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

 Objectives
 Definitions: Psychiatry, antipsychiatry.
 Historical evolution of antipsychiatry movement.
 Prominent leaders/proponents of the
antipsychiatry movement and their views.
 Antipsychiatry and psychiatry
 Pros and cons of antipsychiatry movement.
 Take home message.
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ANTIPSYCHIATRY 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.
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ANTIPSYCHIATRY MOVEMENT

Coined by Johann Christian Reil,
German physician and anatomist in
1808
Greek
 Psyche: Mind/ soul/butterfly.
 Iatry: To treat
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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, 1967
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ANTIPSYCHIATRY MOVEMENT

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Conrad and Schneider : deviance designations in
different historical periods*
 Deviance as sin
 Deviance as crime
 Deviance as sickness
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*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
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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.
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 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
ANTIPSYCHIATRY MOVEMENT 10

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
ANTIPSYCHIATRY MOVEMENT 11

 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
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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
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 David Cooper (South Africa)
 Ronald D. Laing (Britain)
 Michael Foucault (France)
 Franco Basaglia (Italy)
 Erving Goffman (USA)
 Thomas Szasz (USA)
 Aaron Esterson (UK)
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 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.
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 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.
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 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
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Comments:
o No place for the suffering & disability created by the
disorder to the pt. and the surrounding.
o Failure of the therapeutic communities that he
claimed to cure the malady.
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 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 MOVEMENT
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 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
ANTIPSYCHIATRY MOVEMENT 20

 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.
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 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.
ANTIPSYCHIATRY MOVEMENT 22

 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.
ANTIPSYCHIATRY MOVEMENT 23

 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.
ANTIPSYCHIATRY MOVEMENT 24

 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.
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 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.
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 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.
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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.
ANTIPSYCHIATRY MOVEMENT 28

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.
ANTIPSYCHIATRY MOVEMENT
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 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.
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 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.
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 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.
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 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.
o Negative:
 Simplicistic equation between poverty and deprivation is
wrong.
 More politicized than scientific
• Did not give the alternative solution.
• Obstacle to progressive reform.
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 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.
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 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.
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 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.
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 Less vocal than the 1960s and 70s but still
powerful enough to affect the Mental Health Policy
and Practice worldwide.
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 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 MOVEMENT 39

 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 40

 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
ANTIPSYCHIATRY MOVEMENT
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 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
ANTIPSYCHIATRY MOVEMENT 42

 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 MOVEMENT
43

 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”.
ANTIPSYCHIATRY MOVEMENT
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 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.
ANTIPSYCHIATRY MOVEMENT 45

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
46ANTIPSYCHIATRY MOVEMENT

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 2011.1.25
19. http://en.wikipedia.org/wiki/Anti-psychiatry.
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