Homage to the Anti-Psychiatry Movement :
Psychotic Thoughts on the Medical Model of ‘Mental Illness’
Thinking is the brain’s neurochemical product. The medical conception of mind which prevails in modern Psychiatry is overwhelmingly dominated by this assertion i.e. the centrally located paradigm of this model asserts that states of mind originate in states of the neurochemistry of the brain. The human mind is ‘understood’ as a complex biochemical system, malfunctions in which lead to ‘disorder’, ‘disease’ or ‘illness’.
Who would doubt that in relation to conditions like Alzheimer’s Disease or Parkinson’s Disease, medicine has identified underlying biochemical causes in the brain of these disorders? And yet here social and psychological influences have even been indicated in these disorders. But these are specifically neurological disorders of a different type to those categorised as ‘mental illness’. To date, no specific causal relations – as in the mentioned neurological diseases – have been discovered and irrefutably confimed which might even imply that so-called ‘mental illnesses’ have a real, neurochemical basis in the brain itself. Quite the contrary, everything points to any neurochemical changes in these ‘illnesses’ having their primary origins in mental states. In other words these mental states have psychosocial rather than neurochemical origins and that these originated states may alter neurochemical states to the point of biochemical detection. Even the much vaunted ‘genetic susceptibilities’ have not been conclusively demonstrated beyond any rational doubt but rather retain the quality of a scientific myth which at best is propped up by dubious statistical endeavours and debatable epidemiology. The area of ‘mental illness’ remains scientifically problematic for modern medicine.
Of course, this ‘anti-psychiatry’ conception that thinking is not merely a neurological product of the brain (as scientistic thought maintains) is found and developed in the work of Laing, Szasz and others (e.g. The Divided Self, Knots, The Politics of Experience, etc). The origins and causes of mental states are, according to Psychiatry, to be found in the variabilities in the chemistry of the brain from the ‘norm’. Hence the ‘treatment’ of so-called ‘disordered mental states’ with drugs and other physical methods. The medicalisation of mental states – as forms of illness or not – are based on the categorisation of these states of mind as either falling within or outside prevailing normative social paradigms. In other words, these social paradigms are being deployed to ascertain whether or not a person is suffering from a so-called mental disorder which is thought to be essentially neurochemical in origin.
A major criterion used under the English ‘Mental Health Acts’ is strictured on the question as to whether somebody is a danger to themselves or others. Such paradigms are used to determine whether or not an individual is ‘mentally ill’ or ‘not’. But such a paradigm is broad in the extreme and one can think of all manner of situations and scenarios in which people are a danger to themselves or to others, some ‘legal’ and others ‘illegal’. It is legal for an American soldier in a helicopter to target unarmed people on the ground and simply open fire and massacre them. Was he a danger to others? Did he have ‘insight’ into his own thinking when he opened fire? Today such mass killing can be done from a control room of computers thousands of miles away from the ‘target’ linked via telecommunication and satellite devices to ‘drone’ aircraft. A man sits at his computer in a comfortable chair in an air-conditioned office of a military establishment in an American city, identifies a target at 11.45 am, executes the operation, blows to pieces a large group of villagers with a ‘smart’ bomb – men, women and children – in Afghanistan or Pakistan. He then puts his jacket on and goes and sits to eat his lunch amongst the greenery of the nearby park where mothers and fathers play with their children. After lunch, he repeats the same operation for another group of human beings in another part of Afghanistan or Pakistan. At 5 pm he goes home to his wife and children in the leafy suburbs of detached houses: “Have you had a nice day at the office, honey?” And, of course, TV News reports it just as matter-of-factly and usually wrongly. Innocent villagers become “Taliban terrorists” because NATO has said so.
