An absolutely fantastic response to the June report on the consumer/survivor movement in Psychiatric Services. Well done, my friends.

Psychiatr Serv 57:1212, August 2006


David Oaks

To the Editor: The essay “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism” (1) in the June issue attempts to impose false labels and a skewed history on activists for human rights in mental health, including the nonprofit organization that I direct, MindFreedom International.

The origin of our social change movement cannot be traced to a few antipsychiatry theoreticians and campus intellectuals. Many of us actually credit the civil rights movement and our own experiences of psychiatric abuse as the original sources of our inspiration. We can and do organize on our own. The authors use the undefined term “antipsychiatry” 34 times in their essay, applying that label to many of us who do not describe ourselves or our groups in that way. There are, for example, compassionate, practicing psychiatrists who play an active role in MindFreedom.

The authors claim that psychiatry has addressed our key grievances “to some degree.” Even if some psychiatrists have reduced the dosages of neuroleptics prescribed, overall neuroleptic prescriptions are skyrocketing. Neuroleptic prescriptions for youths have shot up more than fivefold in less than a decade (2). From our perspective, both electroshock and psychosurgery have experienced a resurgence in popularity within psychiatry and the mainstream press. Many states have greatly expanded commitment criteria, and most states have implemented involuntary outpatient commitment. Courts now order some MindFreedom members who live peacefully in their own homes to take neuroleptics involuntarily.

The authors appear to observe us from afar through a flawed lens, which may explain their factual errors. The well-respected activist Leonard Roy Frank is not the founder of Support Coalition International. Support Coalition International and MindFreedom International are not two separate organizations—our name change occurred in 2005. The essay aligns the history of our movement with the “radical left” to a great extent, ignoring decades of outstanding work by conservatives and libertarians in fighting psychiatric abuse. Today, conservatives lead the grassroots opposition to mental health screening in schools.

Consider the bias inherent in this sentence: “Psychiatry continues to fight antipsychiatry disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults.” The authors appear to transmogrify into “antipsychiatry disinformation” all public education efforts that are inconsistent with the American Psychiatric Association’s official position.

This is my 30th year working for human rights and alternatives in the mental health system. We have made mistakes. We are not perfect. But I am very proud of our social change movement, which includes concerned family members, advocates, attorneys, mental health professionals, and interested members of the public. The authors claim that the psychiatric profession finds it difficult to communicate with us. The fact is that the American Psychiatric Association has generally refused our repeated invitations for conversation.

Somehow, some people who have experienced serious human rights violations in the mental health system—including unscientific labeling, forced drugging, solitary confinement, restraints, involuntary commitment, electroshock, and more—have reached deep within the human spirit and found the power to speak out and unite nonviolently (3). Please reply with dialogue, not distortion.

David Oaks

Footnotes

Mr. Oaks is director of MindFreedom International, Eugene, Oregon.

References

1. Rissmiller D, Rissmiller J: Evolution of the Antipsychiatry Movement Into Mental Health Consumerism. Psychiatric Services 57:863–866,2006

2. Carey B: Use of antipsychotics by the young rose fivefold. New York Times, June 6, 2006, p A18

3. Mahler J, Unzicker R, Foner J, et al: Taking issue with taking issue: “psychiatric survivors” reconsidered. Psychiatric Services 48:601,1997

———–

Paolo del Vecchio

To the Editor: The Rissmillers’ Open Forum article in the June issue linking antipsychiatry with the mental health consumer movement does a disservice to the thousands of consumers working to improve the lives of people with mental illnesses. The essay also fails to acknowledge the many psychiatrists who partner with them.

Today’s consumer movement is not “radical.” It is a mainstream, cornerstone approach to improve mental health care quality as called for by the U.S. Surgeon General (1), the President’s New Freedom Commission on Mental Health (2), and the Institute of Medicine (3).

Rather than “fighting against pharmacological treatment,” the movement supports the consumer’s choice of treatments—including medications—and is often active in promoting increased financing for mental health services, insurance parity, and the protection of individual rights, such as health care privacy.

The movement comprises courageous individuals who, at some risk to their own livelihoods, come out of the closet about their own experiences with mental illness and give back to their communities by forming support groups, operating drop-in centers, and educating the public against stigma and discrimination. It is unjust to discredit mental health care consumer advocates and their hard work by linking them with antipsychiatrists, including Scientologists.

Contrary to the authors’ assertions, psychiatrists are engaged in ongoing collaborations with the consumer movement, with activities that range from conducting local public awareness events to convening a national dialogue series to identify collaborative approaches to improve care (4). Past APA president Steven S. Sharfstein, M.D., reinforced this effort when he endorsed the need for “a collaborative approach with input solicited and accepted from the patient” (5).

