Posts Tagged ‘establishment psychiatry’

“The idea of mental health took hold in the first three decades of the twentieth-century United States not so much because it was an idea whose time had come, but because of the threat presented by fulminating radical socialist thought.

At the turn of the twentieth century, US elites were drunk on wealth, even as they panicked at the specter of violent social revolution. Their paranoia was not entirely unfounded. The decades following the Civil War were a period of capitalist accumulation that by 1900 resulted in the top 1 percent of households owning 51 percent of the nation’s wealth; the bottom 44 percent owned only 1 percent.

Menaced by falling rates of profit, industrial capitalists and bankers after 1865 began a transition from laissez-faire competition to industrial monopolies, trusts, and mergers, in an attempt to artificially raise profits by controlling prices. This transition from industrial to finance capitalism subjected ordinary workers to the frenzied boom and bust cycles of speculative capital. It relied heavily on the expansion of consumer credit and debt, making ever-greater tranches of the population vulnerable to the convulsions of financial markets.

The nation roiled with class warfare. Class politics in the post–Civil War period were largely articulated via recurrent populist crusades. These movements were mostly comprised of farmers, tenants, and small proprietors, loosely if pugnaciously affiliated around resistance to the banking rackets’ entrenched interests in maintaining high interest rates and keeping the currency wed to gold backing.

By the turn of the twentieth century, one third of all small farmers were mortgaged at dizzying interest rates. 70 percent of the nation’s labor force had been transformed into landless wage earners with no delusions of achieving financial independence from the industrial and financial oligarchs.

The chasm between the increasingly desperate position of deskilled labor — subject, with the introduction of Taylorism, to ever-more tyrannical control by management — and the gilded excesses of the speculative and industrial elite was obvious, most of all to the swelling ranks of the landless and precarious wage earners packed into the squalid flophouses coating the underside of the industrial cities.

The manifest antagonism of interests between Gilded Age capital and labor caused a proliferation of increasingly radical labor organizations, among them the Industrial Workers of the World (IWW), the Knights of Labor, and the American Federation of Labor (AFL). The period between 1870 and 1905 witnessed over thirty-seven thousand strikes.

Flailing to control working-class militancy, industrialists turned to armed scabs and police terror to break labor in bloody confrontations like the Haymarket Riot (1886), the Coeur d’Alene Silver Mine Strike (1892), the Pullman Strike (1894), and the Ludlow Massacre (1914).

Elites were alarmed by the spate of new social pathologies resulting from these social and demographic changes. By 1910, vagrancy, homelessness, and begging were rampant in urban centers. Chicago alone had up to seventy-five thousand homeless men in its streets and flophouses in 1923, and a 1915 government survey estimated the total number of “unemployables” nationally at five million, growing at a rate that eclipsed the general population increase. Divorce, or abandonment — the “poor man’s divorce” — rose to a rate of 20 percent of households in metropolitan areas by 1930, swelling the number of women and children requiring state or philanthropic support.

The dissolution of local or traditional kinship care networks was directly implicated in the seismic increase in the number of persons requiring care in asylums, whose inmates multiplied from 74,000 in 1890 to 150,000 in 1904, and over 267,000 by 1922. By 1920, the total cost of care for those labelled “insane” was estimated to exceed that of all agricultural production, with Americans diagnosed as “insane” growing at double the overall rate of population increase.

In short, by the first decade of the twentieth century, it was clear that the nation was in crisis. The question was a crisis of what? Faced with this question, the newly formed discipline of psychiatry would ally with Gilded Age elites and New Liberal political philosophy to argue that this turmoil could be solved by understanding the vast array of social ills as problems of mental health.

Emotions as Political Substance
If we want to understand the conditions under which “mental health” was proposed as the total cure for the United States’ ills, we need to grasp the dominant forms of political thought that emerged as part of the new liberal consensus. To the ills of a nation riven by class conflict and plagued by social ills, Progressive Era “New Liberals” offered a prescription of harmonious social integration. This vision of society as an integrated organism was to be guaranteed by the “emotional adjustment” and “mental health” of the individual. Its success would be secured through the benevolent rule of technocratic experts, trained and housed in the nation’s freshly minted university system.