If it is your designated social role and function to kill others, then when you kill them it is considered that you have fulfilled that role and function. You have not contravened any of the paradigms which govern the rules of a society which breeds war. In fact when you come home you are treated like a hero, despite the fact that a few days or even hours earlier you have just perpetrated a massacre. But if, driven by a ‘psychotic’ state of mind, you run into the street and gun down a group of bystanders who you have never seen before, then, of course, you are ‘mentally ill’. The killer computer operator can even get away without being labelled and stigmatised with a ‘personality disorder’ which the psychiatrists insist is not a form of ‘mental illness’. He is ‘sane’. Just doing his job. Like the guards in the Nazi camps, like all genocidalists. In fact, he’s paid a fat salary for doing it with prospects for promotion. In my opinion, to do such ‘work’ one must have completely and utterly lost any semblance of, or touch with, one’s own humanity and sense of it.
It is not technology per se which has engineered such a scenario but rather the social system which has co-opted it to serve its barbaric requirements. Exactly the same technology could be deployed to drop food and medicines from a ‘drone’ to the same villagers which it has just exterminated. But if our killer computer operator were to become a radical oxfamista and to devise such an operation from his chair – and were he to be found out – his ‘sanity’ might be questioned and his ‘position’ brought into question by his ‘superiors’.
The basis of ‘mental illness’, say the psychiatrists, the base out of which it originates, is the malfunctioning neurochemistry of the brain. The brain – not the specific character of a given society – is its place of origin, says Psychiatry. But in order to assess the existence or non-existence of ‘psychiatric illness’ in any individual, psychiatrists must employ the criteria and paradigms of social normativity operative in the prevailing, established socio-economic, political order. Bubonic Plague remains Bubonic Plague in medieval England as it does in the slums of East Africa today. But the same cannot be said for certain mental states. The Visionaries, Shamans and Mystics of dead societies had a completely different status within these societies to anyone exhibiting similar mental states in capitalist society at the start of the 21st century. Hallucinogenic experience – drug-induced or not – was not seen as a form of illness but rather as a form of intercommunication with the spirit world. Today such an experience – especialy if it is not drug-induced – would tend to warrant a voluntary or forced visit to the local psychiatric unit.
The diagnoses of physical illnesses and diseases contain their own intrinsic physical paradigms based on the capacity of the human body to physiologically function in a manner which is biologically standard.These are paradigms of which both Hippocrates and Galen were aware. For example, a man who cannot stop coughing would be considered to have a respiratory problem which is rooted in a real physical malfunction, obstruction, etc, because it is physiologically normative for a man to cough sometimes but not continuously all the time. Hippocrates and Galen would have thought more or less the same in ancient times.
The real problem of credibility which psychiatry faces as a branch of medicine is that the mind is not simply a product of the brain but is its social creation. Neurology, Oncology, Cardiology, Dermatology, etc, are branches of medicine which cannot, of course, neglect social factors and influences but their actual subject matters are fundamentally the creations of human physiological and biochemical processes mediated by the interaction and relations of the processes of genetic and phenotypical factors. The stress, poor diet, lack of exercise, etc, in a person’s life can contribute to cardio-vascular disease but the heart and cardio-vascular system are formed under the control of biological processes and mechanisms. Not so for the human mind. Here we are dealing fundamentally with a social creation. The Scotsman, R.D. Laing knew this as did the American, Thomas Szasz. I think today Laing – if he were still alive and had not inconveniently dropped dead of heart failure after a game of Tennis – would probably have considered Evolutionary Psychology and Psychiatry to be the perfect couple.
The diagnostic approach in Psychiatry towards mental states in general is consistent with the approach in medicine generally. However, in attempting to explain mental states exclusively within the framework of a medical biological conception, Psychiatry always had a tendency to overlook the nature of social relations and conditions (and especially the conflicts and dilemmas within the family which Esterson and Laing outlined in their work) under the direct influence of which the human mind is formed and develops. If anything, the ‘social dimension’ is usually considered to have a peripheral influence, a minor factorial in the genesis of the ‘illness’ but never the central consideration. Esterson and Laing showed that so-called Schizophrenia is more comprehensible when the specific prolematics of the given individual’s family life is investigated than when putting an undiscerned neurological cause on it. This really amounts to the diagnostics of despair because Psychiatry cannot ‘cure’ society.