Psychiatry recognizes that alliances with those served—whether on the clinical, community, or policy levels—are in our mutual interest: the promotion of mental health recovery.

Paolo del Vecchio, M.S.W.

Footnotes

Mr. del Vecchio is associate director for consumer affairs at the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

References

1. Mental Health: A Report of the Surgeon General. Washington, DC, Department of Health and Human Services, US Public Health Services, 1999

2. Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President’s New Freedom Commission on Mental Health, 2003

3. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC, Institute of Medicine, 2006

4. Consumers and Psychiatrist in Dialogue. Rockville, Md, Department of Health and Human Services, 1997. Available at www.mentalhealth.samhsa.gov/publications/allpubs/OEL00-0009/

5. Sharfstein S: Recovery model will strengthen psychiatrist-patient relationship. Psychiatric News, Oct 21, 2005, p 3

————

Gregory Ludwig

To the Editor: During the past 27 years, I have studied psychiatry and psychology as a student, as a patient, and as a professional, and since college I have written and edited published work in these areas. From this perspective, I would say that although the Open Forum by the Rissmillers, which claims to survey the “antipsychiatry” movement, aims for a worthy goal, it is weak because of its imprecision about concepts, its less-than-adequate research, and its rather stereotyping characterization of certain intellectual figures in the 1960s and 1970s and the significance of their more responsible ideas.

Perhaps the best way to undermine the authors’ central apparent argument—that antipsychiatry was a golden banner that started as an intellectual game among a few radicals and then, after virtual exhaustion, was picked up by a movement among obstreperous consumers that seemed nostalgic for 1960s leftist political and intellectual styles—is to quote from Dendron, a sort of samizdat newsletter that eventually provided the basis for the organization Support Coalition International, whose name was changed last year to MindFreedom International. In a 1988 interview with none other than the renowned psychiatrist R. D. Laing by David Oaks, editor of Dendron at the time and currently director of MindFreedom, Oaks asked, “How can ex-inmates [of psychiatric wards] and progressive therapists work together?” Laing answered, “I’d have to sit down with actual people, and simply talk about it. I don’t know enough about what Americans call the ‘hands-on’ situation to come up with a formula, some key to open up possibilities. The whole thing is: this is stitched together by personal trust [and] confidence between actual people” (1).

If he was describing how a “progressive therapist” might help the budding “psychiatric survivor” movement, Laing was also characterizing the most fundamental method of relating between doctor and patient. But if this was so, it may have been unintended and ironic because he definitely seemed surprised that Americans—with their homely “hands-on” efforts—could have a pragmatic way of organizing a pro-patient movement. In fact, his tone seems that of a musty old European doctor-patient fundamentalist.

So much for the Rissmillers’ claim or suggestion that there is some substantive continuity—almost on the order of a grand, insidious historical error—between Laing, Szasz, and others and between their hermetic intellectual efforts and the more modern consumer efforts, now enabled by the Internet.

The more likely reason for the growth of the consumerist movement might be today’s widespread style of practice of psychiatry and such things as the pharmaceutical industry’s medical hegemony. More fundamentally, the better reason among many people involved in the movement might simply be good sense.

Gregory Ludwig

Footnotes

Mr. Ludwig is a freelance editor and writer, Highland Lakes, New Jersey.

Reference

1. Exclusive Dendron interview: R.D. Laing. Dendron, Feb 1988, pp 1,6,7

————

Kathleen M. Hill

To the Editor: The description in the June Open Forum of consumer activists and their history might lead your readers to conclude that the consumer movement is a fringe group—marginalized and bent on spreading disinformation. Readers should understand that the movement to ensure the human rights of people with disabilities is international in scope.

After many years of advocacy by the disability community, the United Nations General Assembly established a committee in 2001 to develop an international convention on the rights of persons with disabilities. The International Disability Caucus, currently composed of more than 50 nongovernmental organizations, was established the next year to help draft such a convention. The committee will hold its eighth session in New York this month to discuss the current draft of the convention.

Mental health advocacy groups have sought to include in the convention a universal prohibition of involuntary hospitalization and involuntary treatment. They oppose any language or action that would allow for mental health treatment, such as drugs or electroconvulsive therapy, to be forced upon any individual. They oppose any exceptions to be made to this prohibition for “exceptional circumstances,” with “appropriate legal safeguards,” or when it is “in the best interest of the person.” Advocates oppose the model of substituted decision making because it gives away a person’s legal capacity to another person, including a person’s right to make treatment decisions (4). Instead, they stipulate a model of supported decision making to be the keystone of a voluntary system of services that provides noncoercive support for an individual experiencing a mental health crisis.

