|Year : 2019 | Volume
| Issue : 2 | Page : 284-286
Past and current concepts of “Anti-Psychiatry”: Does it have a future?
Department of Psychiatry, College of Medical Sciences, Bharatpur, Chitwan, Nepal
|Date of Submission||22-Nov-2019|
|Date of Decision||02-Dec-2019|
|Date of Acceptance||04-Dec-2019|
|Date of Web Publication||16-Dec-2019|
Dr. Krishnamurthy Kavirayni
Varuna 305, Navadweepa Apartments, Madhapur, Hyderabad-500 081
Source of Support: None, Conflict of Interest: None
Anti psychiatry can better be called Anti Establishment Psychiatry has been propounded be cause of the differences it had with the establishment of Psychiatry of those days for lack of humanitarian approach and not considering the social causation, and leaning so much on somatic treatments whose mode of action is questionable. Unlike Scientology which meant abolition of Psychiatry as a speciality , the anti Psychiatry movement envisaged only reforms in approach to a Psychiatry patient.
Keywords: Anti psychiatry, humanitarian approach, Social causation
|How to cite this article:|
Kavirayni K. Past and current concepts of “Anti-Psychiatry”: Does it have a future?. Arch Med Health Sci 2019;7:284-6
| Introduction|| |
Psychiatry has a checkered history from its beginning, the cause of mental illness is varying, and ranging from Gods, ghosts, demonology, biology, psychology, sociology, as a medical specialty, and presently sitting pretty as functional neurology. The concept and evolution of the movement of anti-psychiatry could best be called antiestablishment of psychiatry than anti-psychiatry. The reason for development of anti psychiatry movement was the belief that psychiatry does not respect patient's freedom and also the changes and revolutions that happened in 1950s and 1960s in Europe and America including the civil rights movement for equality and freedom influenced its development. During my personal communication with one of the anti-psychiatrists (R. D. Laing) as to why they call themselves anti-psychiatrists, he replied “I am a trained Psychiatrist and others call us Anti Psychiatrists”, but the name anti-psychiatry was coined by a trained and practicing Psychiatrist.
Understanding of psychiatry changed from time to time, psychiatry as a specialty can be traced in Ancient India. The oldest texts on psychiatry include the Ayurvedic text, Charaka Samhita. Some of the first hospitals for curing mental illness were established during the 3rd century BCE, and mental illness was recorded for the first time in Ancient India sometime in the 3rd century B. C There were also historical evidences; some mental hospitals existed as early as 5th century in Arab countries, while the ancient Greeks and Romans believed that psychiatric disorders are due to supernatural phenomena, and later in the same countries, it was believed that psychiatry was caused by ghosts and demons, and the best way to get rid of the ghosts was to burn the mentally ill in open places. Humanitarian treatment reforms started in the early 18th century, and psychiatry was getting recognized as a medical specialty in the early 1800s. For the 1st century of its existence, the field concerned itself with severely disordered individuals confined to asylums or hospitals which were constructed far away from human dwelling to segregate these unfortunate people. Mental hospitals or asylums as they were called were being built with high walls, with security guards, as if patients were criminals to be guarded. These hospitals, were built far from the city outskirts, may be not with an intension to protect patients but to protect the society from the violent mentally ill. Incarceration into a state mental asylum was the only treatment available at one time. The types of treatments included caning, chaining, physical restraints, and threats of punishment. There were treatments which also included personal and social methods of control. Part of the progressive Age of Enlightenment, a “moral treatment” movement, challenged the harsh, pessimistic, somatic (body-based), and restraint-based approaches that prevailed in the system of mental hospitals which were otherwise called “madhouses” for people considered mentally disturbed, who were generally seen as wild animals without reason. Later some scientific thoughts prevailed and treatments like Insulin Coma therapy and Frontal leukotomy were practiced, these treatments were later dropped as they were considered punitive and irrational. Patients were getting discharged from the state mental hospitals with the advent of these new treatments, and the “deinstitutionalization” movement has started. Although a well-funded community mental health system never materialized as promised, psychiatric patients with varying levels of symptoms and dysfunction were being treated as outpatients, often with both medications and psychotherapy. Healing the rift between biological psychiatry and psychotherapy was foreshadowed in the 1970s by George L. Engel's biopsychosocial medical model and by Eric R. Kandel's laboratory work on the cellular basis of behavior. Even at the height of the medicalization of psychiatry in the 1980s and 90s, it was recognized that unconscious dynamics affect the doctor–patient relationship, and that interpersonal factors strongly influence on how patients think and behave.,,,,,
In the 1960s, there were many challenges to mainstream psychiatry where the very basis of psychiatric practice was characterized as repressive and controlling. Psychiatrists involved in challenging the then existing concepts included Jaqus Lacan, Thomas Szasz, Giorgio Antonucci, Ronald Laing, Franco Basaglia, Theodore Lidz, Silvano Arieti, and David Cooper. Others involved were Michel Foucault and Erving Goffman. Thomas Szasz introduced the definition of mental illness as a myth in the book “The Myth of Mental illness” (1961). Giorgio Antonucci introduced the definition of psychiatry as a prejudice in the book “I pregiudizi e la conoscenza critica alla psichiatria” (1986), and a movement in psychiatry has started emphasizing on social causation and treat the patients with a humanitarian touch opposing the traditional punitive methods, which was later named as Anti-psychiatry.