Accordingly, the major approach is that biological diagnoses are made for mental states which are primarily social in their origin. The ‘scientific rigour’ of medicine demands ‘consistency’. However, in the application of this biologistic ‘consistency’ and ‘rigour’, the medicalised conception of the human mind that guides and results can only serve to hinder a real, comprehensive scientific understanding of the origins and development of those mental states which are diagnosed as forms of ‘illness’.
A scientifically demonstrable and consistent neurochemical conception of the causes of such mental states has not been developed which enables Psychiatry to successfully treat or eliminate the causes of these ‘illnesses’ in the same way that a conception of physical disease has been instrumental in the eradication of many forms of physical illness. The drug-induced neurological states, which are referred to as ‘treatments’, if anything merely serve to counter the neurochemical effects of specific states of mind. They are not addressing the ontological ground of these mental states but rather their neurochemical effects. And then such drugs may even have their own neurochemical side-effects which can really induce neurological illness.
For example, the prolonged use of Chlorpromazine (Largactil) has been associated with the onset of Parkinson’s Disease. When the capitalist state in Britain incarcerated the UCATT trade unionist Des Warren in the 1970s for his trade union activities, they gave him Chlorpromazine (aka ‘the liquid cosh’) to keep him ‘quiet’. He later went on to develop Parkinson’s. Des gives an account of his experiences at the hands of the jailers of the state power of capital in his book The Key to my Cell which is an indispensable read to anyone who thinks Britain does not have political prisoners and to anyone who thinks the spineless cowards who govern the trade union movement in Britain are anything but a rogues gallery of career-mongers, place-hunters and proxies of capital and its state power.
To understand the contemporary origins of these so-called ‘mental illnesses’, it is necessary to study the exploitative and alienating nature of the prevailing capitalist social relations and conditions; the abysmal, debilitating and crushing structure of the nuclear family being central to these relations. These relations form the ontological basis on which the interpersonal, psychosocial relationships of people are constituted. They are the same relations out of which these mental states – which Psychiatry refers to as forms of illness – originate and develop.
We do not, of course, preclude the possibility that mental states can mediate and modulate the physiology and neurochemistry of the functioning of the brain and nervous system as a whole. In this way, human physiology itself as a whole is influenced by mental processes. This, in itself, denotes a connection between the mental and the neurological. The recently developing branch of medicine known as psychoneuroimmunology testifies to that. Thinking can actually create states of feeling which affect the physiological processes of the whole body. Prolonged states of anxiety can reduce the capacity of the immune system to resist infection. But this is common knowledge and we need go no further.
But it must also be articulated that in this relation between thinking and neurochemistry, the conceptual content of specific forms of thinking can engender neurochemical effects which, in their turn, can cause the manner in which thought is consciously formulated and ordered to be rearranged and its meaning subjectively re-evaluated and re-interpreted. This ‘derangement’ of thought therefore originates in the nature of the thought-content itself which affects the chemistry of the brain to affect thought itself, altering the ordering and subjective psychological meaning of its content (and thereby ‘mood’) for the thinking individual.
This reflexive process will undoubtedly confound those who have a formal conception of causality in which cause is cause and effect is effect and never the twain shall meet. Different changes in neurophysiology and neurochemistry can arise out of different forms of thinking with their differing conceptual content and, in their turn, affect thought process itself. Without an admission of this relationship, there could be no basis for an explanation of how thinking can modulate emotional and feeling states and how these can affect general physiology. And, moreover, there would be no theoretical scientific grounds for understanding why psychotropic drugs have specific affects on the mind.
Different mental states exist in relation to and with the complexities and progression of different thought-content. Is not the ‘material’ of so-called ‘mental disorder’ to be found in the psychosocial nature of this content which is not a direct, material product of the human brain (e.g. in the same way the stomach produces acid or the liver produces bile) but which is formed within, and is therefore a reflection of, the complexity of the network and fabric of social relations and conditions?
