Unfitting Stories: Narrative Approaches to Disease, Disability, and Trauma

Reports from the Psych Wars

What are the “psych wars”?1 Two references help to provide a context for this concept. On November 19, 1999, the New York Daily News ran a headline on its front page that read “Get the Violent Crazies Off Our Streets.”2 This headline conflates “craziness” with belligerence, and demands that a certain minority be removed from public spaces in which they are seen as dangerous trespassers. Ron Coleman, a prominent member of the Hearing Voices Network in the UK, coined the slogan “psychotic and proud” as a gesture of defiance against such exclusionary practices (James 2001, 110). Instead of protesting the negative effects of being labelled “psychotic,” Coleman affirms an identity that is generally believed to be among the least desirable of all social identities. This “report” is tuned to the “psych wars,” to the sounds of shots ringing out. The first section explores a few of the dimensions of psychiatric imperialism since World War II, invoking the work of Baudrillard to develop an understanding of the unifying text of American—and, increasingly , global—psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (or DSM). The second section critically appraises the concept of “narrative” as it functions in the context of the psych wars. Hyperreal Psych Wars It was the Hollywood mogul Samuel Goldwyn who observed, “Anyone who goes to a psychiatrist ought to have his head examined,” yet most people do not opt to become psychiatric patients. If the psychiatric profession were to rely on voluntary recruits alone, then its scope would be considerably 237 richard ingram Reports from the Psych Wars smaller than it is now. As a disciplinary apparatus, therefore, psychiatry has relied on a steady stream of recruits who are press-ganged into service as patients. From the perspective of the state apparatus, the use of coercion has been justified as an essential component of what is sometimes called “the war on mental illness.” The narrative of fighting to overcome this enemy, however, has been challenged by a counternarrative that considers the very concept of “mental illness” to be fraudulent. By the 1970s, books such as E. Fuller Torrey’s The Death of Psychiatry (1974) suggested that the profession was itself on the verge of collapse. Looking back, however, it is clear that, far from expiring, psychiatry was undergoing a fundamental transformation. Indeed, the profession emerged strengthened from its breakdown by entering into a Faustian pact with the pharmaceutical industry. The condition of this pact was that psychiatry was obliged to renew theories of biologically determined behaviour that had been discredited by the events of World War II. Psychiatry’s rehabilitation was achieved by resuscitating theories of innate defects in order to shore up the concept of “mental illness,” and to gain a more secure position within the medical establishment. The success of the counternarrative that rejects the concept of “mental illness” could be measured in terms of the dramatic reduction in the number of institutionalized patients. By re-inventing itself as psychopharmacology , though, psychiatry has become less dependent on the mechanism of confinement. Not only has it managed to integrate the critique of the “stigma” of mental illness, psychiatry has also produced the category of “consumer” to supplement the category of “patient.” This shift from “patient” to “consumer” enhances psychiatry’s claim that it operates on the basis of consent. Nevertheless, the process of de-institutionalization is being re-evaluated, and there are signs that it may be reversed. I have referred to the prominent American psychiatrist E. Fuller Torrey because he embodies this reversal, having mutated from a dissident within his profession into a leader of the new press gangs. Torrey states, “For a substantial minority … de-institutionalization has been a psychiatric Titanic” (1996, 11). It appears that the main reason behind the great push for de-institutionalization in the 1960s and 1970s is being forgotten, and that we need to have our memory jogged. David Gonzalez, a “mad movement” activist,3 arrived at the following striking comparison by employing information from the World Almanac and Book of Facts on the number of Americans killed in combat (Famighetti 1994, 163), together with figures from the US Substance Abuse and Mental Health Service Administration’s Center for Mental Health Services: 238 the larger picture Between 1950 and 1964, more people died in United States federal, state and county “mental hospitals” than the number of Americans killed in the Revolutionary War, the War...