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== History == === Precursors === [[File:Narrenturm Vienna June 2006 575.jpg|thumb|[[Vienna]]'s [[Narrenturm (hospital)|Narrenturm]]—[[german language|German]] for "fools' tower"—was one of the earliest buildings specifically designed as a "madhouse". It was built in 1784.]] The first widespread challenge to the prevailing medical approach in Western countries occurred in the late 18th century.<ref name="Dain 1994" /> Part of the progressive [[Age of Enlightenment]], a "[[moral treatment]]" movement challenged the harsh, pessimistic, [[Somatic theory|somatic]] (body-based) and restraint-based approaches that prevailed in the system of hospitals and "madhouses" for people considered mentally disturbed, who were generally seen as wild animals without reason.<ref name="Dain 1994" /> Alternatives were developed, led in different regions by ex-patient staff, physicians themselves in some cases, and religious and lay philanthropists.<ref name="Dain 1994" /> This "moral treatment" was seen as pioneering more humane psychological and social approaches, whether or not in medical settings; however, it also involved some use of physical restraints, threats of punishment, and personal and social methods of control.<ref name="Dain 1994" /> As it became the establishment approach in the 19th century, opposition to its negative aspects also grew.<ref name="Dain 1994" /> According to [[Michel Foucault]], there was a shift in the perception of madness, whereby it came to be seen as less about [[delusion]], i.e. disturbed judgment about the truth, than about a disorder of regular, normal behavior or will.<ref>Foucault (1997), pp. 39-50</ref> Foucault argued that, prior to this, doctors could often prescribe travel, rest, walking, retirement and generally engaging with nature, seen as the visible form of truth, as a means to break with artificialities of the world (and therefore delusions).<ref>Foucault (1997), p. 42</ref> Another form of treatment involved nature's opposite, the theater, where the patient's madness was acted out for him or her in such a way that the delusion would reveal itself to the patient. Thus the most prominent therapeutic technique became to confront patients with a healthy sound will and orthodox passions, ideally embodied by the physician.{{citation needed|date=February 2022}} The "cure" involved a process of opposition, of struggle and domination, of the patient's troubled will by the healthy will of the physician. It was thought the confrontation would lead not only to bring the illness into broad daylight by its resistance, but also to the victory of the sound will and the renunciation of the disturbed will. ''We must apply a perturbing method, to break the spasm by means of the spasm.... We must subjugate the whole character of some patients, subdue their transports, break their pride, while we must stimulate and encourage the others'' ([[Jean-Étienne Dominique Esquirol|Esquirol, J. E. D.]], 1816<ref name=DelaFolie>''De la Folie''. Chapter 5: ''Traitement de la folie,'' pp. 132-133: in Foucault (1997), p. 43</ref>). Foucault also argued that the increasing [[internment]] of the "mentally ill" (the development of more and bigger asylums) had become necessary not just for diagnosis and classification but because an enclosed place became a requirement for a treatment that was now understood as primarily the contest of wills, a question of submission and victory. [[File:Kewwoodcut.png|thumb|upright|left|Close up of the "Horrors of [[Kew Asylum]]" featured in Lee's Pictorial Weekly Budget Police News in 1876]] The techniques and procedures of the asylums at this time included "isolation, private or public interrogations, punishment techniques such as cold showers, moral talks (encouragements or reprimands), strict discipline, compulsory work, rewards, preferential relations between the physician and his patients, relations of vassalage, of possession, of domesticity, even of servitude between patient and physician at times".<ref name=DelaFolie /> Foucault summarized these as "designed to make the medical personage the 'master of madness'"<ref name=DelaFolie /> through the power the physician's will exerts on the patient. The effect of this shift then served to inflate the power of the physician relative to the patient, correlated with the rapid rise of internment (asylums and forced detention).<ref>''De la Folie'': in Foucault (1997), p. 44.</ref> Other analyses suggest that the rise of [[History of psychiatric institutions|asylums]] was primarily driven by [[industrialization]] and [[capitalism]], including the breakdown of traditional family structures. By the end of the 19th century, psychiatrists often had little power in the overcrowded asylum system, acting mainly as administrators who rarely attended to patients in a system where therapeutic ideals had turned into institutional routines.<ref name="Crossley2006">{{cite book|author=Crossley, Nick |chapter=Contextualizing contention |title=Contesting Psychiatry: Social movements in Mental Health |publisher=Routledge |location=New York |year=2006 |isbn=978-0-415-35417-2 |chapter-url=https://books.google.com/books?id=RuGQSN6sBA8C}}</ref> In general, critics point to negative aspects of the shift toward so-called "moral treatments", and the concurrent widespread expansion of asylums, medical power and involuntary hospitalization laws, that played an important part in the development of the anti-psychiatry movement.