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MANDELL, Alan. "Anti-Psychiatry and the Search for Autonomy"
Article published on 24 December 2006
last modification on 30 November 2015

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"Too cynical for sentimentality and too sentimental for cynicism, there is, finally, no moral exhortation involved in all this, but there is the available vision of links of solidarity between people who are oppressed in widely different ways."

David Cooper

"People who are having difficulties in living and who seek help with their problems are not served by a system that maximizes their inadequacies and ignores their strengths, nor by one that implies that only incompetent people have problems."

Judi Chamberlin

Washington, D.C. May 2, 1998

What is "political"? What does it mean to be "political"? To act in a "political" way? One of the most significant aspects of the social and cultural movements of the 1960’s in America, Europe, and across the world was to explode a rigid and narrow definition of "political" which—due partially to a legacy of marxian concepts—reduced it to a byproduct of economics. By seeing the need to understand and to respond not only to imperialism and to racism, but to the authoritarianism of our schools and factories and to the sexism that defined many of our most intimate relationships, the confining boundaries of what had constituted the political became more and more obviously inadequate. We could no longer only one-sidedly examine and criticize a world of structures and powers and inequalities that were external to us. Neither politics-as voting-electing nor politics-as-simple-and-necessary-response-to-economics could move us to revise our scant attention to the quality of our daily existences.

Importantly, this "critique of everyday life" (as some came to refer to it) demanded that the world of the "personal" was, in itself, tied to the social world in intricate and critical ways: ways significant to the understanding of the social critic and the activist. Psychology could not purport to describe and claim to know a distinct arena of individual activity or unconscious feeling. Although efforts to locate the connections between Marx and Freud were key aspects of the social theories of Reich, Adorno, Horkheimer, -and later Marcuse, R.D. Laing’s The Politics of Experience (1967) brought to popular attention some of the concerns and orientations of those within the field of psychiatry regarding the interaction between "self and others." Laing’s early works (The Divided Self was first published in 1959; Self and Others in 1961) not only explored the need to locate "webs" and "networks" of interpersonal activity— to see the self within a context, as constituting and constituted by a social world. His works also offered a continuing criticism of the prevalence and distortions of behaviorism, the medical model, and the taken-forgranted dichotomies between health and sickness. Although his writings often dealt with the micro-world of our experience—especially our families, sometimes to the detriment of a fuller exploration of larger constellations of societal interaction; and sometimes confused important differences between social change and therapy (an argument powerfully introduced in Russell Jacoby’s Social Amnesia), Laing’s success in describing the textures of our experiences, the violence we do to others and they to us in our everyday conversations and lives together, and his efforts to examine the alienation (the loss) of our experience and our need to "recover the wholeness of being human" represents a clear and crucial step toward an understanding of freedom and domination on both an individual and social level.

Laing’s writings had reverberations beyond the level of theorizing. His work (and that of others in Britain and the United States) became one of the bases for an understanding of psychiatric labeling as a social and political process and of psychiatric institutionalization as another means to define possible experiences, control behavior, and imprison those who stood outside of the "normal." Illness could no longer be seen as having its roots within the individual; rather, it had to be understood as part of an interactional nexus constituted within the family. And David Cooper, an early co-worker of Laing’s in London, was quick to point to the parallels between the mental hospital itself and the family constellation:

In the mental hospital, society has, with unerring skill, produced a social structure that in many respects reduplicates the maddening peculiarities of the patient’s family. In the mental hospital he finds psychiatrists, administrators, nurses, who are his veritable parents, brothers and sisters, who play an interpersonal game which only too often resembles in the intricacies of its rules the game he failed in at home. Once again, he is perfectly free to choose. He may decide to vegetate his days away. in a chronic back ward or he may decide to oscillate between his family hell and the not dissimilar hell of conventional psychiatric admission ward—the latter course being the usual present-day idea of psychiatric progress. (1967)

Laing, Cooper, and others in England sought new forms of care where small communities could function without the imposition of staff-patient hierarchization, and without clinical preconceptions and medical strategies. Cooper himself was finally given permission in the middle 60’s to convert a ward in a large London hospital ("Villa 21" described in his Psychiatry and Anti-Psychiatry) into a unit where the issues of the meaning of care, of the differences between authentic and inauthentic authority, and of the needs of doctors, nurses, and patients to act toward each other in prescribed and stultifying ways were actively addressed through the on-going participation, discussion, and lived-experience of everyone in the unit. Laing and other Londoners interested in working with these kinds of issues formed the Philadelphia Association (from its origins as "brotherly love") and continued the search for alternatives to hospital outside of mental health institutions. (Kingsley Hall and other households throughout London served as early and important experiments in establishing such alternatives. In its own brochure, Kingsley Hall was described as a place where "everyone’s actions could be challenged by anyone.") By the late 1960’s, Cooper had used his experiences within mental hospitals to develop a critical perspective:

The mental hospital as a social system defines itself by certain limits within which change is possible, but beyond which one cannot venture without threatening the stability of the whole structure. This structure as it has developed historically has acquired institutional sclerosis.

