Dominik Ritter takes a modern look at psychiatry in the traditions of R D Laing and the anti-psychiatry movement.
Contrary to popular belief, psychiatric diagnoses as listed in the Diagnostic and Statistical Manual series (e.g. DSM IV-TR, 1994) do not have anything to do with real illnesses but are simply arbitrary lists of behaviours that some people (e.g. psychiatrists) find objectionable as they seem to violate a mental health ideology, that is acceptable ways of behaving, as well as feeling and thinking about oneself, others and the world in general. They are therefore to be understood as moral judgements used as weapons against those who step out of line. If in fact the so called “mental illnesses” had anything to do with the brain then they would be called brain illnesses and not “mental illnesses”. In the world of medicine, a real illness, in comparison to a psychiatric illness, can be objectively identified by scientific methods and can be observed both in the living as well as in the deceased organism. In psychiatry there are no objective tests (e.g. blood tests; x-rays; tissue samples) but purely subjective judgements in relation to behavioural criteria. This is the reason why psychiatry had to come up with its own diagnostic and classification system (i.e. DSM) to convince policy makers and the public that there are real “mental illnesses”, and that they have “proper” medical treatments (e.g. psychotropic medication; electroconvulsive therapy, psychosurgery).
Psychiatry appears to be primarily about punishing or at least discouraging people (e.g. incarceration, drugging, shocking or the threat to do so) from openly demonstrating that some things in society are just not right, and therefore presenting a challenge to the status quo. Instead it encourages people to regard social problems as individual problems (e.g. mental disorders, or mental illnesses) and to believe that the only remedy is psychotherapy, i.e. to sort out one’s own personal issues with the help of a mental health professional. Let me give you an example to illustrate my point here. It has become quite common to talk about people experiencing too much stress at their workplaces, and that if this is not dealt with quickly and efficiently, it could lead to what has come to be known as “Burnout Syndrome”. Many employees are offered counselling to combat the symptoms of this apparent “mental health problem”. Even trade unions have subscribed to this individualisation and pathologisation of employees’ experiences of their workplace and advocate the provision of counselling (Furedi, 2003). As indicated above, “Burnout Syndrome” (although not an officially recognised psychiatric disorder), just like any other psychiatric diagnosis, is used to stigmatise and punish the individual for inappropriate behaviour (e.g. being irritable, not being productive, absent, etc.). It serves to avert our gaze from other problems in society that might be at the very root of the phenomenon we are trying to make sense of. It allows us to just look away from issues that seem far more meaningful and important such as poor pay, inadequate training, support and supervision, overtime, inflexible working hours, lack of responsibility, mundane and mind numbing tasks, exploitation, poor management, lack of conflict resolution, as well as more general concerns about the economical system of capitalism such as the principles of competition, expansion, profit making, and materialism.
One can see that there is a myriad of contributing factors that can make the workplace a hellish experience and any time that can be spent away from it appears to be more than just appealing. It seems that a lack of solidarity, resourcefulness, and control mixed with a heightened sense of passivity, incompetence, vulnerability, guilt and isolation (views of people which are all actively promoted by the psychotherapeutic industry) can easily lead us to subscribe to the idea that there is something wrong with the individual and that someone (i.e. mental health services) will fix it. After all, it is so much easier and more convenient to get a sick note than, for example, collaboratively engaging in industrial action to fight against domination, oppression and exploitation.
It appears that this psychiatric way of thinking about human affairs has become a dominant ideology, which according to Marxist theory, presents a set of common values and beliefs shared by most people in a given society, framing how the majority think about a range of topics (Marx & Engels, 1932). This dominant ideology is thought to reflect, or serve, the interests of the dominant class in that society. It is spread via people such as intellectuals (e.g. scientists, psychiatrists, lawyers, etc.) who sell their abilities and opinions as a commodity in the marketplace or who use them to support the dominant ideology. One can conceive of a society’s dominant ideology as being constructed in a more or less deliberate fashion by a powerful class such as the middle-class. Since the middle-class owns the media, it can select which ideas are represented there, and select just those ideas which serve its own interests.