<ref name="Crossley1998">{{cite journal |first=Nick |last=Crossley |url=http://cat.inist.fr/?aModele=afficheN&cpsidt=2352280 |title=R. D. Laing and the British anti-psychiatry movement: a socio–historical analysis |journal=Social Science & Medicine |volume=47 |issue=7 |date=1 October 1998 |pages=877–889 |doi=10.1016/S0277-9536(98)00147-6 |pmid=9722108 |access-date=31 August 2011 |archive-date=27 January 2012 |archive-url=https://web.archive.org/web/20120127001650/http://cat.inist.fr/?aModele=afficheN&cpsidt=2352280 |url-status=live }}</ref> [[File:Badverpleging.jpg|thumb|Internee being restrained in a bathtub]] [[File:Man in restraint chair; by H. Clarke; 1869 Wellcome L0019069.jpg|thumb|upright|Internee in a restraint chair at the [[Stanley Royd Hospital|West Riding Pauper Lunatic Asylum]], 1869]] Various 19th-century critiques of the newly emerging field of psychiatry overlap thematically with 20th-century anti-psychiatry, for example in their questioning of the [[medicalisation|medicalization]] of "madness". Those critiques occurred at a time when physicians had not yet achieved [[hegemony]] through psychiatry, however, so there was no single, unified force to oppose.<ref name="Crossley1998" /> Nevertheless, there was increasing concern at the ease with which people could be confined, with frequent reports of abuse and illegal confinement. For example, [[Daniel Defoe]], the author of ''[[Robinson Crusoe]]'', had previously argued for more government oversight of "madhouses" and for due process prior to involuntary internment.<ref>Defoe, Daniel (1697). An Essay upon Projects. London: Cockerill</ref> He later argued that husbands used asylum hospitals to incarcerate their disobedient wives,<ref>Defoe, Daniel (1728). Augusta Triumphans: Or, The Way To Make London The Most Flourishing City In The Universe.</ref> and in a subsequent pamphlet that wives even did the same to their husbands.<ref>Defoe, Daniel (1740) quoted in {{Cite journal|pmc=2745864|year=2008|last1=Somasundaram|first1=O|title=Private psychiatric care in the past: With special reference to Chennai|journal=Indian Journal of Psychiatry|volume=50|issue=1|pages=67–69|doi=10.4103/0019-5545.39765|pmid=19771313 |doi-access=free }}</ref> It was also proposed that the role of asylum keeper be separated from doctor, to discourage exploitation of patients.<ref>Faulkner, B. (1789). Observation on the General and Improper Treatment of Insanity. London</ref> There was general concern that physicians were undermining personhood by medicalizing problems, by claiming they alone had the expertise to judge, and by arguing that mental disorder was physical and hereditary. The [[Alleged Lunatics' Friend Society]] arose in England in the mid-19th century to challenge the system and campaign for rights and reforms.<ref name="Hervey1986">{{cite journal|author=Hervey N |date=July 1986 |title=Advocacy or folly: the Alleged Lunatics' Friend Society, 1845–63 |journal= Medical History|volume=30 |issue=3 |pages=245–275 |pmc=1139650 |pmid=3523075 |doi=10.1017/S0025727300045701}}</ref> In the United States, [[Elizabeth Packard]] published a series of books and pamphlets describing her experiences in the Illinois insane asylum, to which she had been [[involuntary commitment|committed]] at the request of her husband. Throughout, the [[Social class|class]] nature of [[mental hospital]]s and their role as agencies of control were well recognized. The new psychiatry was partially challenged by two powerful social institutions – the church and the legal system. These trends have been thematically linked to the later 20th century anti-psychiatry movement.<ref name="Dain1989">{{cite journal|last=Dain |first=N. |year=1989 |url=http://www3.interscience.wiley.com/journal/112416171/abstract |archive-url=https://archive.today/20130105053454/http://www3.interscience.wiley.com/journal/112416171/abstract |url-status=dead |archive-date=2013-01-05 |title=Critics and dissenters: Reflections on anti-psychiatry in the United States |journal=Journal of the History of the Behavioral Sciences |volume=25 |issue=1 |pages=3–25|doi=10.1002/1520-6696(198901)25:1<3::AID-JHBS2300250102>3.0.CO;2-G|pmid=2647837}}</ref> As psychiatry became more professionally established during the nineteenth century (the term itself was coined in [[1808 in Germany]] by [[Johann Christian Reil]], as "Psychiaterie") and developed allegedly more invasive treatments, opposition increased.<ref>{{cite book|last=Kleinman |first=Arthur |title=Rethinking Psychiatry: From Cultural Category to Personal Experience |url=https://archive.org/details/rethinkingpsychi0000klei |url-access=registration |publisher=Collier Macmillan |year=1988 |isbn=978-0-02-917442-5}}{{page needed|date=January 2014}}</ref> In the Southern US, [[Slavery in the United States|black slaves]] and [[Abolitionism in the United States|abolitionists]] encountered [[drapetomania]], a pseudo-scientific diagnosis that presented the desire of slaves to run away from their masters as a symptom of pathology.<ref>{{cite web |url=https://jimcrowmuseum.ferris.edu/question/2005/november.htm |title=Question of the Month – Jim Crow Museum at Ferris State University |access-date=2024-10-05 |archive-date=2011-06-14 |archive-url=https://web.archive.org/web/20110614115746/http://www.ferris.edu/jimcrow/question/nov05.htm |url-status=live }}</ref> There was some organized challenge to psychiatry in the late 1870s from the new speciality of [[neurology]], largely centered around control of state insane asylums in New York.