Full disclosure: I’m training to be a psychologist (not psychiatrist)
I’ve been browsing here a lot since Genzedong got quarantined, as I had been expecting a full removal soon after. The general community here is so positive and funny, I found myself preferring it to the subreddit.
I decided to break from my lurking ways to comment on an unfortunate trend I’ve noticed: A few, maybe just one or two, users trying to bring legitimacy to anti-psychiatry rhetoric. These users are getting a great deal of attention for their posts, and they seem to me to be legit comrades, regularly posting in other subs as well. I think these users are genuine, and I don’t intend to make this about them, nor am I about to speculate about their personal reasons for perpetuating these messages. I will say only this about them: There is a worrying tendency to fully dismiss the experiences and views of mental health professionals, saying that speaking to us is “like speaking to a wall,” and encouraging other users to simply ignore our responses. I think I only need to describe this sort of behavior for the troublesome qualities of it to become self-evident. No more needs to be said on it.
Now, I want to speak first to the kernel of truth in the anti-psychiatry lie, because this is somewhat personal to me.
Following the death of my 24 year old brother in 2020, I had a very hard time maintaining my professional life for a little over a year. He was not only my closest friend, but also the only person with whom I could share my political thoughts openly, expecting that he might be feeling similar. Simply put, he was the only socialist I knew.
At my field placement at the time, I was often working with people who were hospitalized. The fact that capitalism contributes to mental illness was not a new concept to me, but seeing how many of our patients were homeless, and knowing that, sometimes, they were sent back to the streets after we had gotten them “back to baseline,” was devastating for me. It was the sort of disruption that makes a person question the field they are in.
Cut-to October, 2021, I’m the only student in a classroom, explaining to 6 professors why my performance is slipping lately, and I find myself explaining that I feel impotent as a therapist, eventually yelling something rash to the effect of “If we actually wanted a psychologically-minded approach to helping these people, we’d be giving them houses!” Further, I was boiling in anger so slowly I almost didn’t notice it, because I had no one - zero people - in this liberal-as-hell program to discuss my beliefs with. No one outside of it. Just no one. I was surrounded by people who loved to talk about “systems,” but couldn’t form a coherent thought about the economic system that undergirds all of the ills of these other systems.
It is true that therapy and psychiatry are often bandaids for people living in a sick society. It is true that many of the problems we seek to address are exacerbated or outright caused by living in a capitalist system. It is true that therapy addresses the suffering of individuals, when that suffering is often the result of communal discord.
It’s deeply unhealthy to get stuck there though. I was for a time, and my outpatient clients likely suffered lower quality treatment from me during this time. I know everyone around me suffered a lower quality me.
We are historical materialists. Because of the suffering caused by capitalism, it can be easy to lose sight of the materialist understanding of capitalism as an inevitable and necessary next step beyond feudalism, leading to socialism. Capitalism is not an entity you can diagnose as evil and then determine that everything birthed from within it is therefore also evil. That’s idealism. The fact that psychiatry and therapy inherited flaws from operating within a capitalist system says absolutely nothing about their inherent nature, the intent of them, nor their impact.
Now let’s get more specific. This entire dance of tying capitalism and psychiatry together utterly ignores basic realities - like the fact that some mental illnesses seem to be primarily organic, that is, relating to the person’s biological make-up, their “wiring.” Primary examples of this include ADHD, Bipolar and Schizophrenia. If you suppose a person with schizophrenia or bipolar would suddenly be highly functional, absent medication, in a world where we’ve reached international communism, you are simply making a massive, uneducated guess. We don’t know that, and anyone who has spent considerable time among the severely mentally ill population will tell you that it seems extremely unlikely. Further, we haven’t reached communism, so it seems reasonable to suggest we do what we can for people who are suffering currently.
A lot of anti-psychiatry rhetoric seems to come from the neurodivergent crowd, specifically people with ADHD and/or autism, who have felt mistreated by the field of psychiatry because they aren’t disordered, just different from the type of person who succeeds under capitalism. There is a lot of truth to this, and I wish I had better answers for these individuals. Perhaps under communism, people with ADHD and Autism will feel no need for therapy. Then again, perhaps they’ll still suffer from higher rates of depression than other people, simply because they find it harder to fit in socially. A lot of unhelpful speculation is required to even have that conversation. I’m more interested in helping people with the problems they say they want help with in their lives, at this point in time.
