The Amazing Meeting 2014

Like it? Share it!

Sign up for news and updates!

Enter word seen below
Visually impaired? Click here to have an audio challenge played.  You will then need to enter the code that is spelled out.
Change image

Please leave this field empty

Login Form

The Legacy of the Anti-Psychiatry Movement PDF Print E-mail
Written by Dr. Steven Novella   

The dramatic and horrific events at Sandy Hook elementary school have spawned a wave of useful discussion (in addition to speculation and pontification) about the causes of such actions. The effectiveness of current gun control regulations, treatment of mental illness, violence in our culture, and excessive media coverage have all been targeted. We will likely never be able to unravel the peculiar mixture of thoughts, feelings, personal and cultural factors that lead to the brutal murder of 26 people, mostly young children, but perhaps we can stand back and ask bigger questions about our society.

Of the issues above, I want to focus in this article about our current attitudes and treatment of those with mental disorders. In doing so I am not making any statement about the relevance of this factor in the Sandy Hook tragedy - I am simply using public attention after this event to ask the bigger question: how are we doing as a society in providing treatment and services to those with mental illness or disorders?

There have been a few trends in the last four decades that are worth pointing out. Back in the "dark ages" of psychiatry people who were deemed a threat to themselves or others, or simply who were unable to live independently due to mental illness or cognitive impairment, were often institutionalized. They had little rights or say in their fate. The principle of paternalism held sway - doing what one thinks is best for others as a parent would a child, without consent or even explanation.

This state of affairs spawned an anti-psychiatry movement, whose most notable figure was Thomas Szasz. He rightly criticized the excesses of psychiatry as it was practiced in the 1960s and earlier. He also, in my opinion, went way too far and denied the very reality of mental illness or the need for any mental health treatment.

In the 1960s, 70s, and 80s this largely changed. A series of legal precedents and a new ethical approach to medicine in general ceded increasing rights to the mentally ill. Paternalism was out, and the age of informed consent was here. This is a good thing, and we are all better off for it.

The mentally ill gained greater respect and personal freedom. Health care professionals now had a much greater burden of proof that an individual was an immediate risk to themselves or others to commit them against their will, and only for brief hospital stays. Providers had to avoid restraining patients, and use the least restrictive option available. And patients earned the right to refuse any treatment they did not want.

In essence, Thomas Szasz won his battle for freedom and respect for the mentally ill. He refused to accept this, however, and continued until his recent death to rail against psychiatry as if he were still living in the 1960s. He essentially became a denier of mental illness. He also found common cause with Scientology, who deny the modern concept of mental illness and treatment for their bizarre ideological reasons.

During the 1970s there was also a move to deinstitutionalize as many people with mental illness or cognitive limitations as possible. The idea was to close the "warehouses" and shift to community-based halfway houses and other facilities where those who need services and supervision can get the support they need while maintaining whatever independence and freedom they wanted and were capable of having.

This was actually a reasonable plan, but it was poorly executed. It was much easier for lawmakers to close institutions than to provide the funding for community-based services, which were never adequate. Further, after an initial push for such services, financial support slowly waned over the years and now we have woefully insufficient services available.

The result of this massive shift toward individual freedom, as ethically sound and well-motivated as it was, was to leave millions of people who need mental health services with inadequate help and supervision. The formerly institutionalized population (meeting criteria for serious mental illness) now comprises 20-25% of the homeless population, with 40% reporting some mental illness.

By some estimates 16% of prison inmates have a serious mental illness (with up to 70% reporting some mental illness). The severely mentally ill are now 3.2 times more likely to be in prison than in a hospital.

In short - over the last half century many people with severe mental illness who were previously institutionalized are now largely homeless or in prison. In fact prison has become in many ways our de facto institution for the seriously mentally ill. That is the freedom we have given to this population.

I am not suggesting we return to the days of large institutions to house the mentally ill. This is an area, however, where policy changes and funding can have a huge impact. We should, at the very least, complete the second half of the original plan - to follow the closing of institutions with the establishment of community-based services. This will require funding, which is currently in short supply. However, many experts argue this will be cost effective, even possibly cost saving. We are already paying for many of the mentally ill to be institutionalized - in prisons. Proper treatment could reduce imprisonment and homelessness and the net cost is likely something we can afford.