<ref>{{cite journal |last1=Torrey |first1=E. Fuller |title=The Year Neurology Almost Took Over Psychiatry |journal=Psychiatric Times |date=January 1, 2002 |volume=19 |issue=1 |url=https://www.psychiatrictimes.com/view/year-neurology-almost-took-over-psychiatry |access-date=26 October 2022 |archive-date=26 October 2022 |archive-url=https://web.archive.org/web/20221026235351/https://www.psychiatrictimes.com/view/year-neurology-almost-took-over-psychiatry |url-status=live }}</ref> Practitioners criticized mental hospitals for failure to conduct scientific research and adopt the modern therapeutic methods such as nonrestraint. Together with lay reformers and social workers, neurologists formed the National Association for the Protection of the Insane and the Prevention of Insanity. However, when the lay members questioned the competence of asylum physicians to even provide proper care at all, the neurologists withdrew their support and the association floundered.<ref name="Dain1989" /> === Early 1900s === It has been noted that "the most persistent critics of psychiatry have always been former mental hospital patients", but that very few were able to tell their stories publicly or to confront the psychiatric establishment openly, and those who did so were commonly considered so extreme in their charges that they could seldom gain credibility.<ref name="Dain1989" /> In the early 20th century, ex-patient [[Clifford W. Beers]] campaigned to improve the plight of individuals receiving public psychiatric care, particularly those committed to state institutions, publicizing the issues in his book, ''A Mind that Found Itself'' (1908).<ref>{{cite book|first=Clifford |last=Beers |title=A Mind That Found Itself |place=Pittsburgh and London |publisher=University of Pittsburgh Press |year=1981 |isbn=978-0-8229-5324-1}}</ref> While Beers initially condemned psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient involvement in the movement, he was influenced by [[Adolf Meyer (psychiatrist)|Adolf Meyer]] and the psychiatric establishment, and toned down his hostility since he needed their support for reforms. In Germany during this time were similar efforts which used the term "Antipsychiatrie".<ref>Bangen, Hans: Geschichte der medikamentösen Therapie der Schizophrenie. Berlin 1992, {{ISBN|3-927408-82-4}} Page 87</ref> Beers' reliance on rich donors and his need for approval from experts led him to hand over to psychiatrists the organization he helped found, the National Committee for Mental Hygiene, which eventually became the [[National Mental Health Association]].<ref name="Dain1989" /> In the UK, the National Society for Lunacy Law Reform was established in 1920 by angry ex-patients who sought justice for abuses committed in psychiatric custody, and were aggrieved that their complaints were patronizingly discounted by the authorities, who were seen to value the availability of medicalized internment as a 'whitewashed' extrajudicial custodial and punitive process.<ref name="Fennell1996">{{cite book|last=Fennell|first=Phil |year=1996|url=https://books.google.com/books?id=XqlBoZ_Vm7UC |title=Treatment Without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 |publisher=Routledge |isbn=978-0-415-07787-3 |page=108}}</ref> In 1922, ex-patient Rachel Grant-Smith added to calls for reform of the system of neglect and abuse she had suffered by publishing "The Experiences of an Asylum Patient".<ref>{{cite book|first=Rachel|last=Grant-Smith|year=1922|url=http://mcgovern.library.tmc.edu/data/www/html/texascoll/Psych/EAP/EAPContents.htm|title=The Experiences of an Asylum Patient|publisher=John P. McGovern Historical Collections and Research Center|access-date=2011-08-31|archive-url=https://web.archive.org/web/20080706120312/http://mcgovern.library.tmc.edu/data/www/html/texascoll/Psych/EAP/EAPContents.htm|archive-date=2008-07-06|url-status=dead}}</ref> In the US, [[We Are Not Alone (group)|We Are Not Alone]] (WANA) was founded by a group of patients at Rockland State Hospital in New York, and continued to meet as an ex-patient group.<ref name="Reaume2002">{{cite journal|last=Reaume |first=G |date=July 2002 |title=Lunatic to patient to person: nomenclature in psychiatric history and the influence of patients' activism in North America |journal=Int J Law Psychiatry |volume=25 |issue=4 |pages=405–26 |doi=10.1016/S0160-2527(02)00130-9 |pmid=12613052}}</ref> French surrealist [[Antonin Artaud]] would also openly criticize that no patient should be labeled as "mentally ill" as an exterior identification, as he notes in his 1925 ''L'Ombilic des limbes'', as well as arguing against narcotic's restriction laws in France. Much influenced by the [[Dada]] and [[surrealism|surrealist]] enthusiasms of the day, he considered [[dream]]s, thoughts and visions no less real than the "outside" world.<ref>{{cite book |last1=Armstrong |first1=Lynn Shields & Leslie |title=Social Change and the Global Environment |date=2018 |publisher=EDTECH |isbn=978-1839474293}}</ref> In this era before [[penicillin]] was discovered, [[eugenics]] was popular. People believed [[M'Naghten rules#Disease of the mind|diseases of the mind]] could be passed on so [[compulsory sterilization]] of the [[Law for the Prevention of Hereditarily Diseased Offspring|mentally ill was enacted in many countries]].