On the Existence of Mental Illness and/or Witches in Need of a Burning
Introduction: A Post-Medieval Tale
He had been working at his trade there in the village and people knew him as a result of being his customers, but, for a long time, perhaps, after his mind became infected with the strange thoughts, he kept them to himself; or, perhaps instead, he immediately began speaking of them on every occasions, trying with little success to inject his odd obsessions into the common conversation--as to which, the village was never to know. For, of the content of his mind prior to the period of his inflammation, no one could really say. Down the road from the modest house in which he slept and lived his isolated life when away from his place of business there were an ale house and an open green upon which the village folk, especially the younger ones, were often to congregate and engage in catching the eyes of those whose affections they sought, and he was known to frequent the both of these. But, while the alehouse was the location of many an intemperate voice expounding at both length and volume and providing all listeners with the bounty of the speaker's wisdom, his was not among these, for he was known to sit quietly on his lonesome, nursing his beverages; and although repartee sped back and forth from the lips of many on the green, ever seeking to capture attention and display clever wit, here, too he was not among those either.
Then it came that his customers found him in want of conversation, but such conversation as they were not familiar with. He spoke of things of which none had heard, and if there were any sense at all to it, they mostly could not make it out, and yet he pressed them for agreement, causing many of them ill comfort. Around the same time, he broke his reticence in the ale house and at every moment when silence momentarily held, would address the person of his left or the one on his right and deliver himself of a pronouncement or a question with which he apparently sought to provoke a conversation. In this he was occasionally successful, but more often not; and unlike others who enjoyed creating such extemporaneous dialogue, he did not attempt a different gambit upon finding that his proffered topic had not engaged the interest of the other patrons, but yet reiterated it yet again until the tavern master suspected his obstinate insistence on speaking of it were indicative of the severity of his intoxication and was loathe to bring him more ale.
On the green, the man's insistence on bringing forth and then seeking discussion of his thoughts yielded even greater lengths of annoyed disregard, as most of the banter on that place came lightly, perching on no simple topic before a newly amusing remark would head it along a new path, and here it was that he found people pointedly staring upon him and halting their speech as if in contemplation of that which he had said, only to continue a moment later as if he had not spoken at all; and then to move as a group away from where he stood.
Now, although it was not common that people of the village should write, there were students in the village who knew how to place words upon paper, and could read from the same. And so it came about that the man took pen in hand and put down in diagrams and words the ideas that had occupied his head and began to take these writings to others in the village demanding that they should read them. And this was found to be unusual because none had had reason for believing that the man could write so, and indeed, the reading which they did came mainly at the bidding of the instructors and priests of the village, and it was for the instructors and priests that they themselves wrote when they did write. The man was no instructor and the raw quality of his pen and the pathetic sheets upon which he wrote, these having been apparently chosen at random and often having other items of no relevance written on the back side, reminded people of this if by chance they were otherwise to forget it. And as before, the villagers found what was written to be unfamiliar to them, and not easy to understand, and probably a great many simply set these odd missives aside, and others felt it were as well if they had done likewise. But again the man pursued them in all zeal and determination, attempting to elicit their agreement or to know the grounds upon which they disagreed, and for this trouble he was rewarded with uncertain and nervous faces on all fronts, and doors that opened to him only with rising degrees of reluctance.
The man soon appeared at the doors of the priests and the instructors and bade them read his materials. This they often agreed to do, only to find that like the other villagers they could make of his writings neither head nor tail, and confronted with the man in all of his desperate intensity they knew not how to respond. Once again there were uncertainty and nervousness upon the faces of those to whom the man turned.
After awhile it appeared that there were those of the village who were apparently thought by the man to be especially proper candidates for his ideas, for he stated that the things he felt compelled to say were to have personal implications for them, and to them in particular he spoke and wrote. Of their response aside from that of the others of the village it is difficult to say--if there were those among them who found the man's obsessions less beyond their means to comprehend, there were at least also others among them who did not find them so, and these were sorely perplexed as he kept seeking them out.
And as he wrote and spoke and sought out those with whom he would share his proclamations, he was observed to be of little sleep, and what sleep he did have were as likely to be in the heat of the day, while it was said that he lit the lamp and wrote and paced all night as others slept. And his face took on a strange countenance, his eyes piercing the air and burning into those people with whom he spoke, whose uncertainty and nervousness became ever more so each time he came to them.
And at length, as he encountered closed doors and came to sense people were nervously avoiding him, he wept and rejoiced at the power of what he had put into words, and, apparently believing he understood the substance of their misgivings about his ideas, sought to address these, and did so in further writings which he brought to the dwellings and professional habitat of those he most wished to address, and when the door remained unopened, slipped the documents into a pouch and pushed it beneath, that they might be found and read at a later time.
In the village there were, among the instructors and priests, those who were charged with the care of the afflicted who become possessed to speak strangely and behave of such odd manners as to cause fear for their next action. To these the nervous villages went, bearing with them the mysterious writings, and they feared for their safety, and asked were it true that a diabolical inflammation had taken possession of the man and, afflicting him, led him to afflict them in turn until they slept not well, either. And the priesthood of those concerned with these afflicted brought forth their own copies of the man's peculiar correspondences, for they too had been sought out by him; and they spoke amongst themselves and said, surely he is afflicted indeed. And they sent a party of villagers to the man's cottage and these called him out and told him that the priesthood concerned with the afflicted and possessed wished to speak with him about his ideas and writings, and so he came to them.