Anti-psychiatry is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients. It considers psychiatry a coercive instrument of oppression due to an unequal power relationship between doctor and patient and a highly subjective diagnostic process. It has been active in various forms for two centuries. Contemporary issues of anti-psychiatry include freedom versus coercion and racial and social justice. Iatrogenic effects of antipsychotic medications (unintentionally induced by medical therapy), personal liberty, social stigma, and the right are different. Critics of anti-psychiatry accept that psychiatry has issues which need addressing; antipsychiatry questioned the existing understanding and practice of psychiatry but never meant to abolish psychiatry. Anti-psychiatry was the offshoot of certain thinkers who are qualified, psychiatrists, and academicians, whereas the Scientology (or the church of Scientology) was the creation and imagination of Ron Hubbard, a journalist. The Citizens Commission on Human Rights (CCHR) was founded by Scientology “to expose the evils of psychiatry.” The attacks on psychiatry and psychiatrists by Scientology and the CCHR have continued and indeed have increased with times, with many celebrities joining hands. One striking example is of the Hollywood actor Tom Cruise who advocated in January 2004: “I think psychiatry should be outlawed.”
David Cooper coined the term “Anti-psychiatry” in 1967. Years before him, Michel Foucault propagated a paradigm shift that regarded delusions not as madness or illness, but as a behavioral variant or an “anomaly of judgment.” That anti-medicalization movement was supported by theFirst Church of Christ, Scientist, the legal system, and even the then, a new specialty of neurology, plus social workers and “reformers” who criticized mental hospitals for failing to conduct scientific investigations. Although psychiatry has evolved into a major scientific and medical discipline, the century-old primitive stage of psychiatric treatments instigated an antagonism toward psychiatry that persists to the present day. Radical anti-psychiatry over several decades has changed from an antiestablishment campus-based movement to a patient-based consumerist movement. The antecedents of the movement are traced to a crisis in self-conception between biological and psychoanalytic psychiatry occurring during a decade characterized by other radical movements. Anti-psychiatry originates in an objection to what some people view as dangerous treatments; examples include electroconvulsive therapy (ECT), insulin coma therapy, and brain lobotomy. An immediate concern is a significant increase in prescribing psychiatric drugs for children. There were also concerns about mental health institutions. All modern societies permit involuntary treatment or involuntary commitment of mental patients designed to make the medical personage the “master of madness.” The effect of this shift then served to inflate the power of the physician relative to the patient, correlated with the rapid rise of internment (asylums and forced detention).
What are the “wrongdoings” of psychiatry that generated the long-standing protests and assaults? The original “sin” of psychiatry appears to be locking up and “abusing” mentally ill patients in asylums, which 2 centuries ago was considered a humane advance to save seriously disabled patients from homelessness, persecution, neglect, victimization, or imprisonment. The deteriorating conditions of “lunatic” asylums in the 19th and 20th centuries were blamed on psychiatry, not the poor funding of such institutions in an era of almost complete ignorance about the medical basis of mental illness. The other perceived misdeeds of psychiatry are schematized in a tabular format [Table 1].
Most of the above reasons are exaggerations attributed to psychiatry during an era of primitive understanding of psychiatric disorders. Harmful interventions such as frontal lobotomy – for which its neurosurgeon inventor received the 1949 Nobel Prize in Medicine – were a product of a desperate time when no effective and safe treatments were available. Although regarded as an effective treatment for mood disorders, ECT certainly was abused many decades ago when it was used (without anesthesia) in patients who were unlikely to benefit from it.,,,
| Conclusion|| |
The Anti-psychiatry movement evolved when a group of psychiatrists were against the punitive and harsh methods of treatment given to these unfortunate segment of the population, and they felt that the patient and their community were being exploited, and they tried to emphasize the role of family and society in the causation of mental illness and went on to explain that the patient was a scapegoat in a disordered family or society, and so they were fully justified to name their way of thinking as Anti-psychiatry the name was coined by a psychiatrist and all of them were trained and practicing psychiatrists. On the contrary, Scientology (Church of Scientology) has a strong opposition by the organization against the medical specialty of psychiatry and psychology and never considered psychiatry as a medical specialty and even tried to abolish psychiatry as a medical specialty. Currently, the concept of Anti-psychiatry is a nonexisting entity as psychiatry has been accepted as a subdivision of neurology both in structural and functional abnormalities as causative factors of all psychiatric ailments, and the concept of mind is slowly fading. Unlike in the past, patients now no longer overstay in state mental hospitals facing ill-treatment and dehumanization. With the beginning of general hospital psychiatry units where patients are treated with dignity and respect the old thinking of antipsychiatry is almost nonexistent now, both the name and concept of Anti-Psychiatry were fully justified during its time.
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