Antipsychiatry: Quackery Squared

2. Antipsychiatry: Alternative Psychiatry

25 2 Antipsychiatry Alternative Psychiatry A good catchword can obscure analysis for fifty years. —OL I V E R W E N DE L L HOL M E S J R . (1841–1935) Ronald D. Laing and David Cooper were trained and practiced as hospital psychiatrists. Antipsychiatry developed and took place in institutional settings—first in regular (state) mental hospitals, later in alternative mental hospitals named euphemistically, as was Kingsley Hall, Laing’s famous “antipsychiatric household.” I opposed antipsychiatry from the start, in part because I believed that persons who undertake an explicitly nonmedical, noncoercive, contractual “cure of souls” ought to treat their clients as independent, existentially equal persons and therefore ought not to provide room and board for them. Housing patients in traditional mental hospitals deprives their inmates of liberty. Housing clients in group homes protects legally competent adults from the responsibility to domicile and support themselves. “A rose by any other name would smell as sweet,” said Shakespeare.1 Psychiatry by any other name smells as foul. My objection to psychiatry—as psychiatric power and imprisonment, with which in my view it is synonymous—predates by many years my training in psychiatry. In 1945, when I decided to end my residency in internal medicine and train in psychiatry, I chose the University of Chicago Clinics because the hospital lacked a psychiatric ward and provided outpatient psychiatric services only. The following year, I entered training at the Chicago Institute for Psychoanalysis and, in 1950, received my certificate of graduation from it. 26 | Antipsychiatry In those days, most psychoanalysts worked only with fee-paying patients in their private offices, limited their work to psychoanalysis or psychotherapy (now called “talk therapy”), and had no connections with mental hospitals . The distinction between consensual, office-based psychiatry (psychotherapy ) and coerced, hospital-based psychiatry (somatic therapy) was then clear: analysts treated voluntary patients who provided lodging and food for themselves, whereas psychiatrists treated involuntary patients who were provided room and board by the hospital. (There were exceptions—for example, Frieda Fromm-Reichmann [1889–1957] and others at Chestnut Lodge, in Rockville, Maryland.) Separating the person who receives a psychiatric service from the agency or individual that pays for it is, in practice, incompatible with consensual psychiatry. The psychiatrist’s financial dependence on the patient is the patient’s ultimate and perhaps only protection from the psychiatrist’s power over him. One of the most deleterious consequences of the creation of the antipsychiatry movement was the loss of clear contrast between office-based consensual counseling and hospital-based coerced restraint and its replacement with a contrast between authoritarian, “bad” psychiatry and democratic, “good” antipsychiatry. This is a nonsensical distinction. Consensual psychiatry rests on a buyer-seller relationship between putative equals, whereas coercive psychiatry is based on a welfare relationship between a needy recipient and a benevolent provider. The libertarian-capitalist regards the buyer as a person possessing the means to satisfy his needs and hence sees market relations as empowering, enabling the buyer to hire or fire the expert. The socialiststatist regards the person in need as a helpless individual unable to provide for his needs and sees market relations as disempowering, the would-be buyer the victim of the capitalist seller system. Adaptations of antipsychiatric practices —the Arbours Centres in England, Lacanian psychoanalysis in France, “democratic psychiatry” in Italy, and Soteria Houses in the United States— all rest on “therapists,” agents of the state, providing food and lodging and other “services” for their patients. Laing trained and worked in psychiatric institutions, created a new one of his own, and pretended to erase the economic, existential, and professional boundaries between himself and his clients. In contrast, I trained and worked in the tradition of the private practice of medicine and psychoanalysis, Antipsychiatry | 27 shunned psychiatric institutions, limited my work to consensual relations with persons who supported themselves and paid for my services, and regarded the boundaries—“contract”—between the obligations and duties of expert and client as being of paramount importance.2 I Because Cooper and Laing never defined “antipsychiatry,” others seized the opportunity to do it.3 In A Historical Dictionary of Psychiatry, psychiatric historian Edward Shorter offers this description of the “Antipsychiatry Movement”: “Early in the 1960s, as part of the general intellectual tumult of the time, a protest movement arose against psychiatry. . . . The movement crystallized around a number of prominent intellectual spokespersons.”4 He lists me in first place among...