<ref>{{Cite journal |last=Reilly |first=Philip R. |date=2015 |title=Eugenics and Involuntary Sterilization: 1907-2015 |url=https://pubmed.ncbi.nlm.nih.gov/26322647/ |journal=Annual Review of Genomics and Human Genetics |volume=16 |pages=351–368 |doi=10.1146/annurev-genom-090314-024930 |issn=1545-293X |pmid=26322647}}</ref> === 1930s === In the 1930s several controversial medical practices were introduced and framed as "treatments" for mental disorders, including inducing seizures (by [[Electroshock therapy|electroshock]], [[insulin]] or other drugs) or psychosurgery ([[lobotomy]]). In the US, beginning in 1939 through 1951, over 50,000 lobotomy operations were performed in mental hospitals, a procedure ultimately seen as inhumane.<ref name="Whitaker">{{cite book|last=Whitaker |first=Robert |title=Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill |publisher=Basic Books |year=2004 |isbn=978-0-7382-0799-5|title-link=Mad in America }}</ref> [[Holocaust]] historians argued that the [[medicalization]] of social programs and systematic [[euthanasia]] of people in German [[mental institution]]s in the 1930s provided the institutional, procedural, and doctrinal origins of the [[mass murder]] of the 1940s. The Nazi programs were called [[Action T4]] and [[Action 14f13]].<ref>{{cite book |last=Lapon |first=Lenny |title=Mass Murderers in White Coats : Psychiatric Genocide in Nazi Germany and the United States |publisher=Psychiatric Genocide Research Inst |year=1986 |isbn=978-0-9614961-9-7 |url=https://archive.org/details/massmurderersinw00lapo }}</ref><ref>{{cite web |url=http://home.iprimus.com.au/burgess1/breggin.html |title=The Psychiatric Holocaust – excerpts |access-date=2006-12-24 |archive-date=2008-02-10 |archive-url=https://web.archive.org/web/20080210183053/http://home.iprimus.com.au/burgess1/breggin.html |url-status=dead }}</ref><ref name="Check1">{{cite journal|last=Strous |first=Rael |title=Psychiatry during the Nazi era: ethical lessons for the modern professional |journal=Annals of General Psychiatry |volume=6 |issue=8 |year=2007|doi=10.1186/1744-859X-6-8|pages=8 |pmid=17326822 |pmc=1828151 |doi-access=free }}</ref> The [[Nuremberg Trials]] convicted a number of psychiatrists who held key positions in Nazi regimes. As one Swiss psychiatrist stated: "A not so easy question to be answered is whether it should be allowed to destroy lives objectively 'unworthy of living' without the expressed request of its bearers. (...) Even in incurable mentally ill ones suffering seriously from hallucinations and melancholic depressions and not being able to act, to a medical colleague I would ascript the right and in serious cases the duty to shorten — often for many years — the suffering" (Bleuler, Eugen, 1936: "Die naturwissenschaftliche Grundlage der Ethik". Schweizer Archiv Neurologie und Psychiatrie, Band 38, Nr.2, S. 206). === 1940s and 1950s === The post-World War II decades saw an enormous growth in psychiatry; many Americans were persuaded that psychiatry and psychology, particularly [[psychoanalysis]], were a key to happiness. Meanwhile, most hospitalized mental patients received at best decent custodial care, and at worst, abuse and neglect. The psychoanalyst [[Jacques Lacan]] has been identified as an influence on later anti-psychiatry theory in the UK, and as being the first, in the 1940s and 50s, to professionally challenge psychoanalysis to reexamine its concepts and to appreciate psychosis as understandable. Other influences on Lacan included poetry and the surrealist movement, including the poetic power of patients' experiences. Critics disputed this and questioned how his descriptions linked to his practical work. The names that came to be associated with the anti-psychiatry movement knew of Lacan and acknowledged his contribution even if they did not entirely agree.<ref name="Nasser1995">{{cite journal |first=Mervat |last=Nasser |url=http://pb.rcpsych.org/cgi/content/abstract/19/12/743 |title=The rise and fall of anti-psychiatry |journal=Psychiatric Bulletin |year=1995 |volume=19 |pages=743–746 |doi=10.1192/pb.19.12.743 |issue=12 |access-date=2011-08-31 |archive-date=2011-07-17 |archive-url=https://web.archive.org/web/20110717000132/http://pb.rcpsych.org/cgi/content/abstract/19/12/743 |url-status=live }}</ref> The psychoanalyst [[Erich Fromm]] is also said to have articulated, in the 1950s, the secular humanistic concern of the coming anti-psychiatry movement. In ''The Sane Society'' (1955), Fromm wrote "An unhealthy society is one which creates mutual hostility [and] distrust, which transforms man into an instrument of use and exploitation for others, which deprives him of a sense of self, except inasmuch as he submits to others or becomes an automaton"..."Yet many psychiatrists and psychologists refuse to entertain the idea that society as a whole may be lacking in sanity. They hold that the problem of mental health in a society is only that of the number of 'unadjusted' individuals, and not of a possible unadjustment of the culture itself".<ref>{{cite news |last=Levine |first=B. |date=10 September 2008 |url=http://www.huffingtonpost.com/bruce-e-levine/thinking-critically-about_b_125019.html |title=Thinking Critically About Scientology, Psychiatry, and Their Feud |newspaper=Huffington Post |access-date=31 August 2011 |archive-date=14 November 2012 |archive-url=https://web.archive.org/web/20121114140250/http://www.huffingtonpost.com/bruce-e-levine/thinking-critically-about_b_125019.html |url-status=live }}</ref> [[File:St Thomas Thurstonland 014.jpg|thumb|left|200px|Graveyard attached to the Church of St. Thomas in West Yorkshire, England, where thousands of internees from [[Storthes Hall Hospital]] are buried in unmarked graves]] In the 1950s new psychiatric drugs, notably the antipsychotic [[chlorpromazine]], slowly came into use. Although often accepted as an advance in some ways, there was opposition, partly due to serious adverse effects such as [[tardive dyskinesia]], and partly due their "chemical straitjacket" effect and their alleged use to control and intimidate patients.