Users and survivors of psychiatry are not “antipsychiatry”—we are anti-psychiatric oppression, because we have witnessed or experienced such oppression under existing mental health laws and practices.

More information about the United Nations Programme on Global Disability and the work of the International Disability Caucus can be found on the United Nations Enable Web site at www.un.org/esa/socdev/enable.

Kathleen M. Hill, B.S.

Footnotes

Ms. Hill, who lives in Cobalt, Ontario, is a mental health industry reform activist and a member of Support Coalition International and Survivors of Psychiatry.

————–

Ted Chabasinski

To the Editor: Psychiatric Services has done a disservice to any of its readers who might want an accurate picture of our movement for the human rights of psychiatric consumers/survivors. Anyone familiar with our history would have a hard time recognizing us from the bizarre and highly inaccurate article that appeared in your most recent issue.

The authors got it partly right when they mentioned two of our long-time leaders, Leonard Frank and Judi Chamberlin. If the authors had interviewed either of them, their account might have some resemblance to reality. Instead, the authors seem to have relied completely on articles and books, rather than first-hand reports from the people who have actually been involved.

As for myself, my 35 years of activity in our movement wasn’t inspired by any books written by Drs. Szasz or Laing or the other seminal thinkers named, although I respect their contributions. It came about from my ten years in a state hospital as a child, after I received electroshock treatment at age six at the hands of one of the profession’s most honored child psychiatrists. And most activists in our movement have also become involved because of their own experiences.

Though I would hardly expect a journal of the American Psychiatric Association to support our criticisms of psychiatry, I think that it would be much more useful for your readers—and more interesting—if you exposed them to accurate reports of our positions and activities. Any psychiatrist who relied on articles such as this to get a picture of our movement would be living in a dream world.

Ted Chabasinski, J.D.

Footnotes

Mr. Chabasinski is a patients’ rights attorney, Berkeley, California.

———

Nathaniel S. Lehrman

To the Editor: The Open Forum essay by the Rissmillers in the June issue omits the real reason for the antipsychiatry and consumer movements—the spectacularly harmful effects of biological, drug-based psychiatric treatment. That harm is reflected in the sixfold increase in the number of people receiving Social Security disability payments for psychiatric disabilities since psychopharmacology took over psychiatry 50 years ago (1). During this period, the percentage of the population said to be mentally ill has nearly tripled and the total number of inpatient care episodes for severe mental disorders, on a per capita basis, has quadrupled (1). This wave of mental illness is accelerating. The number of people disabled by mental illness has almost doubled in the past 15 years (1).

Another major omission is an account of how the replacement of psychoanalysis by psychopharmacology as the specialty’s ideological basis (which the essay mentions) produced these effects. In presenting psychoanalysis and psychopharmacology as the specialty’s only therapeutic alternatives, the paper omits, and thus denies, the role of counseling and psychotherapy, which has always been a major tool of physicians. The psychoanalysts maintained that their method, with its primary focus on childhood experiences and passive free association, was deeper than other methods. When its uselessness as a treatment for psychosis was finally recognized, the role of present-focused nonpsychoanalytic psychotherapy was ignored and a new emphasis on drugs took its place. However, when psychiatrists limit their therapeutic focus to medication and to its effects on symptoms, they abandon a fundamental part of their treatment armamentarium: a trusting relationship within which the psychosocial problems behind the patients’ symptoms are actively addressed.

Effective treatment should be the first demand of psychiatry’s critics (2). To attack what is wrong, which is the approach taken by the antipsychiatry movement, is necessary but not sufficient. The Rissmillers’ focus on Foucault, Laing, and Szasz, and their omission of respected professionals, such as Loren Mosher and Peter Breggin, erroneously imply that antipsychiatry’s criticisms have come almost entirely from a small, marginal, left-wing group. The authors do not, for example, mention either the International Center for the Study of Psychiatry and Psychology or its peer-reviewed journal Ethical Health and Human Services.

The Rissmillers’ account makes other errors. Although the Support Coalition International became MindFreedom International in 2005, the essay lists them as separate organizations, and David Oaks, not Leonard Roy Frank, is the founder.

The consumer-survivor movement has problems not mentioned by the Open Forum authors. In objecting to psychiatric abuses, the movement ignores the importance of good psychiatric care—as though such care does not exist—and essentially denies that professionals know how to provide it (3). The movement’s focus on the national and international political scene ignores where public mental health care decisions are really made—in individual states. The movements’ efforts at times to place supporters on psychiatric payrolls (as “consumer advocates,” for example) represent a co-optation that provides benefits to past survivors of the system while ignoring its current victims.

