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I would like to begin by reading a statement
by theologian C.S. Lewis:
Of all tyrannies,
a tyranny sincerely exercised for the good of its victims may be
the most oppressive….The robber baron’s cupidity may
sometimes sleep, his cupidity may at some point be satiated, but
those who torment us for our own good torment us without end for
they do so with the approval of their own conscience…Their
very kindness stings with intolerable insult. To be ‘cured’
against one’s will and cured of states that we may not regard
as disease is to be put on a level with those who have never reached
the age of reason and those who never will (C.S. Lewis, 1970, p.
For over 35 years, I have been an antipsychiatry
activist. While the quotation today is one with which I think that
all of our community can agree, and so one that I wanted to start
with, my speech today comes out of that antipsychiatry background
Antipsychiatry is a very particular perspective.
It differs from the perspective of many people at this conference
which is just fine, for a vibrant movement needs multiple perspectives
and the fact that so many perspectives are represented at this conference
is encouraging. To be clear, antipsychiatry—the perspective
from which I speak--is not one that I ask be adopted or expect to
be adopted by my sisters and brothers here today who hold diverging
views. The point is, we form a community--the community of people
who unite to combat psychiatry. It is a wonderful community, a vibrant
community. Our community encompasses differences, and we need those
differences. We need all of us--antipsychiatry activists, mad activists,
professionals, survivors, artists—if we are to bring about
the life-enhancing more tolerant society for which we are all striving.
It is critical that this be clear from the outset.
As I suggested in my opening remarks on first day of this conference,
one error that has tended to plague our community, as indeed it
plagues most every social movement, is that we have often fallen
into vilifying others in the community with different perspectives,
which is not good, or tried to convert each other, which is also
not good. The fact is that we are not each other’s worst enemy.
The fact is that there is far more that unites us than divides us,
and we need to hold onto that. The fact is, trying to convert each
other is not what good allies do. My hope and trust is that we can
be good allies—that we will work together where we can and
in what ways we can, and where we cannot, that we will agree to
take a pass, but that we will do so respectfully, that we will do
so, that is, while preserving our relationships so that on all sorts
of other fronts we can continue to work together.
None of this means that people who are part of
particular constituencies should not try to develop their perspectives.
That, in fact, is precisely what I am trying to do in this keynote.
I am using this keynote to flesh out a model for one such constituency—the
antipsychiatry constituency. I do so because I am antipsychiatry,
and I believe in the importance of the antipsychiatry agenda. I
do so because at the moment, I see this constituency as in trouble,
and as far as I am concerned, we need all of our community at the
top of their game.
As I look over our diverse community and how it
has operated over the last couple of decades, I would have to say,
I see greater clarity and greater progress in other constituencies.
For some time antipsychiatry per se has been floundering.
One reason it is floundering no doubt is precisely
that it has not always been respectful of other parts of our community.
And I would like to believe that those days are over. It is floundering
more significantly because the powers lined up against it are becoming
increasingly stronger, increasingly more entrenched. The power of
psychiatry, its continual growth, its ever more tenacious entrenchment
in the state is a brutal reality and not one for which we bear responsibility.
I would like to suggest, however, that antipsychiatry is also floundering
because it has no model or models to guide its action.
The point is, antipsychiatry is not a new movement
or constituency. A movement can proceed quite nicely for a long
time on passion, sincerity, vision, and ever-sharper critiques.
If that sufficed to win the battle, however, we would have succeeded
long ago for we have always had such attributes in abundance.
There comes a time, moreover, when not only does
that not suffice, you start to move backward. That is the nature
of movements. You have successes for a while. You have successes
even without being shrewd activists. You have successes almost no
matter what you pin your wagon to—the politics of compassion,
or the politics of entitlement like the ones associated, say, with
human rights battles. And I know because I have had such successes—been
there, done that. However, inevitably the people in power who have
something to lose by your winning push back with all the strength
that their position in power affords them. And when they do, that
is when you need to learn how to be really good activists. Correspondingly,
that is when you absolutely need to bring something to the table
to help guide action. That is the ultimate purpose of this keynote.
The purpose of this keynote is to start fleshing out the beginnings
of a much needed model for guiding antipsychiatry.
Before I go any further, I know that some people
are not exactly sure what I mean by “antipsychiatry”
and are not exactly sure what makes an antipsychiatry perspective
different than the perspective held by various others at the conference.
