The anti-psychiatry movement has already been consigned to the history of psychiatry (Tantum 1991) despite the relatively recent first use of the term in the literature (Cooper 1967). A key understanding of "anti-psychiatry" is that mental illness is a myth (Szasz 1972). The argument is that illness is a physical concept and therefore cannot be applied to psychological disorder without any physical pathology. As soon as it is accepted that mental illness can refer to psychological abnormality then the "anti-psychiatry" argument fails (Farrell 1979).
However, "anti-psychiatry" includes critics with differing views and the essence of its argument has not always been clear (Gijswijt-Hofstra & Porter 1998). Anti-psychiatry has perhaps been defined more by psychiatry itself than by its adherents. R D Laing (1986) never called himself an anti-psychiatrist and distanced himself from David Cooper, as Laing did not regard himself as ideologically Marxist as Cooper. Thomas Szasz attacked Laing for his lack of rigour (Mullan 1995) and although Laing agreed that the term mental illness is a metaphor, he argued that it mapped onto reality. Nonetheless, "anti-psychiatry" has had an anti-authoritarian popular, even romantic, appeal as an attack on psychiatrists' use of psychiatric diagnosis, drug and ECT treatment and involuntary hospitalisation.
Over recent years psychiatry has become more biological in its approach, partly as a reaction to the perceived threats to its foundation from antipsychiatry. Doctors tend to view the mentally ill as blameless victims of brain disease and a structural and physiological basis for mental illness is assumed to have been demonstrated (Double 1992a). Nonetheless the human and inanimate realms are distinct and there are consequences of treating people as though they are objects or things (Johnstone 2000).
Psychiatric legitimacy was embarrassed by Rosenhan (1973) who claimed professionals were unable to distinguish the sane from the insane because of his demonstration that normal people could gain admission to hospital and acquire a diagnosis of schizophrenia by merely feigning a mundane, simple hallucination. Rosenhan suggested that psychiatric diagnosis is subjective in the minds of the observers and does not reflect inherent patient characteristics. Operationalisation of psychiatric criteria as in DSM-III and DSM-IV (American Psychiatric Association 1994) arose as a response to the perceived dire need for objectification in diagnosis. The modern explicit and intentional concern with psychiatric diagnosis contrasts with earlier views de-emphasising diagnosis in favour of understanding the life story of the individual patient. The Meyerian psychobiological model has been devalued and reframed into a neo-Kraepelinian consensus (Double 1990).
In this context renewed criticism of modern psychiatry is needed and it may be important to resurrect "anti-psychiatry" ideas (Double 1992b, 1998). "Anti-psychiatry" in this sense is merely what psychiatry should be if it truly understood the facts of the case (Critical Psychiatry Network website). Anti-psychiatry is part of psychiatry but recognises that objectification of the mentally ill makes psychiatry part of the problem rather than the solution of mental illness (Jones 1997).
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edition). American Psychiatric Association: Washington.
Cooper D (1967) Psychiatry and anti-psychiatry. Tavistock Publications: London.
Critical Psychiatry network website. http://www.critpsynet.freeuk.com/index.htm
Double D B (1990) What would Adolf Meyer have thought of the neo-Kraepelinian approach? Psychiatric Bulletin, 14, 472-474
Double D B (1992a) Understanding schizophrenia. BMJ 1992; 305: 775-6
Double D B (1992b) Training in "anti-psychiatry". Clinical Psychology Forum 1992, 46, 12-4
Double D B (2001) Can psychiatry be retrieved from a biological approach? Changes [in press]
Farrell B A (1979) Mental illness: a conceptual analysis. Psychological Medicine, 9, 21-35.
Gijswijt-Hofstra M & Porter R (eds) (1998) Cultures of psychiatry and mental health care in post-war Britain and Netherlands. Clio Medica: Amsterdam
Johnstone L (2000) Users and abusers of psychiatry: a critical look at psychiatric practice. (Second edition) Routledge: London
Jones C (1997) Raising the anti: Jan Foudraine, Ronald Laing and anti-psychiatry. In Cultures of psychiatry and mental health care in post-war Britain and Netherlands (eds Gijswijt-Hofstra M & Porter R). Clio Medica: Amsterdam
Laing R D (1985) Wisdom, madness and folly. Macmillan: London
Mullan B (1995) Mad to be normal. Free Association Books: London
Rosenhan D L (1973) On being sane in insane places. Science, 179, 250-8
Szasz T S (1972) The myth of mental illness. Paladin: London
Tantum D (1991) The anti-psychiatry movement. In 150 Years of British Psychiatry, 1841-1991 (eds Berrios G E and Freeman H). Gaskell: London.
An Anti-psychiatry Reading List (compiled by Ian Pitchford)
Quote from Professor Anthony Clare in Mullan B (ed) (1997) R. D. Laing: Creative destroyer. Cassell: London:-
"Laing seem[ed] to suggest that schizophrenia is no more than a social construct, that schizophrenics are possessed by some superior vision of reality and truth and psychiatric treatment is nothing more than a banal society's attempt to sterilize and contain revolution. Many parents of sufferers from schizophrenia cannot forgive him either for adding the guilt of having 'caused' the illness in the first place to their strains and stresses of having to be the main providers of support"
Is this what Laing suggested and should he be condemned if he did not?
Read Bob Mullan's new biography of Laing - RD Laing: a personal view.