Honours for Craziness

Frank Cioffi

  • Psycho Politics by Peter Sedgwick
    Pluto, 292 pp, £4.95, January 1982, ISBN 0 86104 352 9
  • The Voice of Experience by R.D. Laing
    Allen Lane, 178 pp, £7.50, April 1982, ISBN 0 7139 1330 4

Peter Sedgwick has given us an informative, penetrating, witty and critical account of anti-psychiatry as represented by Laing, Szasz, Goffman and Foucault. The central ambition of anti-psychiatry has been to replace the so-called medical model of mental illness by a ‘labelling’ one, according to which the behaviours which provoked diagnoses of psychopathology were not manifestations of some underlying pathology but merely conduct found obnoxious by the labellers. Sedgwick counters anti-psychiatry’s startling claim that mental illness is just deviancy with the apparently paradoxical one that illness of any kind is deviancy: ‘The attribution of illness always proceeds from the computation of a gap between presented behaviour (or feeling) and some norm.’

Granted that a preference, on the one hand, for personalities capable of self-control and remorse, without marked propensities for delusion or hallucination, whose sexual inclinations are directed towards persons of the opposite sex and the same species, and a preference for blood-sugar levels compatible with consciousness, on the other, are equally preferences – are there no differences between them such as might support the anti-psychiatrist’s case? Might it not still be possible to distinguish between these ‘norms’ on grounds of universality, culture-neutrality and adaptiveness? Even an Eastern bloc country which ran out of Vitamin D would be unlikely to declare: ‘Straight legs good, bandy legs better.’ If the argument is to work, it must not depend merely on the occurrence of physical conditions which are only culturally dysgenic and are treated by the same personnel as treat incapacitating physical conditions but on the analogy of mental illness with these incapacitating conditions themselves. For example, J.K. Wing has pointed out that under-arm odour is rare among the Japanese and was once felt by them to justify exemption from military service and referral to hospitals for treatment. But the fact that some medical norms are less universal than some psychiatric ones is not sufficient to justify psychiatry. On the other hand, it is relevant that there are no societies in which unprovoked random attacks on people are not seen as symptomatic. The concepts of ‘amok’ and ‘latah’ are not manifestations of psychiatrisation.

In the literature of anti-psychiatry a libertarian thesis was persistently and gratuitously confronted with its ontological one. Although if mental illness were indeed a myth intervention would be unjustifiable, the reverse is not the case. It does not follow from the fact that someone can be justifiably described as mentally disordered that this automatically confers on the community the right of custody or intervention. There is no a priori reason why someone convinced he is Jesus Christ or Napoleon should not be left at large. The abolition of involuntary mental hospitalisation does not require as a premise the mythical status of mental illness. Too many have found this claim sound because they found its policy implications welcome, and were so half-hearted in their libertarianism that they could see no other way of arriving at them. It is as if they feared that unless we declared baldness a myth we would be on the slippery slope which leads to the compulsory wearing of hair pieces. Mental illness can be de-stigmatised without being mythologised, i.e. defined into non-existence. Szasz himself has argued that the disabilities traditionally imposed on epileptics are unjustifiable without concluding that epilepsy is a myth. The apprehensions about Clause 38 (iii) of the Mental Health (Amendment) Bill, which is intended to place obstacles between a patient and treatment to which he has not consented, have a more cogent rationale than simply the sense that mental illness is a reality. Sedgwick is also concerned with what he sees as the baleful social consequences of anti-psychiatry. ‘It is in the battle on the wrong side; the side of those who want to close down intensive psychiatric units and throw the victims of mental illness onto the streets.’ There is an example of the kind of thing Sedgwick is up against in The Voice of Experience. One of Laing’s new atrocity stories involves a young woman with a history of schizophrenia being kept under observation while ‘three first-rank psychiatrists’ monitor her symptoms. If Laing wants to put a stop to this state of affairs he should call it to the attention of the right Conservative MP, who would see to it that she was not long permitted to hog such persecutors. What the mentally afflicted and disabled have now to fear is not wanton intervention but neglect.

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