<ref name="Whitaker" /> Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control.<ref name="Whitaker" /> There was also increasing opposition to the large-scale use of psychiatric hospitals and institutions, and attempts were made to develop [[Community mental health services|services in the community]].{{Citation needed|date=December 2017}} [[File:Royal Earlswood Park - geograph.org.uk - 1214701.jpg|thumb|right|200px|[[Royal Earlswood Hospital|The Royal Earlswood Asylum for Idiots]] was the first hospital for people with learning disabilities, led by Lord Palmerston, Baron Rothschild and Lord Ashley in the 1850s.]] According to the Encyclopedia of Theory and Practice in Psychotherapy and Counseling, "In the 1950s in the United States, a [[Right-wing politics|right-wing]] anti-mental health movement opposed psychiatry, seeing it as [[Liberalism in the United States|liberal]], [[Left-wing politics|left-wing]], subversive and [[Anti-Americanism|anti-American]] or pro-Communist. There were widespread fears that it threatened individual rights and undermined moral responsibility. An early skirmish was over the [[Alaska Mental Health Bill]], where the right wing protestors were joined by the emerging [[Scientology]] movement."<ref>{{Cite web |title=Chapter 4 {{!}} Madness Outside In |url=https://morningside.uoregon.edu/chapter-4/ |access-date=2024-06-23 |website=morningside.uoregon.edu}}</ref><ref>{{Cite book |title=Encyclopedia of Theory and Practice in Psychotherapy and Counseling |publisher=Lulu Press, Inc. |year=2014 |isbn=978-1-312-34920-9 |editor-last=Fadul |editor-first=Jose A. |location=Raleigh |page=34 |chapter=Anti-Psychiatry}}</ref> The field of [[psychology]] sometimes came into opposition with psychiatry. [[Behaviorists]] argued that mental disorder was a matter of [[learning]] not medicine; for example, [[Hans Eysenck]] argued that psychiatry "really has no role to play". The developing field of [[clinical psychology]] in particular came into close contact with psychiatry, often in opposition to its methods, theories and territories.<ref name="MicalePorter" /> === 1960s === Coming to the fore in the 1960s, "anti-psychiatry" (a term first used by [[David Cooper (psychiatrist)|David Cooper]] in 1967) defined a movement that vocally challenged the fundamental claims and practices of mainstream psychiatry. While most of its elements had precedents in earlier decades and centuries, in the 1960s it took on a national and international character, with access to the mass media and incorporating a wide mixture of grassroots activist organizations and prestigious professional bodies.<ref name="MicalePorter" /> Cooper was a South African psychiatrist working in Britain. A trained Marxist revolutionary, he argued that the political context of psychiatry and its patients had to be highlighted and radically challenged, and warned that the fog of individualized therapeutic language could take away people's ability to see and challenge the bigger social picture. He spoke of having a goal of "non-psychiatry" as well as anti-psychiatry.<ref name="MicalePorter">{{cite book|first1=Mark S. |last1=Micale |first2=Roy |last2=Porter |year=1994 |url=https://books.google.com/books?id=h52sUVA3i20C |title=Discovering the History of Psychiatry |place=Oxford |publisher=University Press US |isbn=978-0-19-507739-1}}{{page needed|date=January 2014}}</ref> ::In the 1960s fresh voices mounted a new challenge to the pretensions of psychiatry as a science and the mental health system as a successful humanitarian enterprise. These voices included: Ernest Becker, Erving Goffman, R.D. Laing; Laing and Aaron Esterson, Thomas Scheff, and Thomas Szasz. Their writings, along with others such as articles in the journal ''[[The Radical Therapist]]'', were given the umbrella label "antipsychiatry" despite wide divergences in philosophy. This critical literature, in concert with an activist movement, emphasized the hegemony of medical model psychiatry, its spurious sources of authority, its mystification of human problems, and the more oppressive practices of the mental health system, such as involuntary hospitalisation, drugging, and electroshock.<ref>Ken Barney, [http://www.brown.uk.com/brownlibrary/BARNEY.htm Limitations of the Critique of the Medical Model] {{Webarchive|url=https://web.archive.org/web/20170318075731/http://www.brown.uk.com/brownlibrary/BARNEY.htm |date=2017-03-18 }}, ''The Journal of Mind and Behaviour'', Winter and Spring 1994. Volume 15. Numbers 1 and 2, Pages 19-34.