When I was an undergraduate Biochemist, many years ago, during laboratory studies, I had a rather heated conversation with a supervising post-graduate on the nature of thought. The latter insisted that the thinking process was entirely a “biochemical system” in the same way that glucose or fatty acid metabolism is at a cellular level but just on a larger, more complex scale. “There’s nothing social about it”, he remarked with unbounding conviction, “you’re studying Biochemistry here, not Sociology. Thinking is pure and simple a chemical process”. For the Biochemist perhaps but not in itself as a process. This sums up the scientistic approach to mind. Thinking is the brain’s chemistry taking place within the skull and society is something out there which doesn’t intrude and is best left to speculating sociologists. Today the same subject of discussion with a computer specialist might result in the conviction that the brain is the ‘hardware’ and that the thinking process itself is the ‘software’.
It is the basic thesis of these brief notes that the real source of any given form of ‘mental illness’ – which is a definite state of the mind taking particular form in a given individual under definite social conditions and relations – is not the human brain per se but the social relations and conditions on the basis of which and through which individuals constitute their interpersonal relationships. The individual experience of these conditions and relations, and the manner in which these experiences are assimilated psychologically, determines, to a large extent, the nature of those mental states which are termed ‘illnesses’ i.e. a state of mind which is a product of the history of an individual’s social experience. This implies that under definite social relations and conditions so-called ‘mental illness’ (we use their term) is implicit in the human mind i.e. its possibility is always there given the very nature of these conditions and relations. In such societies, therefore, ‘mental illness’ is latent in the life of every human individual. Changes, alterations, transformations in personal conditions, circumstances, relationships can actualise what is latent; transform what is possible into a reality. But then again, there is a multitude of mental states which are also possible. All these states of mind are products of, and reactions to, the realities of the conditions of social life and how these realities have determined the personal historical development of the individual. They are, taken collectively, psychological manifestations of the real nature of social relations, of their intrinsic contradictions and structures. They are not simply the brain’s chemistry going through its motions.
The subjective experience of the individual, no matter how bizarre its beliefs and notions, has real ontological grounds in the whole society in which they live. And this in so far as this ‘subjectivity’, in its different aspects and sides, is the outcome of the individual’s engagement and interaction with this historically-posited society in the course of their life-history within it.
I was informed by a friend recently that the former TV presenter David Icke, who, in his heyday, was quite well-known as a BBC sports presenter and later published a book entitled The Truth Vibrations, actually believes the British royal family to be reptiles disguised in human form, reptiles incarnate. I cannot vouch that he still believes this.
However, if David Icke still believes the Queen to be a reptile incarnate, (to be more specific I think it is giant lizard) in human form, then everytime he sees the Queen either on the TV or in the flesh, for him he is seeing, accordingly, a disguised reptile despite the fact that all actuality and our collective experience of it contradicts this bizarre belief. But the psychological processing by David Icke of his own life-history, its experiences, thoughts, feelings, etc, in this society, has formed the personal ontological grounds to feed his psyche with enough content of a specific nature for him to arrive at this somewhat incredible belief from someone who was once a well-known TV personality. Nevertheless, we are reminded to be cautious and listen to Hegel in his Philosophy of Mind when he states that..
Error and folly only becomes madness when the individual believes his merely subjective ideas to be objectively present to him and clings to it in the face of the actual objectivity which contradicts it….. To the madman, his purely subjective world is quite as real as the objective world
(Hegel. Philosophy of Mind. (Clarendon, Oxford, 1971) Zusatze p.128)
Let us not be glib about such matters. For bizarre notions, in a legion of forms, like this are the way millions of people experience the reality of the present mind-warping social system the world over. That the Prince Consort is the Reptile-in-Chief is perhaps no less bizarre than the notion that we live in a classless society as promulgated by some British Tory MPs. And some of them actually believe it and insist on its reality.
