Of all the miseries of life under capitalism ‘mental illness’ has been one of the most difficult for the left to tackle, yet there are histories of struggle that we need to connect with and learn from, histories reactivated with the re-launch of Asylum: The Magazine for Democratic Psychiatry. The magazine first appeared in 1986 and since then it has been a leading force in a radical movement that brings together patients and survivors with professionals willing to break from mainstream psychiatric practice. The democratic psychiatry movement poses questions for a left that too often tries to solve problems of ‘mental health’ by simply calling for more resources, more hospitals, as if more drugs and locked wards were a solution. There are more fundamental problems with psychiatry Asylum addressed, and it has done that in different ways since the 1980s.
Psychiatry is organised around a medical model of distress, and its bible of diagnostic categories, the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM) is now in its fourth edition. The number of categories expand with each revision of the DSM, and it is now driven by the pharmaceutical companies who are into the game of discovering what their drugs will stop and then convincing their clients – that is, the psychiatrists and hard-pressed general practitioners – that these are ‘disorders’ for which their brand medicine is the solution. The sales of the DSM pay the mortgage on the headquarters of the American Psychiatric Association, but the connections between mental illness and capital accumulation run much deeper than that.
Alienation and exploitation are the stuff of life for obedient workers and the unemployed, but when those who suffer break under the strain the label ‘mental illness’ gives another cruel twist to their fate. Every dimension of oppression is tangled at some point in psychiatry, ranging from three-fold over-representation of black and ethnic minority people detained under the Mental Health Act, to the forced electroshock given to elderly women, to the Ritalin medication given to thousands of children who are seen as ‘hyperactive’. Capitalism does not cause every mental health problem, but psychiatry is for sure a practice that aims to adapt people to capitalism rather than offer a genuine place of ‘asylum’ as space of refuge.
The phrase ‘democratic psychiatry’ signals a historic debt to the Italian reforms based mainly in Trieste which culminated in 1978 in Law 180 which called for the closure of the mental hospitals. These hospitals were little more than places of confinement with atrocious conditions, and the Democratic Psychiatry movement took steps to implement this closure, with involvement of groups like Democrazia Proletaria and some local Communist Party activists. This also meant mobilising against the fascist trades unions that many of the hospital nurses were members of, and it also meant building democratically-run mental health centres that would provide support rather than simply throwing patients back into the clutches of their families. The movement failed but, as with the encirclement and crushing of other revolutions, we need to understand why it failed and what it still shows us today.
In Britain the democratic psychiatry movement had to engage with the so-called ‘anti-psychiatrists’, and there was a long interview with R. D. Laing in the first issue of Asylum, but this meant tackling the romanticising of ‘madness’ that was popular among some radicals at the time. It was clear right from the start that simply flipping over from pathological labels like schizophrenia to celebrating it as if it was some kind of liberation just did not take suffering seriously. This is why Asylum over the years has been a focus-point for groups of activists inside the system searching for better ways out, and why many of those who had already been organised in the Mental Patients Union from the early 1970s became involved. Groupings like Survivors Speak Out in the 1980s and then in the 1990s the National Self-Harm Network influenced by feminism found a voice in Asylum, as did ‘Mad Pride’ and the Hearing Voices Network (HVN) which brought together those labelled as subject to treatment because the DSM treats the hearing of voices as a first-rank symptom of schizophrenia. One of the grotesque features of psychiatry is that it trains doctors from around the world who buy into Western notions of what is normal and then diagnose as pathological experiences like hearing the voices of spirits that are unproblematic in many other cultures.
One of the paradoxes of the ‘anti-psychiatry’ and democratic psychiatry movements is that they have been led by those with privilege and power, by psychiatrists, whether that has been Franco Basaglia in Trieste, Ronnie Laing in Britain, Marius Romme in Maastricht as inspiration for the HVN, or Alec Jenner as a founding editor of Asylum magazine in Sheffield. But this leadership, by men, white men, has then given way to self-organisation of the oppressed in the field of mental health to argue about whether this suffering should be taken seriously as ‘illness’ with a demand for more resources, whether this suffering is symptomatic of life under capitalism, and what the place of this struggle with other social movements could be.
One of the many ‘re-launch’ events for Asylum over the years, in 2001 in Manchester, connected ‘asylum’ in mental health with the question of asylum and immigration, and this was also occasion for sharp debates between activists who had been involved in different left groups. A few years later we held a large conference, again in Manchester (which for most of its history has been the centre of the Hearing Voices Movement in the UK) for the newly emerging ‘Paranoia Network’. There is a crucial connection with revolutionary politics here, for one thing those who are labelled paranoid are right about is that most people now are not suspicious enough about the activities of the capitalist state.
The spring 2010 re-launch special issue is on the theme of paranoia, with articles on paranoia and psychiatry and politics, on experiences of madness and on the war on terror. For details of Asylum go to www.asylumonline.net and for subscriptions go to the radical humanistic counselling publishing house that has stepped in to rescue the magazine www.pccs-books.co.uk The editorial in the re-launch issue points out that under the agreement with PCCS Books, ‘the Asylum Collective keeps full editorial control but will no longer be able to disrupt the distribution.’ If it keeps its nerve, anger and sense of humour, Asylum could be an important force again for liberation, but to do that it needs the rest of the left to take personal suffering and the role of psychiatry seriously, to give some support to the democratic psychiatry movement now.