But they did not speak with him of his ideas, and did place him in a great stone tower with a great iron door, and there they took from him his pen and his writings, and his clothing, and chained him and left him there, and after that no more were the people in the village fearful and nervous because of him.
To some readers, the presence of literacy in the story above will be a dead giveaway that this "post-medieval" tale is not just post-medieval but quite modern. And they are right: except for the fact that I was a college student and not employed at the time, and therefore could not be said to have had "customers", the tale above is pretty accurately my own, and the events took place in 1980.
And yet, if you remove the references to literacy, the tale I just told becomes with equal accuracy the story of a miller named Menocchio whose independent cosmological theories placed him in trouble in the middle 1500s. (Menocchio himself actually was literate, but the people to whom he spoke, attempting to share his thoughts, mainly were not).
The parallels continue a bit from there: both Menocchio and I were initially released when it appeared that our behavior was not likely to continue to cause problems; and both of us eventually were once again held for continuing to hold and speak of our ideas in ways that disturbed others. For Menocchio, matters ended badly at this point--he was burned at the stake. I was substantially luckier, managing to escape from the psychiatric institution and hitchhike beyond the borders of the state without being apprehended.
A Difference of Opinions
I have friends and associates who disagree with the perspective that I shall be presenting here. They know that the ideas of which I wrote back in 1980 are the same ones that I now publish on my web site as theory papers, and they are sympathetic to my behavior at the time as typical human behavior of a person excited about new ideas, and they do not think it was right that I was treated as a mentally ill person. That much we are in agreement about.
But, unlike, say, witchcraft and demon-possession for which people were persecuted in the 1500s, mental illness, they say, is a medically real problem that afflicts many people; and, unlike the medieval Inquisition incarcerating and later burning Menocchio for heresy, the psychiatric profession is about helping people who really need their help, even if they do make mistakes, as they obviously did in my case. There are people out there who genuinely are mentally ill, they'll say, and those people really do need to be put in an institution, involuntarily if necessary, for their own good, and treated with the best therapeutic treatments the profession has to offer until they can be stabilized and, with luck, released back into the community.
It is unfortunate (they would probably go on to say) that there is such poor funding for services to the mentallly ill that a better diagnostic workup was not done, one which would have brought out the fact that I was not really mentally ill. Meanwhile (they would most likely continue), I should have some consideration for all the poor suffering individuals whose misdiagnosis goes the other way, people who genuinely are mentally ill and in need of treatment, but who are not recognized as being as sick as they are.
In contrast to that general perspective, I, along with many others of the political movement of people who have had the misfortune of being on the receiving end of psychiatric treatment, do not readily accept as proven the notion that "mental illness" really is any more real than demonical possession, and do not appreciate being "treated" in the fashion that the psychiatric profession treats its "patients", and strongly oppose the practice of involuntary psychiatric commitment.
Perhaps most fundamentallly, though, we make the claim that the psychiatric institution does not exist for the benefit of those that it diagnoses and treats. It is not there for us. It is there for those whom we disturb and worry. It is there to protect the rest of society from us.
My colleage Laura Ziegler once referred to the state's Mental Hygiene legal statutes as the "State Mental Sanitation Code". It's true! An ex-inmate writes --
When asked where the nearest washroom was the lady behind the desk at the "mental hospital" advised that I go to the far end of the hall because the washroom only a few steps away was used by "The Patients" Quietly and oh, SO politely I asked if she felt that having trouble coping with some of the shit life can dish out was caught off a toilet seat She was perfectly flustered; however, the sweetest aspect of victory was in the knowledge that she never realized I was one of the people whom she so greatly feared. -- yvonne-marie Phoenix Rising 6(2): p. 12
In Judi Chamberlin's book, to which I will shortly introduce you, another mental patient points out that ""If mental illness is an illness like any other, which I don't believe it is, the illness it most resembles is VD. "
Consider that if it were there for the purpose of helping us with our problems, you would expect an initial focused concern for our emotional condition. People who have been in some manner kicked in the teeth by the trials and tribulations they have faced in their lives are usually going to be feeling pretty fragile, don't you think? Even in my case--and I was happy and confident at the time that I honored the request to "talk to the doctors"--I was tightly wound and really needed to talk about the whole experience of having these ideas in my head and wanting so badly to share them, not to mention talking about the ideas themselves. So you would expect an emotionally supportive environment, one as non-threatening and friendly as possible, one designed to maximize such people's tattered sense of dignity and control over their lives. You would not expect to be stripped of your shoelaces and your belt and the contents of your pockets, perhaps even all of your street clothes, asked a series of impersonal questions printed on an intake form, and then unceremoniously locked behind a heavy door in a large room full of strangers crying, shuffling, and murmuring to themselves and told that a doctor will speak to you the day after tomorrow. But that is mostly how it happens.
Psychiatry and its defenders, of course, claim that there is more to the diseases that they diagnose and treat than "having trouble coping with some of the shit life can dish out". Perniciously, the ideology that says our problems and their emotional (and cognitive) manifestations are all due to wiring problems in our brains is used to shift the focus off of how we feel, because if our feelings are just symptoms, presumably compassion and empathy and a gently supportive and respectful environment wouldn't solve anything. I still fail to understand how they justify deciding that such things would not help (even if my brain is not in perfect working order and some of what I feel and think has nothing to do with my social and physical environment, surely some of it does). Many of us in the movement believe that's all it is--an ideology that justifies the miserable experience they subject us to on behalf of the society they are protecting from our disturbing presence.