As that difference plays a pivotal role in the model, it is critical
that I clarify.
All of us here today are profoundly unhappy with
psychiatry. If we were not, we would not come to a conference of
this nature. What distinguishes an antipsychiatry stance is not
simply that it is critical of psychiatry. It is that its adherents
hold that psychiatry is unqualifiedly untenable, untenable as it
stands today, untenable even if it improved itself substantially.
To put another way, what distinguishes antipsychiatry from other
critical positions is the conviction that critiques of psychiatry
are sufficiently conclusive, compelling, foundational, and damning
to render psychiatry as an institution inherently undesirable and
irredeemable (see Burstow, 2006b).
This position arises from the bitter experiences
of survivors and their writings—writings that go back to Madness
Network News, Phoenix Rising, and continue to this day. More formidably,
it rests on a number of foundational critiques. I will not be going
into them in depth, but they include: Szasz (1974) and Leifer (1990),
who demonstrate that the foundational philosophic and scientific
concepts of psychiatry are flawed, Breggin (1991) and Colbert (2001),
who demonstrate that the treatments are intrinsically damaging,
systemic thinkers like Mirowsky (1990), who demonstrate that the
entire system of diagnostic categorization lacks validity and coherence,
and labeling theorists like Goffman (1964), who as far back as 1964
unmasked psychiatry as a form of social control.
The goal of antipsychiatry is quite simple—nothing
less than the abolition or end of the psychiatric system. Herein
lays its ultimate distinction. While people critical of psychiatry
but not fully antipsychiatry may take certain kinds of changes as
sufficient—the advent of informed consent, less use of drugs,
a kinder gentler industry, or diagnostic categories which are less
overlapping, for example—as clarified in documents like the
CAPA’s fact sheet, antipsychiatry holds that no changes will
be sufficient, for the institution is too flawed and dangerous simply
to be tinkered withi .
A vital question arises from this goal. Namely:
If the abolition of psychiatry, however conceived, is the goal,
in light of that goal, how might antipsychiatry activists proceed?
The question is far from simple. The fact remains
that while a rigorous antipsychiatry position entails some type
of abolitionist stance, no one should be under any illusion that
any demands or well worded critiques will suddenly lead to the closing
of institutions or the cessation of damaging treatment. And in fact,
demands that psychiatry be curbed in any more than a mere reformist
way are themselves likely to lead to terror on the part of the general
public and an increased emphasis on the myth of the dangerous mental
patient, who must be kept under control by all available means.
The point is that we are up against a very complex system, with
huge vested interests, with the complicity of the state, and with
the blessings of a fearful general public. We are also up against
thousands of years of prejudice against people with different ways
of thinking and processing—prejudice, which, as theorists
and members of the mad movement such as Esther (2000) correctly
point out, predate the medical model and predate psychiatry, but
have been made far more formidable by the veneer of science. Additionally,
it should be added, some who use psychiatric services are legitimately
worried that without psychiatry, they will be out in the cold.
All that being the case, there will be no quick
“win” on this issue. It is in this larger context that
I ask: What might be used to guide action? If abolition on some
level is the goal, what might be used as a model or touchstone in
deciding what to do, what not to do, what to support, what not to
In foraging about for how to conceptualize a model,
I have been reminded of a movement which has much in common with
antipsychiatry—the prison abolition movement. While prison
abolitionists uniformly agree that some people (a very small number)
may need to be confined, and the details are still to be worked
out, prison abolitionists too take abolition as the goal. Moreover,
they too have been struggling with a situation where the general
public approves of and indeed considers essential the very industry,
approach, and complex machinery which the abolitionists hope to
dismantle. Additionally, in their case too, the problematic institution
in question is upheld by the state, it is complex, and it is not
going away over night. Moreover, albeit to a lesser extent, in their
case too, some inmates voluntarily seek out its “services”,
with people, indeed, committing crimes precisely so as to get back
What distinguishes the prison abolition movement
is that it has long had a model. Now, indeed, it has had a number
of models, but the most widely accepted one by far is called “the
The attrition model for prison abolition was spelt
out as early as Knopp (1976) and has been reaffirmed and modified
over the decades (e.g., West and Morris, 2000). In the early ground-breaking
book that announces the model, Knopp et al. state, “We have
structured an attrition model as one example of a long range process
for abolition. ‘Attrition’ which means rubbing away
or wearing down by frictions reflects the persistent and continuing
strategy necessary to diminish the function and power of prisons
in our society” (p. 62).