Faced with the twin specters of social breakdown or a revolution of the strain developing in Russia, turn-of-the-century liberals embarked on a political project anchored in a redefinition of democracy. Here, the fundamental unit of politics was not the property owner, but the psyche. This political-philosophical outlook put aside the question of ownership (or not) of property, and instead prioritized the individual as a psychological entity, always conditioned by cultural habits and considered in relation to a cohesive social group unfractured by class conflict.

Thus, the New Liberals performed a kind of magic trick: by waving the wand of psychiatric technocracy over a scene of profound economic inequality, they transformed the subject of politics from the property-owning citizen into a freshly politicized psyche.

The New Liberals performed a kind of magic trick: by waving the wand of psychiatric technocracy over a scene of profound economic inequality, they transformed the subject of politics from the property-owning citizen into a freshly politicized psyche.

The political philosophy of the New Liberals differed from its predecessors in three key ways. First, in place of the free-willed individual posited by classical liberalism, New Liberalism regarded the individual as motivated by unconscious drives and habit formation that occurred below the surface of conscious thought or choice. The individual, they thought, was shaped through the accumulation of habit. As the influential pragmatist psychologist William James wrote in 1890:

Habit is thus the enormous fly-wheel of society, its most precious conservative agent. It alone is what keeps us all within the bounds of ordinance, and saves the children of fortune from the envious uprisings of the poor. It alone prevents the hardest and most repulsive walks of life from being deserted by those brought up to tread therein. It keeps the fisherman and the deck-hand at sea through the winter; it holds the miner in his darkness, and nails the countryman to his log cabin and his lonely farm through all the months of snow; it protects us from invasion by the natives of the desert and the frozen zone … It keeps different social strata from mixing.

This elevation of the unconscious conditioning of the individual over freedom of choice provided the basis for the second key difference that separated the New Liberals from earlier social philosophy. While older positivist social theory (like that of Emile Durkheim) held that something called “society” exerted an inexorable force on the individual, New Liberals thought it was possible to engineer society itself through scientific principles.

If the individual was shaped by the unconscious processes of habit formation, then the best tactic for social control was not in outright force (of the sort witnessed in bloody labor confrontations) but in changing individuals’ education and environment so as to inculcate social consensus. Accordingly, the political theater should be located in the psyche of the individual, one evolving dynamically in his or her environment, taking on habits that could be engineered by the elite, university-trained technicians of social order.

The idea of social consensus was the New Liberals’ third major innovation on older forms of political thought. Previous political economy recognized competing interests (either between classes or between property owners) as creating intrinsic, constitutive social factions whose necessarily clashing positions were mediated through politics.

The New Liberals rejected the notion that society was fundamentally fractured, instead understanding society as a harmonious whole comprised of a division of labor and social roles. As a result, the question of American democracy was not a matter of ensuring equality of property, but of ensuring psychic buy-in to the social system, in which every individual would find their “natural place” to which they were best suited by habit.

The New Liberals thus put the individual psyche and emotions at the center of their vision of democracy. In replacing the question of property with that of the “personality” or psyche, they pivoted from a positive definition of freedom (e.g. freedom to pursue equality of property) to a negative one: freedom from the “emotional disturbances” that result in the individual’s failure to buy into a social harmony based on varying personal roles.

In the words of the future architect of American psychiatry Adolf Meyer, the “very foundation of democracy” rested on the recognition that “men are not born equal” in their habits and natural endowments. Consequently, democratic freedom consisted in each person finding their “natural place” in the social order. The New Liberal vision of society and politics, then, hinged on the enshrinement of what Meyer termed an “emotional culture that will cause people to stand by the rules of the social game even when it is not in one’s own benefit.”

But how was this social consensus to be achieved? The New Liberals’ vision claimed to apply truly scientific principles to the management of social ills. This was American psychiatry’s promise to the US ruling class: a universal science of the individualized psyche that could guarantee the emotional adjustment of each person to their role in the social order.”