For Laing, Cooper, and a growing anti-psychiatry movement around the world, a new and more radical direction was clear: " a step forward means ultimately a step out of the mental hospital into the community."

Since his Psychiatry and Anti-Psychiatry (1967), Cooper has published three books that have continued to explore the meanings and activities of a new politics that could confront the interconnections between self, psychiatry, and society. More than Laing (whose recent works have often isolated the self or speculated upon other bases of experiences in a kind of pre-natal biologism), Cooper’s The Death of the Family (1970), The Grammar of Living (1974), and his most recent The Language of Madness (1978, soon to be published by Urizen in America), have all sensitively and provocatively deepened the discussion of therapy, self-exploration and personal change to include issues of the family, the limits of community health programs (their frequency in duplicating the "logic" of the hospital in miniaturized and more subtle forms), the power of the state, corporate capitalism, and what he more generally describes as "a structuring that evades political truth in the interest of Permanent Mystification." Most significant and edifying in Cooper’s work is to watch the changes in his own descriptions, perceptions, and understandings: his challenges to his own formulations, and his attention to his own language and mood and to the language of others. (He described The Death of the Family as "a revolt" and says of The Grammar of Living that he "hopes to combine bitter attack with a quieter feeling.")

In fact, locating a kind of language that can serve to "break through" the "banalizing chatter of everyday normality" (whether this discourse takes the form of family "conversations" around a dinner table, or the "dialogues" of academics at a national conference, or the "negotiations" among super-powers) is a recurring theme of Cooper’s analysis. Thus, the differences between the "romanticization" of madness (a dangerous and prevelant tendency in much of the writing—fantacizing—about "going crazy") and the "politicization" of madness (its political nature and political implications) becomes critical to Cooper. "The language of madness," he describes: is nothing more nor less than the realization of language. Our words begin to touch the other and that’s where the danger of madness lies: when it tells the truth. One danger, the only danger of madness, is violent denormalization of trivial words and worlds of security." (1978)

The foundation of Cooper’s new politics is the reality of movements of people toward a living "autonomy." These movements are denied, however, by the very forms and understandings of conventional psychoanalytic language and process—often perceived as the bastion of individual freedom and autonomy within an oppressive and self-denying social world. instead of raising the question: what are the possibilities that the person ’being analyzed’ has of reaffirming his/her self-perceptions, the analytic mold strives to defend and continually re-affirm "the analyst’s role as the trustworthy person who understands objectively, who fully knows, by virtue of his own training, his own feelings about himself and therefore about his feelings about you and ultimately your feelings about yourself." According to Cooper, the "comforting abdication to the analyst’s preceiving —a sweet, warm, passive, penny-in-the slot acquiescence—" negates any true sense of self-realization and undercuts associations based upon desire and choice. Importantly, it is the refusal of patients to accept "the evasive response that their political consciousness is an intellectual defense against ’deeper problem,’ " that raises the real possibility of both personal and social change. Psychoanalysis itself has become "yet another agency in the employ of the endlessly devious, repressive and repressively ’tolerant’ bourgeois system. A sort of CIA of the individual psyche." (1974)

When Cooper defines the term "autogestion" in The Language of Madness, he continues to more fully explore the goal of autonomy as a critical political category, one that seeks to resurrect and not to destroy the "absurd hopes, fears, joys of despair and despairs of joy of people who refuse containment by that system (capitalism):"

If autonomy is laying down the law for oneself —the original autonomy—then autogestion is taking over the power structure of one’s life and work, obviously not alone but with identifiable other people who work, kind of live, or live and work with oneself. It’s simply not a matter of ’workers taking over factories’: autogestion applies to every aspect of life. If one’s personal needs conflict with those of the group of other people, that becomes tangible and frangible, we assume we can fight it out. The enemy of the autogestion movement is centralized state power. Autogestion does not mean autodigestion, eating up oneself, but means eating up our indigestible social system, chewing it, drying it out on our stomachs, vomitting it finally when we know its impossibility and flushing it down the toilet pan. (1978)

Clearly for Cooper, there are no "personal problems", only "political problems." In a world where "personal" problems reign supreme, ideologies of personal salvation will only present strategies that depoliticize, and that "will exclude from the concrete field of action mac- ropolitical reality and the repressive systems that mediate this reality to the individual."