The dominant ideology that prevails in a society can also be understood as “conventional wisdom” to describe ideas or explanations that are generally accepted as true by the public or by experts in a field. The term implies that the ideas or explanations, though widely held, remain unexamined and may therefore not be reevaluated upon further examination or as events unfold. Just like popular myths, which are passed on from one generation to the next, our concepts and ideas about other people’s apparently “strange” behaviour has transformed into factual realities (e.g. “mental illness”) that are taken for granted and hardly ever questioned. It appears that we just know, so we don’t have to waste time having to make the effort to think, to think for ourselves. Conventional wisdom is additionally often seen as an obstacle to introducing new theories and explanations. This is to say, that despite new information to the contrary, conventional wisdom has a property analogous to inertia that opposes the introduction of contrary belief, sometimes to the point of absurd denial of the new information set by persons strongly holding an outdated view (e.g. demonic possessions, the existence of witches, the world as the centre of the universe, etc.). This inertia is due to conventional wisdom being made of ideas that are convenient, appealing, and of commercial interest (psychotherapeutics is a multibillion industry) as well as deeply assumed by the public, who hangs on to them even as they grow outdated. So we end up with a situation where debates are severely limited by very narrow parameters that discourages discussions of a conceptual nature such as the very meaning and usefulness of an idea such as “mental illness”, and instead promotes those of a methodological nature such as the most effective ways to manage and cure “mental illness”.These kinds of discussions are similar to the ones focusing on what constitutes adequate care of slaves in the 1800s in the South of the USA (Campbell, 1989) instead of challenging the very notion of slavery (i.e. that a certain group of people are inferior and that it is legitimate to dominate them) as inhumane.
There appears to be something very convenient and comforting about the notion that problems in society are simply due to a group of people who seem somewhat alien compared to mainstream society (note that psychiatrists used to be called “alienists” as they were predominantly dealing with people who found themselves alienated from mainstream middle class society, because they were poor, unemployed, homeless, not married, etc.). Groups of people who do not meet the requirements of the therapeutic enterprise (e.g. single mothers and her children; families whose children commit crimes/take drugs) have always disturbed the welfare establishment as they were regarded as suffering from a range of difficulties such as “family disorganisation” and “personality disturbance” which would lead to the transmission of poverty and its “pathologies” from one generation to the next (Polsky, 1993). Therapeutics is an interventionist approach coming from a group of people in power who in the spirit of “paternal benevolence” think that they act in the best interest of those “inadequate” groups of people with less power. It appears that since the beginning of the psychotherapeutic movement its main goal has been to integrate marginal groups into the mainstream of society by imposing the social norms and conventions of a more powerful group (e.g. middle class) onto a less powerful group (e.g. working class) and thereby violating self-determination and individual freedom. These interventions to “normalise” marginal groups have therefore not been about power used by autonomous people but about power to overwhelm citizen autonomy and rob them of their independence. What is often described by therapeutic activists as “difficult” clients or patients are really people who resist suggestions, instructions and counselling and instead strive for independence.
As a society we now seem to be very much buying into the idea of “mental illness” and the panacea that is psychotherapy. Commercially speaking this is a fantastic situation as any industry in the market economy can only survive by producing goods or services that people are willing and able to buy. Ultimately, in order to sell their products and services companies need to create customers, to keep customers, and to satisfy customers. Consequently, ascertaining consumer demand is vital for a company’s future viability and even existence. Obviously people’s will and ultimately their decision to buy a product or service can be heavily influenced by a successful marketing strategy. In other words if there is no need one can easily create a need in order to sell one’s products and services. I think that this is exactly what happened in the psychotherapeutic industry which has successfully created a particular type or customer now known as “mental patient”. It has cunningly convinced us that there is something wrong with many of us (i.e. “mental disorder” or “mental illness”) and that if only we use its psychotherapeutic services (e.g. psychopharmacological, electroconvulsive or conversational treatments) we would be so much better off. This proposed treatment of “mental illness” is of course just a modern spin on the old claim to have the power to protect us from evil and save our souls propagated by the Catholic Church throughout the Middle Ages. As noted earlier, nothing much seems to have changed apart from altering the name of the product from “salvation” to “mental health” (Szasz, 1997). The point here is that people do not have “mental illnesses” or “mental disorders” but can only be persuaded to feel as if something was wrong with them. Do people feel better after receiving psychotherapy. They often do, especially if they believe that their predicament is of a psychological nature and that psychotherapy is an effective remedy. Unfortunately, the observation that many psychological interventions are successful is all too often regarded as evidence that some kind of illness or disorder has been cured. This is nonsense. If someone believes that he/she feels bad because he is possessed by a demon and feels better after some psychological intervention then one can not conclude that this intervention has rid the person of a demon (similar to exorcisms carried out by the Catholic Church).