No doubt many of you reading this have already found yourselves thinking, "Oh, c'mon, you can't seriously be arguing that mental illness doesn't exist, they know pretty specifically how it works chemically, how the brain is dysfunctional in depressives and schizophrenics, they've proven it."
Well, their profession has certainly made a century's career out of trying to convince everyone of that! David Hill, another author to whom you shall be introduced momentarily, traces the history of the diagnostic concept "schizophrenia" and argues that the claim that it is a distinguishable phenomenon, a specific disease entity recognizable by its symptoms, falls apart upon examination.
Roughly fifteen years ago, shortly after I had managed to extract myself from the first of my two confinements, the medical claim concerning manic-depressive disorder (now renamed "bipolar disorder") and depression was that it had to do with oversensitive dopamine receptors in the nerve cells of the afflicted. Sounds highly scientific, doesn't it? Now the talk is all of serotonin levels in the brain. Not being a neurologist or a biochemist, I made what I thought was a natural assumption, that their talk of serotonin levels was a clarification and a refinement of the earlier pronouncements about dopamine receptors. Then, at an open conference to which both pro-psychiatric and anti-psychiatric advocates had gathered, I made some passing comment about their reduction of human emotional difficulties to dopamine reception problems, and the spokes-shrink from the other table made fun of my ignorance: "Dopamine? No one believes that any more. Our research has now pinpointed the mechanism and I hate to tell you, but you are wrong, it is a true pathological condition, and its mechanism in the brain is interference in the uptake of serotonin".
Their "research" has pinpointed the problem so often and in so many different places over the years that, if it were a bulletin board, the cork would be disintegrating from all the pin holes.
Modern Medical Science?
As an undergraduate working towards my BA degree, I took an elective course, "The Anatomy of Science", which presented the scientific method and the history of western science and its methodologies. One of the course assignments was to pick an experiment and critique it in light of the experimental and logical protocols we had been taught in class.
As this was at a different college and a later time than the one interrupted by my psychiatric incarceration, I had already acquired a critical perspective on psychiatry, and therefore decided to pick on psychiatric research. I "played fair", selecting the experiment from the table of contents of a compilation of articles presented at a conference rather than fishing around for an experiment that I could be sure of tearing apart for this paper. I did pick one that from its title seemed to be making an assertion about how biochemical brain processes cause or manifest themselves as "mental illness", but other than that it was a random selection.
I was both amused and disturbed to find the quality of the research to be even more dismal that I'd expected--
NAME OF EXPERIMENT: "Relationship Between Urinary Constituents and Exacerbation of Behavior in Schizophrenic Patients"
Source: Harold E. Himwich, in "The Biochemistry of Schizophrenia" as published in The Future of the Brain Sciences ed by Samuel Bogoch
OVERALL HYPOTHESES: that schizophrenia is a medical condition (i.e. disease) with direct biochemical correlates demonstrable in clinical experiments; that one of these biological markers is the presence of serum indoleamines, which are endogenous relatives of drugs like LSD [which have been surmised to mimic psychosis, i.e., "psychotomimetic"].
SUMMARY OF EXPERIMENTATION: Eight males, long-term inhabitants of a psychiatric ward and diagnosed as suffering from "chronic schizophrenia" formed the primary population. Psych drugs such as Thorazine, etc., were discontinued 2-4 months prior to onset of experiment. Weekly psychiatric exams of each of the men assigned numbers to changes in their "cooperation and attention, motor behavior, affectivity, thought content, stream of thought, sensorium, and ward adjustment: 0 =not present; -l = mild; -2 = moderate; -3 = severe; -4 = extremely severe. Plus signs would be given if improvements were noted."
All patients had been placed on the metabolic ward so as to eliminate all preformed indoleamines from their diet. Meanwhile, 5-day urine collections were to be made from each patient. In the event of any sudden behavioral changes, urine samples would be taken every 24 hours instead. The idea was to check for correlations between urinary indoleamine level increases and periods of behavioral disturbance. Clinical measurements were made of triptamine, 3-IAA, 5-HIAA, and Creatinine level.
RESULT -- In two out of eight, increased behavior fluctuations developed during the course of the experiment, so 24-hour urine collections were made;in these, experimenters found significant increases of urinary indoleamines,especially triptamine, to precede worsenings of schizophrenic behavior."This rise of urinary triptamine probably reflects a similar rise in blood [triptamine levels]", they hypothesized. Therefore "it would seem that triptamine or a tryptamine compound acts like an endogenous metabolic factor in intensifying the psychotic symptoms." This concluded phase one of the experiment. Author Himwich cites at this point another experiment done elsewhere, "loading schizophrenic patients with methionine and iproniazid [an MAO inhibitor, presumably to prevent swift systemic oxidation of the methionine]". This resulted in an exacerbation of symptoms. Himwich and company "confirmed" this finding: they performed a test using four patients who received, at various stages in the experiment, methionone, a derivative thereof, and placebos, with and without iproniazid. From this confirmation, the experimenters "suggested that a `psychotomimetic' substance [N: N: dimethyltriptamine, known among recreational drug users as DMT].. .[forms] from methionone and triptamine. . triptamine combines with methyl groups released by methionine in schizophrenics to form endogenously a psychogenic compound which acts to aggravate schizophrenic symptoms."
CRITICISMS OF EXPERIMENT
1. Were the psychiatrists aware of when patients in phase two were being dosed with methionone and iproniazid? It would probably be polite to assume they did not know, but this is not stated in the article. Obviously, psychiatrists expecting exacerbations of behavior could be more prone to find them.
