of positions within the mental health movement. This is probably also the reason why this label was rather not used by currents critical of psychiatry, which rather saw themselves as „reformers“.

Antipsychiatric Positions in the 1960s and 1970s and the Development of Social Psychiatry
The concept of antipsychiatry then reappeared from the 1960s onwards, gaining momentum as it entered cultural and academic discourses. In London, David Cooper, a physician from South Africa, developed ideas of an anti-authoritarian psychiatry in which patients would determine their own treatment. As a Marxist, he followed the conviction that madness and psychosis were socially induced and thus could only be dealt with through revolution. He conceived of his construction of a therapeutic community (Villa 21) as a counter-practice to institutional treatment, and he decidedly described his ideas as anti-psychiatric. However, he has remained almost the only representative of directions critical of psychiatry who has explicitly claimed this label for himself. The British psychiatrist Ronald David Laing examined in particular the processes of systematizing mental illness and diagnosing patients, denying psychiatrists a substantial understanding of the genesis and nature of mental illness.

During this period, Franco Basaglia not only challenged the prevailing conditions in psychiatric institutions and pursued concepts of therapeutic communities, but also eventually achieved the dissolution of the previous institutions in favor of outpatient treatment and decentralized facilities and a reform of psychiatry in Italy in 1978 in favor of a direction known as social psychiatry or community psychiatry, which saw itself as a reform movement. Basaglia, himself a psychiatrist, explicitly did not see himself as a representative of an anti-psychiatric movement and sought ways to work „with the institution against the institution.“

With the Dutch psychiatrist Jan Foudraine and his work Who’s Made of Wood? New Ways of Psychiatry from 1973, the shift in the view of mental illness typical of the time away from medical-psychiatric to a more social-psychiatric-psychotherapeutic perspective is expressed once again. Later, Foudraine supplemented his views with spiritual explanations based on the teachings of the yoga master Jiddu Krishnamurti.

Michel Foucault and Thomas Szasz
Psychiatric criticism as it presents itself today cannot be thought of without two important philosophical leaders, namely Michel Foucault and Thomas Szasz. Foucault wrote his work Madness and Society from 1955 – 1959. Based on the dominant discourse in enlightened, rational societies, he conceives of madness as the „other of reason,“ thus as a metaphor for everything that is marginalized by the society that considers itself „rational“ and is to be brought under control. Foucault describes the process of separating the expressions of „madness“ from those of „reason“ discourse-analytically and as a process of increasing stigmatization of deviant psychosocial behavior as „mental illness,“ as expressed in his catchy phrase: „Reason, that is torture.“ If Foucault sees in the increasing marginalization of those diagnosed as mentally ill the precondition for the emergence of modern insane asylums from the end of the 18th century onward, describing the rise of the physician as a moral authority and the transformation of the asylum into a medical space, Thomas Szasz takes his analyses a decisive step further by noting the expansion of medical authority far beyond the confines of the asylum. Szasz resolutely opposed both antipsychiatry and being associated with that label himself. In his major work of 1961, The Myth of Mental Illness, he argued that concepts of mental normality or insanity were in no way objectifiable and thus purely arbitrary claims.

The assessment of a patient’s mental functioning is made by the treating psychotherapist or psychiatrist. In this process, the patient’s own personal conceptions of norms play a decisive role. Inherent in the entire diagnostic process is the fact that the behavior and statements of patients are not judged according to medical standards, but according to ethical and social standards, which are also historically determined. People who deviate to a certain degree from moral or legal social norms are thus excluded from human society and sorted into the category of „mentally ill“. Consequently, Thomas Szasz rejected the concept of mental illness in general and, being a psychiatrist himself, became an ardent opponent of any psychiatric measures carried out against the patient’s will, such as forced hospitalization and compulsory treatment. He pointed out that these are also enforced by the state, namely by law and police, and violate human rights.

Szasz sees the cooperation and intertwining of state organs and psychiatry as the basis for the emergence of a „therapeutic state“ with spillover effects into more and more areas of life and therefore calls for a strict separation of psychiatry and the state. In the therapeutic state, currently undesirable and ever more widespread ways of thinking and acting (from drug use to racism, the list can go on endlessly) are regarded as symptoms of illness in need of treatment, as something that happens to people involuntarily and thus in turn brings countless new therapies and treatment providers onto the scene. This development undermines the individual responsibility and maturity of citizens and plays into the hands of ever more state paternalism. With his approach, which is committed to political and emancipatory liberalism, Thomas Szasz is the psychiatric critic who has most clearly and unmistakably demanded and thought through the individual’s right to his own body and at the same time his own responsibility for it.