The attrition model as articulated here has at
once united prison or penal abolitionists and given them a long-range
basis on which to plan. Anyone who was ever been active in prison
abolition will not fail to recognize the hallmark question that
typically arises when a new action or campaign is considered: “Will
it move us any closer to the long run goal of prison abolition?”
An attrition model assumes that:
• nothing as extensive and entrenched as
the institution in question can be changed quickly
• something as ambitious as abolition takes place slowly and
for the most part by attrition—by gradual but persistent rubbing
away and wearing down.
• not all change that seems positive has the capacity to bring
a movement closer to the abolitionist goal and indeed, on the contrary,
some of what looks promising would actually undermine the long-term
goal in question.
Herein lies a conceptualization which holds promise
My intent in this keynote is to do for antipsychiatry
what was long ago done for prison abolition. The purpose of the
keynote is to construct, articulate, and help readers make sense
of the bare bones of an attrition model. In no way am I suggesting
that it is the only possible model. Nor am I suggesting that an
attrition model per se is straightforward or absolute. It is clear,
however, that an unpopular movement which is at odds with the state
and prevailing hegemony as well as with a massive and entrenched
industry begins at a serious disadvantage. It is further disadvantaged
if it has no vision about how to move closer to the goal which it
In presenting the model, I am aware that my most
focal audience are the sisters and brothers here today who are antipsychiatry
or who verge on it. What I can promise people from other constituencies,
however, is I’ll not be forgetting you.
That said, we come to the model. It proceeds by
questions—what I call “defining questions”. While
the number is somewhat arbitrary, let me suggest there are three
related questions that antipsychiatry activists operating from an
attrition model need to ask when making major decisions. The first
is the most pivotal question. The next two are auxiliary questions
that might best be thought of as derivative of the first. The three
1) If successful, will the actions or campaigns
that we are contemplating move us closer to the long-range goal
of psychiatry abolition?
2) Are they likely to avoid improving or giving added legitimacy
to the current system?
3) Do they avoid “widening” psychiatry’s net?
To shed light on these, the first is the kingpin.
Say that an action or campaign being considered is worthwhile on
other grounds, but we have no reason to believe that its success
will move us closer to the goal of abolition. In that case, someone
else might take it up, but it would not be the proper focus of abolitionists.
To be clear, abolitionists may or may not choose to endorse such
changes or campaigns, depending on whether or not it undermines
the long run goal among other things, but they would not become
active in them. The point is that an attrition mandate would require
that only changes that are abolitionist in nature and not mere reformist
be actively pursued.
Now looked at superficially, this guidance would
appear to rule out any actions not directly related to major changes.
However, that is far from the case. Part of the beauty of the attrition
model is precisely that it is predicated on the passage of time.
In other words, time must be factored in, and certain types of minor
changes which build over time have the potential of shifting worldview.
By way of example, any action which helps de-medicalize
the language used about people who process differently or live in
alternative realities or are in emotional turmoil could be seen
as an abolitionist type change, for if enough of the language used
shifted over time, it would chip away at the impression that psychiatrists
work so hard at maintaining—that such states or ways of being
are “medical issues” and hence the proper domain of
doctors. The language of the mad movement is an example of what
could be supported in this regard. While antipsychiatry activists
in past have been critical of mad language as not antipsychiatry
per se, this model would ask antipsychiatry activists to take another
The next question complicates what might have
initially looked simple: While question 1 asks, if successful, would
our campaign or intended actions move us closer to psychiatry abolition,
question 2 asks: Are they likely to avoid improving or giving legitimacy
to the current system?
While an offshoot of question 1, question 2 raises
the bar. If a campaign or action is likely to lend legitimacy to
the current system, it would make no sense for abolitionists to
support it, for it undermines the ultimate goal. In fact, if lending
legitimacy to the current system are among its primary consequences,
even if otherwise benign, it would not be sensible for an antipsychiatry
group to even endorse it. Examples of activities sometimes engaged
in by people who combat psychiatry which this question would rule
out are: sitting on task forces making recommendations on how to
improve psychiatric institutions; taking part in reformist agendas
such as those associated with organizations like the Canadian Mental
Health Commission; taking part in any events or initiatives sponsored
by psychiatry—including purely cultural ones for they too
lend it legitimacy, indeed, making psychiatric facilities appear
like friendly community centres—a valuable part of the life
of the community.