2. According to Psychiatric Drugs (Richman 1984) MAO inhibitors have side effects as follows, broken up into "frequent", "occasional", and "rare" -- [frequent]: low blood pressure, fainting (when standing up), restlessness insomnia, dry mouth, blurred vision, nausea, loss of appetite, dizziness, drowsiness, weakness, constipation, headaches, muscle tremors and twitches; [occasional]: confusion, memory problems, facial redness (flushing) and warmth, impaired liver function, difficulty urinating, sexual problems, numbness and tingling of the skin, palpitations, and problems with balance and coordination; [rare]: skin rash, hepatitis, muscle spasms, and manic reactions. In light of this, I ask: would an exacerbation of such "symptoms" as "cooperation, motor behavior,affectivity..." be indicative of the effects of endogenous DMT, or of iproniazid drugging?
3. Experimenters seem to be taking the label "psychotomimetic", as applied to DMT, at face value. Meanwhile, other experiments, endeavoring to show that dopamine is the culprit in schizophrenia, began with a comparison of the action of amphetamines and dopamine versus LSD and dopamine: dopamine affects the same neural canal as amphetamines. LSD, however, acts differently. "Schizophrenic" patients adminstered both of these drugs verified that amphetamines exacerbated their problems, whereas LSD "superimposed a different emotional and mental condition on top of their typical pattern." DMT is generally considered a chemopharmaceutical relative of LSD. The label "psychotomimetic", in fact, has gone out of medical vogue, replaced by "hallucinogen" or "psychedelic". I'd say it remains to be demonstrated that "schizophrenia" is likely to have much to do with a chemical whose primary effects on most people are acknowledged to mimic nothing of the sort except in the most general sense of causing them to think, feel, and behave strangely.
4. In phase one, conclusions were drawn based on tests performed on the urine of two out of eight observed mental patients. I don't think you can draw any generalizable conclusions from two men's piss!
5. "This rise in urinary triptamine arguably reflects a similar rise in blood levels" say experimenters. Yeah, probably. Could they have taken a blood sample or two to find out?
6. Phase one began with eight "chronic schizophrenics". This wasn't a large enough sample size to begin with.
7. All test subjects were "schizophrenics". Are we learning anything about "schizophrenics", or about chemical correlates to human mood changes in general? No control group of nonschizzies makes it a poor experiment.
8. In phase one, five-day urine collections were the general rule until behavior changes were cited. Then and only then were 24-hour urine samples taken and checked for changes...against the baseline established by the five-day urine collections? Do they know for sure the chemicals they're checking for don't oxidize or evaporate when sitting in a jar for several days?
9. Phase two of the experiment was performed on only four patients. That's even worse than eight. In addition, the experimenters stated "But not all patients exhibit exacerbations... in response to combined [drug] treatments." Experimenters then went on to make further hypotheses as to what else could possibly be happening to all that methionine and iproniazid if it wasn't making DMT in madmen's brains every time. Not all patients? What percentage out of four failed to show these exacerbations?
10. In all phases: it is implied that psychiatric evaluations continued to be made only at weekly intervals. Despite this, there are references to day-to-day changes in psychotic activity. Who did this assessing? The experimenters? Psychiatric nurses?
11. Phase two of the experiment was largely performed to duplicate a set of expected and desired findings. To a slightly lesser degree, the whole damn experiment seemed to have been designed to find what experimenters had decided in advance that they were going to find.
LOGICAL COMPONENTS OF EXPERIMENT
INDEPENDENT VARIABLE (phase one): theoretically, the presence or absence of serum indoleamines.
DEPENDENT VARIABLE (phase one): theoretically, exacerbations in symptomsof schizophrenia.
In practice, the way they actually did it, the presence of a finding of exacerbations of psychotic behavior led to testing for urinary indoleamines. Which depended upon which between these two variables is highly questionable!
INDEPENDENT VARIABLE (phase two): presence or lack of methionine and iproniazid.
DEPENDENT VARIABLE (phase two): exacerbations in symptoms of schizophrenia, plus rises in urinary indoleamines.
CONTROLS: (phase one): diet (no preformed indoleamines); obfuscating psychdrugs (discontinued 2-4 months prior)
CONTROLS (phase two): patient knowledge of being on meth and iproniazid (placebos alternating with drugs).
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It could be legitimately pointed out that the experiment I chose was printed in a book published in 1968, and that the state of the experimental art in psychiatry in 1968 does not necessarily tell us much about how they conduct their experiments now. One could also state that, having looked at only one experiment, I cannot claim to have proven anything about the general quality to be found in psychiatric experimentation, and that's undeniably true, too. But by 1968, general standards of scientific experimental methodology were certainly established in most of science's subdisciplines; the phenomenon that they call "schizophrenia" is not a new entity such that any exploratory inquiry is likely to yield new and important information, but instead has been a subject of psychiatric research for over 100 years; and therefore the fact that such an endeavor would be presented at a conference and published as part of "the future of the brain sciences" still strikes me as noteworthy.