Whatever form mental health services take, they need to become more available and easy to obtain.

Further, I think we need to continue the trend of destigmatizing mental illness. The brain is just another organ, albeit a very complex and important one. The brain, however, can suffer disease and dysfunction just like any other part of the body. We should not confuse the rights and freedoms of the mentally ill with the notion that mental illness does not exist.

The more challenging task is to reconsider the balance between the need to properly assess, treat, and provide services to those with mental illness and the rights and freedoms of all individuals. Perhaps we have not currently struck the optimal balance.


Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.

Comments (4)Add Comment
written by rosie, December 29, 2012
Good article. But I think it's a pity to use the term "ideological" in connection with Scientology. I would prefer "cynical", or perhaps simply "idiotic".
report abuse
vote down
vote up
Votes: +0
Cognitive Dissonance
written by Willy K, December 31, 2012
From 1933 to 1995, Newtown Connecticut was the site of a very large psychiatric hospital called Fairfield Hills State Hospital. It housed as many as three thousand patients.

Also, Newtown is the headquarters National Shooting Sports Foundation.

Sort of ironic isn't it? A mentally disturbed individual slaughters twenty six people with a firearm legally obtained by his mother. Talk about your cognitive dissonance. smilies/cry.gif

No, my views on the First and Second Amendment are not hard right or hard left. I think rational people can find a balance. I don't know anyone who believes that twenty kids blown apart is the right kind of balance.
report abuse
vote down
vote up
Votes: +0
Anti Psychiatry movement
written by, December 31, 2012
Anti Psychiatry movement is still alive. Composed mostly of psychiatry survivors and people who dont agree with mainstream explainations of mental illness. Myself am I diagnosed as schizophrenic and consider myself a victim of psychiatry more then a victim of mental illness. I've talked to people who have been to both the mental hospital and jail, and the ones Ive talked to all considered jail to be preferable.

I never had the chance to try a jungian self exploratory approach to healing myself, something I wish I couldve tried, because even with my best efforts of avoiding psychiatry after my inital volunatry admission I ended up getting the police at my door, and then I had no choice but to come along.

A broken psyche is not always akin to a broken brain. Most schizophrenics show no signs of brain abnormalities and the brain abnormalities that are shown are also present in the general population in people with no diagnosis. Schizophrenics can improve on their own as shown by John Nashs recovery which continued even after he quit his medications. Mental illness is not like brain diseases (Alzheimers, parkinsons etc) and nobody really understands what it is.

The huberus of the psychiatry movement is stunning, they are talking about transfering their methods to developing, poorer countries despite that fact that these countries have better outcomes for schizophrenics and possibly fewer overall schizophrenics (I've read articles saying they have fewer schizophrenics but also seen statistics claiming they have more schizophrenics per capita). I might be biased againt psychiatry because of being locked up against my will for over a year and having pretty much every aspect of my life dictated to by these people, and I do support people going to psychiatry for help of their own free will, but I should be allowed to choose where I want to go to for help even if its to something considered pseudoscience by mainstream psychiatry (ex. shamanism or jungian psychology, jungian psychology being thought of as more valid then shamanism but still a bit frowned upon by mainstream society)

It might be, and it sounds like it is, a bit different in the states though and for that I applaud you. As much as I consider myself a leftist in most areas, the right seems to be the only ones sticking up for us who feel violated by the psychiatry movement. Sorry for the wall of text, I just needed to get this off my chest and this article seemed relevant.
report abuse
vote down
vote up
Votes: +1
written by quizmasterchris, January 06, 2013
There's still plenty to rail against in modern mental "health." I'm abundantly sure this shooter was one of the MILLIONS of kids now raised on head-blowing pills prescribed by doctors like candy at the whim of unhinged parents who want their kids' problems solved with the least amount of work possible.

You tell me this is coincidence:

So 16% of the prison population has serious mental illness - so what without a baseline? What % of the people walking around free have same?
report abuse
vote down
vote up
Votes: -1

Write comment
This content has been locked. You can no longer post any comment.
You must be logged in to post a comment. Please register if you do not have an account yet.