Now to get on to what most people think of when they think of psychiatry and therapy. When I’m helping someone with OCD learn to work past their compulsions effectively enough that they can finally do something enjoyable with their time, no one gives a flying fuck if capitalism has to do with why they can’t stop checking, and re-checking that everything in their home is “just right.” When I’m helping a socially anxious person find human connection, or a depressed person find something rewarding to engage in, again, the discussion of how their mental illness is a result of capitalism feels trivial in the face of their suffering. Yes, every single one of my clients deserves revolution. No, I’m not capable of bringing about that revolution on my own, but I can help my clients make friends and find meaning in the lives they do have under this capitalist system.
The last problem with anti-psychiatry being tied to Marxism is more pragmatic: People who are curious about communism come to this site. Most people’s (with very unfortunate but real exceptions) experience of psychiatry and therapy will not map onto the exploitative machine described by the anti-psychiatry folks any more than their experience of the medical field does. This means that any curious liberal who comes into this space looking for answers is going to be immediately turned off.
Anyway, I’m really thankful for this place and hope this post doesn’t make me a pariah around here in the future. Thanks for reading, comrades.
Edit: A previous version of this post contained language that was unfair to the anti-psychiatry crowd. This was a mistake pointed out to me in the comments, and I see what they mean. I’ll do better with that in the future.
The criticism is mostly levied at over-prescription of meds and many diagnoses being treated as hard-and-fast science when I’m sorry, but from my experience and my reading, they most certainly are not. For the record, I am diagnosed with Bipolar 2, MDD, comorbid borderline personality disorder, and GAD. I also have years of experience working with individuals with developmental and “intellectual disabilities” (the industry’s terminology, not mine). I am also heavily medicated, and I think it works for me… mostly. For now.
There is a trend recently of many, many diagnoses being treated as a sliding scale. What is considered autism can present in almost an infinite possibility of ways, yet depending on things like your area, your income, etc. the modality of care remains the same, as a dogma proscribed by national psychiatric institutions. Someone who is incapable of deemed “proper” social interaction through understanding jokes or sarcasm might be labeled as suffering from the same condition as someone with uncontrollable fits of rage and the inability to properly feed themselves. Medications prescribed as beneficial to people with autism might, and regularly are, given to both. Women are much more likely to be “(mis)diagnosed” with BPD than with autism, and black kids are rarely diagnosed at all with more of a focus on home life and parental blame.
Brain scans and MRIs have been regularly utilized (at least in the past) to diagnose bipolar disorder and borderline personality disorder. There is considered some scientific correlation between certain abnormalities on the brain and abnormalities in behavior. Yet, diagnostic criteria for many, many disorders necessitates absolutely none of these physical abnormalities, and usually rely on pseudoscientific examinations of haptics and Buzzfeed-style quizzes that rate your depression level or anxiety level with a number utilizing questions regarding suicidal ideation and feelings of restlessness.
Say your car broke down. Your partner left. You’re facing the threat of eviction. You got fired and can’t find a new job. The state is not giving you unemployment. You have a doctor’s appointment. When your “analysis” presents that you’re now a 20 (severe depression) a on the sliding scale of what clinical depression looks like, and two months ago you were a 9 (mild depression), your doctor refers you to a psychiatrist. You tell your psychiatrist you feel like a failure to your family and your loved ones. You tell your psychiatrist that your motivation is dwindling. You tell your psychiatrist you feel you’d be better off dead.
“I think we’re going to try you on a four-week trial of fluoxetine. If by the fourth week you’re not feeling any better, we’ll begin to ween you off of that and try something else.”
Are you telling me that skeptics of this line of thinking are promoting dangerous ideas for not buying the “chemical imbalance” theory? There almost certainly are individuals who were born a certain way that necessitates life-long care and medication (I have met PLENTY of them, very lovely people who would not be able to live totally independently even under a socialist or communist system), but pathologizing poverty is a sick facet of Amerikan and Western medicine that needs to be destroyed.
