This entry briefly describes and outlines the antipsychiatry movement, an amorphous movement that is highly critical of some of the currents and trends in psychiatry mentioned earlier. The entry starts by giving a brief overview of psychiatry as a medical specialty, examining trends and current issues therein. It then describes and analyzes the antipsychiatry movement, detailing the specific critiques of psychiatry by those involved in the movement. Many of these critiques relate to issues of security and surveillance. These include arguments that psychiatry overuses interventions such as medication, forced treatments, and compulsory hospitalization as a form of control and containment of those whom society marks out as deviant or nonconformist.
Psychiatry developed as a specific branch of medicine in the 19th century, and it has consolidated its position as a medical and academic discipline since. The discipline of psychiatry has expanded much scientific effort into fine-tuning the categorization, diagnosis, and treatment of mental disorders. In terms of the treatment of mental disorders, psychiatry has traditionally been propelled by the biopsychosocial model that attempts to address various deficits associated with mental illness with a mixture of biological, psychological, and social interventions. Psychiatric diagnoses and broader categorizations have changed considerably over time and remain the subject of controversial debate. Presently, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, is the gold standard of diagnosis and categorization. This book amounts to 947 pages of descriptive text, listing more than 200 mental disorders.
Psychiatric services have been configured to address various levels of severity. Outpatient services are delivered in the community to patients with less severe mental illness by psychiatrists and allied professionals (e.g., social workers, psychologists, occupational therapists, and general practitioners) and generally involve a mixture of medications, psychotherapies, and psychosocial interventions. Inpatient services are reserved for patients with more severe mental illness and are delivered in specific mental hospitals, forensic hospitals, and psychiatric wards of general hospitals. Inpatient services place a heavy reliance on medications and commonly use seclusion (solitary confinement) and restraint (both chemical and physical) as interventions.
While many patients self-present to psychiatric hospitals, a large portion of inpatients are brought to the hospital involuntarily by police, ambulance, family, or friends. Most Western countries have legislation allowing psychiatrists to compulsorily admit and treat people against their will, and hospital staff can use seclusion, restraint, and coercion inside the hospital where deemed necessary. Such coercion is mainly used in inpatient settings, but it is increasingly being used for community-dwelling patients with mental illness, in the form of community treatment orders. These community treatment orders can force a community-dwelling patient to take medication or face compulsory prehospitalization.
First, the antipsychiatry movement has questioned the validity and reality of psychiatric diagnoses. There have been five editions of the DSM since 1952, and each version lists many new diagnoses, deletes many old diagnoses, and changes the criteria for core categories, implying that even the psychiatric establishment cannot agree on core concepts. Famously, homosexuality was considered a psychiatric disorder until 1973. Others have argued that many of the listed psychiatric disorders are within the normal range of human experience but have been unnecessarily labelled as “mental disorders.” In this argument, social phobia is considered a label for shyness, depression a label for sadness, and attention-deficit/hyperactivity disorder a label for boisterousness. Even disorders such as schizophrenia have been considered societal labels rather than concrete illnesses. Common across this argument is the belief that people considered deviant or nonconformist by mainstream society are given a psychiatric label to better control and monitor them.
Second, and related to the previous point, the antipsychiatry movement has heavily criticized the nature and extent of common psychiatric treatments and interventions. It has been cogently argued that psychiatry has transformed its approach in the 21st century from a biopsychosocial model to a “biobiobio” model that overly emphasizes psychotropic medication to the detriment of equally effective psychosocial approaches. Some have argued that this has been driven by the agenda of profit-driven pharmaceutical companies, rather than by the therapeutic needs of patients. These companies have received sustained critique from academic scholars in the antipsychiatry and critical psychiatry movement, who have accused them of deliberately misleading the public (by underemphasizing side effects and overemphasizing efficacy) and unduly influencing the psychiatric profession to prescribe these medications. Others, especially among the consumer/survivor movement, continue to criticize the use of seclusion (solitary confinement) and restraints in mental hospitals as signs of barbarism and social control.
Third, newer versions of antipsychiatry and critical psychiatry have emphasized the inequalities experienced by marginalized populations within psychiatry. For example, much research has shown that interventions such as seclusion, heavy dosages of medication, and involuntary commitment are disproportionately high among racial and ethnic minorities such as blacks in the United Kingdom and the United States. Other research shows how political dissidents have been labeled with mental illness and coerced into “treatment” in places such as the Soviet Union and apartheid South Africa. Such data are used to bolster the argument that psychiatric interventions are routinely deployed as measures of security in order to control and contain “threatening” populations. Such activity is frequently supported by specific legislation (often known as mental health acts) that gives psychiatrists the power to hospitalize and forcibly medicate patients, a power not enjoyed by other physicians. This leads many supporters of antipsychiatry to conclude that mainstream psychiatry is an agent of social control and an integral part of state security.
See also Deviance ; Health Management Organizations ; Mental Health Inpatient Facilities ; Psychological Assessment ; Psychotherapy ; Social Control ; Stigma
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