Judi Chamberlin’s On Our Own: Patient Controlled Alternatives to the Mental Health System (1978, paperback, 1979) not only vividly recounts her own experiences as a mental patient and those of others, but describes the on-going, exciting, and often successful struggles of many ex-patients in the United States and Canada today to create true alternatives to psychiatric ideology and institutionalization based upon an understanding of their own needs and through their own efforts. (As Cooper would write: "We don’t need a world like this that does violence to our every judgement. We need another world that we can alter by our altering.") Chamberlin’s notion of a "true" alternative focuses upon the necessary realities of autonomy much as Cooper’s does:

What I define as a true alternative is one in which all basic decision-making power is in the hands of those the facility exists to serve. Such places are rare, but where they do exist, they show clearly how well people can help one another in environments that have been set up to maximize the strengths and abilities of each participant.

Chamberlin’s discussion of real and false alternativesand her description of the daily lives of those living in a variety of facilities are excellent in beginning to show that the claims of "participation"themselves can hide more subtle sources of control—can tempt us to accept forms of authority and organization that further twist and confuse the differences between mutual care and help and an externally imposed benevolence that perpetuates submission and passivity. (just as we come to accept the false equation between de-institutionalization and care.) The final "right" listed in the handbook prepared by the Mental Patient’s Liberation Front in Massachusetts— "You have the right to patient-run facilities where the decisions that are made and work that is done are your responsibility and under your control"—becomes even more crucial when placed within the context of contemporary policies regarding hospitals, schools, and factories that use labels like autonomous decision-making, worker-participation, and student/patient/community control to buttress managerial propoganda and tactics for even greater control over peoples’ lives.

The issues of "helping" and of "caring" are significant to Chamberlin’s criticism of professionalization and her understanding of what a truly supportive and "progressive" patient’s association should be directed toward. The "admission of weakness" that seeking help with one’s problems denotes will remain a reality "until seeking help is seen as a normal aspect of human behavior and people give and get help and support freely from one another." Within a "real" alternative to the institutions of mental health professionals, "having problems is seen as a normal component of living in a sometimes difficult and threatening world and not as part of an illness existing only in some unfortunate people." (Here, Cooper’s thinking about a "natural" and "mutual" therapy is relevant. "All relationships are therapy or they are violence," he writes. "If one person in confusion seeks another person, in whose experience she or he trusts, a disciplined ’one-way’ relationship for a while may be necessary—but on the way to free mutuality of relating.")

One element of Chamberlin’s model for a real alternative service for ex-patients includes the following:

Help is provided by the clients of the service to one another and may also be provided by others selected by the clients. The ability to give help is seen as a human attribute and not as something acquired by education or professional degree.

The distrust that patients are taught to feel toward one another (that has been described as "mentalism" which like racism and sexism "infects its victims with the belief in their own inferiority") the problems that they too come to define as "symptoms" which demand professional intervention to "treat", the practical dilemmas of finding work or a place to live which are handled by other experts (social workers) still within a larger psychiatrically ruled context are all barriers that many groups of ex-patients have sought to confront and break down. The world of the mental hospital and its de-institutionalized counterpart that of the singleroom-occupany-dweller on the Upper-West side of New York who has few opportunities for any form of care, stands in stark contrast to the lives of individual members of a group like the Mental Patient’s Association in Vancouver, British Columbia. The MPA embodies the on-going struggle of active people who refuse to be passive victims of an irrational system, but instead seek to find in their lived-experiences the meaning of autonomy.