After telling my doctor about “real stressors” in my life, chronic joblessness and rent and interpersonal struggles, they recommended switching my SNRI to a different one that has been “shown to have more success in patients with bipolar.” This is pseudoscientific garbage. The withdrawals from my SNRI are so bad I can barely breathe, and I’ve been on it for years. Suggesting a switch like this, especially considering a precarious financial situation, is deadly. Yet it happens all over the country, and likely the world.
There was an ethnographic study done regarding schizophrenia in Ghana, India and California by a Stanford researcher. It showed that of those who heard voices, not one Amerikan heard positive or uplifting voices, whereas many in India and Ghana heard the voice of God, the voice of loved ones, the voice of playful spirits. Amerikans heard demons commanding them to rip peoples’ eyes out, and telling them that they were useless. We are social creatures, and many of our mental illnesses are socially constructed. There is a hyper-focus on determining physiological impairments that leads to over-diagnosis, over-prescription, and a severely lacking of modality of care. The groups in charge of psychiatry in Western nations are perfectly fine with this, and treating the DSM as the bible.
Conflating talk therapy with medication is also an issue of your post imo. Psychologists and psychiatrists are similar but play vastly different roles. Therapy is, imo, almost necessary for everyone in the hellworld that we exist in and coping with our humanity and our struggles.
I see that a comrade below may have called you out for comparing anti-psychiatry Marxists to scientologists, and I see that you may have deleted that from OP if it was in there. I appreciate that, but I still want to point out how utterly unfair it is to draw comparisons to billionaire celebrity cultists claiming that dead-alien-thetons or what have you are the root of all our problems, and materialists attempting to deconstruct an industry built on exponential profit and the dialectical conflict within that has created a battle between actual science and pseudoscientific wizardry. There is a trend now of psychiatrists distancing themselves as far as possible from the trend of hard-and-fast diagnoses as well as the DSM generally, and that is for a reason. They’re still, at this point in time, considered heretics by the APA. It’s also important to note that you cannot get disability benefits in most or all states without hard-and-fast diagnoses, so many patients will exaggerate symptoms or cling to diagnoses that may not actually help them at all for fear of not being able to get benefits.
Indeed, I can more effectively speak to talk therapy, so I probably did that. I also have seen people do much better in therapy with the help of meds, so I sort of automatically defend psychiatry as well.
As for the call-out, the Scientology remark was actually not one that was meant the way it apparently came off. I was trying to say that that’s what most people in the west associate with anti-psychiatry bc it’s the only major worldview associated with anti-psychiatry here. But it was mixed in with some other less than above-board language on my end. Your points are well taken and I see that it was uncool to bring up in a way that might read as a comparison.
And nah, you don’t seem angry!
“Are you telling me that skeptics of this line of thinking are promoting dangerous ideas for not buying the “chemical imbalance” theory?”
Absolutely not! And sorry for not knowing formatting stuff. No, if this is someone’s idea of “anti-psychiatry” then I agree with them on a fair number of points as do a fairly large number of people currently in the field. The sub seems more dedicated to an outright dismissal of the field than to the sort of criticisms you’re bringing up.
I agree, I grew up studying to be a psychiatrist, but my family couldn’t afford the ginormous cost of college for going to college and med school, so it never happened, but I had read lots of psychology books and biology and anatomy of the brain. I noticed a lot of bullshit that they taught that I completely agree with here. Like the meds. Obviously someone living on the streets and doing drugs doesn’t just need a certain type of drug to make them think a certain way, they need financial support. And the way that some psychiatrists behave is not always that of someone looking out for the patient’s best interests, which unfortunately I know decently a lot about (2nd hand,someone close, not me) but I absolutely agree not everything that therapy and mental health workers are proffering as solutions are complete bullshit, and plenty of professionals are in a shitty industry, not necessarily them being dicks
I apologize if I seem angry or anything, I’m not at you for the points you’re bringing up or your worries. I am angry about a lot of systemic things ofc lol, and some of my wording is not shouting at you necessarily but more into the void, if that makes any sense, to make my point.