</ref> The psychiatrists [[R D Laing]] (from Scotland), [[Theodore Lidz]] (from America), [[Silvano Arieti]] (from Italy) and others, argued that "schizophrenia" and [[psychosis]] were understandable, and resulted from injuries to the inner-self-inflicted by psychologically invasive "schizophrenogenic" parents or others. It was sometimes seen as a transformative state involving an attempt to cope with a sick society. Laing, however, partially dissociated himself from his colleague Cooper's term "anti-psychiatry". Laing had already become a media icon through bestselling books (such as ''The Divided Self'' and ''[[The Politics of Experience]]'') discussing mental distress in an interpersonal [[Existentialism|existential]] context; Laing was somewhat less focused than his colleague Cooper on wider social structures and radical left wing politics, and went on to develop more romanticized or mystical views (as well as equivocating over the use of diagnosis, drugs and commitment). Although the movement originally described as anti-psychiatry became associated with the general [[counter-culture]] movement of the 1960s, Lidz and Arieti never became involved in the latter. [[Franco Basaglia]] promoted anti-psychiatry in Italy and secured reforms to mental health law there. Laing, through the [[Philadelphia Association]] founded with Cooper in 1965, set up over 20 [[therapeutic communities]] including [[Kingsley Hall]], where staff and residents theoretically assumed equal status and any medication used was voluntary. Non-psychiatric [[Soteria (psychiatric treatment)|Soteria]] houses, starting in the United States, were also developed<ref>{{cite journal|last1=Calton |first1=T |last2=Ferriter |first2=M |last3=Huband |first3=N |last4=Spandler |first4=H |date=Jan 2008 |title=A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia |journal=Schizophrenia Bulletin |volume=34 |issue=1 |pages=181–92 |doi=10.1093/schbul/sbm047 |pmid=17573357 |pmc=2632384}}</ref> as were various ex-patient-led services. Psychiatrist [[Thomas Szasz]] argued that "[[mental illness]]" is an inherently incoherent combination of a medical and a psychological concept. He opposed the use of psychiatry to forcibly detain, treat, or excuse what he saw as mere deviance from societal norms or moral conduct. As a [[Libertarianism|libertarian]], Szasz was concerned that such usage undermined personal rights and moral responsibility. Adherents of his views referred to "the myth of mental illness", after Szasz's controversial 1961 book of that name (based on a paper of the same name that Szasz had written in 1957 that, following repeated rejections from psychiatric journals, had been published in the American Psychologist in 1960<ref>{{cite journal |last=Szasz |first=T. |year=1960 |title=The Myth of Mental Illness |url=http://psychclassics.yorku.ca/Szasz/myth.htm |journal=American Psychologist |volume=15 |issue=2 |pages=113–118 |doi=10.1037/h0046535 |access-date=2011-08-31 |archive-date=2011-09-02 |archive-url=https://web.archive.org/web/20110902063433/http://psychclassics.yorku.ca/Szasz/myth.htm |url-status=live }}</ref>). Although widely described as part of the main anti-psychiatry movement, Szasz actively rejected the term and its adherents; instead, in 1969, he collaborated with [[Scientology]] to form the [[Citizens Commission on Human Rights]].<ref name="Desai 2005 185–187"/> It was later noted that the view that insanity was not in most or even in any instances a "medical" entity, but a moral issue, was also held by [[Christian Scientists]] and certain [[Protestant]] [[fundamentalists]], as well as Szasz.<ref name="Dain1989" /> Szasz was not a Scientologist himself and was non-religious; he commented frequently on the parallels between religion and psychiatry. [[Erving Goffman]], [[Gilles Deleuze]], [[Félix Guattari]] and others criticized the power and role of psychiatry in society, including the use of "[[total institution]]s" and the use of models and terms that were seen as [[Social stigma|stigmatizing]].<ref>{{cite journal|title=Does psychiatry stigmatize? |journal=J R Soc Med |date=March 2001 |volume=94 |issue=3 |pages=148–149 |author=D Summerfield|pmid=11285802 |pmc=1297937 |doi=10.1177/014107680109400316 }}</ref> The French [[sociologist]] and philosopher Foucault, in his 1961 publication ''[[Madness and Civilization]]: A History of Insanity in the Age of Reason'', analyzed how attitudes towards those deemed "insane" had changed as a result of changes in social values. He argued that psychiatry was primarily a tool of social control, based historically on a "great confinement" of the insane and physical punishment and chains, later exchanged in the moral treatment era for psychological oppression and internalized restraint. American sociologist Thomas Scheff applied [[labeling theory]] to psychiatry in 1966 in "Being Mentally Ill". Scheff argued that society views certain actions as deviant and, in order to come to terms with and understand these actions, often places the label of mental illness on those who exhibit them. Certain expectations are then placed on these individuals and, over time, they unconsciously change their behavior to fulfill them.{{citation needed|date=September 2013}} Observation of the abuses of psychiatry in the [[Soviet Union]] in the so-called [[Psikhushka]] hospitals also led to questioning the validity of the practice of psychiatry in the West.<ref>{{cite news |url=http://www.aaas.org/news/releases/2003/1212reich.shtml |title=AAAS – AAAS News Release |publisher=American Association for the Advancement of Science |access-date=2006-03-15 |archive-date=2010-01-31 |archive-url=https://web.archive.org/web/20100131215023/http://www.aaas.org/news/releases/2003/1212reich.shtml |url-status=live }}</ref> In particular, the diagnosis of many [[political dissident]]s with schizophrenia led some to question the general diagnosis and punitive usage of the label [[schizophrenia]]. This raised questions as to whether the schizophrenia label and resulting involuntary psychiatric treatment could not have been similarly used in the West to subdue rebellious young people during family conflicts.