The ‘world of society’ gives rise to the ‘particular internal psychological world of the individual’ and the latter gives rise to mental states which contain the possibility of the identification of merely subjective ideas as actually existing forms of reality independent of the thinking subject. With the example given, the thought that a really existent, specific person is actually a member of a totally different order of animal species in human form.
We can develop our ideas a little, or rather move them on, by using Vygotsky’s concept of the internal dialogue.
The process of monitoring our own thinking is seen as a self-conscious process, an internal dialogue taking place in each and every one of us as we reflect on the progression or train of our own thoughts and feelings. Perhaps these internal dialogues play a role in the psychogenesis of the so-called disordered mental states and in their psychodynamics. What if, in these mental states, internal dialogues are subjectively identified by the individual as a conversation between the ‘self’ and an external ‘other’? The ‘ownership’ of one half of the internal dialogue is transferred to the fictitious ‘other’ which the individual identifies as being objectively real i.e. actually existing outside of the head of the individual.
The internal relationship of the dialogue then becomes identified as a relationship between the ‘self’ and an external ‘other’. This ‘other’ may then take a personalised – often religious – form. The internal dialogue (of self-conscious awareness) becomes replaced in the subject by a kind of fictitious dialogue between the ‘self’ (devoid of the self-monitoring and self-integrating capacity of conscious reflection) and some external ‘other’. An ‘externalised’ fictitious dialogue replaces that of the self-consciously aware internal dialogue so that the individual loses awareness that this subjectively identified ‘externalised’ dialogue is really a self-contained internal dialogue of consciousness and that this ‘external other’ is really just the individual talking to himself in his own mind.
Why might a psychological dissociation take place in which the two sides of the inner dialogue become separated into an internal ‘self’ and a subjectively identified external ‘other’? It may be interesting to note here that Vygotsky says that the internal dialogue – as a definite psychological structural form – is a psychological internalisation of the real social dialogues that take place between an individual and other people in the course of socialisation during childhood and after. Perhaps the fictitious dialogues of ‘mental illness’ are delusionary projections of these real dialogues; the often bizarre content of which may arise out of the particular thoughts and beliefs – conscious or subconscious – which are charged with a powerful emotional content. Of course, such fictitious dialogues are characteristics of specific types of ‘mental illness’ (what psychiatry calls “schizophrenic”). People report hearing voices speaking to them as if from an external source which they sometimes identify as ‘God’ and they refer to having conversations with fictitious figures as if they are really existent, for example, in the same room as them. The founders of religious movements report having visitations from God, angels, spirits, ancestral ghosts, etc, and then ascribe themselves a unique relationship with these identified externalised ‘othernesses’. This relationship beween the significant ‘self’ and the externalised ‘other’ in the dissociation of the internal dialogue becomes dualistically replicated on the wider level of the religion where the devotees and the deity or divinity constitute a relation of the collective ‘selves’ in the worship of the ‘other’.
If we accept that a rapid change of mental state takes place between the integrated self-conscious, monitoring dialogue and the dissociated fictitious form in which a part of the whole self is externalised as the other which speaks to self, then why should such a rapid change take place? Individuals are subjected to a range of psychosocial ‘pressures’, stress, dilemmas, anxiety, personal crises and social demands, etc, which they may increasingly find emotionally difficult or even painful to address through the psychological mechanism of the internal dialogue. The rupturing of this dialogue may be a mechanism of escape from addressing the direct nature of such problems in the life of the individual. Eventually a critical point is reached where the mind can no longer hold and contain the tensions and conflicts which have accumulated within itself and the disintegration of the whole mechanism of the internal dialogue takes place. Something ‘snaps’ or even ‘flips’- so to speak – and the internal dialogue becomes transformed into the form in which the other is identified as external to the self. The mental stress and pain may induce neurochemical alterations which then, in their turn, may trigger the ‘flip’ from one to the other fictitious form. In other words, the disruption of the operation of the internal dialogue arises out of the need to avoid the emotional suffering associated with problems in the social life of the individual.