This initial and limited discussion has not been able to deal with many of the issues that are critical to an understanding of the role and the power of psychiatry in the world today, nor to capture the particular activities of many individuals and groups (like the International Network in Brussels —w hose Statement of Purpose Cooper includes as Appendix II in his The Language of Madness—or Project Release in New York or Network Against Psychiatric Assault in San Francisco both described by Chamberlin) who have opposed the oppression inherent in the medico-technocratic mode and the stigmatization of its victims. Instead, it has attempted to show how people like Cooper and Chamberlin through their thoughts and actions have continued to unravel and to understand complex personal and social issues without relegating either one to an easy reflex of the other. Because so many contemporary popularizations of "self-help" have in fact perpetuated the societal reduction of the person to an isolated monad concerned only with its own narcissitic delights, the efforts of many people to seek and define a new politics based upon a continuing attention to the interdependencies of self and society—to the significance of such goals as participation and autonomy— have remained in the background. The movement for patient’s rights and towards alternatives to psychiatry raises issues and problems concerning what politics is, the quality of peoples’ relations to one another, the meaning and the ends of social action, and the process of coming to understand and attain human freedom that are most significant for all of us to seriously face today.


The literature on the topic of psychiatry and anti-psychiatry is vast. In the following list I have tried to include some titles and comments that could serve as a basis for further discussion of the topics introduced in the essay.

1. All of Laing’s works are available in paperback. Aside from The Politics of Experience, the book, The Politics of the Family (originally given as the Massey Lectures over the C.B.C. in 1968) is an excellent and clear introduction to Laing’s analysis of the family and its - interactions. An example of Laing’s later work is The Facts of Life (1976). A good introduction to Laing’s work in the London community is J.S. Cordon’s essay, "Who is Mad? Who is Sane?" It originally appeared in the January, 1971 issue of The Atlantic and can also be found (along with many other relevant pieces) in Ruitenbeek’s edited, Going Crazy.

2 Cooper’s writings are also available in paperback (as mentioned previously, The Language of Maddness is presently only available as a hard cover from Allen lane in England — but will be published this year by Wizen). The book To Free a Generation edited by Cooper is a compilation of lectures given at the "Congress on the Dialectics of Liberation" (1967). It includes essays by Cooper, Laing, Gregory Bateson, Paul Goodman, Stokely Carmichael, Herbert Marcum-, Paul Sweezey, and others.

3. Herbert Marcuse’s Eros and Civilization (1955) represents a turning point in the discussion of Marx and Freud. The "Epilogue", "Critique of Neu-Freudian Revisionism." has stood as a key to the criticism of conformist psychology Russell Jacoby’s Social Amnesia: A Critique of Contemporary Psychology from Adler to Laing (1975) utilizes and then moves beyond Marcuse’s original insights regarding Freudian and Marxist theory, therapy, and social change- Interestingly. in a review entitled. "Freud Revisited." (New Left Review. Summer. 1963) Cooper addresses Marcuse’s work and develops the beginnings of an interesting critique based upon Sartrian categories.

4. There is a growing literature that attacks not only psychoanalytic theory and practice (as Cooper does), but popular therapies and an entire "culture of narcissism." Christopher Lasch’s work as well as Richard Sennett’s The fall of Public Man are critical to this discussion. Much of this analysis is deeply indebted to the writings of the Frankfurt School. Max Horkheimer’s statement in The Eclipse of Reason (1949) could be seen as a basic assumption of this perspective:

"The theme of this time is self-preservation, while there is no self to preserve."

Importantly, however. there are a number of authors who have recently sought to more sympathetically view the "self-help" movement although acknowledging its dangers and limitations. Marshall Berman’s The Politics of Authenticity places much of the discussion of authenticity within a helpful historical perspective. Michael Rossman’s New Age Blues: On the Politics of Consciousness and Theodore Roszak’s Person/Planet are significant resources.

Judi Chamberlin’s On Our Own includes an excellent bibliography. It also includes a list of alternative facilities, organizations, and publications relating to psychiatric institutionalization. In many ways, Chamberlin’s book serves as an effective complement to Cooper’s The Language of Madness. Its often "pragmatic" orientation deals with the immediate issues of patient life and ex-patient experience. It is both a practical "handbook" and a good introduction to many vital psychiatry-related social and political concerns.

6. A final quote from Cooper adds another dimension to the often ill-conceived bifurcation of self-knowledge and attention to the world:

"Interiority, paradoxically enough, is in fact a movement into the world in what seems to be the wrong direction but which uses the seeming to make the wrongness right enough. It may lead other people to feel locked out from oneself, but that’s because they are locked into them-selves. What seems to be a ruthless denial of the existence of other people is in fact an invitation to mutual liberation." (1978)

7. Special thanks to my friend. Merrill j. Goldstein for thoughts, advice, and insight on this topic. Her own caring for those she tries to aid often goes unspoken .

Alan Mandell works with adult students at Empire State College in White Plains, New York.

arrow On web : First published in Black Rose #4.

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