PSYCHIATRY AND ANTI-PSYCHIATRY

--by David Paul Tahrir Thurston

By any objective measure, US society is in a state of mental health crisis.  Between 2007 and 2014 the suicide rate leapt from a staggering 28,00 per year, to the utterly appalling 42,000 suicides at the end of that time period.  Suicide is the ultimate mental health failure--and it leaves toxic guilt, shame, and profound pain in its wake.  The contention of this brief essay is that acute mental health symptoms are an objective fact in present conditions, and that a critical reevaluation of competing understandings of the mess we're in can only advance our collective understanding of how to build a society where empathy, love, and principles of solidarity and mutual aid can replace the toxicity of the ever more vicious neoliberal economic and social order we have lived with since the late 1970s...

The literature on mental health and mental illness is littered with authors arguing diametrically opposed positions whose respective books usually seem internally coherent.  This suggests that we are in a position analogous to the metaphorical humans blind-folded touching different parts of an elephant.  The social and biological roots of diagnosed mental health conditions are phenomenally complex, providing evidence that can be marshaled for wildly divergent theoretical interpretations....

One relatively unique feature of psychiatry is that its efficacy relies heavily on the quality of the interaction between a doctor and a person with mental health symptoms.  There are some physical tests like MRI’s and EEG’s that can be used to rule out underlying physical dysfunctions, but for the most part psychiatry stands or falls based on whether the clinician asks the right questions and gives those in his care the space to articulate their experiences, and on whether mental health consumers are educated about their symptoms and empowered to participate in shaping the course of their treatment....

All too often the dynamic goes horribly wrong.  Overtaxed psychiatrists carrying heavy case loads at public clinics are usually eager to get consumers in and out in 10 minutes—15 at maximum.  People experiencing highly stigmatized symptoms are often ready to just accept that the doctor knows best and under-report highly debilitating side effects.  Eventually this leads many people to slide into almost comatose lives—or to drop out of treatment altogether.  Statically speaking, its clear that the vast majority of people with mental health symptoms are "treating" them through the many substances available legally or illegally.  The frequently dysfunctional dynamic between practitioner and client also creates a fertile ground for the exponents of anti-psychiatry—a paradigm in which mental illness is viewed as a byproduct of nefarious conspiracy between the psychiatric establishment, major pharmaceutical companies, elected and appointed officials, as well as advocates for mental health treatment...

We are in urgent need of a revolution in our thinking about mental health conditions.  Official statistics estimate that approximately one-fifth of US residents will experience mental health symptoms in their lifetimes.  Yet when you consider the plethora of increasingly obscure mental health diagnoses in the Diagnostic and Statistical Manual—the bible of psychiatry and psychotherapy—its reasonable to suppose that the figure could be a lot higher if everyone experiencing alienation, anxiety, depression, and other symptoms felt empowered to seek help and support...

Evaluating the efficacy of psychopharmacology, individual therapy, art therapy, group therapy, or neo-freudian psychodynamic treatment is challenging.  Our brains and bodies are all unique, and often two people with the same diagnosis will have violently discordant reactions to particular medications.  And its impossible to deny that some people achieve stability through treatment modalities outside the cannon of Western medicine.... 

Its also clear that structural components of our social, economic, and political system aggravate underlying propensities for severe mental health symptoms—while often making treatment far too expensive and hard to find for a majority of people experiencing psycho-social distress.  Pharmaceutical companies should be publicly controlled entities—and single-payer health care should make it possible for everyone to have access to top notch medical treatment....

Recovering our collective supportive human spirit is also critical.  Most people experiencing severe mental health distress suffer in silence and alone—or at best with a small handful of friends and family willing to lend support.  There is no objective economic limit on the amount of mental health support our society could provide.  That should include making access to recreation and exercise—and also creative and artistic actictive—universal rights and social norms....

Alleviating this stigma that continues to surround mental health issues is critical—but it must be accompanied by integrating creative and undogmatic anti-capitalist analysis into the way we view these issues.  Even before The presidential election, therapists were reporting phenomenal levels of anxiety among people utterly petrified of a trump regime, or utterly uninspired by their options at the ballot box.  Fighting for a world where mental health support is a central part of our society is a project that can inspire the phalanxes of resistance that have emerged in response to the proto-fascist regime now clinging to power.  We have a world to win—and nothing to lose but our chains.