The different sides of the dialogue become psychologically dissociated so that one side is subjectively identified as the internal ‘self’ and the other side is psychologically identified as an external ‘other’. The self-conscious so-called ‘insightful’ ‘sane’ form of the internal dialogue becomes transformed into the ‘psychotic’ ‘insane’ form of ‘inner self’ and ‘external other’.
Is this schism of the internal dialogue into an ‘internal self’ and ‘external other’ a psychological manifestation of the ‘psychotically’-thinking individual’s attempt to transcend the emotional dynamics of his internal dialogue? The transformation of these dialogues into an ‘internal self’ and an ‘external other’ serves to displace them into a different psychological scenario. The ‘psychotic’ individual ceases to be aware that an internal dialogue is actually taking place and conceives that the dialogue is between the ‘self’ and an external ‘other’. This may account for the so-called ‘thought-insertion’ (auditory hallucinations) which psychiatry commonly associates with those ‘schizophrenic’ mental states in which the external other is conceived to speak directly to the individual as if from an external source outside the ‘self’. The individual has lost the ‘insight’ (a Psychiatrist’s term) because of the psychological disjunction of the different sides of the internal dialogue. They have ceased to be aware (self-awareness) that what is actually taking place is a continuation of an internal dialogue of consciousness.
Perhaps the so-called ‘anti-psychotic’ drugs help to modify the neurochemical manifestations of the process and thereby help the individual to return to some kind of ‘insight’, i.e. bring the individual back to the normalised, self-consciously aware, operation of the internal dialogue. But these drugs do not fundamentally address the social ontological grounds of these mental states.
Therefore so-called ‘mental illness’ could be viewed as the psychological outcome of the individual’s inability to ‘cope’ with the ‘pressures’ of social life. I tend to think that there is neither a genetic cause nor a genetic pre-disposition towards so-called ‘mental illness’. Rather, every individual can become ‘mentally ill’ as a result of the inabilities to ‘cope’, so to speak.
Associated changes in neurochemistry which serve to induce the move from one state (‘sanity’) to the other and tend to maintain it (‘insanity’) are simply changes which can occur in anyone by virtue of the neurochemical effects of changed psychological states as a result of this inability to ‘cope’. And pivotal to which, I think, is the emotional problems and suffering in the social life of the individual. If this is so, this raises an important ontological question: In what kind of society are human relationships possible without these emotional problems? Indeed, are human relations without these attributes necessary and/or desirable?
Will human beings always suffer from so-called ‘mental illnesses’? Will social conditions and relations always provide the ontological ground for the psychogenesis of such mental states? Oppressive, coercive and exploitative social relations cripple human beings both physically and mentally. However, they also motivate people to overthrow such relations and replace them with relationships more fitting and deserving of people’s humanity.
Anything that feeds our hatred of the rule of capital and its state power must also contain a positive side to it as well as a negative. That which oppresses simultaneously serves to move us in our struggle to end that oppression regardless of its form.
An understanding of the nature of society must be the starting point for the understanding of so-called ‘mental illness’. The neurochemistry of the brain in and by itself cannot form the basis for such an understanding. The forms of human behaviour, which are both a product and manifestation of these mental states, must therefore be explained from the nature of the individual’s personal psychosocial experience of the social conditions and relations of which he or she is a intrinsic active part and which form the determining, ontological basis for the development of the human personality as a whole.
Because a global socialist human life will be without the conflicts of interest and schisms of social class and eventually without the same in the nuclear family, because it will be without wars between human beings and the debilitating competition which characterises capitalist commodity society, because it will eventually eliminate the exploitation, coercion and oppression of man by man and end the disturbing destruction of Nature by man, because the whole system of social and interpersonal relations will be completely revolutionised by the transcendence of the crippling and alienating division of labour, because the human individual will have all the opportunities to freely develop his or her skills, talents and abilities and more in their communal association with their fellow human beings, because of all this and more, I think that socialist human life will be a far ‘saner’ society than the present one. It is one of the reasons why I am a convinced student of Marx. It is just another reason amongst many, speaking for myself, why such a life is the only one really worth fighting for.