Question 3 asks: If successful, would the actions
or campaigns that we are contemplating avoid widening the net. What
is meant by “widening the net”? It means allowing more
and more people and more and more situations to fall under the auspices
of psychiatry. You can see why this would not be desirable. Widening
the net of psychiatry is tantamount to helping psychiatry grow as
opposed to helping it wither.
What is the intent of question 3? The intent is
that no initiative be adopted whose success carries with it the
likely consequence of widening the net—that is, of placing
more people or people at more times under the auspices of the psychiatric
system. Correspondingly, where such initiatives originate from within
the system, for the most part, they should be actively resisted.
An obvious example of a campaign which would widen
the net which originated from within the system was the push for
community treatment ordersii. Despite the rhetoric behind them, it
was clear from the outset that community treatment orders would
widen the net because they would drastically extend psychiatric
control both temporally (past an inmate’s release date) and
spatially (extending the grasp of the hospital further into the
community). Antipsychiatry activists, psychiatric survivors, and
others critical of the system immediately saw what was at stake
and while unsuccessful, quickly mobilized against the initiatives.
Psychiatric measures like this which constitute
obvious power grabs fortunately are fairly easy to identify. By
contrast, measures originating from within the community critical
of psychiatry which inadvertently widen the net are not so easy
to identify. Nonetheless, they too fall under the purview of this
question, and while resistance would generally not be in order,
for we do not obstruct our allies, they should not be supported
or endorsed. An example of an action that would err in this regard
is getting on the bandwagon clamoring for “mental health services”
to be brought into an area when “mental health services”
largely means psychiatric or services controlled by psychiatry.
Questions 2 and 3 may often prove difficult to
hold onto, for they have the potential to place us at odds with
what appears as progress, but this is precisely why they are important.
Quite simply, they let us navigate tricky terrain. An example.
Let us say, for instance, that there is no service
in a major city which offers emotional support for women who have
undergone the shattering experience of giving birth to a stillborn
child. The community responds by pushing for the creation of a service,
and willy-nilly, it is decided that it will be psychiatric. Alternatively,
let us say that there is a psychiatric service for women who have
experienced still birth, but that the service is seen as deficient
in some way, and the community begins pressuring to have that way
addressed—say, to have the service in question expanded or
otherwise improved. Given that services are direly needed for women
facing this devastating life experience, one feels drawn to support
both of these initiatives, for on some level, progress is happening.
As abolitionists, however, it is important to keep in mind that
supporting such changes means a) helping psychiatry get bigger,
b) helping psychiatry become firmly entrenched in yet another area,
and indeed, helping psychiatry appear benign, and c) placing an
entire group of vulnerable women in more jeopardy from psychiatry
than they were previously—for the inevitable depression could
result in drugging, institutionalization, and even electroshock.
Correspondingly, it essentially cedes the ground to psychiatry in
yet another area, relegating any other services including self-help
to becoming at best an alternative for those seen as least affected
and at worst an adjunct to psychiatry.
These two questions, in other words, help us see
what we might otherwise fail to see. Difficult though it may be
to hold onto the last two questions, accordingly, the questions
are pivotal for they keep us from going off course.
Together, the three questions, along with a knowledge
of how psychiatry operates suggest obvious directions for abolitionists.
What goes beyond that, they also provide antipsychiatry with one
way of prioritizing—and let there be no mistake about it,
we need to prioritize for we cannot do everything.
How does one prioritize using these questions?
In a nutshell, the method is as follows: Assume that the action
or campaign being considered will be successful or at least reasonably
successful, then evaluate from there. The closer to abolition some
actions or directions would bring us, short of there being other
objections to them, or reasons to prioritize other campaigns, the
more focal they should be to antipsychiatry organizing. Correspondingly,
anything that actually attacks psychiatry’s power base is
particularly important, so should be given top priority.
To spell out what some of those top priority actions,
directions, or campaigns might be—and people familiar with
the terrain will recognize most of these—particularly apropos
and indeed, more central than they are currently, would be actions
or campaigns which put the state on the defensive when it comes
to psychiatry or weakens the state’s unilateral endorsement
or funding of psychiatry. The reason why this direction is singularly
important is the pivotal role of the state in psychiatric rule.