– Zola Carr, “Medicalizing Society.Jacobin, August 28, 2018.

Read Full Post »

““Don’t be stupid, be a smarty, come and join the Nazi Party” is an intentionally obnoxious line from the hilarious “Springtime for Hitler” in Mel Brook’s The Producers. Not hilarious is the reality that doctors in Nazi Germany were “smarties” in Brook’s sardonic sense, as they joined the Nazi SS in a far higher proportion than the German general population. Also not funny is that U.S. doctors and healthcare professionals—from their “aiding torture” (description used in the CIA Inspector General’s Report) at Guantánamo Bay, Abu Ghraib, and elsewhere to the more recent drugging of detained child migrants—have served U.S. authoritarian policies.

In the Journal of Medical Ethics in 2012, Alessandra Colaianni reports “More than 7% of all German physicians became members of the Nazi SS during World War II, compared with less than 1% of the general population… . By 1945, half of all German physicians had joined the Nazi party, 6% before Adolf Hitler gained power.” Colaianni points out, “Physicians joined the Nazi party and the killing operations not at gunpoint, not by force, but of their own volition.”

Colaianni offers several explanations for doctors’ penchant for authoritarianism—reasons that continue to exist today. Two of her explanations are doctors’ socialization to hierarchy and their exceptional career ambitiousness. “Medical culture is,” she concludes “in many ways, a rigid hierarchy… . Those at the lower end of the hierarchy are used to doing what their superiors ask of them, often without understanding exactly why… . Questioning superiors is often uncomfortable, for fear both of negative consequences (retaliation, losing the superior’s respect) and of being wrong.” She also points out, “Becoming a doctor requires no small amount of ambition… .The stereotypical pre-medical student [is] ruthlessly competitive, willing to do anything to get ahead.”“

“Authoritarian” is defined by the American Heritage Dictionary as “characterized by or favoring absolute obedience to authority.” Authoritarians in power demand unquestioning obedience from those with lower rank, and authoritarian subordinates comply with all demands of authorities.

I have a special interest in authoritarianism among psychiatrists and psychologists. In their schooling and training (and often beyond that), they live for many years in a world where one complies with the demands of all authorities, and so their patients who challenge authority and resist illegitimate authority appear to be “abnormal” and “mentally ill.”

In my training to become a psychologist, I discovered that students, trainees, and subordinate mental health professionals who challenged authorities routinely got labeled as having “authority issues,” which stigmatizes them in terms of career advancement. Both the selection and socialization of mental health professionals breed out most anti-authoritarians, and the handful of anti-authoritarians who manage to slither through the academic hoops to obtain their degrees have all, from my experience, paid a career price for challenging illegitimate authority. And that punishment has intimidated other mental health professionals from taking an anti-authoritarian path.

Corroborating my personal experience of the retribution heaped upon those rare anti-authoritarian psychiatrists, the journal Ethical Human Psychology and Psychiatry (in 2017) devoted an issue to dissident psychiatrists Thomas Szasz (1920-2012) and his protégé, psychiatrist Ron Leifer (1932-2017).

Perhaps the most famous anti-authoritarian psychiatrist in U.S. history is Thomas Szasz. His The Myth of Mental Illness (1961) brought the wrath of the entire psychiatric establishment against him. Szasz continues today to be widely misunderstood. “He did not deny that people suffer mentally and emotionally,” Leifer pointed out, “He was not even denying mental illnesses exist. He acknowledged that they exist, but … not as diseases in the same sense that diabetes or pneumonia are diseases.” Szasz argued that “mental illness” is a metaphor for emotional and behavioral problems in living. Szasz has been widely accused of being anti-psychiatry, but what he opposed was coercive psychiatry. Szasz was a fierce opponent of involuntary psychiatric treatment, believing psychiatry and psychotherapy should only be utilized when there is informed choice and consent.