However, I truly should repeat this whole process with more current publications, and until I find the time to do so and add my findings to this page, you may consider yourself invited to do so as well. I wish to make the following points, however, about whatever you find there:
a) If researchers claim that the pathological action of one or more of the "mental illnesses" is due to either a chemical or a neuro-electrical condition that sets the "mentally ill" subjects apart from those who do not so suffer, they need to do more than demonstrate correlation in order to support their claim. This is emphatically true because the diagnosis of "mental illness" is always, invariably, made on the basis of symptomatic behavior. In other words, if you start off with a population that is experiencing a profoundly different emotional or cognitive state and examine their brains and find differences in what's going on up there, you still don't know if the chemical or electrical "disorder" causes the behavioral and cognitive and emotional symptoms, which is the interpretation that they are likely to infer, or if, instead, certain emotional and cognitive states of mind are simply matched or represented on the physical plane by chemical and electrical markers which are just physical symptoms of what the mind is experiencing at that time.
b) Be particularly wary of arguments that pursue "mental illness" backwards from arguments about the effectiveness of treatment modalities. I have heard such arguments many times from psychiatric-system defenders: "Such-and-such has proven to be an effective treatment for this mental illness, so we decided to study what it actually does when we apply it to the patient. Obviously, then the mental illness must consist of an absence of that action, or an interference in the processes that it facilitates". This is what I call the thorazine-deficiency theory of mental illness. Such claims are seldom as blatantly ridiculous as literally arguing that mental patients suffer from a lack of normal levels of thorazine, but some of the arguments you will hear about neurotransmitters really are derived in this fashion: they study what the psychiatric drugs do to the patents' brain, and then theorize that the mental illness must cause the brain to function to an abnormal degree in the opposite direction of the drugs' effect.
c) No test that focuses on diagnosed mental patients alone is likely to shed much light on "mental illness" if there are no control groups of people with no such diagnosis being studied in the same light. Such tests should use what is called a "double blind" procedure, in which the people evaluating findings or outcomes do not know who is or is not a diagnosed mental patient until after they have rendered their findings and the tests are over, and also do not know which people have or do not have the "independent variable" that is being tested to see how it affects outcomes. For example, if you want to hypothesize that cholinergic response is tied to deep depression cycles in depressives, you'd better set up an experiment in which both depressives and non-depressives have their behavior evaluated under identical conditions by someone who does not know which people are diagnosed as "depressive" and also does not know which subjects at which times have been found to exhibit the cholinergic response pattern. By the way, if the depressives are locked up and know that they can't leave, and this is not true for the control group non-depressives, they are not being studied under the same conditions. If I were a funding source for such research, I'd suggest using diagnosed mental patients who refuse psychiatric "help" and are not participating (voluntarily or otherwise) in any psychiatric programming.
Here are your homework assignments! With permission from the authors, the complete readings are available online, isn't that nice?
1) Judi Chamberlin, from ON OUR OWN: PATIENT-CONTROLLED ALTERNATIVES TO THE MENTAL HEALTH SYSTEM -- Chapter 1: "A Patient's View of the Mental Health System".
2) David Hill, from THE POLITICS OF SCHIZOPHRENIA -- Chapters 9-11, 17-18
When you are done, you will be prepared for continuation on to the next
section...
Witchpaper '97, Part II --
Hi, and welcome back! I will assume that you have completed the Chamberlin and Hill readings, and hope that you found them interesting.
A Little Story about a Conference
Being an activist and an advocate often leads to one being invited to participate in various conferences and summit meetings, and this is certainly as true for mental health issues as for any others. I have been to a few of these myself, one of a handful representing the "patients' / ex-patients' / inmates' / recipients' perspective". [The issue of what to call us was as politically charged as anything else we discussed. The people least critical of the psychiatric system always wanted to refer to us as "service recipients" or "psychiatric consumers", and generally our group strongly preferred "psychiatric inmates' liberation movement"]. At most such conferences, the other likely players at the conference table would include some although rarely all of the following:
As you may well imagine, such conferences are often circuses of the most exasperating yet (occasionally) amusing sort, with different groups lining up on the same side of issues for vastly different reasons (liberation movement people joining community organizations in opposing a "community residence" because we felt it was a coercive extension of psychiatric authority beyond the walls of the bin, while they were worried about loonies in their neighborhood), or fighting furiously over an issue of contention despite a great deal of underlying agreement (the civil libertarians and the AMI groups both were concerned about the lack of treatment provided to incarcerated mental patients, yet AMI did not like the civil libertarians' approach, which was to take legal potshots at involuntary incarceration wherever therapeutic treatment did not seem to be in place). I have many tales of such arguments, but the one I want to share with you here concerns the ongoing friction between those of us representing the movement and the AMI people, over the subjects of the medical model of mental illness and the question of involuntary incarceration and treatment.
The medical model of mental illness is the ideology of which I have been writing: the belief that we behave differently, have disordered emotional states, and/or have disturbed cognitive processes all because of a pathological condition of our brains, and are therefore "sick" and in need of medical (psychiatric) treatment. We feel that the "mental illness" ideology is closely tied to the imposition of involuntary treatment because it provides the excuse for it and makes it sound as if subjecting us to this treatment is an act of kindness towards us. AMI, like the psychiatrists themselves, defends the medical model, and, in accordance with our predictions, supports involuntary incarceration and treatment, blocking us at many conferences from establishing an inter-group resolution opposing it.
Family members, especially parents, are wary of anyone trying to argue against the medical model, because the most commonly articulated alternative, Freudian theory and its offshoots, would put the blame squarely on the parents. I certainly don't blame them for being tired of the implication that many people make, that if their children or other family members are as psychologically messed up as they seem to be, it must be because they raised them wrong, mistreated or neglected or otherwise distorted them through bad parenting!