Psychiatry has the power which it does only because it is an extension
of the state, is part of the apparatus of the state, and as such,
is additionally handsomely funded by the state. Loosen the tie-in
with the state, eliminate all or a sizable part of the state’s
sanction or support, and psychiatry’s size and power to harm
begins to evaporate.
Examples of actions or campaigns that might be
taken up in this regard—and most of these have long figured
in our community arsenal and indeed figure in this conference—include:
directly suing the state for damages—and hats off to survivors
and family members at this conference who are suing; suing hospitals
for damages; challenging the constitutionality of laws which the
state has enacted to empower psychiatry; appealing to a power outside
the state, whether it be the U.N. or some other international body.
And kudos here to work of people like my fellow keynote David Oaks.
Other less foundational but also critically important measures on
the same continuum include:
• demanding moratoriums on new psychiatric
• pressuring for the end to involuntary commitment
• initiatives which support increased patients’ rights
or the upholding of current rights
• advocating cutbacks on funding for psychiatric services
and increased funding for more benign services
• waging campaigns to de-fund private psychotherapy delivered
by doctors, or what I think might well serve us better, to fund
equally psychotherapy delivered by others (psychiatry could not
have the power which it has today without the state giving it a
Many of the other initiatives that survivors and
other critics of psychiatry commonly take up would also be focal.
Included, in this regard, would be consciousness-raising, for consciousness-raising
can clearly help us as a society move toward attrition. Included
are attacks on other parts of the psychiatric industrial complex—not
the least of which are pharmaceutical companies, on which psychiatry
fundamentally rests. And how apropos that there are workshops at
this conference about going after the pharmaceuticals! Thank you,
David Carmichael. Included as well are thought-through critiques—foundational
critiques in particular.
By the same token, actions which are abolitionist
in nature with respect to any of the current “treatments”
blatantly qualify. This, of course, would include the rigorously
abolitionist campaigns currently waged by heroic survivors and their
allies to ban electroshock (for more detail, see Weitz, 2008). However,
it would also include actions, campaigns, and recommendations that
are not immediately abolitionist with respect to current treatment,
but which are likely (if successful) to contribute to attrition.
An example in this last regard are a number of
the recommendations put forward in a report submitted by a panel
which oversaw Toronto-based hearings into psychiatric drugs in 2005.
None of the recommendations in the report were abolitionist in the
immediate sense of the term. If enacted, most, however, would further
the long term work of attrition.
Take, for example, the recommendation “all
doctors who prescribe psychiatric drugs be required by law to review
the choice of drugs and the amount of the drug administered.…doctors
in particular be required biannually to consider less powerful drugs,
drugs with less negative effects…smaller doses, and withdrawal
itself.” (Burstow, Cohan, Diamond et al., 2005). Clearly,
if measures such as these were enacted, they would contribute to
the weakening of psychiatry and the gradual loosening of the psychiatric
drug stranglehold. Note, in this regard, that besides that any substantial
loosening of the drug stranglehold is desirable in and of itself,
psychiatry’s claim to jurisdiction over madness lies largely
with the drugs. Any attack on the drugs is in the long run an attack
on psychiatry’s relevanceiii.
Many, albeit not all, of the examples articulated
so far are obvious. What is particularly useful about an attrition
model, however, is that it helps activists and analysts engage in
the reasoning, weighing, and balancing needed when confronted with
choices that are not at all obvious, or what is not uncommon, where
disagreement arises. And such guides are essential to better functioning.
To offer a practical example of how attrition-type
reasoning helped an antipsychiatry group work through a difficult
and contentious issue, I would highlight a situation that arose
recently in the Coalition Against Psychiatric Assault (CAPA). A
request came from a member-at-large to endorse a bill most everyone
here is aware of—the New York bill banning involuntary electroshock
on children under 16iv. As the request came during the summer when
CAPA was not meeting, it fell to the executive to decide. Initially,
the CAPA executive was seriously split.
Initially, most of the executive did not want
to endorse because CAPA’s own position is the complete abolition
of electroshock, also because they feared that any new law of this
nature would lend legitimacy to electroshock. On the other hand,
the rest of the executive and the member-at-large were convinced
that the initiative should be endorsed because if such legislation
were passed, it would stop some people from being electroshocked,
also because it moves in the direction of the abolition of shock.