The Rissmillers’ account raises important questions about these movements. Its answers fall short.

Nathaniel S. Lehrman, M.D.

Footnotes

Dr. Lehrman is former clinical director of the Kingsboro Psychiatric Center, Brooklyn, New York, and is currently retired.

References

1. Whitaker R: Anatomy of an epidemic: psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Psychology and Psychiatry 7:23–35,2005

2. Lehrman NS: Effective psychotherapy of chronic schizophrenia. American Journal of Psychoanalysis 42:121–132,1982[CrossRef][Medline]

3. Lehrman NS: The rational organization of care for disabling psychosis: “if I were commissioner.” Ethical Human Sciences and Services 5:45–55,2003

———-

Michael Haan

To the Editor: Of particular interest to me were a few sentences near the end of the June Open Forum on antipsychiatry and the consumer movement: “Organized psychiatry has found it difficult to have a constructive dialogue with the evolving radical consumerist movement. Consumerist groups are viewed as extremist, having little scientific foundation and no defined leadership. The profession sees them as continually trying to restrict ‘the work of psychiatrists and care for the seriously mentally ill.’ “

Our message is actually very simple. We don’t like the way the profession treats people. The purpose of a consumer-driven mental health system, as suggested by the President’s New Freedom Commission Report, is to give life to the voices of the people who are being affected by the system.

Michael Haan

Footnotes

Mr. Haan is a consumer advocate in Seattle, Washington.

——-

Wesley Sowers

To the Editor: In the June issue, Rissmiller and Rissmiller provide an interesting report on the development of alternative perspectives on the nature of mental illness and the role of treatment. The authors describe two movements: the intellectually and academically based antipsychiatry movement and the community-based-populist “consumerist” movement. They contend that as the antipsychiatry movement lost momentum in the early 1980s, it was essentially transformed and incorporated into the more mainstream “consumerist” movement. They believe that antipsychiatry tactics had a significant impact on the course followed by the “consumerist” movement and that it became more radicalized as a result.

Although there may be some controversy with regard to this view, their report does provide an accurate assessment of the reforms that these two movements, alone or in combination, brought about. Their concluding remarks are unfortunate, however, stressing divisions between psychiatrists and consumer activists. Although it is true that some psychiatrists have had difficulty interacting with the more hostile elements of the consumer movement, and these elements have likewise had difficulty softening their perception of psychiatry, psychiatrists and consumers have made great strides in creating a dialogue in recent years, regardless of sometimes divergent viewpoints. Failure to acknowledge this evolution misses the key to the transformation that is currently under way.

Wesley Sowers, M.D.

Footnotes

Dr. Sowers is president of the American Association of Community Psychiatrists and medical director of the Office of Behavioral Health, Allegheny County Department of Human Services, Pittsburgh.

———

Laura Van Tosh

To the Editor: I am writing in regard to the Open Forum essay, “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism.” From a historical perspective the essay was interesting and provocative. However, I was left with a hollow feeling. I wondered about patients and psychiatrists who work hard every day and toward greater understanding of mental illness and recovery. I especially wondered about the hesitancy a patient may have to take the first step for help, either in a self-help program or a psychiatrist’s office.

The authors’ conclusion was profoundly concerning in that it maintains acrude and cold separation between patient and doctor that does not further the relationship on which so many depend. In fact, it could easily drive help-seeking consumers from the development of a therapeutic relationship. This relationship must be seen as key to consumers who wish to delve further into analysis or clinical interventions that are required for many of us to maintain lives rooted in recovery values.

At a time when consumers are most vulnerable, we must foster the clinical dialogue, not drive a wedge that creates a problem to which there is really no solution. The authors’ message, while academically controversial, merely emphasizes this schism. Yes, some psychiatrists and consumers may be at war over ideology, but it is the struggle and eventual healing that can result in ultimate recovery. In this most fundamental instance, psychiatrists and consumers can make a new history that is based on mutual understanding and compassion.

Laura Van Tosh

Footnotes

Ms. Van Tosh, who is an editorial consultant for Psychiatric Services, is director of consumer affairs at Western State Hospital, Tacoma, Washington.

———

David J. Rissmiller and Joshua H. Rissmiller

In Reply: We appreciate the numerous letters regarding our article, “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism.” We apologize for erroneously listing Mr. Frank as the founder of Support Coalition International. We also acknowledge that a fundamental problem was the need to summarize in 3,000 words three decades of history. This required limitation necessitated, as Mr. Oaks points out, “the authors appear[ing] to observe us from afar.”