Well, one rare day at such a conference, it finally happened: a concerned family member from one of the AMI groups slapped the table in exasperation and said to us, "OK, look...I don't believe that, but, just for the sake of argument, let's say, let's pretend that you people are right and mental illness really is a myth. We'll say it's not in people's brains, it's...the weather, or radiation from flying saucers passing overhead, whatever. We still have to do something about these people! [Not you of course, we are all very impressed with your group, you're all so eloquent and high-functioning and well-dressed and you hardly 'act out' at all]. But what about Jane's daughter Kim, who slit her wrists three times and won't attend school and won't change her clothes? Don't you understand? She really has a problem, I don't care what you call it, she is not OK! She needs help! And we're here to make sure she gets it!"
We asked her: Had Kim indicated a desire for or a willingness to accept help? Did she want the psychiatrists to help her?
"Yes, but they [the hospital] wouldn't keep her", Kim's mother Jane replied angrily.
We reiterated our main point--that the psychiatric institution does not exist for us--and sympathized with Jane and Kim, and for a moment we were all actually in accord, angry at the psychiatric system for simply not giving a damn about what we are going through, we who are their so-called "patients". But then we tried, once again, to lead them to the point of understanding why we wanted to establish our fundamental right to refuse non-helpful "help".
Another AMI woman [speaking somewhat slowly as if to the feeble-minded] asked about a person who, at the time he was picked up by police and taken to the psychiatric emergency room, was walking right down the centerline of the highway and reaching out to the cars as they flew by. Such people don't understand how sick they are. You have to put them away involuntarily or they'll hurt themselves.
Long angry argument on this, with movement people insisting that you could lock that guy up for interfering with traffic and then hold a legal competency hearing in a court of law, you don't have to "psychiatrize" him. And if the person is "disturbed" enough to be doing really foolish things but would still pass the legal definition of a "person with the capacity to understand and make his or her own decisions"? Our right to liberty and due process outweighs this legitimate concern for such people's welfare, you can't go around protecting competent people from themselves.
Then an angry middle-aged man named Matt said, "Look, I've got a daughter at home, OK? And she slit her wrists three times, too, just like that lady [Jane], and she won't get out of bed, she won't seek a job, she...when she does get out of bed, she's impossible, she smashes dishes, curses at us, she uses drugs--I've got a younger daughter, you think I want her to get involved in that shit?--anyway...she smashed up our car last week...you don't know what it's like! This is ruining our marriage, it's ruining my family, we can't just put her out on the streets like a bum. So, you don't want us to be able to put her in the hospital, and God knows she wouldn't go on her own. Do you want her living with you? You want to take her in?" The other AMI people nodded sympathetically, many of them having been there.
Ahhh...now we're seeing a new level of consensus, aren't we? AMI in agreement with the fearful community-members, the ones who worry that without involuntary incarceration they'd be up to their eyeballs in Staten Island Ferry slashers and Jeffrey Dahmer types. OK, so maybe it's not mental illness but still, we can't deal with your behavior so we need to be able to put you away. Beneath layers of guilt and ambivalence and--yes, definitely, love--is this truth, not the only truth, but a truth nevertheless.
The insistence of people on their right to institutionalize us because of our disturbing, unpredictable "psychotic" behavior is about them and their need to keep us from disrupting their lives. I'm not saying there is not caring and concern--you don't sit at a table with these parents for long without knowing that, feeling that, it's real--but removing us from circulation is a much bigger and central function of the psychiatric institution if only because more people are worried about Jeffrey Dahmer than are concerned about Jane's daughter Kim. Meanwhile, the guilt and personal ambivalence apparent in the AMI parents' attitudes causes them to conceal from themselves the fact that, often, much of their concern is for themselves and not for their disruptive children.
If You Can't Take the Heat, Get Down From that Stake
"I should add that many of these 'treatments'...illustrate an obvious expression of the moral attitudes of the 'experts' towards the 'patients.' They were punishing them; and they were doing so despite the fact that the physiological theories they espoused denied any responsibility on the part of those they were punishing."
--David Hill, from the readings you did just prior to this section
There is this inconsistency that exists between the ideology of mental illness (that, since it is a brain disorder causing our disruptive and peculiar thoughts and behavior, we can't be held responsible for it, we can't help it) and the practice of institutional psychiatry. Practice is punitive. In the "Phase I / Phase II / Phase III / Phase IV" system described in the Judi Chamberlin reading, ordinary human freedoms are taken away as initial punishment for psychotic behavior and then doled back out as privileges to reward cooperation and improvement...and taken away again as punishment for relapsing. The entire institutional environment is harsh, both socially and physically, and unnecessarily so regardless of the presence or absence of pathological neurochemical brain conditions. To be in such a place carries a horrible emotional stigma, making it a humiliation just to be brought and kept there, and the institution does nothing to offset this, to make the patient feel valued and respected. Psychiatric institutional staff yell at the patients when they do not ignore them, and speak of them derisively to one another where they can be easily overheard, often in ways that make it obvious that such was the intent. And brute force is used to coerce and to punish disobedience, even to revenge insubordinate attitudes expressed by patients' tone of voice or facial expressions. Immobilizing drugs, physical restraints such as straitjackets or cots with 6-way tie-down restraining sleeves, and isolation rooms (the infamous "padded cell"), theoretically present in the institution either for their medically therapeutic value or to protect patients from violence against themselves or others from their outwardly-directed violence, are actually used, once again, as punishments for misbehaviors. Last, but far from least, release refusal is the ultimate punishment held over the patients' heads: act up if you want, but if you do you will not leave this place.