To be clear, this dispute predates any articulation
of an attrition model for antipsychiatry. Attrition, nonetheless,
was at issue from the beginning, and it is a careful focusing on
attrition that allowed this question to be resolved. One of the
reasons given against endorsing drew on a principle inherent in
the attrition model—that such a new law would lend legitimacy
to the electroshock industry. All of the reasons to endorse connected
with attrition principles: That is, it prevents some people from
being electroshocked, or to put it another way, would narrow the
electroshock net. Additionally, it would begin chipping away at
electroshock. The point is, if electroshock is not good for children,
it could be argued, it is also not good for the elderly. Accordingly,
the successful passing of such a bill would take New York one stage
closer to abolishing electroshock for other populations and potentially
ultimately for everyone.
The principles of attrition allowed us to quickly
work through what began as a divisive and hotly debated issue. It
was determined that the worry that such a new law would lend credibility
to the electroshock industry was ill founded. Additionally, it was
agreed that such a law would protect some people, narrow the sway
of electroshock, and lead in the direction of electroshock abolition.
Significantly, all members of the executive followed the logic.
What is also significant, none of these deliberations weakened or
any way altered CAPA’s own commitment to personally launch
only ECT actions which call for complete abolition. However, it
did allow us to work through the endorsement issue and quickly transit
from a seemingly irresolvable standoff to endorsement of a bill
which merited our support.
The three questions which I have been discussing
this morning are the definitional ones, and indeed, are the questions
that ensure that antipsychiatry initiatives are compatible with
the ultimate antipsychiatry goal. This notwithstanding, given the
complexity of the issues, given the vulnerability of some who access
psychiatric services, and given our broader commitments as human
beings, of course, these are not the only questions that antipsychiatry
activists should be asking when contemplating new actions or campaigns.
While it is beyond the scope of this keynote to discuss these, besides
questions of strategy, additional questions which I would recommend
organizations or individuals holding an attrition model ask themselves
1) What sorts of non-psychiatric services, what
sort of help—self help, for example, or withdrawal centres—are
we advocating or supporting?
2) Are we finding ways to link up with others in the critical of
psychiatry community—psychiatric survivor organizations and
mad groups in particular?
3) Given that psychiatry is not the first oppressor of the people
deemed mad, what measures are we taking to avoid helping pave the
way for another oppressor to replace psychiatry?v
4) Is the initiative that we are considering compatible with the
creation of a more caring society?
5) Does it leave any vulnerable people in the lurch?
6) Does the initiative that we are considering in any way empower
the people most affected or most at risk from the psychiatric system
(past psychiatric patients, current psychiatric patients, people
who would appear to have psychiatry on their horizon)?
7) Are we paying sufficient attention to the special jeopardy in
which psychiatry places otherwise oppressed populations? Women?
People who are homeless? Racialized people? Lesbians and gays? Transsexuals—transsexual
youth in particular? Arguably, most importantly of all, the elderly?vi
As regards this last item, the point is that psychiatric
oppression intersects in horrific and manifold ways with all systemic
oppressions, and it is critical that it be critiqued and attacked
with that awareness. Hence the profound significance of such developments
as feminist antipsychiatry and the very particular agendas, mandates,
and priorities which these open upvii.
At this point, I have given you some idea how
this model can be used to determine what to actively take up and
what not take up, what support, what not support. I have shown also
how it can be used to establish priorities, and what some of those
priorities might be. At this juncture I want to enter trickier territory.
I said at the beginning that use of the model would inevitably lead
to a reexamination of some of the types of activities that some
of us would have supported in the past. I do not want to dwell on
this, for I know many of these continue to be supported by people
who are here today, but I do want to touch on some of the areas
where the model would encourage rethinking. One such area is some
of the measures taken up and understandably taken up with regard
to different oppressions.
Notwithstanding the enormous importance of paying
rigorous attention to systemic oppression and notwithstanding the
legitimacy of differing priorities, there have long been initiatives
related to oppressed groups that an attrition model require be looked
at more critically. These include:
a) pressuring for the removal of specific noxious
diagnoses that particularly or uniquely oppress members of an otherwise
oppressed group and
b) advocating for culturally sensitive psychiatric services.