<ref>{{cite web |url=http://www.antipsychiatry.org/kendra-c.htm |title=Why Outpatient Commitment Laws Change (Almost) Nothing |author=Douglas A. Smith |website=Antipsychiatry.org |date=December 19, 1999 |access-date=March 14, 2007 |archive-date=April 4, 2007 |archive-url=https://web.archive.org/web/20070404124750/http://www.antipsychiatry.org/kendra-c.htm |url-status=live }}</ref>{{unreliable source?|date=January 2014}} === Since 1970 === [[File:Scientology psychiatry kills.jpg|right|thumb|[[Scientology|Scientologists]] on an anti-[[psychiatry]] demonstration]] [[File:Narodowa antypsychiatria.jpg|thumb|Anti-psychiatric movement in Poland]] New professional approaches were developed as an alternative or reformist complement to psychiatry. ''[[The Radical Therapist]]'', a journal begun in 1971 in North Dakota by Michael Glenn, David Bryan, Linda Bryan, Michael Galan and Sara Glenn, challenged the psychotherapy establishment in a number of ways, raising the slogan "Therapy means change, not adjustment." It contained articles that challenged the professional mediator approach, advocating instead revolutionary politics and authentic community making. [[Social work]], [[humanistic]] or [[existentialist]] therapies, [[family therapy]], [[counseling]] and [[self-help]] and clinical psychology developed and sometimes opposed psychiatry. The psychoanalytically trained psychiatrist [[Thomas Szasz|Szasz]], although professing fundamental opposition to what he perceives as medicalization and oppressive or excuse-giving "diagnosis" and forced "treatment", was not opposed to other aspects of psychiatry (for example attempts to "cure-heal souls", although he also characterizes this as non-medical). Although generally considered anti-psychiatry by others, he sought to dissociate himself politically from a movement and term associated with the radical left-wing. In a 1976 publication "Anti-psychiatry: The paradigm of a plundered mind", which has been described as an overtly political condemnation of a wide sweep of people, Szasz claimed Laing, Cooper and all of anti-psychiatry consisted of "self-declared [[socialists]], [[communists]], [[anarchists]] or at least anti-[[capitalists]] and [[Collectivist anarchism|collectivists]]".{{request quotation|date=January 2014}} While saying he shared some of their critique of the psychiatric system, Szasz compared their views on the social causes of distress/deviance to those of anti-capitalist anti-[[colonialists]] who claimed that [[Chile]]an poverty was due to plundering by American companies, a comment Szasz made not long after a [[CIA]]-backed coup had deposed the democratically elected Chilean president and replaced him with [[Pinochet]]. Szasz argued instead that distress/deviance is due to the flaws or failures of individuals in their struggles in life.<ref>{{cite book|last=Kotowicz |first=Zbigniew |year=1997 |title=R.D. Laing and the Paths of Anti-Psychiatry |url=https://archive.org/details/rdlaingpathsanti00zbig |url-access=limited |publisher=Routledge |isbn=978-0-415-11611-4 |page=[https://archive.org/details/rdlaingpathsanti00zbig/page/n98 90]}}</ref> The anti-psychiatry movement was also being driven by individuals with adverse experiences of psychiatric services. This included those who felt they had been harmed by psychiatry or who felt that they could have been helped more by other approaches, including those compulsorily (including via physical force) admitted to psychiatric institutions and subjected to compulsory medication or procedures. During the 1970s, the anti-psychiatry movement was involved in promoting restraint from many practices seen as psychiatric abuses. The [[gay rights]] movement continued to challenge the classification of homosexuality as a mental illness and in 1974, in a climate of controversy and activism, the [[American Psychiatric Association]] membership (following a unanimous vote by the trustees in 1973) voted by a small majority (58%) to remove it as an illness category from the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]], replacing it with a category of "sexual orientation disturbance" and then "ego-dystonic homosexuality," which was deleted in 1986, although a wide variety of "[[paraphilias]]" remain. The diagnostic label [[gender identity disorder]] (GID) was used by the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]] until its reclassification as ''gender dysphoria'' in 2013, with the release of the [[DSM-5]]. The diagnosis was reclassified to better align it with medical understanding of the condition and to remove the [[Stigmatization|stigma]] associated with the term ''disorder''.<ref name="recommendations">{{cite journal |last1=Fraser |first1=L |last2=Karasic |first2=D |last3=Meyer |first3=W |last4=Wylie |first4=K |title=Recommendations for Revision of the DSM Diagnosis of Gender Identity Disorder in Adults |journal=International Journal of Transgenderism |year=2010 |volume=12 |pages=80–85 |doi=10.1080/15532739.2010.509202 |issue=2|s2cid=144409977 }}</ref><ref name="Karl Bryant">{{cite encyclopedia|first=Karl|last=Bryant|title=Gender Dysphoria|encyclopedia=[[Encyclopædia Britannica Online]]|date=2018|access-date=August 16, 2018|url=https://www.britannica.com/science/gender-dysphoria|archive-date=April 18, 2020|archive-url=https://web.archive.org/web/20200418213857/https://www.britannica.com/science/gender-dysphoria|url-status=live}}</ref> The American Psychiatric Association, publisher of the DSM-5, stated that [[gender nonconformity]] is not the same thing as gender dysphoria,<ref name="What Is">{{cite web |title=What Is Gender Dysphoria? |publisher=[[American Psychiatric Publishing]] |access-date=November 20, 2018 |url=https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria |archive-date=January 14, 2020 |archive-url=https://web.archive.org/web/20200114173204/https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria |url-status=live }}</ref> and that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."