Mr. del Vecchio writes, “Today’s consumer movement is not ‘radical.’ It is a mainstream, cornerstone approach to improve mental health care quality.” We disagree. Quoting from the eighth edition of Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, “it is important to distinguish between the mental health ‘consumer movement,’ which has been positive through empowering patients … and the ‘consumer/survivor’ movement, which has advanced a radical reform.”

Mr. Oaks, Mr. Ludwig, Dr. Lehrman, and Mr. Chabasinski all maintain that our basic hypothesis is false. They maintain that the survivor movement had nothing to do with the antipsychiatry movement. We dispute this point of view. As Tomes (1) noted, “The modern consumer/survivor movement arose in the wake of a radical restructuring of the U.S. mental health system between 1950 and 1970, resulting from deinstitutionalization, new psychotropic drug treatments, the widening legal conceptions of patients’ rights, and the intellectual critiques associated with the antipsychiatry movement.” We maintain that the antipsychiatry ethos, as disseminated by its seminal thinkers, was maintained as the antipsychiatry movement declined. It significantly affected two other movements: the consumerist movement that had been in existence since the late 19th century and the survivor movement, which dates back to worldwide deinstitutionalization. Many of the resultant hybrid radical consumer-survivor coalitions have carried forward, to this day, a message almost identical to that of the earlier antipsychiatry movement: that organized psychiatry is a self-serving guild that oppressively sacrifices consumers’ needs and has little basis in science.

Mr. Haan and Ms. Hill state that the survivor movement is “not ‘anti-psychiatry’” but is against “the way the profession treats people” and against “psychiatric oppression,” which Ms. Hill defines as “any language or action that would allow for mental health treatment … to be forced upon any individual.” Her listed doctrine could have been taken directly from the 1960s antipsychiatry manifesto, which contended that society deals with undesirables by locking them away. Foucault, as noted in our article, argued against society’s pressing need to sequester members who would not comply with its definition of “Reason.”

Mr. Oaks notes that survivor organizations encompass many disciplines, including psychiatrists. We never asserted otherwise. As Dain (2) notes, “Over the years psychiatry has been a target for antipsychiatry groups competing for influence or authority over the mentally ill. At various times these groups have included neurologists, social workers, new religions, consumers, and psychiatrists themselves.” The authors of several letters state that members of their movements do not consider themselves antipsychiatrists. However, many members do. Weitz (3), in an article titled “Call Me Antipsychiatry Activist—Not ‘Consumer,’” made the point, and organizations such as the Antipsychiatry Coalition emphasize it.

Mr. Oaks disputes our contention that in response to pressure from the antipsychiatry movement, psychiatry marginalized electroconvulsive therapy and psychosurgery, and he states that both are now resurging. In 1991 Fink (4) noted, “In spite of its acknowledged efficacy and safety … electroconvulsive therapy remains a controversial treatment, with limited use … the controversy results from attack by the antipsychiatry movement.” The demise of psychosurgery following the antipsychiatry movement has also been documented by Feldman (5). He noted that after the turbulent 1960s, “Public and political scrutiny severely restricted, or actually banned, the use of psychosurgery in many American states, as well as in other countries such as Germany, Australia, and Japan.”

Finally, the authors respectfully disagree with Ms. Van Tosh, who maintains that our essay widens an already existing schism and “could easily drive help-seeking consumers from the development of a therapeutic relationship.” We believe our essay offers a balanced view of the antipsychiatry movement’s evolution. However, we applaud and close with her sentiment, “Yes, some psychiatrists and consumers may be at war over ideology, but it is the struggle and eventual healing that can result in ultimate recovery. In this most fundamental instance, psychiatrists and consumers can make a new history that is based on mutual understanding and compassion.”

David J. Rissmiller, D.O. and Joshua H. Rissmiller

References

1. Tomes N: The patient as a policy factor: a historical case study of the consumer/survivor movement in mental health. Health Affairs 25(3):720–7292006

2. Dain N: Reflections on antipsychiatry and stigma in the history of American psychiatry. Hospital and Community Psychiatry 45:1010–10141994

3. Weitz D: Call me antipsychiatry activist—not “consumer.” Ethical Human Sciences and Services: An International Journal of Critical Inquiry 5:71–722003

4. Fink M: Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States. Psychiatric Clinics of North America 14:793–8011991

5. Feldman RP, Goodrich JT: Psychosurgery: a historical overview. Neurosurgery 48:647–6592001[CrossRef][Medline]

Added: Aug 12, 2006 9:13 pm | Trackback URI |  Email This Post  | Print