Journal
of the International Association of Transdisciplinary Psychology
PSYCHIATRY
AGAINST ITSELF
Radicals,
Rebels, Reformers, and Revolutionaries
Abstract
This essay inverts
the logic of anti-psychiatry to
describe various movements critical of the profession as psychiatry against itself. Like Alain Badiou’s contrast of
philosophers with anti-philosophers, anti-psychiatrists compel the established
tradition of psychiatry to confront fresh problems with new perspectives to
renew psychiatric thought. The dual themes that emerge from this study are: tradition vs. innovation and negation vs. affirmation.
This thesis is threefold: (1) What is intriguing about
the psychiatrists associated with the anti-psychiatry movement and what unites
them is negation. In each case, their
work proceeds by a key critical negation,
to the point that the defining characteristic of anti-psychiatric psychiatrists
is precisely negation. (2) Each negation and how it was practised made each
anti-psychiatrist, depending on his temperament and circumstances, into a rebel, a radical, a reformer or a
revolutionary anti-psychiatrist. (3) Each anti-psychiatrist wielded an
instrument for change that I have coined Badiou’s
sickle. Based on a key critical negation, each anti-psychiatrist resisted
the suturing of psychiatry to a given subdiscipline, regional practice, or
dominant ideology by separating it gently or more forcefully with Badiou’s scalpel, scissors, shears, scythe
or sickle to liberate psychiatry as a general theory and practice and
return it to its originary task.
Four key 20th
century Western psychiatrists who were critical of their field are examined
through their basic attitudes and contributions to the redefinition of
psychiatry. Scotsman Ronald David Laing (1927-1989) was a radical psychiatrist-psychoanalyst, returning psychiatry to its
clinical roots, with his trenchant critiques of Ludwig Binswanger’s existential
analysis and psychiatric practice generally, calling for social phenomenology, negating
the mystification of mental illness by placing the suffering of the self in
social, family, and political context. The French Jacques Lacan (1901-1981) was
both a subversive psychoanalyst and a
psychiatric rebel, affirming the centrality of Freud in his construction of
psychoanalysis while rebelling against both the psychoanalytic and psychiatric
establishment, negating the
institutionalization of psychoanalytic practice, whether in the academy or
in psychoanalytic institutes. Italian psychiatrist Franco Basaglia (1924-1980)
was a reformer who instigated psychiatric deinstitutionalization
around the world with his key text, L’Istituzione
negata, “The Institution Negated” (1968) and by joining the Radical Party
in the Italian Parliament that reformed Italy’s mental health legislation. As a
psychiatrist, philosopher and
revolutionary, Martinican Frantz Fanon (1925-1961) negated nothing less than the claim of European psychiatry to
universalism in his radical critiques of the psychology of colonization and
identity formation, offering a more humane psychology on which to found
psychiatry in a revolutionary program for a new society. Fanon’s critiques were
far more trenchant than other anti-psychiatrists, with far-reaching impacts on
critical theory, post-colonial studies and Marxist political theory, yet his
project remained unfulfilled when he died all-too-young, bequeathing us
psychiatry’s unfinished revolution.
Two other critical thinkers are examined to complete this study. One
is Hungarian-American Thomas Szasz (1920–2012) whom I characterize as a reactionary psychiatrist in the guise of
a progressive who negated the reality of
psychiatric disorders. Szasz trivialized mental and relational suffering as
mere “problems in living,” arguing against the majority of psychiatric
disorders having biomedical origins, thus promoting the medical model in its
most reductive form. In contrast with the other anti-psychiatrists, Szasz’s
negation was destructive, leading the way to greater stigmatization of mental
illness and diminished resources and services. Finally, the work of French psychologist
and philosopher Michel Foucault (1926-1984) overshadows the entire discourse of
anti-psychiatry, just as he informs and impels us to reorder medical perceptions and psychiatric thought, upending the very
“order of things.” Foucault’s negation
was the most disturbing to psychiatric thought because he questioned the
very basis for imagining madness and reason/unreason.
[1] Prepared for a seminar on “Psychiatry and the
Humanities” at the University of Montreal Department of Psychiatry that is also
offered as a course in the Faculty of Medicine. The ideas were elaborated as
part of my philosophical investigations for a doctorate in philosophy at the
European Graduate School, Trauma and
Event: A Philosophical Archaeology (Di Nicola, 2012b). This essay sets out
some of the key ideas I will explore in a forthcoming book with the working
title, Deconstructing Crazy: Letters to
Young Psychiatrists.
[2] Vincenzo Di Nicola, M.Phil., M.D., Ph.D.,
F.R.C.P.C, F.A.P.A., is a psychologist, psychiatrist and philosopher. Di Nicola
is a tenured Full Professor of Psychiatry at the University of Montreal where
he is Chief of Child and Adolescent Psychiatry and founder of a seminar and
course on Psychiatry and the Humanities.