The actual effect of the ideology of mental illness is not to absolve us from responsibility for our actions, but, rather, to absolve the institution, and those on whose behalf it acts, from any moral obligation to attempt to address our troublesome behavior by making rational appeals for our voluntary cooperation in the matter. By pretending that we lack "insight" into our situation, they are able to hide from themselves the fact that they wish to disallow us the freedom to exhibit these behaviors, as well as disguising from themselves their lack of patience with us at this point. [Although, in the case of the actual authority figures on the ward floors--generally charge nurses--the lack of patience is usually vividly manifested and acknowledged with statements of paternalistic exasperation and threats in response to every noncompliance].
Meanwhile, using reward-and-punishment behavior modification techniques as described by Goffman, they are able to insist that we do change, our capitulatory compliance being labeled by them as "improvement" in our "condition" (conditioning, actually). As a bonus, the content of the lesson--the tacit rules for how to behave in society--are in this way accepted by us without them ever having to spell them out. Operating below the level of ideology is an attitude that seems to run something like this: How dare you try to force the issue of how you can and cannot behave just because no one wants to spell it out in so many words! You know what you're doing and you'd damn well better stop it! And, perhaps below that, even, the attitude that if this is not so, that if we really don't know the secret behavioral rules for how to behave, they would rather pretend otherwise than acknowledge it.
Sorry About the Heat, But We Need to Sterilize the Deviance
And the secret rule is: you are not supposed to go forth in life refusing to accept as valid every little thing that does not make sense to you. If everyone else is accepting them, that should be quite enough for you. Saying or indicating that you would be willing to go along with these matters and habits and ways of thinking, if only someone would only be so kind as to explain to you why we do them that way, is outrageous behavior. When you do that, you could put other people into a position of having to explain that they don't understand why we do them that way either, and then they'd have to come right out and say that, yes, they go along with a great many things in life that they do not understand, that's just how things are, you're supposed to, you aren't allowed not to do so, it can be very upsetting to people when you do.
And they sure as hell don't want to get into this conversation with you because at this point you might ask why. These questions are upsetting, can't you just accept that?
I, personally, accept as generally factual the premise that such questions are upsetting to people because I believe that I understand why. No, it is not because people are deeply embarrased to acknowledge that there are things they do not understand. I'm typing this on my Mac, and although I have some limited comprehension of digital data and megahertz, there is so much I would not be able to explain to you if you asked, including plain old household electrical wiring! And so it is for most people, about many things. But knowledge or ignorance of alternating current and polarized plugs and such is different from knowledge about why we people-folks should do certain things certain ways--behavior-indicative concepts, let's call these--because behavior-indicative concepts get an extra emotional charge because of the moral baggage they often contain. This is not to say that every behavior-indicative thought that is widely shared is so strewn with emotional barbed wire that everyone will get upset if you persist in asking why we do it that way, but you are supposed to learn to sense when you have hit one that is, and to quit upsetting people by questioning it.
You ask in your sunday school class or your schule why murder is wrong and you get an animated discussion. You ask your friends while you're comparing notes on boyfriends and girlfriends why the boys always expect the girls to relocate to advance his career and you get some defensive friends who want to change the subject. Ask your Dad (after reading Heinlein) what's wrong with cannibalism if the person to be eaten died of natural causes and the body is not diseased, and he offers conjectures intermingled with teasing and you have an interesting discussion. Go to your Human Sexuality course and during the sexual deviance section ask why it's "transvestitism" or "cross-dressing" if a guy wears women's clothing but not if a girl wears boy's clothes, and you get vague references from the teacher and giggles from the students, along with some joking about whether or not you're, you know, a little funny. Go home and, if you're a guy, tell your mom you want to wear a skirt to class tomorrow and watch your mom get increasingly upset if she can't talk you out of it. If you're a girl, tell her about the nice program you've decided to pursue in Michigan, miles from your almost-fiancee's intended college career in Virginia, and watch your mom keep on saying of course your career is as important as his, but her face takes on this LOOK and she keeps saying she hopes you won't get hurt. Sit down with the guy and keep trying to explain to him that this is not about somehow being mad at him, and of course he did not consult you before accepting Virginia and he can get into Michigan but your progam has to be at Michigan, and watch him refuse to talk about it and get very upset. Meanwhile, if you're the guy, stand in the hall in your skirt trying to explain first to the hall monitor and then to the principal that there really isn't any reason you should not be allowed to attend classes this way, it is as long as a skirt has to be according to the dress code...
Sometimes you just upset some people. Sometimes you upset some people over and over again until they decide that something has to be done about it. Sometimes it only takes one inadvisable deviant behavior on your part, one that strikes people as completely unacceptable, and they make that 911 phone call. Some of you will never meet the proverbial "men in the white coats". Those of you that do will discover that they actually wear police uniforms and are obliged, if sufficient cause seems to exist to suspect you of being a danger to yourself or other people, to bring you down involuntarily for a psychiatric evaluation. In most states, two psychiatrists will ask you some questions and interview you, and if they both agree that you need their version of "help", you become a resident of a psychiatric ward for awhile
No, you are quite correct--I haven't told you why it upsets them so much. The truth is, they are scared that maybe absolutely no one knows why it is so necessary that we do these things the way we do. It wouldn't be half so bad if some wiser folks did know, and their reasons were of course sound and valid, but the notion that maybe we are all doing a great many things for absolutely no coherent valid reason is very frightening. It casts the validity of the whole species into question: are we sensible and rational after all? It calls into question all kinds of scary thoughts about the immense range of ridiculous and perhaps harmful, even horrendously evil, things we might be conforming to, and, worse even than that from their fearful viewpoint, it threatens them with the possibility that the degree of peaceful and pleasant order that we have attained so far may be due to pure chance, with people conforming to notions that just magically happen to work sufficiently well for us to get by, and if deviant people like you direct everyone else's attention to the possibility that it is all pretty arbitrary, it could all fall apart!