There are numerous ways in which the psychotherapeutic industry flogs its ever growing line of psychotherapeutic interventions to combat the common enemy that is “mental illness”. A popular strategy is direct marketing which involves carefully seeking out people within a target market, and communicating to them about the nature of their product or service (Guinn, 2008). This can include directly approaching the purchasers of products and services within various mental health organisations or educational facilities in the public, private and voluntary sector, and range from selling particular kinds of therapeutic programs (e.g. computerised cognitive behavioural therapy) as well as psychological testing materials (e.g. aptitude tests; intelligence tests, personality tests), specific literature (e.g. diagnostic manuals such as the DSM and ICD), as well as teaching, study and training materials that will have a bearing on what is taught in undergraduate and postgraduate courses (e.g. psychopharmacology; psychological testing; quantitative research methodology) and is likely to secure new customers and further purchases. Marketing in the educational sector can also include lectures, seminars and workshops where customers learn about the latest psychotherapeutic approaches or update their skills in advanced courses. The direct approach frequently also takes the form of so called “drug lunches” in public settings such as the National Health Services in the UK, which are events sponsored by pharmaceutical companies in exchange for the permission to give commercial presentations to advertise their products (i.e. psychotropic drugs), which often also involves the provision of samples and “freebies”. A further popular strategy to inform the general public of one’s products and services is publicity (Dean, 2002). This involves attaining space in the media, without having to pay directly for such coverage. As an example, an organisation may have the launch of a new product covered by a newspaper or TV news segment (such as a new pill to sedate children who have been given the psychiatric label of “ADHD”, Attention Deficit Hyperactivity Disorder). This benefits the company in question since it is making consumers aware of its product, without necessarily paying a newspaper or television station to cover the event. Companies are pursuing this avenue very frequently as they can sell their products and services as a form of public information rather than as a form of advertising.
Although there is nothing to be psychologically treated or cured, there is now growing social pressure on people to get themselves fixed if they do not want to end up being locked up or in other ways ostracised. A crucial factor in marketing is what has come to be known as “herd behaviour”. This term is used to explain the dependencies of customers’ mutual behaviour (Rook, 2006). Here we are dealing with the subject of the simulation of adaptive human behaviour to increase impulse buying and get people “to buy more by playing on the herd instinct.” The basic idea is that people will buy more of products that are seen to be popular. Many online retailers make use of this by increasingly informing consumers about “which products are popular with like-minded consumers”. The online bookseller Amazon, for example, inform customers who make purchases that other customers who made the same purchase also bought other items which might be of interest to the former customer. Another important factor in the area of marketing is the so called Product Life Cycle (PLC). This is a tool used by marketers to gauge the progress of a product, especially relating to sales or revenue accrued over time (Vernon, 1966). The PLC is based on a few key assumptions, including that a given product would possess an introduction, growth, maturity, and decline stage. Furthermore, it is assumed that no product lasts perpetually on the market. The PLC appears to explain the ever growing number of new psychotherapies that promise to provide customers with the ultimate cure. There are now hundreds of various psychotherapies all promising to be either totally new or significantly modified and improved versions of psychotherapy that will give customers the edge. It is also generally the case that the packaging of a product is of utmost importance – often even more than the product itself. Again this very much applies in the case of the psychotherapeutic industry. The various psychotherapeutic approaches are cleverly wrapped up in the language of science (e.g. evidence based practise) and adorned with fancy ceremonial and technical gimmicks (e.g. Hypnotherapy, EMDR) to distract from the fact that we are ultimately dealing with issues of everyday morality, of how we are expected to behave towards as well as think and feel about ourselves and others.
I would like to conclude with a quote by James Rorty on the subject of promotional messages taken from his book “Our master’s voice: Advertising” (1934).
It is never silent, it drowns out all other voices, and it suffers no rebuke
It has taught us how to live, what to be afraid of, how to be beautiful, how to be loved, how to be envied, how to be successful.
Is it any wonder that the American population tends increasingly to speak, think, feel in terms of this jabberwocky?
American Psychiatric Association (1994). DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Press Inc.
Campbell, R. (1989). An Empire for Slavery: The Peculiar Institution in Texas,1821-1865. Baton Rouge: Louisiana State University Press.
Dean. J. (2002). Publicity’s Secret: How Technoculture Capitalizes on Democracy. Cornell University Press.
Furedi, F. (2003) Therapy Culture: Cultivating Vulnerability in an Uncertain Age. Routledge.
Guinn, T. (2008). Advertising and Integrated Brand Promotion, International Edition. South Western College.
Marx, K & Engels, F (1979). The German Ideology. 1932. The Marx-Engels Reader. Ed. Robert C. Tucker. 2nd ed. New York: W & W Norton & Company. Inc.
Polsky, A. (1993) The Rise of the Therapeutic State (City in the Twenty-First Century). Princeton University Press.
Rook, L. (2006). “An Economic Psychological Approach to Herd Behavior.” Journal of Economics, 40 (I), 75-95.
Rorty, J. (1934). Our Master’s Voice: Advertising. New York: John Day.
Szasz, T. (1997). The Manufacture of Madness: Comparative Study of the Inquisition and the Mental Health Movement. Syracuse University Press.
Vernon, R. (1966). International Investment and International Trade in the Product Life Cycle. The Quarterly Journal of Economics, Vol. 80 (2), 190-207.