<ref name="DSM-5 fact sheet">{{cite web |title=Gender Dysphoria |publisher=[[American Psychiatric Publishing]] | access-date=December 24, 2016|url=https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf |archive-date=2022-10-09 |url-status=live}}</ref> Some transgender people and researchers support declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the [[Gender binary|binary model of gender]].<ref name="recommendations" /><ref>{{cite journal |last=Newman |first=L |title=Sex, Gender and Culture: Issues in the Definition, Assessment and Treatment of Gender Identity Disorder |journal=Clinical Child Psychology and Psychiatry |date=July 1, 2002 |volume=7 |pages=352–359 |doi=10.1177/1359104502007003004 |issue=3|s2cid=145666729 }}</ref><ref>{{cite book|editor-last=Wright |editor-first=RH |editor2-last=Cummings |editor2-first=NA |year=2005 |title=Destructive Trends in Mental Health: The Well-intentioned Path to Harm |publisher=Routledge |isbn=978-0-415-95086-2 |page=67}}</ref> Szasz also publicly endorsed the transmisogynist work of [[Janice Raymond]]. In a 1979 ''[[New York Times]]'' book review of Raymond's ''[[The Transsexual Empire]]'', Szasz drew connections between his ongoing critique of psychiatric diagnosis and Raymond's feminist critique of trans women.<ref>{{Cite news|last=Szasz|first=Thomas|date=1979-06-10|title=Male and Female Created He Them|language=en-US|work=The New York Times|url=https://www.nytimes.com/1979/06/10/archives/male-and-female-created-he-them-transexual.html|access-date=2021-04-21|issn=0362-4331|archive-date=2018-06-21|archive-url=https://web.archive.org/web/20180621171325/https://www.nytimes.com/1979/06/10/archives/male-and-female-created-he-them-transexual.html|url-status=live}}</ref> Increased legal and professional protections, and a merging with [[human rights]] and [[disability rights]] movements, added to anti-psychiatry theory and action. Anti-psychiatry came to challenge a "[[biomedical]]" focus of psychiatry (defined to mean [[genetics]], [[neurochemical]]s and [[pharmacology|pharmaceutic]] drugs). There was also opposition to the increasing links between psychiatry and [[pharmaceutical companies]], which were becoming more powerful and were increasingly claimed to have excessive, unjustified and underhand influence on psychiatric research and practice. There was also opposition to the codification of, and alleged misuse of, psychiatric diagnoses into manuals, in particular the American Psychiatric Association, which publishes the ''Diagnostic and Statistical Manual of Mental Disorders''. Anti-psychiatry increasingly challenged alleged psychiatric pessimism and institutionalized alienation regarding those categorized as mentally ill. An emerging [[Psychiatric survivors movement|consumer/survivor movement]] often argues for full [[recovery model|recovery]], [[empowerment]], self-management and even full liberation. Schemes were developed to challenge [[social stigma|stigma]] and discrimination, often based on a [[social model of disability]]; to assist or encourage people with mental health issues to engage more fully in work and society (for example through [[social firms]]), and to involve service users in the delivery and evaluation of mental health services. However, those actively and openly challenging the fundamental ethics and efficacy of mainstream psychiatric practice remained marginalized within psychiatry, and to a lesser extent within the wider mental health community. Three authors came to personify the movement against psychiatry, and two of these were practicing psychiatrists. The initial and most influential of these was [[Thomas Szasz]] who rose to fame with his book ''[[The Myth of Mental Illness]]'', although Szasz himself did not identify as an anti-psychiatrist. The well-respected [[R. D. Laing|R D Laing]] wrote a series of best-selling books, including ''[[The Divided Self]]''. Intellectual philosopher [[Michel Foucault]] challenged the very basis of psychiatric practice and cast it as repressive and controlling. The term "anti-psychiatry" was coined by [[David Cooper (psychiatrist)|David Cooper]] in 1967.<ref name=tburns/><ref name=nasral/> In parallel with the theoretical production of the mentioned authors, the Italian physician [[Giorgio Antonucci]] questioned the basis themselves of psychiatry through the dismantling of the psychiatric hospitals'' Osservanza'' and ''Luigi Lolli'' and the liberation – and restitution to life – of the people there secluded.<ref>{{cite web|url=http://www.nopazzia.it/Antonucci/marainiantonucci.htm|title=DACIA MARAINI INTERVIEWS GIORGIO ANTONUCCI|language=it|access-date=2014-01-13|archive-url=https://archive.today/20130413063207/http://www.nopazzia.it/Antonucci/marainiantonucci.htm|archive-date=2013-04-13|url-status=dead}}</ref>
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