What was establishment psychiatry’s reaction to Szasz? Psychologist Chuck Ruby reports, “Starting immediately on his open revolt, Szasz’s colleagues ridiculed him, and they considered him a traitor to the profession of psychiatry.” Ruby, the Executive Director of the International Society for Ethical Psychology and Psychiatry, notes, “There were unsuccessful attempts by New York state officials to remove him as a professor at SUNY Upstate Medical University at Syracuse, and his superiors at the university attempted to goad him into quitting.” Szasz was a full professor with tenure; but the chairman of the Department of Psychiatry, David Robinson, according to Leifer, “tried to drive Szasz into insubordination so he could fire him.” Szasz ultimately had to hire a lawyer to defend and protect his tenured appointment.

Ron Leifer, lacking tenure, was far more vulnerable to a career “hit.” Leifer reported that he was “excommunicated” from academic psychiatry in 1966, “fired [by Robinson] in retaliation for publishing a book that was interpreted to be criticism of psychiatry.” Leifer recounted, “I applied at other departments of psychiatry … but was rejected because of my association with Szasz. So much for the free expression of ideas in academic psychiatry!”

Then there is the case of Loren Mosher (1933–2004), the psychiatrist perhaps most respected by ex-patients who have become activists fighting for human rights. In 1968, Mosher became the National Institute of Mental Health’s Chief of the Center for Schizophrenia Research. In 1971, he launched an alternative approach for people diagnosed with schizophrenia, opening the first Soteria House in Santa Clara, California. Soteria House was an egalitarian and non-coercive psychosocial milieu employing nonprofessional caregivers. The results showed that people do far better with the Soteria approach than with standard psychiatric treatment, and that people can in fact recover with little or no use of antipsychotic drugs. Mosher’s success embarrassed establishment psychiatry and displeased the pharmaceutical industry. Not surprisingly, the National Institute of Mental Health choked off Soteria House funding, and Mosher was fired from NIMH in 1980.

Dissident psychiatrists are a rare breed, and those whom I have known tell me that the attempted hit on Szasz and the successful hits on Leifer and Mosher were as predictable as any hit by La Cosa Nostra (“our thing”)—as the psychiatry establishment is also not exactly tolerant of any challenges to “their thing.”

Anti-authoritarian patients should be especially concerned with psychiatrists and psychologists—even more so than with other doctors. While an authoritarian cardiothoracic surgeon may be an abusive jerk for a nursing staff, that surgeon can still effectively perform a necessary artery bypass for an anti-authoritarian patient. However, authoritarian psychiatrists and psychologists will always do damage to their anti-authoritarian patients.

Psychiatrists and psychologists are often unaware of the magnitude of their obedience, and so the anti-authoritarianism of their patients can create enormous anxiety and even shame for them with regard to their own excessive compliance. This anxiety and shame can fuel their psycho-pathologizing of any noncompliance that creates significant tension. Such tension includes an anti-authoritarian patient’s incensed reaction to illegitimate authority.

Anti-authoritarian helpers—far more commonly found in peer support—understand angry reactions to illegitimate authority, empathize with the pain fueling those reactions, and genuinely care about that pain. Having one’s behavior understood and pain cared about opens one up to dialogue as to how best to deal with one’s pain. Because anti-authoritarian mental health professionals are rare, angry anti-authoritarian patients will likely be “treated” by an authority who creates even more pain, which results in more self-destructiveness and violence.

It is certainly no accident that anti-authoritarian psychiatrists and psychologists are rare. Mainstream psychiatry and psychology meet the needs of the ruling power structure by pathologizing anger and depoliticizing malaise so as to maintain the status quo. In contrast, anti-authoritarians model and validate resisting illegitimate authority, and so anti-authoritarian professionals—be they teachers, clergy, psychiatrists, or psychologists—are not viewed kindly by the ruling power structure.”

– Bruce C. Levine, ““Don’t Be Stupid, Be a Smarty”: Why Anti-Authoritarian Doctors Are So Rare.” Counterpunch, August 16, 2018. (via quoms)

Source: antoine-roquentin

Read Full Post »