And, yes, of course, I can hear some of you protesting with irritation that even if some people (such as myself) get locked up and "psychiatrized" for nonconformity and originality and so on, our experiences have little if anything to do with the profoundly disturbed people who hide under beds or walk down the median strip of the highway thinking that they are blessing the automobiles as they reach out to them. But it is strongly related, nevertheless. It is disconcerting on a deep level to contemplate the possibility that people in general have extremely limited independent versions of a grasp on reality, and that quite possibly the collectively shared version of it is profoundly wrong. With some people, the adaptation consists of copying and conforming and trying not to think of these matters, i.e., becoming normal. (Don't get so upset--it's no more insulting that most of Freud's theories of "normal" psychological development!). With some, the adaptation consists of abandoning the main body of collectively shared versions of reality and clinging with devout faith to whatever set of explanatory set or sets of images come to mind which seem to make sense of things. Some such ideas may be incisive, clarifying, highly useful and elegant, whereas others may be accidentally appealing, "of the moment", explanations which held a certain appeal last Friday and perhaps never will again describe observations quite so smoothly. Given the tremendously frightening state of not knowing the world, it is understandable that some who defect from the conventionally shared version of reality end up clinging to their own newly minted and largely untested model of reality with a tenacity identical or even stronger than that of the normal person clinging to the conventional version. And, definitely, some people are wise enough to be suspicious of any replacement descriptions of reality and will not embrace these until one such model actually describes reality dependably, without horrid inconsistencies, in ways that match their experience, and, deprived of any such model and uninclined to lie to themselves, they retreat in understandably terrified confusion from a world that makes no sense to them, and hiding under the bed seems entirely rational under such circumstances when you think about it. (So does suicide, if one becomes convinced that there is no way out). Lastly, now and then, perhaps a lot more often than you might think, some people persevere and find a model that seems to describe reality for them, and they make use of it, but without clinging to it uncritically, and they gradually find a lot of useless garbage mixed in with revelation and insight, and they learn to laugh at some of the independently-derived concepts, and at themselves, just as they laugh at the ludicrous concepts that the normals cling to. At any given moment, such people may be found reaching out to automobiles to bless them, or hiding under the bed, but more often than not they have their feet in closer proximity to the ground, even while their heads are in the clouds, and they produce significant and, often, externally coherent insights that even the normals can obtain something from if they are sufficiently brave. But such people are no less vulnerable to the reach of the proverbial men in the white coats than the rest of us, and the psychiatrists and their minions are helping none of us with their interference, and frankly we find it entirely oppressive.
Theoretical Confluences
These writings, addressing psychiatric oppression and the theoretical foundations of the psych inmates' liberation movement, exist on a web site where the primary attention is given to radical feminist theory. Probably most of you know that, but possible circulation of the URL for the "Sociology of Deviance" title page makes it possible that some of you were not aware of that. Those who have been reading the fem theory might be waiting to see how I tie all of this together with radical feminist theory; the rest of you, I daresay, have something to gain by scrolling through those theoretical renderings.
In a (dare I say it?) nutshell, radical feminist theory says that the cognitive processes considered "normal" in our society ("patriarchy" to those of you who have the feminist theory background at this point) are badly skewed and slanted by the illegitimate ways in which feelings are disregarded as cognitive. I spoke earlier on this page of "behavior-indicative" belief systems, as you'll recall. I have written of these at length along with the general question of how we, collectively, come to arrive at models of reality that we can realistically expect each other to share in common, in my admittedly long and imposing theoretical piece "The Radical Feminist Perspective in (and/or on) the Field of Sociology". In that writings, I explain how it is that our society screens out most of our felt experiences, thus insulating from change the set of beliefs that we are all "supposed" to share. Ideologically, this culture teaches us individually not to expect to contribute much to this set of beliefs and to assume that wiser people somewhere else are coming up with the "right answers" if there are any we do not already know. In actuality, a great deal of it is running on a sort of "automatic pilot", insulated from our critical questioning, protected from inquiry or experiential data, and shoved down our collective throats. A great deal of it does not make any sense to us individually because it does not make any sense in our modern lives, even if perhaps a long time ago more of it did.
Ruminations along these lines are developed in more theoretical (and metaphorical) detail in my older piece, "Witchpaper '86", which you may have read before arriving here. If you did, I have high hopes that some of what was said there will make more sense at this point. If not, you may wish to view it before proceding to the next paper in this series.
Meanwhile, for those of you who are from the inmates' movement--you need to understand that institutional psychiatry is performing a function for the patriarchy. It is the same function as the witch-hunts of the middle ages: eliminating the socially inconvenient who disturb others. The point is not that psychiatric ideology is just as illegitimate as the ideology of witches in need of a good burning back in medieval times--you already knew that! No, the point is, unless we grasp the larger picture, it is not enough to contend with and ultimately expose and defeat the phony ideology of mental illness. Because, since, it serves a purpose under these oppressive circumstances, another new and perhaps even more slippery and dangerous form of anti-deviance process will arise to replace it, and the whole damn struggle will still lie in front of us all once again.