Having addressed the veracity of some of the key arguments, we probably have a healthy skepticism of this claim at the start of PBM’s last chapter, “Dusting Ourselves Off and Starting Anew”:
One conclusion that has already been reached is that the institution of psychiatry must go.
Again, while many critics of psychiatry propose what PBM calls “tinkering,” this notion here, as is typical with antipsychiatry, is rejected wholesale.
A frequent criticism of the movement is that no viable solution is offered to replace what we are throwing out, the theory being that at least removing all this harm is a massive improvement over the current situation.
PBM differs in that it offers us a solution, admittedly preliminary in nature.
Solution revealed
Here’s the starting point:
One obvious direction that has surfaced is freeing ourselves from our frightening over-belief in and fetishization of science-the privileging of positivism, evidence-based research, and instrumental reason. What goes along with this and is likewise pivotal, we need to free ourselves from rule by “experts.”
It shortly continues:
That noted, cutting back on experts hardly suffices. Nor is insertion of peer workers into the current system. Such measures cannot simply by add-ons to an inherently injurious system. Moreover, even if we rid ourselves of psychiatry and even if we dispensed with mental health services as now know them—indeed, even if we drastically reduced our reliance on all associated workers—we would not have gone far enough.
The point is, you cannot simply separate out a part of a gestalt, part of a discourse—and our entire society is penetrated/constructed by regimes of ruling.
What follows is a remarkable vision of a society, a “eutopia” (“a good place”) that in its very structure provides a less competitive, more communal vision for how we all live with each other. Specifically related to mental distress, it posits a realm that values and thrives on diversity, peer support, local decisions that better respect autonomy and differences, without the centralized power structures that exist today. Some of it actually sounds quite lovely in many respects, though may be a bit too close to a “socialist paradise” for the comfort of many.
This eutopia would necessitate a few changes. In particular, it requires overturning every single cultural, legal, social, political, environmental, artistic, communal and economic foundation of our current society.
I therefore feel on safe footing if I take issue with the second part of this statement:
This chapter is necessarily both highly visionary and highly practical
From here to there
This sort of visioning exercise has its place in thinking about what kind of society would we ideally want, if we were able to start from scratch. Typically you’ll see this in university classes on political philosophy. Fresh from studying Rousseau, Locke, and Hobbes, our eager students imagine the creation of a new society, arising from a “state of nature” where life is “solitary, poor, nasty, brutish, and short.”
Yet, given that we’re rather further down the road in a different direction already, how do we make it happen?
Acknowledging that due to vested interests, big government nor big business will make these changes, this can only be accomplished by working outside the system.
There are some concrete suggestions for specific groups, mostly involving talking and starting to think about things a little bit differently, which sounds slow, incremental and unreliable. Mind you, PBM explicitly condemns incremental approaches as ineffectual and insufficient.
Perhaps greater hopes are pinned on a Kuhn-ian paradigm shift, where a rising tide of ideas finally overwhelms and replaces our existing systems and institutions en masse. This would be spurred on by activist movements akin to what we’ve seen during the antiglobalization protests, the environmental movement, or Idle No More. (The reader is presumably being asked to suspend disbelief that any such movement would be capable of coming to any shared understanding on even matters of terminology, let alone multiple substantive, highly-interconnected, complex organizational systems, and to say nothing of an implementation plan).
Extremism revisited
I’ve remarked since the beginning of this article that a concerted effort to logically “disprove,” at a fundamental level, an entire discipline seems distinctly like overkill. If the goal was to shed light on negative practices, to argue for substantial changes to practice, this could proceed without heavily relying on deeply flawed arguments. An openness to engage with critics and practitioners would presumably be warranted, rather than eschewed.
The deceptive cloak of objective scholarship and academia notwithstanding, the movement’s writings appear designed to persuade the reader, not inform them. To what end?
In light of the proposed “solution” suggested above, we perhaps gain new insight into the extremist “all or nothing” nature of the antipsychiatry movement.
The movement appears to literally be looking to recruit activists, the more engaged the better. Effective activist discourse is inherently one-sided, and often (as here) with a goal of not influencing the status quo, but overpowering and replacing it. The best chance to achieve a radical new vision of society, with a complete reconceptualization of mental health, can only possibly proceed through the mobilization of a vast army of unquestioning supporters.
Evidence, discussion, collaboration and compromise all lessen the chances of that happening. Black and white, good and evil, and not shades of grey must carry the day. As we have seen public discourse elsewhere fracture into “us vs. them,” “you’re with us or against us,” etc., the true message for antipsychiatry, despite the high-sounding rhetoric, is good humanity vs. evil psychiatry.
The worst thing that can happen for antipsychiatrists is legitimate progress continues to be made in psychiatry—in science, law, practice and culture. The opposite, an uptick in verifiable human suffering and abuses, though likely to be taken advantage of by the movement, is wisely left unstated.
And just as they have accused the “madness industry” itself of doing, they are preying on the weak and vulnerable, at times when they are most in need of real help.
To be clear, antipsychiatrists feel the best hope of replacing psychiatry, to improve the lives of people suffering from great anguish and distress, lies not in improving what we have. It is proposed instead that we replace almost every aspect of our entire society within a short time period, most likely to be accomplished by a (successful) activist revolution and mass uprising on a scale never before seen.
