What you have in your hands is a relatively static object—a book. You picked it up, perhaps, because something in the title piqued your interest. Even though you can, metaphorically speaking, engage in conversations with it, nonetheless it belongs on some level to the category of “things.” That said, no book is “just a thing.” Every book was once upon a time a book project. Every book required people to perform certain tasks to bring it into existence. Moreover, there was a reason for writing it; there was “knowledge” that one hoped to disseminate, create, validate, or even, in some instances, to mandate. Such is the nature of all book projects. At the same time, what underlays this specific one is a particularly multifaceted project that goes beyond the book, yet that is critical to understanding it.
As an entry point into this larger project, at this juncture I introduce you to a section of the very first document produced in relation to it. In the opening months of 2014, hundreds of people from various walks of life received a letter that read in part:
The document went on to invite those interested to a series of four free workshops (five-and-a-half days in total), three of which were to help people acquire or hone “institutional ethnography” skills (as well as to help them get started on their own particular research project), and one explicitly devoted to helping participants “unhook from psychiatry.” With this, possible contributors found their entry point into the project. And with this, we have our entry point into this book.Dr. Bonnie Burstow, Simon Adam, and Dr. Brenda LeFrançois invite you to become involved as a potential contributor in an exciting and original project. … Combining capacity-building and knowledge production, the project will culminate in an anthology of institutional ethnography (IE) pieces on psychiatry. Each contributor will be writing about a different aspect of the regime of ruling, perhaps also out of a specific disjuncture or problem that occurs to a specific population (e.g., trans, gay, “intellectually disabled,” Aboriginal, women, children “in care”), and inevitably with respect to texts that are activated in a very specific location (e.g., Quebec, British Columbia, New York, Poland, in the cells at Penetanguishene, in a nursing home in Bolivia). … You have been contacted because we feel that you could contribute something unique and important. This may be on the basis of past IE work. Alternatively, it may be on the basis of your expert critical knowledge of psychiatry. In this regard, this is a two-pronged project: a) providing IE training to people who are interested but lack the necessary IE knowledge, and b) producing an anthology. As such, it is an opportunity for old hands at IE to apply their well-honed skills to critiquing psychiatry, and for old hands at critiquing psychiatry to at once produce a stunning piece of work and acquire a handy new skill. (Burstow, Adam, and LeFrançois, personal correspondence with prospective contributors)
This book contains a series of institutional ethnography inquiries into psychiatry. This being the introduction, by the time this chapter ends, you will have a good idea about what you will find in this book—that is, what themes run through it, what each chapter covers or attempts to make visible, what institutional ethnography (IE) itself is, why IE is being applied to psychiatry, and what the purpose of the book and the project are. Systematically, making all this visible and intelligible, 1 such is the work of this chapter.
To begin with the last of these, for we have already dipped into these waters, as suggested in the foregoing, the purpose of this book and the project underlying it is: (1) to shed a critical light on psychiatry and (2) to bring the power of institutional ethnography to bear in the process. In addition, the purpose of the project per se is to help those critically aware, especially those already involved in antipsychiatry or “mad” activism, to acquire a highly serviceable new tool with which to expose psychiatry; and also to swell the ranks of psychiatry’s able critics by attracting old hands at IE into the area. The book, in this regard, is both an educational product and a way of injecting new life into a liberatory movement.
Why “Take on” Psychiatry?