To begin with the first, the critiquing of specific
diagnoses is not only unproblematic, it is a critical part of consciousness-raising,
on which all attrition models depend, and as such, it is mandatory
for antipsychiatry. Indeed, it has quite rightly been one of the
hallmarks of feminist antipsychiatry. Whether as women, or as racialized
people, or both, we want the damage done to our communities acknowledged
and stopped. Correspondingly, oppressed populations have ample reason
to want specific diagnoses removed from the books for they uniquely
pathologize these populations and make it easy for psychiatry to
intrude. Included, in this regard, are such historical diagnoses
as ego-dystonic homosexuality and hysterical personality disorder
(currently histrionic personality disorder), which have oppressed
the lesbian and gay and the women’s community respectively,
current diagnoses as “gender identity disorder”, which
are oppressive to the trans communityviii.
That women, lesbians and gays, and trans people
work to have such diagnoses quashed is hardly surprisingly. The
primary question here is not whether women, gays and lesbians, or
trans people should organize against such diagnoses, or even whether
people generally critical of psychiatry should organize against
them. It is whether or not mobilization against such diagnoses is
a proper antipsychiatry initiative. Herein the attrition model sheds
its own light, albeit I have no questions that intersecting identities
makes this issue particularly complicated for many.
Ultimately, for an attritionist, the question
largely boils down to, how does it measure up to the definitional
questions? That is, do the successes of such campaigns contribute
to the erosion of psychiatry? Do they avoid widening the net? And
do they avoid improving or lending legitimacy to psychiatry? Now
the question of widening the net is unclear. However, enough of
these campaigns have “succeeded” to demonstrate that
there are no encouraging answers to the other questions. A number
of diagnoses that we as women and as lesbians and gays rightly find
oppressive have been struck down, and yet these successes have not
impeded psychiatry, changed it significantly, or remotely resulted
in less diagnoses. On the contrary, the number of diagnoses continues
to skyrocket (see in this regard, Kirk and Kutchin, 1997 and Kirk
and Kutchin, 1994). Given psychiatry’s ingenuity in hiding
old unpopular diagnoses behind new labels (for a discussion of this
tendency, see Burstow, 1990), and given its ability to turn acknowledged
oppression into a syndrome, it is often unclear what is achieved
for the actual population in question. At best, they constitute
somewhat of an improvement, albeit not the kind which contributes
to attrition; and at worst, they only appear to improve, drawing
people who began as critical into their terrain in the process.
What is also problematic, such campaigns give legitimacy to psychiatry
for they tacitly acknowledge its authority by the sheer act of appealing
to it. Moreover, the apparent success of such campaigns has lent
psychiatry the further credibility of allowing it to appear progressive.
As such, involvement in such campaigns is questionable for abolitionists,
albeit progressive professionals with antipsychiatry leanings such
as Caplan have long engaged in them, and continued discussion would
A similar problem arises with respect to campaigns
for more culturally sensitive psychiatric approaches—and what
is particularly problematic—for the creation of new culturally
sensitive psychiatric programs. Again, it is totally understandable
that populations affected by psychiatric racism, or sexism, or transphobia
would push for such changes. And given the dearth of funding for
services not under the auspices of psychiatry, it is totally understandable
that communities which are not mainstream—especially those
subject to significant transgenerational trauma and/or insidious
trauma—would ask for the creation of culturally sensitive
psychiatric programs, whether it be the trans community or the Aboriginal
communitiesx. Nonetheless, such campaigns are in conflict with all
three major tenets of an attrition model: That is:
1. They do not move us closer to abolition.
2. They do not avoid improving or lending legitimacy to the current
system; in fact they are precisely reformist changes which serve
to improve psychiatry and give it greater credibility.
3. They widen the net, allowing more and more members of the populations
in question to fall under psychiatric auspices, and now with the
active cooperation of their community.
As such, campaigns for such services are at odds with psychiatry
abolition, and arguably hazardous for the communities in question.
If an attrition model became a standard part of
an antipsychiatry toolkit, inevitably, other types of mobilization
which currently may look benign or a reasonable tradeoff will likewise
start looking increasingly problematic or minimally incompatible
with an abolition mandate. The question would be to weigh carefully,
to be open to reconsidering, to factor in other questions as needed,
and what is particularly important, to understand that allies who
make different decisions remain our allies.
Throughout this keynote, I have been demonstrating
how an attrition model can help antipsychiatry activists make choices,
establish priorities, and rethink directions and initiatives. While
I do not suggest that is equal, in ending, I would like to suggest
that there is something in this model for other constituencies in
our community as well. Now I do not wish to overstate my hand here,
for it could sow division as well. If held with sensitivity, this
model might nonetheless be of some assistance in easing some of
the tension between antipsychiatry activists and others in our community
and in creating bridges. It might foster clearer communication and
understanding, for example. Additionally, it might enable antipsychiatry
organizations to support and join with others in more initiatives.
