I’m a big fan of the anti-psychiatry movement. Not because I’m anti-psychiatry - I’m not - but because it gives a voice to some of the complexities inherent in living with mental illness - and in treating it as an illness in the first place.

It’s easy to say ‘whatever works,’ but who gets to define what ‘works’ means?

If two people disagree on whether one of them is ill or not, whose voice carries?

Anti-psychiatry engages these questions strongly and provides a community and a place to speak and be heard for those who do not feel that the DSM speaks for them, and for those whose voices are hard to hear in a clinically-defined context.

Insight is one of yer basic bones of contention. A psychotic, schizophrenic person who refuses treatment on the grounds that she is not ill and does not wish to be drugged is considered clinically to be ‘lacking in insight’ because she doesn’t see herself from the outside; she perceives her broken brain with her broken brain and does not see the problem. The job of the clinician is to try to get her to accept medication she doesn’t want, to fix a problem she can’t see, to improve her functioning for her own good.

From her perspective, she doesn’t have a problem. She’s just fine the way she is. She doesn’t want to accept treatment. She wants society to accept her as she is. If she can accept herself, as difficult and marginal an example of the human condition as there is, why can’t other people do the same?

When I lived in Nigeria, there were a couple of schizophrenics in the local community. They walked solitary, naked, up and down the road. Sometimes they talked to themselves. One of them lived in a broken-down car visible from the highway; his family brought him meals. Physically, they seemed in good shape. As community members their status signalled to me an acceptance of diversity, though it’s equally probable that they served as bogeymen, warnings of what could happen to people who don’t conform. Either way, they had a place in their communities.

Clinically, they were clearly ill. Medication could probably have improved their functioning. If it had been more available to them, and if they had refused, how wrong would that have been?

I’m not trying to romanticise mental illness. Even people who deny their illness may be obviously suffering. Some may be dangerous to others, especially if they are paranoid.

A guy I had a crush on in junior high (the strong, silent type I could project anything I wanted on) assaulted two neighbours when he was in his twenties, killing one of them. Last I heard he was doing time, having refused a sentence that took into account his mental illness on the grounds that he was not mentally ill.

I definitely want my brother taking his meds instead of living in a homeless shelter and frightening people. He was convinced to accept psychiatric hospitalisation and medication on the grounds that the alternative was inprisonment for stealing a bicycle and assaulting a police officer. Now he (mostly) stays on his meds because accepting his status as mentally ill is what gets him his disability cheque and subsidised apartment.

But still, when a friend talked to me about wanting to start medication for depression, I warned her that there were consequences. That depending on how severe her depression was she might have choices and should think carefully about them. I take medication for depression (and hypo-hypomania) and the consequences are something I have made peace with. That doesn’t mean they aren’t there. Identifying your own suffering as a symptom of illness is a double-edged sword. It can be empowering but also alienating.

There are also concrete, here-and-now consequences of treating the marginal. If you treat a homeless person, or someone on welfare who lives in a rooming house and eats in shelters, with depot injections of antipsychotics - what happens in a heat wave? Some antipsychotics put people at risk of fulminating hyperthermia, which can be fatal. If you are living under a bridge, or simply don’t have air conditioning, and you are isolated, who is going to make sure that you drink extra liquid and stay cool? Anti-psychiatry makes the point that people need to be enabled to look after themselves on their own terms. And that legislation that would put marginalised people at increased risk of dying so that those of us who are clinically considered ‘well’ will not have to face panhandlers yelling at invisible voices, quiet panhandlers being bad enough, would be fundamentally disrepectful of the psychotic.

Psychiatry speaks to the empowerment of being able to identify suffering as something outside oneself and to treat it as an illness to improve one’s function. Being able to do this has saved my life. (In another society, however, one less demanding of the individual to be self-sufficient in multiple areas simultaneously, it might not have been necessary. I can never know.)

Anti-psychiatry speaks to the alienation inherent in this approach, and advocates for the interests of people treated medically against their own perceived self-interest.

I can’t see that as a bad thing.

[originally transmitted by e-mail August 18, 2007]

A couple of months ago on a routine visit to my psychiatrist I confessed to screaming at Mark in the Metro. “Perhaps he was being annoying?” she asked. “Yes,” I answered, “he was being deliberately hateful and provocative. But there are much better ways to handle that than shrieking at someone in the Metro.” And I listed some. She prescribed me a mood stabilizer, meaning that my freakish temper tantrums have been reinterpreted as irritable mania - the kind that gets worse with PMS (I hadn’t known that) - and hoisting me up onto the bipolar bandwagon.

Here I am being written up in the New York Times as a wannabee! Caveat: the author has a too-narrow conception of mania as being fun, creative and productive. Mania can also express itself as irritability, which is none of the above. So psychopharmacologists who see mania everywhere are not just killjoys.

http://www.newyorkmetro.com/nymetro/health/features/n_9986/

[originally transmitted by e-mail March 10, 2004]

Just got back from the Festival International Nouveau Cinéma Nouveaux Médias Montréal.

Saw Stormy Weather, a lovely story about mental illness and comparing Belgian and Icelandic ways of coping. The Belgian psychiatrist wants her patient to stay with her, in Belgium, where she can live forever in a well-funded hospital with lots of pleasant, well-spoken, polite and slightly dysfunctional patients and be tended to by trained professionals who restrain her kindly and reluctantly when necessary, addressing her as Madame when they regretfully have to sedate her. The patient’s husband loves her and wants her to live at home with him in Iceland where there is no psychiatrist and no treatment. He’s a little dingy himself and would totally lose it if his wife were taken away from him and institutionalised. (This is a terrible movie about psychiatry, by the way. In real life it’s not nearly so either/or. Hospitals are largely for keeping mentally ill people safe, or for evaluating them (both short-term propositions), or for offering outpatient care (a longer-term proposition). There is absolutely no reason a mentally ill person like the woman in this movie couldn’t be evaluated in Reykjavik and sent home to her family and GP with some prescriptions. And no, psychiatrists do not work by selecting a single patient out of the hospital or treat them by taking them shopping and on extended field trips. If a patient is well enough to handle going into a store without freaking out they probably don’t need to be hospitalised. Also, in this fantasy Belgian hospital mental patients were allowed to stay in bed as long as they wanted to. Not in any psychiatric ward I’ve ever known!)

But, whatever, yes it’s a terrible movie about psychiatry but still a lovely movie about mental illness, and coping, or not; and about the burden of trying to act as if everything were okay when it isn’t. Highly recommended. Even if you have no interest in mental illness, the Icelandic scenery is beautiful. (Plus it meets the Alison Bechdel lesbian criteria.)

A little while ago I mentioned Matchstick Men in the context of a theme of older men paired with much younger women that had become rather tedious. Well, Matchstick Men starts out as a totally refreshing movie about mental illness. I was thrilled to see Nick Cage up there on screen representing me: visibly unhinged, dependent on meds, and getting by. Even getting by rather well. Then the dénoument ruins everything. Go ahead and see it anyway: it’s rather more likely to be playing in a theatre near you than Stormy Weather is.

Does anyone have any suggestions for movies about mental illness? Or psychiatry? I don’t want a movie where mentally ill people are simply mildly eccentric and flourish when someone is nice to them. Someone who flourishes is not ill.

I never saw Girl, Interrupted. How was that?

[originally transmitted by e-mail October 14, 2003]