Those of us who have been studying, combatting, and writing about psychiatry for years have little trouble answering the question posed in the heading, why “take on” psychiatry? Although psychiatry may seem like a lifeline to some and though its tenets and approaches have become so hegemonic—so like the air we breathe—that it may even seem counterintuitive to question them, as a critical mass of survivors have testified for decades now (e.g., see Fabris 2011) and as able critics have repeatedly demonstrated, psychiatry is a fundamentally problematic institution. For one thing, it rips people out of their lives and whatever may or may not have been bothering them earlier; suddenly, they find themselves with a serious new problem—they have little or no control over their daily existence. A statement made by an interviewee during one of my research projects fully exemplifies this dimension:
What we see here, at the very least in part, is control being presented as “treatment.” This story, I would add, is hardly unique. Nor is what has surfaced here the totality of what is wrong with this institution.So I’d mouthed off! Not ideal, I agree, but it was nothing. It’s not as if other guys haven’t done something similar from time to time, and it’s not as if there was no provocation. My co-worker, he had just made fun of my work, and like, I’m sensitive about stuff like that. Anyway, I go back to my desk. Then I start getting ready to take off for lunch when this ambulance pulls up. Seriously! And before I know it, these two men, they have me in restraints and are taking me to hospital. Anyway, we arrive at the hospital and I try to explain that some sort of mistake has been made, but this nurse is asking me these questions that make no sense to me. Then they are pumping these drugs into me—and I have no say whatever—drugs which are making it impossible for me to think straight, even to stand. And a couple of days later, maybe a week, they are telling me that my regular ways of handling conflict are but a few of the many symptoms of this disease that I have, also that I probably have to stay on these medications for life. Anyway, for two long months, I am forced to stay in this place, all the while staff insisting I take these meds, watching my every move, telling me where to go, what to do, and, like, calling almost all of my actions symptoms. Now finally, they release me. But the thing is, I am still on these meds—and these workers, they keep turning up at my home to ensure that I am continuing to be what they call “treatment compliant.” So I have to ask, just what has happened to my independence? What has happened to my life? (interview with Lucas—pseudonym used)
Difficult though it may be to wrap one’s head around this, there is additionally something profoundly wrong with psychiatry “medically,” also on what might be called the hermeneutic level. As shown by Breggin (1991), Whitaker (2010), Woolfolk (2001), and Szasz (1987), there is no valid science underlying psychiatry, no proof that a single one of these putative diseases arise from a chemical imbalance—this despite years of insisting that they do—nor indeed proof that any physical correlate of any sort exists. Nor do their categorization schema (e.g., diagnoses) hold any explanatory value—for they are intrinsically circular (in this last regard, see Burstow 2015, Chapters 4 and 5). To quote from an interview with me in this regard:I proceed by offering the following example. “Selective mutism,” I begin:
LS: You refer in your book to the DSM [Diagnostic and Statistical Manual of Mental Disorders] as a “boss text.” Could you elaborate?
BB: As a central text, it sets practitioners up to look at distressed and/or distressing people in certain ways. So, if they go into a psychiatric interview, they’re going to be honing in on questions that follow the logic of the DSM, or to use their vocabulary, the “symptoms” for any given “disease” they’re considering. In the process it rips people out of their lives. And so now there’s no explanation for the things people do, no way to see their words or actions as meaningful because the context has been removed. In essence, the DSM decontextualizes people’s problems, then re-contextualizes them in terms of an invented concept called a “disorder.”
…is a diagnosis given to people who elect [to] not speak in certain situations. So, if I were a non-psychiatrist—that is, your average thinking person who is trying to get a handle on what’s going on with somebody—I would try to figure out what situations they aren’t speaking in, try to find out if there’s some kind of common denominator, to ascertain whether there’s something in their background or their current context that would help explain what they are doing. You know, as in: Is it safe to speak? Is this, for example, a person of color going silent at times when racists might be present? Alternatively, is this a childhood sexual abuse survivor who is being triggered? Whatever it is, I would need to do that. But this is not what the DSM, as it were, prompts. In the DSM, “Selective Mutism” is a discrete disease. So, according to psychiatry, what causes these “symptoms” of not speaking? Well, “Selective Mutism” does. Note the circularity. That’s what all the “mental disorders” are like: No explanatory value whatever. (Burstow and Spring 2015, p. XX)
Now for some—not me—even the circularity evident here might be acceptable if the “treatments” actually helped people. However, far from correcting imbalances—the “treatments” have been shown conclusively to cause imbalances (see Breggin 2008; Whitaker 2010). They also give rise to highly uncomfortable neurological diseases (see Breggin 2008). Moreover, evidence suggests that in the long run, irrespective of “diagnosis,” people who were never once on these substances fare better than people who either stay on them or use them for a short time (see Whitaker 2010; Burstow 2015). Put all this together, and what starts to become clear is that framing what is happening as “help” is at the bare minimum suspect.
By everyday standards, this is harm. Which is not to say that individual psychiatrists are never helpful to people—only that the evidence suggests that psychiatry overall does far more harm than good. People end up hooked on brain-damaging drugs for life. People end up losing the multifaceted life that they once knew. Indeed, as Foucault (1980) and Burstow (2015) suggest and, as Lucas’s words exemplify, what is being called help would appear to be little more than control. Nor is that the whole of the story.
Probe further and what you find, as demonstrated by Whitaker (2010), Burstow (2015), and Whitaker and Cosgrove (2015), whatever else may be involved, vested interests underlying and associated with psychiatry are blatantly driving this pathologization agenda—whether it be those of the multinational pharmaceutical enterprises or those of the American Psychiatric Association (which alas, at this point are close to identical). That is, interests are being served that are far from those of the people hypothetically being helped—all the while with the aid of claims that do not stand up to scrutiny and explanations that are circular. Still, psychiatry as an institution continues to wield incredible power—including the power to invalidate people’s words, to drum people out of their professions (see Chapter 3), and to incarcerate people who have committed no crime. Moreover, firmly ensconced as an agent of the state, it continues to grow by leaps and bounds; and ...