Significantly, while not identified as antipsychiatry,
many of the initiatives, focuses, and actions specific to other
critical constituencies have the potential of whittling away at
psychiatry, and as such, could be supported by the antipsychiatry
community far more enthusiastically than they have been in the past.
An example is the creation and defense of a mad culture, which to
date, sadly, has received little support from antipsychiatry. The
attrition model provides a way of recognizing points of meeting
that are obscured by other types of abolitionist stances, for these
become visible when approached from the vantage point of slow but
persistent wearing away. It also provides others in the larger community
with a view of what might be added or what modifications might be
made to turn an action inimical to antipsychiatry into one which
antipsychiatry groups can actively support or minimally endorse.
While I would not wish to overstate the case, the model also might
be of more direct assistance to the broader community. The point
is, while other constituencies legitimately have other priorities,
I can see the value of groups coming from a different perspective
touching base with such a model from time to time.
Bottom line: We all of us have this in common.
None of us are deliriously happy with psychiatry. All of us minimally
would like it smaller, would like it curtailed, would like room
for more benign help to take root. In other words, all constituencies
in our community in some way favour some type of withering. Accordingly,
groups with other perspectives may be served by at least occasionally
have these three questions be among the ones which they factor in
when choosing actions or campaigns.
That said, I have a proposal for my fellow delegates
to this conference. Take it, if you will, as an experiment. As you
sit in the paper sessions that follow, as you listen to speakers
and panelists, as you take part in workshops, as you try to tease
out directions in the plenary, every so often let the three questions
which make up this model come to mind. And if you find they shed
any light, take them home with you, and let them continue to shed
light in the weeks, months, and years to come.
In ending, let me also invite anyone so minded
to come up with your own models and to share them, whether it be
models for antipsychiatry, models for the mad movement, models for
the psych survivor movement. The reality is, we need a plethora
of workable models if we are to bring about the more caring the
more tolerant society for which we are all of us fighting. And let
there be no mistake about it. Besides that they have the lion’s
share of the power, people who successfully make this world a living
hell for many many others are very good at what they do. We need
to be equally good.
This historic conference is
a major step in that direction. My hope is that we all of us continue
to build on the serious and very necessary work that we have begun
here together. Thank you.
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Breggin, P. (1991). Toxic psychiatry. New York: St. Martin’s
Burstow, B. (2006b). Electroshock as a form of violence against
women. Violence Against Women,12(4), 372-392.
Burstow, B. (2003). Toward a Radical Understanding of Trauma and
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i In 2008 CAPA created a myth/fact
sheet to correct misimpressions about antipsychiatry, as well as
to help bring the community together. For CAPA’s Antipsychiatry
Fact Sheet, see http: capa.oise.utoronto.ca/Fact_Sheet.html.
iiFor an insightful critique of community treatment orders
as well as a compelling read, see Fabris (2006).
iiiFor a highly informative exploration of the role of
psychiatric drugs in entrenching and propping up psychiatric power,
see Scull (1977).
ivSponsored by Assemblyman Ortiz, the bill may be found
vEarlier oppressors include the church and businessmen.
See in this regard, Szasz (1977)
viFor an examination of the special jeopardy of oppressed
populations, see Breggin (1991) and Burstow (2003). For an examination
of the massive psychiatrization of the elderly and its tragic effects,
see Breggin (1991). For a revealing look at ageism in the administration
of electroshock, see Weitz (1997).
viiSee, in this regard, Smith (1987), Chesler (1972)
Grobe (1995), Burstow (2003), Blackbridge and Gillhooly, 1985, and
Chan, Chunn and Menzies, 2005.
viiiiFor a discussion of various diagnoses which have
historically served or currently serve to pathologize people from
the LGBTQ community, see Burstow (1990). For a discussion of diagnoses
oppressive to women, see Unger (2004) and Caplan (1995).
For the articulation of the diagnosis gender identity disorder,
see DSM-IV-TR (American Psychiatric Association, 2000, p. 576 ff.).
ixFor Caplan’s own account of her involvement in
this regard, see Caplan (1995).
trauma is trauma passed down from one generation to the next. Insidious
trauma is the every day trauma of living in a world in which you
are oppressed. For further elaboration
on these terms, see Burstow (2003).